Metastatic spread of malignant melanoma to the small intestine occurs more frequently than primary intestinal melanoma, which remains an exceptional finding. Clinical manifestations often include gastrointestinal hemorrh...Metastatic spread of malignant melanoma to the small intestine occurs more frequently than primary intestinal melanoma, which remains an exceptional finding. Clinical manifestations often include gastrointestinal hemorrhage, intestinal obstruction, or acute peritonitis. Prompt surgical intervention is essential in emergency presentations, both to control life-threatening bleeding and to improve survival prospects. This report describes a rare case of jejunal melanoma presenting with massive gastrointestinal bleeding and an additional tumor with identical histological characteristics in the right parotid gland.
INTRODUCTION: Primary splenic angiosarcoma (PSA) is a rare type of angiosarcoma often associated with an unfavorable prognosis. The presenting symptoms are usually nonspecific, adding to the diagnostic difficulty of this...INTRODUCTION: Primary splenic angiosarcoma (PSA) is a rare type of angiosarcoma often associated with an unfavorable prognosis. The presenting symptoms are usually nonspecific, adding to the diagnostic difficulty of this disease. Limited cases have been described in younger adults, as most cases have been reported in individuals between 50 and 70 years old. PRESENTATION OF CASE: We report the case of a 25-year-old patient with cerebral palsy who initially presented for high-grade fever and left upper quadrant (LUQ) pain. On computed tomography (CT) scan, a large heterogenous mass was discovered in the spleen, and the patient underwent total splenectomy with pathological analysis confirming the diagnosis of PSA. The patient had no further complications and is still clinically stable. DISCUSSION: PSA's pathogenesis is not fully understood, though potential risk factors include exposure to chemicals or radiation, none of which were present in this case. Diagnosing PSA is challenging due to nonspecific symptoms and imaging findings that overlap with benign splenic lesions. Treatment primarily involves splenectomy, but prognosis remains poor due to the high likelihood of early metastasis. Adjuvant therapies, including chemotherapy and targeted agents, are under investigation. CONCLUSION: PSA is a rare and aggressive malignancy with significant diagnostic and therapeutic challenges. Early recognition and timely management may be important in selected cases, and outcomes remain poor, highlighting the need for further research to optimize treatment strategies.
Retained guidewire after central venous catheterization (CVC) placement is a rare but preventable complication. Despite advances in ultrasound-guided catheterization and procedural safety, guidewire retention continues t...Retained guidewire after central venous catheterization (CVC) placement is a rare but preventable complication. Despite advances in ultrasound-guided catheterization and procedural safety, guidewire retention continues to be reported and may result in vascular injury, thrombosis, embolization, arrhythmia, or infection. We report the case of a 62-year-old male who underwent ascending aorta and total arch replacement for acute type I aortic dissection. On postoperative Day 11, a hemodialysis catheter was inserted into the right femoral vein under ultrasound guidance for continuous renal replacement therapy (CRRT). Sequential radiographs obtained within hours demonstrated cranial migration of a retained guidewire from the inferior vena cava (IVC) to the internal jugular vein (IJV); however, the finding was initially misinterpreted as an imaging artifact. The guidewire was recognized ~24 h after insertion and successfully retrieved percutaneously in the angiography suite using a 6-Fr loop snare under fluoroscopic guidance. Completion venography confirmed intact removal without vascular injury or immediate complication. Although the patient later developed an aorto-esophageal fistula and died of septic shock on postoperative Day 86, there was no clinical or radiologic evidence linking the retained guidewire or its retrieval to the cause of death. This case highlights the potential for rapid intravascular migration, the risk of radiographic misinterpretation, and the necessity of structured "wire-out" verification before flushing or securing CVCs, even when ultrasound guidance is used.
