Case Reports in Surgery最新文献

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.

A rare case of Fournier's gangrene (FG) secondary to varicella-zoster virus (VZV) affecting the penis and scrotum of a 7-year-old boy is presented. To the authors' knowledge, there are four cases of FG in children as a result of VZV reported to date. Our patient underwent a total of four surgical debridements and was reconstructed using a split-thickness skin graft (SSG). At 1-year post-reconstruction, his graft is robust, and he has no functional issues.

Background: Primary retroperitoneal seminoma is an exceedingly rare type of germ cell tumor, accounting for less than 5% of all such tumors. These tumors are typically large at presentation due to their slow growth and the nonspecific nature of symptoms, which often leads to delayed diagnosis. Case Presentation: A 40-year-old male presented with intermittent abdominal pain and a palpable lump in the right paraumbilical region. Ultrasonography revealed a large retroperitoneal mass. Fine needle aspiration cytology confirmed the diagnosis of poorly differentiated malignant tumor, for which he was evaluated with CT-angiogram of the abdomen and FDG PET-CT scans, which showed a large retroperitoneal mass. The patient, then, had a surgical resection of the mass, with postoperative histopathological and immunohistochemical diagnosis of primary retroperitoneal seminoma, and then underwent three cycles of BEP chemotherapy. Scrotal ultrasonography showed no testicular abnormalities, obviating the need for orchiectomy. FDG PET showed a complete response following treatment completion. Postoperative management included routine monitoring of tumor markers and follow-up imaging, which showed a complete response. Conclusion: This case highlights the diagnostic and therapeutic challenges of primary retroperitoneal seminoma. A multidisciplinary approach, including accurate histopathological diagnosis and a combination of chemotherapy and surgery, is essential for optimal management. Early diagnosis and tailored treatment strategies significantly improve patient outcomes.

Trichobezoars are accumulations of undigested hair. Usually, this disorder follows a psychiatric etiology; however, sometimes a nonpsychiatric etiology, such as pica, can also be suspected. Rapunzel syndrome is a rare type of trichobezoar in which the hair is usually confined to the stomach and small intestine. The authors present a rare case of trichobezoar in a young female without any psychiatric symptoms. Trichobezoar results in nonspecific GI symptoms and this causes delays in its diagnosis. It should always be considered a differential in a young female with nonspecific GI symptoms, especially in those with evidence of iron deficiency anemia.

Background and importance: Meningiomas are one of the most frequent primary central nervous system (CNS) tumors. According to the World Health Organization (WHO) classification of brain tumors, meningiomas are categorized into Grade 1 (benign meningioma; 80%), Grade 2 (atypical meningioma; 4%-15%), and Grade 3 (anaplastic meningiomas; 1%-3%). Grade 2 meningioma has a higher recurrence rate, ranging from 29%-52%. However, the transformation from atypical meningioma into benign meningioma is poorly understood. The present article describes a patient with Grade 2 meningioma that transformed into a benign subtype. Case presentation: A 51-year-old female with a history of seizures, presented with left-sided progressive weakness. Radiological imaging revealed a large extra-axial parasagittal lesion measuring 5 cm × 5 cm × 4.8 cm, suggestive of meningioma. The patient underwent subtotal resection of the lesion. Histologically, the tumor was in favor of Grade 2 meningioma. Radiological follow-up 8 years postoperatively revealed a recurrent meningioma. The patient underwent right-sided craniotomy and resection of the parasagittal meningioma. The histopathological features were suggestive of a Grade 1 meningioma. Conclusion: The transformation from atypical to benign meningiomas is rarely reported and the mechanism remains unclear. The present case provides insights into the natural history of this entity, describes possible etiologies, and lists the surgical management with an emphasis on preoperative radiological imaging and histopathological investigations.

Background: Caecal volvulus in the paediatric population is uncommon, yet at worst this condition is a life-threatening surgical emergency. In children, caecal volvulus can be associated with a variety of predisposing factors such as chronic constipation, intestinal malrotation, or neurological disease. Case Representation: We present a rare case of caecal volvulus, internal hernia, and an intestinal rotational abnormality in a previously healthy 8-year-old boy. The patient presented with a history of abdominal pain and vomiting for 3 days and was admitted to the hospital in a severe septic shock. After the initial stabilisation with fluids and vasopressors, an emergency laparotomy was performed. A necrotic caecum volvulus, a transmesocolic hernia, and an abnormal rotation of the small intestine were diagnosed. The necrotic bowel segment was resected in a right-sided hemicolectomy, after which a resection distal to medial colic artery was cut-off to achieve normal anatomy. The patient was discharged on the 12th postoperative day in good health and has since returned to normal active life without any health issues within the follow-up of 5 months. Conclusions: Caecal volvulus and internal hernia can lead to a life-threatening condition requiring immediate surgical treatment. Rare causes of abdominal pain in children should be kept in mind when severe symptoms are present.

Paraganglioma of the middle mediastinum has a prevalence of 1%-2% of paragangliomas and less than 1% of mediastinal masses. It is generally asymptomatic and can easily be confused with other pathologies. The following is the case of a 50-year-old patient who, as an incidental finding, documented an injury between the aorta and the pulmonary artery, hypervascularized, which was embolized prior to surgery, which facilitated the complete resection of the lesion by sternotomy. With favorable evolution of the patient and discharge on the fourth postoperative day. A thorough review of the literature on the diagnostic and treatment approach to this pathology has been also carried out.