INTRODUCTION: Pancreaticoduodenal artery (PDA) pseudoaneurysm is a rare occurrence. The intricate clinical manifestations and frequent rupture present challenges in diagnosing and treating the condition. CASE PRESENTATIO...INTRODUCTION: Pancreaticoduodenal artery (PDA) pseudoaneurysm is a rare occurrence. The intricate clinical manifestations and frequent rupture present challenges in diagnosing and treating the condition. CASE PRESENTATION: A 56-year-old man was admitted to the emergency department (ED) with sudden, severe abdominal pain, dizziness, and a history of two fainting events on the same day at home. A decreased blood pressure of 75/60 mmHg was detected on arrival. He had a medical background characterized by a history of gastritis and peptic ulcer disease (PUD) with ongoing use of pantoprazole and sucralfate. A contrast-enhanced computed tomography (CT) scan revealed retroperitoneal hematoma and a saccular outpouching in the superior and inferior pancreaticoduodenal arcades, in favor of visceral aneurysm, probably with the origin of the PDA. The patient underwent a laparotomy. The ruptured pseudoaneurysm was ligated using 4.0 polypropylene threads, and a Jackson-Pratt drain was inserted. The patient's recovery following the surgery was uneventful, and he was discharged after 5 days without any issues. CONCLUSION: This case highlights the importance of considering a ruptured PDA pseudoaneurysm, which should be evaluated in the differential diagnosis of abdominal discomfort and related symptoms, especially in patients with duodenal ulcers. The successful management of the condition is accomplished through suture ligation, and the diagnosis is effectively made through CT angiography.
Complex aortic aneurysm repair has witnessed remarkable advancements through endovascular solutions. In current practice, many endovascular repairs of the abdominal and thoracic aorta rely on patient-specific endografts...Complex aortic aneurysm repair has witnessed remarkable advancements through endovascular solutions. In current practice, many endovascular repairs of the abdominal and thoracic aorta rely on patient-specific endografts designed and manufactured on demand, as their anatomical requirements cannot be met by assembling conventional off-the-shelf components. However, the E-nside system is currently the only commercially available thoracoabdominal endograft that incorporates pre-cannulated inner branches in an off-the-shelf design. The objective of this case series is to describe and compare clinical indications, technical features, and intraoperative outcomes of complex abdominal aortic aneurysm (AAA) treated using the inner branched off-the-shelf E-nside and custom-made E-xtra Design MultiBranch endografts under real-life circumstances. Both endografts were safe for treating complex aortic aneurysms. E-nside was more suitable for emergent cases due to easy availability and quick access. Patients of the custom-made series had lower aortic coverage, but radiation exposure did not differ.
Systemic lupus erythematosus (SLE) is a multi-system autoimmune disorder, with gastrointestinal (GI) involvement in 20%-50% of cases. Mostly, symptoms are non-specific, but lupus enteritis is a rare acute manifestation o...Systemic lupus erythematosus (SLE) is a multi-system autoimmune disorder, with gastrointestinal (GI) involvement in 20%-50% of cases. Mostly, symptoms are non-specific, but lupus enteritis is a rare acute manifestation occurring in less than 6% of patients with SLE. This infrequency often leads to a delayed diagnosis, resulting in significant morbidity and mortality. We present the case of a 40-year-old female with a 9-year history of SLE, who developed severe diffuse lupus enteritis and hypovolemic shock in a regional hospital located 400 km from a tertiary care centre. The patient exhibited abdominal distension, vomiting and acute kidney injury. A contrast-enhanced CT scan revealed circumferential bowel wall thickening and free fluid, consistent with lupus enteritis. Initial management focused on stabilisation through aggressive rehydration and monitoring while awaiting transfer to a tertiary facility. Corticosteroids and supportive care led to a gradual resolution of symptoms. This case is educational for rural surgeons, highlighting the importance of recognising and managing rare acute GI manifestations of collagen vascular diseases like SLE in resource-limited settings. Early diagnosis and transfer are crucial to reducing mortality, and this case demonstrates the need for high clinical suspicion and decisive damage control intervention if indicated.