Zenker's diverticulum (ZD) is an acquired outpouching of the mucosa and the submucosa through a point of weakness between the inferior pharyngeal constrictor and the cricopharyngeus muscles. It commonly presents with dys...Zenker's diverticulum (ZD) is an acquired outpouching of the mucosa and the submucosa through a point of weakness between the inferior pharyngeal constrictor and the cricopharyngeus muscles. It commonly presents with dysphagia, regurgitation, and halitosis. We retrospectively reviewed seven patients treated with open cervical surgery between 2010 and 2025. Six underwent diverticulectomy and cricopharyngeal myotomy, and one underwent diverticulopexy. The mean age was 59.4 years, and 85.7% were male. All patients experienced dysphagia, and regurgitation and halitosis were present in 42.8% each. Diagnosis was established through a barium swallow study, with complementary imaging performed in selected cases. No postoperative complications or mortality occurred. The mean hospital stay was 2.4 days, and after a mean follow-up of 7 months, no recurrences or reinterventions were observed. Open cervical surgery remains a safe and effective option in properly selected patients, although the small sample size and short follow-up warrant cautious interpretation of these findings.
BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disorder characterized by recurrent nodules, abscesses, and sinus tracts, frequently leading to significant morbidity. Severe cases often require...BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disorder characterized by recurrent nodules, abscesses, and sinus tracts, frequently leading to significant morbidity. Severe cases often require surgical intervention, and multimodal approaches are increasingly being explored to optimize outcomes. CASE PRESENTATION: We report the case of a 49-year-old male with long-standing, treatment-refractory Hurley III HS affecting the gluteal and proximal thigh regions. Despite lifestyle modifications and pharmacologic therapies, including antibiotics, methotrexate, and biologic treatment with adalimumab, there was no sustained clinical improvement. The patient subsequently underwent wide local excision followed by perioperative adjunctive hyperbaric oxygen therapy (HBOT) and reconstructive skin grafting as part of a multimodal salvage strategy. First, a wide local excision of the affected regions was performed, targeting areas with the most extensive disease activity. In the second stage, HBOT was administered to enhance granulation, reduce edema, and promote wound bed preparation. Finally, the patient underwent plastic reconstruction with split-thickness skin grafts and a tie-over dressing. Postoperative recovery was uneventful, with excellent graft integration and significant improvement in local inflammation, pain, and functional status. The patient was discharged ambulating and resumed daily activities without significant limitations. CONCLUSION: This case highlights the potential role of HBOT as a perioperative adjunct in refractory gluteal HS after failure of anti-TNF therapy with adalimumab. In this setting, the combination of wide surgical excision, adjunctive HBOT, and reconstructive skin grafting resulted in satisfactory healing and functional recovery.
Basal cell carcinoma (BCC) is the most common type of skin cancer and is a significant focus in plastic surgery practice. BCC also represents the most common epithelial tumor of the periocular region, particularly affect...Basal cell carcinoma (BCC) is the most common type of skin cancer and is a significant focus in plastic surgery practice. BCC also represents the most common epithelial tumor of the periocular region, particularly affecting the medial canthus and lower eyelid. Multiple studies have suggested that tumor recurrence is more likely when BCC arises in specific anatomical sites, such as the medial canthus, or involves aggressive histological subtypes like morpheaform or sclerosing variants. BCC located near the medial canthus may extend to involve the lacrimal drainage system and adjacent ocular structures if not treated promptly. Nevertheless, direct invasion of the lacrimal canaliculus or sac remains uncommon, with only a few cases reported in the literature to date. In this report, we present a case of morpheaform BCC with invasion of the lacrimal sac and discuss the surgical management and reconstructive approach.
