Surgical Case Reports最新文献

{"title":"Successful Surgical Repair of Complete Duodenal Transection Caused by Horse Kick: A Case Report.","authors":"Yusuke Asai, Yusuke Tsunetoshi, Yuta Susa, Akiko Matsuzawa, Seiji Miyazaki, Yuki Itagaki, Hiroyuki Yamamoto, Kotaro Kimura, Hiroki Kushiya, Shoki Sato, Naoya Okada, Takumi Yamabuki, Kentaro Kato, Yoshihiro Kinoshita, Minoru Takada, Yoshiyasu Ambo, Fumitaka Nakamura","doi":"10.70352/scrj.cr.24-0059","DOIUrl":"10.70352/scrj.cr.24-0059","url":null,"abstract":"<p><strong>Introduction: </strong>Horse kicks are a rare cause of injury and tend to cause severe complications such as visceral organ injury. Traumatic duodenal injuries are associated with high mortality rates. Furthermore, their reconstructive procedures vary widely and require appropriate on-the-spot judgment by the surgeon. We experienced a case of blunt abdominal trauma with a complete transection of the first portion of the duodenum caused by a horse kick without any associated lesions. A good postoperative course was achieved by trimming the pyloric part of the stomach and performing an end-to-end anastomosis between the gastric remnant and the duodenum, along with tube decompression and biliary drainage.</p><p><strong>Case presentation: </strong>A woman in her 50s was kicked in the right upper quadrant of her abdomen by a horse and transported to a local hospital. Computed tomography revealed pneumoperitoneum and hematoma near the duodenum, discontinuity of the duodenal wall, and a poorly contrasted area in the pancreas head. The patient underwent emergent laparotomy 6h after the accident. The first portion of the duodenum was completely lacerated. No contamination around the pancreatic head or saponification of fat tissue was observed. Because the patient's vital signs were stable and the condition of the damaged tissue was favorable, the transection was repaired with trimming of the pyloric part of the stomach and end-to-end anastomosis between the gastric remnant and the duodenum. Decompression, feeding and biliary drainage tubes were placed. The patient's postoperative course was favorable and the patient was discharged on postoperative day 20 in a stable condition. At an outpatient visit 3 months postoperatively, the patient reported no abdominal pain or stenosis symptoms.</p><p><strong>Conclusions: </strong>We experienced a rare case of a single complete duodenal transection due to a horse kick. End-to-end anastomosis with tube decompression and biliary drainage was performed because the patient's vital signs were stable, there was little contamination or contusion of the surrounding tissue, and it had not been >24h since the injury. The patient had a good course of treatment.</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/PMC11925644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671070","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":"Robot-Assisted Ultra-Low Anterior Resection for Rectal Neuroendocrine Tumors after Severe Perineal Tears: A Case Report.","authors":"Kenji Baba, Masumi Wada, Naoki Kuroshima, Yuto Hozaka, Daisaku Kamiimabeppu, Masataka Shimonosono, Yota Kawasaki, Ken Sasaki, Michiyo Higashi, Hiroaki Kobayashi, Takaaki Arigami, Takao Ohtsuka","doi":"10.70352/scrj.cr.24-0012","DOIUrl":"10.70352/scrj.cr.24-0012","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical repair of severe perineal tears is required immediately postpartum. Owing to their low prevalence, the post-treatment course of severe tears is not well known. Herein, we report a rare case of a young woman who underwent robot-assisted curative resection with anal preservation for a rectal neuroendocrine tumor (NET) incidentally discovered following a severe perineal tear.</p><p><strong>Case presentation: </strong>A 29-year-old woman experienced a severe perineal tear during the first vaginal delivery, which led to the incidental discovery of a 20-mm rectal NET. Four months after the perineal tear, the gynecology and digestive surgery teams ensured that the tear wound had completely healed and anal function was preserved. The patient underwent robot-assisted ultra-low anterior resection with lymph node dissection. The procedure was successfully completed, preserving anal function, and histopathology confirmed an NET (G2, pT2N2aM0, pStage IIIB). The patient recovered smoothly and was discharged on the seventh postoperative day.