Showing papers in "Journal of Surgical Case Reports in 2021"
TL;DR: In this paper, the second case of priapism in a patient with SARS-CoV2 was reported and the patient was managed by aspiration and Phenylephrine injection and achieved detumescence and reported normal erection at 2 weeks follow-up.
Abstract: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been linked to thromboembolic complications Priapism has been reported only once in link to SARS-CoV2 Here we report the second case of priapism in a patient with SARS-CoV2;our case is unique in being that the patient had priapism for 10 days while being hospitalized We discuss potential causes and possible prevention strategies The patient was managed by aspiration and Phenylephrine injection and achieved detumescence and reported normal erection at 2 weeks follow-up
11 citations
TL;DR: In this article, the authors presented the first reported experience of managing a patient diagnosed with subglottic stenosis following previous intubation and tracheostomy for coronavirus disease 2019 (COVID-19).
Abstract: Laryngotracheal stenosis (LTS) is a rare but serious condition characterized by narrowing of the airway. Iatrogenic injury from endotracheal intubation or tracheostomy insertion is the most common cause of LTS. We present the first reported experience of managing a patient diagnosed with subglottic stenosis (a subtype of LTS) following previous intubation and tracheostomy for coronavirus disease 2019 (COVID-19). This patient required an urgent surgical tracheostomy and subsequent referral to a tertiary airway surgery unit for definitive treatment, which included microlaryngoscopy, laser excision and balloon dilatation. This case highlights that LTS should be included in the differential diagnosis for patients re-presenting with breathing difficulties after prolonged intubation or tracheostomy for COVID-19. Furthermore, it raises the concern of a rise in the incidence of this condition and an increased burden on the few units specializing in airway surgery.
8 citations
TL;DR: The case of a 63-year-old man who presented with this condition that resulted in colonic ischemia necessitating surgical resection was described and the cause of IMHMV in this patient was attributed to a Chinese herbal supplement used for degenerative osteoarthritis of the knees.
Abstract: Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is caused by proliferation of smooth muscle cells in the wall of small mesenteric veins and venules with accumulation of a proteoglycan matrix leading to a non-thrombotic, non-inflammatory venous occlusion resulting in venous ischemia. IMHMV is a rare and poorly understood disease, with <20 case reports in the literature. The purpose of this report is to describe the case of a 63-year-old man who presented with this condition that resulted in colonic ischemia necessitating surgical resection. The cause of IMHMV in this patient was attributed to a Chinese herbal supplement used for degenerative osteoarthritis of the knees. A brief review of the literature is provided along with the case report.
6 citations
TL;DR: In this article, a case of ileocolonic intussusception in an adult with active COVID-19 infection was reported, where a right hemicolectomy was performed.
Abstract: The most common symptoms of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) are fevers, fatigue and dry cough. However, growing data suggest gastrointestinal (GI) manifestations occur in the majority of patients. Small bowel obstruction remains a significant cause of surgical abdominal emergencies in the adult population, although most cases are secondary to adhesive disease. We present a case of ileocolonic intussusception in an adult with active COVID-19 infection. Our patient presented with small bowel obstruction 4 days after diagnosis of COVID-19 with typical respiratory symptoms. Imaging revealed ileocolonic intussusception and possible cecal mass for which a right hemicolectomy was performed. Recovery was unremarkable. Pathology suggested necrosis without an identifiable mass. To the best of our knowledge, this is the first documented case of small bowel obstruction secondary to ileocolonic intussusception in an adult related to GI manifestation of COVID-19.
6 citations
TL;DR: In this paper, a case where a lost gallstone caused a retroperitoneal abscess formation and was retrieved from a back abscess in the right paraspinal region was presented.
Abstract: Laparoscopic cholecystectomy is a routinely performed surgery nowadays. However, it is associated with certain complications. Gall bladder perforation during the procedure can result in spilled and lost gallstones. Lost gallstones most commonly cause intra-abdominal infection. However, very rarely, they can be associated with troublesome retroperitoneal abscess formation. We present a case where a lost gallstone caused a retroperitoneal abscess formation and was retrieved from a back abscess in the right paraspinal region.
