Surgical Case Reports最新文献

{"title":"Radiation-Associated Angiosarcoma of the Breast: A Case Report with Review of Reported Cases in Japan.","authors":"Eri Ida, Mahiro Ohashi, Fuminao Kanehisa, Momoko Komai, Naoko Itoi, Yoji Urata, Makoto Nagata, Tecchu Lee","doi":"10.70352/scrj.cr.25-0777","DOIUrl":"10.70352/scrj.cr.25-0777","url":null,"abstract":"<p><strong>Introduction: </strong>Radiation-associated angiosarcoma of the breast (RAASB) is an extremely rare but serious complication that can occur several years after breast-conserving surgery and adjuvant radiotherapy. Owing to its rarity and nonspecific cutaneous manifestations, the diagnosis of RAASB is often delayed. There is no established treatment for RAASB, and its prognosis remains poor.</p><p><strong>Case presentation: </strong>A 63-year-old woman developed progressive breast edema 14 years after breast-conserving surgery with axillary lymph node dissection and adjuvant radiotherapy for invasive ductal carcinoma. Two years later, she presented with breast masses with purpura and biopsy-confirmed angiosarcoma. Wide mastectomy with skin grafting was performed, followed by weekly administration of adjuvant paclitaxel. The patient remained recurrence-free for 12 months postoperatively.</p><p><strong>Conclusions: </strong>RAASB can develop long after breast-conserving therapy and may be preceded by subtle skin changes or persistent breast edema. Long-term follow-up and patient education are essential for patients who have undergone breast irradiation. Early imaging or biopsy should be considered when breast lymphedema is observed.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13070623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147676539","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":"Disseminated Carcinomatosis of the Bone Marrow in Colorectal Cancer: A Case Series of Two Patients with Rapidly Fatal Outcomes.","authors":"Yuki Fujii, Takuji Ota, Koki Ise, Masanori Sato","doi":"10.70352/scrj.cr.26-0348","DOIUrl":"10.70352/scrj.cr.26-0348","url":null,"abstract":"<p><strong>Introduction: </strong>Disseminated carcinomatosis of the bone marrow (DCBM) is a rare but highly fatal complication in colorectal cancer (CRC) patients. Although previous reports have described favorable responses to urgent chemotherapy, we encountered 2 cases of CRC-associated DCBM with a devastating clinical course. Here, we present these cases and discuss current optimal management in light of the literature.</p><p><strong>Case presentation: </strong>The first patient was a 69-year-old man with stage IIIC rectal cancer who underwent high anterior resection with lymph node dissection and partial ileal and bladder resection after chemoradiotherapy. Four months after the surgery, the patient was admitted with severe fatigue. The second patient was a 69-year-old man with sigmoid colon cancer who underwent laparoscopic sigmoid colectomy with regional lymph node dissection. Pathological examination revealed lymph node metastases and peritoneal dissemination, and the disease was classified as stage IVC. He received 20 cycles of mFOLFOX6 plus bevacizumab; however, the peritoneal dissemination gradually progressed. Two years after the initial diagnosis, he was hospitalized due to fever of unknown origin. Both patients presented with cytopenia and circulating immature hematopoietic cells on admission and were promptly diagnosed with DCBM through hematology consultation, whole-body imaging, and bone marrow biopsy. Despite urgent initiation of systemic chemotherapy combined with a molecular-targeted agent and therapy for disseminated intravascular coagulopathy (DIC), hematologic abnormalities remained refractory, and both patients died shortly after diagnosis. Of note, the first patient delayed hospitalization due to financial reasons, resulting in severe DIC, rapid disease progression, and death eight days after admission.</p><p><strong>Conclusions: </strong>This series emphasizes the extremely high mortality of CRC-associated DCBM and highlights the importance of earlier detection during routine follow-up and urgent intervention for oncological DIC, along with consideration of palliative care at the time of diagnosis. Further studies are needed to better understand its biology and optimal management.