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

Unusual foreign body in the buccal mucosa: A case report

BACKGROUND

Intraoral honeybee stings are very rare. Stings by these insects occur 25% of the time in the head and neck region. In addition, a stinger intraorally can lead to persistent irritation, inflammation, and secondary infections if not promptly excised.

CASE SUMMARY

We report the case of a 52-year-old female patient who was stung in her mouth by a honeybee, causing a local irritation. The patient presented with a one-month history of pain, swelling, and redness in the left buccal mucosa. Inadvertently retained, the stinger was discovered during a clinical evaluation following initial treatment for facial swelling and erythema. After the stinger was removed, the patient’s symptoms resolved without complications.

CONCLUSION

This case emphasizes the importance of thorough examination and prompt management of insect stings to prevent prolonged discomfort and potential complications.

Spontaneous uterine rupture in the second trimester with fetal Cyclopia at a resource-limited setting: A case report

INTRODUCTION AND IMPORTANCE

Spontaneous uterine rupture in the second trimester is a rare and life-threatening obstetric emergency, typically associated with pre-existing risk factors. This case presents a unique instance of spontaneous uterine rupture in a multiparous woman without typical risk factors, highlighting the challenges of diagnosis and management in a resource-limited setting. The associated fetal cyclopia adds to the rarity of the case and contributes to the existing literature on uterine rupture. This report demonstrates the need for high clinical suspicion and prompt intervention, even in the absence of usual risk factors.

CASE PRESENTATION

A 30-year-old, gravida 7, para 6 female presented with a two-day history of abdominal pain, vomiting, and subjective fever. The patient progressed to hemodynamic instability, vaginal bleeding, and loss of consciousness within a few hours of admission.

CLINICAL DISCUSSION

The main diagnosis was spontaneous uterine rupture with hemoperitoneum and a non-viable fetus with cyclopia. The therapeutic interventions included emergency exploratory laparotomy, evacuation of the hemoperitoneum, and subtotal hysterectomy. The patient recovered well and was discharged on postoperative day five.

CONCLUSION

This case underscores the unpredictable nature of uterine rupture and the importance of maintaining a high index of suspicion for this diagnosis, even in the absence of typical risk factors, particularly in resource-limited settings. Prompt surgical intervention and appropriate postoperative care are essential for favorable maternal outcomes.

Common bile duct exploration with choledochotomy and primary repair during pregnancy: Case Report

We present a case of a woman in the second trimester of pregnancy who was admitted due to symptomatic common bile duct stones and gallstones. The patient underwent ultrasonography (US) and magnetic resonance cholangiopancreatography (MRCP) imaging, as well as a series of relevant blood tests, to establish a diagnosis. After a comprehensive assessment, simultaneous T-tube-free laparoscopic transcholedochal stone extraction and cholecystectomy were performed safely in the pregnant patient with common bile duct stones and gallstones. Postoperatively, the patient had an uneventful recovery. This case report aims to provide detailed information on the selection of treatment options for symptomatic choledocholithiasis combined with gallstones during pregnancy and to explore the feasibility and safety of performing concurrent T-tube-free laparoscopic choledochotomy for stone extraction in pregnant patients.

Intravesical foreign bodies in pediatric: A case report highlighting the critical role of psychosocial assessment and intervention

A 12-year-old female presented with lower abdominal pain and hematuria following the self-insertion of a pencil into her bladder. Imaging revealed a 10.2 cm radiopaque object, which was removed intact via cystoscopy. Postoperative recovery was uneventful, and psychiatric evaluation diagnosed mild depression, highlighting the need for integrated psychosocial intervention. This case underscores the critical importance of a multidisciplinary approach that combines medical and psychosocial care in the management of intravesical foreign bodies, particularly in pediatric populations. Proactive measures, including mental health education and early psychosocial support, are essential for prevention and recurrence mitigation.

Intussusception and Internal Hernia After Roux-en-Y Gastric Bypass Surgery in a Woman With Twin Pregnancy: A Case Report

Severe obesity is a global concern now, and bariatric surgery has been proven to be the best solution. Most candidates are women of reproductive age; therefore, an increasing number of pregnant women with the history of gastric bypass is noticed. A 33-year-old woman at 23 weeks' gestation with a twin pregnancy, with a history of bariatric surgery 2 years prior her pregnancy, presented to our hospital with small bowel necrosis due to internal hernia and intussusception, we proceeded to laparotomy and resection of the necrotic segment of the bowel. The patient underwent cesarean section on the 35 weeks of her pregnancy due to preterm labor and intra uterine growth retardation of the fetuses. Since the gravid uterus increases the intraabdominal pressure, the complications of bariatric surgery such as intussusception or internal hernia may occur even more frequently during pregnancy. Although computed tomography scan or ultrasound could assist clinicians for early diagnosis of complications, negative findings could not rule out small bowel obstruction; therefore, in a pregnant woman with persisting abdominal pain, obstipation, and vomiting, exploratory laparotomy or laparoscopy is mandatory. Pregnant women with a history of Roux-en-Y gastric bypass surgery (RYGB) should be considered high-risk obstetric, and symptoms like ongoing abdominal pain, and vomiting should be taken as alarm sign for small bowel obstruction. Computed tomography (CT) scan is the modality of choice for detecting the small bowel obstruction, and is mandatory, taking into consideration the considerable harms to the fetus.

Complete second branchial cleft fistula in a fifteen-year-old boy: A case report

INTRODUCTION AND IMPORTANCE

The branchial or pharyngeal apparatus, crucial in embryological development, consists of clefts, arches, pouches, and membranes. Anomalies arising from this apparatus particularly involving the second branchial arch, are rare. Among these anomalies, complete second branchial cleft fistulas, with both external and internal openings, are exceptionally uncommon. This case report presents such a rarity in a fifteen-year-old boy, highlighting the clinical presentation, diagnostic approach, surgical management, and outcome.

CASE PRESENTATION

A fifteen-year-old boy presented with a history of mucoid discharge from an opening on the lateral aspect of the right neck, noticed since birth. Clinical examination revealed a pinhole opening along the anterior border of the sternocleidomastoid muscle. Imaging studies confirmed the diagnosis of a complete second branchial cleft fistula, extending from the right lateral neck to the right tonsillar fossa. Surgical excision using a stepladder approach was performed under general anesthesia, leading to complete resolution of symptoms.

CLINICAL DISCUSSION

Complete second branchial cleft fistula is a rare entity. The diagnosis requires thorough history and examination, imaging, biopsy and surgical excision along with certain period of folllow-up.

CONCLUSION

Complete second branchial cleft fistulas are exceedingly rare congenital anomalies, typically presenting with mucoid discharge from a neck opening since birth. Diagnosis involves clinical examination and imaging studies, such as sinography with water-soluble contrast. Surgical excision, often via a stepladder approach, remains the mainstay of treatment, resulting in favorable outcomes. Early recognition and prompt intervention are essential for optimal management.

The diagnosis and treatment of 56 cases of breast hamartoma: a single-center analysis and a review of the literature

Introduction

To analyze and summarize the clinical and pathological features of breast hamartoma to enhance clinicians' awareness of this rare and benign lesion of the breast.

Methods

We retrospectively described the clinical data, imaging results, and pathological findings of 56 patients with breast hamartoma who underwent surgical treatment at the First Hospital of Jilin University between January 2005 and December 2020, and summarized the features. Additionally, a literature review was conducted using the PubMed database for clinical reports on breast hamartoma and analyzed them.