5 citations
TL;DR: In this article, the robot-assisted thoracoscopic (RATS) lobectomy technique for patients with severe incomplete interlobar fissures was demonstrated for pulmonary resection.
Abstract: An incomplete interlobar fissure makes thoracoscopic lobectomy difficult and is predictive of morbidity after thoracoscopic lobectomy. This report demonstrates the robot-assisted thoracoscopic (RATS) lobectomy technique for patients with severe incomplete interlobar fissures. A fissureless approach was chosen for pulmonary resection. Near-infrared fluorescence imaging with intravenous indocyanine green (ICG) was used to detect the interlobar line after transection of the bronchus, pulmonary artery and vein. Interlobar fissure was identified and divided by robotic staplers. This combined technique using ICG and fissureless lobectomy made RATS lobectomy safe for patients with severe incomplete interlobar fissures.
5 citations
TL;DR: In this paper, a 52-year-old male with SIT presented with obstructive jaundice and pancreatic-head mass, and it was decided to perform a laparoscopic pancreaticoduodenectomy.
Abstract: Situs inversus totalis (SIT) is a congenital disorder in which the thoracic and abdominal viscera organs are mirrored from their normal anatomical position. Thus, the presence of any cancerous mass in one of the visceral organs of patients with SIT represents a great challenge due to the anatomical variation. We report a 52-year-old male with SIT who presented with obstructive jaundice and pancreatic-head mass. After preoperative examinations, it was decided to perform a laparoscopic pancreaticoduodenectomy. In this case, we aim to demonstrate the diagnosis and management of pancreatic cancer in an SIT patient, in addition to presenting the advantages and difficulties of laparoscopic surgery in this case.
5 citations
TL;DR: A 22-year-old Saudi female with body mass index 41 underwent laparoscopic sleeve gastrectomy in 2017, presented 18 months later to emergency department complaining of fever and abdominal pain for 3 months prior to presentation.
Abstract: Laparoscopic sleeve gastrectomy is currently a stand-alone bariatric procedure with a low complication profile. A rare complication of leak following sleeve gastrectomy was reported in this study. Its rareness and nonspecific clinical presentation could make the diagnosis difficult and could be easily confused with leak and subdiaphragmatic abscess. A 22-year-old Saudi female with body mass index 41 underwent laparoscopic sleeve gastrectomy in 2017, presented 18 months later to emergency department complaining of fever and abdominal pain for 3 months prior to presentation. Computed tomography of abdomen revealed a large splenic abscess, upper gastrointestinal studies were unremarkable. Patient was taken for laparoscopic exploration with finding of splenic abscess and gastric fistula, splenectomy and clipping of fistula was performed. The management of splenic abscess remains controversial. Splenectomy and antibiotics have generally been the definitive treatment particularly with large multilobulated collection. Familiarity with the rare complications as splenic abscess will allow for a prompt diagnosis and treatment.
4 citations
TL;DR: In this paper, an elderly man presenting with acalculous haemorrhagic cholecystitis was successfully treated with laparoscopic choleocystectomy.
Abstract: Haemorrhagic cholecystitis is a seldom seen cause of right upper quadrant pain that can result in gallbladder rupture, massive intraperitoneal haemorrhage and death if untreated Haemorrhagic cholecystitis is usually seen in the presence of cholelithiasis, malignancy, trauma and coagulopathies Here, we present the unusual case of an elderly man presenting with acalculous haemorrhagic cholecystitis, who was successfully treated with laparoscopic cholecystectomy We review the radiological and laparoscopic findings of haemorrhagic acalculous cholecystitis This case highlights the importance of prudent use of radiological imaging to differentiate haemorrhagic cholecystitis from alternate pathology and early surgical intervention to avoid massive intraperitoneal haemorrhage and the high mortality with which it is associated
4 citations
TL;DR: In this article, a 71-year-old man who had undergone a nephrectomy for renal cell carcinoma (RCC) went to a hospital in a state of shock.
