The SCARE 2020 Guideline: Updating Consensus Surgical CAse REport (SCARE) Guidelines

Adult ileo cecal intussusception as a manifestation of colon carcinoma: A case report

BACKGROUND

Intussusception is the invagination of a segment of the bowel into an adjacent segment. It is the most common cause of intestinal obstruction in children, but in adults, it is rare, accounting for 1% of all intestinal obstructions and 5% of all intussusceptions, with malignancy being the most common cause. In the past, it was typically diagnosed intraoperatively. However, with the availability of computed tomography for abdominal imaging, recognizing the condition's signs has become crucial. Surgical intervention is essential for managing neoplastic cases and their complications.

CASE SUMMARY

A 45-year-old female presented with severe abdominal pain encompassing her entire abdomen, abdominal distension, vomiting, and persistent constipation. Over the past two months, she has also experienced considerable weight loss. After an initial history review, examination, and imaging investigations, the patient was diagnosed with ileo cecal intussusception resulting from a colo rectal mass located in the cecum and ascending colon. This condition was surgically managed through an extended right hemi colectomy.

CONCLUSION

Intussusception is uncommon in adults, but it should be considered in patients with intestinal obstruction. Surgical intervention is essential.

Saving exposed titanium mesh cranioplasty using adipocutaneous anterolateral thigh flap: A case series

Introduction

Scalp thinning and soft tissue atrophy are significant risk factors for prosthetic material exposure after cranioplasty surgery. Reconstruction of the forehead and scalp to ensure functional coverage and aesthetics continues to be challenging.

Patients and Methods

This prospective study assessed 15 patients with titanium mesh material exposure, scalp thinning, and soft tissue atrophy following cranioplasty from 2020 to 2023 to identify contributory factors. All patients underwent reconstruction with free adipocutaneous anterolateral thigh flap to cover skin defects and fill soft tissue. The results were evaluated based on flap survival, coverage, and symmetry after surgery.

Results

The average age in the study was 40.46 (range 11-68) years, and the male/female ratio was 9/6. From 2020 to 2023, 15 free adipocutaneous anterolateral thigh flaps were used for reconstruction. Complete flap survival was achieved in 93.3 % (14/15) patients with all titanium mesh implants retained. Symmetry and soft tissue hypoplasia correction was achieved in all 15 cases.

Conclusion

Adipocutaneous anterior lateral thigh (ALT) flap is a versatile flap to treat complications following cranioplasty with titanium mesh. The ALT flap provides extensive coverage, reduce the risk of recurrent infections, and create an implant for soft tissue atrophy or skin thinning to restore the scalp's aesthetics.

[Rethinking scientific integrity in plastic surgery: Reflections on editorial and institutional responsibilities]

Plastic surgery, by nature an innovative discipline, has historically relied on clinical case reports to advance its techniques. Often unique, these cases are a valuable vehicle for disseminating breakthroughs - especially in a field marked by highly individualized practices and artisanal surgical approaches, where randomized trials are often impractical. However, this reliance on case reports raises significant ethical concerns. In multidisciplinary settings, attribution of contributions often remains ambiguous. Misconduct, such as unauthorized publications or omission of institutional recognition, threatens the integrity of scientific output. As artificial intelligence reshapes biomedical research - automating literature reviews and meta-analyses - original case reports, by their singularity, escape these predictive models. Their heuristic value fully justifies their inclusion within the spectrum of scientific evidence. For this reason, their publication must be tightly regulated. Redefining publication standards in our field is essential. This includes the systematic application of international guidelines (CARE, SCARE, STROBE, GRIPP2), mandatory institutional approval before submission, formal training in research ethics for junior staff, and full transparency regarding patient consent and authorship attribution. When rigorous, novel, and well-contextualized, the clinical case remains a cornerstone of surgical progress. By safeguarding it from opportunistic misuse, we preserve its scientific and educational value.

Case Report: Based on the diamond theory, successful treatment of stubborn tibial nonunion after six surgeries using PRP-augmented therapy: a case report and literature review

Background

The treatment of stubborn tibial nonunion remains a significant challenge. This case report describes a patient who underwent six surgeries and was treated using a stepwise surgical approach based on the diamond theory. The application of platelet-rich plasma (PRP) enhanced autologous iliac bone grafting combined with locked compression plate fixation ultimately achieved successful healing. This study also reviews relevant literature to explore the treatment experiences and outcomes of similar cases.

Patient and methods

A middle-aged Asian male with severe heart disease underwent five failed surgeries, including two autologous bone graft procedures. Clinically, he presented with right calf pain, poor soft tissue condition on the anterior medial tibia, and signs of nonunion. During the sixth surgery, we applied a stepwise surgical procedure based on the diamond theory, achieving excellent clinical and bone healing, as well as satisfactory limb function at a follow-up of 11.3 months post-operation.

Conclusion

We utilized a stepwise surgical procedure based on the diamond theory: locked compression plate internal fixation, PRP-enhanced structural autologous iliac bone grafting, and bioactive center creation techniques, providing a strong and stable mechanical and superior biological environment for the nonunion site.

Quadruple bilateral fracture-dislocation of the elbow and the wrist: A rare and complex case report

We report an exceptionally rare and complex case of quadruple bilateral fracture dislocation of the elbow and the wrist in a 39-year-old construction worker, who sustained the injury after falling from a scaffold of 9 m secondary to a 6.9 magnitude earthquake. The patient was treated with a combination of closed and open reduction, internal fixation, and radial head arthroplasty, and had a good functional outcome at 12 months follow-up, with no complications or instability. This case illustrates the challenges and the possibilities of managing such complex injuries, and adds to the scarce literature on this topic.

Systematic Review and Case Report of a Left Gonadal Vein Anastomosing Hemangioma

Background/Objectives: Anastomosing hemangioma (AH) is a rare, benign vascular tumor predominantly found in the genitourinary tract and often associated with impaired renal function. Due to its nonspecific radiological features, AH is frequently misinterpreted as a malignant vascular neoplasm, particularly angiosarcoma (AS), leading to potentially unnecessary surgical interventions. This study presents a systematic review of AH cases and describes a rare instance of retroperitoneal AH arising from the left gonadal vein, which was resected due to diagnostic uncertainty. Methods: A 68-year-old man underwent imaging for benign prostatic hyperplasia, incidentally revealing a 15-mm hypervascular retroperitoneal nodule adjacent to the left psoas muscle. Imaging findings, including moderate metabolic uptake on 18FDG-PET/CT, raised suspicion for AS. Given the diagnostic uncertainty and high-risk location, the multidisciplinary team (MDT) recommended surgical resection. Laparoscopic excision was performed, and histopathological analysis confirmed AH. The patient remained asymptomatic at a 22 month follow-up. In addition, a systematic review of 159 cases from 64 studies (2009-2024) was conducted to analyze radiological features, treatment approaches, and outcomes. Results: Among the reviewed cases, 68% were incidentally diagnosed, with AH occurring predominantly in the genitourinary system (70%), especially in the kidney, adrenal gland, and ovary. Chronic kidney disease (CKD) was present in 23.3% of cases, while 19.5% had a history of malignancy. Imaging was inconclusive in differentiating AH from malignancies: CT (71.9%) and MRI (6.1%) were the most used modalities, but none could reliably exclude AS. Management strategies included upfront surgical resection in 85%, while a growing proportion (9%) of cases underwent biopsy-based observation rather than immediate surgery. No cases were followed with imaging alone. Conclusions: AH remains a diagnostic challenge due to its overlap with malignant vascular tumors. While surgical excision is often performed, our review highlights an increasing trend toward conservative management with biopsy-based diagnosis. Improved awareness and the integration of histopathology, molecular markers, and MDT-based decision-making are crucial to prevent overtreatment in cases of suspected AH.