INTRODUCTION: Bochdalek hernia (BH), a congenital anomaly that typically manifests in infancy, occasionally presents in adults and can lead to serious complications. "Splenic flexure incarceration" within a BH is a rare...INTRODUCTION: Bochdalek hernia (BH), a congenital anomaly that typically manifests in infancy, occasionally presents in adults and can lead to serious complications. "Splenic flexure incarceration" within a BH is a rare but clinically significant event, in which the colonic segment near the spleen becomes entrapped, leading to potential acute complications. CASE PRESENTATION: A 51-year-old male with no significant medical history presented with acute abdominal pain, nausea, and an absence of bowel movements. Diagnostic imaging revealed a left-sided BH with splenic flexure and incarcerated omentum, causing marked colonic distension. Emergency surgery was performed, successfully releasing the adhesions and restoring colonic integrity. The patient's postoperative course was unremarkable, and he was discharged in good health. CONCLUSION: This case highlights the rarity of adult BH with splenic flexure incarceration, and the need for swift surgical intervention to prevent life-threatening sequelae.
Bochdalek hernia (BH) is a rare paediatric condition, but late diagnoses occur in adults. It occurs following incomplete posterolateral development of the diaphragm. Adult BH is asymptomatic in most cases, but it has the...Bochdalek hernia (BH) is a rare paediatric condition, but late diagnoses occur in adults. It occurs following incomplete posterolateral development of the diaphragm. Adult BH is asymptomatic in most cases, but it has the potential of being life-threatening. This case report is of a 35-year-old female patient who presented to us with a history of childhood abdominal discomfort leading to frequent hospitalisation. Presently, she came with complaints of increasing abdominal pain, postprandial vomiting, and a 31% weight loss over 3 months before the current admission to our facility. A preoperative diagnosis of a Type IV hiatus hernia with a possible volvulus was made with the assistance of radiology, which turned out to be left BH intraoperatively. Only the herniated stomach was laparoscopically reduced due to technical difficulties and pexied along the defect to seal it. The postoperative period was unremarkable. This case report highlights the need for maintaining a high index of suspicion and surgical preparedness for BH in patients with high-grade hiatus hernia.
INTRODUCTION: De Garengeot hernias are a rare type of femoral hernia which contains the appendix inside the hernia sac. Prompt surgical intervention is required when appendicitis develops within the hernia. Diagnosis and...INTRODUCTION: De Garengeot hernias are a rare type of femoral hernia which contains the appendix inside the hernia sac. Prompt surgical intervention is required when appendicitis develops within the hernia. Diagnosis and management are often challenging due to the uncommon nature of this condition. CASE PRESENTATION: We report the case of a 61-year-old female who presented to the clinic with right lower quadrant pain and an erythematous bulge in the right groin. A CT scan confirmed the presence of a femoral hernia with an incarcerated appendicitis. She was managed by the general surgery team and underwent a staged appendectomy followed by femoral hernia repair via an open anterior approach. The patient recovered uneventfully. DISCUSSION: De Garengeot hernia is a rare clinical entity which is often misdiagnosed preoperatively. The decision to treat in a one- or two-stage fashion, as well as open or laparoscopically, is nuanced and requires consideration of contamination within the femoral space and if mesh is required for hernia repair. CT imaging can aid in diagnosis but has a relatively low sensitivity and specificity. Prompt recognition and surgical management are critical for preventing complications. CONCLUSION: De Garengeot hernia is a rare but serious surgical condition requiring prompt intervention for optimal outcomes.
spp. are rare but important zoonotic pathogens that can cause prosthetic joint infection (PJI). We present 3 cases of prosthetic joint infections (PJIs) following close animal contact that required treatment with DAIR (...spp. are rare but important zoonotic pathogens that can cause prosthetic joint infection (PJI). We present 3 cases of prosthetic joint infections (PJIs) following close animal contact that required treatment with DAIR (debridement, antibiotics, and implant retention) procedures. An extensive literature review was performed which identified 57 described cases of PJI. Transmission commonly occurred following scratches, bites and licks from cats and dogs. Patients often do not recognise the potential severity of these injuries and should be warned following arthroplasty of the risks of infection due to spp. following close contact with these animals, particularly given the increased morbidity and mortality associated with PJI.
