Surgical Case Reports

Journal Information
ISSN / EISSN : 2613-5965 / 2613-5965
Published by: Science Repository OU (10.31487)
Total articles ≅ 371
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Nilanchali Singh, Reva Tripathi, Ym Mala, Shakun Tyagi
Published: 19 November 2021
Surgical Case Reports, Volume 2021, pp 1-2; https://doi.org/10.31487/j.scr.2021.11.05

Abstract:
Introduction: Herlyn-Werner-Wunderlich Syndrome is a rare anomaly and exact incidence is not known. It is usually diagnosed in young girls who present with cyclical abdominal pain along with cyclical menstruation. Case Report: We present case of two girls who had this syndrome. An ultrasound was performed in both patients. In first patient, it revealed uterus didelphys with hematocolpos on right side. In the second patient, a large hematometra of size 9.8×12.2 cm, along with hematocolpos was present on the left side. Both the patients underwent examination under anaesthesia and excision of septum. They remained asymptomatic during one year follow-up. Conclusion: Treatment of such cases is excision of septum and to maintain the patency of the outflow tract and prevent stricture formation later. A good follow-up in immediate post-operative period is necessary.
Giada Garufi, S Cardali, G Ricciardo
Published: 12 November 2021
Surgical Case Reports, Volume 2021, pp 1-4; https://doi.org/10.31487/j.scr.2021.11.02

Abstract:
Sclerosing meningioma is a rare histological variant of meningioma, first described in the literature by Davidson and Hope in 1989 as an invasive bulking mass consisted of whorling collagen bundles with a minimum percentage of meningothelial resembling cells [1]. The literature showed very rare cases of the intramedullary location of sclerosing meningiomas: in our opinion, it is mandatory to describe its clinical, surgical, histological and immunohistochemical features in order to reach the best final outcome. Sclerosing meningiomas are often misdiagnosed because of their invasive behaviour: it does require a correct diagnosis in order to prevent unnecessary postoperative treatment. Literature reports only 30 cases of sclerosing meningiomas and only 2 of them are intramedullary. We present the case of a cervical intramedullary sclerosing meningioma presenting with gait disturbances, sensory deficits, four extremities weakness and hypereflexia in a patient with the history of meningiomatosis.
Xin Zheng, Yang Su, Haitao Yang
Published: 11 November 2021
Surgical Case Reports, Volume 2021, pp 1-3; https://doi.org/10.31487/j.scr.2021.10.04

Abstract:
Objective: To retrospectively analyse the lung ultrasound images of 60 patients undergoing thoracoscopic partial pneumonectomy and compare the difference of bilateral lung ultrasound images. Results: B3 lines were predominant in ventilating side lung, B7 lines and atelectasis were predominant in operative side lung. Conclusion: Short-term lung injury after one-lung ventilation is mainly on the ventilation side, and the main manifestation is pulmonary edema.
Mohamed A. Elkoushy, Sameer A Munshi, Mohnna S Subahi, Shafaq Mujtaba
Published: 8 November 2021
Surgical Case Reports, Volume 2021, pp 1-3; https://doi.org/10.31487/j.scr.2021.10.06

Abstract:
Metanephric adenoma (MA) of the kidney is a rare benign neoplasm, which is mostly incidental-discovered during imaging studies for other clinical problems. However, this tumor may overlap in morphology with the papillary renal cell carcinoma and there are descriptions of metastatic disease. To date, fewer than 200 cases of MA have been reported worldwide and usually have a good prognosis. In the current report, a case of MA in a middle-aged lady is presented, which developed postoperative morbidity resulting from prolonged perinephric leakage secondary to urinary and perinephric fungus infection as a part of systemic candidiasis. The clinical, morphological and immunohistochemical features are presented together with a review of the current literature.
Lili Liu, Xiuming Zhu, Hongming Pan
Published: 5 November 2021
Surgical Case Reports, Volume 2021, pp 1-4; https://doi.org/10.31487/j.scr.2021.11.07