Primary Neuroendocrine Tumor of the Breast: A Rare Case

Primary neuroendocrine tumors (NETs) predominantly affect postmenopausal women. This case study focused on a 54-year-old woman who presented with a painless right breast lump. While the lump exhibited estrogen and progesterone receptor (PR) positivity, it lacked human epidermal growth factor receptor 2 expression. Further evaluation revealed positivity for the neuroendocrine markers chromogranin A (CGA) and synaptophysin (SYN). It also revealed a 3% positive Ki-67 proliferation index. Treatment for neuroendocrine breast cancer (NEBC) mirrors that of standard invasive breast cancer: breast conservation or mastectomy combined with sentinel lymph node biopsy or axillary dissection. The patient underwent a right mastectomy with sentinel lymph node biopsy, followed by hormonal therapy based on her tumor's immunohistochemical profile. Due to the low incidence and limited research on primary NETs, their exact origin remains shrouded in mystery. Accurate diagnosis, specific treatment options, and long-term prognosis remain significant challenges in managing this rare form of breast cancer.

The rolling stone: migration of an intrauterine device leading to bladder stone formation nine years after insertion: a case report

BACKGROUND

Intrauterine devices are safe, affordable, convenient, and the most common form of contraception used by females of childbearing age in Palestine. A rare complication of intrauterine devices is migration to nearby structures, rarely the urinary bladder, leading to bladder stone formation.

CASE PRESENTATION

A 34-year-old female patient presented due to repeated urinary tract infections and flank pain associated with lower urinary tract symptoms, including dysuria, frequency, and gross hematuria. Subsequent laboratory tests revealed a past medical history of iron-deficiency anemia. Urinalysis revealed hematuria and pyuria, and the urine culture confirmed colonization of Escherichia coli. Computed tomography revealed an irregularly shaped 5.5 cm hyperdense calculus in the urinary bladder. Open cystolithotomy was done to extract the calculus, which was later incidentally revealed to be encrusting a migrated intrauterine device.

CONCLUSIONS

This case highlights the rare potential for intrauterine devices to migrate to the urinary bladder, leading to calculus formation, which, in this case, was discovered in this patient nine years post-insertion. The intrauterine device perforation into the urinary bladder was due to delayed inflammatory migration. This case underscores the critical need for both patient and physician education in low-resource settings on the warning signs of intrauterine device migration, including new-onset irritative lower urinary tract symptoms, hematuria, and missing intrauterine device threads, ensuring routine scheduled follow-ups, patient self-checks, and timely imaging can aid in early detection and prevent complications associated with intrauterine device migration.

Transurethral migration of vesical gossypiboma following open prostatectomy: a case report and review of the literature

Gossypiboma refers to a retained surgical sponge within the body after a surgical procedure. It is commonly reported in the abdominal cavity and is rare in the urinary bladder (vesical gossypiboma). There are only a few reports of vesical gossypiboma in the literature, and patients often present long after the initial surgery. Features of recurrent urinary tract infections (UTIs) are common symptoms of vesical gossypiboma, but transurethral migration is a rare manifestation. We present a case of vesical gossypiboma with transurethral migration in a 64-year-old patient who underwent an open trans-vesical prostatectomy 3 months before visiting our hospital. He was repeatedly treated for recurrent UTIs until the diagnosis of vesical gossypiboma was finally confirmed using cystourethroscopy. We successfully removed the retained gauze via open bladder exploration. Gossypiboma can easily be overlooked, and we urge urologists to maintain a high index of suspicion to diagnose similar cases promptly.

Co-infection of COVID-19 and pulmonary tuberculosis: a case report on lung and liver damage

Background

Co-infection with COVID-19 and tuberculosis (TB) often leads to symptoms such as fever, coughing, low blood pressure, altered blood cell counts, elevated liver enzyme levels, and reduced hemoglobin. Additionally, there is significant concern regarding lung damage caused by severe COVID-19, which increases susceptibility to TB.

Case presentation

On May 19, 2022, a 50-year-old retired Black African woman visited the emergency department with a sore throat, a 12 kg weight loss over the previous month, and shortness of breath that began a day earlier. She also experienced muscle weakness, fever, a productive cough, loss of appetite, headache, and 3 days of night sweats. Chest auscultation revealed reduced breath sounds in the right upper and middle lung regions. A throat swab polymerase chain reaction (PCR) test confirmed a COVID-19 diagnosis 36 hours later. During her hospital stay, the patient required continuous oxygen therapy via a nasal cannula at 4 L per minute for the first 5 days. She remained on anti-tubercular medication and received intravenous ceftriaxone at a dosage of 1 g daily for 5 days to prevent hospital-acquired infections.

Clinical discussion

Patients with active pulmonary tuberculosis (TB) have a poorer prognosis and are at risk of developing COVID-19. Both TB and COVID-19 are infectious diseases that primarily target the lungs. Mortality rates associated with COVID-19 are notably higher in individuals with active pulmonary TB.

Conclusion

COVID-19 and Mycobacterium tuberculosis are among the most critical global health challenges. TB infection is linked to a heightened risk of severe COVID-19 outcomes.

Two adult cases of canal of Nuck cyst: diagnosis and treatment

Abnormalities of the canal of Nuck are rare congenital defects in females, typically repaired in childhood. Canal of Nuck cysts or hydroceles often present as fluctuating inguinal masses, commonly misdiagnosed as hernias. Ultrasonography is key for accurate diagnosis, and surgical excision is usually the primary treatment. We present two cases of canal of Nuck cysts in female patients, aged 28 and 32, with no significant past medical history. The 28-year-old underwent surgical excision, while the 32-year-old opted for a watchful waiting approach. Both cases had unremarkable follow-up, with no complications. This report highlights the importance of considering a broad differential diagnosis when evaluating inguinal masses or pain, including canal of Nuck.

Removal of a 'cold-welded' femoral head lag screw in a nail combination

We present a case of a femoral head lag screw 'cold welded' to an intramedullary nail (IMN) in a female in her 20s during exchange femoral nailing of a subtrochanteric femoral osteotomy non-union. We subsequently developed a reverse spiral-fluted bolt extraction socket, designed to engage the outer wall of a bolt or screw. The lag screw was removed from the Smith and Nephew Meta-Tan IMN, 1 week later, and exchange nailing was successfully completed. This case report describes a technically challenging situation of a cold-welded femoral head lag screw during a complex revision. This report introduces a novel removal device and technique for such cases.

Single-Stage Management of Benign Thyroglossal Duct Cyst in the Setting of Papillary Thyroid Cancer

INTRODUCTION

The presented case is unique as the patient presented with biopsy-proven papillary thyroid carcinoma (PTC) of the thyroid gland with an incidentally found concurrent thyroglossal duct cyst (TGDC) on computed tomography (CT). The patient was managed with a one-stage procedure.

CASE REPORT

A 26-year-old previously healthy female presented with a progressively enlarging neck lump over 6 months. Thyroid ultrasound revealed a 2.6 cm mass of the inferior right thyroid lobe, classified as TIRADS 5. Subsequent fine-needle aspiration of the mass confirmed PTC (Bethesda VI). A neck CT scan revealed a calcified, heterogeneous 2.6 cm mass in the right thyroid lobe along with a cystic lesion at the base of the tongue with likely extension into the floor of the mouth, consistent with a TGDC. The patient underwent simultaneous thyroidectomy and TGDC excision in a single operative session after discussion due to concerns for possible malignancy within the thyroglossal duct as well as possible enlargement of the TGDC leading to dyspnea or even dysphagia. At follow-up, the patient was doing well.

DISCUSSION

TGDCs are typically benign which is consistent with the findings in this case. The presence of biopsy-proven glandular thyroid cancer and an incidentally found TGDC present a unique challenge in surgical decision-making. In this case, there were no signs on imaging of malignancy of the TGDC so it was likely a primary glandular PTC. In this case, a one-stage procedure, combining total thyroidectomy and Sistrunk procedure, was selected based on the confirmed diagnosis of PTC with slight potential for synchronous cancer in the TGDC as well as prophylaxis against future aerodigestive tract symptomatology caused by the TGDC.

