The SCARE 2018 statement: Updating consensus Surgical CAse REport (SCARE) guidelines

Transverse testicular ectopia: two case reports and literature review

INTRODUCTION AND IMPORTANCE

Transverse Testicular Ectopia (TTE) is characterized by the presence of testis in the hemiscrotum, which can be associated with a broad spectrum of complications. It is usually manifested in pediatrics. However, on rare occasions, it can occur in adults. The diagnosis is confirmed by magnetic resonance imaging (MRI). We present two cases of Transverse Testicular Ectopia (TTE), demonstrating the significance of early diagnosis and treatment to reach optimal outcomes.

CASE PRESENTATION

We reported two patients with common features suggestive of Transverse Testicular Ectopia (TTE). Case 1 had open surgery; his left testis was impalpable, whereas his right side was palpable. Case 2 had undergone laparoscopy surgery, and his right and left spermatic cord was discovered on the right side.

CLINICAL DISCUSSION

Transverse Testicular Ectopia (TTE) is classified according to clinical presentation; Type 1 is associated with inguinal hernia ranging between 40 and 50 %. Type 2 is related to persistent mullerian duct syndrome (PMDS), with a rate of 30 %. Type 3 is associated with genital anomalies and azoospermia, with a rate of 20 %. The pathogenesis is unclear. However, studies suggest that the persistence of the mullerian duct prevents normal descent of the testis. Treatment is purely dependent on early clinical presentation and surgical methods.

CONCLUSION

Transverse Testicular Ectopia (TTE) requires delicate care by the pediatric surgeon as it is considered a rare entity in such cases. Heroin, we highlight the significance of early surgical treatment and the possibility of complications if left untreated.

Diagnosis and emergency surgical management of stercoral colitis-induced colonic ischemia: A case report and literature review

INTRODUCTION AND IMPORTANCE

Stercoral colitis is an urgent complication of fecal impaction that requires aggressive management. The rare complicated with bowel ischemia requires a high index of suspicion for early diagnosis. This case report describes the detection and management of this rare and fatal complication of stercoral colitis.

CASE PRESENTATION

An 80-year-old man presented after 3 days of obstipation. Abdominal plain radiography revealed several air-fluid levels in the colon with centralized small bowel gas. Computed tomography revealed fecal impaction and stercoral colitis without evidence of bowel ischemia.

CLINICAL DISCUSSION

Fecal impaction and stercoral colitis without evidence of bowel ischemia was suspected. Owing to the development of refractory septic shock, we performed damage control surgery. Definitive surgery with end ileostomy was follow by 48 h later. The patient was discharged home safely.

CONCLUSION

Stercoral colitis-induced ischemia is rare but potentially fatal; ischemia should be highly suspected. CT can help diagnosed of stercoral colitis but no single parameters for diagnosed of bowel ischemia. Prompt resuscitation and surgical exploration with damage control surgery are recommended.

Musculoskeletal manifestations associated with transthyretin-mediated (ATTR) amyloidosis: a systematic review

BACKGROUND

Hereditary and wild-type transthyretin-mediated (ATTRv and ATTRwt) amyloidoses result from the misfolding of transthyretin and aggregation of amyloid plaques in multiple organ systems. Diagnosis of ATTR amyloidosis is often delayed due to its heterogenous and non-specific presentation. This review investigates the association of musculoskeletal (MSK) manifestations with ATTR amyloidosis and the delay from the onset of these manifestations to the diagnosis of ATTR amyloidosis.

METHODS

This systematic review utilized Medline and EMBASE databases. Search criteria were outlined using a pre-specified patient, intervention, comparator, outcome, time, study (PICOTS) criteria and included: amyloidosis, ATTR, and MSK manifestations. Publication quality was assessed utilizing Joanna Briggs Institute (JBI) critical appraisal checklists. The search initially identified 7,139 publications, 164 of which were included. PICOTS criteria led to the inclusion of epidemiology, clinical burden and practice, pathophysiology, and temporality of MSK manifestations associated with ATTR amyloidosis. 163 publications reported on ATTR amyloidosis and MSK manifestations, and 13 publications reported on the delay in ATTR amyloidosis diagnosis following the onset of MSK manifestations.

RESULTS

The MSK manifestation most frequently associated with ATTR amyloidosis was carpal tunnel syndrome (CTS); spinal stenosis (SS) and osteoarthritis (OA), among others, were also identified. The exact prevalence of different MSK manifestations in patients with ATTR amyloidosis remains unclear, as a broad range of prevalence estimates were reported. Moreover, the reported prevalence of MSK manifestations showed no clear trend or distinction in association between ATTRv and ATTRwt amyloidosis. MSK manifestations precede the diagnosis of ATTR amyloidosis by years, and there was substantial variation in the reported delay to ATTR amyloidosis diagnosis. Reports do suggest a longer diagnostic delay in patients with ATTRv amyloidosis, with 2 to 12 years delay in ATTRv versus 1.3 to 1.9 years delay in ATTRwt amyloidosis.

CONCLUSION

These findings suggest that orthopedic surgeons may play a role in the early diagnosis of and treatment referrals for ATTR amyloidosis. Detection of MSK manifestations may enable earlier diagnosis and administration of effective treatments before disease progression occurs.

Small intestinal perforation secondary to metastasis from skin squamous cell carcinoma: A case report and literature review

INTRODUCTION AND IMPORTANCE

Primary and metastatic carcinoma of the small intestine are rare. While most of these malignancies are adenocarcinomas, squamous cell carcinoma (SCC) of the gastrointestinal tract is uncommon. We present a case report of a rare occurrence of skin SCC metastasizing to the ileum, highlighting diagnostic challenges and clinical implications.

CASE PRESENTATION

An 83-year-old female had a history of cutaneous SCC excision in the right temporal region two years prior to the current emergency department visit, followed by metastatic recurrence in a right intra-parotid lymph node treated with radiotherapy. The patient exhibited septic shock and an acute abdomen, and an abdominal computed tomography scan revealed signs of intestinal perforation. Emergency exploratory laparotomy confirmed purulent peritonitis and perforation of the terminal ileum. Subsequently, a 20 cm intestinal resection was performed. Histopathological examination of the resected specimen revealed a 4 cm perforated SCC of the small intestine (pT4 pN0 L0 V1 Pn0 R0).

CLINICAL DISCUSSION

Metastases of the small intestine are rare. The primary sites for these metastases are typically the uterus, cervix, colon, lung, breast, or melanoma. SCC of the small intestine is particularly rare and poses challenges in diagnosis owing to non-specific symptoms. The prognosis for SCC of the small intestine is generally poor, and the potentially aggressive behavior of some skin SCC emphasizes the need for increased awareness and vigilance in managing such cases.

CONCLUSION

This case report underscores the importance of considering metastatic disease in the small bowel of patients with a history of skin SCC who present with new-onset abdominal symptoms.

A rare case of a recurrent atypical adenomyoepithelial tumor of the breast: Case report

INTRODUCTION

Adenomyoepithelial tumors of the breast are very rare tumors comprising of - fibroepithelial and myoepithelial components PRESENTATION OF THE CASE: We present the case of a 66 years old lady who presented with a right breast lump 5 cm in size, diagnosed as an atypical adenomyoepithelioma who underwent successful excision and returned two and half years later with a recurrence DISCUSSION: These tumors present a diagnostic dilemma needing histopathology for definitive diagnosis. Recurrence is not uncommon CONCLUSION: Adenomyoepitheliomas demand regular surveillance for early detection of any recurrence.

Huge spindle cell sarcoma of esophagus in a middle-aged man with a recent-onset dysphagia: Case report

INTRODUCTION

Esophageal sarcoma is a rare neoplasm of the gastrointestinal tract. The majority of the esophageal neoplasms have an epithelial origin. In this report, we present a case of a middle-aged man with an enormous spindle cell sarcoma whose symptoms initiated only a few weeks before diagnosis.