</p><p><strong>Conclusions: </strong>Rectal surgery after severe perineal tears may be associated with scarring and fibrosis around the rectum, and precautions should be taken at the time of rectal dissection. Depending on the tumor condition, it may be advisable to perform rectal surgery several months after the tear rather than immediately after treatment for the tear.</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/PMC11850458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504233","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":"Spontaneously Ruptured Pancreatic Mucinous Cystic Neoplasm: A Case Report.","authors":"Masataka Hirano, Masanori Tsujie, Takayoshi Goto, Chikato Koga, Soichiro Mori, Daisuke Takiuchi, Kentaro Nishida, Masatoshi Nomura, Yukihiro Yoshikawa, Koki Tamai, Takuya Hamakawa, Mitsuyoshi Tei, Yusuke Akamaru","doi":"10.70352/scrj.cr.24-0087","DOIUrl":"10.70352/scrj.cr.24-0087","url":null,"abstract":"<p><strong>Introduction: </strong>Pancreatic mucinous cystic neoplasm (MCN) is a cystic tumor of the pancreas typically located in the pancreatic body or tail in middle-aged women. However, MCN rupture is rare. This report describes a case of MCN with spontaneous rupture during follow-up.</p><p><strong>Case presentation: </strong>The patient was a 34-year-old woman. Contrast-enhanced computed tomography (CECT) and magnetic resonance imaging (MRI) revealed a 130 mm multifocal cyst in the pancreatic tail. The cyst, characterized by multiple septa and cyst-in-cyst structures, was diagnosed as an MCN. Initially, the patient opted for periodic follow-ups instead of surgical resection. After a gradual increase in cyst size, surgery was scheduled approximately 1 year later. Two days before the scheduled surgery, the patient experienced unexplained lower abdominal pain. Moreover, CECT revealed a shrinking cystic mass in the pancreatic tail along with the presence of ascites, leading to a diagnosis of spontaneous rupture of the pancreatic cyst. No peritonitis was detected, and a distal pancreatectomy was performed 2 days after admission. Pathological examination confirmed that the pancreatic cyst was a noninvasive mucinous cystadenocarcinoma. The abdominal cavity contained large amounts of turbid ascites with neutrophils but no bacterial growth. Strong inflammatory changes were noted at the cyst wall disruption site. Despite the development of a pancreatic fistula (ISGPF Grade BL, Clavien-Dindo Grade II), the patient was discharged from the hospital on postoperative day 16 and remained alive and recurrence-free for 18 months after surgery.</p><p><strong>Conclusion: </strong>Spontaneous rupture of an MCN is rare. In this study, we report our case and review previously published cases of MCN rupture. We also discuss the potential causes of the spontaneous rupture in our case.</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/PMC11850215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504333","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":"Late Graft Failure Due to Arterio-Venous Fistula in the Free Jejunal Graft Mesentery Following Total Pharyngo-Laryngo-Esophagectomy for Cervical Esophageal Cancer: A Case Report.","authors":"Koutarou Yamamoto, Tomoyuki Okumura, Takeshi Miwa, Yoshihisa Numata, Tatsuhiro Araki, Ayaka Itoh, Mina Fukasawa, Nana Kimura, Masakazu Nagamori, Kosuke Mori, Naoya Takeda, Tomohiro Minagawa, Kenta Sukegawa, Toru Watanabe, Katsuhisa Hirano, Isaya Hashimoto, Kazuto Shibuya, Isaku Yoshioka, Hideharu Abe, Toshihiko Satake, Noriko Okuno, Tsutomu Fujii","doi":"10.70352/scrj.cr.25-0147","DOIUrl":"10.70352/scrj.cr.25-0147","url":null,"abstract":"<p><strong>Introduction: </strong>Insufficient blood supply to free jejunal grafts after total pharyngo-laryngo-esophagectomy (TPLE) occurs primarily due to failure of the vascular anastomosis, often resulting in rapid graft necrosis. This report details a case of ischemic enteritis caused by an arteriovenous fistula (AVF) in the mesentery of the free jejunal graft, resulting in chronic stenosis and total removal of the jejunal graft.