Abstract: In some patients with metastatic renal cell carcinoma to the pancreas, gastrointestinal hemorrhages occur, but because of the rarity of this condition, treatment strategies have not been established. A 71-year-old man who had undergone a nephrectomy for renal cell carcinoma (RCC) went to a hospital in a state of shock. Computed tomography revealed a hypervascularized tumor in the head of the pancreas, suggesting metastatic RCC. Upper endoscopy revealed bleeding in the duodenum due to tumor invasion. An emergency angiogram showed that the tumor received its blood supply mainly from the gastroduodenal artery. Transarterial embolization (TAE) of the gastroduodenal artery was performed and bleeding was controlled. Two months after TAE, elective pancreaticoduodenectomy was performed. The patient currently continues to undergo outpatient follow-up 2 years later without recurrence. TAE was very effective in controlling the acute phase of severe gastrointestinal hemorrhage from pancreatic metastasis of RCC.
4 citations
TL;DR: In this paper, a case report of Congenital Peritoneal encapsulation of the small bowel with signs of intestinal malrotation was described, where peritoneal membrane excision, terminal ileum release and complementary appendicectomy were performed.
Abstract: Congenital peritoneal encapsulation is a rare congenital malformation in which all or part of the small bowel is covered by a thin accessory peritoneal membrane. Despite being usually asymptomatic and an incidental finding during surgery or autopsy, there is a small number of reports in the literature whose diagnosis was established in the context of intestinal obstruction. The authors review the topic and describe a case report undergoing surgery for intestinal obstruction. Intraoperatively, there was a partial peritoneal encapsulation of the small bowel with signs of intestinal malrotation. Peritoneal membrane excision, terminal ileum release and complementary appendicectomy were performed. There was a favorable clinical evolution in the postoperative period. Although rare, it is important to remember this entity in the differential diagnosis of patients with intestinal obstruction, in the absence of other etiologic factors.
TL;DR: In this article, a case of perianal abscess due to a long fish bone was reported, where a 72-year-old man who was toothless and wore a denture had a chief complaint of anal pain.
Abstract: Few articles have reported cases of perianal abscess due to ingested foreign bodies. Herein, we report a case of perianal abscess due to a long fish bone.
A 72-year-old man who was toothless and wore a denture had a chief complaint of anal pain. His left-side buttock had swelling and redness. Computed tomography revealed a perianal abscess on his left-side buttock and high-intensity linear structure in the abscess cavity. We made a diagnosis of perianal abscess due to a fish bone and performed an emergency operation. We opened the abscess cavity and removed the 5 cm fish bone from the cavity. After drainage of the abscess cavity and antibiotic administration, he was discharged from our hospital on day 8.
A long fish bone could cause perianal abscesses. Rapid diagnosis and ensuring fish bone removal are important to prevent sepsis.
TL;DR: In this paper, a 20-year-old female known to have wandering spleen was presented with infarcted spleen requiring emergency splenectomy, which is a rare medical condition due to developmental abnormality or acquired laxity of the ligaments that hold the spleen in its normal anatomical position.
Abstract: Spleen is normally positioned in the left upper quadrant. Abnormal location where it is not found in its normal anatomical position is called wandering spleen (WS). Wandering spleen is a rare medical condition that occurs due to developmental abnormality or acquired laxity of the ligaments that hold the spleen in its normal anatomical position. It affects children and young adults, especially childbearing age women. Patients affected with this condition may present with nonspecific symptoms requiring a high index of suspicion. Here, we are presenting a 20-year-old female known to have WS ended up with infarcted WS requiring emergency splenectomy.
TL;DR: In this paper, the authors discuss two similar cases of jejunojejunal intussusception following open Roux-en-Y gastric bypass and abdominoplasty that were managed with operative reduction of the involved bowel.
Abstract: Intussusception is a rare long-term complication following bariatric surgery. With unclear risk factors and a variable presentation, intussusception is often diagnosed in emergency departments on cross-sectional imaging. Due to the nature of the disease process, prompt involvement of a bariatric surgeon and operative intervention offers the best outcome. Here, we discuss two similar cases of jejunojejunal intussusception following open Roux-en-Y gastric bypass and abdominoplasty that were managed with operative reduction of the involved bowel.
