Case Rep Surg [JOURNAL]
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200 papers
Achilles Allograft Reconstruction for Ankle Multiligament Injuries in a Patient Presenting With Rotational Ankle Instability: A Surgical Technique.
Gholipour M, Salmannezhad A, Abbasi F
Case Rep Surg · 2026 · PMID 42257059 · Full text
The ankle comprises two main ligamentous complexes: the medial and lateral complex. In cases of chronic ankle instability following a sprain involving both complexes, rotational ankle instability can develop. We introduc...
The ankle comprises two main ligamentous complexes: the medial and lateral complex. In cases of chronic ankle instability following a sprain involving both complexes, rotational ankle instability can develop. We introduce a 25-year-old male with rotational ankle instability who reported having 20 episodes of "giving away" over the 6 months following an ankle sprain. Due to persistent instability, the patient was deemed a candidate for surgical reconstruction. An Achilles tendon allograft was utilized to reconstruct four ligaments-two from the lateral complex (the anterior talofibular ligament [ATFL] and calcaneofibular ligament [CFL]) and two from the medial complex (the tibiocalcaneal ligament and anterior tibiotalar ligament, components of the deltoid ligament). At the final follow-up, the patient's American Orthopedic Foot and Ankle Society (AOFAS) score was 89, the pain level was rated at 2 on the visual analog scale (VAS), and there was no significant restriction in the range of motion. While arthroscopic repair is the preferred option, an open surgical approach was chosen to adequately address all the ligamentous injuries, as the patient had two complete ruptures in addition to two partial tears.
Incidentally Identified Pneumatosis Cystoides Intestinalis in Patients With Gastric Outlet Obstruction From Addis Ababa, Ethiopia: A Case Report.
Regassa M, Meshesha T, Berhane KA … +1 more , Zeleke M
Case Rep Surg · 2026 · PMID 42257058 · Full text
Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by the presence of multiple gas-filled cysts within the submucosal or subserosal layers of the intestinal wall. Although often asymptomatic and d...
Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by the presence of multiple gas-filled cysts within the submucosal or subserosal layers of the intestinal wall. Although often asymptomatic and detected incidentally, PCI may be associated with significant underlying gastrointestinal or systemic pathology. We report two young adults from Addis Ababa, Ethiopia, who presented with long-standing upper gastrointestinal symptoms, including early satiety, postprandial epigastric pain, reflux, vomiting, and marked weight loss. Clinical, laboratory, and endoscopic evaluations confirmed gastric outlet obstruction (GOO) secondary to chronic duodenal stenosis. Both patients underwent retrocolic gastrojejunostomy with truncal vagotomy and Braun's anastomosis. During surgery, multiple gas-filled cystic lesions consistent with PCI were incidentally identified on the serosal surface of the small intestine. There were no signs of bowel ischemia, perforation, or peritonitis. No bowel resection was performed, and PCI was managed conservatively. Postoperative recovery was uneventful in both cases, with complete symptom resolution and significant weight gain at follow-up. These cases emphasize that PCI may occur secondary to chronic mucosal disruption and increased intraluminal pressure in GOO. Recognition of PCI in this clinical context is essential to guide appropriate management. When incidentally detected in the absence of complications, PCI does not warrant specific surgical intervention. Management should instead focus on addressing the underlying pathology to avoid unnecessary bowel resection.
Spontaneous Entero-Scrotal Fistula: A Rare Complication of Inguinal Hernia in a Developed Country-A Case Report.
Owusu-Ansa I, Ayeni FE, Vagg D … +1 more , Edirimanne S
Case Rep Surg · 2026 · PMID 42257057 · Full text
INTRODUCTION AND IMPORTANCE: Entero-scrotal fistula is an exceptionally rare and severe complication of inguinal hernias in adults. We present the first reported Australian case, highlighting the unique diagnostic challe...