PRESENTATION OF CASE

A 41-year-old man with an unremarkable past medical history and physical examination presented with recent aggravation of cough and severe, progressive dysphagia to solid foods resulting in a 25-kilogram weight loss without any prior symptoms. He had no history of cigarette smoking and alcohol consumption. The CT scan showed a huge soft tissue mass with heterogeneous enhancement from the proximal esophagus to 4 cm above the gastro-esophageal junction, causing luminal bulging. Trans-hiatal esophagectomy and gastric pull-up were performed. Pathology report confirmed the diagnosis of sarcoma. Further pathological evaluation using immune-histochemical studies, confirmed the tumor as spindle cell sarcoma. The postoperative period was uneventful, and there were no signs and symptoms related to tumor recurrence one year after surgery.

DISCUSSION

The most challenging aspect of diagnosing sarcomas is differentiating them from other pathologies, such as gastrointestinal stromal tumors, synovial sarcomas, sarcomatoid carcinomas, melanomas, and solitary fibrous tumors. Immunohistochemical studies play a vital role in this differentiation. Additionally, cytokeratin AE1/AE3 has been introduced as a marker of epithelial differentiation and can verify the presence of the epithelial component in tumors, such as in carcinosarcomas.

CONCLUSION

Considering the potential for an unusual size, sarcoma should be considered in a differential diagnosis for huge esophageal masses.

Duodenal Web in an Elderly Patient with Abdominal Discomfort and Vomiting: A Rare Case

Duodenal web is complete or incomplete obstruction of the duodenum due to a membranous web or intraluminal diverticulum. This abnormality is one of the main causes of intestinal obstruction in children. The symptoms of this disease may rarely appear in older age and cause gastric outlet obstruction in adults. In the present paper, we report a 69-year-old male patient with heartburn, abdominal discomfort, frequent non-bilious, non-bloody vomiting for the past 6 months. Furthermore, the patient had experienced a weight loss of 12 kg during this period. He had been taking aspirin daily for years due to his ischemic heart disease. After performing contrast-enhanced CT imaging, esophagogastroduodenoscopy and barium meal examination, the patient was diagnosed to suffer from duodenal web. Since surgery is currently the mainstay of treatment in the management of this disease, the patient finally underwent a gastrojejunostomy.

Extensive subcutaneous emphysema of the thigh as a rare complication following total knee arthroplasty: A case report

INTRODUCTION AND IMPORTANCE OF THE CASE

This is the first report of subcutaneous emphysema of the thigh as a complication after total knee arthroplasty (TKA).

PRESENTATION OF CASE

A 78-year-old female patient with valgus knee arthropathy underwent TKA. Two days postoperatively, the patient experienced left thigh swelling and pain, and subcutaneous emphysema was detected upon palpation. Although the skin tone was comparable to the other side, the left thigh was tender and firm. The surgical wound did not exhibit erythema. Computed tomography imaging revealed emphysema in the subcutaneous and intermuscular regions of the left thigh. Gram stain and culture tests from arthrocentesis were negative, and blood culture results were also negative. As there was no fever or disturbance of consciousness, and the LRINEC score was 1, supportive care was provided to the patient. At 5 days postoperatively, there was an observable improvement in the emphysema, and by day 9 postoperatively, the emphysema had fully resolved.

CLINICAL DISCUSSION

There is a lack of documented cases reporting extensive subcutaneous emphysema of the thigh following TKA, suggesting it to be an exceedingly rare complication. In this case, we conducted a thorough investigation to assess the potential association of infection. Subsequently, the symptoms were successfully alleviated with supportive care without antibiotics.

CONCLUSION

The occurrence of subcutaneous emphysema in the thigh was identified as a postoperative complication following TKA. Blood tests, culture tests and LRINEC score can be valuable tools for differentiation.

Bangle pessary: An unusual cause of vesicovaginal fistula

Vaginal pessaries are commonly used for uterine prolapse. Long forgotten pessaries get incarcerated in the vagina and may erode in the bladder and rectum. We present a unique case of a 60-year-old female patient who presented with dysuria and urge incontinence. In remote areas, bangles are still used as a pessary, which may present with atypical symptoms due to bladder perforation, encrustation, and Vesicovaginal fistula (VVF). VVF with a long curved tract can heal with prolonged catheterization. To our knowledge, this is the first case of glass bangle pessary being reported.

Case report: Duplicated appendicitis with history of cloacal exstrophy causing bowel obstruction

INTRODUCTION

Cloacal and bladder exstrophy are rare embryological defects that can cause developmental disruption of surrounding organ structures, the pelvis, spinal cord, and small intestines being the most commonly affected. Duplicated appendix is another rare embryological defect that has historically caused confusing clinical presentations. Our case highlights a rare instance of a patient with cloacal exstrophy who presented with a bowel obstruction and an associated inflamed duplicated appendix.

CASE PRESENTATION

A newborn male is born with omphalocele-exstrophy-imperforate anus-spinal defects (OEIS) complex. As primary surgical reconstruction was pursued, the patient was found to have a non-inflamed duplicated appendix, which was left unremoved. In the following months, the patient experienced episodes of small bowel obstruction, eventually requiring surgical intervention. During this operation, the duplicated appendix was noted to be inflamed, prompting removal of both appendices.

DISCUSSION

This case highlights the increased prevalence of duplicated appendix in a patient with cloacal exstrophy, as well as the utility of prophylactic appendectomy for patients incidentally found to have a duplicated appendix intraoperatively. The duplicated appendix may lead to increased rates of complications and atypical presentation of appendicitis, supporting the practice of prophylactic appendectomy in patients with an incidentally found duplicated appendix.

CONCLUSION

We suggest clinicians be aware of the association and potentially atypical presentation of appendicitis in patients with a duplicated appendix, particularly in the setting of cloacal exstrophy. The decision to prophylactically remove an incidentally found, non-inflamed duplicated appendix may be beneficial in preventing confusing clinical presentations and future complications.

A Giant Eyelid Molluscum Contagiosum Revealing an HIV Infection: A Case Report and Literature Review

Molluscum contagiosum (MC) is a common benign cutaneous viral infection. It can affect any part of the skin with a high propensity for facial skin, especially in human immunodeficiency virus (HIV) patients with low CD4 count. We report a case of a 16-year-old female patient who presented with a giant isolated right upper eyelid MC lesion that served as the first clinical indicator of her HIV infection and acquired immunodeficiency syndrome (AIDS). A final diagnosis of MC was made based on the history, clinical findings, and histopathological examination. Moreover, due to its vital location, large size, and atypical presentation, a surgical excision by simple unroofing and curettage was performed under local anesthesia to speed recovery, prevent corneal complications, and reduce transmission. Her follow-up visits showed satisfactory clinical and cosmetic outcomes. Patients presenting with giant atypical eyelid lesions must be thoroughly investigated for immunosuppressive states, especially HIV infection. MC can have atypical presentations in HIV patients. To our knowledge, this is one of a few cases in the literature reporting a giant isolated eyelid MC lesion leading to a diagnosis of HIV infection with AIDS.

Diabetic foot ulcer with osteomyelitis, successfully treated with the holistic approach of multiple ayurvedic treatment modalities - A case report

INTRODUCTION

Diabetic foot ulcer (DFU) with osteomyelitis is the devastating condition, which is a challenge to surgeons in saving the limb of the patient and in many circumstances ends up with amputation, which leaves physical and psychosocial trauma for both the patient and patient's family.

