Case Reports in Surgery最新文献

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.

Staghorn calculi pose challenges in urology, often necessitating more invasive procedures such as percutaneous nephrolithotomy (PCNL) to clear a large stone burden with fewer procedures. Here we present a case of a 76-year-old female with chronic kidney disease and a malrotated right pelvic kidney who underwent PCNL for a 3.5 cm staghorn calculus. Postoperatively, she developed a rare complication of ascending colon perforation, requiring emergent surgical intervention including exploratory laparotomy and right hemicolectomy. Colon perforation during PCNL is rare (0.3%-0.8%). Preoperative imaging, namely computed tomography (CT) of the abdomen and pelvis, is crucial to identify anatomical variations and mitigate the risk of injury. Conservative management strategies have demonstrated success in similar cases, emphasizing the importance of prompt recognition and multidisciplinary management. This case contributes to the paucity of literature regarding this rare complication underscoring the necessity for detailed preoperative planning to avoid complications in PCNL, especially in patients with complex renal anatomy. Future research should focus on developing tailored guidelines for PCNL in patients with anatomical abnormalities to enhance procedural safety and optimize outcomes.

Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal tumors of unknown etiology composed of myofibroblastic cells admixed with inflammatory cells. Presented is a 72-year-old male hospitalized for severe abdominal pain and hematochezia with onset of associated symptoms of fever and sweats a few hours prior to abdominal pain. A computed tomography (CT) demonstrated left colonic thickening interpreted as partial obstruction, gross adhesions, and ischemia. At surgery, marked bowel ischemia from the distal transverse to proximal sigmoid colon was seen with extensive gross adhesions. Histopathology revealed a mesenteric mass chiefly composed of stellate-to-spindled myofibroblastic cells and fibrous adhesions, intermixed with lymphocytes, histiocytes, and plasma cells. The tumor was positive for desmin, smooth muscle actin, and keratin; tumor staging, grade, and postsurgical follow-up were not completed as the patient expired postoperatively. Illustrated is a rare pathologic mimic of ischemic colitis with fibrous adhesions, IMT. Thus, it should not be assumed that fibrous adhesions are always the etiology of obstruction when "adhesions" between sections of bowel are noted radiologically or surgically.

Mastoid obliteration can be performed after canal wall down (CWD) mastoidectomy with various materials. Homologous bone tissue harvested from cadaver donor represents a feasible option with advantages. The purpose of the study is to describe the case of a patient diagnosed with middle ear cholesteatoma treated with mastoidectomy of the CWD and mastoid obliteration with homologous freeze-dried corticocancellous bone particulate in the Cittadella Hospital Ear, Nose, Throat (ENT) unit. The preoperative characteristics of the patients, the procurement and processing of bone allografts, the surgical technique, and postsurgical outcomes are described. No perioperative and postoperative complications were observed, and no rejection or foreign body reactions occurred. The patient then underwent a seriated follow-up. Audiometric tests showed an improvement in hearing levels. The volume of the neoexternal ear canal was 2.01 cm³. The case demonstrated clinical stability, substantial hearing recovery, and no need for specialist cleaning of the reformed external ear canal (EEC). The freeze-dried bone tissue allograft, in the technical way we used, appears to be a viable option in mastoid obliteration because homologous bone is not affected by material shortage, has fast assimilation, and ensures a useful radiological examination scan, at a low cost.

Background: Odontoid fracture (OF) is one of the most common spinal fractures. Type II in D'Alonzo's classification is still the most common and should be considered unstable unless proven otherwise. Thus, surgical stabilization has received significant attention. Although posterior displacement is common in type II OF, complete displacement is extremely rare, and very few reports are available in the literature. Case Presentation: We report the case of a 60-year-old man with acute type II OF with complete posterior displacement and myelopathy. The patient was managed utilizing a posterior-only single approach for reduction and stabilization. Conclusion: Posterior displacement of type II OF has been traditionally managed with close reduction and anterior or posterior stabilization. Closed reduction in cases of complete posterior displacement carries a significant risk of neurologic deterioration. Anterior, combined, and posterior approaches have been taken for this condition. The posterior-only approach in experienced hands has the least mortality and morbidity with at least the same neurologic and fusion outcomes.