INTRODUCTION AND IMPORTANCE: Entero-scrotal fistula is an exceptionally rare and severe complication of inguinal hernias in adults. We present the first reported Australian case, highlighting the unique diagnostic challenges of Richter-type hernias, particularly in socially isolated patients, where presentation is often delayed. CASE PRESENTATION: A 71-year-old male with a history of hypertension and chronic alcohol disorder was transferred from a group home with sepsis and a necrotic scrotal ulcer. Computed tomography confirmed a right inguinal hernia with an enterocutaneous fistula originating from the terminal ileum. Intraoperative findings revealed a Richter's hernia with the antimesenteric wall of the terminal ileum incarcerated within the deep inguinal ring, leading to a spontaneous fistula through the scrotal wall. Management involved an ileocecal resection with side-to-side anastomosis and debridement of necrotic scrotal tissue. Due to gross fecal contamination, a primary tissue repair was performed rather than mesh placement. CLINICAL DISCUSSION: Spontaneous fistulization typically results from prolonged incarceration. In this case, the Richter-type hernia allowed for intermittent bowel patency, which masked typical obstructive symptoms and delayed surgical intervention. In the setting of gross contamination (Type IV), primary suture repair-such as the "Nylon Darn" technique-is preferred over synthetic mesh to prevent prosthetic infection and chronic wound complications. CONCLUSION: This case underscores the importance of considering socioeconomic factors and atypical hernia types in surgical delays. In contaminated fields, primary tissue repair remains the gold standard to ensure a safe recovery and optimal patient outcomes.
Malignant Phyllodes Tumor in Adolescent Females: A Report of Three Cases and Review of the Literature.
J JY, S GB, D EM … +2 more , Okecha T, Othieno E
Case Rep Surg · 2026 · PMID 42199378 · Full text
Malignant phyllodes tumors (MPTs) are quite a rare type of mesenchymal breast cancer that can mimic benign lesions such as fibroadenomas histologically and radiologically. They account for less than 1% of all breast canc...
Malignant phyllodes tumors (MPTs) are quite a rare type of mesenchymal breast cancer that can mimic benign lesions such as fibroadenomas histologically and radiologically. They account for less than 1% of all breast cancers, and they usually occur commonly in younger and middle-aged women. We report three cases of MPT with ages ranging between 15 and 20 years from the Eastern region of Uganda that were obtained consecutively at our institution for the period of 3 years (from 2023 to 2025). Case 1 was a 15-year-old female with 2 months history of a left breast mass that was painful, rapidly growing, and associated with ulceration; it was confirmed histologically to be MPT and was treated successfully with ifosfamide 390 mg, doxorubicin 48 mg, and dexamethasone 8 mg. Case 2 was a 19-year-old female with 6-month history of a right breast mass that was associated with pain and tenderness, and the mass was confirmed histologically to be MPT though she died before the initiation of treatment. Case 3 was a 20-year-old female with 3-month history of a left breast mass that was associated with intermittent pains. She also had a positive family history of breast cancer. Her mass in the breast was confirmed histologically to be MPT and she was also treated with ifosfamide 390 mg, doxorubicin 48 mg, and dexamethasone 8 mg. All three cases tested positive for vimentin, but case 2 also showed focally positive SMA, but all of them were triple negative with Ki67 expression ranging from 20% to 35%. MPTs are rare and are more likely to recur, and they tend to have rapid growth and metastasis. Timely and proper management of patients with MPT helps to prevent possibilities of metastasis and improve the prognosis of the patients.
Surgical Management of Recurrent Gastrojejunocolic Fistula With Gastric Antrectomy and Bilateral Vagotomy.
Sticca G, Morin M, Poirier M … +2 more , Sideris L, Bendavid Y
Case Rep Surg · 2026 · PMID 42183476 · Full text
BACKGROUND: Gastrojejunocolic fistulas (GJCFs) are rare complications following gastrojejunostomy and Roux-en-Y procedures, most often in the context of peptic ulcer disease. CASE REPORT: A 42-year-old woman, with a hist...