Results

This study included 56 female patients. Preoperative ultrasound revealed round or elliptical heterogeneous echoes with clear boundaries: hypoechoic in 35 cases (63%), iso-echoic in 8 cases (14%), hyperechoic in 1 case (2%), mixed echo in 9 cases (16%), slightly strong echo in 1 case (2%), and uneven echo of fat in 2 cases (4%). Mammography was performed in 33 cases, revealing clear and dense shadows in 20 cases (61%) and dense shadows on the outer edges in 16 cases (48%). The excised masses were solid, with light yellow and gray cut surfaces. Pathological analysis identified ducts and fibrous tissue, with intra-tumoral fat content ranging from 10 to 90%.

Conclusion

Breast hamartoma is prevalent among perimenopausal women and is characterized by ultrasound and radiography; surgical intervention remains the primary treatment with a good prognosis.

Duodenum and ascending colonal perforation due to biliary stent migration

Introduction

Bowel perforation due to migrated biliary stent is a rare complication. Here, we report a case of duodenal and ascending colonal perforation due to biliary stent migration.

Case presentation

A 35-year-old man is complaining of right upper abdominal pain presented to the gastroenterology department. Two months ago, he was diagnosed with common bile duct stone with acute cholangitis, a straight plastic biliary stent was placed in his common bile duct. Abdominal computed tomography, upper endoscopy and colonoscopy confirmed that the stent penetrated the duodenum into the ascending colon. The stent was extracted by upper endoscopy, and the defects of the duodenum and ascending colon were closed by clips endoscopically.

Discussion

Bowel perforation due to biliary stent migration is a rare but severe complication. Risk factors for dislocation of stents include stent insertion for more than one month, wide stent, benigh diseases and longer stent. Endoscopy is a minimally invasive and safe meneuver to retrieve stent.

Conclusion

Patients inserted with long, wide and straight biliary stent for more than one month are at high risk of stent dislocation. Endoscopy is a minimally invasive and safe meneuver to retrieve stent, and should be considered as the first-line treatment.

Mapping the scientific landscape and evolution of the International Journal of Surgery : a scientometric analysis (2004-2024)

AIM

The purpose of this study was to analyze the publication characteristics and development of the International Journal of Surgery (IJS) over its 20-year history.

METHODS

This study included articles published in IJS during the 20 years from 2004 to 2024. The data were analyzed using the Citespace, VOS viewer, and the 'Bibliometrix' package in R software. The authors studied the dynamics and trend patterns of IJS literature production through descriptive bibliometrics and identified the most prolific authors, publications, institutions, and countries. Bibliometric maps were utilized to visualize published articles' content and identify the most prolific research terms and topics in IJS , as well as their evolution over time.

RESULTS

A total of 5964 publications in the IJS from 2004 to 2023 and 356 publications in 2024 were included in the analysis. The study revealed a positive trend in literature production, although the number of articles published in IJS has slightly decreased recently. The most productive country was China ( n =1211), the most productive institution was Sichuan University ( n =151), and the most prolific author was Wang Yang ( n =87). The top 15 most cited articles focus primarily on research reporting standard guidelines for surgical studies. Research published in IJS mainly targeted middle-aged and older adults, emphasizing postoperative complications and treatment outcomes. The future research focus in IJS might center on integrating artificial intelligence and deep learning technologies to revolutionize surgical research and practice.

CONCLUSIONS

The International Journal of Surgery significantly contributes to advances in surgical research. IJS prioritized enhancing patient outcomes and advancing surgical techniques, focusing on middle-aged and older adults, postoperative complications, and treatment outcomes. The journal emphasized robust evidence through retrospective, controlled, and cohort surgical studies. Integrating artificial intelligence and deep learning represented a significant frontier poised to revolutionize surgical care, shaping the future landscape of research and practice.

Primary Tracheal Schwannoma With Extension to the Thyroid Gland: Management

The occurrence of neurogenic tumors in the tracheobronchial tree is uncommon. We report a case of transmural tracheal schwannoma with extraluminal component extending upto the left thyroid lobe. 40-year-old male presented with scanty hemoptysis due to transmural tracheal schwannoma with extraluminal part of tumor extending till the left lobe of thyroid gland. Patient underwent tracheal resection and anastomosis with en-bloc excision of left thyroid lobe due to the nature and size of the tumor. Tracheal Schwannoma are not that frequent. Symptoms can misguide the clinician causing delay in diagnosis from the onset of symptoms. Definitive diagnosis is made after histopathological examination and immunohistochemical studies. So far, resection and anastomosis of trachea has been adequate treatment. Tracheal neoplasms are unusual and tracheal schwannomas are very unique. The case highlights the varied presentation of tracheal schwannoma and confusion faced to diagnose the patient and provide an optimal management.

Feasibility and Safety of Bridging Antiplatelet Therapy with Cangrelor in Neuro-Oncology: A Preliminary Experience

Antiplatelet therapy is mandatory for prevention of thrombotic events in patients with a recent history of acute coronary syndromes and/or percutaneous coronary interventions. However, if an urgent surgery is required during antiplatelet therapy, a compromise between the ischemic/thrombotic and hemorrhagic risk has to be reached. Different bridging schemes are reported in the literature, but there is no clear consensus on the optimal treatment strategy in terms of efficacy and safety. Although some indications about the perioperative management of antiplatelet therapy regarding specific surgical specializations are available, balancing the thrombotic and hemorrhagic risk on an individual basis, no evidence referring to neurosurgical or neuro-oncologic procedures is reported. Herein, we present our preliminary experience in the perioperative management of a patient who underwent a neurosurgical procedure for the resection of a primary malignant brain tumor using an intravenous P2Y12 inhibitor (cangrelor) as bridging therapy after a recent acute myocardial infarction treated with primary percutaneous coronary intervention and stenting. The oral P2Y12 inhibitor (clopidogrel) was withdrawn 5 days prior to the surgical procedure and continuous infusion of cangrelor was started 3 days before the surgery at a dose of 0.75 μg/kg/min. Cangrelor was discontinued 2 hours before surgery and resumed 72 hours after tumor resection for further 60 hours. Neither cangrelor-related bleeding nor cardiac ischemic events were observed in the perioperative period and the following 90 days, supporting data regarding the feasibility and safety of this bridging scheme. Further studies are needed to confirm our promising results.

Fatal outcome of postpolypectomy syndrome: A case report

Postpolypectomy syndrome (PPS), also known as postpolypectomy coagulation syndrome or transmural burn syndrome, is a rare complication following colonic polypectomy characterized by abdominal pain, fever, and leukocytosis. Herein, we present a case of a patient in his 70s who developed abdominal pain and fever after a polypectomy. He was diagnosed with PPS, which rapidly progressed to septic shock necessitating left hemicolectomy. Pathological findings confirmed intestinal necrosis and severe electrocoagulation injury. Despite surgical intervention, the patient succum to multiple complications. While usually mild, approximately 0.07% of PPS cases require hospitalization due to localized peritonitis from electrocautery. Conservative management is effective, though severe complications are rare. Despite its generally favorable prognosis, our case highlights rapid progression to fatal septic shock postsurgery. Recognition of PPS is crucial, particularly in patients with abdominal pain postpolypectomy, as it can lead to life-threatening outcomes.