Colon obstruction due to sunflower seed bezoar: A case report

INTRODUCTION

This case report aims to present a rare case of colon obstruction caused by a bezoar in a 15-year-old teenager. The significance of this case lies in the rarity of such obstructions and the necessity for early diagnosis and appropriate intervention to optimize patient outcomes.

PRESENTATION OF CASE

A 15-year-old teenager presented with colicky abdominal pain, abdominal distension, nausea, vomiting, and rectal bleeding for three days. Initial investigations yielded normal results, but a digital rectal examination and abdominal X-ray suggested colon obstruction. The patient underwent surgical consultation and emergent laparotomy, during which a bezoar was identified and successfully removed endoscopically. Colonoscopy revealed that the bezoar was composed of shelled sunflower seeds, which correlated with the patient's dietary history.

DISCUSSION

This case highlights the rarity of bezoars causing colon obstruction. Early recognition and appropriate intervention are crucial for optimizing patient outcomes and preventing complications associated with colon obstruction.

CONCLUSION

This report highlights the importance of considering bezoars as a differential diagnosis in patients with colon obstruction. Early identification and treatment can prevent serious complications and improve clinical outcomes.

Rare Encounter With Hepatic Epithelioid Hemangioendothelioma: A Case Report

Malignant hepatic epithelioid hemangioendothelioma (HEHE) is a rare vascular tumor with variable malignant potential, often affecting middle-aged individuals. Hepatic involvement is uncommon, presenting diagnostic challenges due to overlapping imaging features with other liver pathologies. We report a case of a 35-year-old female with HEHE initially presenting with epigastric pain and an incidental liver mass. Imaging revealed multifocal hepatic lesions, confirmed as HEHE through biopsy and immunohistochemistry. Despite initial stability on tamoxifen, disease progression occurred after seven years, manifesting as an increase in the size and number of hepatic lesions. Hepatic transplantation was planned, which was refused by the patient. Subsequently, the disease progressed to a large confluent hepatic mass with calcifications, lymphadenopathy, and pulmonary metastases. Systemic chemotherapy was henceforth initiated. This case underscores the importance of a multimodal approach integrating imaging, histopathology, and tailored therapeutic strategies for diagnosing and managing HEHE. Early detection and comprehensive management are critical to improving outcomes where liver transplantation offers a potential cure.

A Case Report of Cutaneous Larva Migrans Treated With Naakupoochi Kudineer, a Traditional Siddha Medicine

Cutaneous Larva Migrans (CLM) is a helminthic infection that is prevalent in tropical and subtropical regions. It is caused by zoonotic hookworms, predominantly the Ancylostoma species, which infrequently infect humans. Hookworms primarily inhabit the small intestine of canines and felines, where adult worms release eggs that are excreted in the host's feces into the environment. Human infections occur through direct contact with contaminated soil, with humans serving as dead-end hosts for parasites. Clinically, CLM presents as erythematous, serpiginous, and intensely pruritic cutaneous eruptions caused by penetration and migration of larvae. Although the infection is generally confined to the skin, rare instances of larval migration to the lungs can result in more severe complications. A 71-year-old male presented with a progressive, curvilinear, erythematous track in the left upper quadrant region of the abdomen, accompanied by intense pruritus, a burning sensation, and a localized nodular lesion. Erythema was observed approximately 3-4 cm from the site of larval penetration, with the serpiginous tract extending approximately 10 cm in length. The diagnosis of cutaneous larva migrans (CLM) was established based on the characteristic clinical presentation. The Siddha herbal formulation Naakupoochi Kudineer was administered 60 ml twice after meals for seven days, resulting in gradually reducing symptoms and resolving the tract over the following weeks. This study highlights the safety and effectiveness of a Siddha herbal formulation in the treatment of CLM.

Neglected obturator hip dislocation with associated avascular necrosis of the femoral head in adolescent, a rare case report

INTRODUCTION AND IMPORTANCE

Neglected obturator hip dislocation is rare and possesses a dilemma in management to an orthopedic surgeon however total hip arthroplasty yield good to excellent outcome.

CASE PRESENTATION

23 years male, with four-month history of painful right hip associated with limping and inability to use the right lower limp, following a motor traffic crush and managed traditionally prior visiting our clinic, he had no any other associated injuries and medical history was uneventfully. On clinical evaluation, he was alert and oriented, with stable vitals, limping on walking with a stick, his right hip joint was slightly flexed, abducted and externally rotated, with limited hip range of motion and discrepancy of 3 cm. Pelvis X-ray revealed anterior inferior right hip joint dislocation, shallow acetabula, and features suggestive of avascular necrosis of head and neck. A diagnosis of neglected right obturator hip dislocation with avascular necrosis of the head and neck was made and advised for Total Hip Arthroplasty; however, patient and family refused the plan due to their financial constraints and traditional believes in spite of proper discussion provided, he was advised on weight bearing as tolerated, using crutches, and follow up visits, however he was lost to follow up.

DISCUSSION

Our case report is unique due to its rarity in occurrence and it was neglected due to traditional believes in their family and poor health seeking behavior. Total hip arthroplasty was considered as a treatment of choice in our case; however, the patient and family refused the option due to financial constraints and traditional believe and trust to bone settlers.

CONCLUSION

A neglected obturator hip dislocation is very rare and in spite of a dilemma on treatment, total hip arthroplasty is recommended for this case. Community health education should be considered so that hip dislocation being managed as early as possible.

Viable Ileosigmoid Knotting, A Very Phenomenon Finding and Rare Cause of Intestinal Obstruction: A Case Report and Literature Review

Introduction

Ileosigmoid knotting is the wrapping of an active component of either the ileum or the sigmoid colon over each other. It is an unusual cause of intestinal obstruction, accounting for 1-2% of cases of all mechanical obstruction in the majority published literatures. A viable knot is a unique phenomenon of this seldom cause of bowel obstruction.

Case Presentation

A sixteen-year-old female patient presents with a complaint of central abdominal distension and obstipation of 12-hour duration. Later, she also developed abdominal cramps and vomiting of ingested matter. Her vital signs were all in the normal range, and the abdominal examination was positive for a grossly distended abdomen with mild upper and central abdominal tenderness. The ileosigmoid knotting was clearly visible on the computed tomography. Emergency exploratory laparotomy was performed, and a viable ileosigmoid knot was identified. Unknotting, derotation, and decompression of the sigmoid colon were performed. The postoperative course was uneventful.

Discussion

Ileosigmoid knotting is a rare, life-threatening cause of intestinal obstruction with rapid progression to intestinal vascular compromise and gangrene. It is a hyperactive segment of ileum that winds around the pedicle of the redundant sigmoid colon, resulting in a closed-loop obstruction. There are different classification schemes of ileosigmoid knotting depending on the active component of the knot and based on the viability of the bowel and physiology of the patient. Preoperative diagnosis of this condition is often challenging and usually confirmed intraoperative.

Conclusion

A high index of suspicion and prompt surgical exploration are crucial for the best outcome of the patient. Despite being a rare cause of intestinal obstruction, ileosigmoid knotting poses a significant morbidity and mortality to the patient. Management of a patient with viable ileosigmoid knotting is controversial, as some scholars suggest non-resective options and others recommend resective treatment as a recurrence preventive measure.

Developing a tool for assessing and communicating the expected difficulty of performing a tracheostomy

There are no guidelines for assessing and communicating the expected difficulty of a tracheostomy, leading to difficulties planning a percutaneous approach in intensive care or referring onwards to surgical teams. A Delphi process was used to develop a tool containing metrics which are relevant for either specialty and can be universally assessed by both. Palpable tracheal rings, prior surgery or radiotherapy to the anterior neck, uncorrectable clotting or platelet dysfunction, ability to extend the neck freely, and overlying vessels visible, palpable or on imaging were all found to be relevant. It is hoped this tool will aid communication between specialties.

