Case Reports in Surgery最新文献

Background: Our case highlights the challenges in diagnosing and managing achalasia cardia, particularly in resource-limited settings and more so in adolescents who fall outside of the typical age range. Case Presentation: We present a case of an 18-year-old female from Uganda who was admitted with a 6-month history of progressive dysphagia, weight loss, and postprandial vomiting. Diagnosis of achalasia cardia was confirmed via endoscopy and barium swallow. Heller cardiomyotomy via open transthoracic approach was performed, but she developed an esophageal perforation, which was successfully managed with repeat thoracotomy and esophageal repair. Complete resolution of achalasia symptoms was achieved at a 5-month follow-up. Conclusion: This case highlights the importance of maintaining a high index of clinical suspicion, especially in young patients, and the significance of informed consent prior to initiating treatment. Additionally, it emphasizes the importance of early recognition of treatment-related complications, such as esophageal perforation, as key to prompt management and improved patient outcomes.

Background: Cryptorchidism is one of the most common congenital anomalies in newborn males, with the majority diagnosed in infancy and treated surgically before puberty. In some cases, cryptorchid testes are discovered incidentally during inguinal hernia repair in adults, requiring appropriate management at the time of surgery. Case Presentation: Case 1: A 58-year-old male underwent emergency laparoscopic surgery for a left incarcerated hernia. Intraoperatively, an M2 indirect inguinal hernia with omental strangulation of the spermatic cord was identified. Despite attempts to pull the testis down manually, it did not descend into the scrotum, leading to the diagnosis of cryptorchidism. The spermatic cord was excised and a 3D mesh was placed to cover the hernia defect. Case 2: A 33-year-old man with Noonan syndrome presented with localized pain and swelling in the right groin. Laparoscopy revealed an indirect L3 inguinal hernia and incidentally an intra-abdominal testis was found. The testis and spermatic vessels were found to terminate intra-abdominally, confirming the diagnosis of cryptorchidism. An orchiopexy was performed to secure the testis subcutaneously in the scrotum and the hernia was repaired with a 3D mesh. Conclusion: The safety of mesh-based hernia repair in cases of cryptorchidism with concomitant inguinal hernia has been previously reported. In cases where preoperative palpation is difficult due to pain, intraoperative traction of the testis may help differentiate between cryptorchidism and retractile testis. In addition, orchiopexy may serve as a temporary measure, with consideration of staged orchiectomy if necessary.

Tricuspid valve regurgitation/rupture is a rare complication of trauma, with only around 150 cases reported in the literature, though this prevalence may be underestimated due to subtle clinical manifestations. The tricuspid valve is the most frequently affected heart valve following blunt chest trauma due to its anterior anatomical position between the sternum and the vertebrae. The diagnosis of tricuspid regurgitation is often delayed in the traumatic setting due to the subtlety of clinical manifestations. Many trauma patients also present with distracting injuries. The subsequent treatment delay can result in development of irreversible dilatation of right-sided heart chambers, making it imperative to have a high index of suspicion for tricuspid regurgitation as a cause of acute hemodynamic instability in the setting of blunt trauma to the chest. In this report, we present a unique case of traumatic tricuspid valve regurgitation in a patient with a history of congenital atrial septal defect (ASD)/partial anomalous pulmonary venous return (PAPVR).

Schwannomas are the most common tumors of the peripheral nerves, originating from their support cells, the Schwann cells. The location of the tumor in the vagus nerve is rare. Vagus schwannomas usually present as a solitary, slow-growing, asymptomatic mass that rarely causes neurological alterations. The differential diagnosis of vagus nerve schwannomas includes other tumors of the parapharyngeal space or neoplasms of the jugular foramen. We report the case of a patient with an asymptomatic schwannoma of the vagus nerve involving important neck structures, with radiological compression of the carotid artery with a high risk of stroke; because of this, we underwent surgery using a transcervical approach with intracapsular excision of the tumor. The patient has a good outcome. In asymptomatic patients' surgical indication is not an easy decision; in this case, the main reason for surgical indication was the risk of stroke with potential neurological sequels.

Intussusception in adults is rare and poses a diagnostic challenge, often due to neoplastic causes. Metastatic melanoma is known to spread to the gastrointestinal tract, especially the small intestine. We report the case of a patient with obstructive symptoms and a history of metastatic melanoma. An emergency abdominal computed tomography (CT) scan identified an obstruction caused by ileoileal intussusception located at the site of a previously described enteric metastasis. Following palliative surgery with ileal resection, two nodular lesions causing intussusception were identified, and pathological examination confirmed intramural metastases from melanoma. In adult patients with obstructive symptoms and a history of melanoma, intussusception secondary to intestinal metastases should be considered in the differential diagnosis.