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689874","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 Intraductal Tubulopapillary Neoplasm of the Pancreas Requiring Superior Mesenteric Vein-Portal Vein Axis Resection after Systemic Chemotherapy.","authors":"Haruto Sone, Yasuhisa Ando, Jun Kozai, Dongping Feng, Hiroshi Taketani, Hiroyuki Matsukawa, Bunpei Nishiura, Akihiro Kondo, Kiyoyuki Kobayashi, Hironobu Suto, Takayoshi Kishino, Ryou Ishikawa, Yoichi Yamashita, Minoru Oshima, Hideki Kobara, Keiichi Okano","doi":"10.70352/scrj.cr.26-0181","DOIUrl":"10.70352/scrj.cr.26-0181","url":null,"abstract":"<p><strong>Introduction: </strong>Intraductal tubulopapillary neoplasm (ITPN) is a rare intraductal pancreatic tumor, accounting for approximately 3% of all intraductal neoplasms. ITPN is characteristically paucimucinous and lacks low-grade (adenomatous) components. Since reported cases of ITPN remain limited, its prognosis, prognostic factors, and role of perioperative chemotherapy are not well defined.</p><p><strong>Case presentation: </strong>A 64-year-old man presented with loss of appetite and abdominal pain in year X-1. Endoscopic US-guided fine-needle aspiration (EUS-FNA) was performed, and the findings showed atypical epithelial cells suspicious for adenocarcinoma. The lesion was radiologically assessed as borderline-resectable pancreatic head cancer with portal venous involvement. Curative-intent resection was attempted at the referring hospital; however, the tumor was judged intraoperatively to be locally unresectable because safe vascular dissection around the superior mesenteric vein (SMV) was difficult. Choledochojejunostomy, cholecystectomy, and gastrojejunostomy were performed for obstructive jaundice and duodenal stenosis. From October X-1, the patient received gemcitabine plus nab-paclitaxel, followed by tegafur/gimeracil/oteracil. The maximum tumor diameter decreased from 60 to 50 mm, and the imaging response to systemic chemotherapy was classified as stable disease according to the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, without distant progression. In May X, the patient was referred to our department for consideration of surgical treatment. Repeat EUS-FNA strongly suggested ITPN. Subtotal stomach-preserving pancreatoduodenectomy with SMV-portal vein (PV) axis resection and reconstruction was performed using a right common femoral vein graft. Postoperative right deep femoral vein thrombosis was managed with anticoagulation. The patient was discharged on POD 16, and follow-up CT 1 year after surgery confirmed thrombus resolution. Histopathological examination confirmed invasive ITPN without lymph node metastasis or vascular invasion. The histological treatment effect was classified as grade 1a according to the Japanese classification of pancreatic carcinoma by the Japan Pancreas Society, eighth edition, and as grade I according to the Evans classification. Adjuvant chemotherapy was not administered. The patient remained disease-free 29 months after surgery.</p><p><strong>Conclusions: </strong>This case highlights the importance of multidisciplinary re-evaluation in pancreatic tumors initially managed as pancreatic ductal adenocarcinoma, particularly when an unusual histology such as ITPN is suspected.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13572855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971457","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":"Dedifferentiated Gastric Gastrointestinal Stromal Tumor with Rapid Growth Mimicking Other Malignancies: A Case Report.","authors":"Ken Iijima, Tsuyoshi Takahashi, Yukinori Kurokawa, Takuro Saito, Takaomi Hagi, Shigeto Nakai, Kota Momose, Kotaro Yamashita, Koji Tanaka, Tomoki Makino, Kiyokazu Nakajima, Yoshiharu Genko, Masako Kurashige, Eiichi Morii, Hidetoshi Eguchi, Yuichiro Doki","doi":"10.70352/scrj.cr.26-0416","DOIUrl":"10.70352/scrj.cr.26-0416","url":null,"abstract":"<p><strong>Introduction: </strong>Gastrointestinal stromal tumors (GISTs) are diagnosed based on morphological and immunohistochemical findings. However, in rare instances, GISTs may undergo morphological and immunophenotypic dedifferentiation, making diagnosis challenging. Here, we report a rare case of a rapidly growing gastric GIST with a dedifferentiated component that posed a diagnostic challenge, together with a review of the literature.