Ruptured aortic aneurysm with previous endovascular aneurysm repair in a patient with high-grade angiosarcoma

Ruptured aortic aneurysms after endovascular repair is rare, particularly in the absence of type I or type III endoleaks. In such cases, a thorough investigation into the causes is imperative, including the consideration of an underlying malignancy. We report a case involving a 78-year-old woman who experienced abdominal aortic aneurysm rupture 4 years after aortic endograft treatment. We explanted the endograft and performed aortobi-iliac bypass. Initial aortic thrombus pathological analysis revealed atherosclerosis. However, the patient returned 4 months later with multiple lesions suggestive of metastases, and a reevaluation of the pathology slides uncovered a diagnosis of angiosarcoma.

Sebaceous carcinoma of the back: a case report and literature review

BACKGROUND

Extra ocular sebaceous carcinoma is a very rare, aggressive, malignant tumor arising in the adnexal epithelium of sebaceous gland that account for only about 25% of all sebaceous carcinomas (Wick et al. in Cancer 56(5):1163-72, 1985). The diagnosis of this tumor is difficult because its clinical appearance is atypical. The common treatment consists in wide local excision of the lesion with removal of local lymph node. We report the second case of sebaceous carcinoma involving the back. It was treated with surgical excision and sentinel lymph node biopsy.

CASE PRESENTATION

A 69 year-old Caucasian woman presented with an erythematous, violaceus and exophytic lesion with central ulceration and leakage of purulent material in dorsal region at the level of T10-T11, measuring 7 × 6 cm in size. A biopsy of the lesion reported a moderately differentiated sebaceous carcinoma with lymph, vascular and perineural invasion. Extension studies revealed axillary lymphadenopathy and a renal lesion suggestive of angiomyolipoma based on tomographic findings. A biopsy of the axillary lymphadenopathy was performed, which was negative for malignancy. A wide excision of the lesion with a 2 cm margin and sentinel lymph node biopsy were performed. On histopathological examination was confirm the diagnosis of sebaceous carcinoma of the back. The patient had a good clinical course, and it was decided to follow up clinically every 6 months.

CONCLUSION

Sebaceous carcinoma can occur in locations other than the ocular region. It is frequently difficult to diagnose and has an unpredictable prognosis. The back is a particularly unusual site for this lesion. Surgery remains the mainstay of treatment, and a sentinel lymph node biopsy can be performed instead of removing all regional lymph nodes.

Microsurgical clipping of large MCA aneurysm in a 2-month-old child

BACKGROUND

Cerebral aneurysms in children have a low incidence and accounts for less than 4% of all cerebral aneurysms. These aneurysms have been linked to various factors. Severe headache, seizures, and motor-sensory deficits are common presentations.

CASE REPORT

We describe the case of a 2-month-old male patient who presented with generalized tonic-clonic seizures for 4 days. At the hospital, he was stabilized with ventilatory support, sedation, and antiepileptic drugs. A NCCT (Head) showed intraparenchymal hemorrhage in the left fronto-parieto-temporal lobe and subarachnoid hemorrhage. Subsequently a CT angiogram revealed an aneurysm of the left M3 segment of MCA. Successfully, the patient underwent microsurgical clipping of aneurysm and evacuation of hematoma.

CONCLUSIONS

Pediatric cerebral aneurysms differ from their adult counterparts, mainly in their etiology and evolution. As per literature, aneurysmal clipping and neurological endovascular therapy have shown similar results.

Disseminated Ureaplasma infection: A case report of septic polyarthritis in a patient on Rituximab therapy

Introduction

Immunocompromised individuals, such as those undergoing Rituximab therapy, are susceptible to severe infections by these organisms. We present a rare case of polyarticular septic arthritis caused by disseminated Ureaplasma urealyticum in a Rituximab-treated patient.

Presentation of case

A 38-year-old male with a history of schizophrenia and multiple sclerosis presented with intense pain, swelling, and fever, along with limited joint mobility. Despite initial treatment with antibiotics and surgical intervention, the patient's condition deteriorated. PCR assays confirmed the presence of Ureaplasma urealyticum, prompting a change in antibiotic therapy. With focused antimicrobial treatment and supportive care, the patient exhibited gradual improvement, although reinfection occurred one month after discharge, necessitating additional surgical interventions and antibiotic therapy.

Discussion

Septic arthritis due to Ureaplasma urealyticum is exceedingly rare but can occur in immunocompromised patients undergoing Rituximab therapy. Accurate pathogen identification using PCR assays is crucial for optimizing therapeutic outcomes in such cases. Treatment typically involves a combination of surgical debridement and tailored antimicrobial therapy with agents effective against Ureaplasma species. Close monitoring for disease recurrence and joint function is essential for long-term management.

Conclusion

This case highlights the diagnostic challenges and therapeutic complexities of septic arthritis caused by Ureaplasma urealyticum in immunocompromised patients undergoing Rituximab treatment. Interdisciplinary collaboration and the use of PCR assays for accurate pathogen identification are crucial for successful outcomes in such cases. Clinicians should consider the unique susceptibility of immunocompromised individuals to rare pathogens and tailor antimicrobial therapy accordingly.

Anaphylactoid reactions during implantation of polymer-filled ring stent grafts for treatment of abdominal aortic aneurysms

Polymer ring stent grafts from Endologix are reliable to treat challenging abdominal aortic aneurysm anatomy (hostile neck and tortuous or narrow iliac arteries). Rare cases of anaphylactoid reactions have been reported during the filing time of the graft rings due to polymer leakage. Management with amines, an antihistamine drug, and supportive care quickly stabilized both of our patients, which permitted the continuation and completion of their surgery. In our experience, there was no death-related events nor negative impact on patients surgical and clinical outcomes. We report on polymer leakage using the Ovation IX and ALTO stent grafts resulting in an anaphylactoid reaction.

Giant prostatic adenocarcinoma revealed by bilateral edema of the lower limbs

Adenocarcinoma of the prostate affects up to 70 % of men over 80 and is the second leading cause of cancer related death in men. We reported an unusual case of a giant prostatic adenocarcinoma compressing bilaterally the 2 external and internal iliac veins that was revealed by a bilateral edema of the lower limbs after histological confirmation the patient was treated by radiotherapy and hormone therapy with a clinical amelioration.

A knowledge synthesis of health research reporting standards relevant to epilepsy surgery

OBJECTIVE

Numerous studies have examined epilepsy surgery outcomes, yet the variability in the level of detail reported hampers our ability to apply these findings broadly across patient groups. Established reporting standards in other clinical research fields enhance the quality and generalizability of results, ensuring that the insights gained from studying these surgeries can benefit future patients effectively. This study aims to assess current reporting standards for epilepsy surgery research and identify potential gaps and areas for enhancement.

METHODS

The Enhancing the Quality and Transparency of Health Research (EQUATOR) repository was accessed from inception to April 27, 2023, yielding 561 available reporting standards. Reporting standards were manually reviewed in duplicate independently for applicability to epilepsy and/or neurosurgery research. The reporting standards had to cover the following aspects in human studies: (1) reporting standards for epilepsy/epilepsy surgery and (2) reporting standards for neurosurgery. Disagreements were resolved by a third author. The top five neurosurgery, neurology, and medicine journals were also identified through Google Scholar's citation index and examined to determine the relevant reporting standards they recommended and whether those were registered with EQUATOR.

