Surgical Case Reports最新文献

{"title":"Spontaneous Rupture of Solid Pseudopapillary Neoplasm of the Pancreas: A Case Report and Literature Review.","authors":"Yuta Nakaguchi, Shinji Kishi, Naoto Shirakami, Takashi Ito, Takamasa Ohnishi","doi":"10.70352/scrj.cr.25-0079","DOIUrl":"10.70352/scrj.cr.25-0079","url":null,"abstract":"<p><strong>Introduction: </strong>Pancreatic solid pseudopapillary neoplasms (SPNs) are rare tumors, accounting for 1%-3% of all pancreatic tumors, with a predilection for young women. Owing to their often asymptomatic nature, SPNs are typically discovered incidentally. Spontaneous rupture of SPNs is extremely rare, with few reported cases. Herein, we report a case of spontaneous SPN rupture and review the literature on similar cases.</p><p><strong>Case presentation: </strong>A 17-year-old girl presented with sudden, severe left upper abdominal pain and hemorrhagic shock. Contrast-enhanced computed tomography revealed a 13-cm heterogeneous pancreatic tail tumor with internal extravasation and massive ascites, indicative of intraperitoneal hemorrhage. The patient underwent distal pancreatectomy and splenectomy. Histopathological examination confirmed SPN with no vascular invasion. Immunohistochemistry was positive for β-catenin, CD10, CD56, and synaptophysin, with a low Ki-67 index (1%-2%). The patient had an uneventful recovery and was discharged on postoperative day 13.</p><p><strong>Conclusions: </strong>Spontaneous SPN rupture is an exceedingly rare occurrence, and its underlying mechanisms remain unclear. Ruptured SPNs may pose a higher risk of recurrence and peritoneal dissemination, necessitating long-term follow-up. Further studies are needed to elucidate the factors influencing SPN rupture and its long-term implications.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Idiopathic Myointimal Hyperplasia of the Mesenteric Veins: Diagnosed After Resection due to Insufficient Palliative Surgery.","authors":"Natsuki Hoshino, Jun Yamamoto, Nao Obara, Shogo Takei, Eiichi Nakao, Yasuhiro Shimizu, Yusaku Tanaka, Taichi Yabuno, Hiroyuki Hayashi, Yasuhisa Mochizuki","doi":"10.70352/scrj.cr.25-0129","DOIUrl":"10.70352/scrj.cr.25-0129","url":null,"abstract":"<p><strong>Introduction: </strong>Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is a rare, non-thrombotic ischemic bowel disease caused by the proliferation of smooth muscle cells in the venous intima. Most patients are initially diagnosed with typical ischemic colitis or inflammatory bowel disease (IBD) and are treated nonsurgically. There is no established treatment for IMHMV, and surgery is the mainstay of treatment, although the optimal surgical approach remains unclear.</p><p><strong>Case presentation: </strong>A 66-year-old man visited the previous hospital with abdominal pain and was clinically diagnosed with ischemic colitis. Diagnostic colonoscopy showed inflammation from the sigmoid colon to the lower rectum. The biopsy did not reveal malignancy or IBD. His clinical condition did not improve after 2 months of conservative treatment, and he underwent a diverting colostomy. The symptoms temporarily improved, and he was referred to our hospital. However, 1 month postoperatively, computed tomography showed a rupture of the sigmoid colon and fluid collection around the sigmoid colon. He was diagnosed with perforation of the sigmoid colon due to relapse of ischemic colitis and underwent Hartmann's procedure. Histopathological examination showed stenosis and obstruction of the venous lumen at the perforation site with whole-layer necrosis, and proliferation of smooth muscle cells in the venous intima. The pathological diagnosis was IMHMV. He was discharged from our hospital 23 days after surgery without major complications and has had no symptoms or recurrence 8 months after surgical resection.</p><p><strong>Conclusions: </strong>IMHMV is a rare disease, infrequently suspected preoperatively and typically diagnosed after surgical resection. Palliative surgery, such as colostomy, may not be a sufficient treatment for IMHMV.