Esophageal bleeding management typically involves endoscopy but becomes challenging with large or hemorrhagic tumors, especially in cases of rare basal cell carcinoma. This malignancy, with a poorer prognosis than squamous cell carcinoma, often requires definitive surgery. A 78-year-old man with severe hematemesis underwent transarterial embolization (TAE) after failed endoscopic hemostasis for a middle thoracic esophageal tumor. Subsequently, he successfully underwent radical tumor resection on the seventh day of hospitalization. While emergency surgery is an option, its invasiveness may be a limitation, especially for patients in poor general condition. TAE is effective for hemostasis and serves as a crucial bridge to radical esophageal tumor resection.

Introduction: Phlebolith is a term that refers to round-shaped calcified thrombi commonly located in the pelvic region. The occurrence of dense, linear calcifications or phlebolith-like formations within the soft tissues of the lower extremities, particularly in the superficial femoral, greater saphenous, or popliteal veins, is rare. Patient Concerns: This study presents the case of a 73-year-old woman who was being evaluated for postmenopausal bleeding. During the patient's diagnostic workup, an incidental linear-shaped phlebolith was discovered. She had a positive history of deep vein thrombosis (DVT) for 36 years following her previous vaginal delivery. Diagnosis: Upon further examination and imaging, the patient was found to have a chronic calcified thrombus in the iliofemoral, popliteal, great saphenous, and superficial femoral veins, which was initially reported as a foreign body in the femoral vein on computed tomography (CT). Interventions and Outcomes: Conservative management was undertaken, with no worsening of her condition upon further follow-up. Conclusion: This study showcased a rare form of a radiographically visible calcified thrombus in the veins of the lower extremities of our patient. Calcified venous thrombosis in the lower extremities is rare, as previously documented cases of venous calcifications have been observed in the pelvis with round shapes or as phleboliths. The common presentations differ from those in our case, making it important to consider such cases when formulating a differential diagnosis. While the precise mechanisms behind the formation of calcified thrombi remain unclear, this study emphasizes the significance of further exploration and future case studies to shed light on this enigmatic phenomenon.

Meningomyelocele and meningocele are types of neural tube defects, which are congenital abnormalities of the spine and spinal cord. These conditions are frequently encountered by pediatric neurosurgeons worldwide and represent a significant public health concern due to their association with a range of collateral conditions, other malformations, and increased morbidity. While many cases can be identified during prenatal ultrasound screenings, this is often challenging in resource-limited settings with poor health-seeking behaviors. Surgical intervention is the primary treatment for these defects, and while various methods are described in the literature, larger defects require complex flaps and techniques, with limited options available. Beyond early surgical intervention, patients require lifelong care involving multidisciplinary medical teams.

Iatrogenic urethral-rectal perforation represents a rare but severe complication arising from medical interventions, notably highlighted in the context of Foley catheter insertion. This case report outlines the presentation, diagnosis, management, and outcomes of a 71-year-old male patient who experienced iatrogenic rectal perforation during the routine insertion of a Foley catheter, against the backdrop of several predisposing factors, such as atrial fibrillation, valvular disease, benign prostatic hyperplasia, urethral stenosis, and colorectal cancer with liver metastasis. The inadvertent creation of a rectourethral fistula during the procedure led to an urgent multidisciplinary approach involving surgery and postoperative management, including fecal and urine diversion and antibiotic therapy. The case highlights the critical importance of meticulous technique and comprehensive preoperative patient assessment in minimizing the risk of such iatrogenic complications. It further discusses the management strategies for rectourethral fistulas, ranging from conservative approaches to surgical interventions, and emphasizes the role of fecal diversion, urine diversion, and the potential of robotic surgery in enhancing outcomes for complex cases. The report concludes by reflecting on the intricate balance between routine medical procedures and the potential for severe complications, highlighting the need for heightened awareness and skill in the prevention and management of iatrogenic rectal perforation.

Splenic rupture leads to massive hemorrhage and requires immediate surgical intervention. Splenic rupture results from trauma or from underlying disease processes. Lymphoma is a rare cause of atraumatic splenic rupture (ASR) with high mortality rates. We present a case of ASR due to T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL) requiring splenectomy and large-volume transfusion. This case report highlights the necessity of prompt surgical intervention and massive transfusion for hemodynamically unstable ASR. This report also discusses massive transfusion protocol (MTP) and its limited use in nontraumatic surgical patients.