Pulmonary sequestration is a rare congenital malformation of the lower respiratory tract, characterized by nonfunctioning lung tissue without tracheobronchial communication and receiving its blood supply from the systemi...Pulmonary sequestration is a rare congenital malformation of the lower respiratory tract, characterized by nonfunctioning lung tissue without tracheobronchial communication and receiving its blood supply from the systemic circulation. It can present as either intralobar or extralobar sequestration, with intralobar being more common. Surgical resection remains the treatment of choice, although preoperative strategies such as endovascular occlusion can reduce the risk of intraoperative complications. We report the case of a 52-year-old woman with a history of recurrent pulmonary infections who was referred for evaluation of an incidentally discovered cystic lesion in the left lower lobe following a transient episode of amaurosis fugax. Chest CT revealed a 5.3 cm pulmonary sequestration supplied by a large aberrant artery (AA) originating from the descending aorta. A two-stage hybrid procedure was performed, starting with thoracic endovascular aortic repair (TEVAR) to exclude the AA, followed by video-assisted thoracoscopic surgery (VATS) left lower lobectomy. The patient had an uneventful recovery and was discharged postoperatively. TEVAR was employed as a preoperative strategy to minimize the bleeding risks associated with the large AA during minimally invasive lobectomy. A hybrid two-stage approach using TEVAR followed by VATS is a safe and effective method for managing intralobar pulmonary sequestration with large aberrant vessels. Careful preoperative planning and a multidisciplinary approach are essential for optimal outcomes.
Perforated duodenal ulcers are a rare occurrence in patients with a history of Roux-en-Y gastric bypass (RNYGB). This case report is of a patient who had two separate presentations of perforated duodenal ulcer despite a...Perforated duodenal ulcers are a rare occurrence in patients with a history of Roux-en-Y gastric bypass (RNYGB). This case report is of a patient who had two separate presentations of perforated duodenal ulcer despite a history of RNYGB and who progressed to a high-output duodenal-cutaneous fistula after failing the second Graham patch. This highlights the impact ulcer disease can have even in RNYGB patients.
Gallstones and alcohol consumption are the most common causes of acute pancreatitis. Lung carcinoma typically presents with respiratory symptoms, and in some cases, locoregional or distant metastases. However, acute panc...Gallstones and alcohol consumption are the most common causes of acute pancreatitis. Lung carcinoma typically presents with respiratory symptoms, and in some cases, locoregional or distant metastases. However, acute pancreatitis as the initial manifestation of lung carcinoma is rare. Herein, we report the case of a 75 year-old man who presented with acute pancreatitis and was diagnosed with metastatic lung carcinoma upon evaluation.
INTRODUCTION AND IMPORTANCE: Enterocutaneous fistulas (ECFs) caused by ingested foreign bodies are extremely rare. Accurate fistula localization is essential for guiding management, especially in comorbid patients at hig...INTRODUCTION AND IMPORTANCE: Enterocutaneous fistulas (ECFs) caused by ingested foreign bodies are extremely rare. Accurate fistula localization is essential for guiding management, especially in comorbid patients at high surgical risk. CASE PRESENTATION: We report a 76-year-old woman who developed an ECF secondary to a swallowed chicken bone. Initial imaging suggesting a high small-bowel fistula and severe peristomal skin breakdown prompted consideration of surgery. Extended conservative management allowed skin healing, and follow-up imaging revealed a more distal fistula, supporting continuation of nonsurgical management. CLINICAL DISCUSSION: Management of ECF is challenging due to morbidity from intestinal failure, electrolyte disturbances, sepsis, and skin damage. Optimal care requires multidisciplinary strategies guided by sepsis control, nutritional support, anatomical assessment, and procedure planning (SNAP framework). CONCLUSION: This case highlights the importance of individualized management and careful assessment of fistula location. It also illustrates that prolonged conservative management can achieve acceptable outcomes in high-risk patients.
