Surgical Case Reports最新文献

{"title":"Longitudinal Pancreatojejunostomy for Pancreaticodigestive Reconstruction in the Resection of Pancreatic Head Malignancy with Chronic Pancreatitis: A Case Report.","authors":"Hironori Hayashi, Yuichiro Furutani, Hiroaki Sugita, Kei Sugano, Takahiro Yoshimura, Tetsuro Oda, Daisuke Fujimori, Koichiro Sawada, Masanori Kotake, Kaeko Oyama, Shintaro Yagi, Takuo Hara","doi":"10.70352/scrj.cr.24-0015","DOIUrl":"10.70352/scrj.cr.24-0015","url":null,"abstract":"<p><strong>Introduction: </strong>With progress in pancreatic surgery, a preservation of residual organ function has become more important. Pancreatic malignancies are occasionally accompanied by chronic pancreatitis (CP) and pancreatolithiasis (PL). Longitudinal pancreatojejunostomy (LPJ) is reportedly a useful method of surgical management in cases of CP with PL. We describe a patient with pancreatic head intraductal papillary mucinous carcinoma (IPMC) concomitant with PL, who underwent subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) and LPJ for reconstruction.</p><p><strong>Case presentation: </strong>A man in his 70s was referred to our hospital with a pancreatic head tumor. He had been treated for CP, diabetes mellitus, and chronic kidney disease. Imaging revealed a cystic pancreatic head tumor with a solid component that was histologically confirmed as IPMC. In addition, multiple calcifications suggestive of PL were observed in the pancreatic body and tail. SSPPD and LPJ were performed to excise the PL as much as possible and preserve the residual pancreatic function. The postoperative course was uneventful, and no abdominal symptoms or tumor recurrences were observed for approximately 8 months after surgery.</p><p><strong>Conclusion: </strong>This patient with IPMC with residual pancreatic PL was treated with SSPPD and LPJ to maximize the residual pancreatic function and reduce the occurrence of postoperative pancreatitis.</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/PMC11905986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625968","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":"Pneumatocele Development after Deceased-Donor Liver Transplantation for Multiple Hepatic Cysts due to Autosomal Dominant Polycystic Kidney Disease: A Case Report.","authors":"Atsushi Yoshiyama, Mitsuaki Kawashima, Sodai Nagata, Takahito Fukushima, Koji Aze, Yue Cong, Keita Nakao, Masayuki Nakao, Gouji Toyokawa, Chihiro Konoeda, Kiyoshi Hasegawa, Masaaki Sato","doi":"10.70352/scrj.cr.24-0005","DOIUrl":"10.70352/scrj.cr.24-0005","url":null,"abstract":"<p><strong>Introduction: </strong>A pneumatocele is a cystic change in the lung that can develop as a sequelae of infection, inflammation, positive-pressure ventilation, thoracic trauma, and rarely after lung resection. Pneumatocele development triggered by an extrathoracic etiology is rare. Herein, we report a case of a pneumatocele that developed after a deceased-donor liver transplantation.</p><p><strong>Case presentation: </strong>A 57-year-old woman with a diagnosis of autosomal dominant polycystic kidney disease underwent deceased-donor liver transplantation for polycystic liver disease. She did not have any background lung disease, although her right lower lobe was mostly atelectatic due to a remarkably elevated diaphragm. The liver transplant itself was uneventful. A small hole was made in the right diaphragm during the dissection of the liver, but it was successfully repaired without any injury to the lung. On postoperative day 1, the chest radiograph revealed a round hypertranslucency on the right side, which was initially considered subphrenic air retention, and no further evaluation was made at that time. Given that the hypertranslucency persisted, follow-up computed tomography was performed on postoperative day 18, and revealed an air-fluid level above the diaphragm in the right thoracic cavity. Thoracoscopic investigation revealed an intrathoracic hematoma within a pneumatocele in the right lower lobe, which was not detected in the pretransplant computed tomography. The hematoma was removed, and the pneumatocele was resected.</p><p><strong>Conclusions: </strong>We experienced a case of a pneumatocele that developed after deceased-donor liver transplantation for multiple hepatic cysts due to autosomal dominant polycystic kidney disease. Although the mechanisms are speculative, the pneumatocele might have been triggered by the sudden alleviation of the elevated diaphragm and reinflation of the atelectatic lung.