PRESENTATION OF CASE

A 48-year-old female patient with uncontrolled type 2 diabetes presented with swelling and gangrenous deep circular ulcer of size approx. 3 × 4 cm on plantar aspect of great toe of her left foot with involvement of first webspace from last three months. Plain X ray showed disrupted and necrotic proximal phalanx suggestive of diabetic foot ulcer with osteomyelitis. Despite using antibiotics and antidiabetic drugs for past three months she didn't get significant response and was suggested for toe amputaion. Hence, she approached our hospital for further treatment. We successfully treated the patient with the holistic approach of surgical debridement, medicinal leech therapy (MLT), irrigation of the wound with triphala decoction, jatyadi tail dressings, oral ayurvedic antidiabetic drugs to control blood sugar levels and a mixture of herbo mineral drug which is having antimicrobial property.

DISCUSSION

DFU may lead to infection, gangrene, amputation, death of the patient. Hence it is the need of the hour to look for limb salvage treatment modalities.

CONCLUSION

The holistic approach of these ayurvedic treatment modalities are effective and safe in treating DFUs with osteomyelitis and in preventing amputation.

Neglected patellar tendon rupture augmentation using fibertape augmentation: A case report

INTRODUCTION AND IMPORTANCE

Rupture to the patellar tendon caused by athletic activities is rare, but if not treated promptly, it can lead to unfavorable results such as quadriceps contracture, residual weakness, and reduced knee flexibility.

CASE PRESENTATION

A female patient who injured her knee seven months ago while twisting it experienced pain, instability, and tested positive for the anterior drawer and Lachman tests. Radiology results showed a complete tear of the anterior cruciate ligament (ACL) and a partial tear of the patellar tendon on the MRI scan of the right knee. We used a direct end-to-end approximation technique for the patellar tendon, with augmentation through the transosseous site at the patella proximally and tibial tubercle distally, without using a graft. The outcome was good, and this is the first reported case of a successful patellar tendon reconstruction without using implants, synthetic augmentation, or graft.

CLINICAL DISCUSSION

This technique could be a promising alternative to repair a chronic patellar tendon rupture without using expensive methods. The use of fiber tape augmentation can be a practical solution for treating a neglected patellar tendon rupture in conjunction with aligamentous injury that requires graft repair.

CONCLUSION

The use of fiber tape augmentation might be an alternative method for treating a neglected patellar tendon rupture with concurrent ligament injury needing graft repair. We believe that this technique is easily reproducible and warrants further investigation.

Invasion of undifferentiated pleomorphic sarcoma (UPS) in breast tissue; a case report study

INTRODUCTION AND IMPORTANCE

Breast sarcomas are scarce, histologically heterogeneous with nonepithelial malignancies that originate from the connective tissue within the parenchyma of breast. They can develop primarily, after radio-therapy (RT), or secondary due to chronic condition, including metastatic cancers.

CASE PRESENTATION

The present case report concerns 58-year-old women which was unbeknown to her malignancy in the early stages, until the mass became substantial in size. Chemotherapy and also radiotherapy were not effective, and the growth of tumor could not be prevented which the patient eventually died, due to respiratory complications.

CLINICAL DISCUSSION

Breast sarcomas are categorized in very rare malignancies, and the mortality of these types of cancers are significantly high as they often are not diagnosed in early stages. Based on the location and condition of the malignant tumor, therapeutic methods considered as chemotherapy, radiotherapy, and surgery.

CONCLUSION

In advance stages of breast sarcoma, chemotherapy, radiotherapy, and even surgery cannot be effectual. Therefore, periodical evaluation of breast wellness by diagnostic methods are recommended to all adult women.

Do Case Reports on Total Mandibular, Extended, and Bilateral Total Temporomandibular Joint Reconstruction Prostheses Adhere to the Surgical CAse REport Guidelines?

PURPOSE

The Surgical CAse REport (SCARE) guidelines are a standardized format for reporting surgical cases. The aim of this study was to evaluate the completeness of case reports documenting alloplastic reconstruction of large craniomaxillofacial defects involving total mandibular, bilateral, and extended temporomandibular joint in major high-quality craniomaxillofacial journals, based on the SCARE guidelines.

METHODS

An extensive online search was performed according to the Priority Reporting Items for Systematic Reviews and Meta-Analyses statement in PubMed, Embase, Scopus, Google Scholar, and Dimensions databases to identify relevant case reports. Each selected case report was assessed on 16 topics (38 items) of the SCARE guidelines, using a scoring scale of "0" (No/noncompliance), "1" (Yes/compliance), and 2" (unclear). The completeness of reporting (COR) score was calculated as the ratio of "yes" responses to "total" (ie, yes + no + unclear) responses. Adequacy of case reporting was denoted by a COR score of 70% or more.

RESULTS

A total of 35 case reports were selected, where the male to female patients ratio was 3:4 cases, mean ± standard deviation (SD) age: 34.9 ± 16.7 years, mean ± SD follow-up duration: 17.0 ± 12.9 months, and number of patients with left, right, and bilateral temporomandibular joint reconstruction prostheses were 16, 10, and 09, respectively. The mean ± SD COR score for all 35 case reports and the individual item of the SCARE guidelines was 70.2 ± 10.5% and 66.5 ± 31.2%, respectively. The minimum and maximum COR score was found for "Keywords" (0.0%) and "Introduction" (100%) and "Clinical Findings" (100%), respectively. Adequate reporting was found for 20/35 (57%) case reports.

CONCLUSIONS

This study revealed that case reports in major high-quality craniomaxillofacial journals suffer from insufficient reporting. Widespread adoption of available standards, such as SCARE guidelines, is proposed to improve the quality and robustness of case reporting.

First experience with a supercharged pedicled jejunal interposition for esophageal replacement after caustic ingestion in a middle-income Latin American country

Caustic or corrosive substance ingestion that results in severe esophageal and gastric lacerations frequently requires surgical management. The most common sequelae after an upper gastrointestinal tract caustic injury include non-responding luminal strictures, which are subject to esophageal replacement. Late corrective surgery may include esophagectomy with gastric pull-up and jejunal or colonic interpositions. Although long-segment esophageal reconstruction with jejunum is technically feasible and has demonstrated good outcomes, the complexity of the surgery has precluded the widespread use of this procedure in low- and middle-income countries. This document summarizes the most relevant aspects of caustic ingestion surgical management and describes the first Latin American experience in the reconstruction of an esophageal-gastric caustic injury using a pedicled jejunal interposition, as a viable and functional option in mid- and lower-income countries with well-established Thoracic Surgery departments and microsurgery access.

Combined liver-kidney transplantation with delayed kidney implantation: A case report

INTRODUCTION

In rare cases, patients require a combined liver-kidney transplant. However, the peri- and postoperative care of liver transplant recipients differs from kidney transplant recipients, which can lead to conflicts of interest. In the case of poor coagulation status and/or instable hemodynamics of the patient, liver transplantation, followed by delayed kidney transplantation can lead to better postoperative recovery.

PRESENTATION OF CASE

In our case report, we present a 48-year old man with Alagille syndrome and IgA nephropathy with bilirubin-associated acute kidney injury, causing him to develop both end-stage liver and kidney disease. He underwent a combined liver-kidney transplant as the first patient in the Netherlands, in which the donor kidney was transplanted one day after the liver transplantation. One-year post-transplant patient is in good clinical condition, with normal liver function and an eGFR of 57 ml/min.

CONCLUSION

Combined liver-kidney transplantation with delayed kidney implantation in a medical center with no previous experience with this technique is feasible and safe. This could be better for both the patient and the kidney graft.

Huge primary retroperitoneal mature cystic teratoma mimicking adrenal incidentaloma: A case report and literature review

INTRODUCTION

Teratomas originating from extra-gonadal account for 15 % of all teratomas, while retroperitoneal site being the least site for teratoma 1-11 %, extremely rare adrenal teratoma is less than 4 % of the retroperitoneal teratomas. Usually, patients are asymptomatic and the tumours are detected incidentally during imaging.