This case report presents two unique cases of reactive hydrocele formation following transabdominal preperitoneal (TAPP) inguinal hernia repair in adult patients. Although hydrocele development after pediatric inguinal h...This case report presents two unique cases of reactive hydrocele formation following transabdominal preperitoneal (TAPP) inguinal hernia repair in adult patients. Although hydrocele development after pediatric inguinal hernia repairs is well-documented, cases in adults are rare and potentially underreported, likely due to the separation of surgical and urological specialties in adult care. Both patients experienced postoperative hematomas within the inguinal region, which resolved initially but subsequently led to symptomatic hydrocele formation over several months. The first patient, a 65-year-old male, developed a left-sided hydrocele with moderate to severe scrotal pain 8 months postoperatively. The second patient, a 70-year-old male, presented with a right-sided hydrocele 4 months after TAPP repair, initially managed conservatively but later requiring further evaluation due to persistent scrotal swelling and tenderness. Both patients underwent ultrasound imaging, which confirmed the presence of fluid collections around the affected testicles, with no abnormalities in testicular blood flow or echogenicity. A conservative management approach was taken in both cases, and symptoms gradually resolved without surgical intervention. These cases illustrate the potential for postoperative hematomas to exert pressure on lymphatic vessels, possibly leading to reactive hydrocele formation. The delayed onset and symptomatology underscore the importance of recognizing hydrocele as a potential delayed complication of laparoscopic inguinal hernia repair in adults. These cases contribute to the limited literature on this topic and suggest the need for larger cohort studies to explore the pathogenesis, prevalence, and potential correlation between postoperative hematomas and hydrocele formation. Awareness of this rarely reported but impactful complication may improve postoperative management and patient outcomes following TAPP procedures.
The mortality of injuries sustained from blunt thoracic trauma (TT) is significantly higher than the mortality of penetrating injuries, and decisions made during the first hour of hospitalization play a critical role in...The mortality of injuries sustained from blunt thoracic trauma (TT) is significantly higher than the mortality of penetrating injuries, and decisions made during the first hour of hospitalization play a critical role in determining outcomes. Patient survival depends on the effective management of injuries that result in the disruption of respiration, circulation, or both. Presented is a case of a 44-year-old female who survived a traumatic avulsion of the right lung from the bronchus intermedius, subsequent multifactorial shock, and complications associated with her complex treatment plan, including emergent use of extracorporeal membrane oxygenation (ECMO), completion pneumonectomy, and rib fixation.
We describe a rare case of a mechanical small bowel obstruction secondary to multiple enteroliths expelled from underlying jejunal diverticular disease. A 59-year-old male, without any past surgical history presented to...We describe a rare case of a mechanical small bowel obstruction secondary to multiple enteroliths expelled from underlying jejunal diverticular disease. A 59-year-old male, without any past surgical history presented to a regional hospital in Queensland with symptoms consistent with an acute small bowel obstruction. A CT scan performed on arrival confirmed the diagnosis of a small bowel obstruction with a transition point at the level of mid small bowel however the aetiology was not radiologically apparent. He proceeded to an exploratory laparotomy which revealed at least three intraluminal enteroliths, one of which was impacted within the mid jejunum resulting in the bowel obstruction. These enteroliths were all milked distally and successfully retrieved via an enterotomy in a healthy segment of distal ileum. He was also noted intraoperatively to have extensive proximal jejunal diverticular disease as the likely source of his dislodged enteroliths. Retrospectively, his CT scan could be correlated to his intraoperative findings, bringing to light this rare phenomenon which has been documented only in a handful of published cases within surgical and gastroenterology literature.