Abstract:
SMARCA4 mutant non-small cell lung cancer (SMARCA4m-NSCLC) has a poor prognosis owing to rapid growth. Effective treatments for SMARCA4m-NSCLC have not yet been established. Recently, many preclinical studies support the hypothesis that SMARCA4m-NSCLC may be vulnerable to immune checkpoint inhibitors. Here, we report a patient with programmed death-ligand1 (PD-L1) highly expressive SMARCA4m-NSCLC who showed an extremely rapid and long-term response to pembrolizumab. He was referred to our hospital for a mass of the right lung. Positron emission tomography-computed tomography showed right lung tumor, hilar, mediastinal and bone metastases. Pathological and immunohistochemical results showed it was a lung adenocarcinoma and revealed the tumor proportion score of PD-L1 was 80%. SMARCA4 and K-RAS genes were co-mutations. BRG1 protein expression was negative. Subsequently, pembrolizumab treatment as the first line of therapy was commenced for the patient. With only one dose, pembrolizumab significantly inhibited tumor growth and a partial response was obtained. To date, pembrolizumab treatment has been continued for about 29 months. Severe immune-related adverse events were not observed. Our case showed that an extremely rapid and long-term response can be achieved with pembrolizumab for PD-L1 highly expressive SMARCA4m-NSCLC. Immune checkpoint inhibitors treatment may be a promising strategy for PD-L1 positive SMARCA4m-NSCLC.
Jo-Celine M. Leong, Erin Camille A Caritativo, Ma Socorro C Martinez, Jay B Villavicencio, Manuel M Mariano
Published: 4 November 2021
Surgical Case Reports, Volume 2021, pp 1-4; https://doi.org/10.31487/j.scr.2021.11.01

Abstract:
Von Hippel-Lindau syndrome is a rare genetic condition characterized by the development of benign and malignant tumors in various organ systems. We report a case of a 58-year-old Filipino male with unremarkable family history who presented with progressive right homonymous hemianopia. Work up revealed presence of retinal and CNS hemangioblastomas as well as renal cell carcinoma. Confirmatory gene testing is pending but is ultimately not required to make the diagnosis.
Filip W. N. Haenen, T Sloane Guy, Inez Rodrigus
Published: 3 November 2021
Surgical Case Reports, Volume 2021, pp 1-4; https://doi.org/10.31487/j.scr.2021.11.10

Abstract:
Background: Barbed sutures have rarely been used in cardiac surgery. The reason is the absence of safety and feasibility data. This study was set up to assess the safety and efficacy using barbed sutures for right atrium cannulation-site closure both in short and longer-term follow up. Methods: Ten patients undergoing routine CABG through sternotomy with the use of ECC were included after giving written informed consent. After performing CABG, closure of the venous cannulation site at the right atrium is performed, using Stratafix® 2/0 non-resorbable, spiral polypropylene (SXPL1B400), without knotting. Results: No postoperative bleeding complications or revisions for bleeding or tamponade were noted. No complications or major adverse cardio-cerebrovascular incidents were registered during follow-up. The relevance of this lies in the difficulty in tying timely knots, even in experienced hands, during scopic or minimally invasive procedures. Being able to avoid this cumbersome procedure would largely reduce time spent on tying knots (the single most efficient time reducing step in minimally invasive cardiac surgery). Conclusion: Using knotless barbed sutures with an additional self-locking manoeuvre is feasible for the closure of the right atrium cannulation site in cardiac surgery, with no short-term or long-term complications. This opens up possibilities using knotless barbed sutures safer in minimally invasive cardiac surgery. This study confirms barbed knotless sutures perform adequately when closing a low-pressure cardiac structure, and in such, potentially saving time in minimally invasive surgery. Further investigation in closure of other cardiovascular structures is advisable and are planned by the authors.
Augusta Cardoso, Gustavo Coelho, Joana Esteves, Horacio Costa
Published: 29 October 2021
Surgical Case Reports, Volume 2021, pp 1-4; https://doi.org/10.31487/j.scr.2021.10.01