</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/PMC11937134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721311","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":"Delayed Onset Immune-Related Pituitary Adrenal Insufficiency Induced by Neoadjuvant Nivolumab Therapy for Locally Advanced Lung Cancer in the Postoperative Period: A Case Report.","authors":"Takafumi Kabuto, Shizuka Kaneko, Shinnosuke Nomura, Satoshi Terashita, Kaito Kitahori, Masaki Ikeda, Naohisa Chiba, Masashi Ishikawa","doi":"10.70352/scrj.cr.24-0044","DOIUrl":"10.70352/scrj.cr.24-0044","url":null,"abstract":"<p><strong>Introduction: </strong>Neoadjuvant, adjuvant, and perioperative immune checkpoint inhibitor (ICI) regimens for treating locally advanced lung cancer have dramatically evolved in recent years. Despite these immunotherapies being very promising, they can be associated with potential life-threatening immune-related adverse events (irAEs), and there is not much awareness regarding irAEs in surgical regimens.</p><p><strong>Case presentation: </strong>A Japanese man in his 70s was diagnosed with right upper lobe lung adenocarcinoma (cT3N1[#12u]M0, parietal pleural invasion, cStage IIIA), with the programmed death-ligand 1 expression level of <1%. He underwent right upper lobectomy via open thoracotomy followed by 3 cycles of neoadjuvant cisplatin, pemetrexed, and nivolumab. The pathological response rate was 50% and the pathological stage was ypT2bN0M0, ypStage IIA. Seven months after the surgery, he experienced gradually worsening anorexia, fatigue, and hyponatremia. He was diagnosed with pituitary adrenal insufficiency induced by neoadjuvant immunotherapy by the 100 μg corticotropin-releasing hormone stress test. Cardiogenic shock caused by takotsubo cardiomyopathy occurred, and intensive treatment was performed. Steroid therapy was effective, but the physical dysfunction persisted, although no recurrence of lung cancer was observed.</p><p><strong>Conclusions: </strong>Patients receiving neoadjuvant immunotherapies can develop life-threatening irAEs late in the postoperative period. Surgeons who follow up patients after neoadjuvant immunotherapies must be as vigilant regarding the development of irAEs in the postoperative phase as clinical oncologists.</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/PMC11842875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484032","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 Laparoscopic Resection of Gastric Cancer Using Novel Laparoscopic Fluorescence Spectrum System and Near-Infrared Fluorescent Clips.","authors":"Shion Uemura, Yuma Ebihara, Kazuya Konishi, Satoshi Hirano","doi":"10.70352/scrj.cr.24-0028","DOIUrl":"10.70352/scrj.cr.24-0028","url":null,"abstract":"<p><strong>Introduction: </strong>In laparoscopic gastrectomy, accurate marking of the lesion site is essential in determining the resection line of the stomach, owing to the lack of haptics and the direct link between negative pathological margins and prognosis. Intraoperative endoscopy may require personnel and prolong the operation time, whereas preoperative endoscopic tattooing using India ink faces problems related to the spread of ink and visibility. ZEOCLIP FS (Zeon Medical, Tokyo, Japan) is a clip made of fluorescent resin, covered by insurance since March 2019. It can be visualized from the serosal side using a near-infrared scope; however, its weak fluorescence intensity often poses viewing difficulties. Lumifinder (ADVANTEST, Tokyo, Japan) is a laparoscopic fluorescence spectrum system available for clinical use since February 2023. It can measure fluorescence intensity using a near-infrared laser and detect weak fluorescent signals. We report a case of gastric cancer in which the location of the lesion was confirmed intraoperatively using ZEOCLIP FS and Lumifinder.</p><p><strong>Case presentation: </strong>A man in his 80s was diagnosed with gastric cancer following an examination for anemia. Two lesions were found: a 0-IIc type (cT1) at the lesser curvature of the gastric angle and a type 1 tumor (cT2) at the anterior wall of the upper gastric body. The preoperative assessment indicated no lymph node or distant metastasis. The tumor was diagnosed as cStage I and laparoscopic distal gastrectomy was planned. Two ZEOCLIP FS clips were placed on the oral side of the tumor on the anterior wall of the upper gastric body on the day before surgery. During surgery, fluorescent signals from the clips were detected using Lumifinder, enabling easy confirmation of the lesion location and determination of the gastric resection line.</p><p><strong>Conclusions: </strong>The combined use of ZEOCLIP FS and Lumifinder was a useful new method for identifying the appropriate resection line of the stomach. We plan to evaluate this method further in additional cases to enhance the detection efficacy.