Well-differentiated liposarcomas are common retroperitoneal lesions, but exceedingly rare when primary to the small bowel mesentery, with only a handful of cases reported in the literature. Presented is a patient with a...Well-differentiated liposarcomas are common retroperitoneal lesions, but exceedingly rare when primary to the small bowel mesentery, with only a handful of cases reported in the literature. Presented is a patient with a primary mesenteric well-differentiated inflammatory liposarcoma with mucosal extension at high risk for misdiagnosis. A broad differential diagnosis with careful histopathologic observation, ancillary immunohistochemical studies, and fluorescent in situ hybridization for MDM2 amplification are key to make a correct diagnosis. This is especially true if such a lesion was first noted in the lamina propria on histopathology from an endoscopic mucosal biopsy.
Volvulus of the caecum, ascending colon and first third of the transverse colon is a very rare surgical emergency. Timely diagnosis and intervention can avert serious complications. A 54-year-old woman presented to the...Volvulus of the caecum, ascending colon and first third of the transverse colon is a very rare surgical emergency. Timely diagnosis and intervention can avert serious complications. A 54-year-old woman presented to the emergency department with colicky epigastric pain radiating to the left iliac fossa that lasted for 12 h. Vital signs were stable upon arrival at the hospital. Physical examination revealed that left abdomen and suprapubic fullness and bowel sounds were recorded, and rebound tests were negative. Laboratory results were neutrophils: 78% (35%-72%), lymphocytes: 16% (20%-45%), HB: 11 g/dL (12-16), HCT: 33% (36%-48%); all the rest were normal. Furthermore, computed tomography revealed a distended close of the large bowel extending from the left hypochondrium to the left iliac fossa. During explorative laparotomy, volvulus of the first third of the transverse, ascending colon and caecum was detected. Because the viability of the bowel wall was compromised, right extended hemicolectomy was performed with consequent ileotransverse anastomosis. The postoperative period was uneventful, and the patient was discharged on the fourth postoperative day. Expeditious diagnosis and early intervention of very rare surgical emergencies such as ascending colon volvulus may avert disastrous complications.
is an exceedingly rare cause of ventriculoperitoneal (VP) shunt infection, even in patients who have a history of long-term antibiotic use, immune-compromised newborns, and intensive care unit patients. We hereby report...is an exceedingly rare cause of ventriculoperitoneal (VP) shunt infection, even in patients who have a history of long-term antibiotic use, immune-compromised newborns, and intensive care unit patients. We hereby report a case of a 53-year-old male who presented with subarachnoid hemorrhage and had a complicated postoperative course due to infection, and we discuss the pertinent clinical aspects.
Cryptorchidism is one of the most common congenital anomalies in newborn males, with the majority diagnosed in infancy and treated surgically before puberty. In some cases, cryptorchid testes are discovered incidentally...Cryptorchidism is one of the most common congenital anomalies in newborn males, with the majority diagnosed in infancy and treated surgically before puberty. In some cases, cryptorchid testes are discovered incidentally during inguinal hernia repair in adults, requiring appropriate management at the time of surgery. Case 1: A 58-year-old male underwent emergency laparoscopic surgery for a left incarcerated hernia. Intraoperatively, an M2 indirect inguinal hernia with omental strangulation of the spermatic cord was identified. Despite attempts to pull the testis down manually, it did not descend into the scrotum, leading to the diagnosis of cryptorchidism. The spermatic cord was excised and a 3D mesh was placed to cover the hernia defect. Case 2: A 33-year-old man with Noonan syndrome presented with localized pain and swelling in the right groin. Laparoscopy revealed an indirect L3 inguinal hernia and incidentally an intra-abdominal testis was found. The testis and spermatic vessels were found to terminate intra-abdominally, confirming the diagnosis of cryptorchidism. An orchiopexy was performed to secure the testis subcutaneously in the scrotum and the hernia was repaired with a 3D mesh. The safety of mesh-based hernia repair in cases of cryptorchidism with concomitant inguinal hernia has been previously reported. In cases where preoperative palpation is difficult due to pain, intraoperative traction of the testis may help differentiate between cryptorchidism and retractile testis. In addition, orchiopexy may serve as a temporary measure, with consideration of staged orchiectomy if necessary.