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12162148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior Mediastinal Lymph Node Metastasis of Intrahepatic Cholangiocarcinoma: A Case Report and Literature Review.","authors":"Tomoaki Tabata, Ryusuke Saito, Takeki Taniguchi, Kyohei Kasuda, Naruhito Takido, Hiroyuki Ogasawara, Yoshihiro Shono, Muneyuki Matsumura, Kengo Sasaki, Atsushi Fujio, Kazuaki Tokodai, Takanori Morikawa, Michiaki Unno, Takashi Kamei","doi":"10.70352/scrj.cr.24-0025","DOIUrl":"10.70352/scrj.cr.24-0025","url":null,"abstract":"<p><strong>Introduction: </strong>Intrahepatic cholangiocarcinoma (ICC) is the second most common liver malignant tumor with a poor prognosis. Lymph node (LN) metastasis is found in 15% of ICC at the time of initial diagnosis. However, the LN metastasis to the anterior mediastinum is extremely rare. Herein, we report a case of anterior mediastinal LN metastasis of ICC.</p><p><strong>Case presentation: </strong>The patient is a 74-year-old man who had surgery for cervical esophageal cancer. During follow-up, a low-density hepatic tumor and swollen LNs in the anterior mediastinum were detected. The tumor of the liver was diagnosed as ICC by needle biopsy. Excisional biopsy of the LN was performed and the diagnosis was metastasis of ICC. Because the prognosis of the patient with ICC Stage IVB is poor, the patient received 8 courses of chemotherapy. Although the new lesion appeared next to the main tumor, these tumors were located in the left liver. In addition, it was difficult for the patient to continue the chemotherapy due to the renal dysfunction. Hepatectomy with lymphadenectomy was performed. The patient survives without recurrence for 9 months after surgery. This is the first report of anterior mediastinal metastasis of ICC without any other organ involvement.</p><p><strong>Conclusions: </strong>Metastasis to the anterior mediastinum of hepatic tumor can be explained by the system that lymphatic fluid running under the capsule of the liver drains to the anterior mediastinal LNs through the coronary ligament. Metastasis of ICC to mediastinal LNs can occur when the tumor is located at the surface of the liver. Excisional biopsy is effective in determining the accurate disease stage and the treatment strategy.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Pediatric Retroperitoneal Schwannoma Presenting with Myoclonus of the Lower Limb: A Case Report and Review.","authors":"Takazumi Kato, Yuki Sengoku, Shinya Banno, Souji Ibuka, Saori Endo, Michio Ozeki, Yukiko Tani, Naruhiko Murase, Yuta Sato, Itaru Yasufuku, Yu Jesse Tajima, Nobuhisa Matsuhashi","doi":"10.70352/scrj.cr.24-0077","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0077","url":null,"abstract":"<p><strong>Introduction: </strong>Schwannomas arise from Schwann cells of the peripheral nerve sheath. Schwannomas are usually benign, and most of them are located in the head, neck, or distal extremities. The retroperitoneal region is an unusual location for schwannomas. Schwannomas are usually seen in adults and are very rare in the pediatric population.</p><p><strong>Case presentation: </strong>A 6-year-old boy was referred to our institution with a right abdominal mass. His main complaint was intermittent myoclonus of his right lower limb. Abdominal computed tomography (CT) and magnetic resonance imaging scans revealed a round-shaped solid mass measuring 78 × 61 mm adjacent to the caudal side of the right kidney. Right hydronephrosis and hydroureters resulting from ureteral compression were present. A positron emission tomography-CT scan showed mild accumulation of fluorodeoxyglucose. Tumor resection was performed by laparotomy, and the mass was completely excised. Postoperative pathologic examination showed a benign schwannoma. The myoclonus of the right lower limb that had been present before surgery disappeared after surgery. At 9 months since the operation, there has been no recurrence.</p><p><strong>Conclusions: </strong>We present a pediatric case of a retroperitoneal schwannoma causing myoclonus of the lower limb. Retroperitoneal schwannomas in children are extremely rare, with only 4 cases having been reported in English.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Catheter-Guided Technique for Second Branchial Cleft Fistula Excision in Infants: A Case Report.","authors":"Akio Kawami, Yudai Goto, Yuri Nemoto, Tomohiro Aoyama, Kouji Masumoto","doi":"10.70352/scrj.cr.25-0013","DOIUrl":"10.70352/scrj.cr.25-0013","url":null,"abstract":"<p><strong>Introduction: </strong>Second branchial cleft (SBC) fistulas are the most common branchial cleft anomalies and typically present in infancy or early childhood. While complete surgical excision is the standard treatment, surgical challenges in younger children arise because of narrower fistula tracts and inadequate visualization, which increase the risk of complications and recurrence.