Case Reports in Surgery最新文献

A male in early adolescence presented with 1 week of chest pain, respiratory symptoms and diarrhoea. Thoracic computed tomography (CT) revealed suspicious findings of necrotising mediastinitis without signs of a descending infection. The patient underwent bilateral thoracotomy and laparotomy with several revisions. After 58 days in the hospital, the patient was discharged home, fully recovered, with no sequelae. This case highlights the importance of a multidisciplinary approach when managing severe and rare conditions, emphasising the need for early diagnosis and prompt, appropriate surgical treatment.

Introduction: Chilaiditi's sign consists of the interposition of a segment of the intestine between the right diaphragm and the liver; when this anomaly causes gastrointestinal symptoms, it is referred to as Chilaiditi's syndrome. If conservative treatment fails, surgical intervention is often necessary, especially in severe or complicated cases. Case Presentation: An 82-year-old woman with a 2-year history of right-sided abdominal pain, constipation, malaise, and weight loss was diagnosed with Chilaiditi's syndrome following an extensive workout to exclude other pathologies. Following the failure of medical therapy, she underwent elective robotic surgery for hepatic flexure mobilization and right colopexy. The procedure was performed using the Versius robotic system (Cambridge Medical Robotics, CMR), resulting in successful repositioning of the colon and resolution of symptoms. Discussion: Chilaiditi's syndrome is often underdiagnosed and can be effectively treated with surgical intervention in cases unresponsive to medical therapy. The Versius robotic system offers a highly effective, minimally invasive solution, reducing surgical trauma, and promoting faster recovery. This case highlights the benefits of robotic-assisted surgery in managing complex gastrointestinal conditions like Chilaiditi's syndrome. Conclusion: Robotic surgery, particularly with the Versius robotic system, offers significant technical advantages in such complex cases due to its precision and minimally invasive nature, with improved clinical outcomes, and enhanced recovery times for patients requiring surgical intervention.

Omental infarction was first described in 1896 mimics other causes of acute abdomen. Improved imaging modalities such as ultrasound and CT scans, have enhanced preoperative diagnosis with conservative management emerging as a treatment option. We report the case of a 51-year-old man presenting with epigastric pain migrating to the right iliac fossa, fever, nausea and anorexia. Examination revealed a stable patient with a right lumbar mass (5 cm × 6 cm) and rebound tenderness. CT imaging identified fat stranding near the ascending colon and hepatic flexure (6 cm ×10 cm ×10 cm) with peritoneal thickening. He underwent exploratory laparotomy, omentectomy and peritoneal washout, which revealed an infarcted omentum (8 cm × 8 cm) and 200 ml of haemoserous fluid. The patient recovered well postoperatively. A systematic search of the literature identified 237 articles reporting 479 cases of omental infarction, with clinical data extracted for analysis. Male predominance was observed (2:1) and 326 patients (68.1%) underwent surgical intervention. Conservative management was successful in 121 patients (25.3%), while 32 (6.7%) required surgery following failed conservative treatment. Among those managed surgically, the most common preoperative diagnosis was appendicitis. CT imaging was performed in 245 cases (51.1%), of which 103 (42.0%) within this group were successfully managed conservatively, while 26 (10.6%) required surgical intervention after conservative failure. Omental torsion was diagnosed preoperatively in 220 patients (45.9%); in this subset, 21 (9.5%) underwent surgery after failed conservative management and only 5 (2.3%) were successfully treated conservatively. While omental infarction can often be managed conservatively, surgery remains a key treatment for intractable pain or omental torsion, where conservative management failure rates are high.

We present our experience with a patient with acute-on-chronic asymptomatic pneumoperitoneum with spontaneously resolving idiopathic pneumatosis intestinalis that was solely managed on close observation alone. This case is unique in that it details the approach to nonoperative management of massive free air under the diaphragm identified incidentally on routine preventative health screening and longitudinal follow-up over an 8-month period. In the absence of known and underlying systemic disease, efficient and coordinated clinical work-up and evaluation for comorbid diagnoses associated with pneumoperitoneum can serve to guide management and avoid unnecessary surgery for stable and asymptomatic patients.