BACKGROUND: Gastrojejunocolic fistulas (GJCFs) are rare complications following gastrojejunostomy and Roux-en-Y procedures, most often in the context of peptic ulcer disease. CASE REPORT: A 42-year-old woman, with a history of cocaine addiction, underwent an gastrojejunostomy, a transgastric closure of the gastric pylorus, and a Graham patch for a perforated duodenal ulcer. She then presented with a dehisced gastrojejunal anastomosis. Resection of the dehisced anastomosis and Roux-en-Y reconstruction was performed. Eight months later, the patient returned to the hospital with a GJCF. A one-stage en-bloc GJCF resection with redo Roux-en-Y was performed. Six months later, a scan demonstrated a recurrent GJCF. Antrectomy and bilateral truncal vagotomy were performed to avoid recurrent gastric acid secretion. Resection of the dehisced gastrojejunal anastomosis and the segment of fistulized transverse colon was performed. A third Roux-en-Y reconstruction was fashioned. The patient evolved well and showed no signs of recurrent disease. DISCUSSION: The cornerstone treatment of GJCF is the administration of parenteral nutrition, followed by a single-stage en-bloc procedure. Some factors that can contribute to recurrent GJCF are retained gastric antrum syndrome, incomplete vagotomy, and noncompliance with oral antacid therapy. Despite the significant leaps in the medical management of peptic ulcer disease in recent years, surgical strategies that reduce excess gastric acid secretion should be considered in select cases. CONCLUSION: This case highlights that gastric antrectomy and bilateral vagotomy have not been rendered obsolete in the 21st century, particularly in patients who cannot be compliant with oral proton pump inhibitors.
Late Visceral Herniation Secondary to Traumatic Left Hemidiaphragmatic Rupture After Blunt Trauma.
Santiago Pabón-Castro J, Díaz-Castillo JA, Fernando Vélez-Cuorvo L … +3 more , Ramírez-Pérez JC, Velasco-Muñoz V, Prieto-Rodríguez S
Case Rep Surg · 2026 · PMID 42170317 · Full text
Traumatic hemidiaphragmatic rupture (TDR) after blunt thoracoabdominal trauma is uncommon but potentially lethal if diagnosed late. The aim of this report is to highlight the delayed presentation of TDR and the diagnosti...
Traumatic hemidiaphragmatic rupture (TDR) after blunt thoracoabdominal trauma is uncommon but potentially lethal if diagnosed late. The aim of this report is to highlight the delayed presentation of TDR and the diagnostic and therapeutic considerations in a resource-limited setting. We present a case report of a 21-year-old man with obesity (BMI 30) suffered blunt trauma from a 2-m fall. On initial evaluation, the chest X-ray showed no hemidiaphragmatic elevation or pneumothorax, and he was discharged with recommendations. Fifteen days later, he was readmitted due to progressive dyspnea and desaturation. A Chest X-ray and contrast-enhanced computed tomography showed a left hemidiaphragmatic defect (46 × 70 mm) with herniation of the stomach, omentum, tail of the pancreas, and spleen. Exploratory laparotomy was performed, revealing a 10 cm × 7 cm defect with viable contents. Repair was achieved by primary closure with interrupted 0 polypropylene sutures, Stamm gastrostomy, and left thoracostomy. Postoperative evolution was satisfactory, and he was discharged after 12 days. This case is relevant because of its delayed presentation and the unusual inclusion of the pancreatic tail and spleen in the hernia sac, underscoring the need for a high index of suspicion and early imaging in closed thoracic trauma. TDR may present in a delayed fashion; early diagnosis by CT and timely surgical repair are essential to prevent severe complications, especially in resource-limited contexts.
Heartburn Takes a Whole New Meaning: Multidisciplinary Management of a Gastropericardial Fistula.
Sypniewski J, Kelley JK, Fritz GD … +2 more , Lam G, Zolotarevsky E
Case Rep Surg · 2026 · PMID 42146870 · Full text
Gastropericardial fistulas (GCs) are exceedingly rare in the reported literature. Etiologies include prior abdominal surgery, malignancy, and perforated gastric ulcers. Presenting symptoms range from chest pain to cardia...
Gastropericardial fistulas (GCs) are exceedingly rare in the reported literature. Etiologies include prior abdominal surgery, malignancy, and perforated gastric ulcers. Presenting symptoms range from chest pain to cardiac tamponade. Early imaging can help delineate the origin of the fistula. Management involves a multidisciplinary team, involving endoscopic stenting for temporization followed by definitive surgery for fistula closure. Robotic, video-assisted thoracoscopic surgery (VATS) with pericardial window has only been reported once in modern literature as definitive management for GCs. Thus, we present a case of a gastro-pericardial fistula that was temporized with endoscopic stenting and surgically managed with right robotic VATS with a pericardial window and definitive fistula closure. The patient had presented in cardiac tamponade with initial imaging demonstrating a large, loculated hydropneumopericardium and GC. The patient's postoperative course was unremarkable, and she was discharged on postoperative day 7. Follow-up within our health system is currently 4.5 years, and she continues to do well.