RESULTS

Of the 561 EQUATOR reporting standards, 181 were pertinent to epilepsy surgery. One was related to epilepsy, six were specific to surgical research, and nine were related to neurological/neurosurgical research. The remaining 165 reporting standards were applicable to research across various disciplines and included but were not limited to CONSORT (Consolidated Standards of Reporting Trails), STROBE (Strengthening the Reporting of Observational Studies in Epidemiology), and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). None of these required reporting factors associated with epilepsy surgery outcomes, such as duration of epilepsy or magnetic resonance imaging findings.

SIGNIFICANCE

Reporting standards specific to epilepsy surgery are lacking, reflecting a gap in standards that may affect the quality of publications. Improving this gap with a set of specific reporting standards would ensure that epilepsy surgery studies are more transparent and rigorous in their design.

Surgical treatment of a Salmonella-related infective native aortic aneurysm: A case report

Infective native abdominal aortic aneurysms are a life-threatening condition with a high mortality rate. We report the case of a 53-year-old male patient who presented with abdominal pain and fever. Laboratory results showed an elevated white blood cell count and C-reactive protein levels. Blood cultures detected Salmonella species, and computed tomography revealed a saccular abdominal aortic aneurysm. After 14 days of preoperative antibiotic therapy, the patient underwent a successful surgical bypass from the descending thoracic aorta, through the diaphragm and muscle layers of the anterior abdominal wall, to the bilateral common femoral arteries. The patient was discharged after 30 days of hospitalization and continued antibiotic treatment for another 30 days. Follow-up clinical evaluations and imaging studies showed good recovery and no signs of infection. This case highlights the importance of combining appropriate antibiotic therapy with surgical intervention in managing infective native aortic aneurysms. In particular, an extra-anatomical approach from the descending aorta can be a viable option in selected cases of infected aortic aneurysms, providing an effective means to achieve thorough debridement and prevent future graft infections.

Unmasking a Rare Cause of Acute Abdomen in Adults: A Case Report of an Infected Urachal Cyst

The urachus is a remnant of the fetal duct that typically obliterates and becomes a fibrous cord after birth. However, in rare cases where this process fails, urachal cysts and other abnormalities can form, often remaining undiagnosed due to their asymptomatic nature. Infection is the primary complication and can be misdiagnosed due to the cyst's obscurity and varied presentations. Delayed diagnosis can lead to severe complications such as sepsis, fistula formation, and cyst rupture, potentially causing peritonitis. This paper discusses a 48-year-old male who consulted in the emergency department with acute abdominal symptoms, was diagnosed with an infected urachal cyst via imaging and successfully treated with antibiotics and subsequent surgical excision.

Incarcerated obturator hernia with a fistula to the adductor muscles: Case report of a rare hernia with uncommon symptoms, discovered by CT

INTRODUCTION

Obturator hernias are rare, occur mainly in slender people and predominantly in females. Underlying pathology of the obturator hernia is a weakening of the obturator membrane. The obturator hernia is situated between the pubic and ischial bones and is therefore clinically occult. Patients predominantly present with symptoms of bowel obstruction, but can also present with sensory disturbance, leg pain and hip pain. Due to the usually delayed diagnosis, the obturator hernia is associated with increased morbidity and mortality.

CASE PRESENTATION

A 71-year-old female patient with hip pain underwent a protracted diagnostic work-up and was referred to the surgical department by the treating orthopedic surgeon. An incarcerated obturator hernia with a fistula in the adductor ligament was finally diagnosed via CT. The operation included laparoscopic reduction, hernia repair, open small bowel segment resection, local surgical exploration, lavage and antibiotic treatment. The primary hernia repair was performed by direct suture due to the contamination, and a post-primary mesh repair was indicated. However, after complete recovery and no remaining symptoms, the patient refused this despite the indication for definitive laparoscopic hernia repair.

DISCUSSION

Hip pain can have multiple causes. Taking physical characteristics into account can lead to the correct diagnostic pathway. The CT scan revealed the fistula which led to the laparoscopic surgery. Due to the intestinal damage and contamination, the surgical steps were adapted.

CONCLUSION

Obturator hernias should be considered as a reason for atypical symptoms in slender, older patients. Adequate surgical management can be chosen after correct diagnosis.

Duodenal stenosis in adult malrotation: When Ladd procedure is not enough: A case report

INTRODUCTION

Congenital causes of duodenal obstruction can be grouped into intrinsic and extrinsic causes. The degree of obstruction caused by such etiologies determines the severity and timing of symptom presentation. Early neonatal diagnosis is common in patients with etiologies that present with high degrees of obstruction such as atresia whereas etiologies that cause lesser degrees of obstruction such as malrotation and duodenal stenosis can go undiagnosed into adulthood.

PRESENTATION OF CASE

We report a case of a 24-year-old female who presented with acute on chronic abdominal pain with bilious vomiting. She was diagnosed with intermittent small bowel volvulus which resolved spontaneously but was found to have adult intestinal malrotation diagnosed intraoperatively. She had a Ladd procedure done but had persistent obstructive small bowel symptoms after the Ladd procedure. She was found to have duodenal stenosis from fibrosis of the duodenum on relaparotomy which was treated surgically with Heineke-Mikulicz strictureplasty leading to total resolution of symptoms.

DISCUSSION

Congenital extrinsic and intrinsic causes of partial duodenal obstruction such as Ladd bands in malrotation and duodenal stenosis respectively, can co-exist and persist into adulthood due to their lesser symptomatology and degree of obstruction. Surgical treatment must identify and correct both conditions when they co-exist to ensure complete resolution of symptoms.

CONCLUSION

This case report highlights the association of duodenal stenosis with adult malrotation which may account for persistent symptoms after the Ladd procedure and suggests the use of Heineke-Mikulicz strictureplasty as a complementary procedure for complete symptom resolution.

Transorbital penetrating intracranial injury involving bilateral frontal lobes with evisceration of right eye: A case report

Key Clinical Message

Timely diagnosis, multidisciplinary surgical intervention, and appropriate imaging are crucial in managing transorbital-penetrating intracranial injuries (TOPIs), minimizing morbidity, and optimizing patient outcomes.

Abstract

Transorbital-penetrating intracranial injuries (TOPIs) are rare occurrences with potential for severe neurological complications and high mortality rates. Prompt diagnosis and management are essential to mitigate adverse outcomes. Understanding injury patterns and employing appropriate imaging modalities are crucial for effective surgical planning and patient care. We present a case of a 22-year-old male mechanic who sustained a TOPI involving bilateral frontal lobes with evisceration of the right eye following a workplace accident with a metal cutter. Upon arrival at the emergency department, the patient exhibited vision loss in the right eye, proptosis, and a dilated pupil. Imaging studies revealed the trajectory of a metal arrow through the right orbital roof, necessitating surgical intervention. A multidisciplinary team performed bifrontal craniectomy with duroplasty to remove the foreign body and address associated injuries. Postoperatively, the patient received broad-spectrum antibiotics and anticonvulsants, leading to full recovery and discharge on postoperative day 10. TOPIs present unique challenges due to their rarity and potential for devastating consequences. Our case highlights the importance of timely diagnosis, meticulous surgical planning, and multidisciplinary collaboration in achieving favorable outcomes. Radiological imaging plays a crucial role in guiding treatment decisions and optimizing patient care. This report underscores the significance of early surgical intervention, antimicrobial therapy, and prophylactic measures in reducing morbidity and mortality associated with TOPIs.

Autogenous, alloplastic, or hybrid for total mandibular reconstruction; is here an optimal path?

