Case Reports in Surgery最新文献

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.

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.