Dual-Segment Colonic Volvulus Involving the Sigmoid and Transverse Colon: A Surgical Emergency.
Goyal G, Meena J, Singh M
Case Rep Surg · 2026 · PMID 42131863 · Full text
Synchronous colonic volvulus is an extremely rare and life-threatening cause of large bowel obstruction, characterized by simultaneous torsion of two separate colonic segments. Early diagnosis is challenging due to its n...
Synchronous colonic volvulus is an extremely rare and life-threatening cause of large bowel obstruction, characterized by simultaneous torsion of two separate colonic segments. Early diagnosis is challenging due to its nonspecific clinical presentation and overlapping radiological features with isolated volvulus. Delay in recognition increases the risk of ischemia, perforation, sepsis, and mortality, making rapid identification and surgical intervention critical. We present a case of a middle-aged patient who arrived at the emergency department with progressive abdominal pain, distension, constipation, and absence of flatus. Physical examination revealed a markedly distended abdomen with diffuse tenderness, and laboratory tests demonstrated leukocytosis. Abdominal radiographs suggested large bowel obstruction, while contrast-enhanced computed tomography (CECT) demonstrated the characteristic whirl sign at two distinct anatomical sites, consistent with synchronous volvulus of the sigmoid and transverse colon. The patient underwent emergency exploratory laparotomy, which confirmed volvulus of both affected segments with compromised vascularity. Surgical management included resection of the necrotic segments with primary anastomosis. The postoperative course was uneventful, and the patient was discharged in stable condition with scheduled follow-up. This case highlights the importance of maintaining a high index of suspicion in patients presenting with acute large bowel obstruction, particularly when imaging demonstrates atypical or dual transition points. While sigmoid volvulus is the most common form, synchronous involvement of multiple colonic segments is exceedingly uncommon but should be considered to prevent diagnostic delay. Timely surgical intervention remains the cornerstone of management and is paramount in preventing progression to gangrene, peritonitis, and septic shock.
A Giant Mesenteric Cystic Lymphangioma Causing Abdominal Mass Effect: A Case Report of a 57-Year-Old Woman.
Abebe TB, Ayana DI, Bone AG … +2 more , Barkneh KA, Tilahun BD
Case Rep Surg · 2026 · PMID 42109562 · Full text
Mesenteric cystic lymphangioma (MCL) is a rare benign abdominal tumor. This report describes a giant MCL in a 57-year-old woman presenting with progressive abdominal distension and dyspnea. Examination revealed a massive...
Mesenteric cystic lymphangioma (MCL) is a rare benign abdominal tumor. This report describes a giant MCL in a 57-year-old woman presenting with progressive abdominal distension and dyspnea. Examination revealed a massive abdominal mass. Magnetic resonance imaging (MRI) showed a giant cyst (34.8 cm × 46.5 cm × 25.0 cm) with T2 hyperintensity and T1 hypointensity. Laparotomy revealed a 46 cm cyst arising from the ileal mesentery. Complete en bloc excision was performed. Histopathology confirmed MCL with endothelial-lined channels and lymphoid aggregates; the cyst contained greenish fluid. The patient recovered well with symptom resolution. MCL should be considered in the differential diagnosis of massive abdominal cysts, even in adults. Complete surgical excision remains the definitive treatment, offering excellent outcomes when performed adequately. This case highlights how delayed diagnosis due to healthcare access limitations can lead to extreme presentations requiring complex management.
Chest Pain and Palpitations After Spinal Surgery: An Atypical Presentation of Acute Cholecystitis.
Purewal J, Silvers J, Gennett J … +3 more , Knight M, Ahmed N, Sun X
Case Rep Surg · 2026 · PMID 42109561 · Full text
Acute cholecystitis is a common disease that affects ~200,000 people in the United States each year. Early diagnosis and gallbladder removal are associated with improved patient outcomes, including fewer postoperative co...