PRESENTATION OF CASE

A case of a 29 years old female, presented with intractable pain for four weeks. Computed tomography scan study of the abdomen showed an avascular septate cystic lesion measuring 11.6 × 11.4 14.5 cm (cranial-caudal x transverse x anterior-posterior) with central fat density and large punctate calcification in the right suprarenal region displacing the inferior vena-cava laterally, abutting the gall bladder, pancreas and duodenum. Impressions of right adrenal teratoma and less likely adrenal myelipoma were suggested. She remarkably improved one day post operation. During clinic visit a month later, she was completely recovered and resumed her daily activities.

DISCUSSION

In adults primary retroperitoneal mature cystic teratoma are uncommon, mostly are secondary tumours and very rare will occur in adrenal gland. Adrenal incidentaloma have been seldom reported mimicking primary mature cystic teratoma. Biochemical and Imaging studies are of great importance in diagnosing and showing relationship of the tumour and other organs. This work has been reported in line with the SCARE criteria (Agha et al., 2018 [1]).

CONCLUSION

Primary retroperitoneal tumours are rare and surgery is the main stay of treatment whether it be open or laparoscopic, the latter being best for small lesion for it offers early recovery and complete excision gives excellent prognosis of 100 %.

The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines

BACKGROUND

The Surgical CAse REport (SCARE) guidelines were first published in 2016 as a tool for surgeons to document and report their surgical cases in a standardised and comprehensive manner. However, with advances in technology and changes in the healthcare landscape, it is important to revise and update these guidelines to ensure they remain relevant and valuable for surgeons.

MATERIALS AND METHODS

The updated guidelines were produced through a Delphi consensus exercise. Members of the SCARE 2020 guidelines Delphi group, editorial board members, and peer reviewers were invited to participate. Potential contributors were contacted by e-mail. An online survey was completed to indicate their agreement with the proposed changes to the guideline items.

RESULTS

A total of 54 participants were invited to participate and 44 (81.5%) completed the survey. There was a high degree of agreement among reviewers, with 36 items (83.7%) meeting the threshold for inclusion.

CONCLUSION

Through a completed Delphi consensus exercise we present the SCARE 2023 guidelines. This will provide surgeons with a comprehensive and up-to-date tool for documenting and reporting their surgical cases while highlighting the importance of patient-centred care.

Intrathoracic liver herniation after pericardial fenestration - a case report

BACKGROUND

Pericardial effusions with its potential life threatening progression towards cardiac tamponade have to be often managed with surgical intervention. In our case study we describe a complication after a common surgical procedure which has only scarce literature mentions.

CASE PRESENTATION

We present a case of a 22-year-old male patient who underwent subxiphoidal pericardial fenestration, due to symptomatic pericardial effusion with the Chamberlain procedure and biopsy of enlarged mediastinal lymph nodes. The histology report confirmed classical Hodgkin lymphoma and subsequently the patient underwent oncological treatment. Later on he was admitted to the hospital with dyspnoea and chest pain. The initial examinations stated a suspicion for intrathoracic tumour arising from the pericardium or liver. Further investigation revealed symptomatic intrathoracic liver herniation for which the patient underwent laparoscopic surgery with the mobilisation of liver and placement of a perforated Parietene^™ composite mesh.

CONCLUSION

The purpose of this case report is to describe a rare complication after pericardial fenestration with its potential clinical implications.

A poor prognosis of a mediastinal bronchogenic cyst with malignant transformation: A case report

INTRODUCTION

Bronchogenic cysts (BC) are congenital lesions, it results from an abnormal budding of the tracheobronchial tree. Malignant transformation is very rare. We report a case of adenocarcinoma arising in a BC of the posterior mediastinum detected after surgery.

PRESENTATION OF CASE

We report the case of a 32-year-old man, without a particular medical history. The patient presented a cough associated with dyspnea, and a weight loss 4-month before the diagnosis. The imaging tools, showed a voluminous latero-tracheal mass of the posterior mediastinum. The diagnoses of a neurogenic tumor or a BC were suspected. The patient was treated by video-assisted thoracoscopy. Complete excision was done complicated by lesion's small rupture. The microscopic exam revealed unfortunately an adenocarcinoma arising in a BC. The patient had started the cure of chemotherapy. Six months later, the patient died due to tumor recurrence with cerebral metastasis.

DISCUSSION

Mediastinum BC, is usually located within the middle and posterior mediastinum. This condition is a benign congenital lesion. His curative therapy was a complete surgical resection with a good prognosis. However, malignant transformation may seldom occur and is most often accidentally diagnosed during the histological examination of specimens. In this case, the surgical treatment may be insufficient, and the prognosis may be poor.

CONCLUSION

Malignant degeneration of mediastinal BC, despite being rare, should be kept in mind, carefully avoided and managed.

Use of intraoperative indocyanine green fluorescence in determining testicular viability in testicular torsion patients in rural settings: A case report

INTRODUCTION AND IMPORTANCE

Testicular torsion (TT) is the result of spermatic cord twisting which can lead to significant ischemia, making it a time-sensitive surgical emergency. General surgeons in rural centers may lack the resources to adequately evaluate the viability of the affected testicle. Indocyanine green fluorescence (IGF) has been increasingly used to assess vascular perfusion in general surgery cases. In this case report, we show the use of IGF in a rural setting to assess testicular viability in TT.

CASE PRESENTATION

A 17-year-old male was transferred to our rural regional hospital emergency department for sudden and persistent right scrotal pain. The onset of symptoms was approximately 52 h at presentation. TT was diagnosed with a doppler ultrasound by a radiologist. Urgent detorsion surgery was performed. Intraoperative assessment of viability was unclear after the usual means and IGF helped confirm the absence of testicle vascularization and the need for orchiectomy.

CLINICAL DISCUSSION

General surgeons in rural communities are called to manage TT with limited resources and experience. IGF is widely used in general surgery and urology. Animal studies and two case reports show potential benefits of IGF in TT. In our patient, IGF was useful to confirm without a doubt that the right testicle was ischemic and non-viable.

CONCLUSION

In a rural setting with limited access to radiology and distant urology coverage, IGF is an excellent resource to determine intraoperative blood flow in TT with uncertain viability.

Rare cause of intussusception in a young male with a new possible etiology - A case report

INTRODUCTION

Inflammatory Fibroid Polyp (IFP) is a rare benign tumor of the gastrointestinal tract with no proven etiology. IFPs may sometimes produce complications like intussusception when present in the small bowel. This is a case report of a patient with an established diagnosis of inflammatory fibroid polyp with abdominal tuberculosis. Such co-existence has not been reported yet in literature.

CASE PRESENTATION

In this case report we see a 22-year-old gentleman presenting with a 10-day history of generalized abdominal pain which then progressed to obstipation. X-ray abdomen findings were consistent with small bowel obstruction. Computerized tomography imaging revealed the presence of a Jejuno-ileal intussusception. The patient was taken up for emergency laparotomy and he underwent resection of the intussuscepted segment with a polyp found as the lead point accompanied by dense bowel adhesions. Histopathological examination revealed it to be a Benign Fibro epithelial Polyp. Histopathology of the resected bowel segment and mesenteric lymph node also revealed findings confirmatory of abdominal tuberculosis. This may be a possible new etiology of the fibro epithelial polyp and this co-existence has never been reported before in literature.

CONCLUSION

Tuberculosis may be a possible inciting factor for the development of benign fibro epithelial polyp in the small bowel which may in turn lead to complications such as small bowel intussusception warranting need for surgical intervention.

Case report: Congenital mesoblastic nephroma

INTRODUCTION AND IMPORTANCE

Congenital mesoblastic nephroma is a common benign renal tumor that mainly affects infants below the age of six months (Daskas et al., 2002). Identifying the pathology type is crucial for determining the appropriate plan of action and predicting the patient's prognosis.

