Journal of Surgical Case Reports
ISSN / EISSN : 2042-8812 / 2042-8812
Published by: Oxford University Press (OUP) (10.1093)
Total articles ≅ 2,432
Latest articles in this journal
Journal of Surgical Case Reports, Volume 2021; https://doi.org/10.1093/jscr/rjab436
Renal fungal bezoars or fungal balls is a rare condition in neonates and infants, usually occurring in immunocompromised patients. Renal bezoars result from accumulations of fungal cells and renal epithelial cells. The most common manifestation is candiduria, which can cause urinary tract obstruction. The treatment of choice is prompt medical or surgical intervention, as indicated to eliminate the infection and preserve renal function. Herein we report the case of a 34-week preterm male infant who presented with feeding intolerance, fever, acute kidney injury and alteration of consciousness. His initial creatinine was 3.4 mg/dL and urine analysis showed pyuria and yeast cells. A renal ultrasound demonstrated a dilated bilateral renal pelvis and calyx with bilateral fungal bezoars. The management was intravenous fluconazole with bilateral nephrostomy tubes and later surgical removal of bilateral fungal balls.
Journal of Surgical Case Reports, Volume 2021; https://doi.org/10.1093/jscr/rjab441
Button battery ingestion can cause serious injury or death in young children who cannot communicate symptoms. An 18-month-old male presented after his mother noted drooling, nonbilious emesis and a metallic smell to his breath. He underwent rigid esophagoscopy and a 3-V 20-mm button battery was removed. Subsequent bronchoscopy after a 1-week interval revealed progression to a large broncho-esophageal fistula on the posterior wall of the right mainstem bronchus past the carina. A fenestrated nasogastric tube for local control of secretion and a feeding jejunostomy was placed. Six weeks later, the patient underwent a right thoracotomy for division and repair of the fistula and intercostal muscle flap interposition. Utilizing a well-placed fenestrated nasogastric tube to manage secretions can help reduce fistula size and improve conservative management results. When surgical repair is required, an intercostal muscle flap can reinforce fistula closure while simultaneously buttressing the bronchus and esophagus.
Journal of Surgical Case Reports, Volume 2021; https://doi.org/10.1093/jscr/rjab442
Kikuchi-Fujimoto disease (KFD) is a rare lymphohistiocytic disorder with an unknown etiopathogenesis. Due to its non-specific lymphadenopathy presentation, treatment is complicated by the frequency by which it is misdiagnosed—for example up to one-third of cases are misdiagnosed as malignant lymphoma, leading to expensive clinical testing and overtreatment of this typically self-limiting illness. KFD has a strong association with SLE, although its transience and rarity make it difficult to investigate. We present a case of KFD to illustrate the variance in presentation and typical outcome of KFD. We want to increase awareness and shed some light on some typical and atypical clinical presentations of KFD to reduce the incidence of misdiagnosis.
Journal of Surgical Case Reports, Volume 2021; https://doi.org/10.1093/jscr/rjab444
Prompt removal of unintended surgical foreign bodies is essential for prevention of adverse consequences of retained surgical foreign bodies postop. Current practices utilizing radiographic images in combination with visual inspection and palpation to remove foreign bodies can lead to increased surgical times and tissue damage. A suture needle fragment broke off during a laparoscopic cholecystectomy performed on a morbidly obese adult female. After being unable to retrieve the fragment by increasing the midline incision by ~7 cm and undergoing an additional ~1 of intraoperative time, a pacemaker magnet wrapped in sterilized plastic was able to instantaneously remove the shard. Techniques utilizing magnetism could be researched and developed for the removal of surgical foreign bodies both intraoperatively and postop.
Journal of Surgical Case Reports, Volume 2021; https://doi.org/10.1093/jscr/rjab445
Hemangioma is a benign vascular soft tissue tumor. It is the most common soft tissue tumor in children and >60% of hemangiomas occur in the head and neck region. However, these tumors are rare in the external auditory canal (EAC). This case report describes a case of capillary hemangioma in the EAC in a woman 54 years of age. With the patient under local anesthesia in microscopic surgery, the mass was excised completely via a transcanal approach. If there is a cystic and pinkish mass in the EAC with symptoms of bleeding or pulsatile tinnitus, hemangioma should be considered. For symptomatic hemangioma, complete surgical excision is necessary and the prognosis is good after excision. Histopathologic confirmation is mandatory after excision.