Acute cholecystitis is a common disease that affects ~200,000 people in the United States each year. Early diagnosis and gallbladder removal are associated with improved patient outcomes, including fewer postoperative complications, shorter length of stay, and lower hospital costs. Acute cholecystitis typically presents with right upper quadrant (RUQ) pain associated with nausea and vomiting. The pathophysiological mechanism of RUQ pain corresponds with dermatomes that arise from thoracic spinal cord levels T6 to T8. We describe a case of a 40-year-old male who presented with a 2-day history of substernal chest pain, which was worked up for acute coronary syndrome and was later found to have acute cholecystitis. This atypical presentation was attributed to the patient's history of a paraspinal schwannoma after resection with laminectomy, complicated by persistent right hemi-thoracoabdominal paresthesia. We aim to shed light on this atypical presentation of acute cholecystitis.
Giant Mesenteric Lymphangioma in a Young Adult: A Rare Clinical Entity.
El Tawil AI, Machoski LAF, Mendes BA … +4 more , Domingos MF, Chiquetto Filho JC, Tabushi FI, Ramos EJB
Case Rep Surg · 2026 · PMID 42088478 · Full text
Cystic lymphangioma is a rare benign tumor of lymphatic origin, characterized by slow growth and variable clinical presentation. The presence of a peritoneal diverticulum is exceedingly rare in adults and often poses a d...
Cystic lymphangioma is a rare benign tumor of lymphatic origin, characterized by slow growth and variable clinical presentation. The presence of a peritoneal diverticulum is exceedingly rare in adults and often poses a diagnostic challenge owing to nonspecific symptoms and imaging findings. A 22-year-old previously healthy male presented with abdominal fullness and flatulence without other relevant symptoms. On physical examination, a firm, palpable abdominal mass was identified. Laboratory tests revealed mild elevations in alanine aminotransferase and alkaline phosphatase levels. Abdominal computed tomography (CT) revealed a cystic lesion in the epigastric and right hypochondriac regions adjacent to the liver, pancreas, and stomach. Magnetic resonance imaging (MRI) revealed a cystic mass suggestive of lymphangioma, measuring 21 cm × 20 cm × 16 cm. The patient underwent open retroperitoneal lymphadenectomy with complete excision of the lesion and additional foci located above the superior mesenteric vein. Histopathological examination confirmed the diagnosis of mesenteric cystic lymphangioma. Mesenteric lymphangiomas are rare in adults and present with vague, nonspecific abdominal symptoms. Imaging studies play an essential role in diagnosis, although definitive confirmation requires histopathological evaluation of the tissue. Complete surgical resection remains the treatment of choice and is critical for preventing recurrence and potential complications, such as infection, rupture, or intestinal obstruction. Given the rarity and diagnostic challenges of mesenteric cystic lymphangioma in adults, clinicians should maintain a high index of suspicion when evaluating abdominal cystic lesions in adults. Early surgical intervention is fundamental for achieving optimal outcomes and preventing future complications.
Gallstone Ileus Secondary to Cholecystoduodenal Fistula: A Case Report and Review of Surgical Management.
Adeyemi O, Patel M, Shamoun E … +2 more , Cort C, Franco C
Case Rep Surg · 2026 · PMID 42079896 · Full text
Gallstone ileus is a rare cause of small bowel obstruction (SBO). It occurs when a gallstone passes through a cholecystoenteric fistula and obstructs the bowel. This case report aims to share our experience in managing a...
Gallstone ileus is a rare cause of small bowel obstruction (SBO). It occurs when a gallstone passes through a cholecystoenteric fistula and obstructs the bowel. This case report aims to share our experience in managing an uncommon cause of SBO and to discuss available surgical management options, including the rationale for a staged approach in patients with significant comorbidities. We describe a 63-year-old woman with a history of hypertension, diabetes, gallstones, and uterine cancer treated with hysterectomy and radiation therapy, who presented with right upper quadrant pain and vomiting and subsequently developed signs of SBO. A computerized tomography scan of the abdomen and pelvis revealed a cholecystoduodenal fistula with evidence of a stone in the distal ileum. She subsequently underwent emergency enterolithotomy, successfully removing the stone, and was scheduled for a cholecystectomy at a later date to reduce her surgical risk. We discuss the three approaches to the surgical management of gallstone ileus-enterolithotomy alone, one-stage surgery (enterolithotomy + cholecystectomy with fistula repair), and two-stage surgery (enterolithotomy and delayed cholecystectomy with fistula repair).