CASE PRESENTATION

A one-day-old Hispanic neonate was referred for surgical evaluation after detecting a LUQ mass. Ultrasound imaging revealed a heterogenous solid mass that infiltrated the hilum of the left kidney. The patient underwent a left radical nephrectomy, and the pathology results indicated that the mass was consistent with the classic type of congenital mesoblastic nephroma. The patient will be closely monitored by nephrology with frequent abdominal ultrasounds.

CLINICAL DISCUSSION

The case describes a one-day-old female baby with an asymptomatic LUQ abdominal mass, which was diagnosed as mesoblastic nephroma. The baby was born full-term with no significant medical history, and after experiencing hypertensive episodes, she underwent a left radical nephrectomy to remove the tumor. Pathology confirmed mesoblastic nephroma, classic type, and the patient was diagnosed with stage I disease since the tumor was entirely resected with no renal vessel involvement. Follow-up ultrasounds were recommended to monitor for recurrence, and chemotherapy may be considered if recurrence occurs (Pachl et al., 2020). Calcium and renin levels should also be monitored (Bendre et al., 2014).

CONCLUSION

Although congenital mesoblastic nephroma is typically benign, patients require ongoing monitoring for potential paraneoplastic syndromes. Furthermore, certain types of mesoblastic nephroma can progress to malignancy, necessitating close follow-up during the first few years of life.

Incomplete ureteral quintuplication obstructed by proximal calculus: Case report and review of literature

INTRODUCTION

Ureteral duplication is a common congenital anomaly, although multiple ureters is a rare disorder. Bifid ureter or multiple ureters are diagnosed incidentally and generally associated with obstruction by lithiasis.

CASE PRESENTATION

We present a case of ureteral quintuplication converging into a sacculation obstructed by a 7 cm calculus.

CONCLUSION

Two or more ureters are more common in women and it is mostly associated with asymptomatic presentation, excepting when related to complications of urinary tract infection or lithiasis. More than four ureters are extremely rare and our case is the first of incomplete quintuplication found so far in the literature.

Acute abdomen secondary to perforated jejunal gastrointestinal stromal tumor and imatinib-related isolated pericardial effusion in a 50-year-old female patient: A case report and review of literature

INTRODUCTION

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract; occurring most often in the stomach and to a lesser extent in the jejunum. The majority of the tumors express activating mutations in either c-KIT or PDGFRA tyrosine kinases, which respond to tyrosine kinase inhibitors (TKI). Jejunal GIST is considered to be extremely rare and challenging to diagnose due to its non-specific presentation. As a result, patients usually present at an advance stage of the disease, making the prognosis poor and difficult to manage.

CASE PRESENTATION

In the present study, we report a 50-year-old female who was diagnosed with metastatic jejunal GIST. She was commenced on Imatinib (TKI) and shortly after she presented to the emergency department with an acute abdomen. A CT scan of the abdomen revealed ischemic changes in the jejunal loops and pneumoperitoneum. The patient required emergency laparotomy due to perforated GIST, and creation of pericardial window due to hemodynamic instability possibly secondary TKI-related isolated pericardial effusion.

CONCLUSION

Jejunal GIST is rare and usually presents as emergency due to obstruction, hemorrhage or rarely perforation. Although, systemic therapy with TKI is the principal treatment for advance disease, Jejunal GIST should be removed surgically. It is surgically challenging due to the anatomical complexity of the tumor. Surgeons treating such patients must be cautious for TKI side effects.

Ovarian Sertoli-Leydig tumor: A tricky tumor case report

INTRODUCTION AND IMPORTANCE

Ovarian Sertoli-Leydig cell tumors (SLCT) are a rare sex cord-stromal tumors, accounting for <0,2 % of all ovarian malignancies. As these tumors are found at an early stage in young women, the whole management dilemma is finding the right balance between a treatment efficient enough to prevent recurrences but that still enables fertility-sparing.

CASE PRESENTATION

We report the case of a 17 years old patient hospitalized in the oncology and gynecology ward of the university hospital Ibn Rochd in Casablanca, presenting a moderately differentiated Sertoli-Leydig cell tumor in the right ovary, our aim is to analyze the clinical, radiological and histological characteristics of this rare tumor that can be tricky to diagnose and review the different management therapies available and the challenges they present.

CLINICAL DISCUSSION

Ovarian Sertoli-Leydig cell tumors (SLCT) are rare sex cord-stromal tumors that should not be misdiagnosed. The prognosis of patients with grade 1 SLCT is excellent without adjuvant chemotherapy. Intermediate and poorly differentiated SLCTs require a more aggressive management. Complete surgical staging and adjuvant chemotherapy should be considered.

CONCLUSION

Our case reaffirms that in the presence of a pelvic tumor syndrome and signs of virilization, SLCT should be suspected. The treatment is essentially surgical, if diagnosed early on, we can offer an effective treatment that preserves their fertility. Efforts should be focused on the creation of regional and international registries of SLCT cases in order to achieve greater statistical power in future studies.

Combined two-stage total pancreatoduodenectomy and esophagectomy for synchronous malignancy of the pancreatic corpus and the esophagus: A surgical case report

INTRODUCTION

Synchronous visceral malignancy is rare especially for esophagogastric junction adenocarcinoma combined with malignancy in the pancreas. So far only 7 cases of combined partial pancreatoduodenectomy and esophagectomy for synchronous malignancy have been described in the literature and none for combined total pancreatectomy and esophagectomy.

PRESENTATION OF CASE

We report the case of a 67-year-old male patient, who underwent multi-modality treatment including two-stage total pancreatoduodenectomy and subsequent Ivor-Lewis esophagectomy for synchronous adenocarcinoma of the distal esophagus and pancreatic multilocal metastases of a renal cell carcinoma after nephrectomy 17 years ago. Pathology revealed R0 resections for both malignancies and there were no postoperative complications. A 12 months follow-up showed no signs of recurrence and a good quality of life.

CONCLUSION

Curative-intent, combined oncological two-stage open total pancreatoduodenectomy and esophagectomy with several days interval is safe and feasible in selected cases when performed by an experienced interdisciplinary team in a high-volume surgical center.

Successful uniportal thoracoscopic removal of a new generation implantable loop recorder accidentally migrated into the left pleural cavity and concomitant re-implantation: A case report

INTRODUCTION

With the spread of the use of implantable loop recorders (ILRs) by cardiologists for outpatient cardiac monitoring, intrathoracic migration represents a rare but possible complication occurring after the placement of these devices. Very few cases of ILRs intrathoracic migration into the pleural cavity have been reported, followed in even fewer cases by surgical removal of the devices, but in none re-implantation was performed.

PRESENTATION OF CASE

We report the first case of a patient with a new generation ILR accidentally migrated into the postero-inferior costophrenic recess of the left pleural cavity, successfully removed by uniportal video-assisted thoracic surgery (VATS) and submitted to re-implantation of a new ILR in the same operating session.

DISCUSSION

To reduce the risk of ILRs intrathoracic displacement, the insertion technique must be performed in the most suitable part of the chest wall, with the correct incision and angle of penetration, by an expert operator. When migrated into the pleural cavity, surgical removal should be performed to avoid the onset of early and late complications. A mini-invasive surgical approach by uniportal VATS could be considered as the first choice, ensuring a favourable patient outcome. Re-implantation of a new ILR can be safely performed in the same operating session.

CONCLUSION

In case of intrathoracic migration of ILRs, early removal by mini-invasive approach is recommended as well as concomitant re-implantation. Beyond periodic monitoring of ILRs by cardiologists, strict radiological follow-up with chest X-ray is advisable after implantation, in order to early identify any abnormalities and correctly manage them.

A case report of appendiceal adenocarcinoma extending from the retroperitoneum to the psoas muscle

INTRODUCTION

Invasive appendiceal adenocarcinoma is rare. We describe the first reported case of appendiceal adenocarcinoma invading the psoas muscle in a 27-year-old man.