Journal of Surgical Case Reports, Volume 2021; https://doi.org/10.1093/jscr/rjab440
Bilateral adrenal hemorrhage (BAH) is a rare condition, which can easily become a serious threat to life. It is even rarer in the setting of antiphospholipid syndrome (APLS), which in itself is associated with coagulopathy as well as the need for lifelong anticoagulation. Death from BAH is commonly due to adrenal insufficiency from infarction within the gland. Our case is that of a 53-year-old woman with APLS who presented to the emergency department with a markedly raised international normalized ratio and bilateral loin pain. She developed adrenal insufficiency and required glucocorticoids while on admission. Her anticoagulants were also adjusted and she received vitamin K. She made good progress thereafter and was discharged after 11 days. Vitamin K should be considered in patients with markedly deranged clotting profile and BAH to prevent ongoing bleeding. Early adrenal axis testing is also recommended to forestall delayed diagnosis of adrenal insufficiency.
Journal of Surgical Case Reports, Volume 2021; https://doi.org/10.1093/jscr/rjab439
Resection of malignant tumors in the posterior pelvis requires multidirectional approaches for the resection and the subsequent spine-pelvic fixation. The multifidus muscle can be scarified during the operation. This is a case report of a 44-year-old male with a secondary chondrosarcoma arising from an osteochondroma in the sacral ala. Recurrence occurred 11 months after the initial operation, and the resected tissue from the recurrence was diagnosed as a chondrosarcoma. In both operations, the multifidus muscle was elevated from its distal attachment to provide an adequate view of the tumor resection and insertion of spine-pelvic instrumentation. An adequate view by elevation of the multifidus muscle is useful for a safe operation. A preserved multifidus muscle covering the instrumentation may reduce the risk of infection. The elevation and preservation of the multifidus muscle is an easy and simple method that contributes to successful resection of a malignant tumor of the pelvis.
Journal of Surgical Case Reports, Volume 2021; https://doi.org/10.1093/jscr/rjab476
Granulomatosis with polyangiitis (GPA, formerly Wegener’s) is a rare form of vasculitis, commonly affecting the upper and lower respiratory tract with simultaneous glomerulonephritis. Ear, nose and throat (ENT) manifestations account for the majority of presentations. The presence of antineutrophil cytoplasmic antibody is a recognized hallmark of GPA, but clinicians should remain cautious of false negative results. We describe a rare case of GPA presenting with concurrent middle ear disease and multiple lower cranial nerve palsies. Clinical judgment was affected by repeated negative autoimmune screens, and a definitive diagnosis was only achieved following renal biopsy. Reported cases of GPA presenting with mastoiditis or cranial nerve involvement are typically seropositive, with seronegative GPA following a less aggressive process. This case highlights the importance of clinical suspicion in the face of treatment resistant ENT pathology, and the need for early histopathological analysis. Early diagnosis and treatment are crucial in limiting disease progression.
Journal of Surgical Case Reports, Volume 2021; https://doi.org/10.1093/jscr/rjab391
Extrahepatic blood supply is seen in around 17–27% of hepatocellular carcinoma lesions. Evidence suggests that this extrahepatic supply most commonly originates from a right intercostal artery (70–83%) followed by left intercostal, omental and right renal arteries. Thus a comprehensive knowledge of variations in standard vascular anatomy and cognisance of factors influencing or predicting extrahepatic blood supply in HCC is instrumental in ensuring the success of surgical and interventional procedures. We present the unusual case of a 66-year-old male with HCC in Segment I of the liver with aberrant blood supply from the right renal artery in the absence of any risk factors for extrahepatic circulation. He successfully underwent transarterial chemoembolization. There was no evidence of residual disease on repeat imaging.
Journal of Surgical Case Reports, Volume 2021; https://doi.org/10.1093/jscr/rjab437
Celiac artery is a visceral abdominal vasculature whose aneurysms are very rare, accounting for less than 0.01% of all aneurysms. This condition can be treated by open aneurysmectomy or aneurysmorrhaphy and endovascular intervention. Due to the high mortality and morbidity associated with open surgery, endovascular intervention may be a better treatment option. Here, we present a case related to a 40-year-old man who had been experiencing vague epigastric pain for 4 months prior to admission and was managed endovascularly.