Our case highlights the challenges in diagnosing and managing achalasia cardia, particularly in resource-limited settings and more so in adolescents who fall outside of the typical age range. We present a case of an 18-...Our case highlights the challenges in diagnosing and managing achalasia cardia, particularly in resource-limited settings and more so in adolescents who fall outside of the typical age range. We present a case of an 18-year-old female from Uganda who was admitted with a 6-month history of progressive dysphagia, weight loss, and postprandial vomiting. Diagnosis of achalasia cardia was confirmed via endoscopy and barium swallow. Heller cardiomyotomy via open transthoracic approach was performed, but she developed an esophageal perforation, which was successfully managed with repeat thoracotomy and esophageal repair. Complete resolution of achalasia symptoms was achieved at a 5-month follow-up. This case highlights the importance of maintaining a high index of clinical suspicion, especially in young patients, and the significance of informed consent prior to initiating treatment. Additionally, it emphasizes the importance of early recognition of treatment-related complications, such as esophageal perforation, as key to prompt management and improved patient outcomes.
Grynfelt's lumbar hernia is the rarest of all abdominal wall hernias, accounting for between 1.5% and 2% of cases, with only 300-350 instances described to date. Lumbar hernias can be congenital or acquired, often trigge...Grynfelt's lumbar hernia is the rarest of all abdominal wall hernias, accounting for between 1.5% and 2% of cases, with only 300-350 instances described to date. Lumbar hernias can be congenital or acquired, often triggered by trauma or surgery (iatrogenic). Diagnosis is clinical and confirmed via computed tomography. Surgical intervention is required for resolution, with repair performed either through open or laparoscopic surgery. We present the case of a young female with no prior surgical or traumatic history, in whom the diagnosis of Grynfelt's hernia was made. The patient underwent elective left lumbotomy surgery with hernioplasty using a supra-aponeurotic polypropylene mesh. Postsurgical recovery was adequate, and she was discharged 4 h after surgery. Follow-up in the general surgery outpatient clinic occurred at 20 days, 1, 3, and 6 months, with no recurrence, complications, or incidents. Grynfelt's hernia is a rare entity that requires a high index of suspicion for accurate diagnosis. Although cases are often asymptomatic, untreated hernias can lead to significant morbidity. Early recognition and timely surgical intervention are crucial for symptom relief and prevention of complications. In this case report, surgical management involved hernioplasty through a left lumbotomy approach, repairing the hernia defect and reducing the hernia content. Supra-aponeurotic mesh was placed to ensure adequate closure. Given the rarity of this pathology, no specific management guidelines exist in the literature. Therefore, the decision for this type of repair was based on intraoperative findings. Further research is needed to clarify management strategies and optimize outcomes for patients with Grynfelt's hernia.
Post-traumatic diaphragmatic hernia (PTDH) is defined as the migration of intra-abdominal organs into the chest through a pathological defect in the diaphragm caused by trauma. PTDH is a rare condition, occurring in 3%-7...Post-traumatic diaphragmatic hernia (PTDH) is defined as the migration of intra-abdominal organs into the chest through a pathological defect in the diaphragm caused by trauma. PTDH is a rare condition, occurring in 3%-7% of all thoracoabdominal injuries. Approximately 14.6% of PTDH cases present months to years after the initial trauma. Cases of delayed PTDH complicated by bowel obstruction and perforation are exceedingly uncommon, with a reported prevalence of 0.17%-6%. In Africa, fewer than 10 cases of delayed PTDH have been documented over the past three decades. Despite the availability of published reports, there are no established practice guidelines for managing PTDH. Here, we present a case of delayed PTDH that manifested as acute bowel obstruction 12 years after a gunshot wound to the chest. The condition led to a fatal postoperative outcome. This case highlights the critical need for clinicians to consider PTDH in patients with a history of trauma presenting with acute bowel obstruction and underscores the importance of urgent surgical management to prevent fatal complications.