CASE PRESENTATION

The patient presented with lower right quadrant pain, persisting since the last two months. Computed tomography revealed a retroperitoneal mass with a central calcified focus in the right iliac fossa, with a mass effect on the adjacent iliopsoas muscle and apparent invasion of the cecal wall.

CLINICAL DISCUSSION

Magnetic resonance imaging showed a retrocecal appendicular mass with central necrosis. Colonoscopy showed an extra luminal mass effect that caused bulging of the ileocecal valve. Biopsy revealed lymphoid hyperplasia of the mucosa of the terminal ileum, with no malignant changes. An elective right hemicolectomy was done along with ileotransverse anastomosis. Histopathology examination of the surgical specimen revealed a moderately differentiated adenocarcinoma (Stage IV). Hence, adjuvant chemotherapy followed by hyperthermic intraperitoneal chemotherapy was employed.

CONCLUSION

Non-specific symptoms and difficulties in reaching a diagnosis pre-operatively, may contribute to underreporting of appendiceal adenocarcinomas. Besides, few therapeutic options are available due to the rarity of this tumor. Complete surgical excision and/or chemotherapy may be lifesaving.

Twin pregnancy combining complete hydatidiform mole and healthy fetus: Case report and review of the literature

INTRODUCTION AND IMPORTANCE

Twin pregnancy combining a complete mole and a normal fetal pregnancy with its own healthy trophoblast is a rare entity. A partial molar pregnancy almost always ends in miscarriage due to a triploid fetus.

CASE PRESENTATION

We report the case of a 43-year-old female patient admitted for bleeding during the 20th week of pregnancy. Pelvic ultrasound showed the combination of a complete hydatidiform mole and a normal fetal pregnancy. The decision to medically terminate the pregnancy was taken after consultation with the family. Examination of the placenta and histological study confirmed the diagnosis of complete hydatidiform mole associated with a normal fetus. The evolution was uneventful.

CLINICAL DISCUSSION

Twin pregnancy combining a complete mole and a normal fetal pregnancy with its own healthy trophoblast is a rare entity that should not be misdiagnosed. There is still no consensus in terms of therapeutic attitude, the dilemma remains and the decision should always include the couple after a thorough explanation of all the risks.

CONCLUSION

Our case reaffirms that to successfully manage this rare yet life-threatening condition, heterotopic pregnancy should be included in the differential diagnosis for any gravid women presenting with persistent abdominal pain, abnormal bleeding and/or extrauterine mass.

Management of Fourniers gangrene secondary to perineal invasion by rectal cancer

INTRODUCTION AND IMPORTANCE

Fournier's gangrene is a known disease process resulting in a severe necrotizing soft tissue infection involving the perineum and scrotum. Although most cases are known to be associated with diabetes (Go et al., 2010 [1]), it is rare to develop this extensive infection secondary to tumor invasion from the rectum. Treatment typically requires several debridements until infection is fully controlled.

CASE PRESENTATION

A 65 year old man with a history of locally invasive and unresectable rectal cancer presents to our emergency department with severe perineal and scrotal pain and was found to be in septic shock. He had previously undergone a diverting colostomy as well as radiation to the pelvis. He underwent several surgical debridements until the infection was controlled. He then required procedures to close the large defects created until complete wound healing was achieved within 3 months of presentation.

CLINICAL DISCUSSION

This condition is associated with a high morbidity and mortality, and its management can be split in to two stages. The early phase includes resuscitation, initial debridements and likely several sequential debridements as well as fecal diversion. The late phase then involves the healing process with reconstruction efforts. A multi-disciplinary team is required for appropriate management under the direction of the general surgeon, which also include urologists, plastic surgeons and wound care nurses.

CONCLUSION

Fournier's gangrene secondary to tumor invasion should be recognized as a potential cause other than the typical culprits. Resuscitation, antibiotics, debridements and a team approach is needed to recover from such a debilitating disease.

Malposition of subcutaneous central venous port system in a toddler with acute lymphoblastic leukemia: A case report

INTRODUCTION

Central venous port systems are essential for reliable and long-term venous access in children, mainly for cancer therapy, parenteral nutrition, administration of medications, blood transfusion, etc. However, complications either periprocedural, early, or delayed can be expected and may affect the venous port function, with occasional revision and even port removal.

CASE PRESENTATION

A central venous port device was implanted in a 2.5-year-old boy for chemotherapy administration in the treatment of acute lymphoblastic leukemia. After a month he presented again to our clinic due to a venous port device dysfunction, and inability to aspirate blood or infuse medications. A reoperation was done that revealed a port chamber in-place rotation. The chamber was repositioned in the pouch and suture-fixated. No port-related problems occurred in the follow-up period.

CLINICAL DISCUSSION AND CONCLUSION

Central venous port chamber rotation is among the rarest complications, which usually makes the port unusable. It should be quickly recognized, to avoid further damage, such as extravasation of the chemotherapeutic agent or mechanical chamber impairment. A reoperation is almost always needed with subsequent placement of the port in the correct position. This paper also emphasizes the key concepts of complication in implantable venous ports in children.

Case report: Caecal epiploic appendagitis mimicking acute appendicitis

INTRODUCTION

Acute appendicitis is a very common cause of abdominal pain which is optimally treated surgically. On the other hand, epiploic appendagitis is a self-resolving condition typically managed with analgesia alone, which can also present with severe abdominal pain. Both can present similarly and be difficult to distinguish.

CASE

A 38 year old male presented with 2 days of periumbilical and right iliac fossa pain, with features of localised peritonism on physical exam. Inflammatory markers were only very mildly elevated but a computed tomography scan demonstrated findings in keeping with mild acute appendicitis.

OUTCOME

Laparoscopic appendectomy demonstrated a torted epiploic appendage immediately adjacent to the vermiform appendix. The appendix had very mild inflammatory changes at the base adjacent to the appendage, but otherwise normal macroscopic appearance. Histopathology confirmed periappendicitis without features of acute appendicitis.

CONCLUSION

Right sided epiploic appendagitis can mimic acute appendicitis, and in select patients with right iliac fossa pain there may be a role for serial observation to avoid an unnecessary operation.

Case report: A surgically treated case of diaphragmatic clear cell carcinoma without relation to endometriosis

INTRODUCTION AND IMPORTANCE

Diaphragmatic tumor is a rare neoplastic disease. Only three reports have revealed diaphragmatic primary clear cell carcinoma. On the other hand, secondary membranous nephropathy is sometimes triggered by the carcinoma. We describe a case of primary diaphragmatic clear cell carcinoma without relation to endometriosis or ovarian malignancies, and secondary membranous nephropathy was triggered by diaphragmatic primary clear cell carcinoma.

CASE PRESENTATION

A 67-year-old woman was found to have membranous nephropathy due to examination for renal dysfunction. A rare diaphragmatic tumor was identified on CT scan for rule out secondary membranous nephropathy. She had underwent resection of the right diaphragm tumor and reconstruction with expanded polyterafluoroethylene (e-PTFE).

CLINICAL DISCUSSION

Pathological examination revealed the presence of clear cells with papillary arrangement and no findings of the endometriosis. Immunohistochemistry revealed that the tumor was positive for CK7, p53, and HNF-1-beta. And there had been no evidence of ovarian malignancies. A diagnosed of clear cell carcinoma of the right diaphragm without relation to endometriosis or ovarian malignancies was made. After resection of the tumor, it was revealed that her renal function was improvement.

CONCLUSION

This is the first report of diaphragmatic clear cell carcinoma without relation to endometriosis or ovarian malignancies that caused secondary membranous nephropathy. One year after the resection of the tumor, she is being followed up and has shown no signs of recurrence.

Transurethral ureteric embolization for locally advanced cervical cancer with uretero-vaginal fistula - A case report

INTRODUCTION

Targeted radiotherapy, surgery, and localised disease progression can all result in fistulous tract formation in patients with a pelvic malignancy, in particular cervical or endometrial cancer. This report discusses a novel technique for palliative management of ureterovaginal fistulas in end-stage disease.