For less fit patients, total reconstruction of the mandible (TRM) is an elucidated alternative for severe maxillofacial defects. This study aimed to comprehensively review and analyze the existing evidence, irrespective of the underlying pathologies, to provide a consolidated overview of the current state of TRM. An electronic search was performed on PubMed, Embase, Scopus, and Google Scholar to identify studies reporting TRM without restrictions on patient age, type of pathology underlying the mandibular defect, and study type. Electronic search identified 390 studies; only 21 met the inclusion criteria, documenting 7 (33.3%) autogenous, 6 (28.6%) alloplastic, and 8 (38.1%) hybrid TRMs. All studies reported one clinical case, except for two studies that reported two patients treated with TRM. The mean age of the patients was 39.0 ± 19.4 years, and the mean follow-up was 22.3 ± 14.7 months. Osteomyelitis was the most common pathology. Bilateral condyles were preserved in only two cases. The TRM has been reported in clinical cases only and no large cohort study is available. Functional and aesthetic parameters have either not been reported or have been reported in heterogeneous formats, thus hampering comparisons of autogenous, alloplastic, and hybrid TRMs. Overall, TRM in patients presenting with severe maxillofacial defects achieved promising clinical outcomes endowed with acceptable function and aesthetics. Large cohort studies are needed to validate these results.

Sirolimus monotherapy for Kasabach-Merritt phenomenon in a neonate; Case report

INTRODUCTION AND IMPORTANCE

The Kasabach-Merritt Phenomenon (KMP), characterized by thrombocytopenia and consumptive coagulopathy due to endothelial cell growth in the infantile vascular tumor kaposiform hemangioendothelioma, presents a therapeutic challenge. This case highlights the novel use of sirolimus in a neonate, an approach less explored in this age group.

CASE PRESENTATION

A female neonate presented with a right anterior chest mass, progressing to respiratory distress and congestive heart failure. Diagnosed with KMP, she exhibited low platelet count and coagulation abnormalities. Treatment with sirolimus (0.06 mg/day) led to mass reduction, improved bleeding, and a stable tumor after 12 months, without side effects. This case contrasts with existing literature advocating for combination therapy or higher sirolimus concentrations for effective treatment. Yet, our patient achieved favorable outcomes with low-dose monotherapy, suggesting a potentially safer approach in neonates with immature hepatic and renal metabolism.

CLINICAL DISCUSSION

This case demonstrates the efficacy of low-dose sirolimus monotherapy in treating KMP in a neonate, challenging current preferences for combination therapies or higher doses. It emphasizes the need for further research into age-specific treatment protocols in KMP, considering the unique metabolic profiles of neonates and infants.

CONCLUSION

Sirolimus has demonstrated potential in treating KMP in pediatric patients. While initial results are promising, determining optimal dosages and trough concentrations, especially in neonates and infants, remains essential.

Bezoar in Meckel's diverticulum: Case report and narrative review

INTRODUCTION

Bezoars are a known cause of complications in Meckel's diverticulum. We present a case in which a bezoar in a Meckel's diverticulum resulted in intestinal obstruction. In addition, we conducted a narrative review to explore the association between Meckel's diverticulum and bezoars.

CASE PRESENTATION

We present the case of a 22-year-old patient admitted for bowel obstruction persisting for three days and periumbilical tenderness. Abdominal CT tomography revealed a hyper dense circular structure with a diameter of 2 cm, small bowel distension of 41 mm, and free fluid. During surgical exploration, a Meckel diverticulum was found between the antimesenteric border of the small bowel and posterior wall of the umbilicus. The Meckel diverticulum was resected, and upon examination, it was found to contain a calcified phytobezoar. The postoperative course was uneventful.

DISCUSSION

The clinical and paraclinical presentation of bezoars in Meckel's diverticulum is nonspecific and diagnosis remains challenging despite improved diagnostic modalities. The association between Meckel's diverticulum and bezoars is often identified during surgery, as it is difficult to diagnose using CT scans. The choice between laparoscopic and open surgery depends on the patient's situation.

CONCLUSION

Diagnosing a bezoar in a Meckel's diverticulum remains challenging. Treatment involves surgery, and the choice of surgical approach depends on the context.

Perforation of descending colonic cancer as a rare cause of gas gangrene of the lower limb in an 80-year-old female: a case report

Gas gangrene is a rare, severe gas-producing infection that can be related to colorectal cancer. Gas gangrene can be confirmed by radiologic findings and crepitation on touch. Spontaneous gas gangrene can be associated with colorectal cancer. An 80-year-old female complaint about a sudden abdominal pain, accompanied with progressive swelling pain in thigh and fever. Diagnosis based on assessment findings were gas gangrene and descending colonic cancer perforation. Emergency surgery was performed for debridement and drainage, followed by vacuum sealing drainage (VSD) with polyurethane (PU). Two more surgical interventions were given before the colonic tumor surgery. The patient recovered well in the long-term follow-up. This report demonstrates the diagnosis, treatment, and management of a successful case of gas gangrene caused by perforation of descending colonic cancer. Accurate preoperative diagnosis and reasonable use of VSD (PU) material played an important role in the treatment of this case.

Complete regression of intrahepatic cholangiocarcinoma after right portal vein ligation. Case report

INTRODUCTION

Spontaneous tumor regression is an extremely rare phenomenon in the oncology field.

PRESENTATION OF CASE

We present the case of a 72-years-old male patient presenting with a bulky hepatic tumor mass located in segment V and extending into segments IVb and VI with MRI features of atypical cholangiocarcinoma with a liver metastasis in segment III. In first surgical step, excision of the metastasis, and ligation of the right portal vein was done. A new MRI examination performed 5 weeks later shows significant tumor regression, and 2 weeks later, during the second surgery, the tumor was not found. Under these conditions we performed a limited segment V liver resection, in the area indicated by the radiologist as the site of the tumor. No viable malignant cells existed in the tumor specimen, and a third MRI examination didn't identify any residual tumor.

DISCUSSION

From our literature study this is the only case of complete tumor regression of an intrahepatic cholangiocarcinoma following portal vein ligation. We believe the portal vein ligation resulted in a marked regression/deficiency in the tumor blood supply.

CONCLUSION

Serial MRI examinations demonstrated the regression of intrahepatic cholangiocarcinoma after portal vein ligation. Intrahepatic cholangiocarcinoma should be included in the tumors that could extremely rarely spontaneously regress.

Small Intestinal Perforation after 360-Degree Liposuction: A Case Report

OBJECTIVE

As one of the most commonly performed cosmetic procedures, liposuction is relatively safe. Bowel injury following liposuction is a rare but devastating complication, which necessitates hospital admission and surgical intervention. The authors highlight a case report describing the presentation, diagnosis, and management of a patient with bowel injury following liposuction.

CASE

A 58-year-old woman presented with abdominal pain, erythema, and discharge three days after 360-degree abdominal liposuction with concomitant fat grafting to bilateral buttocks at an outpatient surgery center. Bowel perforation was suspected after CT-scan revealed extraluminal gas in the abdomen and communication that traversed the peritoneum. Exploratory laparotomy was performed which demonstrated at least one site of distinct perforation of the small bowel and an area omentum noted to be inflamed, thickened and with a purulent rind. The patient underwent 20-cm small bowel resection and partial omentectomy temporarily closed with negative pressure wound therapy. After subsequent abdominal wall debridements the patient received ventral hernia repair with bridging mesh and abdominal closure.