</p><p><strong>Case presentation: </strong>A woman in her 70s presented with abdominal distention and was found to have a rapidly enlarging 21 cm gastric tumor. Endoscopic US-guided biopsy showed Class V cytology; however, a definitive histologic diagnosis could not be established, and immunohistochemical staining was negative for all examined markers. Distal gastrectomy and partial resection of the transverse colon were performed. Histologically, the tumor consisted of a conventional GIST component with immunohistochemically positive atypical spindle cells and a dedifferentiated component with immunohistochemically negative pleomorphic atypical cells. The tumor was diagnosed as dedifferentiated GIST. Anastomotic recurrence and peritoneal dissemination developed 11 months postoperatively.</p><p><strong>Conclusions: </strong>Here, we report an extremely rare case with findings most compatible with dedifferentiated gastric GIST occurring without prior TKI therapy. GIST should not be excluded even when both KIT and DOG1 are negative; a careful integrated diagnosis based on histopathological findings, imaging findings, and the clinical course is essential.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931163","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":"Rectal Cancer Complicated by a Pelvic Arteriovenous Malformation Managed with Preoperative Embolization and Robotic Surgery: A Case Report.","authors":"Kazunosuke Yamada, Shinsuke Takeno, Yusuke Araki, Takuya Hara, Eiji Furukoji, Atsushi Nanashima","doi":"10.70352/scrj.cr.26-0030","DOIUrl":"10.70352/scrj.cr.26-0030","url":null,"abstract":"<p><strong>Introduction: </strong>Pelvic arteriovenous malformations (AVMs) are rare vascular anomalies that may cause marked venous engorgement and increase the risk of massive hemorrhage during pelvic surgery. When rectal cancer coexists with a pelvic AVM, achieving oncological radicality while maintaining surgical safety becomes particularly challenging.</p><p><strong>Case presentation: </strong>A patient with rectal cancer complicated by a pelvic AVM was referred for surgical treatment. Preoperative imaging demonstrated a pelvic AVM supplied by branches of the internal iliac artery with venous drainage into the rectal venous plexus. Selective preoperative coil embolization was performed to treat the AVM while rectal arterial perfusion was preserved. Robotic-assisted total mesorectal excision (TME) was subsequently undertaken. Despite residual presacral venous dilatation related to chronic hemodynamic changes, robotic-assisted TME was completed without hemorrhagic complications. Intraoperative indocyanine green fluorescence angiography confirmed adequate perfusion of both the proximal colon and the distal rectal stump, allowing safe primary anastomosis without a diverting stoma. The postoperative course was uneventful.</p><p><strong>Conclusions: </strong>Rectal cancer associated with a pelvic AVM presents unique surgical challenges due to altered pelvic vascular anatomy. This case suggests that careful preoperative planning, selective embolization, and appropriate integration of advanced surgical techniques may facilitate safe radical resection in similarly complex pelvic conditions.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13101083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781753","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":"Recurrence of Transverse Colon Cancer in Diverticulum 14 Years after Endoscopic Mucosal Resection: A Case Report.","authors":"Kazuki Shimomura, Hiromitsu Iwamoto, Kenji Matsuda, Yasuyuki Mitani, Yuki Nakamura, Norio Takemoto, Toshihiro Sakanaka, Masato Tamiya, Takahiko Hyo, Katsuya Ueda, Mizuki Nishikawa, Manabu Kawai","doi":"10.70352/scrj.cr.25-0700","DOIUrl":"10.70352/scrj.cr.25-0700","url":null,"abstract":"<p><strong>Introduction: </strong>Carcinoma arising from a colonic diverticulum is extremely rare, with only 21 cases being reported in the literature. Accurate pathological assessment of lesions within diverticula is often challenging due to distortion or discontinuity of the muscularis mucosae, which may lead to misjudgment of invasion depth and inappropriate therapeutic decisions.