Seymour fracture management and functional outcome assessment: a case report

Seymour fracture, a rare entity whose management is complex due to the mechanism and rate of complications. We present a case to describe our management approach. A 14-year-old child with a laceration secondary to a boot crush of 1 day of evolution. The physical examination reveals a lacerated fifth digit involving skin, nail bed, and distal phalange. Radiography was performed, Salter-Harris I fracture was diagnosed. Early surgical intervention was performed, irrigation, nail bed repair, debridement, open reduction, and osteosynthesis with K-wires. The patient was referred to rehabilitation and an antibiotic scheme of amoxicillin-clavulanic plus clindamycin was given. After 8 weeks Kirschner wire was removed, and no complications were reported. A fingertip injury outcome score was performed obtaining 11 points. Early intervention is a must. The use of Fingertip Injuries Outcome Assessment Score is vital for followup in children. Collaboration across disciplines is key to improving outcomes.

Early Detection for Better Patient Outcome: A Case Report on Two Patients Presenting With Fibrodysplasia Ossificans Progressiva at Tikur Anbessa Specialized Hospital, Ethiopia

Fibrodysplasia ossificans progressiva is an ultrarare disorder of endochondral ossification. It is unfamiliar to most care providers in low-income countries such as Ethiopia. Even though the clinical presentation is typical, most cases remain misdiagnosed in our region. Moreover, we hypothesize that many such cases undergo unnecessary or harmful interventions for a painless lump. In Ethiopia, with a population of approximately 120 million, only one case has been reported in the literature so far. We present two cases that were referred to our institution for a biopsy of a mass. This report is aimed at summarizing the typical presentation of the disease and at highlighting the harmful interventions one should avoid in such patients. We also hope that this report serves as an entry point to try to find more patients with this similar condition early in their clinical course. Furthermore, we believe that in order to lessen the overall impact of the illness, it is crucial to provide caregivers with health education about the causes of disease flare-ups.

Laparoscopic surgery for synchronous double colorectal cancer with obstruction, plus small B cell lymphoma: a case report

Synchronous colorectal cancer is a rare disease. It remains challenging for diagnosis and treatment. This paper reports a case of a 75-year-old Chinese male patient presenting with intestinal obstruction, alongside primary thrombocytopenia and a diagnosis of small B-cell lymphoma. Computed tomography scans revealed space-occupying lesions in both the sigmoid colon and ascending colon. The patient initially underwent a transverse colostomy procedure to alleviate the intestinal obstruction and then underwent laparoscopic radical tumor resection. The patient exhibited favorable prognosis and maintained satisfactory bowel function at the nearly 8 months' postoperative follow-up. Multiple colonoscopies are crucial in the management of synchronous colorectal cancer, and radical surgical resection remains the sole curative option when surgical intervention is deemed tolerable. A thorough preoperative examination and evaluation are crucial for successful surgery. The selection of surgical procedures for synchronous colorectal cancer should be based on the patient's medical condition.

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.

Complete traumatic urethral cut and vesicovaginal fistula in a 3-year-old girl, managed by Mitrofanoff procedure: a case report

We report a 3-year-old patient with urethral cut injury and iatrogenic vesicovaginal fistula following a pelvic fracture; managed with Mitrofanoff procedure. Our patient presented with straining on urination with continuous colorless discharge on her diaper for the past 4 months. Investigations identified vesicovaginal fistulization making a definitive diagnosis of complete urethral injury. It was managed with the Mitrofanoff procedure to preserve the patient's urinary continence. Our case is to our knowledge the youngest reported case of a complete traumatic urethral cut in a female; an already rare encounter in this population. This is also the first such case to be managed via the Mitrofanoff procedure. Although the management was delayed, it was successful.

Stone-free rate of laser lithotripsy for large pediatric stones: 15-year experience from a tertiary endourology pediatric center

Background

Pediatric urolithiasis, while less common than in adults, is increasing in incidence. However, current guidelines on the optimal management of this condition vary. Technological advances have led to improvements in the quality and size of ureteroscopes, thus enabling their use in children. Despite this, there remains some hesitancy about using ureteroscopic lithotripsy in the pediatric population, particularly in cases of large stones ⩾10 mm.

Objectives

In this study, our aim was to evaluate the efficacy and safety of ureteroscopy and laser stone fragmentation (URSL) for managing pediatric patients with a cumulative stone burden of ⩾10 mm in our tertiary referral center.

Methods

A dataset was collected of pediatric renal tract stone patients treated at a single tertiary urological center between June 2010 and May 2024 (15 years). Pediatric patients undergoing URSL procedures for a minimum cumulative stone burden ⩾10 mm were included. A retrospective analysis of the dataset was conducted. The primary outcomes measured were stone-free rates (SFR), complications classified according to the Clavien-Dindo classification, and hospital length of stay.

Results

A total of 61 pediatric patients with a mean age of 10 years (range: 2.3-16) underwent 83 URSL procedures in a tertiary endourology pediatric center over a 15-year period (2010-2024). The median initial stone burden was 17 mm (IQR: 12.5-24 mm), acquired from preoperative ultrasonography (USS). Results showed a first-pass SFR of 63.9% and a cumulative SFR of 93.4% (on USS) following one or multiple URSL procedures (1.4 procedures/patient). Immediate postoperative complications were minimal, with 6% experiencing complications classified as Clavien-Dindo I or II. The average hospital length of stay was 1.4 days.

Conclusion

The findings in this study support that URSL is effective in treating pediatric urolithiasis, even for larger stone burdens. Further research is needed to standardize guidelines and optimize management strategies in this population.

Refractory Gastric Outlet Obstruction Due to a Duodenal Stricture in the Setting of a Cholecystoduodenal Fistula

Gastric outlet obstruction (GOO) is a clinical condition in which an underlying disease process leads to a lack of gastric emptying. The presentation and management of GOO due to a variety of benign and malignant causes have been researched; however, limited medical literature exists on the presentation and management of refractory GOO caused by a duodenal stricture secondary to a cholecystoduodenal fistula. This case report highlights the diagnostic challenges and the significance of timely intervention. This case of a 66-year-old female with GOO refractory to multiple endoscopic interventions demonstrates the presentation and management of such a rare cause of GOO and highlights the importance of surgical consultation in persistent GOO. The etiology of GOO varies widely, requiring a range of treatments from medical management to surgery. This case underscores the importance of identifying the cause to ensure effective treatment. Cholecystoduodenal fistulas are rare but significant, often necessitating surgical intervention when endoscopic procedures fail. Our patient had a duodenal stricture due to a cholecystoduodenal fistula, indicating the necessity for surgical consultation.

Intraoperative indocyanine green with ultrasound-guided localization as prodigious adjuncts explicating negative margin in functional insulinoma: A case report

INTRODUCTION AND IMPORTANCE

Insulinomas are rare pancreatic neuroendocrine neoplasms with an incidence of one to four cases per million annually and a 5 % to 10 % association with hereditary multiple endocrine neoplasia type-1. While most insulinomas are benign and well-encapsulated, approximately 6 % may have malignant potential. Intraoperative localization remains a vital component of treatment, often facilitated by modern imaging techniques like intraoperative ultrasound and fluorescence modalities.

CASE PRESENTATION

A 52-year-old woman was referred to Kathmandu Medical College with generalized weakness, recurrent headaches, and fatigue relieved by food intake. She had a history of hypoglycemia-induced abnormal body movements and loss of consciousness. After biochemical and imaging evaluations, she was diagnosed with pancreatic insulinoma. Based on the higher affinity of neuroendocrine tumoral cells for Indocyanine Green compared to normal pancreatic cells, the patient underwent Indocyanine Green-directed laparoscopic-assisted pancreaticoduodenectomy managed perioperatively with subcutaneous octreotide. She had an uneventful postoperative period and was discharged on the eighth day.