CONCLUSIONS

While safe, elective cosmetic procedures are not without risk of serious and even fatal complications. Providers must be familiar with the presentation of bowel injury following abdominal liposuction to prevent delays in appropriate surgical and medical care.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Rare finding of a symptomatic epidermoid cyst of the diaphragm - a case report

Cystic lesions of the diaphragm are rare and accordingly present a diagnostic challenge. Specific radiological features with which to clinch a diagnosis may be elusive. Herein we present the case of a patient who presented with symptoms attributable to a cyst in the left upper abdomen, irritating the diaphragm. Surgery was considered appropriate for diagnostic and symptomatic purposes. Final histology demonstrated an epidermoid cyst. Resolution of symptoms was reported after surgery. Diaphragmatic epidermoid cysts appear to be a rare entity with only three prior cases reported in the literature. Given the rarity of this lesion and the lack of unique features by which they can be characterized, accurately diagnosing epidermoid cysts of the diaphragm is likely to remain difficult without surgery, although they are presumed to have a benign behaviour.

Delayed surgical treatment of asymptomatic severe traumatic C7-T1 spondylolisthesis: a rare case report from Syria

Introduction

Spondylolisthesis is described as the displacement of one vertebra over another, leading to spinal instability and potential nerve compression. When this occurs in the cervicothoracic junction, it can result in unique clinical manifestations. High-grade spondylolisthesis caused by trauma in the cervicothoracic junction of the spine usually results in acute spinal cord injury and quadriparesis. However, a few uncommon cases of the same injury reported minimal or no neurological deficits. Biomechanical evaluation of the underlying pathology can offer insights into the mechanism of injury and the preservation of neurological function.

Case presentation

This paper explains the case of a 32-year-old white male patient who suffered from a traumatic C7-T1 spondylolisthesis. Despite having radiographic evidence of grade III traumatic spondylolisthesis, cord compression, fracture in the isthmus of the C7 vertebra, and intervertebral disc traumatic change and protrusion, the patient did not exhibit any motor neurological deficits. The patient underwent posterior spine fixation via the posterior approach as the first step of the surgical management, followed by anterior spine fixation via the anterior approach after several days (360° fixation). Fortunately, after 6 months of follow-up, the patient showed good outcomes. The patient was pain-free with an intact neurological clinical examination, the radiographs showed well-maintained fusion and alignment.

Discussion

The best management approach to cervical spondylolisthesis without neurological injury is complicated and arguable due to the rarity of occurrence of such cases.

Conclusion

A combined anteroposterior surgical approach, or 360° fixation, is a valuable technique for addressing complex spinal conditions such as the condition seen in our case, offering comprehensive stabilization and improved outcomes.

Rupture of a giant jejunal mesenteric cystic lymphangioma misdiagnosed as ovarian torsion: A case report

BACKGROUND

Cystic lymphangioma is a rare benign tumor that affects the lymphatic system. Mesenteric lymphangiomas in the small bowel are extremely uncommon.

CASE SUMMARY

We present a 21-year-old female patient who complained of abdominal pain. The diagnosis of ovarian torsion was suspected after abdominopelvic unenhanced computed tomography and ultrasound revealed a large cyst in contact with the bladder, ovary, and uterus. The patient underwent emergency laparotomy performed by gynecologists, but it was discovered that the cystic tumor originated from the jejunum. Gastrointestinal surgeons were then called in to perform a cystectomy. Pathological examination confirmed the diagnosis of cystic lymphangioma of the mesentery. The patient had an uneventful postoperative recovery.

CONCLUSION

Mesenteric lymphangiomas can cause abdominal pain, and imaging techniques can help determine their characteristics, location, and size. Complete surgical excision and pathological examination are considered the standard treatment and diagnostic method.

Idiopathic Pneumatosis cystoides intestinalis of the small bowel with pneumoperitoneum and consecutive small bowel mesenteric torsion. A case report

INTRODUCTION

Pneumatosis cystoides intestinalis (PCI) is a condition characterized by the presence of gas-filled cyst-like structures in the submucosa and subserosa of the small or large intestine and in some cases accompanied by pneumoperitoneum. PCI is commonly considered a benign condition as opposed to pneumatosis intestinalis in life-threatening conditions such as mesenteric ischemia. Only a minority of cases of PCI are assumed to be primary or idiopathic with the majority being caused by a variety of underlying conditions. Symptoms of PCI are non-specific or may be absent altogether. Provided that there is no suspicion of an underlying life-threatening disease, PCI can be treated non-operatively.

CASE PRESENTATION

We present the case of a 71-year-old patient with pneumatosis intestinalis with free intraperitoneal gas known for three years. Due to self-limiting symptoms and lack of evidence of a life-threatening underlying disease, no specific therapy had been carried out so far. No underlying diseases could be found. Because of recurrent worsening abdominal pain and newly diagnosed partial small bowel obstruction with radiological signs of mesenteric torsion, resection of the affected small bowel was successfully performed.

DISCUSSION

Non-surgical management of PCI is possible provided that life-threatening causes of pneumatosis have been ruled out. Bowel obstruction is a rare complication of PCI which requires surgical treatment.

CONCLUSION

Our case report illustrates that symptoms of PCI may worsen over time, and that complications requiring surgical intervention may occur. We recommend regular monitoring of patients who are primarily treated non-operatively.

Pathologic fractures of the humerus during adjuvant pembrolizumab in patients with renal cell carcinoma after radical nephrectomy: A case report

INTRODUCTION AND IMPORTANCE

Immune checkpoint inhibitors (ICIs) have noticeably enhanced oncologic outcomes associated with patient survival in different subtypes of metastatic cancer by enhancing cytotoxic T-cell activity. ICI-associated toxicities are often referred to as immune-related adverse events (irAEs) and occur in nearly every organ system. However, the effect of ICIs on the skeleton is poorly examined, and only a few case series have been published.

CASE PRESENTATION

A 37-year-old man who presented with pathologic fractures of the right proximal humerus during adjuvant pembrolizumab therapy following laparoscopic radical nephrectomy for right renal cell carcinoma.

CLINICAL DISCUSSION

ICIs are associated with various irAEs virtually affecting all host tissues, most of which have been described well by pharmacovigilance analyses. However, to date, very few studies have examined the effects of ICI on the skeleton.

CONCLUSION

Urologic oncologists and urologists should be aware of the rare but potentially fatal bone side effects of ICIs.

Co-occurrence of Guillain-Barre syndrome and rheumatoid arthritis in a young female: A case report from a low middle-income country

Key Clinical Message

We present the case of an adult female who had rheumatoid arthritis at first but later tested positive for Guillain-Barré syndrome (GBS). In symptomatic GBS patients (related to large joints), physicians (and therapists) should consider rheumatoid arthritis when risk factors are present.