: Necrosis of the rectus or lateral abdominal wall investing fascia may be associated with invasive infections or closure under extreme tension. This can lead to fascial dehiscence and evisceration of the intra-abdominal...: Necrosis of the rectus or lateral abdominal wall investing fascia may be associated with invasive infections or closure under extreme tension. This can lead to fascial dehiscence and evisceration of the intra-abdominal contents. Globally, abdominal wound dehiscence varies from 0.4% to 3.5% with associated mortalities reaching up to 45% in the perioperative period. Redo surgical operations and infectious complications are the major risk factors for abdominal wound dehiscence, but also presence of low albumin, glucocorticoid use, chest infections, and emergency surgeries have been also implicated. Open abdomen has been employed in incidences of trauma where a second look operation may be necessary, loss of abdominal wall, sepsis after penetrating abdominal trauma, and in cases of severe secondary peritonitis and acute pancreatitis. Patients with open abdomen are at a risk of fistula formation, sepsis, and loss of abdominal domain due to lateral fascial retraction. To reduce the mentioned complications mesh and nonmediated techniques to bridge fascia defects have been recommended with particular emphasis on biologic meshes with or without negative pressure wound therapy, component separation, or planned ventral hernia. We report a case of necrosis of the rectus and abdominal wound dehiscence and its management in a sub-Saharan setting, highlighting the challenges encountered and lessons learned. Retention sutures should be used cautiously in the management of wound dehiscence as it increases the risk of fascial necrosis in cases of intra-abdominal hypertension, as seen in our patient. In the absence of a VAC dressing, the utilization of routine saline gauze dressing promotes epithelialization over the exposed bowel and is a viable alternative to temporary abdominal closure modes of managing an open abdomen in a resource-limited setting.
Schwannomas are the most common tumors of the peripheral nerves, originating from their support cells, the Schwann cells. The location of the tumor in the vagus nerve is rare. Vagus schwannomas usually present as a solit...Schwannomas are the most common tumors of the peripheral nerves, originating from their support cells, the Schwann cells. The location of the tumor in the vagus nerve is rare. Vagus schwannomas usually present as a solitary, slow-growing, asymptomatic mass that rarely causes neurological alterations. The differential diagnosis of vagus nerve schwannomas includes other tumors of the parapharyngeal space or neoplasms of the jugular foramen. We report the case of a patient with an asymptomatic schwannoma of the vagus nerve involving important neck structures, with radiological compression of the carotid artery with a high risk of stroke; because of this, we underwent surgery using a transcervical approach with intracapsular excision of the tumor. The patient has a good outcome. In asymptomatic patients' surgical indication is not an easy decision; in this case, the main reason for surgical indication was the risk of stroke with potential neurological sequels.
Tricuspid valve regurgitation/rupture is a rare complication of trauma, with only around 150 cases reported in the literature, though this prevalence may be underestimated due to subtle clinical manifestations. The tricu...Tricuspid valve regurgitation/rupture is a rare complication of trauma, with only around 150 cases reported in the literature, though this prevalence may be underestimated due to subtle clinical manifestations. The tricuspid valve is the most frequently affected heart valve following blunt chest trauma due to its anterior anatomical position between the sternum and the vertebrae. The diagnosis of tricuspid regurgitation is often delayed in the traumatic setting due to the subtlety of clinical manifestations. Many trauma patients also present with distracting injuries. The subsequent treatment delay can result in development of irreversible dilatation of right-sided heart chambers, making it imperative to have a high index of suspicion for tricuspid regurgitation as a cause of acute hemodynamic instability in the setting of blunt trauma to the chest. In this report, we present a unique case of traumatic tricuspid valve regurgitation in a patient with a history of congenital atrial septal defect (ASD)/partial anomalous pulmonary venous return (PAPVR).
Intussusception in adults is rare and poses a diagnostic challenge, often due to neoplastic causes. Metastatic melanoma is known to spread to the gastrointestinal tract, especially the small intestine. We report the case...Intussusception in adults is rare and poses a diagnostic challenge, often due to neoplastic causes. Metastatic melanoma is known to spread to the gastrointestinal tract, especially the small intestine. We report the case of a patient with obstructive symptoms and a history of metastatic melanoma. An emergency abdominal computed tomography (CT) scan identified an obstruction caused by ileoileal intussusception located at the site of a previously described enteric metastasis. Following palliative surgery with ileal resection, two nodular lesions causing intussusception were identified, and pathological examination confirmed intramural metastases from melanoma. In adult patients with obstructive symptoms and a history of melanoma, intussusception secondary to intestinal metastases should be considered in the differential diagnosis.