DISCUSSION

Insulinomas present a unique diagnostic and therapeutic challenge, especially in cases of sporadic occurrence. Surgical resection is the mainstay of treatment, with enucleation preferred for benign tumors. In this case, fluorescence-guided surgery and intraoperative ultrasound aided in accurate localization and successful excision.

CONCLUSION

Insulinomas, though rare, require prompt diagnosis and surgical intervention to prevent malignancy and metastasis.

Open Surgical Repair in a Patient With Loeys-Dietz Syndrome and Extensive Vascular Compromise: A Case Report and Literature Review

Loeys-Dietz syndrome (LDS) has been associated with multiple vascular abnormalities involving the entire arterial tree. However, limited reports regarding compromise in the aortoiliac and femoral bifurcation are available. Further, recommendations for optimal approach, thresholds for diameter at the time of surgery, and surveillance are also limited. We present a case of a 67-year-old male patient with LDS and aneurysmal aortoiliac and enlarging common femoral arteries aneurysms, who underwent open surgical repair. His past surgical history included multiple vascular interventions for lower extremity claudication and bilateral hip replacements. The right hip arthroplasty was previously removed due to infection. From the vascular standpoint, the patient underwent staged endovascular left hypogastric artery embolization and open aorto-bi-profunda bypass with a Rifampin-soaked Dacron graft. At 5-month follow-up, he remains asymptomatic with healed incisions and patent bypasses. This case highlights the challenges in managing peripheral aneurysms in LDS patients, emphasizing the need for tailored treatment strategies. While open repair is preferred, endovascular options may be considered in selected cases. Surveillance remains critical with annual cross-sectional imaging. Surgical planning is intricate due to comorbidities, anatomical complexities, and previous surgical infection. Surveillance of these patients must be strict as multiple vascular and non-vascular complications may arise. Therefore, collaborative decision-making is essential for optimal outcomes in this known high-risk population with connective tissue disorders.

Retropharyngeal carotid body tumor: A challenge in terms of surgical technicality

INTRODUCTION AND IMPORTANCE

Carotid body tumors are rare neoplasms originating from neural crest cells, commonly presenting as a painless, slow-growing mass in the lateral neck. The retropharyngeal variant of these tumors is particularly uncommon, with an incidence of approximately 2.6 %.

CASE PRESENTATION

A 50-year-old man presented to the Otolaryngology Department at Rasoul Akram Hospital with a painless 3 × 4 cm mass on the right side of his neck, which had gradually increased in size. Clinical examination revealed a pulsatile, nontender mass exerting pressure on the right lateral aspect of the pharynx. A CT scan showed a well-defined, enhancing retropharyngeal mass located between the internal and external carotid arteries on the right side, suggestive of a carotid body tumor. The patient underwent surgical resection, achieving complete tumor removal without complications. A four-year follow-up revealed no signs of tumor recurrence.

CLINICAL DISCUSSION

Carotid body tumors are indolent masses. Diagnosis typically involves clinical evaluation, supplemented by imaging techniques such as ultrasound, CT scan, and MRI, which aid in delineating the tumor's morphology and dimensions. Surgical resection remains the preferred treatment, aiming to achieve complete tumor excision while preserving blood flow, avoiding damage to critical organs and nerves, and safeguarding brain function.

CONCLUSION

The retropharyngeal location of carotid body tumors represents an exceptionally rare variant, and their surgical resection presents a significant challenge for surgeons. This case report offers crucial insights into the surgical management of a retropharyngeal carotid body tumor, serving as a valuable resource for future surgeons who may face similar cases.

A simplified approach to managing a complex infected left ventricular pseudoaneurysm

BACKGROUND

Left ventricular pseudoaneurysm (LVP) is a rare but life-threatening condition resulting from acute myocardial infarction, trauma, bacterial infection, or previous cardiac operations. Diagnosis can be challenging as LVPs remain asymptomatic or present with nonspecific clinical symptoms. Early diagnosis is crucial to prevent rupture and recurrent septicemia. Various imaging techniques can aid in diagnosis, including transthoracic echocardiography (TTE), transesophageal echocardiography, computed tomography angiography, and cardiac magnetic resonance imaging.

CASE REPORT

A 72-year-old man with a history of coronary artery bypass grafting presented with episodes of recurrent fever. An infected LVP was diagnosed using TTE and thoracic Computed tomography (CT) angiography. The patient underwent removal of the infected hematoma with excision and repair of the pseudoaneurysm via left anterior thoracotomy with peripheral cannulation. The neck of the pseudoaneurysm was repaired with a Dacron patch. Post-operative TTE showed no residual pseudoaneurysm tissue, and the patient recovered well.

CONCLUSION

Our experience with the anterior thoracotomy approach with peripheral cannulation in specific cases of infected LVPs has yielded promising results. However, it is crucial to recognize that this approach may not be universally suitable.

An intracranial odyssey: pediatric ganglioneuroma arising from the trigeminal ganglion: a case report and review of the literature

BACKGROUND

Ganglioneuroma represents an uncommon benign tumor arising from the sympathetic nerves, and its development from the fifth nerve is an infrequent entity. Few ganglioneuromas arising from the fifth nerve have been discussed in literature. The authors describe the second pediatric ganglioneuroma arising from the fifth nerve.

CASE PRESENTATION

A 7 year-old Asian male suffering from left-sided facial paresthesia, accompanied by several episodes of complex seizures over the past 2 years, presented to our clinic. The patient also complained of sudden unconsciousness and concurrent upward gaze lasting less than a minute. A brain computed tomography scan and magnetic resonance imaging revealed an isodense lesion containing focal calcifications measuring 31 × 28 mm and a solid mass extending from the pontine surface to Meckel's cave, probably originating from the fifth nerve or its root entry zone. The lesion was mildly hypointense on T1-weighted sequences and hyperintense on T2-weighted and fluid attenuated inversion recovery sequences. Gadolinium injection revealed only minimal heterogeneous enhancement. Histopathologic and immunohistochemical findings were consistent with ganglioneuroma. A lateral approach via retrosigmoid incision and suboccipital lateral craniectomy toward the cerebellopontine angle was performed under neuromonitoring supervision, and the postoperative period was uneventful.

CONCLUSION

Although ganglioneuroma arising from the fifth nerve is an extremely rare entity, it should be considered when diagnosing lesions in Meckel's cave or the cerebellopontine angle cistern.

Anterior communicating artery aneurysm with concomitant A2 segment triplication and anterior communicating artery fenestration, A rare case series on microsurgical treatment

Introduction and importance

There are few cases of multiple simultaneous anterior communicating artery (AComA) aneurysms with A2 triplication and AComA duplication.

Cases presentation

(1) A fenestrated AComA with a saccular aneurysm (neck diameter 9 mm; dome height 8 mm) projecting superiorly from the distal AComA branch, as well as an anomalous artery arising from the posterior surface of the same AComA. (2) A duplicate AComA with a saccular aneurysm (neck diameter of 5 mm; dome height of 9 mm) projecting superioposteriorly from the distal AComA branch, as well as an anomalous artery arising from the anterior surface of the same AComA was diagnosed. Both were treated by microsurgical titanium clip occlusion.

Clinical discussion

Anatomical variations are believed to enhance the risk of anterior communicating artery (AComA) aneurysms, accounting for ~30% of all intracranial aneurysms. In such circumstances, the goal is to occlude the aneurysmal lesions safely while preserving the patency of other branches.

Conclusion

AComA aneurysms accompanied by anomalous triplicated A2 and fenestrated AComA are rare and challenging. Such complex cases response best using microsurgery using titanium clip occlusion with durable favorable outcomes.

Bart syndrome with musculoskeletal deformity: a rare case report

Introduction

Bart syndrome is a rare genetic disorder characterized by epidermolysis bullosa (EB), aplasia cutis congenita, that is congenital local absence of skin and nail abnormalities.

Case Presentation

The authors herein, present a case of a 14-year-old boy with Bart syndrome. The syndrome was diagnosed clinically. On examination, multiple generalized blisters were present and absence of nails in the toes of both feet and the middle finger of the left hand, which was associated with musculoskeletal deformity.