Introduction: Angiogenic leiomyosarcoma (LMS), a soft tissue sarcoma, primarily occurs in the inferior vena cava (IVC) in over 50% of cases, with renal vein LMSs being exceedingly rare. We present a case of primary LMS of the left renal vein. Case Report: A 73-year-old woman with a history of hypertension and prior left colon adenocarcinoma presented with intermittent left flank pain. Imaging revealed a large left latero-aortic mass. Exploratory laparotomy confirmed a multinodular tumor around the left renal hilum, necessitating en bloc resection with left nephrectomy. Pathological examination identified it as a grade 2 LMS. The patient recovered well postoperatively with no complications. Discussion: LMSs, especially of vascular origin, are rare and aggressive malignancies. Despite their insidious presentation, they predominantly manifest in women, typically adults, and often on the left side. Diagnosis is challenging due to nonspecific symptoms and imaging findings. Surgical resection remains the cornerstone of treatment, with complete resection offering better outcomes. Prognosis is poor, particularly with larger tumors, partial resection, and high-grade lesions. Adjuvant therapy's efficacy is uncertain. Conclusion: LMS of the renal vein is a rare entity with challenging diagnosis and management. Radical surgical resection remains the mainstay, but prognosis is guarded, especially in high-risk cases. Further research is needed to optimize treatment strategies for this rare malignancy.

Background: Intestinal intussusception is a common condition in children, and the cause is often idiopathic. In contrast, adult intussusception is rather rare and almost always secondary due to an underlying condition such as a tumor, inflammatory disease, or a diverticulum. Hence, the treatment almost always is surgical resection of the lesion. Methods: We retrospectively analyzed a case of asymptomatic intussusception in a male adult using patient data retrieved from the hospital patient database. This includes findings from both physical and radiological and endoscopical examinations. The patient was contacted 4 weeks and 6 months postsurgery for a clinical follow-up. Aim: Until this day, there is no guideline regarding the underlying pathology. Hence, this case report wants to contribute to a field where there is only insufficient patient data. Results and Discussion: We presented a case of colocolic intussusception in an adult caused by a large intramural lipoma. After a full gastrointestinal diagnostic protocol and interdisciplinary case discussion, we decided to offer surgical resection, from which the patient recovered quickly. The benign nature of the tumor and the complete lack of symptoms despite significant tumor size make this case particularly interesting. We emphasize the need for a larger study group to create robust data that aid in creating care guidelines.

Sacrococcygeal teratomas are rare in adults, despite being common in infants. Adult presentations are often asymptomatic and may go undetected until complications arise. We report a case of a 20-year-old female with a long-standing sacral swelling. Imaging revealed a large, well-circumscribed mixed solid-cystic mass in the presacral region causing displacement of pelvic structures. Surgical excision of the tumor was done along with the surrounding rectal wall. Early surgical intervention is essential to prevent malignant transformation and optimize outcomes.

Peptic ulcer disease (PUD) results from erosion and ulceration of the upper digestive tract mucosa. Clinical presentations can vary from asymptomatic to severe complications such as perforation, strictures, or bleeding. Perforation can release enteric contents and gas into the abdomen, leading to intra-abdominal sepsis, requiring surgical intervention for source control and repair. We present a case of a 69-year-old male who developed both Fournier's gangrene and a right-sided pneumothorax secondary to a nontraumatic perforated duodenal ulcer. The patient underwent an emergent thoracostomy, laparotomy with Graham omentoplasty, and extensive debridement with successful outcome. While rare complications like pneumothorax and necrotizing soft tissue infections have been documented, their simultaneous occurrence from a nontraumatic ulcer perforation is unprecedented in literature. Previous reports suggest enteric contents can traverse retroperitoneal fascial planes and peritoneal defects to reach distant anatomical sites as a possible mechanism for these complications. This case highlights the potential for atypical presentations of PUD and the importance of comprehensive evaluation, early recognition, and prompt surgical intervention.

This is a case report of an alternate laparoscopic reconstruction possibility in a patient that required a cephalic duodenopancreatectomy (DPC) who previously underwent a Roux-en-Y gastric bypass (RYGB). The question of what type of reconstruction is to be performed in such patients is thoroughly debated in this article.

Intestinal malrotation is often considered a disease of the newborn. It involves the failure of the 270° counterclockwise rotation of the midgut during embryonic development. Patients typically present with symptoms such as bilious vomiting and can further be diagnosed through imaging. The complications of intestinal malrotation include midgut volvulus which can cause ischemia of the intestine. In order to prevent this feared complication and treat malrotation, the four-step Ladd's procedure was developed. Proficiency of the procedure is more common among pediatric surgeons due to the higher incidence rate of malrotation; however, it can occur at any age. Adult presentations are reported to account for only 0.2%-0.5% of all cases of intestinal malrotation. Due to that, adult general surgeons are less likely to encounter the pathology and need to perform a Ladd's procedure. However, with the consequences being so dire, the ability to perform Ladd's procedure remains important in all general surgeons. In this report, we present two cases of intestinal malrotation in adults managed with Ladd's procedure and emphasize the importance with familiarity of both the pathology and procedure.