Abstract

The co-existence of GBS and other autoimmune disorders is uncommon. We present the case of an adult female who had rheumatoid arthritis at first but later tested positive for GBS. Further details are provided regarding the interdisciplinary diagnostic and therapy strategy that led to the patient's complete recovery. An adult female patient with rheumatoid arthritis presented with progressive weakness in her lower limbs, affecting her arm and causing numbness in her left hand and bilateral lower limbs. She has not passed stool for the last 2 days and has experienced gastroenteritis with watery, profuse diarrhea. On admission, the patient was awake, alert, and able to communicate. She had a thorough history of vital signs, with no signs of dehydration, jaundice, pallor, or edema. The patient's lower limbs were hypotonic and her upper limbs were normal. She experienced loss of sensation in her lower limbs, vibration, and proprioception. The patient's EMG-NCS report indicated sensory and motor axonal neuropathy (AMSAN variant). Plasmapheresis sessions were finished in our patient, and a very good result was achieved. In symptomatic GBS patients (related to large joints), physicians (and therapists) should consider rheumatoid arthritis when risk factors are present. Appropriate clinical treatment, which includes prompt evaluation of alternate diagnoses in the case of therapeutic failure, can improve patient outcomes.

A rare case of invasive endometriosis causing intestinal obstruction

A 35-year-old woman presented to the emergency department with severe right iliac fossa pain with features of subacute intestinal obstruction and recurrent episodes of similar pain in the past. CT scan showed a mass with fluid collection with no trace of the appendix in the right iliac fossa. The patient was taken up for a diagnostic laparoscopy and proceeded. Operative findings were that of a mass in the lumen of the terminal ileum just 6 inches from the ileocaecal junction. Normal pelvis with normal uterus and ovaries. The patient underwent a laparoscopic resection of the terminal ileum and limited resection of the ascending colon with an ileo-colic anastomosis. The patient recovered well and was discharged. The biopsy was reported as invasive endometriosis involving the muscularis layer of the terminal ileum with stricture of the terminal ileum with transmural inflammation. The case is being presented for the rarity of invasive endometriosis causing bowel obstruction with a normal pelvis.

A Case Report on a Hybrid Approach to Managing Acute Large Bowel Obstruction Secondary to Spigelian Hernia

Spigelian hernias are an uncommon type of primary ventral hernia and are defined as a defect in the Spigelian aponeurosis (fascia). Herein, we present an uncommon case of Spigelian hernia to highlight the potential complications of these hernias and the need for surgical management. This is a case report of an 86-year-old gentleman presenting post-fall with an acute rib fracture and an incidental Spigelian hernia seen on a CT trauma pan scan. The Spigelian hernia surgical treatment was planned for elective management due to the anesthetic risks associated with an elderly patient and acute rib fractures. Ultimately, the patient developed a large bowel obstruction secondary to the Spigelian hernia and required emergency operative management to relieve the obstruction. The patient had an uncomplicated recovery following his emergency surgery. This case report highlights the importance of assessing anesthetic risks versus surgical risks when it comes to surgical planning. Clinicians should recognize occult hernias and continue ongoing clinical reviews with a high index of suspicion, as symptoms of Spigelian hernia obstruction might be non-specific.

Small bowel obstruction in adults, Ladd's band is an exceptional cause: a case report

Malrotation of the gut is a congenital anomaly of foetal intestinal rotation and it's principally discovered in early childhood as acute intestinal obstruction. This condition is veritably rare and constantly silent in adults. Intestinal malrotation in adults is frequently asymptomatic and is diagnosed as a casual finding during a radiological examination performed for other reasons. Infrequently, it can be diagnosed in adults, associated with an acute abdomen. Adult patients rarely present with acute midgut volvulus or internal hernias caused by Ladd's bands. We present a case of an admitted 18-year-old female with a small bowel obstruction due to an intestinal volvulus complicating intestinal malrotation in the presence of Ladd's band. Laparotomic Ladd's procedure was performed successfully with division of Ladd's band, adhesiolysis, appendicectomy, and reorientation of the small bowel on the right and the cecum and colon on the left of the abdominal cavity; the postoperative evolution was favorable. Although it is a rare pathology, it should be kept in mind in cases of patients presenting small bowel obstruction.

Primary acinic cell carcinoma of the breast: A case report and review of literature

BACKGROUND

In the current World Health Organization classification, acinic cell carcinoma (AcCC) of the breast is considered a rare histological subtype of triple-negative breast cancer. Because of the few reports in the literature, data concerning clinical outcomes are limited. Here, we report a case of AcCC of the breast in a 48-year-old woman.

CASE SUMMARY

A 48-year-old woman with a mass in her right breast came to our hospital for further diagnosis. Mammography and an ultrasound (US) scan showed a mass in the upper inner side of the right breast. She then underwent surgery to resect the mass in her right breast. Postoperative pathological examination revealed that the tumor had abundant acinar-like structures formed by tumor cells with prominent eosinophilic granules in the cytoplasm, consistent with acinar cell carcinoma. The results of immunohistochemical analysis supported the diagnosis of breast acinar cell carcinoma. Two months later, she underwent breast-conserving surgery and sentinel lymph node biopsy. The pTNM stage was T2N0M0. After surgery, the patient received 30 radiotherapy sessions. The patient was followed up for a period of one year, and no recurrence was found.

CONCLUSION

AcCC of the breast is a rare type of malignant tumor. Because it is usually asymptomatic and can be detected by imaging studies, routine breast US or mammograms are important. However, there are no characteristic diagnostic imaging findings or clinical manifestations, so immunohistochemical examination is critical for an accurate diagnosis of AcCC of the breast.

Clavicle Fracture Site Surgical Contouring: A Case Report

Clavicle fractures are frequent injuries accounting for approximately 4% of all fractures in adults with about 35% occurring in the shoulder region among which midshaft fractures are the most common (>66%). Nonsurgical management is the treatment of choice for most clavicle fractures; however, poor functional and aesthetic outcomes may result from nonunion, symptomatic malunion, and aesthetic impairment which are the most common complications. A young woman was referred to our clinic for a "Step Deformity" resulting after primary, nonsurgical treatment of a midshaft clavicle fracture. Residual deformity was corrected with a novel simple and little invasive approach. Midshaft clavicle fractures typically only require conservative nonsurgical treatment, nevertheless suboptimal outcomes may occur. Selective osteotomies and fixation are deemed too invasive when only cosmetic impairment of the clavicle contour is present without any functional or sensitive damage and most patients are discouraged from undergoing surgery. Thus far, no specific focus on this topic, nor exploration of possible correction can be found in the published literature. These residual deformities may be very noticeable sometimes and cause psychological distress and social life impairment. Despite no related functional impairment, this deformity should still be addressed, to improve patients' quality of life.

Transarterial embolization of acquired uterine artery pseudoaneurysm post cesarean section: A case report

We present a case report of 31 31-year-old woman with refractory secondary postpartum hemorrhage after 44 days of cesarian section. Patient was in shock and found to have a ruptured Uterine artery pseudoaneurysm (UAP) in computed tomography angiography (CTA). Emergency trans-arterial Uterine artery embolization (UAE) was performed, aiding in the stabilization and recovery of the patient. The benefits of early recovery, minimal invasiveness, and the option of preserving fertility are offered by UAE compared to uterine artery ligation or hysterectomy.

A giant peripheral ossifying fibroma of the mandible: A rare case report

INTRODUCTION

Peripheral ossifying fibroma (POF) is an unusual localized, reactive benign gingival growth. POF is usually small in size, it's measure <2 cm in diameter, but rarely reaches important sizes. The aim of this work was to present a rare case report of a giant peripheral ossifying fibroma of the mandible measuring >2 cm in diameter, misdiagnosed as peripheral myxoma.