</p><p><strong>Case presentation: </strong>A 61-year-old woman diagnosed with squamous cell carcinoma of the cervical and thoracic esophagus underwent TPLE with gastric conduit and free jejunal graft reconstruction. The third jejunal artery and vein were anastomosed to the left transverse cervical artery and the internal jugular vein, respectively. On postoperative day (POD) 9, leakage was observed at the free jejunal-gastric anastomosis. The fistula healed with conservative treatment but a stenosis at the pharyngeal-jejunal anastomosis developed. Endoscopic observation after balloon dilation of the stenosis showed mucosal hemorrhage and ulcer scarring in the jejunal graft. A 3D reconstructed contrast-enhanced CT revealed the presence of an AVF in the free jejunal mesentery despite well-preserved blood flow across the vascular anastomosis. As no local inflammation was observed in the neck, and oral intake was sufficient after balloon dilatation, she was discharged from hospital. Seven months after surgery, she was admitted to our hospital due to obstruction of the pharyngeal-jejunal anastomosis with cutaneous fistula. Based on the disease course and endoscopic findings of the free jejunal graft, she was diagnosed with cutaneous fistula with scarring obstruction following chronic ischemic enteritis, considered difficult to heal with conservative treatment. Total removal of the free jejunum and reconstruction with an antero-lateral femoral thigh (ALT) flap was performed at 8 months after initial surgery. Oral intake was allowed on POD13, and she was discharged in good condition on POD30.</p><p><strong>Conclusions: </strong>We report here a rare case of late graft failure after TPLE due to chronic ischemia from an AVF in the mesentery of the free jejunal graft. Detailed assessment of mesenteric blood flow by 3D-constructed contrast-enhanced CT is useful and early removal of the ischemic jejunal graft is suggested.</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/PMC12119138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174107","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":"Successful Prevention of Bronchopleural Fistula in Single-Stage Esophagectomy and Right Lower Lobectomy: A Case Report.","authors":"Tomonari Oki, Shuhei Iizuka, Makoto Tomatsu, Toru Nakamura","doi":"10.70352/scrj.cr.25-0170","DOIUrl":"10.70352/scrj.cr.25-0170","url":null,"abstract":"<p><strong>Introduction: </strong>Bronchopleural fistulae (BPFs) following pulmonary resection are potentially fatal complications, with right lower lobectomy being the most susceptible among lobectomies. As esophagectomy also increases the risk of tracheobronchial ischemia and postoperative malnutrition, performing a single-stage esophagectomy combined with right lower lobectomy may further elevate the risk of BPFs, underscoring the need for meticulous preoperative planning.</p><p><strong>Case presentation: </strong>A 64-year-old male with a history of heavy smoking was referred to our hospital after an abnormal mass was detected on a chest radiograph during an annual health check. Chest CT revealed a 3.7 cm consolidative mass in the right lower lobe, resulting in a diagnosis of primary lung cancer, classified as T2aN0M0, stage IB. Additionally, abnormal fluorodeoxyglucose (FDG) uptake was observed in the lower thoracic esophagus, leading to a diagnosis of synchronous esophageal cancer, classified as T1bN0M0, stage I. As both lesions required upfront surgical resection via the right thoracic cavity, a single-stage esophagectomy and right lower lobectomy were planned. Initially, esophagectomy was performed using a five-port video-assisted thoracic surgery (VATS) approach in the prone position from the right side. To preserve the blood supply to the fifth intercostal muscle for subsequent harvesting as a muscle flap, the utility port in the corresponding intercostal space was placed as ventrally as possible. The esophagectomy was performed while preserving the right main bronchial artery. The patient was then repositioned to the left lateral decubitus position, and the preserved fifth intercostal muscle flap was harvested. A right lower lobectomy was completed, preserving the bronchial artery, and the bronchial stump was reinforced using the harvested muscle flap. Despite postoperative development of esophagogastric anastomotic leakage, the patient did not develop a BPF, and no signs of BPF have been observed during 12 months of follow-up.</p><p><strong>Conclusions: </strong>Preservation of the right main bronchial artery and reinforcement of the bronchial stump with an intercostal muscle flap facilitated prevention of BPF following single-stage esophagectomy and right lower lobectomy, despite the patient's history of heavy smoking and transient postoperative malnutrition.