</p><p><strong>Case presentation: </strong>We report the case of a 6-month-old boy with an SBC fistula who presented with persistent mucoid discharge from a right cervical orifice. Fistulography confirmed the presence of a complete SBC fistula. At 9 months of age, a fistulectomy was performed using a 28-gauge peripherally inserted central venous catheter (PICC) as a guide to identify the entire fistula tract. The catheter facilitated the precise identification of the fistula tract, saline irrigation, dissection under endoscopic guidance, and confirmation of the internal end by creating a knot at the catheter tip. The tract was excised completely without any complications. The patient recovered uneventfully and showed no recurrence at 6 months postoperatively.</p><p><strong>Conclusions: </strong>Complete surgical resection remains the gold standard for SBC fistulas. However, anatomical challenges in younger children limit the applicability of various intraoperative tools and techniques. The use of a small-diameter catheter as a guide to identify an entire fistula tract is a valuable approach that overcomes these challenges, enhances surgical precision, and reduces the risk of complications and recurrence.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tracheal Obstruction by Thyroid Gland Extension into the Trachea after Blunt Tracheal Transection.","authors":"Hironori Ishibashi, Michi Aoki, Shunichi Baba, Akihiro Fujita, Kenichi Okubo","doi":"10.70352/scrj.cr.24-0072","DOIUrl":"10.70352/scrj.cr.24-0072","url":null,"abstract":"<p><strong>Introduction: </strong>Tracheal injuries due to blunt force trauma are rare yet life-threatening conditions, comprising only 4% of chest trauma cases. Diagnosis is often delayed, increasing the risk of severe complications. This report describes a unique case of tracheal obstruction caused by thyroid gland extension into the trachea following blunt trauma, which was managed successfully with venovenous extracorporeal membrane oxygenation (ECMO) and surgery.</p><p><strong>Case presentation: </strong>A 50-year-old male presented with severe respiratory distress following a seizure-induced fall at his residence. On arrival at the hospital, the patient was in respiratory failure with an SpO₂ of 92% on a 10 L/min reservoir mask, had severe subcutaneous emphysema, and an upper airway stridor. Computed tomography revealed mediastinal emphysema and a 13-mm endotracheal mass obstructing the trachea. Flexible bronchoscopy indicated a suspected tracheal tumor, but intubation was unsuccessful due to bleeding and obstruction. Emergency tracheostomy was considered but deemed risky because imaging showed that the distal trachea was located near the sternum's suprasternal margin. The patient's respiratory distress worsened, and his SpO₂ dropped to 86%. Venovenous ECMO was then administered, stabilizing his condition. Surgical intervention was performed to address the endotracheal mass and tracheal injury. A transverse neck incision allowed dissection and identification of the tracheal injury, revealing the inferior thyroid gland which extended into the tracheal lumen. Pathological examination confirmed the endotracheal mass as normal thyroid tissue. Tracheal anastomosis was successfully completed, and the patient was discharged on postoperative day 10 without complications.</p><p><strong>Conclusion: </strong>This case highlights an unusual presentation of tracheal obstruction caused by thyroid gland extension into the trachea following blunt trauma. Rapid initiation of ECMO enabled successful airway management and surgical repair. Recognizing atypical presentations of tracheal injuries is critical in trauma cases, as prompt intervention can prevent further complications and improve patient outcomes. This case underscores the importance of tailored airway management and the potential role of ECMO in cases of similar complex airway obstructions.