</p><p><strong>Case presentation: </strong>We report the case of a 74-year-old female with a history of left breast cancer and prior endoscopic mucosal resection (EMR) for a 7-mm transverse colon cancer 14 years earlier. Histopathology at that time revealed a moderately differentiated adenocarcinoma with submucosal invasion of 800 μm, negative vertical and horizontal margins, and no indication for additional surgery. Surveillance colonoscopy at 6 months showed only a scar, but then she was lost to follow-up. After detection of an elevated carcinoembryonic antigen level of 56.8 ng/mL, the patient was referred to us. A lesion adjacent to the transverse colon was seen on CT and PET, but no abnormalities were seen on colonoscopy. We performed laparoscopic transverse colectomy with D2 lymph node dissection. Histopathological examination revealed a tumor centered in the subserosal/pericolic tissue, histologically identical to the prior EMR specimen, staged as pT3, and consistent with local recurrence of the original lesion. Re-evaluation of the original EMR slides with desmin immunostaining confirmed that the tumor had arisen within a diverticulum, and the true invasion depth was 4000 μm rather than the initially reported 800 μm. The patient recovered uneventfully, underwent laparoscopic incisional hernia repair 1 year later, and remains recurrence-free 24 months after colectomy.</p><p><strong>Conclusions: </strong>This case highlights the diagnostic difficulty of accurately assessing invasion depth in tumors arising within diverticula. Misinterpretation may result in underestimation of metastatic risk and inadequate treatment. In this case, recurrence of colon cancer was detected 14 years after EMR. Diverticula should always be carefully documented during colonoscopy and should be considered in pathological interpretation. Recurrence may occur many years after endoscopic therapy, so close communication between endoscopists and pathologists is essential, and long-term surveillance is warranted.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729889","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":"Adenocarcinoma Developing Overlying a Colonic Lipoma: A Case Report.","authors":"Yasuma Nakata, Kazunosuke Yamada, Akiko Ichihara, Roko Hamada, Daisuke Hara, Takumi Kiwaki, Yoshiko Umekita, Yuichiro Sato, Shinsuke Takeno","doi":"10.70352/scrj.cr.26-0198","DOIUrl":"10.70352/scrj.cr.26-0198","url":null,"abstract":"<p><strong>Introduction: </strong>Colonic lipomas are benign mesenchymal tumors composed of mature adipocytes and are most commonly located in the submucosal layer. They are usually asymptomatic and are often managed conservatively. Although adenomas arising overlying colonic lipomas have been reported, the coexistence of adenocarcinoma directly overlying a lipoma is extremely rare. The pathogenic relationship between submucosal tumors and epithelial malignancies remains unclear.</p><p><strong>Case presentation: </strong>A 76-year-old man was diagnosed with a lipoma in the descending colon (diameter, approximately 30 mm) and was managed with surveillance. After 26 months of follow-up, colonoscopy revealed a newly developed small type 2 ulcerative lesion located directly over the lipoma. A biopsy confirmed adenocarcinoma. Endoscopic ultrasonography demonstrated a homogeneous hyperechoic lesion in the 3rd layer consistent with a lipoma, along with focal thickening of the 2nd layer, without evidence of deep invasion. CT and MRI showed imaging features characteristic of a lipoma, with a peripheral component suspicious for malignancy. The patient was diagnosed with descending colon cancer (cT2N0M0, Stage I) and underwent laparoscopic left hemicolectomy with lymph node dissection. A histopathological examination revealed a lipoma extending from the submucosa into the muscularis propria, while the carcinoma was confined to the mucosa and muscularis propria overlying the lipoma, without invasion into the lipomatous tissue. No histological findings indicative of chronic inflammation were observed.