PRESENTATION OF CASE REPORT

We report the case of a 37 year old female with metastatic cervical squamous cell carcinoma previously treated with chemoradiation who presented with progressive disease and secondary development of a symptomatic ureterovaginal fistula.

DISCUSSION

This case report discusses the causes and sequalae of uretero-vaginal fistula formation, the role of the interventional radiology with regards to palliative intervention, and potential patient factors that can affect performance of such procedures.

CONCLUSION

Interventional radiology plays an important role in palliative and symptomatic management of end stage malignant disease. Ureteric embolisation via a retrograde transurethral approach by way of an existing stent is a novel approach to access making the procedure easier for both the patient and radiologist.

A case report of a combined laparoscopic and open approach for a De Garengeot hernia

INTRODUCTION

A De Garengeot hernia is defined as a femoral hernia containing the appendix. They are rare, representing 0.5-5 % of all femoral hernias.

PRESENTATION OF CASE

A sixty-five-year-old lady presented to the emergency department with a five-day history of right sided groin swelling and pain. She was an active smoker. Her workup included a computed tomography scan of her abdomen and pelvis which revealed a right sided femoral hernia containing the appendix. A laparoscopic appendicectomy and an open repair of femoral hernia with a mesh plug was performed. Intraoperatively, the distal appendix was seen to be incarcerated within the hernia sac. The histopathology confirmed acute appendicitis.

DISCUSSION

The increasing use of computed tomography scanning allows preoperative diagnosis of De Garengeot hernia. There is no standardized method for managing a De Garengeot hernia. The surgical technique used should be the one with which the surgeon is most comfortable. The decision to use a mesh to repair the hernia defect is based on the level of contamination in the field.

CONCLUSION

De Garengeot hernias are rare. They should be treated with appendicectomy and repair of the femoral hernia, at present there is no standardized approach and the surgeon should perform the method with which they are most comfortable.

[Isolated splenic lymphangioma]

Splenic lymphangioma is a rare malformation of splenic lymphatic channels characterized by cysts resulting from increased number of enlarged thin-walled lymphatic vessels. In our case, there were no clinical manifestations. Lymphangioma was congenital and diagnosed by ultrasound as an accidental finding. Surgery is the only method of radical treatment of splenic lymphangioma. We describe an extremely rare case of pediatric isolated splenic lymphangioma and laparoscopic resection of spleen as the most advantageous variant of surgical treatment.

Habitual khat chewing and oral melanoacanthoma: A case report

BACKGROUND

Habitual khat (Catha edulis) chewing has been proven to cause numerous oral tissue changes. However, oral melanoacanthoma triggered by chronic khat chewing is rare. Oral melanoacanthoma is an uncommon, sudden, asymptomatic, benign pigmentation of the oral cavity. Under the microscope, the epithelial layer of the oral mucosa showed dendritic melanocyte proliferation and acanthosis. The study aimed to highlight chronic khat chewing as a trigger for oral melanoacanthoma.

CASE SUMMARY

In the current study, we report a case of a 26-year-old male patient with a rare presentation of oral melanoacanthoma triggered by regular khat chewing. Many intrinsic and extrinsic factors can cause oral pigmentation. Chewing khat is an extrinsic factor that can cause several diseases, including oral pigmentation. In this case, the definitive diagnosis was oral melanoacanthoma. This diagnosis was made based on the patient’s history, clinical lesion presentation, and microscopic biopsy results.

CONCLUSION

Habitual khat (Catha edulis) chewing causes many oral tissue changes including oral melanoacanthoma. The study aimed to highlight chronic khat chewing as a trigger for oral melanoacanthoma.

Mediastinal mature cystic teratoma in a child: A case report study

INTRODUCTION

A mediastinal teratoma is a very rare disease, in which a relatively large mass grows in the space between the two lungs. Although it is a congenital abnormality, it is diagnosed late in the second or third decade. It could be benign or malignant, symptomatic or asymptomatic.

PRESENTATION OF CASE

A five-year-old child presented with an acute respiratory distress episode due to an acute infection, unresponsive to first-line antibiotics and had a history of similar recurrent pulmonary infections. On imaging, the patient showed an abnormal mediastinal mass which was speculated to be a hydatid cyst or abscess; however, it was later diagnosed during surgery as a mature mediastinal cystic teratoma.

DISCUSSION

Mediastinal tumors are slow-growing tumors that are mostly benign and asymptomatic, but sometimes they may grow, reaching a state where they can affect the neighboring anatomical structures, causing symptoms, which may lead to misdiagnosis.

CONCLUSION

Teratomas, as a differential diagnosis, should be considered in children with recurrent pulmonary infection and radiological findings that resemble masses in the chest. This emphasizes on the importance of performing detailed radiological and lab investigations to set an appropriate diagnosis to ensure a better treatment and prognosis.

Primary costal hydatid cyst resembling urolithiasis: A case report

INTRODUCTION

Hydatid disease (HD) is a zoonotic infection caused by echinococcus granulosus tapeworms. HD accounts for approximately one million cases worldwide. HD is more prevalent in endemic areas, such as the Mediterranean region.

PRESENTATION OF CASE

A middle-aged male patient presented with right flank pain for years. His vital signs and physical examination were unremarkable. The whole-body bone scan revealed an area along the sixth rib's posterior arch with increased metabolic activity and CT and MRI were compatible with a hydatid cyst. The cyst was surgically resected and irrigation of the area with hypertonic saline was done. Medical treatment with albendazole was initiated and the patient had no complications.

DISCUSSION

Bone involvement is an uncommon finding in HD and involvement of the ribs is even more scarce. Surgical resection complemented with medical treatment is the preferred approach.

CONCLUSION

In the Mediterranean and middle eastern regions, high infection rates with E. granulosis are evident hence, uncommon manifestations of the disease should be regarded. Although renal stones are far more prevalent when in endemic areas of HD, the physician should also consider skeletal HD as a differential diagnosis.

Renal-inferior vena cava fistula complicating laparoscopic cholecystectomy causing heart failure repaired endovascularly, a case report and literature review

INTRODUCTION

Renal-caval Arterio-venous fistulas are rare entity which can be acquired, idiopathic or congenital. Laparoscopic cholecystectomy complicated by arteriovenous fistula formation is extremely rare and often go unnoticed. High output heart failure can occur as a consequence of such high flow fistulas. Repair can be done through open or endovascular approach with the latter being effective and less invasive. Repair can result in resolution of symptoms and improvement of heart function.

CASE PRESENTATION

We report a 43-year old female who developed an iatrogenic renal-caval fistula following laparoscopic cholecystectomy, that was complicated by intraoperative bleeding. She presented with worsening high output cardiac failure a year post-operative. Due to past history of Cor-triatriatum surgical repair -a congenital heart disease-, the diagnosis of renal arteriovenous fistula remained insidious. The fistula was diagnosed during cardiac catheterization in an attempt to diagnose her rapidly decompensating heart failure, and repaired successfully by endovascular repair.

DISCUSSION

To our knowledge, there are only a few reports in literature describing iatrogenic renal artery-caval fistulas in association with laparoscopic cholecystectomy. Such high flow fistulas can result in a significant, potentially life threatening physiologic impairment. The case was managed by endovascular approach resulting in return to baseline cardiac function and resolution of symptoms.

CONCLUSIONS

Renocaval arteriovenous fistulas are extremely rare to complicate laparoscopic cholecystectomy. It might go unnoticed, but may present with decompensated heart failure. It can be reversed by early recognition of symptoms, and diagnosis. High index of suspicion is a key, and endovascular modality is excellent treatment approach.