Postoperative sepsis after appendectomy can sometimes be led by surgical site infection, intra-abdominal abscess, or intestinal obstruction. However, there have been no reports that postoperative sepsis is certainly caus...Postoperative sepsis after appendectomy can sometimes be led by surgical site infection, intra-abdominal abscess, or intestinal obstruction. However, there have been no reports that postoperative sepsis is certainly caused by only fecal retention in the intestine, including the appendectomy stump. A 60-year-old healthy woman visited a doctor with a chief complaint of right lower abdominal pain. Abdominal computed tomography (CT) showed a swollen appendix with fecal calculus, and then the patient was diagnosed with acute appendicitis. The patient underwent a laparoscopic appendectomy the next day. The appendix was resected at the level of the appendicular root with an endostapler. The patient was discharged from the hospital on postoperative day (POD) 4 in a good general condition. However, the patient visited the hospital on POD 15 with a chief complaint of fever. A medical interview revealed a decrease in the number of bowel movements compared to before the appendectomy. The quick Sequential Organ Failure Assessment (SOFA) score with the vital signs showed two points, and the SOFA score with the blood examination showed a total increase of four points compared to the previous blood examination. The patient was therefore suspected of sepsis after appendectomy. Abdominal CT showed obvious fecal retention in the ileocecal region, including the appendectomy site. Furthermore, abdominal contrast CT did not reveal any obvious thrombosis in the portal venous system. With conservative treatment by antibiotics and laxatives, the fever gradually resolved, and the patient was discharged on POD 27. Abdominal radiography showed no findings of fecal retention. The patient has had regular bowel movements and has not experienced a recurrence of the symptoms. Postoperative sepsis might be caused even in healthy patients. It was conceivable that postoperative assessment of bowel movements was necessary to detect the risk of postoperative sepsis.
INTRODUCTION: Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon form of non-Hodgkin's T-cell lymphoma associated with textured breast implants and tissue expanders. CASE PRESENTATION: A 4...INTRODUCTION: Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon form of non-Hodgkin's T-cell lymphoma associated with textured breast implants and tissue expanders. CASE PRESENTATION: A 46-year-old female presented with a 1-week history of a firm lump in the upper inner quadrant of her right breast. She had a history of augmentation mammoplasty with textured implants 8 years prior. Ultrasound guided biopsy of the 15 mm × 18 mm mass confirmed a diagnosis of BIA-ALCL on histopathology. Pre-operative staging with PET CT showed a peri-implant nodule with avid nodules within and deep to the pectoralis muscle with no evidence of distant metastases. Bilateral en bloc removal of the breast implants, capsulectomy (including palpably involved pectoralis major and minor muscles) and right axillary dissection were performed. Final histopathology confirmed BIA-ALCL, pT4N0, with clear margins. Post-operative PET-CT demonstrated complete excision of local disease, however, a new FDG-avid right internal mammary node was identified, which increased in size and avidity on follow up imaging. Mediastinoscopy with core biopsy were performed and histopathological features were consistent with metastatic cells (BIA-ALCL). Patient subsequently completed six cycles of adjuvant chemotherapy with evidence of interval response on imaging. To date, patient remains in complete clinical and radiological remission and the expected duration of follow up is 5 years. CONCLUSIONS: BIA-ALCL poses a significant challenge due to increasing use of implants for reconstructive and cosmetic procedures. Patients most commonly present with peri-implant fluid collections but palpable masses, capsular contracture and lymphadenopathy are also commonly seen. Diagnosis involves ultrasound and histopathological analysis of fluid or tissue with CD30 immunohistochemistry and staging with PET-CT. Patient education and a multidisciplinary team approach allow for timely diagnosis and complete surgical excision, which are key for a good prognosis. Clinical and radiological surveillance detect early recurrence and assess need for adjuvant therapy.
INTRODUCTION: Hepatic cystic mucinous neoplasm is a low-prevalence tumor with malignant potential. Due to its infrequent presentation, it is often misdiagnosed and inadequately treated. The purpose of the present work is...INTRODUCTION: Hepatic cystic mucinous neoplasm is a low-prevalence tumor with malignant potential. Due to its infrequent presentation, it is often misdiagnosed and inadequately treated. The purpose of the present work is to report a case, review the corresponding literature, determine the most optimal surgical treatment option, and contrast it with what has been performed. CLINICAL CASE: A 53-year-old female patient with upper hemiabdomen pain and elevated serum liver enzyme levels. Computed tomography revealed a multilocular cystic liver tumor measuring 52 mm × 63 mm between segments 4 and 5. The patient underwent a first surgery, laparoscopic unroofing. The anatomopathological result was mucinous cystic neoplasm (MCN-L) without malignancy. With the result, a second surgery was scheduled to complete the resection of the remaining cyst, and an open left hepatectomy was performed. DISCUSSION: MCN-L of the liver is an infrequent presentation and occurs in <5% of cystic liver tumors. Because this tumor has malignant potential, complete surgical resection is the best treatment option. CONCLUSION: We present a case of MCN-L of the liver with two-stage complete resection because this tumor, although benign, has a high potential for malignancy and recurrence.