Discussion

Bart syndrome, an inherited autosomal dominant disorder, is an exceedingly rare disorder. Musculoskeletal deformity is an uncommon presentation of this syndrome. It is mostly associated with Dystrophic type of EB. It is mostly a clinical diagnosis; however, histopathological study, direct immunofluorescence, and genetic testing helps in diagnosing the type of EB.

Conclusion

The absence of skin in a localized area at birth is a crucial indicator for diagnosing Bart syndrome at birth, which later heals and can obscure the diagnosis. Early diagnosis and conservative management prevent the disease progression and complications.

Single-Stage Endoscopic Repair of Pediatric Basal Encephalocele: A Comprehensive Multimedia Case Report

BACKGROUND AND IMPORTANCE

Basal encephaloceles are the result of a concomitant cranial and dural defect that allows for inferior displacement of cerebral tissue, meninges, and cerebrospinal fluid into the paranasal sinuses and outside the cranial vault. This work illustrates a step-by-step surgical approach of a successful single-stage, endoscopic repair of a congenital basal encephalocele in a 10-year-old child, using a free mucosal middle turbinate graft that provided effective results without utilization of traditional open reconstructive techniques or vascularized flaps.

CLINICAL PRESENTATION

A previously healthy 10-year-old male with a history of unilateral clear rhinorrhea was admitted as an inpatient because of an acute episode of nausea, vomiting, and confusion, accompanied by fever, diplopia, and bilateral abducens nerve palsies. Preoperative imaging revealed a 2-cm right-sided intranasal mass accompanied by a subcentimeter skull base defect spanning the lateral lamella. After completing a course of intravenous antibiotic therapy for 1 week after a negative lumbar puncture to ensure clearance of intracranial infection, the decision was made to proceed with definitive endoscopic skull base repair to obviate recurrent bacterial meningitis episodes and potential neurological complications.

CONCLUSION

This study demonstrates technical feasibility of a single-stage endoscopic endonasal approach for pediatric basal encephalocele resection and repair which minimizes craniofacial morbidity associated with traditional open approaches and sinonasal morbidity associated with local pedicle-based flaps for small cranial base defects in this unique patient population.

Sympathetic Ophthalmia Following an Evisceration Surgery-A Case Report

Sympathetic ophthalmia (SO) is a rare, bilateral, granulomatous, panuveitis following perforating trauma or surgical intervention in one eye. Here, and to the best of knowledge, we report the first case of SO following an evisceration surgery in Pakistan. A 32-year-old, Pakistani, female presented with pain and decreased visual acuity in her right eye, at Civil Hospital, Karachi, 1 week after an evisceration surgery was performed on her left eye, following corneal perforation due to unresolved keratitis. Diagnosis of SO was made on the basis of clinical presentation and confirmed by slit lamp examination which revealed mutton fat keratic precipitates, posterior synechiae, and optic disc swelling. She was administered high-dose corticosteroids to which she did not respond. She was then prescribed methotrexate which resolved the inflammation and improved visual acuity. Initiating prompt treatment for the sympathizing eye led to effective management of the patient and prevented complete blindness.

The most lethal human protozoan parasite is plasmodium falciparum: severe malaria-associated acute renal failure - a case report

Introduction and importance

Malaria continues to be a significant global public health problem, particularly in endemic nations. The most common cause of acute renal failure is a Plasmodium falciparum infection.

Case presentation

A 28-year-old male was brought into the emergency room with significant complaints of fatigue, chills, fever, and a lack of appetite. The patient had no prior history of malaria. He was not given any antimalarial medication as prophylaxis while traveling to his workplace. As a result of laboratory investigations to identify malarial parasites in peripheral blood using thin and thick smears, malaria parasites were found in the patient's blood. At the border of the colitis, the liver was palpable. Both the chest radiograph and abdominal ultrasonography were clear. His level of consciousness assessment indicated a Glasgow coma scale reading of 10 out of 15. He received 1000 ml of normal saline solution with 40% glucose solution as part of his supportive care. He received intravenous artesunate 60 mg (2.4 mg/kg) when he was admitted to an ICU, and then every 12 and 24 h for the next 3 days (a total of three doses, 540 mg).

Clinical discussion

A typical symptom of severe malaria is acute kidney injury, which also carries its own risk of death. In regions with active transmission, Plasmodium falciparum is recognized as a significant contributor to acute renal damage.

Conclusion

The mechanism proposed for kidney injury by severe malaria is hemodynamic dysfunction, followed by inflammation and immunological dysregulation in the patient in this study. He had reduced serum sodium levels within the red blood cells, which led to calcium influx into the cell, altering the red blood cell's deformability.

COVID-19 is associated with high blood glucose levels: diabetic neuropathy during the SARS-CoV-2 pandemic: a case report

Introduction and Importance

The nerves in the legs and feet are most frequently damaged by diabetic neuropathy. The COVID-19 infection is associated with a high risk of neuropathy symptoms.

Case Presentation

On 12 July 2022, a 58-year-old black female retiree with significant symptoms of numbness and muscle weakness in the hands and legs was brought into the emergency room. Seventeen years prior, she was diagnosed with type 2 diabetes mellitus. Metformin 1.5 g twice a day and glibenclamide 10 mg twice a day were part of her therapy regimen. When she was admitted to the emergency room, she described a one-day history of shortness of breath, frequent urination, excessive thirst, hyperglycemia, excessive appetite, fever, headache, and dehydration. A chest radiograph showed bilateral diffuse, patchy airspace opacities that could be caused by multifocal pneumonia or viral pneumonia. She started receiving 1000 ml of fluid resuscitation (0.9% normal saline) as soon as she was moved to an ICU, along with a drip-in insulin infusion.

Clinical Discussion

Diabetes, infections like COVID-19, poor vitamin levels, and other factors can all contribute to diabetic neuropathies. According to the Centers for Disease Control and Prevention, patients with type 2 diabetes mellitus are much more likely to experience severe morbidity and death from coronavirus disease.

Conclusion

Symptoms of diabetic neuropathy continued for months after a COVID-19 infection test resulted in a positive result.

Case Report: A rare case of antenatally diagnosed mature adrenal teratoma in an infant: insights and literature review

Teratomas are germ cell tumors that arise from the derivatives of the three germ cell layers. They are categorized into subtypes by the extent of maturation, with mature teratomas being the most common subtype. While they can arise in various extragonadal regions, including the retroperitoneum, their occurrence in the retroperitoneal space is extremely rare. It is even more exceptional for these tumors to be located within the adrenal gland. In this report, we describe an 18-day-old female infant who presented with a left suprarenal mass. The mass was detected during prenatal screening via ultrasound at 30 weeks of pregnancy. Evaluation after birth, including a chest and abdomen computed tomography (CT) scan, revealed a large, well-defined left suprarenal mass. The mass was surgically resected and found to measure 9 cm × 7 cm × 5 cm. Histopathological examination confirmed a cystic mature teratoma containing a variety of well-differentiated tissues. The patient has shown excellent progress over the 1-year follow-up, with no evidence of recurrence. Only a few cases of mature adrenal teratoma have been reported, highlighting the importance of this case report.