</p><p><strong>Conclusions: </strong>We report a rare case of adenocarcinoma developing directly over a colonic lipoma during surveillance. Although chronic inflammation has been proposed as a possible mechanism linking submucosal tumors to epithelial malignancies, no such features were identified in this case, and a causal relationship could not be established. While colonic lipomas are generally managed conservatively, careful endoscopic surveillance may be considered in selected patients with relatively large lipomas requiring long-term follow-up.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13533600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875882","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":"Pancreatic Cancer with Concomitant Median Arcuate Ligament Syndrome Requiring Arterial Reconstruction During Pancreaticoduodenectomy: A Case Report.","authors":"Wataru Miyoshino, Teijiro Hirashita, Shun Nakamura, Yuiko Nagasawa, Masahiro Kawamura, Hiroomi Takayama, Yoko Kawano, Takashi Masuda, Yuichi Endo, Masafumi Inomata","doi":"10.70352/scrj.cr.26-0185","DOIUrl":"10.70352/scrj.cr.26-0185","url":null,"abstract":"<p><strong>Introduction: </strong>Pancreatoduodenectomy (PD) for pancreatic head malignancies can be complicated by coexisting vascular anomalies. Median arcuate ligament syndrome (MALS), occurring in 2.1%-7.6% of PD cases, causes celiac artery (CA) stenosis and poses a significant risk of ischemic complications. While division of the median arcuate ligament (MAL) may restore blood flow in some cases, arterial reconstruction is occasionally necessary. We report a challenging case of pancreatic head adenocarcinoma with MALS requiring emergent intraoperative arterial reconstruction.</p><p><strong>Case presentation: </strong>A 69-year-old man presented with a 31-mm pancreatic head tumor in contact with the superior mesenteric artery (SMA) and complete CA occlusion due to MALS. Preoperative imaging revealed well-developed collateral circulation via the dorsal pancreatic artery (DPA). After 6 cycles of neoadjuvant chemotherapy with gemcitabine plus nab-paclitaxel, the tumor decreased to 18 mm. Anticipating the potential need for arterial reconstruction during PD, preoperative simulations were conducted with the vascular surgery team. Intraoperatively, MAL division was performed, and a gastroduodenal artery (GDA) clamp test confirmed adequate hepatic arterial flow via the DPA. However, hepatic arterial flow ceased during subsequent surgical manipulation, requiring emergent arterial reconstruction. Initial middle colic artery-GDA anastomosis was complicated by repeated thrombosis; definitive reconstruction using a lesser saphenous vein graft successfully restored hepatic arterial flow. Pathological examination revealed a complete pathological response. The patient was discharged on POD day 18 without major complications and remains recurrence-free at 22 months.</p><p><strong>Conclusions: </strong>This case demonstrates that in PD for patients with concomitant MALS, collateral circulation may be disrupted by intraoperative manipulation, potentially necessitating emergent arterial reconstruction. Therefore, meticulous preoperative imaging evaluation, vigilant intraoperative monitoring of hepatic arterial flow, and thorough preparation for vascular reconstruction are essential for the safe management of these complex cases.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875924","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":"Simultaneous Celiac and Pancreaticoduodenal Artery Aneurysms in Median Arcuate Ligament Syndrome: Successful Long-Term Management via Staged Hybrid Treatment.","authors":"Shoji Takagi, Yoshifumi Mitani, Masaaki Akai, Motohiko Yamada, Tomihiro Fukushima, Nobuhisa Tajiri, Koji Nakanishi","doi":"10.70352/scrj.cr.26-0021","DOIUrl":"10.70352/scrj.cr.26-0021","url":null,"abstract":"<p><strong>Introduction: </strong>Median arcuate ligament syndrome (MALS) is characterized by chronic mesenteric ischemia resulting from external compression of the celiac artery (CA). While rare, this compression can alter local hemodynamics, potentially leading to the formation of visceral artery aneurysms. Although pancreaticoduodenal artery (PDA) aneurysms are a known collateral complication, the concurrent presentation of a poststenotic CA aneurysm and a collateral PDA aneurysm is exceedingly rare. We report the long-term outcomes of a patient with MALS complicated by simultaneous aneurysms of both the CA and the PDA.