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11873735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracic Endovascular Aortic Repair Using Stent Grafts in Japan.","authors":"Akihiko Usui, Rena Usui, Shunsuke Nakata","doi":"10.70352/scrj.ed.25-2001","DOIUrl":"10.70352/scrj.ed.25-2001","url":null,"abstract":"<p><p>A stent-graft technique was developed by Parodi et al. and has been used clinically for thoracic endovascular aortic repair (TEVAR) since the 1990s. We evaluated how the new stent-graft technology contributed to expanding aortic surgery and improving surgical outcomes of aortic surgery. TEVAR was performed in a limited number of institutes in the early 2000s and was greatly enhanced by the approval of commercially available stent grafts in 2008. Its performance increased steadily thereafter, with 0 cases performed in 1999, 1658 in 2009, and 6461 in 2019. The ratio of TEVAR was 0% in 1999, which increased to 13.9% in 2009 and 28.5% in 2019, respectively. TEVAR has greatly contributed to the improvement of surgical outcomes, especially in non-dissection ruptured aneurysms and type B acute aortic dissection. TEVAR was performed in 53% of ruptured aneurysms, and the 30-day mortality rate improved to 13.9% in 2019 due to a 30-day mortality rate of 12.5% in TEVAR. The effect of TEVAR was more remarkable in patients with acute type B aortic dissection, where the 30-day mortality rate was 5.7%, and the procedure was performed in 75% of cases. The overall 30-day mortality rate improved to 7.0% for all patients with type B acute aortic dissection in 2019. The expansion of TEVAR using stent grafts greatly increased the number of aortic surgeries and played a significant role in improving surgical outcomes. Stent-graft technology has influenced the field of aortic surgery.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11835547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two Cases of Adult-Onset Intestinal Duplication Manifested as Acute Abdomen: Case Report and Review of the Literature.","authors":"Yuki Nomura, Satoshi Nagayama, Sachie Fujioka, Go Takeuchi, Yuma Takeuchi, Michio Okamoto, Riki Ganeko, Yusuke Nakayama, Kyoichi Hashimoto, Yoshihiro Kubota","doi":"10.70352/scrj.cr.24-0023","DOIUrl":"10.70352/scrj.cr.24-0023","url":null,"abstract":"<p><strong>Introduction: </strong>Gastrointestinal duplication is a rare congenital anomaly, usually occurring in childhood and rarely in adults. It is most common in the ileum, but can occur anywhere in the gastrointestinal tract from the mouth to the anus. An adult case of intestinal duplication is accompanied by non-specific symptoms and, hence, it is often difficult to establish accurate diagnosis preoperatively in adults.</p><p><strong>Case presentation: </strong>We experienced two cases of ileal duplication that was manifested as acute abdomen. In both cases, we performed emergency surgery with a tentative preoperative diagnosis of perforation peritonitis related to intestinal duplication. The first case was a 36-year-old male presenting with a cystic non-communicating intestinal duplication, which was perforated, causing abdominal pain. The second case was a 77-year-old male presenting with tubular communicating intestinal duplication, in which a fecal stone was fitted into the root of the duplicated intestine, and the duplicated intestine itself became abscessed, causing abdominal pain. Their postoperative courses were uneventful and the patients were discharged from hospital without any sequelae on the 5th and 10th postoperative day, respectively.</p><p><strong>Conclusion: </strong>Although preoperative diagnosis is not easy, because the clinical presentation varies depending on the occurrence site, in-depth evaluation of preoperative CT images could lead to a precise diagnosis especially when considering intestinal duplication as one of the differential diagnoses of acute abdomen.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Obturator Hernia Involving the Urinary Bladder Discovered Following a Femoral Incarcerated Hernia.","authors":"Nobuhiro Naito, Toshiki Hirakawa, Mikio Nambara, Naoki Kametani, Akiko Tachimori, Nobuya Yamada, Shigehiko Nishimura, Naoyuki Taenaka","doi":"10.70352/scrj.cr.25-0097","DOIUrl":"https://doi.org/10.70352/scrj.cr.25-0097","url":null,"abstract":"<p><strong>Introduction: </strong>Obturator hernias are rare, accounting for 0.05%-1.4% of all hernias, and typically affect elderly, thin women. Bladder hernias, though uncommon, comprise 1%-4% of groin hernias, with bladder herniation through the obturator foramen being extremely rare. We report a case of an obturator hernia involving the urinary bladder, which was incidentally discovered during femoral hernia repair.