Iatrogenic aneurysms of the splenic artery constitute a rare yet potentially severe complication arising from diverse medical or surgical interventions. The clinical complexity and challenging management strategies associated with these aneurysms pose significant difficulties for clinicians. This circumstance is exemplified in our case report, detailing an iatrogenic aneurysm of the splenic artery that emerged secondary to a pancreatic fistula following a median pancreatectomy performed for a Frantz tumor. The intricate clinical presentation of this case underscores the considerable management challenges posed by such iatrogenic complications.

Background: Schwannomas are well-encapsulated, solitary tumors that grow slowly from the nerve sheath. Sellar schwannomas tend to be mistaken for other sellar/parasellar lesions due to similar clinical and radiological findings. The present article describes the clinical presentation, radiological findings, histopathological features, and outcome of a patient with sellar schwannoma. Case Description: A 23-year-old female, known to have hypothyroidism secondary to Hashimoto's thyroiditis, presented with multiple episodes of galactorrhea, weight gain, and irregular menstrual cycle for 8 months. It was associated with decreased visual acuity and episodic headaches. Neurological examination revealed no focal deficits. Brain magnetic resonance imaging (MRI) showed a well-defined lobulated lesion in the sellar region, compressing the right optic nerve and optic chiasm. The patient underwent craniotomy and tumor resection. The histopathological sections were diagnostic of schwannoma. Postoperatively, the patient noted a subjective improvement in her visual acuity. She was discharged in stable condition with regular follow-ups at neurosurgery, endocrine, and ophthalmology clinics. Conclusion: Schwannoma of the sellar region is rare and can be misdiagnosed as pituitary adenomas. Preoperative hormonal profile and meticulous neuroradiological assessment narrow down the differential diagnosis for patients with sellar lesions. The diagnosis of sellar schwannomas is established with histopathology and immunohistochemistry results.

Aortic valve replacement (AVR) in a patient with a bio-Bentall conduit can be very challenging, especially if there was a previous endocarditis process for significant morbidity and mortality. We report a case of sutureless AVR in an old patient with a bio-Bentall conduit (Carpentier-Edwards Perimount Magna Ease 25 aortic valve and Hemashield 30 aortic conduit), who developed an endocarditis on aortic prosthesis valve. We believe that sutureless AVR is the best option for redo-operation in older patients with a high surgical risk because it allows for easy rapid deployment implantation, avoids anchoring sutures on a fragile aortic anulus, and reduces cardiopulmonary and aortic cross-clamp times. In this setting, it should be considered as a safe and valid alternative not only to traditional prosthesis but also in selected cases to transcatheter valve-in-valve solutions.

Enterobius vermicularis is a common parasitic infection worldwide. Acute appendicitis (AA) is a frequently encountered condition in general surgery; however, its association with E. vermicularis remains controversial. AA caused by E. vermicularis is a relatively uncommon infection that primarily affects children. We reported a 21-year-old female who was admitted to our hospital due to right lower quadrant abdominal tenderness. Laboratory tests and imaging were not consistent with AA. She underwent a diagnostic laparoscopy and appendectomy. Histopathological examinations revealed the presence of E. vermicularis in the lumen of the appendix, which caused its obstruction without evidence of inflammatory cell infiltration or lymphoid hyperplasia.

Anorectal diseases are a major health threat in the field of health sciences. Fistula-in-ano is one of the treatable complex benign lesions of the rectum and anal canal. Complex high anal fistulas can reoccur even after surgical treatment. Establishing a cure for cryptoglandular fistula-in-ano is problematic, as a significant percentage of these diseases persist or recur if the internal opening of the anal fistula is left untreated. Here, we report a case of complex left anterolateral supralevator anal fistula with communication to the prostate gland that forms a prostatic abscess, as it is very rare. After following Ksharasutra (Ayurvedic medicated seton) treatment with regular wound care, significant regression in the condition was observed. A follow-up scan showed no evidence of fistula-in-ano. A 50-year-old businessman presented with complaints of discomfort deep inside the rectum and perineum associated with pain at the base of the scrotum and pus discharge from the perianal region for 1 year. He was diagnosed to have a complex left anterolateral supralevator anal fistula with communication to the prostate substance after a thorough clinical examination and transrectal ultrasonography. After undergoing Ksharasutra treatment for 4 months, pus discharge completely stopped, and sonofistulogram report showed no evidence of fistula-in-ano. Images of the sonofistulogram report were documented before and after the treatment. This article highlights the unique feature of Ksharasutra therapy where the fistula extending to the prostate was treated with no loss of function of the anal sphincter.