Absorbable Haemostatic Artefacts as a Diagnostic Challenge in Postoperative Follow-Up After Oncological Resection in Head and Neck Tumours: Systematic Review of Current Literature and Two Case Reports

Objectives: This article aims to define the clinical, radiological, and pathological characteristics of non-resorbed oxidised cellulose-induced pseudotumours to raise awareness among surgeons and radiologists, to prevent misdiagnosis, and avoid unnecessary invasive procedures and delays in adjuvant oncological treatments. Methods: A systematic review of oxidised resorbable cellulose (ORC)-induced pseudotumours of the head and neck was conducted following PRISMA 2020 guidelines. Articles were retrieved from PubMed, Scopus, Cochrane, and Web of Science. Two ORC-induced pseudotumour cases from the Maxillofacial Surgery Department of Verona are also presented. Results: In most cases, pseudotumours were monitored using ultrasound. Further investigations included CT, MRI, PET-CT, and scintigraphy. Ultrasound images showed stable, elongated, and non-homogeneous masses. In CT scans, pseudotumours showed a liquefied core, and none or only peripheral enhancement. In MRI, pseudotumours presented none or only peripheral enhancement, and a heterogeneous pattern in T2-weighted images. 18-FDG PET scans demonstrated an FDG-avid mass (SUV 7.5). Scintigraphy was inconclusive. Cytology indicated a granulomatous reaction without neoplastic cells. Where surgical excision was performed, a granulomatous reaction with the presence of oxidised cellulose fibres was confirmed. Conclusions: Surgeons should consider artifacts from retained oxidised absorbable haemostatic material when suspecting tumour recurrence or metastasis on postoperative imaging, especially if certain features are present. Fine-needle aspiration cytology (FNAC) is a useful diagnostic tool, but surgical excision may be needed if FNAC is inconclusive or impractical. Collaboration between surgeons and radiologists is essential to avoid misdiagnosis and delays in treatment. Documenting the use and location of haemostatic material in operative reports would aid future understanding of these phenomena.

Case Report: Combined Laparoscopic Perineal Hernia and Abdominal Parastomal Hernia Repair With a Mesh After Abdominoperineal Resection: A Video Vignette and Review of the Literature

BACKGROUND

Postoperative perineal hernia (PH) is an uncommon complication after abdominoperineal resection (APR). Different techniques have been described in literature and there is no consensus regarding the optimal repair approach. In the present study, we reported a case of a laparoscopic combined repair of a perineal hernia and abdominal parastomal hernia (PSH) with mesh. Studies have shown that the prosthetic PSH and PH repair can be performed at the same time by laparoscopy with the same trocars positioning, adding the advantages of minimally invasive surgery and avoiding large laparotomy.

METHODS

A literature search in Pubmed was performed. All articles in English describe laparoscopic repair of combined perineal and parastomal hernias. A case presentation of an 83-year-old woman with combined parastomal and perineal hernias after abdominoperineal resection (APR) shown in a video vignette is provided.

RESULTS

Three single patient case reports published between 2016 and 2023 were found in literature. Two patients with rectal cancer underwent APR procedure, while the third patient underwent an anterior pelvic exenteration (APE) for carcinoma of the urinary bladder (CUB). The laparoscopic procedures did not require conversion and all procedures successfully closed the defect using a mesh. In our case, the operative time was 3 h with the major time spent for PH repair. The intraoperative blood loss was non-significant and the postoperative course was regular. The patient has been discharged on the fourth postoperative day. At 1 year follow-up, the patient noticed a great improvement in her daily-life due to the absence of the previous discomforts and there was no evidence of early recurrence or other postoperative complications.

CONCLUSION

Combined laparoscopic transabdominal PH and PSH repair with the use of synthetic mesh was shown to be a safe and effective repair for this rare disorder. To accurately compare techniques, we require prospective studies with longer follow up durations.

CARE-radiology statement explanation and elaboration: reporting guideline for radiological case reports

Despite the increasing number of radiological case reports, the majority lack a standardised methodology of writing and reporting. We therefore develop a reporting guideline for radiological case reports based on the CAse REport (CARE) statement. We established a multidisciplinary group of experts, comprising 40 radiologists, methodologists, journal editors and researchers, to develop a reporting guideline for radiological case reports according to the methodology recommended by the Enhancing the QUAlity and Transparency Of health Research network. The Delphi panel was requested to evaluate the significance of a list of elements for potential inclusion in a guideline for reporting mediation analyses. By reviewing the reporting guidelines and through discussion, we initially drafted 46 potential items. Following a Delphi survey and discussion, the final CARE-radiology checklist is comprised of 38 items in 16 domains. CARE-radiology is a comprehensive reporting guideline for radiological case reports developed using a rigorous methodology. We hope that compliance with CARE-radiology will help in the future to improve the completeness and quality of case reports in radiology.

An infected intracranial dermoid cyst at the region of torcular herophili: A case report

Background

Dermoid cysts result from embryonic fusion anomalies, with intracranial dermoid cysts being rare (0.1-0.7% of intracranial tumors). Often asymptomatic, they can manifest as midline swelling, headaches, seizures, or cerebral ischemia. Recognition and management are crucial for mitigating complications and ensuring favorable patient outcomes.

Case Description

A 14-year-old girl presented with swelling at the occiput for 3 months. Initial imaging was suggestive of an extra-dural abscess in the occipital region with surrounding bone erosion. An infectious workup, including tests for tuberculosis, was non-contributory. A suboccipital craniectomy was done. On lifting, the bone flap, thick, purulent, and sebaceous contents with hair were spotted, which was adherent to the inner table of the skull and the dura overlying the torcular herophili, suggesting an infected dermoid cyst. A near-total excision was done, and culture-directed antibiotics were given. Postoperatively, the child made a complete recovery.

Conclusion

The diagnosis of a dermoid cyst must be kept in mind, and it should be considered in the differential diagnosis of midline posterior fossa lesions. The risk of postoperative recurrence from incomplete excision should be weighed against the risk of injuring the venous sinuses during the extensive resection of dermoid cysts adherent to the torcular region.

Deep Infiltrating Endometriosis of the Left Ureter Managed with Laparoscopic Ureterolysis Combined with Allium Ureteral Self-Expandable Stent: A Case Report

Introduction: In endometriosis, urinary tract involvement occurs in 1-5.5% of cases, where the ureter is affected in 9-23%. Unfortunately, endometriosis may remain asymptomatic even with significant anatomical progression. A delay in the diagnosis and treatment of ureteral endometriosis may result in hydronephrotic kidney damage and functional impairment. Methods: We present a case of a 36-year-old woman with a left ureteral stricture caused by deep infiltrating endometriosis accompanied by severe kidney-induced arterial hypertension. In March 2022, the patient underwent both laparoscopic excision/evaporation of deep infiltrating endometriosis from the left ovarian fossa and left ureterolysis, followed by an ureterorenoscopic dilatation of the left ureter via the placement of an Allium self-expandable stent. Results: This stent was successfully removed 18 months later. A computed tomography check-up confirmed normal ureteral patency with no signs of endometriosis. Elevated blood pressure also resolved. Conclusions: Deep infiltrating endometriosis can lead to asymptomatic yet serious complications. A successful treatment of ureteral endometriosis may require multidisciplinary management, including a simultaneous laparoscopic and ureterorenoscopic approach. Ureteral stent placement is a minimally invasive state-of-the-art solution for ureteral stricture(s) and should be considered the first choice in women of reproductive age suffering from ureteral deep infiltrating endometriosis.

Case report: How I do it? Laparoscopic hepatectomy with transcatheter arterial ICG staining for hepatolithiasis review

Background

Hepatolithiasis is regarded as the presence of stones in the intrahepatic bile ducts. Recurrent inflammation of bile ducts can bring many bad effects. How to completely remove stones is still a challenge.

Presentation

A 66-year-old male went to our hospital because of hepatolithiasis and choledocholithiasis. Selective hepatic arteriography and transcatheter arterial embolization followed by laparoscopic watershed hepatectomy under fluorescent navigation and laparoscopic common bile duct exploration on mass removal are performed.

Clinical discussion

For patients who suffer from hepatolithiasis, the main treatment principles of the operation are to remove the stones, correct the stenosis, and prevent recurrence. The laparoscopic watershed hepatectomy under fluorescent navigation can provide important support for precision liver surgery, which can give some suggestions for future hepatectomy.

Conclusion

Based on the three-dimensional (3D) visual watershed analysis, trans-arterial DSA positive fluorescence navigation has some advantages, which successfully overcome the shortcomings of the reverse staining method and the positive staining method.