TL;DR: In this article, a 17-month-old male craniopagus conjoined twins were separated using handheld optical coherence tomography (OCT) plus portable slit-lamp biomicroscopy, indirect ophthalmoscopy and modified forced-choice preferential looking assessment.
Abstract: Craniopagus conjoined twins are extraordinarily rare and present unique challenges to the multidisciplinary team There is a paucity of literature on optimizing neuro-ophthalmologic evaluation in craniopagus twins Herein, we present our enhanced neuro-ophthalmologic evaluation and management in 17-month-old male craniopagus twins, uniquely using handheld optical coherence tomography (OCT) plus portable slit-lamp biomicroscopy, indirect ophthalmoscopy and modified forced-choice preferential looking assessment Staged surgical separation was supported by enhanced neuro-ophthalmologic evaluation, detailed radiology, three-dimensional printing and virtual reality simulation This represents the fourth separation of craniopagus twins by our unit
TL;DR: Kimura's disease is a rare chronic inflammatory disorder of unknown etiology which typically presents with subcutaneous nodules in the head and neck region and is frequently associated with regional lymphadenopathy or salivary gland enlargement as discussed by the authors.
Abstract: Kimura's disease is a rare chronic inflammatory disorder of unknown etiology which typically presents with subcutaneous nodules in the head and neck region and is frequently associated with regional lymphadenopathy or salivary gland enlargement. Peripheral blood eosinophilia and elevated serum immunoglobulin E levels are constant features of the disease. We present herein a 31-year-old male patient who presented with chronic neck lymphadenopathy. Kimura's disease was diagnosed on fine needle aspiration cytology, the patient initially decided not to have further intervention. He presented 6 years later with lymphadenopathy and was treated with surgery. The diagnosis of Kimura's disease was confirmed on histopathology. This patient had the disease for 6 years and did not have the typical features of peripheral eosinophilia and raise serum IgE level.
TL;DR: In this article, the case of a 32-year-old man who experienced spontaneous migration of a bullet within the brain following a gunshot injury was reported, where the bullet was located in the posterosuperior side of mesencephalon.
Abstract: Herein, we report the case of a 32-year-old man who experienced spontaneous migration of a bullet within the brain following a gunshot injury. Emergent computed tomography revealed the bullet located in the posterosuperior side of mesencephalon. During follow-up after 10 days, the neurological status of the patient had worsened. Computed tomography revealed that the bullet had migrated posteriorly and lodged in the occipital lobe. Although a few studies have reported on the spontaneous migration of a bullet within the brain, the present case is unique as the patient examination changed with migration. We recommend serial imaging and surgery in cases of bullet migration in the brain.
TL;DR: In this article, a patient with a pancreatic tail pseudocyst with splenic extension and rupture was decided to conservative management, however, he developed tachycardia with severe abdominal pain associated with signs of peritoneal irritation, requiring an emergency laparotomy.
Abstract: Pancreatic pseudocyst is a common complication of acute and chronic pancreatitis. However, spleen involvement in pancreatitis is rare. We present a patient with a pancreatic tail pseudocyst with splenic extension and rupture. Due to initial stability, conservative management was decided. However, he developed tachycardia with severe abdominal pain associated with signs of peritoneal irritation, requiring an emergency laparotomy. A large pancreatic tail pseudocyst was identified in addition to a ruptured spleen. Splenectomy and double layer hand-sewn gastrocystic anastomosis were performed. The patient had a satisfactory recovery and was discharged on the 11th postoperative day. Conservative management is an option in stable patients but with a high rate of failure. Surgery remains the standard choice in these cases.
TL;DR: In this article, the advantages of the endonasal endoscopic approach in managing different cases of dentigerous cyst and ectopic teeth were studied, where the use of different angled endoscopes and instruments was used to preserve physiological function while minimizing morbidity and preventing complications.