Appendicitis and small bowel obstruction (SBO) are common causes of acute abdomen encountered in clinical practice. However, appendicitis as a cause of SBO is very rare and often overlooked, commonly resulting in delayed...Appendicitis and small bowel obstruction (SBO) are common causes of acute abdomen encountered in clinical practice. However, appendicitis as a cause of SBO is very rare and often overlooked, commonly resulting in delayed diagnosis and management. Appendico-ileal knotting, a rare but dangerous way appendicitis could lead to mechanical SBO, occurs when an inflamed appendix forms a ring-like structure through which a small bowel loop herniates, resulting in closed-loop obstruction that could be complicated by small bowel strangulation and gangrene if not identified and intervened early. Preoperative diagnosis of appendico-ileal knotting is very challenging, with most cases diagnosed intraoperatively. We present a case of a 35-year-old female who presented with crampy abdominal pain of 2 days duration associated with vomiting, abdominal distension, and constipation. Blood pressure was unrecordable, and abdominal examination was positive for diffuse guarding, rigidity, and rebound tenderness. A plain abdominal X-ray revealed multiple centrally located air-fluid levels, after which she was diagnosed with SBO and taken to the operating room for exploratory laparotomy. With the intraoperative finding of appendico-ileal knotting complicated by distal ileal gangrene, she was managed with appendectomy, ileal resection, and end ileostomy. Appendico-ileal knotting is a very rare condition with a limited number of case reports in the existing literature. This case report aims to contribute to a better understanding of this condition and emphasize the significance of early identification and intervention in reducing the substantial risk of morbidity and mortality associated with the condition if not managed timely.
Acute appendicitis is rare in the neonatal population, and delayed diagnosis is associated with increased morbidity and mortality. Pneumoperitoneum is infrequently identified on plain radiography in cases of neonatal app...Acute appendicitis is rare in the neonatal population, and delayed diagnosis is associated with increased morbidity and mortality. Pneumoperitoneum is infrequently identified on plain radiography in cases of neonatal appendicitis, which can result in delays in diagnosis and intervention. In this case, we report a 15-day-old preterm female neonate who presented with irritability and abdominal distention. A plain abdominal radiograph demonstrated significant pneumoperitoneum, and surgical exploration revealed perforated appendicitis.
INTRODUCTION: Although the reported incidence of congenital vascular malformations is ~1.5% of the general population, the true incidence of these lesions is difficult to assess due to the heterogeneity of vascular anoma...INTRODUCTION: Although the reported incidence of congenital vascular malformations is ~1.5% of the general population, the true incidence of these lesions is difficult to assess due to the heterogeneity of vascular anomalies and the variability in terminology used in reporting. These vascular anomalies can involve capillaries, lymphatics, venous, and/or arterial structures and can occur anywhere in the body. Rarely does a vascular malformation originate from the gastrointestinal (GI) mesentery and present as a bowel obstruction. CASE REPORT: This report describes an adolescent patient with an unusual presentation of a vascular malformation involving the GI mesentery, manifesting as midgut volvulus. Emergent laparotomy revealed a large intra-abdominal cystic structure that volvulized resulting in a small bowel obstruction. The lesion and involved segment of small bowel were resected and found to be a mesenteric venous malformation on pathology. CONCLUSION: Vascular anomalies of the GI tract are uncommon but should be included in the broad differential for patients presenting with abdominal pain, symptoms consistent with a small bowel obstruction, and/or a cystic intra-abdominal mass. In addition, utilization of accurate and standardized terminology when reporting these lesions is important to facilitate prompt and accurate diagnosis and treatment of patients and to establish a reliable foundation of continued research on vascular anomalies.
