Case Reports in Surgery最新文献

Bochdalek hernias (BHs) are rare, and the presentation, diagnosis, and management of them can be complex. We present a 70-year-old man presenting with left flank pain who underwent a successful laparoscopic repair of BH with mesh placement.

Endometriosis is characterized by endometrial-like glands and stroma outside the uterine cavity, affecting women of reproductive age. Thoracic endometriosis syndrome (TES) is an entity producing a range of clinical and radiological manifestations, including catamenial pneumothorax, haemothorax, haemoptysis, and pulmonary nodules within the thoracic cavity or on the diaphragm. TES symptoms are nonspecific, warranting a high degree of clinical suspicion. Management includes hormone replacement therapy, surgical management, or a combination of both. We present a case of a 37-year-old woman who presented with TES and unilateral diaphragmatic palsy, managed with robotic-assisted thoracoscopic surgery and hormone replacement.

Introduction: Gallstone sigmoid ileus is a very rare manifestation of large bowel obstruction. Mainly, three conditions predispose the manifestation of the entity; in particular, an episode of cholecystitis causing cholecysto-colonic fistula; a large gallstone; and narrowing of the sigmoid colon secondary to diverticular disease or malignancy. Case Report. An 82-year-old man presented to the emergency department with a one-week history of severe constipation, tachypnoea, tachycardia, hypotension, and high lactate. Physical examination demonstrated cyanosed upper and lower extremities and palpation of the abdomen revealed signs of peritonism, abdominal distention, and guarding. Computerized tomography scan demonstrated perforation of the hollow viscus organ secondary to impaction of the large gallstone in the sigmoid colon. Laparotomy revealed sigmoid perforation and widespread feculent peritonitis. The patient underwent Hartmann's procedure. After the intervention gave concerns regarding the patient's haemodynamic stability, he was transferred to the intensive care unit. The patient passed away on the third postoperative day due to complications secondary to haemodynamic instability.

Conclusions: Patients with early diagnosed uncomplicated sigmoid gallstone ileus can be managed with endoscopic mechanical lithotripsy. In case of failure, open or laparoscopic enterolithotomy can be applied. However, when patients present with complications, surgery should not be delayed. In our case, Hartmann's procedure was an absolute indication due to sigmoid perforation and widespread feculent peritonitis.

The case of vascular reconstruction of the superior mesenteric and portal vein confluence using a left renal vein (LRV) graft has been researched in this paper. The patient was a 66-year-old female who presented with features of biliary obstruction. A contrast-enhanced computed tomography scan revealed bile duct dilatation and a common bile duct tumor mass. Four years ago, she underwent stomach resection with subsequent Billroth II gastrojejunostomy due to gastric cancer. After surgical resection, on histopathological and immunohistochemistry examination, a recurrence of previously resected poorly cohesive gastric cancer was found.

Isolated fallopian tube torsion (IFTT) is a rare pathology that causes acute abdomen in women, it is even less common in pediatric patients. We present a case of an 11-year-old girl who presented with abdominal pain 24 hours of evolution, the diagnosis could not be specified with cabinet methods, so the definitive diagnosis was made using a diagnostic laparoscopy. A necrotic hemorrhagic tubal cyst was found. A left salpingectomy had to be performed due to necrosis. Early diagnosis can have a positive impact on the fertility of these patients.

A 41-year-old male presented to the emergency department of a regional Australian hospital with chest and abdominal pain. He became rapidly haemodynamically unstable and was diagnosed with a ruptured splenic artery aneurysm and large volume hemoperitoneum. Due to the regional location of our small hospital, endovascular services are not available and the patient required emergency laparotomy. At laparotomy, a 2 L hemoperitoneum was evacuated, and the bleeding splenic artery aneurysm was identified and controlled. The aneurysm was approached with a unique technique via division of the gastro colic omentum to enter the lesser sac. This allowed adequate exposure of the splenic artery and proximal and distal control of the vessel was achieved. Adequate perfusion to the spleen was preserved by this surgical technique and splenectomy was therefore not required. This study details the management of this patient, details of the interoperative technique, and a discussion regarding splenic artery aneurysms. Splenic artery control and ligation without splenectomy may be considered in appropriate patients and splenectomy is therefore not always required in cases of hemodynamic instability where open surgical management is performed.