Phlebolith is a term that refers to round-shaped calcified thrombi commonly located in the pelvic region. The occurrence of dense, linear calcifications or phlebolith-like formations within the soft tissues of the lower...Phlebolith is a term that refers to round-shaped calcified thrombi commonly located in the pelvic region. The occurrence of dense, linear calcifications or phlebolith-like formations within the soft tissues of the lower extremities, particularly in the superficial femoral, greater saphenous, or popliteal veins, is rare. This study presents the case of a 73-year-old woman who was being evaluated for postmenopausal bleeding. During the patient's diagnostic workup, an incidental linear-shaped phlebolith was discovered. She had a positive history of deep vein thrombosis (DVT) for 36 years following her previous vaginal delivery. Upon further examination and imaging, the patient was found to have a chronic calcified thrombus in the iliofemoral, popliteal, great saphenous, and superficial femoral veins, which was initially reported as a foreign body in the femoral vein on computed tomography (CT). Conservative management was undertaken, with no worsening of her condition upon further follow-up. This study showcased a rare form of a radiographically visible calcified thrombus in the veins of the lower extremities of our patient. Calcified venous thrombosis in the lower extremities is rare, as previously documented cases of venous calcifications have been observed in the pelvis with round shapes or as phleboliths. The common presentations differ from those in our case, making it important to consider such cases when formulating a differential diagnosis. While the precise mechanisms behind the formation of calcified thrombi remain unclear, this study emphasizes the significance of further exploration and future case studies to shed light on this enigmatic phenomenon.
Esophageal bleeding management typically involves endoscopy but becomes challenging with large or hemorrhagic tumors, especially in cases of rare basal cell carcinoma. This malignancy, with a poorer prognosis than squamo...Esophageal bleeding management typically involves endoscopy but becomes challenging with large or hemorrhagic tumors, especially in cases of rare basal cell carcinoma. This malignancy, with a poorer prognosis than squamous cell carcinoma, often requires definitive surgery. A 78-year-old man with severe hematemesis underwent transarterial embolization (TAE) after failed endoscopic hemostasis for a middle thoracic esophageal tumor. Subsequently, he successfully underwent radical tumor resection on the seventh day of hospitalization. While emergency surgery is an option, its invasiveness may be a limitation, especially for patients in poor general condition. TAE is effective for hemostasis and serves as a crucial bridge to radical esophageal tumor resection.
Meningomyelocele and meningocele are types of neural tube defects, which are congenital abnormalities of the spine and spinal cord. These conditions are frequently encountered by pediatric neurosurgeons worldwide and rep...Meningomyelocele and meningocele are types of neural tube defects, which are congenital abnormalities of the spine and spinal cord. These conditions are frequently encountered by pediatric neurosurgeons worldwide and represent a significant public health concern due to their association with a range of collateral conditions, other malformations, and increased morbidity. While many cases can be identified during prenatal ultrasound screenings, this is often challenging in resource-limited settings with poor health-seeking behaviors. Surgical intervention is the primary treatment for these defects, and while various methods are described in the literature, larger defects require complex flaps and techniques, with limited options available. Beyond early surgical intervention, patients require lifelong care involving multidisciplinary medical teams.
Splenic rupture leads to massive hemorrhage and requires immediate surgical intervention. Splenic rupture results from trauma or from underlying disease processes. Lymphoma is a rare cause of atraumatic splenic rupture (...Splenic rupture leads to massive hemorrhage and requires immediate surgical intervention. Splenic rupture results from trauma or from underlying disease processes. Lymphoma is a rare cause of atraumatic splenic rupture (ASR) with high mortality rates. We present a case of ASR due to T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL) requiring splenectomy and large-volume transfusion. This case report highlights the necessity of prompt surgical intervention and massive transfusion for hemodynamically unstable ASR. This report also discusses massive transfusion protocol (MTP) and its limited use in nontraumatic surgical patients.
A rare case of Fournier's gangrene (FG) secondary to varicella-zoster virus (VZV) affecting the penis and scrotum of a 7-year-old boy is presented. To the authors' knowledge, there are four cases of FG in children as a r...A rare case of Fournier's gangrene (FG) secondary to varicella-zoster virus (VZV) affecting the penis and scrotum of a 7-year-old boy is presented. To the authors' knowledge, there are four cases of FG in children as a result of VZV reported to date. Our patient underwent a total of four surgical debridements and was reconstructed using a split-thickness skin graft (SSG). At 1-year post-reconstruction, his graft is robust, and he has no functional issues.
Iatrogenic urethral-rectal perforation represents a rare but severe complication arising from medical interventions, notably highlighted in the context of Foley catheter insertion. This case report outlines the presentat...Iatrogenic urethral-rectal perforation represents a rare but severe complication arising from medical interventions, notably highlighted in the context of Foley catheter insertion. This case report outlines the presentation, diagnosis, management, and outcomes of a 71-year-old male patient who experienced iatrogenic rectal perforation during the routine insertion of a Foley catheter, against the backdrop of several predisposing factors, such as atrial fibrillation, valvular disease, benign prostatic hyperplasia, urethral stenosis, and colorectal cancer with liver metastasis. The inadvertent creation of a rectourethral fistula during the procedure led to an urgent multidisciplinary approach involving surgery and postoperative management, including fecal and urine diversion and antibiotic therapy. The case highlights the critical importance of meticulous technique and comprehensive preoperative patient assessment in minimizing the risk of such iatrogenic complications. It further discusses the management strategies for rectourethral fistulas, ranging from conservative approaches to surgical interventions, and emphasizes the role of fecal diversion, urine diversion, and the potential of robotic surgery in enhancing outcomes for complex cases. The report concludes by reflecting on the intricate balance between routine medical procedures and the potential for severe complications, highlighting the need for heightened awareness and skill in the prevention and management of iatrogenic rectal perforation.