Superior mesenteric artery (SMA) syndrome is an extremely rare condition that can result from a multitude of causes that devoid the mesenteric fat pad or structurally narrow the space resulting in duodenal obstruction. I...Superior mesenteric artery (SMA) syndrome is an extremely rare condition that can result from a multitude of causes that devoid the mesenteric fat pad or structurally narrow the space resulting in duodenal obstruction. It is predominantly seen in females. If not treated, it can result in life-threatening complications. Herein, we present four patients with SMA syndrome who presented to our outpatient department at Adera Medical and Surgical Center, Addis Ababa, Ethiopia.
INTRODUCTION: Retained surgical instruments (RSIs) are rare but serious surgical complications. This report presents a unique case of a retained surgical blade identified 12 years post-hysterectomy, highlighting diagnost...INTRODUCTION: Retained surgical instruments (RSIs) are rare but serious surgical complications. This report presents a unique case of a retained surgical blade identified 12 years post-hysterectomy, highlighting diagnostic challenges and the need for vigilance. CASE PRESENTATION: A 60-year-old female presented with chronic abdominal pain for 4 years, initially misdiagnosed as urinary tract infection (UTI) and gastritis. Investigations, including X-ray and computed tomography scan (CT scan), revealed a retained surgical blade. Elective laparotomy was performed, and the rusted blade, encapsulated by the omentum, was removed. Postoperative recovery was uneventful. DISCUSSION: The delayed diagnosis underscores vulnerabilities in surgical safety protocols. Nonspecific symptoms of RSIs often lead to delayed detection. While manual counting is the standard, human error can occur. This case emphasizes the need for advanced technologies and standardized protocols. Underreporting of RSIs obscures true rates, necessitating improved data transparency and systemic learning. CONCLUSION: This case highlights the importance of multidisciplinary collaboration, technological integration, and institutional accountability to prevent RSIs. Enhanced postoperative surveillance and heightened clinical suspicion are crucial. This will improve patient safety and uphold healthcare credibility. This case underscores the need for long-term postoperative vigilance, even in the absence of immediate symptoms.
Postoperative adhesions present a complex surgical challenge, often leading to complications, such as small bowel obstruction (SBO). Among these, appendicular band syndrome, although rare, is a serious condition that und...Postoperative adhesions present a complex surgical challenge, often leading to complications, such as small bowel obstruction (SBO). Among these, appendicular band syndrome, although rare, is a serious condition that underscores the importance of meticulous management of the appendix stump during surgery to prevent life-threatening outcomes. We report a case of a 67-year-old female who presented to the emergency department with post-prandial epigastric pain and vomiting. Notably, she did not open her bowels for the last 2 days. The patient had a medical history of hypertension and gastroesophageal reflux disease, and previous surgeries, including laparoscopic appendectomy and ovarian cystectomy. Computed tomography revealed a high-grade, incomplete SBO. Diagnostic laparoscopy revealed thick band adhesions arising from a residual appendiceal stump from previous appendectomy site, which had caused a clockwise torsion of jejunal loops; division of the band and completion appendicectomy resolved the obstruction. These findings highlights the complex interplay between surgical technique and stump length in preventing adhesion formation. The formation of adhesions is primarily initiate from disturbances to peritoneal mesothelial surfaces, triggering inflammatory and coagulation pathways. Our discussion delves into the optimal management of the appendix stump, highlighting current literature that suggests a stump length of approximately 5 mm as optimal for minimising the risk of both stump appendicitis and appendicular band adhesions. While traditional inversion of the stump may limit exposed mucosa, it is not universally recommended because an inverted stump can later mimic a caecal mass or create diagnostic uncertainty. When a laparoscopic endoloop technique is selected, achieving a critical view of the appendix with complete visualisation of the caeco-appendiceal junction before ligation, allows precise placement of the loop flush with the base, thereby keeping the residual stump short and reducing the risk of stump appendicitis. Identifying high-risk patients, with prior abdominal surgery or severe intra-operative inflammation, and tailoring stump management accordingly remain crucial to preventing complications, such as appendicular band syndrome.
