Journal of Surgical Case Reports

Acute pancreatitis (AP) is a rare complication in the post-operative period and the incidence following colorectal surgery is unknown. Although benign hyperamylasaemia following colonic resection is a documented phenomenon, clinically significant AP in the post-operative setting is poorly described in the literature and little is understood about the underlying pathophysiology. Additionally, while gastrointestinal fistulae are a well-recognized complication of bowel surgery, nil previous reports discuss the possible contribution of post-operative AP to their development...

Biliary stent insertion during endoscopic retrograde cholangiopancreatography is used as a therapeutic intervention allowing flow of bile into the duodenum. In rare circumstances, distal gastrointestinal perforation can be attributed to a migrated biliary stent, with the most common site being the sigmoid colon. In these cases, surgical and/or endoscopic intervention may be required. We report a case of a 98-year-old male presenting with small bowel obstruction secondary to migrated plastic and metal biliary stents placed for acute biliary pancreatitis...

Blast injuries are subjected to high morbidity and mortality in the general population. They cognate to single or multiple organ-related injuries that may be life-threatening. The unique injury patterns of blast injuries make treatment therapy complex. An adult male patient presented to our setting with multiple severe deep burn wounds resulting from a dynamite explosion. His computed tomography (CT) scan revealed numerous sharp shards around his body and a ruptured hemiscrotum with exposed testicles. Surgery was immediately done and with a good post-operative outcome...

Gastrointestinal complications following radical cystectomy (RC) are a common occurrence, with small bowel obstruction (SBO) a known complication. Limited cases have been reported of SBO following RC due to internal herniation of the small intestine around the ureter, ileal conduit, obturator nerve and, as a consequence of retroperitoneal lymphadenectomy, even the abdominal vasculature. We present a rare case in which intestinal herniation beneath the external iliac artery (EIA) resulted in a closed-loop SBO with ischaemia and necrosis...

Metastatic abdominal carcinomas have been reported in the literature to cause bowel ischaemia. However, these are often associated with diffuse disease or direct invasion of adjacent bowel secondary to high-grade malignancies. There are no reported cases of extensive small bowel wall nor arterial occlusion as a result of metastasis from treated early-stage urothelial carcinoma. We present an octogenarian male patient who was diagnosed with small bowel ischaemia secondary to extensive metastatic urothelial carcinomatous to the small bowel...

Reconstruction with a pedicled latissimus dorsi flap is used for a large defect after resection of soft tissue sarcoma of the shoulder. Primary donor site closure is sometimes difficult and a skin graft is necessary, possibly delaying postoperative chemotherapy. Combined latissimus dorsi and scapular flaps are used for free flaps in head and neck reconstruction. Myxofibrosarcoma resection in the shoulder of a 76-year-old man resulted in a 16 cm diameter skin resection. The defect was reconstructed with a scapular flap (width = 5 cm) for the distal defect and a pedicled latissimus dorsi muscle flap (flap size, 10 × 7 cm) for the proximal defect...

Candy cane syndrome (CCS) is a rare complication of Roux-en-Y gastric bypass (RYGB), in which the afferent jejunal limb is excessively long. Common symptoms include abdominal pain, nausea and vomiting. A 57-year-old female with a history of RYGB 15 years prior to presentation reported 7 months of persistent heartburn refractory to proton pump inhibitors. Upper endoscopy revealed a 9 cm blind, afferent jejunal limb. After the blind limb was resected laparoscopically, her symptoms resolved. Fifteen years is the longest duration reported from time of RYGB to symptom onset of CCS...

Meigs' syndrome is defined as a secondary triad of ascites, pleural effusion and benign ovarian tumor, usually fibroma. While pseudo-Meigs' syndrome is a rare condition that is associated with benign ovarian tumor-other than fibroma-or even malignant. The case presented is a 40-year-old Saudi, nulliparous woman who was referred for precise diagnostic work-up as a case of huge pelvic-abdominal mass, tense ascites and pleural effusion. After further investigations cancer antigen-125 was found to be elevated. An abdominal CT scan revealed significant interval increase in the size of ascites, which cause huge abdominal distention, as well as a significant pleural effusion...

Haemorrhoidal disease (HD) is a common condition that often requires surgical treatment. In comparison with other traditional techniques, radiofrequency thermocoagulation (RFTC) has multiple advantages to traditional repairs and can be a good alternative in surgical management of HD. We retrospectively analysed 20 patients with Grades 2 ( n  = 6, 30%) and 3 ( n  = 12, 70%) haemorrhoids undergoing RFTC from 1 September 2019 to 31 December 2021. Outcomes including post-operative (PO) pain, immediate/late PO complications, recurrence and patient satisfaction were assessed...