</p><p><strong>Case presentation: </strong>A 59-year-old woman was admitted with sudden, severe abdominal and back pain. Imaging revealed severe hook-shaped stenosis of the CA, a 15-mm poststenotic CA aneurysm, and a 7-mm inferior PDA aneurysm. Given the high risk of rupture, urgent endovascular coil embolization of the CA aneurysm was performed first. Although the pain initially improved, severe symptoms recurred, suggesting a neurogenic etiology involving celiac plexus compression. Nine days after embolization, the patient underwent laparoscopic median arcuate ligament release with celiac neurolysis, which provided immediate relief. However, residual stenosis of the CA subsequently caused recurrent ischemic pain. Percutaneous transluminal angioplasty (PTA) was then performed, fully restoring antegrade flow and resolving all symptoms. At the 8-year follow-up, the patient remained asymptomatic with sustained patency of the CA. Notably, the untreated PDA aneurysm regressed spontaneously from 7 to 2 mm on follow-up CT 2 months after hemodynamic normalization and remained stable thereafter.</p><p><strong>Conclusions: </strong>This report illustrates the efficacy of a staged hybrid strategy-consisting of aneurysm embolization, surgical decompression with neurolysis, and PTA-for managing MALS complicated by multiple aneurysms. The restoration of antegrade celiac flow was associated with the normalization of collateral hemodynamics, subsequent resolution of ischemic symptoms, and the long-term spontaneous regression of the collateral PDA aneurysm.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781369","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 Distal Gastrectomy with Preservation of a Congenital Portosystemic Shunt for Gastric Neuroendocrine Tumor: A Case Report.","authors":"Tsuyoshi Saito, Koshiro Harata, Rena Kunimatsu, Kaita Suzuki, Nobuaki Kagohashi, Ryosuke Niwamoto, Motoki Futamata, Shuji Koide, Takeyasu Katada, Futoshi Teranishi, Shuji Takiguchi","doi":"10.70352/scrj.cr.26-0289","DOIUrl":"10.70352/scrj.cr.26-0289","url":null,"abstract":"<p><strong>Introduction: </strong>Gastric neuroendocrine tumors (gNETs) are rare neoplasms; their coexistence with a congenital portosystemic shunt (CPSS) presents unique surgical challenges caused by the risks of intraoperative hemorrhage and postoperative hepatic dysfunction secondary to altered portal hemodynamics. To the best of our knowledge, no reports have described robot-assisted gastrectomy preserving a CPSS during gNET resection.</p><p><strong>Case presentation: </strong>A 54-year-old man presented with gastrointestinal hemorrhage and was diagnosed with a gNET (G1). Contrast-enhanced CT revealed a CPSS connecting the left gastric vein (LGV) and left renal vein (LRV) adjacent to the stomach. Given the absence of hepatic dysfunction and the potential risk of portal hypertension after shunt interruption, preservation of the anomalous vessel was planned. Robot-assisted distal gastrectomy with D2 lymphadenectomy was performed. The robotic platform provided stable 3D visualization and facilitated precise dissection around the anomalous vessel, thereby enabling complete tumor resection with adequate margins while preserving the shunt. Histopathological examination confirmed a G1 neuroendocrine tumor, without lymph node metastasis. The postoperative course was uneventful, with no hepatic or oncological complications.</p><p><strong>Conclusions: </strong>Robot-assisted gastrectomy may facilitate safe and precise resection in selected patients with gNETs concurrent with CPSSs.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13370068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456661","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}