Laparoscopic Management of Small Bowel Obstruction and Ischemia Caused by Spontaneous Transomental Hernia in a Virgin Abdomen: A Case Report.
Mousli A
Case Rep Surg · 2026 · PMID 42065096 · Full text
Transomental hernias (TOHs) are a rare form of internal hernia, accounting for ~1%-4% of all internal hernias and 0.5%-3% of bowel obstructions. Preoperatively diagnosing TOH is challenging owing to nonspecific obstructi...
Transomental hernias (TOHs) are a rare form of internal hernia, accounting for ~1%-4% of all internal hernias and 0.5%-3% of bowel obstructions. Preoperatively diagnosing TOH is challenging owing to nonspecific obstructive symptoms and the absence of a hernia sac. This challenge can lead to delayed interventions and increased risk of bowel ischemia. In this report, we present the case of a 71-year-old female patient with a negative surgical history who presented with small bowel obstruction and a high lactate level. Abdominal computed tomography (CT) showed a closed-loop obstruction with wall thickening and decreased enhancement, raising concerns of ischemia. Laparoscopic exploration revealed spontaneous TOH through the greater omentum, resulting in small bowel obstruction and ischemia, which were successfully managed entirely with laparoscopic resection, anastomosis, and closure of the mesenteric defect. The patient's postoperative course was uneventful. This report discusses diagnostic challenges, surgical approaches, and key intraoperative findings.
Evaluation of Rare Hand Injection Injuries With Three Different Substances.
Çağlı HB, Sezer SC, Yurttaşer AE … +4 more , Özdemir A, Babahan T, Özger M, Yılmaz M
Case Rep Surg · 2026 · PMID 42058955 · Full text
Injection injuries to the hand are rare and often underestimated in the initial evaluation due to minor external findings and mild symptoms. However, these injuries can lead to local and systemic complications with mecha...
Injection injuries to the hand are rare and often underestimated in the initial evaluation due to minor external findings and mild symptoms. However, these injuries can lead to local and systemic complications with mechanical and toxic damage mechanisms. This study presents three cases of hand injection injuries caused by different substances.
Axial Torsion of a Necrotic Giant Meckel's Diverticulum With Secondary Peritonitis in a 7-Year-Old: A Case Report.
Trăilescu MD, Pavel AI, Crișan AS … +3 more , Cindea CN, Osakwe HI, Boștinaru GM
Case Rep Surg · 2026 · PMID 42058954 · Full text
Axial torsion with subsequent gangrene of Meckel's diverticulum represents an exceptionally rare cause of small bowel obstruction, one of the rarest causes of small bowel obstruction. Meckel's diverticulum is the most co...
Axial torsion with subsequent gangrene of Meckel's diverticulum represents an exceptionally rare cause of small bowel obstruction, one of the rarest causes of small bowel obstruction. Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, and it is often discovered incidentally during abdominal surgery, particularly in pediatric patients. Approximately 4% of individuals with Meckel's diverticulum develop complications, including bleeding, obstruction, inflammation, intussusception, or perforation, with torsion being the rarest. Despite its rarity, symptomatic Meckel's diverticulum poses serious diagnostic and therapeutic challenges due to its nonspecific clinical presentation, which may mimic other intra-abdominal pathologies. Consequently, preoperative diagnosis is difficult, and delayed management may lead to life-threatening complications. We report a case of axial gangrenous torsion of a giant Meckel's diverticulum in a child without a history of previous abdominal surgery. In such cases, prompt decision-making for exploratory laparotomy or laparoscopy is crucial to achieving a favorable outcome. We report a case of axial torsion with gangrene of a giant Meckel's diverticulum in a 7-year-old boy with no prior history of abdominal surgery. This case highlights the importance of early recognition and timely operative management in atypical presentations of acute abdomen in children.