</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/PMC11842931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484028","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":"Reconstruction of a Complex Posterior Tracheal Wall Defect via Transtracheal Running Suture and Pedicled Pectoralis Major Muscle Flap.","authors":"Tomoyuki Nakagiri, Alaa Selman, Tobias Goecke, Hayan Merhej, Akylbek Saipbaev, Arjang Ruhparwar, Patrick Zardo","doi":"10.70352/scrj.cr.24-0009","DOIUrl":"10.70352/scrj.cr.24-0009","url":null,"abstract":"<p><strong>Introduction: </strong>A tracheal membranous injury is a known complication of tracheostomy. After esophageal resection, such injury may prove fatal. No natural buttressing of the lesion occurs, and severe sepsis and mediastinitis may occur. In these situations, a circumferential tracheal resection is the treatment of choice, sometimes on cardiopulmonary bypass. However, the outcome is not always favorable.</p><p><strong>Case presentation: </strong>We report a case of a long tracheal membranous wall defect (> 7cm) after esophageal resection. We successfully performed a transtracheal direct repair of the defect through a partial sternotomy, and reconstructed the ventrolateral wall with a muscle flap using the right pectoralis major muscle.</p><p><strong>Conclusion: </strong>Tracheal reconstruction through a T-shaped incision and anastomotic buttressing using a pectoralis major muscle flap could prove to be useful when reconstructing a posterior tracheal wall injury, especially after esophageal resection.</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/PMC11850052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493532","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":"Breast Cancer with a Newly Diagnosed Variant in the <i>PTEN</i> Gene: A Case Report.","authors":"Yuka Maeda, Tatsuhiko Ikeda, Ayana Sato, Akiko Matsumoto, Hiromitsu Jinno","doi":"10.70352/scrj.cr.24-0082","DOIUrl":"10.70352/scrj.cr.24-0082","url":null,"abstract":"<p><strong>Introduction: </strong>The phosphatase and tensin homolog hamartoma tumor syndrome (PHTS) refers to a spectrum of disorders caused by variants of the phosphatase and tensin homolog (<i>PTEN</i>) gene, including Cowden syndrome (CS), Bannayan-Riley-Ruvalcaba syndrome, adult Lhermitte-Duclos disease, and autism spectrum disorders associated with macrocephaly. PHTS is characterized by hamartomas in multiple organs and is associated with an increased risk of developing malignant tumors including, breast, thyroid, endometrial, colorectal, and kidney tumors. Breast cancer is the most common malignancy associated with PHTS.</p><p><strong>Case presentation: </strong>We describe the case of a 44-year-old female patient with invasive ductal carcinoma of the right breast. Cobblestone papillomatosis was present in the gingiva. She had a medical history of bilateral adenomatous goiters for 10 years. Her mother had been diagnosed with breast cancer, thyroid and tongue tumors, gastric polyps, hepatic hemangioma, and collagen disease. Additionally, the patient's maternal grandmother had a history of colon cancer. Based on the patient's family history and physical findings, CS was suspected, and direct DNA sequencing analysis revealed a haplotype c.634del mutation in exon 7 of the <i>PTEN</i> gene. Although there is no clear evidence supporting risk-reducing surgery for PHTS, a right nipple-sparing mastectomy, sentinel lymph node biopsy, and tissue expander reconstruction were performed.</p><p><strong>Conclusions: </strong>We report a case of breast cancer with a newly diagnosed c.634del mutation in the <i>PTEN</i> gene. We also reviewed the current literature on <i>PTEN</i> genetic variants and breast cancer subtypes.</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/PMC11835985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458724","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":"Outcome of Surgical Intervention for Intrathoracic Lymph Node Metastasis in Uterine and Ovarian Cancer without Lung Metastasis: A Report of Three Cases.","authors":"Ryohei Miyazaki, Masaya Tamura, Marino Yamamoto, Hironobu Okada, Yusuke Ujihara, Takashi Ushiwaka, Nagamasa Maeda","doi":"10.70352/scrj.cr.24-0080","DOIUrl":"10.70352/scrj.cr.24-0080","url":null,"abstract":"<p><strong>Introduction: </strong>Metastasis to the hilar and mediastinal lymph nodes in gynecological cancer is rare, and isolated hilar or mediastinal lymph node metastases are even rarer. In this report, we describe the results of lymph node dissection performed on 3 patients with hilar mediastinal lymph node metastasis but no lung metastasis from uterine or ovarian cancer.