Abstract: Dentigerous cyst is a type of developmental odontogenic cysts that arises from the crown impacted, embedded or unerupted teeth that standardly managed by Caldwell-luc procedure, which is found to be associated with morbidities and complications. Endonasal endoscopic removal is a minimally invasive approach aiming to prevent morbidities and complications. The aim of this article is to study the advantages of the endonasal endoscopic approach in managing different cases of dentigerous cyst and ectopic teeth. In this article, we reported three different cases (two pediatric and one adult), one presenting with unilateral dentigerous cyst with traumatic ectopic teeth in the maxillary sinus, and one presenting with bilateral dentigerous cysts and ectopic teeth in the maxillary sinuses, the third case of unilateral ectopic intranasal canine tooth. All managed by endonasal endoscopic approach, with no complications and complete recovery. The endonasal endoscopic approach is a minimally invasive surgical approach. With the use of different angled endoscopes and instruments, this approach is preserving physiological function while minimizing morbidity and preventing complications.
TL;DR: The Coronavirus 2019 disease (COVID-19) originated in Wuhan in China in December 2019 has evolved over the past year in terms of its pathophysiology, clinical presentation, imaging manifestations and management strategies.
Abstract: The Coronavirus 2019 disease (COVID-19) originated in Wuhan in China in December 2019 has evolved over the past year in terms of its pathophysiology, clinical presentation, imaging manifestations and management strategies. Though COVID-19 is predominantly a pulmonary illness, it is now established to show widespread extra pulmonary involvement. Gastrointestinal manifestations of COVID-19 are also well known. COVID-19 infection presenting with the involvement of gallbladder is extremely rare in medical literature. Gallbladder perforation should be thought of in COVID-19 patients complaining of with acute abdomen in with acute cholecystitis.
TL;DR: In this paper, the authors presented three cases of traumatic tracheobronchial injury managed with extracorporeal membrane oxygenation (ECMO) support at a level-1 trauma center and emphasized the benefits of anticipation and early institution of ECMO support perioperatively, in these high-risk cases.
Abstract: Tracheobronchial injury is a rare, but potentially life-threatening condition, and in most cases requires urgent treatment to restore normal respiratory physiology. Over the past decades, extracorporeal membrane oxygenation (ECMO) has evolved as an important adjunct in airway surgery. We presented three cases of traumatic tracheobronchial injury managed with ECMO support at a level-1 trauma center and emphasized the benefits of anticipation and early institution of ECMO support perioperatively, in these high-risk cases. The management of traumatic tracheobronchial injuries requires early measures to guarantee adequate ventilation. Anticipation and early institution of ECMO in these patients may support respiratory physiology, facilitate repair and improve survival. The time factor and multidisciplinary communication and plan prior to intervention should be considered. ECMO support, whenever available, plays important role in the management of complicated tracheobronchial surgical procedure and thereby reduces risk of mortality.
TL;DR: In this article, a 60-year-old female with difficulty in breathing and extensive acute intestinal ischemia confirmed to be associated with SARS-CoV-2 infection was reported.
Abstract: Novel coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China, and declared by World Health Organization as a pandemic in March 2020. Since then, it has been well known for COVID-19 patients to present with clinical manifestations of severe acute respiratory syndrome (SARS-CoV-2) similar to the influenza. However, in the course of the disease, various pathological complications of high clinical significance have remained unknown. Impaired blood supply to the visceral vascular system can cause serious life-threatening acute damage. We report a case of a 60-year-old female with difficulty in breathing and extensive acute intestinal ischemia confirmed to be associated with SARS-CoV-2 infection. The patient developed a sudden abdominal pain and succumbed shortly after admission before imaging studies were performed. Autopsy revealed massive bowel ischemia. This case highlights the importance of paying attention to serious and less known clinical manifestations other than pulmonary symptoms and fever.
TL;DR: In this paper, a 72-year-old man was referred to a hospital with complaints of left facial pain and nasal obstruction. Computed tomography (CI) revealed a tumor 5.5 cm in size in the left nasal cavity.