Primary retroperitoneal seminoma is an exceedingly rare type of germ cell tumor, accounting for less than 5% of all such tumors. These tumors are typically large at presentation due to their slow growth and the nonspecif...Primary retroperitoneal seminoma is an exceedingly rare type of germ cell tumor, accounting for less than 5% of all such tumors. These tumors are typically large at presentation due to their slow growth and the nonspecific nature of symptoms, which often leads to delayed diagnosis. A 40-year-old male presented with intermittent abdominal pain and a palpable lump in the right paraumbilical region. Ultrasonography revealed a large retroperitoneal mass. Fine needle aspiration cytology confirmed the diagnosis of poorly differentiated malignant tumor, for which he was evaluated with CT-angiogram of the abdomen and FDG PET-CT scans, which showed a large retroperitoneal mass. The patient, then, had a surgical resection of the mass, with postoperative histopathological and immunohistochemical diagnosis of primary retroperitoneal seminoma, and then underwent three cycles of BEP chemotherapy. Scrotal ultrasonography showed no testicular abnormalities, obviating the need for orchiectomy. FDG PET showed a complete response following treatment completion. Postoperative management included routine monitoring of tumor markers and follow-up imaging, which showed a complete response. This case highlights the diagnostic and therapeutic challenges of primary retroperitoneal seminoma. A multidisciplinary approach, including accurate histopathological diagnosis and a combination of chemotherapy and surgery, is essential for optimal management. Early diagnosis and tailored treatment strategies significantly improve patient outcomes.
Trichobezoars are accumulations of undigested hair. Usually, this disorder follows a psychiatric etiology; however, sometimes a nonpsychiatric etiology, such as pica, can also be suspected. Rapunzel syndrome is a rare ty...Trichobezoars are accumulations of undigested hair. Usually, this disorder follows a psychiatric etiology; however, sometimes a nonpsychiatric etiology, such as pica, can also be suspected. Rapunzel syndrome is a rare type of trichobezoar in which the hair is usually confined to the stomach and small intestine. The authors present a rare case of trichobezoar in a young female without any psychiatric symptoms. Trichobezoar results in nonspecific GI symptoms and this causes delays in its diagnosis. It should always be considered a differential in a young female with nonspecific GI symptoms, especially in those with evidence of iron deficiency anemia.
Meningiomas are one of the most frequent primary central nervous system (CNS) tumors. According to the World Health Organization (WHO) classification of brain tumors, meningiomas are categorized into Grade 1 (benign meni...Meningiomas are one of the most frequent primary central nervous system (CNS) tumors. According to the World Health Organization (WHO) classification of brain tumors, meningiomas are categorized into Grade 1 (benign meningioma; 80%), Grade 2 (atypical meningioma; 4%-15%), and Grade 3 (anaplastic meningiomas; 1%-3%). Grade 2 meningioma has a higher recurrence rate, ranging from 29%-52%. However, the transformation from atypical meningioma into benign meningioma is poorly understood. The present article describes a patient with Grade 2 meningioma that transformed into a benign subtype. A 51-year-old female with a history of seizures, presented with left-sided progressive weakness. Radiological imaging revealed a large extra-axial parasagittal lesion measuring 5 cm × 5 cm × 4.8 cm, suggestive of meningioma. The patient underwent subtotal resection of the lesion. Histologically, the tumor was in favor of Grade 2 meningioma. Radiological follow-up 8 years postoperatively revealed a recurrent meningioma. The patient underwent right-sided craniotomy and resection of the parasagittal meningioma. The histopathological features were suggestive of a Grade 1 meningioma. The transformation from atypical to benign meningiomas is rarely reported and the mechanism remains unclear. The present case provides insights into the natural history of this entity, describes possible etiologies, and lists the surgical management with an emphasis on preoperative radiological imaging and histopathological investigations.