CASE PRESENTATION

We present the case of a 42-year-old woman with a large peripheral ossifying fibroma in the oral cavity measuring 6 × 4 cm in diameter. The patient presented with an asymptomatic, slowly growing gingival mass in the left anterior and posterior region of the mandible. It gradually increased in size for more than two years. The patient had a mild mental deficit; however, we performed biopsy surgery, which revealed a peripheral myxoma, and then treated the tumor by excision under local anesthesia. The final histopathological examination revealed a peripheral ossifying fibroma.

CLINICAL DISCUSSION

This case report shows that POF can grow and reach unusual dimensions that may contribute to occlusal problems. The diagnosis of POF is based on clinical and radiographic features. The histopathological examination of the biopsy specimen can misdiagnose the lesion; therefore, the final diagnosis is based on the histopathological examination of the complete excised lesion.

CONCLUSION

POF is usually small, but can reach a larger size. The histopathological examination of the entire lesion is of paramount importance to make a final diagnosis.

Spinal epidural cavernous hemangiomas in the lumbar spine: A case report

INTRODUCTION

Spinal epidural cavernous hemangiomas (SECHs) are relatively rare intradural epidural lesions of the spinal canal, and those occurring in the lumbar spine are even rarer.

CASE PRESENTATION

A 60-year-old man presented for low back pain with right leg pain. His pee and feces were both normal but symptoms were very similar to a typical lumbar disc herniation. The MRI findings suggest an epidural space of unknown nature in the spinal cord at the L2-3 level and a definite diagnosis of SECHs was made by postoperative pathological examination.

CLINICAL DISCUSSION

Patients who are suspected of having SECHs should undergo initial classification and differential diagnosis based on MRI imaging features. It is crucial to identify the responsible segment in correlation with the presenting symptoms. During surgery, the primary objective should be the complete removal of the mass, while taking utmost care to protect the nerves. Dynamic stabilization systems, utilizing pedicle rods, can be considered as one of the treatment options for such patients.

CONCLUSION

Patients presenting with low back pain and neurological symptoms should undergo MRI, and diagnosed with SECHs should undergo early surgical intervention. For patients with an intradural mass in the spinal canal, complete resection should be performed while prioritizing nerve protection.

Multiple Foci of Basal Cell Carcinoma Arising in Rhinophyma: A Case Report and Literature Review

Background

Rhinophyma is a benign condition caused by the excessive growth of sebaceous glands in the nasal tissue, presenting with symptoms such as nasal hypertrophy, erythema, and papules. Cases of basal cell carcinoma in rhinophyma have been reported in literature, but its etiological role remains unclear. It is uncertain whether rhinophyma is predisposed to neoplasm development or if their coexistence is coincidental.

Material and Method

We conducted a literature survey to identify such cases reported over the years.

Results

We identified 22 studies reporting a total of 47 cases in the literature, all involving male patients. The most common pattern of occurrence was the rapid growth of a nodular formation within the context of rhinophyma.

Discussions and Conclusion

The elucidation of the association between basal cell carcinoma and rhinophyma remains challenging. The presence of multiple foci supports the theory that rhinophyma may play a role in their development, but larger studies are needed to establish a causal relationship.

Implant-Prosthetic Rehabilitation of Mandibular Posttraumatic Severe Dentoalveolar Loss With a Reconstructive Staged Approach: A Clinical Report With 3-Year Follow-Up

This clinical report describes the oral rehabilitation of a 25-year-old male patient who lost the lower incisors, right canine, and a significant amount of anterior mandibular bony and soft tissue following severe dentoalveolar trauma due to a car accident. The patient's young age, anterior esthetic zone in the lower jaw, previous mandibular fracture, and extended bony and soft-tissue defect hindering ideal 3-dimensional implant placement oriented the therapeutic plan toward a staged approach, with several reconstructive surgical procedures before implant rehabilitation. The treatment involved deepening the labiobuccal vestibule and lingual sulcus to correct cicatricial shrinkage due to previous surgical fixation of the mandibular fracture, vertical guided bony augmentation to regenerate adequate volumes of bone, free gingival graft to achieve sufficient height and thickness of peri-implant soft tissues, and a prosthetic-driven surgical procedure to place the implants in a good functional and esthetic position. This therapeutic approach restored function and esthetics and achieved outcome stability at 3-year follow-up.

Selecting the best surgical approach in various cases of prolapsed pedunculated submucosal fibroids: A case series

INTRODUCTION

The pedunculated fibroid is classically managed through vaginal myomectomy. However, vaginal myomectomy cannot be safely and easily performed in all cases. We reviewed three cases of prolapsed pedunculated submucosal fibroids, each with a specific surgical difficulty.

PRESENTATION OF CASES

The first case had a prolapsed pedunculated uterine fibroid in pregnancy and underwent fibroid extirpation during an emergency cesarean section through the lower uterine segment incision. The second case was a nulliparous woman with recurrent abnormal uterine bleeding due to a giant prolapsed pedunculated uterine fibroid who underwent laparotomy fibroid extirpation through posterior colpotomy, preserving the uterus. The third case had a prolapsed pedunculated uterine fibroid in perimenopause with multiple fibroids and underwent fibroid stalk excision through an isthmic incision to facilitate a safe laparotomy hysterectomy procedure.

DISCUSSION

Vaginal removal has become the standard surgical method for prolapsed pedunculated submucous fibroids. However, some possible consequences of vaginal myomectomy include severe stalk bleeding, infection, and uterus inversion induced by excessive traction. Therefore, specific approaches are needed in some circumstances.

CONCLUSION

Customised surgical approaches provided safe and efficient access to the prolapsed pedunculated fibroid stalk during myomectomy or hysterectomy.

A case of esophageal cancer in a diverticulum treated by surgical resection: a case report

BACKGROUND

An esophageal diverticulum is a relatively rare disease, with reports of treatment for esophageal cancer in the diverticulum even rarer.

CASE PRESENTATION

The case involved a 72-year-old male with a chief complaint of dysphagia. He was diagnosed with an esophageal diverticulum (Zenker's diverticulum) measuring 10 cm in diameter. Five years later, an upper gastrointestinal endoscopy revealed an iodine-unstained 0-IIb lesion of 20 mm in diameter with type B1 vessels in the diverticulum. An endoscopic biopsy and CT revealed it to be squamous cell carcinoma, cT1a-EP/LPM N0 M0, cStage 0. Because the lesion was in the diverticulum and endoscopic resection was difficult with the risk of perforation, surgical resection was set as the course of treatment. Diverticulectomy was performed via a cervical approach, using a stapler, and the patient was discharged on the 16th day without any complications. The pathological diagnosis was pTis-EP, ly0, v0, R0.

CONCLUSIONS

We think this case is very rare and diverticulectomy of early esophageal cancer in the diverticulum is available and safe.

Multiple symmetrical lipomatosis: A literature review and case report of a patient with Madelung's disease

<b><br>Introduction:</b> Madelung's disease is a rare condition characterised by the symmetric growth of fatty tumours (lipomas) around the neck, shoulders, upper arms and trunk.</br> <b><br>Case report:</b> We present a description of a male patient with extensive adipose tissue overgrowth around the neck. Once the possibility of malignancy was excluded, the patient's history and clinical and radiological findings led to the diagnosis of Madelung's disease. A two-stage surgery was planned and the patient underwent lipectomy of the lipomas around the neck.</br> <b><br>Conclusions:</b> This article analyses the clinical data with Madelung's disease; discusses its aetiology, clinical manifestations, diagnosis and treatment methods; and provides help with clinical diagnosis and treatment.</br>.