INTRODUCTION AND IMPORTANCE: Wandering spleen (WS) is a rare condition caused by the absence or laxity of splenic suspensory ligaments, predisposing the spleen to displacement and potential complications. While torsion i...INTRODUCTION AND IMPORTANCE: Wandering spleen (WS) is a rare condition caused by the absence or laxity of splenic suspensory ligaments, predisposing the spleen to displacement and potential complications. While torsion is the most commonly reported issue, infarction due to vascular compromise is a serious and rare complication, particularly in pregnancy. We present a case of splenic infarction in a WS during pregnancy, emphasizing diagnostic challenges and management strategies. CASE PRESENTATION: A 19-year-old primigravida at 5 months of gestation presented with progressively worsening abdominal pain and a palpable right-sided abdominal mass. Ultrasound and magnetic resonance imaging (MRI), chosen for its safety in pregnancy, confirmed an enlarged, ectopic spleen with infarction and splenic vein thrombosis. Conservative management with anticoagulation and supportive therapy was initially attempted but failed due to worsening pain and clinical deterioration. Surgical intervention was deemed necessary, and a splenectomy was performed. The patient recovered well postoperatively, with fetal well-being maintained throughout. CLINICAL DISCUSSION: Diagnosing WS in pregnancy is challenging due to nonspecific symptoms and limited imaging options. MRI plays a pivotal role in identifying ectopic spleen and assessing vascular compromise. Although torsion is commonly associated with infarction, infarction can occur through other mechanisms such as venous thrombosis or outflow obstruction. Early recognition and timely surgical intervention are essential to reduce maternal and fetal morbidity. CONCLUSION: WS in pregnancy presents a diagnostic and therapeutic challenge, with infarction posing a significant but underreported risk. MRI is a valuable tool in pregnant patients, allowing safe and accurate diagnosis. A multidisciplinary approach and individualized treatment strategies are essential for optimizing both maternal and fetal outcomes.
Obesity is a challenging condition for pancreatic surgery, and some authors recommend delaying pancreatic resection for non-malignant pancreatic tumors in obese patients. We present a case of a 45-year-old woman with a b...Obesity is a challenging condition for pancreatic surgery, and some authors recommend delaying pancreatic resection for non-malignant pancreatic tumors in obese patients. We present a case of a 45-year-old woman with a body mass index (BMI) of 56 who was surgically treated in our department for a mucinous cystadenoma discovered during preoperative work-up for bariatric surgery. To decrease the risk involved in pancreatic surgery, a glucagon-like peptide-1 receptor agonist was administered for 6 months, which led to a weight loss of 20 kg and a BMI of 48 at the time of surgery. A laparoscopic left splenopancreatectomy was performed within 7 months of the diagnosis. The postoperative length of stay was 19 days. Pathology confirmed that the tumor was mucinous cystadenoma with mild dysplasia. As of 17 months later, the patient is doing well and has lost an additional 10 kg.
INTRODUCTION: Hepatic artery aneurysms (HAAs) are rare but significant vascular lesions associated with high mortality due to rupture, particularly in symptomatic cases. This report highlights the clinical importance of...INTRODUCTION: Hepatic artery aneurysms (HAAs) are rare but significant vascular lesions associated with high mortality due to rupture, particularly in symptomatic cases. This report highlights the clinical importance of timely intervention and presents a case of surgical management of a true HAA. CASE PRESENTATION: We present a 58-year-old man with a history of Crohn's disease who exhibited acute right upper quadrant and epigastric pain. Initial evaluation, including CT angiography (CTA), revealed a 24-mm fusiform HAA involving the common hepatic artery. Despite transient relief of pain with analgesics, surgical intervention was deemed necessary due to the aneurysm's size and risk of rupture. The patient underwent an aneurysmectomy with reconstruction using an inverted great saphenous vein graft through a bilateral subcostal incision. The surgical procedure was completed without intraoperative complications, successfully excising the aneurysm and restoring blood flow via the graft. The patient experienced a complex postoperative course, including a sudden episode of bleeding from the left gastric artery, which was effectively managed with endovascular coil embolization. Follow-up imaging at 12 months showed no residual aneurysm and confirmed graft patency, along with favorable perfusion of the intrahepatic arteries. CONCLUSIONS: This case illustrates that surgical repair can be a safe and effective treatment for HAAs when endovascular options are not feasible. It underscores the necessity of personalized management strategies based on individual patient characteristics and specific aneurysm features. Further studies are required to optimize treatment protocols for HAAs.