Presentation of a large pseudoaneurysm of the brachial artery: A case report

Brachial artery pseudoaneurysms (PSA) are considered uncommon, but they can be limb and life threatening. Most etiologies are related to iatrogenic injury or following a fracture. Here we present a 37-year-old male complaining of a large swelling in his right upper arm that was gradually increasing in size for the last 7 months. It started with a sudden onset of pain while lifting heavy boxes at his daily job. Ultrasound and MRA showed a pseudoaneurysm of the right brachial artery. Resection of the PSA was performed with a vein interposition graft. This case illustrates the significance of considering PSA as a differential diagnosis in patients presenting with upper arm swelling without history of obvious trauma.

Atypical Firearm Injury to the Anterior Triangle of the Neck With an Unusual Projectile Trajectory: A Rare Case Report

The use of firearms is increasing in our society, which increases the incidence of gunshot injuries in developing countries like India. Gunshot injuries in the neck regions are significantly associated with high mortality and morbidity because of the major vascular and other vital structures present in the neck. However, it's very rare that a bullet may have a trajectory that passes through the neck region and does not damage the vital structures. We present one such case of gunshot injury to the neck. A 20-year-old male reported to the emergency department after sustaining a gunshot wound to the left anterior cervical region of the neck. On examination, the right sternocleidomastoid muscle was taut and tender to the touch. It is very rare that a bullet injury in the neck without damage to even a single vital structure. The most critical steps in managing patients with high-velocity penetrating injuries to the head and neck region are securing an airway, controlling hemorrhage, and identifying and repairing residual traumatic deformities at the earliest possible key points for the best outcome.

Abdominal pregnancy: a case report and review of 17 cases

PURPOSE

To analyze the clinical characteristics of abdominal pregnancy, and to explore the diagnosis and prognosis of different treatment methods.

METHODS

The cases of patients with abdominal pregnancy admitted to Peking Union Medical College Hospital between January 1, 1989 and January 1, 2021, were analyzed retrospectively.

RESULTS

The median age of 17 patients was 34 years (22-42 years); the median gestational duration was 57 days (from 41 days to 32 weeks). Among all 17 patients, 15 (88.24%) presented with abdominal pain. The implantation sites of the gestational sac included the bladder peritoneal reflection, anterior wall of the rectum, omentum, serous membrane of the uterus, and inside or on the surface of uterosacral ligament. In all, only 29.41% cases (5/17) were diagnosed before surgery. All 17 patients were treated via surgery. Further, 58.82% (10/17) patients recovered without complications, 29.41% (5/17) developed fever, 5.88% (1/17) underwent reoperation because of intra-abdominal bleeding, and 5.88% (1/17) developed double lower limb venous thrombosis. All 17 patients survived.

CONCLUSION

The preoperative diagnosis rate of abdominal pregnancy is low. Planting sites in the pelvic peritoneum and pelvic organs are more common than the others. Laparoscopic surgery in the first trimester of pregnancy can achieve better therapeutic effects. However, the blood supply of the placenta should be fully evaluated before surgery. When it is expected that attempts to remove the placenta will cause fatal bleeding, the placenta can be left in place, but long-term close follow-up should be paid attention to.

Primary Retroperitoneal Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP): A Diagnostic Enigma

Retroperitoneal sarcomas represent a group of rare malignant neoplasms with complex clinical management and often a poor prognosis. An elderly male presented with a slowly progressive, right-sided abdominal lump for four months associated with loss of appetite and abdominal discomfort. Abdominal examination revealed an apparent retroperitoneal lump in the right lumbar and umbilical region, which was well-defined, and firm in consistency with the bosselated surface. Contrast-enhanced computed tomography (CECT) of the abdomen and pelvis revealed a heterogenous lobulated malignant appearing retroperitoneal lesion arising from the right anterior perirenal space with a differential of retroperitoneal sarcoma. Wide local excision of the tumor was done. Histopathology of the lesion revealed a smooth muscle tumor of uncertain malignant potential (STUMP). The patient is asymptomatic and recurrence-free after 24 months of follow-up.

Primary peritoneal ectopic pregnancy: A case report

INTRODUCTION

Primary peritoneal ectopic pregnancy is a rare condition that can be life-threatening. Herein, we report such a case which was managed by laparoscopy.

PRESENTATION OF THE CASE

A 31-year-old G1P0 woman, who had a history of pelvic infection and primary infertility, presented with lower abdominal pain and mild vaginal spotting. Abdominal and bimanual pelvic examination revealed mild left pelvic tenderness. Her serum β-human chorionic gonadotropin (β-HCG) was 7247 IU. Transvaginal ultrasound demonstrated a mass measuring around 1.5 cm in diameter with a well-defined yolk sac adherent to the left ovary. A left fallopian tube ectopic pregnancy was suspected. Laparoscopy revealed that both fallopian tubes were normal and freely moving. Peritoneal ectopic pregnancy was seen behind the uterus which was removed laparoscopically. Histopathology confirmed the diagnosis. The patient had a smooth postoperative recovery.

DISCUSSION

Primary peritoneal pregnancy can be life-threatening. A thorough laparoscopic examination of the entire pelvis and abdomen should be done by an experienced surgeon when the location of the suspected ectopic pregnancy could not be identified.

CONCLUSION

Diagnostic laparoscopy for ectopic pregnancy should include the whole pelvis and the accessible part of the abdomen when the tubes and ovaries are normal.

Perforation of ileum by unnoticed toothpick ingestion presenting as acute appendicitis: A case report

INTRODUCTION

Many distinct pathologic disorders can cause acute abdomen, and it can be challenging for doctors to distinguish between them. Appendicitis and small bowel perforation are two examples. This case is being reported to highlight a rare instance in which acute appendicitis can be mistaken for ileal perforation by sharp solid objects.

CASE PRESENTATION

We discuss the case of a 9-year-old boy who arrived at our hospital complaining of right iliac fossa abdominal pain that started two days earlier with no other associated symptoms. Physical examination revealed right iliac fossa tenderness and rebound tenderness. The results of the imaging and laboratory tests were inconclusive; therefore, the patient was admitted for observation and further assessment. Re-evaluation 4 h after admission found no clinical improvement, and abdominal examination revealed guarding and rebound tenderness, prompting the surgical team to opt for an appendectomy. During surgery, an elliptical incision was made to remove a sharp foreign body penetrating the ileum.

DISCUSSION

Even during surgery, diagnosing acute appendicitis is difficult. Some cases of small bowel perforation caused by foreign body ingestion have been linked to a clinical picture similar to acute appendicitis, while others present with acute peritoneal signs. This report describes a sealed ileal perforation by a sharp solid object, manifested as acute appendicitis.

CONCLUSION

Perforation of the small bowel by sharp solid objects may easily be missed on imaging, probably related to their ability to seal off the resulting perforation. A sharp solid object's perforation seems to cause localized tenderness mimicking appendicitis.

Surgical resection for accessory spleen torsion: A case report

INTRODUCTION

Accessory spleen torsion is extremely rare, and surgery is often the emergency or elective treatment of choice.

PRESENTATION OF CASE

A 20-year-old female with no specific medical history presented to our outpatient clinic with a chief complaint of abdominal pain. The patient was diagnosed with accessory spleen torsion by computed tomography. However, the abdominal symptoms and inflammatory reaction based on blood tests were mild, so a conservative treatment was selected. Subsequently, blood tests were normalized, and imaging studies showed that the accessory spleen was shrinking. Contrast-enhanced examination showed contrast enhancement in a portion of the infarcted accessory spleen region, indicating that the accessory spleen torsion had been released. Surgical resection was performed to prevent possible future re-torsion and hemorrhage of the accessory spleen.

DISCUSSION

The removed specimen seemed to be normal accessory spleen tissue with clear infarcted foci edges. This artery showed evidence of luminal organization and untwisting of the occluded artery.

CONCLUSION

This accessory spleen torsion was treated conservatively; however, the patient was referred for surgical treatment.