</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/PMC12162247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302847","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":"Obese Patient with Gastric Diverticulum Undergoing Laparoscopic Sleeve Gastrectomy Guided by Preoperative Endoscopic Measurement: A Case Report and Literature Review.","authors":"Kensuke Hirosuna, Hajime Kashima, Ryohei Shoji, Yuki Matsumi, Yoshihiko Kakiuchi, Satoru Kikuchi, Shinji Kuroda, Fuminori Teraishi, Shunsuke Kagawa, Toshiyoshi Fujiwara","doi":"10.70352/scrj.cr.25-0141","DOIUrl":"10.70352/scrj.cr.25-0141","url":null,"abstract":"<p><strong>Introduction: </strong>Gastric diverticulum is a rare condition, often asymptomatic and incidentally detected. Laparoscopic sleeve gastrectomy (LSG) is a widely performed bariatric procedure, but a gastric diverticulum complicates surgical planning. In this case, careful preoperative assessment allowed safe execution of LSG despite the diverticulum's proximity to the esophagogastric junction.</p><p><strong>Case presentation: </strong>A 45-year-old woman (BMI: 46.8 kg/m²) with hypertension, dyslipidemia, and glucose intolerance was referred for bariatric surgery after unsuccessful weight loss with conservative management. Preoperative endoscopy revealed an 18 × 14 mm gastric diverticulum on the posterior wall of the gastric fundus, 40 mm from the esophagogastric junction. LSG was performed using a surgical stapler, ensuring complete diverticulum resection while preserving gastric tube integrity. The surgery was uneventful, with minimal blood loss and a duration of 2 hours and 52 minutes. The patient had an uneventful postoperative course and was discharged on day 9. Her BMI decreased to 39.3 kg/m² at the 1-year follow-up, with improved metabolic parameters.</p><p><strong>Conclusions: </strong>This case highlights the importance of thorough preoperative evaluation when performing LSG in patients with gastric diverticulum. Accurate endoscopic measurement of the diverticulum's location aids in determining the optimal resection line, ensuring surgical safety and efficacy. Surgeons should remain vigilant when encountering such anatomical variations to optimize outcomes in bariatric 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/PMC12159294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286550","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":"Middle Pancreatectomy for Traumatic Main Pancreatic Duct Injury with Delayed Presentation: Two Case Series.","authors":"Yuki Itagaki, Shintaro Takeuchi, Takehiro Noji, Yuma Ebihara, Masataka Wada, Kimitaka Tanaka, Aya Matsui, Yoshitsugu Nakanishi, Toshimichi Asano, Toru Nakamura, Satoshi Hirano","doi":"10.70352/scrj.cr.25-0094","DOIUrl":"10.70352/scrj.cr.25-0094","url":null,"abstract":"<p><strong>Introduction: </strong>Pancreatic trauma is an uncommon, yet potentially lethal condition, with main pancreatic duct (MPD) disruption guiding surgical management. Middle pancreatectomy (MP) with Roux-en-Y pancreatojejunostomy (PJ) offers an organ-preserving alternative to distal pancreatectomy, particularly for young patients. However, the extent of its applicability and the specific surgical techniques-including key technical tips-remain unclear in the context of traumatic pancreatic injury. This is especially true in cases of delayed presentation, where severe intra-abdominal inflammation further complicates surgical intervention.</p><p><strong>Case presentation: </strong>We report 2 cases of young patients with MPD injuries from blunt trauma, both presenting late with significant peripancreatic contamination. Case 1 included a 22-year-old male who sustained pancreatic and liver injuries while skiing. He was transferred 30 hours post-injury with stable hemodynamics. Endoscopic retrograde pancreatography (ERP) confirmed MPD disruption. Intraoperatively, saponification obscured the anatomical structures, but MP with PJ was successfully performed. The patient recovered without major complications. Case 2 involved a 17-year-old female who was initially observed at another hospital after a traffic accident. Three days later, she developed peritonitis, and a retrospective computed tomography review revealed a pancreatic body rupture. An ERP confirmed MPD disruption. During surgery, extensive inflammation and adhesions were noted, and the MPD was extremely small. Despite technical complexities, an MP with PJ was successfully completed. The pancreatic fistula from the pancreatic head stump required drainage treatment following spinal surgery for vertebral fractures, and the patient recovered without sequelae.