</p><p><strong>Case presentation: </strong>Case 1 was a 50-year-old woman diagnosed with ovarian cancer with mediastinal lymph node metastasis. After 4 courses of chemotherapy, a total hysterectomy, omentectomy, and mediastinal lymph node dissection were performed simultaneously. The patient is still alive 58 months after surgery. Case 2 was a 68-year-old woman who underwent a total hysterectomy after chemotherapy for endometrial cancer with multiple lymph node metastases. Forty-two months after surgery, mediastinal lymph node dissection was performed for metastasis of uterine cancer. She is still alive 75 months after surgery. Case 3 was a 69-year-old woman who underwent a hysterectomy for endometrial cancer. One year after surgery, she underwent thoracoscopic hilar and mediastinal lymph node dissection due to metastasis. Thirty-nine months have passed with no recurrence. Aggressive local control, particularly surgical resection of isolated hilar mediastinal lymph nodes in gynecological cancer, may contribute to prolonging patient survival.</p><p><strong>Conclusions: </strong>Aggressive local control, especially surgical resection, for isolated hilar mediastinal lymph nodes due to gynecological cancer is safe and may contribute to prolonging survival.</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/PMC11835979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459372","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 Cystic Neutrophilic Granulomatous Mastitis in Which <i>Mycobacteroides abscessus</i> Was Detected.","authors":"Hirokazu Yamazaki, Yasushi Ito, Keigo Goto, Masako Kasami","doi":"10.70352/scrj.cr.24-0115","DOIUrl":"10.70352/scrj.cr.24-0115","url":null,"abstract":"<p><strong>Introduction: </strong>Cystic neutrophilic granulomatous mastitis (CNGM) is characterized by granulomas with cysts that sometimes contain bacteria in the lumen, a surrounding neutrophilic infiltrate, and Langhans giant cells. There are no universally accepted diagnostic criteria for CNGM. <i>Corynebacterium kroppenstedtii</i>, a Gram-positive bacillus, has been reported to cause several infections, but the exact cause remains unclear. We report our experience with a case of CNGM, thought to be due to a rare <i>Mycobacteroides abscessus</i> infection.</p><p><strong>Case presentation: </strong>We report the case of a 36-year-old Japanese woman with granulomatous mastitis due to <i>Mycobacteroides abscessus</i> who had not undergone surgery and was not immunosuppressed. She presented with a chief complaint of pain and swelling in her left breast for 1 month. Mammography showed asymmetrical focal increased density, and ultrasonography showed an irregular hypoechoic area in the left 3 o'clock position. Contrast-enhanced magnetic resonance imaging showed segmental non-mass-enhancement. Ultrasound-guided vacuum-assisted biopsy with pathology revealed granulomatous mastitis. Ziehl-Neelsen staining revealed red-staining bacilli. The patient was followed up for observation because her breast pain had decreased after the examination, and there was no redness or fever. However, the breast pain has not completely disappeared, and intermittent purulent discharge from the biopsy site persisted for 5 months. Hence, two 12-Fr drains were inserted along the ductal dilatation-like hypoechoic area. Imipenem, amikacin, and clarithromycin were administered for 8 days. After 8 days of this therapy, the patient developed a drug-associated rash; therefore, antimicrobial therapy was discontinued, and the drains were removed. Her symptoms improved, and magnetic resonance imaging after 1 month showed that the previous imaging findings in her left breast had disappeared. At the time of writing, 18 months have passed since treatment, and no recurrence has been observed.</p><p><strong>Conclusions: </strong>We experienced a rare case of CNGM associated with <i>Mycobacteroides abscessus</i>. This case suggests that a combination of drainage and antimicrobial therapy may shorten the duration of antimicrobial therapy in CNGM.</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/PMC11850989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504318","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":"Confronting Upside-Down Video-Assisted Thoracic Surgery Approach for Hemorrhagic Bronchogenic Cyst Manifested by Sudden Back Pain.","authors":"Masato Kambe, Tomonari Oki, Shuhei Iizuka, Yoshiro Otsuki, Toru Nakamura","doi":"10.70352/scrj.cr.24-0126","DOIUrl":"10.70352/scrj.cr.24-0126","url":null,"abstract":"<p><strong>Introduction: </strong>Bronchogenic cysts, arising from an aberrant bronchial primordium inclusion during the fetal period, are typically located in the mediastinum but can develop in ectopic regions. While generally asymptomatic, these cysts may become symptomatic due to infection or, rarely, hemorrhage. This report details a case of a hemorrhagic bronchogenic cyst in the supradiaphragmatic region, successfully resected using video-assisted thoracic surgery (VATS) with a confronting upside-down monitor setting.