Abstract: SWItch/Sucrose Non-Fermentable (SWI/SNF) -related matrix-associated actin-dependent regulator of chromatin (SMARC) subfamily B member 1 (SMARCB1) deficient sinonasal carcinoma (SdSNC) is a rare variant of sinonasal undifferentiated carcinoma (SNUC). A 72-year-old man was referred to our hospital with complaints of left facial pain and nasal obstruction. Computed tomography (CI) revealed a tumor 5.5 cm in size in the left nasal cavity. Atypical cells with eosinophilic cytoplasm proliferating as solid nests and exhibiting necrosis were observed and diagnosed as poorly differentiated carcinoma. Carbon ion radiotherapy was performed. Follow-up CI revealed multiple masses in both lungs. Partial resection of the right lung was performed. Proliferating atypical cells with clear-to-eosinophilic cytoplasm were observed and resembled those in the paranasal sinus tumor. Immunohistochemical analysis indicated a metastatic lung tumor derived from the SNUC revealed completely negative SMARCB1 expression in the nuclei of the tumor cells. SdSNC is difficult to diagnose. However, molecular targeted therapy may be useful. Thus, it is necessary and important to recognize this rare cancer accurately.
TL;DR: In this article, a case of gestational gigantomastia complicated by life-threatening haemorrhage is presented and discussed, where the preferred approach is conservative management, as foetal viability and well-being is of significant importance.
Abstract: Gestational gigantomastia is a psychologically and physically debilitating disease of unknown aetiology. Underlying diseases that present as gigantomastia should be excluded by a thorough workup. Most cases respond to the preferred approach: conservative management, as foetal viability and well-being is of significant importance. However, in those cases where the maternal mortality is at risk, the surgical approach is preferred. Life-threatening haemorrhage may occur and early recognition and treatment is paramount to outcome. A case of gestational gigantomastia complicated by life-threatening haemorrhage is presented and discussed.
TL;DR: In this paper, the authors report non-pregnant women of reproductive age presenting with acute lower abdominal pain, and ultrasound findings prompted management for Pelvic Inflammatory Disease.
Abstract: Acute pelvic pain is a common complaint in reproductive age women and has a large differential diagnosis. Decision for conservative vs. surgical management is often dependent on clinical, biochemical and imaging findings. Isolated tubal torsion is a rare cause of pelvic pain that requires prompt diagnosis and surgical management to avoid morbidity. Here, we report non-pregnant women of reproductive age presenting with acute lower abdominal pain. Raised inflammatory markers and ultrasound findings prompted management for Pelvic Inflammatory Disease. Despite some improvement with antibiotics, the patient had ongoing symptoms. At surgery, bilateral para-tubal cysts and a left sided hydrosalpinx were found, along with an isolated left tubal torsion. Isolated tubal torsion most commonly occurs in reproductive aged women, and risk factors include intrinsic tubal pathology and extrinsic lesions. Clinically, biochemically and radiographically, it is often indistinguishable from other pelvic pathology, potentially leading to diagnostic delay, and necrosis of the tube.
TL;DR: In this paper, the authors describe a clinical case, involving an inflammatory response to both Coronavirus Infectious Disease 2019 (COVID-19) and intestinal amebiasis 54-year-old, COVID-positive Mexican gentleman was admitted to surgery following 6 days of hematochezia.
Abstract: The parasite Entamoeba histolytica, the causal agent of amebiasis, is considered a worldwide emergent disease and still represents an important cause of death in Mexico. Here, we describe a clinical case, involving an inflammatory response to both Coronavirus Infectious Disease 2019 (COVID-19) and intestinal amebiasis 54-year-old, COVID-positive Mexican gentleman was admitted to surgery following 6 days of hematochezia. An exploratory laparotomy and colonoscopy revealed multiple fibrous and amebic ulcerations (5-10 cm in diameter), with necrotic tissue predominantly localized in the sigmoid, descending and ascending colon. We discuss the pathophysiological interplay of both COVID-19 and intestinal amebiasis with the aim of highlighting a potentially novel aggravating mechanism in surgical patients suffering from colonic perforation in the setting of abdominal sepsis.
