Case Reports in Surgery最新文献

Seminal vesicle cyst (SVC) is a rare condition that can arise from congenital or acquired causes. In this report, we describe the case of a 33-year-old male who was incidentally discovered to have SVC and seminal vesicle stones following complaints of abdominal pain. He presented to the emergency department with these symptoms, which prompted further investigation and diagnosis. Computerized tomography (CT) scan revealed diverticulitis and a fluid attenuation lesion within the right aspect of the prostate gland. He was referred to urology, and further evaluation showed a right SVC of 1.8 × 1.5 × 1.5 cm on magnetic resonance imaging (MRI). The patient underwent endoscopic drainage of the SVC via transurethral seminal vesiculoscopy (TRU-SVS) and holmium laser incision. Three stones ranging from 2 to 4 mm were identified and removed with N-gage basket from the seminal vesicle resulting in successful removal of the stones and restoration of the ejaculatory duct's patency. Follow-up visits showed resolution of pain and an improvement in semen volume. This case report highlights the importance of considering SVC as a differential diagnosis in male patients presenting with such symptoms. TRU-SVS is a feasible and effective treatment option for SVC and associated seminal vesicle stones.

Benign liver tumors are infrequently observed in the pediatric age group, with an incidence reported at 0.7 per million population annually. Among these tumors, mesenchymal hamartoma constitutes 18%-29%. Imaging studies commonly reveal a well-marginated, solitary mass, often measuring up to 30 cm. The mass, primarily located in the right liver lobe (75% of cases), may exhibit a pedunculated structure. We present a case of a 1-year-and-9-month-old boy diagnosed with hepatic mesenchymal hamartoma. A contrast-enhanced computed tomography of the abdomen and magnetic resonance imaging (MRI) were performed and demonstrated a large multiloculated septated liver lesion measuring approximately 13.6 × 17.7 cm, demonstrating multiple partially thickened internal septations. The procedure was done for the patient in the form of an extended right hepatectomy with segment 4A and cholecystectomy.

Fibrosarcoma is a rare malignant neoplasm consisting of fibroblasts with a large variety of collagen production. They usually involve deep soft tissues in extremities and trunk. However, fibrosarcoma can be seen in fields that received previous irradiation. Here, we report a case of parastomal fibrosarcoma after laparoscope-assisted extra-levator abdominal perineal resection (ELAPE) and colostomy. Prior to surgery, the patient underwent neoadjuvant chemoradiotherapy. The patient received extensive stomal lumpectomy and stoma reconstruction. The patient is free of local or distal recurrence for 1 year and died 4 years after diagnosis.

Primary neuroendocrine tumors (NETs) predominantly affect postmenopausal women. This case study focused on a 54-year-old woman who presented with a painless right breast lump. While the lump exhibited estrogen and progesterone receptor (PR) positivity, it lacked human epidermal growth factor receptor 2 expression. Further evaluation revealed positivity for the neuroendocrine markers chromogranin A (CGA) and synaptophysin (SYN). It also revealed a 3% positive Ki-67 proliferation index. Treatment for neuroendocrine breast cancer (NEBC) mirrors that of standard invasive breast cancer: breast conservation or mastectomy combined with sentinel lymph node biopsy or axillary dissection. The patient underwent a right mastectomy with sentinel lymph node biopsy, followed by hormonal therapy based on her tumor's immunohistochemical profile. Due to the low incidence and limited research on primary NETs, their exact origin remains shrouded in mystery. Accurate diagnosis, specific treatment options, and long-term prognosis remain significant challenges in managing this rare form of breast cancer.

Well-differentiated liposarcomas are common retroperitoneal lesions, but exceedingly rare when primary to the small bowel mesentery, with only a handful of cases reported in the literature. Presented is a patient with a primary mesenteric well-differentiated inflammatory liposarcoma with mucosal extension at high risk for misdiagnosis. A broad differential diagnosis with careful histopathologic observation, ancillary immunohistochemical studies, and fluorescent in situ hybridization for MDM2 amplification are key to make a correct diagnosis. This is especially true if such a lesion was first noted in the lamina propria on histopathology from an endoscopic mucosal biopsy.

Introduction: Volvulus of the caecum, ascending colon and first third of the transverse colon is a very rare surgical emergency. Timely diagnosis and intervention can avert serious complications. Case Report: A 54-year-old woman presented to the emergency department with colicky epigastric pain radiating to the left iliac fossa that lasted for 12 h. Vital signs were stable upon arrival at the hospital. Physical examination revealed that left abdomen and suprapubic fullness and bowel sounds were recorded, and rebound tests were negative. Laboratory results were neutrophils: 78% (35%-72%), lymphocytes: 16% (20%-45%), HB: 11 g/dL (12-16), HCT: 33% (36%-48%); all the rest were normal. Furthermore, computed tomography revealed a distended close of the large bowel extending from the left hypochondrium to the left iliac fossa. During explorative laparotomy, volvulus of the first third of the transverse, ascending colon and caecum was detected. Because the viability of the bowel wall was compromised, right extended hemicolectomy was performed with consequent ileotransverse anastomosis. The postoperative period was uneventful, and the patient was discharged on the fourth postoperative day. Conclusions: Expeditious diagnosis and early intervention of very rare surgical emergencies such as ascending colon volvulus may avert disastrous complications.

