Case Reports in Surgery最新文献

Cholecystectomies have become one of the more commonly practiced procedures. As a result, there has been a rise in neoplastic changes in excised specimens. Due to this, surgeons must be prepared to manage possible malignancy after resecting what was previously thought to be a benign gallbladder. While management for high-grade dysplasia has been more clearly laid out in literature, data on management of low-grade dysplasia are limited. Here, we report a novel case of a 46-year-old woman with an incidental low-grade dysplasia of the cystic duct stump after a laparoscopic cholecystectomy for biliary colic. The decision was made to excise the remaining stump without further surveillance postoperatively given benign pathology findings. More documented cases and their management and ultimately longitudinal cohort studies will help facilitate the creation of guidelines for managing this particular pathology.

Reactive lymphoid hyperplasia (RLH) is a benign disease, rarely occurring in the liver. Reactive immune phenomenon has been reported in association with its occurrence, but the true pathogenesis is unknown. No case was reported in association with inflammatory bowel disease. We report a case of RLH of the liver in a patient with ulcerative colitis (UC). A 55-year-old woman with UC went to the outpatient clinic with abdominal pain, and antibiotics were prescribed with diagnosis of acute appendicitis. Imaging study detected a mass in the liver but ruled out appendicitis. She was referred to our hospital for further examination after pain improving. A 12 mm hypoechoic mass was detected in the liver on ultrasonography. There were no typical malignant findings on computed tomography and magnetic resonance imaging. Regular image follow-up was recommended, but the patient strongly requested surgery because of family history of malignant disease. Laparoscopic partial hepatectomy was performed. Histopathological findings revealed a conglomerate hyperplasia of lymphoid follicles with germinal centers. Infiltrating lymphocytes were non-neoplastic. Final diagnosis was RLH of the liver. UC is chronic inflammatory bowel disease and may be related to RLH, but there is no clear explanation at this point. This is the first known reported case of RLH of the liver in a patient with UC. But the relationship between the RLH and UC remains uncertain. Further investigation and case accumulation are necessary.

Type IV hiatal hernia of the esophagus is characterized by herniation of the stomach and associated organs, such as the spleen, large and small bowel, and pancreas, through the esophageal hiatus. It is a relatively rare form of hiatal hernia that sometimes requires emergency surgery due to gastric incarceration, volvulus, and strangulation. Of these, small bowel obstruction is extremely rare and requires surgery. We report the case of an 83-year-old woman who was admitted to the hospital for small bowel obstruction caused by an ileum that had incarcerated the esophageal hiatus; emergency laparoscopic surgery was performed.

Iliopsoas phlegmon/abscess is uncommon, and individuals often present with nonspecific symptoms. Diagnosis is often delayed and almost always requires advanced imaging techniques such as computed tomography or magnetic resonance imaging. We report a case of a 51-year-old woman who presented with right lower limb swelling and associated rash with imaging demonstrating iliopsoas abscess secondary to an infected intrauterine contraceptive device. This rare case highlights the nonspecific presentation of iliopsoas abscess and the need to consider unusual sources of infection such as an intrauterine contraceptive device in women presenting with iliopsoas phlegmon and abscess.

Introduction: Isolated fallopian tube torsion (IFTT) has rarely been confirmed in sexually inactive adolescents, and preoperative diagnosis of IFTT is difficult because of the absence of specific symptoms. Therefore, pediatric patients with IFTT tend to be misdiagnosed before the surgery.

Case: A 15-year-old female patient with no history of abdominal surgery or sexual intercourse presented with acute left lower abdominal pain and purpura. MRI revealed hydrosalpinx in the left adnexal region. Her abdominal pain had completely resolved at our examination; she was followed up as an outpatient. One month after the initial presentation, she experienced a large volume of watery discharge. Magnetic resonance imaging, which was performed every three months, showed a gradual decrease in the size of the hydrosalpinx; however, it persisted in the left adnexal region. She was counseled to receive laparoscopy to treat the hydrosalpinx, which was the most likely cause of the watery discharge. IFTT was detected during the laparoscopy, and left salpingectomy was performed for pathological evaluation of the persistent hydrosalpinx. Following laparoscopy, the patient's watery discharge was resolved. Pathological findings confirmed no signs of malignancy.

Conclusion: Our current report highlighted watery discharge as an indicative symptom of IFTT. It is unclear whether IFTT induced the hydrosalpinx or vice versa. We presumed that the patient's hydrosalpinx occurred due to IFTT, because the patient complained watery discharge one month after the initial appearance, and noncongenital hydrosalpinx in adolescents, especially without a history of sexual intercourse, is a rare event. Clinicians should consider IFTT in patients presenting with unremitting watery discharge and hydrosalpinx, because IFTT may persist even after the pain disappears.