</p><p><strong>Case presentation: </strong>An 18-year-old female presented with a fever and sudden left-sided back pain. Blood tests revealed leukocytosis and an elevated C-reactive protein. Imaging studies identified a well-circumscribed cyst along the left diaphragm, suspected to be an infected bronchogenic cyst. Magnetic resonance imaging 2 days later indicated disease progression with concomitant empyema, prompting emergency surgery. Using the confronting upside-down monitor setting, the cyst was resected. Thoracoscopic findings revealed a dark red cyst and bloody pleural effusion. The surgery was uneventful, and the patient was discharged on postoperative day 2. Bacterial cultures of the pleural effusion and cystic content were negative, and histopathological analysis confirmed the diagnosis of a hemorrhagic bronchogenic cyst.</p><p><strong>Conclusions: </strong>Hemorrhagic bronchogenic cysts should be considered in the differential diagnosis of intrathoracic cysts presenting with sudden pain. Upfront surgery is recommended for symptomatic bronchogenic cysts, irrespective of the location or etiology. VATS via the confronting upside-down monitor setting is the feasible option alongside the conventional approach.</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/PMC11861584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516781","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 Acute Pancreatitis after Pancreatectomy in Grade C Leading to Walled-Off Necrosis Successfully Treated with Necrosectomy by Retroperitoneal Approach.","authors":"Makoto Shinohara, Masakazu Hashimoto, Ryo Nagao, Michinori Hamaoka, Masashi Miguchi, Nobuaki Fujikuni, Satoshi Ikeda, Yasuhiro Matsugu, Hideki Nakahara","doi":"10.70352/scrj.cr.24-0002","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0002","url":null,"abstract":"<p><strong>Introduction: </strong>Grade B or C post-pancreatectomy acute pancreatitis (PPAP) is associated with a higher incidence of postoperative complications and mortality. The reason for this is the activation of proteolytic processes that can lead to pancreatic destruction and the activation of systemic reactions that can have adverse consequences such as systemic inflammatory response syndrome, sepsis, and death. We report a case of a patient with Grade C PPAP with walled-off necrosis (WON) who was successfully treated with necrosectomy using a step-up approach.</p><p><strong>Case presentation: </strong>A 73-year-old man was referred to our hospital with elevated biliary enzymes. Results of blood tests, computed tomography (CT), and magnetic resonance imaging led to the diagnosis of distal bile duct cancer. He underwent a pyloric ring-sparing pancreaticoduodenectomy with lymph node dissection. Postoperative P-AMY (pancreatic amylase) was high at 1766 U/L, and contrast-enhanced CT showed increased density of peripancreatic fatty tissue and fluid accumulation on the pancreatic resection surface, leading to the diagnosis of postoperative pancreatitis and pancreatic fistula. On postoperative day (POD) 9, continuous washing with saline solution was started through the drain at the pancreatic anastomosis. Contrast-enhanced CT showed increased fluid retention in the pancreatic body tail. On POD 43, endoscopic ultrasonography drainage was performed for pancreatic necrosis encapsulated in the retroperitoneum; however, the patient self-extracted the drainage tube. On POD 50, CT-guided drainage was performed for a retroperitoneal subcapsular abscess. On POD 69, the patient underwent necrotomy with guided retroperitoneal drainage, a drain was inserted, and continuous flushing was performed. On POD 76, fecal discharge was observed from the drain, and drainage and enterography were performed; a fistula with the colon was confirmed, and an ileal bifurcation colostomy was performed on the same day. On PODs 83, 85, and 100, endoscopic necrotomy was performed through a retroperitoneal incision wound because a contrast-enhanced CT showed a residual abscess on the gastric dorsum. The patient's general condition improved, and his inflammatory response also improved. On POD 139, the patient was transferred for rehabilitation.</p><p><strong>Conclusion: </strong>We describe a case of successful postoperative nutritional management and necrosectomy for Grade C PPAP leading to WON.</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/PMC11868872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543577","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}