</p><p><strong>Conclusions: </strong>MP with Roux-en-Y PJ is a technically challenging but viable approach for MPD injuries in young patients, even with delayed presentation. It preserves the pancreatic and splenic functions, making it a valuable approach for young patients when performed by experienced surgeons. These cases demonstrate the clinical impact and potential implications of MP as a viable treatment approach for pancreatic trauma.</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/PMC12177570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333901","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":"Extracorporeal Membrane Oxygenation-Assisted Thoracic Surgery: A Series of 10 Cases.","authors":"Yuzu Harata, Kazuhiro Imai, Shinogu Takashima, Shoji Kuriyama, Hidenobu Iwai, Haruka Suzuki, Ryo Demura, Sumire Shibano, Yoshihiro Minamiya","doi":"10.70352/scrj.cr.24-0004","DOIUrl":"10.70352/scrj.cr.24-0004","url":null,"abstract":"<p><strong>Introduction: </strong>Extracorporeal membrane oxygenation (ECMO) is a type of extracorporeal circulation used to divert blood from and deliver blood to peripheral blood vessels. Recently, the use of ECMO has been reported in various non-transplant surgeries. Particularly in tracheal surgeries, ECMO provides an unobstructed surgical field and enables safe induction of general anesthesia in difficult intubation cases. Here, we report on 10 cases of thoracic surgery in which ECMO was employed at our institution.</p><p><strong>Case presentation: </strong>These 10 cases comprise 4 tracheal cancer surgeries, 2 lung cancer surgeries, and 1 case each of surgery for thyroid cancer, mediastinal cancer, tracheomalacia, and tracheobronchial injury. Veno-venous (VV)-ECMO is most often selected, but veno-arterial (VA)-ECMO is chosen when recirculation with VV-ECMO is unacceptable, when pulmonary artery bleeding needs to be controlled, or when cardiac support is necessary. Among the 10 presented cases, VV-ECMO was used in 8, while VA-ECMO was employed in 2. Three of these cases involved ECMO bailout due to dyspnea caused by airway stenosis. Six of the patients did not receive heparin maintenance. Of those, 1 was maintained on nafamostat mesilate, 2 were maintained on nafamostat mesilate after receiving a single dose of heparin, and 3 received only a single dose of heparin. In none of those cases did ECMO fail to maintain flow due to thrombus formation. A postoperative hemothorax occurred as one of the ECMO-related complications in Case 4. There were no perioperative cardiopulmonary complications, in-hospital deaths, or deaths within 30 days after surgery. One patient died from metastatic recurrence of non-small cell lung cancer 5 months after surgery, another from progression of disease in mediastinal anaplastic cancer 4 months after surgery, and the 3rd from upper gastrointestinal bleeding 2 years after surgery. The other 7 patients remain alive.</p><p><strong>Conclusions: </strong>ECMO is useful in tracheal surgery and in cases where intubation is difficult or dangerous, because it facilitates safe and accurate surgery. We also believe that individualized anticoagulant strategies can be safely implemented.</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/PMC11926330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692848","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":"Impact of Right Top Pulmonary Vein Location on Subcarinal Lymph Node Dissection in Thoracoscopic Esophagectomy: A Case Report and Literature Review.","authors":"Takeshi Horaguchi, Yuta Sato, Yuji Hatanaka, Yoshihiro Tanaka, Noriki Mitsui, Masahiro Fukada, Itaru Yasufuku, Ryuichi Asai, Jesse Yu Tajima, Nobuhisa Matsuhashi","doi":"10.70352/scrj.cr.24-0093","DOIUrl":"10.70352/scrj.cr.24-0093","url":null,"abstract":"<p><strong>Introduction: </strong>The right top pulmonary vein (RTPV) is a rare anatomical variant that arises independently of the right superior lobe. It drains behind the right main bronchus or bronchus intermedius and into the left atrium or another pulmonary vein. This anomaly poses challenges during subcarinal lymph node dissection in thoracic surgery, such as esophagectomy, owing to the risk of vascular injury. The RTPV is mainly located behind the right main bronchus and right intermediate bronchus; however, reports of subcarinal dissection focusing on these sites are lacking. Herein, we present a case of esophageal cancer with an RTPV that was treated with thoracoscopic esophagectomy and propose a convenient classification for the anatomical findings and RTPV site.