Candida parapsilosis is an exceedingly rare cause of ventriculoperitoneal (VP) shunt infection, even in patients who have a history of long-term antibiotic use, immune-compromised newborns, and intensive care unit patients. We hereby report a case of a 53-year-old male who presented with subarachnoid hemorrhage and had a complicated postoperative course due to C. parapsilosis infection, and we discuss the pertinent clinical aspects.

Background: Grynfelt's lumbar hernia is the rarest of all abdominal wall hernias, accounting for between 1.5% and 2% of cases, with only 300-350 instances described to date. Lumbar hernias can be congenital or acquired, often triggered by trauma or surgery (iatrogenic). Diagnosis is clinical and confirmed via computed tomography. Surgical intervention is required for resolution, with repair performed either through open or laparoscopic surgery. Material and Methods: We present the case of a young female with no prior surgical or traumatic history, in whom the diagnosis of Grynfelt's hernia was made. Results: The patient underwent elective left lumbotomy surgery with hernioplasty using a supra-aponeurotic polypropylene mesh. Postsurgical recovery was adequate, and she was discharged 4 h after surgery. Follow-up in the general surgery outpatient clinic occurred at 20 days, 1, 3, and 6 months, with no recurrence, complications, or incidents. Conclusion: Grynfelt's hernia is a rare entity that requires a high index of suspicion for accurate diagnosis. Although cases are often asymptomatic, untreated hernias can lead to significant morbidity. Early recognition and timely surgical intervention are crucial for symptom relief and prevention of complications. In this case report, surgical management involved hernioplasty through a left lumbotomy approach, repairing the hernia defect and reducing the hernia content. Supra-aponeurotic mesh was placed to ensure adequate closure. Given the rarity of this pathology, no specific management guidelines exist in the literature. Therefore, the decision for this type of repair was based on intraoperative findings. Further research is needed to clarify management strategies and optimize outcomes for patients with Grynfelt's hernia.

Post-traumatic diaphragmatic hernia (PTDH) is defined as the migration of intra-abdominal organs into the chest through a pathological defect in the diaphragm caused by trauma. PTDH is a rare condition, occurring in 3%-7% of all thoracoabdominal injuries. Approximately 14.6% of PTDH cases present months to years after the initial trauma. Cases of delayed PTDH complicated by bowel obstruction and perforation are exceedingly uncommon, with a reported prevalence of 0.17%-6%. In Africa, fewer than 10 cases of delayed PTDH have been documented over the past three decades. Despite the availability of published reports, there are no established practice guidelines for managing PTDH. Here, we present a case of delayed PTDH that manifested as acute bowel obstruction 12 years after a gunshot wound to the chest. The condition led to a fatal postoperative outcome. This case highlights the critical need for clinicians to consider PTDH in patients with a history of trauma presenting with acute bowel obstruction and underscores the importance of urgent surgical management to prevent fatal complications.

Introduction: Necrosis of the rectus or lateral abdominal wall investing fascia may be associated with invasive infections or closure under extreme tension. This can lead to fascial dehiscence and evisceration of the intra-abdominal contents. Globally, abdominal wound dehiscence varies from 0.4% to 3.5% with associated mortalities reaching up to 45% in the perioperative period. Redo surgical operations and infectious complications are the major risk factors for abdominal wound dehiscence, but also presence of low albumin, glucocorticoid use, chest infections, and emergency surgeries have been also implicated. Open abdomen has been employed in incidences of trauma where a second look operation may be necessary, loss of abdominal wall, sepsis after penetrating abdominal trauma, and in cases of severe secondary peritonitis and acute pancreatitis. Patients with open abdomen are at a risk of fistula formation, sepsis, and loss of abdominal domain due to lateral fascial retraction. To reduce the mentioned complications mesh and nonmediated techniques to bridge fascia defects have been recommended with particular emphasis on biologic meshes with or without negative pressure wound therapy, component separation, or planned ventral hernia. Methods: We report a case of necrosis of the rectus and abdominal wound dehiscence and its management in a sub-Saharan setting, highlighting the challenges encountered and lessons learned. Conclusion: Retention sutures should be used cautiously in the management of wound dehiscence as it increases the risk of fascial necrosis in cases of intra-abdominal hypertension, as seen in our patient. In the absence of a VAC dressing, the utilization of routine saline gauze dressing promotes epithelialization over the exposed bowel and is a viable alternative to temporary abdominal closure modes of managing an open abdomen in a resource-limited setting.