A young female's battle with toxic epidermal necrolysis induced by NSAIDs: a case report

Introduction

Stevens-Johnson Syndrome (SJS) is a rare but severe mucocutaneous reaction often triggered by medications or infections, characterized by extensive epidermal detachment and mucosal involvement. This condition poses a high risk of morbidity and mortality, requiring prompt recognition and treatment.

Case presentation

An 18-year-old Asian female from eastern Nepal presented with nonitchy red spots, high fever, and significant discomfort following the administration of ibuprofen for minor sores. She developed extensive skin involvement covering 25% of her body surface area and severe mucosal lesions. Laboratory investigations revealed anemia, leukocytosis, and coagulopathy. She was admitted to the ICU, where she received broad-spectrum antibiotics, corticosteroids, and supportive care. The patient also developed acute kidney injury during treatment but eventually recovered and was discharged after a week.

Clinical discussion

The rapid onset of SJS in this patient reveals the unpredictable nature of drug-induced reactions. Early intervention with a multidisciplinary approach involving dermatology, intensive care, and infectious disease specialists was crucial in managing her condition. Despite the controversy surrounding corticosteroid use in SJS, their administration likely contributed to the rapid improvement in inflammation and skin healing. The case highlights the importance of early recognition, prompt management, and careful monitoring for adverse drug reactions, especially when prescribing medications known to cause SJS.

Conclusion

The successful outcome achieved through a multidisciplinary approach provides valuable insights into the effective strategies for handling severe drug reactions, emphasizing that early diagnosis and comprehensive management in patients with SJS is critical.

Idiopathic intracranial hypertension following childbirth: a case report and management strategies

Introduction

A postpartum headache, also known as pseudotumor cerebri, is defined as a headache and shoulder or neck pain that occur in the first 6 weeks following childbirth. Common causes of headaches during puerperium include pre-eclampsia, subarachnoid hemorrhage, cerebral venous thrombosis, meningitis, brain tumors, cerebrovascular diseases, and posterior reversible encephalopathy syndrome. Pseudotumor cerebri is an extremely rare cause of postpartum severe headache with visual disturbance with or without papilledema.

Case presentation

Here, the authors present a 32-year-old postpartum female patient who presented with a severe headache and visual disturbance for 10 days. Neurological examination did not show any focal or lateralizing deficit. However, a fundus examination showed severe bilateral papilledema. A contrast-enhanced brain MRI did not reveal a space-occupying mass lesion. MRV excluded venous occlusion. A lumbar puncture demonstrated a high opening pressure of 75 cmH2O with a normal cell count and protein and glucose levels. The patient was diagnosed with idiopathic intracranial hypertension. After 8 weeks of treatment with diazomid and topiramate, the patient improved clinically, and her papilledema regressed.

Clinical discussion

The occurrence of IIH is very rare among postpartum females. To our knowledge, very few cases of postpartum IIH have been reported in the medical literature. Although rare, patients with postpartum headache with visual disturbances should have a fundoscopic examination. The patient was diagnosed and managed in time, which led to significant clinical improvement and salvage of her vision.

Conclusion

As described in this case, idiopathic intracranial hypertension can cause severe headaches with and without visual disturbance during the postpartum period (despite being rare in this period), so it should be considered in the differential diagnosis.

A case of invasive Aspergillus niger spondylodiscitis with epidural abscess following COVID-19 infection in an immunocompromised host with literature review

Introduction and Importance

Aspergillosis is defined as an opportunistic infection that may spread hematogenously. COVID-19 infection has not been reported as a direct cause or risk factor. Its treatment (e.g. corticosteroids) significantly increases the risk for invasive infections. The respiratory system remains the main target, and the Aspergillus fumigatus is the most responsible subtype. Other species like Aspergillus (A) flavus, A. niger, and A. nidulans follow in frequency. Other included sites are the skeletal muscular system and the entire spine leading to spondylodiscitis. Only a total of 118 cases of Aspergillus spondylodiscitis have been reported in the literature, and only 21 cases reporting spinal epidural abscess were identified.

Case Presentation

The authors report a new rare case of invasive A. Niger spondylodiscitis with epidural and iliopsoas abscesses in a 63-year-old North African female patient with a history of coronavirus infection (COVID-19) treated with high doses of corticosteroids. The patient had favorable medical and radiological outcomes after 6 months of antibiotic and antifungal therapy.

Clinical Discussion

Fungal spondylodiscitis is a rare pathology that may be lethal. Immunosuppression plays a determining role. Discovertebral contamination results from hematogenous dissemination, found in the majority of cases in adults. The main symptom is segmental spinal pain, with an inflammatory pattern most often predominating in the thoracolumbar spine. Clinical signs of spinal cord compression, such as paresthesias, radiculalgia, and paraplegia, can sometimes be associated. Diagnosis of such spondylodiscitis is based on cultures and/or histology, whereas in most cases, it was made by MRI. Epidural abscess remains a rare entity. The authors will explore the current literature in more detail to dissect and explain this rare entity.

Conclusion

Aspergillus spondylodiscitis remains a rare and very demanding clinical entity. Early diagnosis and well-targeted medical treatment seem the ideal solution given that this type of infection has a poor prognosis.

Rare presentation of huge ectopic ureterocele in an adult female: a case report

Introduction and importance

Ectopic ureteroceles are primarily found in children, often detected incidentally during antenatal ultrasonography or due to urinary tract infection (UTI) symptoms. However, they are rare in adults, with limited published cases.

Case presentation

This report details a case of a 24-year-old woman who experienced recurrent UTIs and sudden urinary retention, ultimately needing manual compression to urinate due to poor urine flow. Intravenous urography revealed a large right ectopic ureterocele that protruded through the urethra during urination. Cystoscopy confirmed extensive right-sided ureteroceles affecting the bladder and causing her urinary difficulties.

Clinical discussion

Although ectopic ureteroceles in adults can present with a range of symptoms, including obstruction and recurrent infections, the management approach is often individualized based on the clinical presentation and imaging findings. In this case, endoscopic incision was chosen for its minimally invasive nature, leading to full recovery without complications. Despite the risks of recurrence and potential scarring, the patient showed no recurrence at follow-up and remains symptom-free.

Conclusion

This case underscores the rarity of symptomatic giant ectopic ureteroceles in adult females and highlights the importance of considering this condition in women with recurrent UTIs.

Laparoscopic-Assisted Enterolithotomy for Recurrent Gallstone Ileus: A Case Report

Gallstone ileus is the mechanical obstruction of the bowel due to gallstone impaction. It forms when a fistula is created between the gallbladder and the gastrointestinal tract, which can result in small bowel obstruction. Its surgical management ranges from enterolithotomy, cholecystectomy, and fistula closure performed together (one-stage) or performed separately (two-stage), while some patients undergo simple enterolithotomy. Emergency surgery with open enterolithotomy, with or without biliary tract surgery, has been replaced by laparoscopic-assisted enterolithotomy as a safer and more rapid procedure. This report is of a 68-year-old woman treated with laparoscopic-assisted enterolithotomy for gallstone ileus which recurred. A 68-year-old woman with type 2 diabetes mellitus, hypertension, breast cancer, and end-stage renal disease on hemodialysis presented with a gallstone ileus and was surgically managed with successful laparoscopic-assisted enterolithotomy. Seven days after the initial surgery, she again presented with gallstone ileus requiring reoperation. A repeat laparoscopic-assisted enterolithotomy was performed with no complications and full resolution of her symptoms. Operative management of gallstone ileus and subsequent recurrence continues to be highly debated. With no randomized studies and limited data, there is no current gold standard surgical procedure for either setting. Simple laparoscopic-assisted enterolithotomy is the favored surgical technique as it is associated with decreased morbidity, mortality, operative time, and complications. This report demonstrates that a CT scan is crucial in differentiating recurrent gallstone ileus from postoperative ileus, with a repeat laparoscopic-assisted enterolithotomy providing a safe and effective treatment option. Moreover, patient follow up is essential for monitoring symptom resolution.