</p><p><strong>Case presentation: </strong>A 71-year-old man underwent a thoracoscopic esophagectomy for esophageal cancer (T1bN0M0) during a routine medical checkup. A preoperative computed tomography scan revealed an anomaly in which the RTPV drained into the left atrium behind the right main bronchus. Radical subcarinal lymphadenectomy was performed while preserving the RTPV, using 3 dimensions for preoperative simulation and intraoperative navigation. The operation lasted 6 h and 42 min, and the blood loss volume was 30 mL. The patient's postoperative course was uneventful, and he was discharged on postoperative day 21.</p><p><strong>Conclusions: </strong>In a retrospective review of esophageal cancer surgery cases at our hospital, RTPV was observed in 17/314 cases (5.4%). The most common inflow site was the inferior pulmonary vein (IPV) (9 cases), followed by the left atrium (5 cases), superior pulmonary vein (2 cases), and superior branch of the IPV (1 case). The inflow site was behind the right main bronchus and the right intermediate bronchus in 4 and 13 cases, respectively. Compared to past reviews, the inflow site varied somewhat; however, the vascular location remained the same. By classifying the areas behind the right main and right intermediate bronchi as Zones 1 and 2, respectively, cases in which the RTPV runs through Zone 1, as identified on preoperative computed tomography, should be manipulated with caution due to the risk of injury during lymph node dissection beneath the tracheal bifurcation.</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/PMC11873321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543579","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 Appendicitis Due to Burkitt Lymphoma Masking the Systemic Symptoms of Rapidly Progressing Burkitt Lymphoma.","authors":"Tomoya Masuda, Ryoma Sugimoto, Kenta Kobashi, Hiroshi Ishii, Kensuke Tsunemitsu","doi":"10.70352/scrj.cr.24-0178","DOIUrl":"10.70352/scrj.cr.24-0178","url":null,"abstract":"<p><strong>Introduction: </strong>Primary malignant lymphoma of the appendix is a rare disease, and primary Burkitt lymphoma of the appendix has been reported very rarely in Japan. Burkitt lymphoma is an aggressive lymphoma that progresses more rapidly than other malignant lymphomas, making it sometimes difficult to distinguish between systemic symptoms, such as fever associated with lymphoma progression and fever caused by appendicitis.</p><p><strong>Case presentation: </strong>A 21-year-old man underwent open appendectomy after antibiotic treatment for acute appendicitis proved ineffective. Postoperative pathological findings confirmed acute appendicitis. Antibiotics were continued after surgery, and the patient's fever and abdominal symptoms gradually improved. However, abdominal distension recurred on the 18th day of hospitalization. Blood tests showed a re-elevation of the white blood cell count, suggesting a postoperative intraperitoneal abscess. Despite further antibiotic treatment, fever and leukocytosis persisted. On the 28th day of hospitalization, abnormal lymphocytes were detected in the peripheral blood, and we realized that the persistent fever was due to systemic symptoms of malignant lymphoma rather than a complication of appendicitis. On the 30th day, the patient was referred to the hematology department and subsequently diagnosed with Burkitt lymphoma. Chemotherapy was initiated on the 40th day of hospitalization. At the time of this writing, the patient had remained alive without recurrence for 4 years 3 months postoperatively.</p><p><strong>Conclusion: </strong>In this case, symptoms of acute appendicitis and systemic symptoms of malignant lymphoma appeared simultaneously. As a result, the systemic symptoms of malignant lymphoma were misdiagnosed as postoperative complications, leading to a delay in diagnosis. Primary appendiceal Burkitt lymphoma is extremely rare, and its clinical features remain unknown. It is important to recognize that primary appendiceal Burkitt lymphoma can present with systemic symptoms concurrently with appendicitis. Surgeons should be aware of the clinical features of appendicitis caused by Burkitt lymphoma, which differ from those caused by other appendiceal tumors or malignant lymphoma.</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/PMC11879255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558035","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}