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Odontogenic keratocyst has been of particular interest due to its distinctive behavior and its tendency to frequently recurrence and the diversity of treatment methods. Researchers have differed over the past decades about the nature of this lesion, sometimes it was classified as a cyst and sometimes it was classified as a tumor because of its specific histopathologic features, high recurrence rate and aggressive behavior. We discuss a case of a large odontogenic keratocyst (OKC) that was treated by marsupialization followed by peripheral ostectomy...

Cystic fibrosis (CF) is commonly associated with gastrointestinal manifestations from infancy to adulthood. Distal intestinal obstruction syndrome (DIOS) affects 20% of CF patients, where intussusception can be a rare complication. A 20-year-old CF male was diagnosed with a 3-day history of right iliac fossa pain and diarrhoea. Clinical examination revealed a tender palpable mass in the right iliac fossa and raised serum inflammatory markers. Contrast computerized-tomography of the abdomen-pelvis suggested intussusception of the appendix and further confirmed on histological analyses...

A 68 year-old woman with no significant medical history discovered a lump incidentally in her left breast. The patient's initial imaging revealed a 4.6-cm irregular mass at 11:00 categorized as a BI-RADS 5 as well as an enlarged axillary lymph node and an area of 2.5 cm of heterogeneous calcifications in the 3 o'clock position. The 4.6-cm lesion was revealed to be infiltrating ductal carcinoma with a squamous component, mixed metaplastic carcinoma, which was strongly ER (100+)/PR (100+) positive, HER-2/Neu negative on FISH...

Congenital diverticulum of the appendix as well as diverticulitis of the vermiform appendix remain a rare, mainly retrospective diagnosis, reported by the pathologist, post-appendicectomy. In clinical practice, however, it is important to be aware of this entity, the different types, diagnosis, association with malignancy and treatment options. We are presenting a young female case of pathologically proved true diverticulum of the appendix with associated uncomplicated appendicitis and an overview of the literature...

Mixed neuroendocrine-non-neuroendocrine neoplasms of the gallbladder are rare with a lack of established standardized therapeutic strategies. We report a case of gallbladder mixed neuroendocrine-non-neuroendocrine neoplasm with liver metastasis of neuroendocrine carcinoma. A patient who underwent radical cholecystectomy for gallbladder adenocarcinoma was detected with increasing liver mass, and hepatectomy was performed. Pathological report revealed neuroendocrine carcinoma. To find primary origin, pathological review of the old specimen from previous cholecystectomy with a slightly different perspective was conducted, where the neuroendocrine component was positively dyed...

Left-sided appendicitis is usually caused by situs inversus totalis or midgut malrotation. Clinical and imaging diagnoses have been presented relatively fully in the literature. However, this is a rare condition, and each related case should be further reported to help the day-to-day clinician better investigate and understand. Therefore, in this paper, we present a case of left-sided acute appendicitis in an adult male patient with situs inversus totalis. In addition, we also discuss the laparoscopic technique of the left-sided appendectomy as it is technically more difficult because of the mirror nature of the anatomy...

Mucinous cystadenoma of the appendix is a rare condition characterized by abnormal mucus accumulation in the appendiceal. Laparoscopic appendectomy is a common approach worldwide and can be used in the management of mucinous cystadenoma with lower postoperative complication rates. A 30-year-old female had sharp pain localized to the right abdomen for 2 days. It was aggravated by movement and associated with nausea and vomiting. Laboratory findings were normal, but the abdominal computerized tomography scan demonstrated a cystic tumor in the right abdomen dorsal to the cecum and the ascending colon...

Increasing utilization of a laparoscopic total extraperitoneal (TEP) approach for inguinal hernia repairs has led to rare complications. We describe a rare case of subcutaneous emphysema, pneumomediastinum and pneumothorax following a laparoscopic TEP inguinal hernia repair in a 29-year-old male. Mechanisms posited include extraperitoneal carbon dioxide migration via the retroperitoneal space and dissection along the fascia transversalis and endothoracic fascia anteriorly to enter the mediastinum. Intra-operatively the patient coughed vigorously, potentially propagating the extent of extraperitoneal gas dissection and exacerbating these complications...

Our study aims to present a new case of maxillary third molar dislodgement into the infratemporal fossa during the effort of extraction and the surgical approach performed to retrieve the tooth. Guidelines to prevent this complication are presented. We describe a new case of maxillary third molar displacement into the infratemporal fossa following an unsuccessful surgical procedure of tooth removal by a general dentist. The location of the displaced tooth was confirmed with computed tomography (CT) scanning with a 3D reconstruction...

This is a case of a 68-year-old female with spontaneous and rare periduodenal hematoma of unknown origin without any signs or symptoms of duodenal stenosis. All causes of known precipitating factors, such as trauma, intervention, anticoagulation, pancreatitis or malignant processes, were ruled out. She was managed conservatively, with a series of radiological investigations performed throughout her 7-day admission to further define stability and investigate the possible cause for the periduodenal hemorrhage...