Cauda equina syndrome (CES) results from compression of the cauda equina (CE) nerve roots and presents with a spectrum of neurological deficits. We report four cases of CES with symptom durations ranging from 3 days to 1...Cauda equina syndrome (CES) results from compression of the cauda equina (CE) nerve roots and presents with a spectrum of neurological deficits. We report four cases of CES with symptom durations ranging from 3 days to 1 month at presentation. The clinical features included urinary incontinence, reduced perianal sensation, lower limb weakness, and erectile dysfunction in select cases. Despite delays in surgical intervention for some patients, all demonstrated significant postoperative improvement in bladder function and lower limb strength. Bladder sensation began to recover within 5-20 days postoperatively, with complete bladder function restoration achieved between 10 and 120 days. While early surgical decompression remains the standard for optimal outcomes, these cases suggest that meaningful recovery is still possible following delayed intervention. Prompt diagnosis and timely surgery, even in late-presenting cases, may improve functional outcomes. Our series reports early postoperative timelines for recovery and aligns observations with key domains from CES core outcome set in low- and middle-income countries.
McKittrick-Wheelock is a rare syndrome characterized by a severe, difficult to correct electrolyte imbalance, chronic mucus diarrhea, and a large rectal polyp. In this case report, we describe an elderly patient diagnose...McKittrick-Wheelock is a rare syndrome characterized by a severe, difficult to correct electrolyte imbalance, chronic mucus diarrhea, and a large rectal polyp. In this case report, we describe an elderly patient diagnosed with a large nonmalignant rectal polyp during a routine colonoscopy 10 years prior to admission. For years, the patient has suffered from diarrhea, causing episodic life-threatening hypokalemia and hyponatremia with several unsuccessful attempts at endoscopic polyp removal. Due to symptomatic cholelithiasis, the patient was transferred to the surgical ward and diagnosed with McKittrick-Wheelock syndrome. The patient had undergone cholecystectomy and, after a period of preoperative preparation, underwent an abdominoperineal resection of the rectum. Histopathologic evaluation revealed a low-grade (G1) rectal carcinoma. This case report highlights the importance of a careful assessment of patients with electrolyte level disturbances, with some, albeit very rarely, requiring surgical intervention.
BACKGROUND: Male breast cancer (MBC) is rare, accounting for only 1.8% of all breast cancer cases diagnosed globally. However, there is a rising trend in its incidence over the past decades. Spontaneous regression (SR) o...BACKGROUND: Male breast cancer (MBC) is rare, accounting for only 1.8% of all breast cancer cases diagnosed globally. However, there is a rising trend in its incidence over the past decades. Spontaneous regression (SR) of a tumor, on the other hand, is a rare but well-documented phenomenon. CASE PRESENTATION: We reported a case of MBC that showed SR in the surgical specimen after the histopathologic diagnosis of invasive breast cancer in the core needle biopsy sample. A 58-year-old gentleman presented with a palpable left retroareolar mass, nipple retraction and intermittent pain for 2 months. Imaging and histopathological examination (HPE) confirmed an estrogen- and progesterone-receptor-positive, HER-2 negative invasive carcinoma, which was treated with left mastectomy with axillary clearance (MAC). Intraoperatively, no breast mass was palpable, and SR of the tumor was reported for the surgical sample. CONCLUSION: This case not only emphasizes the rarity of MBC but also draws attention to the exceptional phenomenon of SR in invasive carcinoma. Recognition of such rare events underscores the importance of cautious decision-making, multidisciplinary management, and further research into the biological and immunological mechanisms underlying tumor regression.