Abstract:
Introduction: Breast conserving surgery plus radiation therapy and mastectomy procedures has equal results in terms of survival. Oncoplastic surgery principles along with breast reduction techniques allow for very good aesthetic results in immediate breast reconstruction with local tissues in several well-defined clinical scenarios. Nevertheless, we still find several limitations to their use regarding the location of the tumor or the need for inconvenient skin resections out of the standard markings of breast reduction. We present a case where traditional breast reduction techniques were inadequate and technical modifications of standard markings and pedicle design were developed to avoid the need to undergo a mastectomy. Methods: We present a patient diagnosed with breast cancer where the clinical characteristics of the tumor (location, skin excision needed) precluded the use of traditional oncoplastic breast reduction techniques. Modifications to the traditional breast reduction techniques were used to cope with the oncological resections needed. Results: A good global symmetry and aesthetic result were achieved. Scar pattern obtained was considered relatively camouflaged and patient satisfaction was high. Conclusion: Breast reduction procedures can be the solution for the treatment of breast cancer. The location of the tumor in the superior quadrants outside standard markings and the need to include skin in the tumor resection can be sidetracked by using enlarged NAC pedicles with modifications to classic skin markings without compromising oncologic safety. The final aesthetic results obtained are considered very good and the patient is very satisfied.
Roberto Valente, Alfredo Torretta, Dimana Kaludova, Mayank Roy, Satya Bhattacharya
Published: 5 October 2021
Surgical Case Reports pp 1-6; https://doi.org/10.31487/j.scr.2021.10.03

Abstract:
Background: Major bile duct injuries (BDIs) are hazardous complications after laparoscopic cholecystectomy (0.4%-0.6% of all laparoscopic cholecystectomies) [1, 2-4]. Major BDIs usually require surgery, ideally either within one week or after 3 three months after index surgery [1]. We describe the case of iatrogenic transection of the common bile duct (CBD) complicated by a complex full midline abdominal evisceration presented on day 12 after emergency laparotomy for biliary peritonitis. Case Presentation: A 65-year-old male underwent laparoscopic cholecystectomy in a district general hospital and was discharged on the same day, following apparently uneventful surgery. He, however, re-presented two days later with biliary peritonitis when emergency ERCP showed full CBD transection. The local surgical team performed midline exploratory laparotomy, washout, and external drainage aside the leaking CBD and referred the case to our tertiary HPB service. While awaiting transfer (due to bed shortage), full wound dehiscence occurred. On transfer arrival at our HPB service on postoperative day 11, the patient presented extensive evisceration with loss of domain and persisting high-volume biliary spillage aside bowels. Following assessment and fast literature review, we considered operation undeferrable and planned multi-stage surgeries, including primary Roux-en-Y hepaticojejunostomy (HJ) and progressive abdominal wall closure in multiple sessions under general anaesthesia, aided by vacuum-assisted wound closure and intraperitoneally mesh-mediated fascial traction-approximation (VAWCM) with permeable mesh. An expected late incisional hernia was eventually repaired through component separation and biological mesh. Discussion and Conclusion: The complexity of our case lies in the coexistence of 2-weeks biliary peritonitis following early BDI with massive midline evisceration, in combination, both representing over 40% mortality risk, requiring immediate, simultaneous repair. Roux-en-Y HJ and VAWCM have proven safe and effective.
Olivier Choussy, Nicolas Viault, Wahib Ghanem, Antoine Dubray Vautrin, Christian Lamer
Published: 30 September 2021
Surgical Case Reports, Volume 2021, pp 1-2; https://doi.org/10.31487/j.scr.2021.09.13

Abstract:
Epistaxis is a common and a well-known symptom. Nasal packing is an effective treatment in most cases [1]. The COVID-19 disease treatment includes conventional or high flow nasal oxygen therapy and systemic anticoagulation [2]. Patients in intensive care unit may require therapeutic anticoagulation for venous thromboembolism, hyperinflammatory status, extracorporeal membrane oxygenation (ECMO) and multiple other pathologies. The use of therapeutic anticoagulation increases risk of nose bleeding, and its management may be challenging. CAVI-T (Figures 1 & 2) is a new asymmetrical low-pressure balloon that have shown promising results to control epistaxis in emergency. We report herein the management of severe epistaxis in two COVID-19 patients admitted to ICU for severe respiratory failure.
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