</p><p><strong>Case presentation: </strong>A 70-year-old woman presented with a 2-day history of abdominal pain and vomiting. She had no urinary symptoms. Abdominal computed tomography (CT) revealed a right femoral hernia and an unexpected bladder herniation through the obturator foramen. Laparoscopic transabdominal preperitoneal (TAPP) repair was performed using 3 ports. The incarcerated bowel was reduced after incising the lacunar ligament. The prolapsed bladder was carefully dissected to prevent injury, and a dual-layered Bard mesh (Medicon, Franklin Lakes, NJ, USA) was placed to reinforce the defect. The patient recovered uneventfully and was discharged on the 7th postoperative day. No recurrence or urinary symptoms were observed several months postoperatively.</p><p><strong>Conclusions: </strong>Bladder herniation through the obturator foramen is extremely rare and often asymptomatic, making preoperative diagnosis challenging. Surgeons should consider this condition during hernia repair to prevent intraoperative bladder injury. Preoperative imaging is crucial for safe and complete surgical management.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent Tumor in Colorectal Cancer Requiring Combined Resection of Iliac or Femoral Vessels: Report of Four Cases.","authors":"Kentaro Abe, Hiroaki Nozawa, Katsuyuki Hoshina, Toshio Takayama, Kazuhito Sasaki, Koji Murono, Shigenobu Emoto, Yuichiro Yokoyama, Kensuke Kaneko, Takuro Shirasu, Shinya Abe, Yuzo Nagai, Masaru Kimura, Takahide Shinagawa, Yuichi Tachikawa, Satoshi Okada, Munetoshi Hinata, Akiko Takase, Tetsuo Ushiku, Soichiro Ishihara","doi":"10.70352/scrj.cr.24-0159","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0159","url":null,"abstract":"<p><strong>Introduction: </strong>Recurrent tumors in colorectal cancer may be removed along with adjacent blood vessels to achieve R0 resection. However, it remains unclear whether to aggressively perform this procedure because it may cause serious intraoperative or postoperative complications.</p><p><strong>Case presentation: </strong>In Case 1, a 62-year-old man underwent radical surgery for rectosigmoid cancer. Three years later, computed tomography scans revealed a disseminated nodule near the left external iliac vessels. We resected the tumor and vessels that were reconstructed by bypass surgery. Histologically, the margins of the tumor were in contact with the adventitia of the vessels. In Case 2, a 63-year-old man underwent radical surgery for ascending colon cancer. A nodule was detected at the right iliac fossa 16 years later and appeared to invade the right femoral vessels. After systemic chemotherapy, the nodule was removed with partial resection of the right femoral artery and vein that were reconstructed by end-to-end anastomosis and bypass surgery, respectively. Histologically, the tumor was located 0.7 mm from the vessels. In Case 3, a 67-year-old woman underwent radical multivisceral resection for obstructive rectosigmoid cancer invading the adjacent organs. Fifteen months later, she developed local recurrence and subsequently received chemotherapy. She underwent en bloc resection of the tumor and the left internal iliac artery (IIA) near the bifurcation. The left external iliac artery was reconstructed by end-to-end anastomosis. Direct invasion of the IIA was proven histologically. In Case 4, a 74-year-old woman underwent radical surgery for ascending colon cancer with high microsatellite instability. Eight months later, a recurrent tumor was detected near the right external iliac vessels. After pembrolizumab and chemoradiotherapy, we resected the tumor and part of the external iliac vein; the defect was primarily closed with sutures. No viable tumor cells were found in the specimen. During the follow-up period (median: 52 months), 3 patients were alive without vascular surgery-related complications.</p><p><strong>Conclusions: </strong>It is difficult to accurately evaluate whether a recurrent tumor from colorectal cancer directly invades vessels using preoperative imaging. However, the combined resection of recurrent tumor and vessels may be required to achieve R0 resection, considering a short distance even in invasion-negative cases.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}