Upper extremity pseudoaneurysms are uncommon, and involvement of collateral branches of the brachial artery is particularly rare. A 78-year-old woman without antecedent trauma presented with a new pulsatile mass and prog...Upper extremity pseudoaneurysms are uncommon, and involvement of collateral branches of the brachial artery is particularly rare. A 78-year-old woman without antecedent trauma presented with a new pulsatile mass and progressive dysfunction of the proximal arm. Duplex ultrasonography provided sufficient diagnostic and planning information, demonstrating a pseudoaneurysm arising from a collateral branch of the brachial artery measuring 38 mm × 29 mm × 46 mm, with an estimated neck diameter of 3 mm and neck length of 5 mm, and a thin peripheral mural thrombus. Given lesion size and compressive features, open repair was performed under general anesthesia: sac excision and arterial reconstruction with a reversed basilic vein interposition graft using end-to-end anastomoses. The postoperative course was uneventful, with discharge on postoperative Day 1; at 7-day follow-up, duplex ultrasonography confirmed patency of the reconstructed segment without stenosis, residual sac, arteriovenous fistula, or signs of distal ischemia. This case supports open venous autologous reconstruction as an effective option for large and compressive arterial pseudoaneurysms of brachial collateral branches.
Schistosomiasis is a parasitic disease caused by blood flukes commonly found in sub-Saharan Africa and select other areas in Asia and the Americas. The disease can manifest in a wide range of acute and chronic conditions...Schistosomiasis is a parasitic disease caused by blood flukes commonly found in sub-Saharan Africa and select other areas in Asia and the Americas. The disease can manifest in a wide range of acute and chronic conditions, rarely presenting as acute appendicitis. Herein we report a case of a 36-year-old female patient from a nonendemic area (New York City) with a history of travel presenting with acute appendicitis secondary to instestinal schistosomiasis.
Chylous ascites from small bowel obstructions is a very rare finding with only a handful of case reports previously published. This case report of a patient with chylous ascites related to an obstruction from Petersen's...Chylous ascites from small bowel obstructions is a very rare finding with only a handful of case reports previously published. This case report of a patient with chylous ascites related to an obstruction from Petersen's hernia supports the trend from existing reports. Prior studies have linked chylous ascites to closed-loop obstructions, such as small bowel volvulus or internal hernia, even when the bowel is viable and does not require resection.
Stump appendicitis is a rare but serious complication following an appendectomy, resulting from incomplete removal of the appendix. It often mimics acute appendicitis with nonspecific symptoms, such as abdominal pain, na...Stump appendicitis is a rare but serious complication following an appendectomy, resulting from incomplete removal of the appendix. It often mimics acute appendicitis with nonspecific symptoms, such as abdominal pain, nausea, vomiting, and fever, making diagnosis challenging. Here, we report the case of a 17-year-old male who presented with diffuse abdominal pain, fever, and nausea just 11 days after undergoing an open appendectomy. Physical examination revealed tenderness at the surgical site, and imaging showed inflammatory changes in the right lower quadrant. Exploratory surgery confirmed stump appendicitis due to retained appendiceal tissue, which was resected. The patient recovered uneventfully.
Manzaneda-Peralta M, Morales-Rodriguez J, Ramos-Ocola E
… +5 more, Valdivia-López J, Alvarez-Delgadillo Y, Jiménez-Vera J, Fuenzalida-Valdivia J, Terreros-Abril K
Primary hepatic ectopic pregnancy is rare; it has been reported to have an incidence of 1:15,000 per uterine pregnancy approximately. This study aims to determine the clinical presentation and treatment of hepatic ectopi...Primary hepatic ectopic pregnancy is rare; it has been reported to have an incidence of 1:15,000 per uterine pregnancy approximately. This study aims to determine the clinical presentation and treatment of hepatic ectopic pregnancy. We present the case of a patient with no history of pregnancy who presented with abdominal pain refractory to treatment. With a human chorionic gonadotropin hormone (β-hCG) measure of 55,710 mIU/mL, an abdominal ultrasound that revealed the presence of a rounded image of 50 mm × 50 mm at the level of the right hepatic lobe and the complication of hypovolemic shock. Under the diagnosis of an abdominal ectopic pregnancy, the patient underwent surgery. Initially, an exploratory laparotomy was performed, which revealed the presence of bleeding, clots, and a gestational sac; subsequently, a wedge resection was done, and a Pringle maneuver and hepatic packing were performed, obtaining favorable results in the patient's case. The diagnosis of primary hepatic ectopic pregnancy is made through β-hCG measurement and serial abdominal ultrasonography. Treatment can be pharmacological (methotrexate) or surgical, applying techniques such as the Pringle maneuver.