TL;DR: In this paper, the authors describe two female patients who were suspected of having mesenteric GIST, but opted for surveillance rather than definitive treatment, and both patients demonstrated increased tumor mass with no evidence of distant metastasis.
Abstract: Gastrointestinal stromal tumors (GISTs) occurring outside the gastrointestinal tract are known as extragastrointestinal stromal tumors (EGIST). They share some common histopathologic and molecular characteristics. This report describes two female patients who were suspected of having a mesenteric GIST, but opted for surveillance rather than definitive treatment. Upon reassessment, both patients demonstrated increased tumor mass with no evidence of distant metastasis. The intraoperative findings confirmed the conclusion of clinical and imaging studies performed preoperatively and radical excisions were performed. Histopathological examination (spindle cell neoplasm) and immunohistochemistry (CD117) confirmed EGIST. Both patients underwent Imatinib therapy following surgery with no evidence of disease recurrence or metastasis upon follow up. Although sharing histologic features with GIST, EGIST frequently demonstrates distinct characteristics that facilitate the proper diagnosis and management of EGIST. Since it is a rare and aggressive disease with a poor outcome, early detection and curative surgical resection remains the mainstay of treatment.
TL;DR: In this article, a malignant phyllodes tumor of breast in 57-year-old female patient was treated with mastectomy combined with axillary lymph node dissection and adjuvant chemotherapy.
Abstract: Phyllodes tumors are rare mesenchymal tumors of breast. Malignant phyllodes tumors can develop metastases to distal organs with spreading hematogenously to most frequent sites as lungs, bone and brain. Regional lymph node enlargement is common but metastasis to lymph node is a very rare phenomenon with prevalence about 1.1-3.8%. In this report, we introduce a case of malignant phyllodes tumor of breast in 57-year-old female patient. Synchronous metastases to axillary lymph nodes and lung were found at the presentation. She was treated with mastectomy combined with axillary lymph node dissection and adjuvant chemotherapy. Axillary lymph node dissection can be considered in case of proven metastatic or suspiciously palpable lymph nodes.
TL;DR: In this paper, the authors presented a case of a 69-year-old male with an AJCC Stage IV moderately differentiated adenosquamous carcinoma of the gallbladder treated with radical cholecystectomy including liver segments IVb, V, VI.
Abstract: Representing 90-95% of all malignant gallbladder neoplasms, adenocarcinoma is by far the most common subtype. Adenosquamous carcinoma is a rare subtype, accounting for only 1-5% of all gallbladder carcinomas. These tumors have been shown to have aggressive biologic behavior, commonly extending to adjacent structures. Some studies have shown that the squamous component often displayed a greater proliferative capacity than the adenocarcinomatous component (possibly even up to twice as fast). Complete surgical resection is currently the mainstay of treatment but the prognosis is often poor. In this paper, we present a case of a 69-year-old male with an AJCC Stage IV moderately differentiated adenosquamous carcinoma of the gallbladder treated with radical cholecystectomy including liver segments IVb, V, VI.
TL;DR: In this paper, a 59-year-old male who appeared in the emergency department with diffuse abdominal pain associated with vomiting was found to have a congenital band extending from mesentery to ileum and causing an internal hernia.
Abstract: The exact incidence of small bowel obstruction (SBO) due to congenital adhesions remains unclear. Herein, we report a 59-year-old male who appeared in the emergency department with diffuse abdominal pain associated with vomiting. The patient reported no previous medical or surgical history. Clinical examination revealed a soft, distended abdomen and diffuse tenderness. Computed tomography indicated a close loop obstruction. A congenital band extending from mesentery to ileum and causing an internal hernia was identified via a midline incision. The band was ligated and divided. There is no difference in the clinical presentation, and the initial work-up of SBO on account of congenital adhesions was compared to other bowel obstruction causes. Surgical exploration is crucial for the diagnosis and treatment of congenital adhesions. Although laparotomy is considered the cornerstone of surgical management, laparoscopy has emerged as a feasible and safe alternative for the diagnosis and treatment of these congenital bands.