Background: A 19-year-old male requiring emergency surgery after presenting to the emergency department (ED) as a trauma activation status post-motor vehicle collision. Summary. The patient presented to the ED after a motor vehicle collision. He was taken emergently to the operating room after finding hemoperitoneum on computerized tomography scan without evidence of solid organ injury. Significant small and large bowel injuries were discovered requiring resection and anastomosis. The patient had an uneventful post-operative recovery and was discharged home. He was later re-admitted to the hospital with a large pelvic abscess and a left mid-ureteral stricture causing hydronephrosis. The abscess was treated with antibiotics, and the left ureteral injury was treated with a nephrostomy tube and stent placement. He made a full recovery after hospital re-admission and a delay in diagnosis of blunt ureteral injury.

Conclusion: Patients involved in motor vehicle collisions are at risk of multi-system trauma including genito-urinary injuries. A small percentage of these patients may present with blunt ureteral injuries. A high index of suspicion is required to make an early diagnosis. Earlier diagnosis may help to prevent morbidity.

Bouveret syndrome is a gastric outlet obstruction, and biliary ileus is an obstruction of the small bowel, and both are caused by a gallstone that escaped the gallbladder through a bilio-enteric fistula. The concurrent occurrence of obstruction at both sites is encountered very rarely, and only two such cases associated with Bouveret syndrome were reported before. We now present a case involving a 78-year-old female with simultaneous obstruction at both the duodenum and jejunum. The literature is reviewed to evaluate the incidence of such a situation and to discuss the management of the case.

Introduction and Importance. Endoscopic retrograde cholangiopancreatography (ERCP) is a non-surgical method utilized to manage biliary tract obstruction, but the complication of biliary stent migration occurs in 5-10% of patients. Though migrated stents are commonly passed through the gastrointestinal tract without harm, intestinal perforation is a rare but severe complication, affecting less than 1% of cases. Case Presentation. We report a case of a 65-year-old woman who presented to the emergency department with symptoms of abdominal pain, nausea, and loss of appetite. According to clinical examination and evidence, the patient underwent surgery with high suspicion of appendicitis, which unexpectedly uncovered a perforated cecum with a protruding biliary stent. Clinical Discussion. Our report describes a unique and unexpected finding of cecal perforation caused by a migrated biliary stent in a patient. We also conducted a review of current literature on ERCP complications, including risk factors for stent migration, relevant statistics, and appropriate interventions. Conclusion. Surgeons should be aware of the risk of stent migration and complications in patients with a history of ERCP. Removal of migrated biliary stents is recommended, regardless of the presence of complications. Additional assessments for alternative diagnoses are recommended for older patients with abdominal pain complaints. Flexible plastic stents should be used for patients at risk of stent passage.

Background. The use of oral or nasal route for enteral feeding is a standard practice in intensive care patients with a safe profile in general. However, complications associated with the insertion of a nasogastric (NGT) or orogastric tube (OGT) are common in the medical literature compared to the removal of such tubes. Case presentation. We presented a 38-year-old male who was involved in a motor-vehicle collision and found with low Glasgow Coma Scale outside his vehicle. He had polytrauma and was intubated-and commenced on enteral feeding via an OGT. Esophageal bezoar developed within a few days around the feeding tube, resulting in significant force being required to remove it, which was complicated by esophageal perforation. The esophageal injury was treated conservatively with uneventful recovery. Discussion and conclusions. Although limited case reports of esophageal enteral feeding bezoar formation do exist in the literature, we believe that this is the first case report of esophageal perforation due to the forceful removal of a wedged OGT secondary to esophageal bezoar formation. Morbidity associated with OGT/NGT is not common and may require a high index of suspicion to be identified. This is especially true if resistance is appreciated while removing the NGT/OGT. Gastroenterology consultation is recommended as early as possible to detect and manage any complications, however, their role was very limited in such stable case. In addition, early computed tomography (CT) can be considered for timely recognition of esophageal perforation. Non-operative management may be considered in stable patients, especially if the leak is in the cervical portion of the esophagus. Finally, prevention is better than cure, so being diligent in confirming NGT/OGT position, both radiologically and by measuring the tube length at the nostril/mouth, is the key to avoid misplacement and complication. This case raises the awareness of physician for such preventable iatrogenic event.