Surgical Resection of Fibrolamellar Hepatocellular Carcinoma After Reassessment of Resectability: A Case Report.
Lozano-Salazar RR, Rios-Covian-Molina X, Rochel-Perez A … +3 more , Huchim-Mendez O, Ferro OB, Mendez-Dominguez N
Case Rep Surg · 2026 · PMID 42046780 · Full text
BACKGROUND: Fibrolamellar hepatocellular carcinoma (FL-HCC) is a rare variant of hepatocellular carcinoma (HCC) that typically arises in non-cirrhotic livers and affects younger individuals compared with conventional HCC...
BACKGROUND: Fibrolamellar hepatocellular carcinoma (FL-HCC) is a rare variant of hepatocellular carcinoma (HCC) that typically arises in non-cirrhotic livers and affects younger individuals compared with conventional HCC. Because patients usually have preserved hepatic function, surgical resection may be feasible even in the presence of large tumors. However, diagnostic uncertainty and concerns regarding extrahepatic disease may limit initial surgical decision-making. CASE PRESENTATION: We report the case of a 48-year-old male patient who presented with epigastric discomfort, weight loss, and a palpable abdominal mass. Contrast-enhanced imaging demonstrated a large hepatic lesion involving segments II, III, and IV, with additional pulmonary and adrenal findings initially raising concern for metastatic disease. The patient had previously been declined surgical treatment at another institution. Further multidisciplinary evaluation, imaging reassessment, and histological confirmation by percutaneous biopsy supported the diagnosis of FL-HCC without confirmed metastatic disease. An open anatomical left hepatectomy was performed. Histopathology confirmed FL-HCC with negative surgical margins and no lymph node metastases. Follow-up 36 months after surgery demonstrated no evidence of recurrence. CONCLUSION: This case highlights the importance of comprehensive staging and multidisciplinary reassessment in patients with suspected FL-HCC. Even when surgery has initially been declined, careful evaluation may identify candidates for potentially curative hepatic resection. Long-term surveillance remains essential due to the risk of recurrence following resection. Additionally, this report illustrates that FL-HCC can occur outside the typical age range, emphasizing the need to consider this diagnosis in compatible clinical and radiologic contexts.
Primary Jejunal Melanoma Presenting as Widespread Metastases: Clinicopathological and Embryological Perspectives-A Case Report.
Balcı M
Case Rep Surg · 2026 · PMID 42037984 · Full text
Primary malignant melanoma of the small intestine is an exceptionally rare and diagnostically challenging condition, largely due to the predominance of metastatic involvement in the gastrointestinal (GI) tract. We report...
Primary malignant melanoma of the small intestine is an exceptionally rare and diagnostically challenging condition, largely due to the predominance of metastatic involvement in the gastrointestinal (GI) tract. We report the case of a 71-year-old male presenting with a large, pigmented jejunal mass accompanied by multiple distant metastases in the liver, adrenal glands, and lungs. Histopathological and immunohistochemical analyses performed on the jejunal mass confirmed the diagnosis of malignant melanoma. Although systemic metastases were present, thorough clinical examination revealed no evidence of cutaneous, ocular, or mucosal primary lesions elsewhere, supporting the jejunum as the primary mucosal site of origin. This report discusses the embryological background, diagnostic challenges, and clinical significance of this rare entity. This case highlights that primary small bowel melanoma, although extremely rare, should be considered in patients presenting with intestinal lesions and disseminated metastases in the absence of an identifiable cutaneous primary lesion.
A Large Galenic Dural Arterio-Venous Fistula in an Adult Managed Surgically: A Case Report.
Pahari S, Bhandari PB, Baniya P … +2 more , Dhungana V, Gurung N
Case Rep Surg · 2026 · PMID 42028397 · Full text
Galenic dural arteriovenous fistulas (GDAVFs) are rare, high-risk vascular malformations within the vein of Galen (VoG), commonly acquired due to factors like venous thrombosis, trauma, or infection and often resulting i...
Galenic dural arteriovenous fistulas (GDAVFs) are rare, high-risk vascular malformations within the vein of Galen (VoG), commonly acquired due to factors like venous thrombosis, trauma, or infection and often resulting in severe complications such as hemorrhage or neurological deficits. A 55-year-old female presented with pulsatile tinnitus and headaches, with computed tomography (CT) angiography revealing a Borden type III GDAVF with obstructive hydrocephalus. She underwent microsurgical interruption of the fistula via a posterior interhemispheric approach, achieving significant nidus reduction, though a residual fistula persisted. At 3-month follow-up, the patient remained asymptomatic. This case underscores the challenges of GDAVFs, where their deep anatomical location complicates treatment, often necessitating a combination of endovascular and microsurgical approaches. Moreover, it highlights the impact of socioeconomic factors on healthcare access, particularly in resource-limited settings, and emphasizes the need for tailored, multidisciplinary strategies to optimize outcomes.
Extensive Odontogenic Deep Neck Infection Complicated by Necrotizing Fasciitis and Bilateral Mastitis: A Rare Case Report.
Aytaç A, Dönmez U, Keyik BY
Case Rep Surg · 2026 · PMID 42028396 · Full text
OBJECTIVES: Odontogenic infections are a leading cause of deep neck space infections and may progress rapidly through fascial planes, leading to severe complications such as necrotizing fasciitis, mediastinitis, and seps...
OBJECTIVES: Odontogenic infections are a leading cause of deep neck space infections and may progress rapidly through fascial planes, leading to severe complications such as necrotizing fasciitis, mediastinitis, and sepsis. This case represents an exceptionally rare example of odontogenic deep neck infection complicated by necrotizing fasciitis with bilateral breast involvement, emphasizing its potential for aggressive, life-threatening spread. CASE REPORT: We describe a 58-year-old woman with diabetes, hypertension, and coronary artery disease who presented with neck and chest wall swelling, erythema, crepitus, and sepsis after 2 weeks of inadequate treatment for a buccal abscess. Imaging revealed multicompartment spread with subcutaneous emphysema, myositis, abscess formation, and bilateral breast involvement. The patient underwent aggressive resuscitation, broad-spectrum intravenous antibiotics, and serial surgical debridements through extended cervical and anterior chest wall incisions, followed by negative pressure wound therapy (NPWT), resulting in clinical and laboratory improvement. DISCUSSION: This case highlights the potential for odontogenic infections to progress beyond the neck into the thoracic wall and breast tissue, emphasizing the importance of early imaging and comprehensive source control. Diabetes was likely a significant predisposing factor for the rapid and extensive spread observed. Contrast-enhanced CT is critical for mapping disease extent and guiding timely surgical intervention, which is associated with reduced morbidity and mortality. CONCLUSIONS: Early recognition, imaging, and a multidisciplinary treatment strategy, including prompt broad-spectrum antibiotic therapy and repeated surgical debridement, are essential to prevent life-threatening complications of odontogenic deep neck infections. Clinicians should maintain a high index of suspicion in patients with systemic symptoms and comorbidities, even when initial dental infections appear minor.
Blunt Tracheal Trauma Managed Conservatively and Surgically: Two Case Reports.
Alabdallat M, Kloub A, Younis B … +5 more , Afifi I, El-Menyar A, Peralta R, Rizoli S, Al-Thani H
Case Rep Surg · 2026 · PMID 42004905 · Full text
Traumatic tracheobronchial injuries (TTBIs), while rare, are associated with significant morbidity and mortality. The management of these injuries requires a high degree of clinical suspicion, rapid diagnosis, and a mult...
Traumatic tracheobronchial injuries (TTBIs), while rare, are associated with significant morbidity and mortality. The management of these injuries requires a high degree of clinical suspicion, rapid diagnosis, and a multidisciplinary approach. We present two cases of TTBI, managed with varied approaches to achieve prompt, comprehensive, and optimal outcomes. The first case reported a 20-year-old male who presented with a blunt traumatic posterior tracheal wall at the T1/T2 level that was managed conservatively. The second case reported a 25-year-old motorcyclist presented with a tracheal injury at the T1 vertebra level that required surgical repair. The two treatment options were successful. The management of TTBI requires a highly individualized approach, balancing the urgency of surgical intervention with the potential benefits of conservative management.
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