Surgical Case Reports最新文献

{"title":"A Resected Case of Metachronous Gallbladder Metastasis of Gastric Cancer Mimicking Gallbladder Cancer.","authors":"Ryohei Matsumoto, Koichiro Haruki, Masami Yuda, Yoshihiro Shirai, Masashi Tsunematsu, Shinji Onda, Michinori Matsumoto, Kenei Furukawa, Fumiaki Yano, Toru Ikegami","doi":"10.70352/scrj.cr.25-0093","DOIUrl":"10.70352/scrj.cr.25-0093","url":null,"abstract":"<p><strong>Introduction: </strong>Gallbladder metastases from malignancies, including gastric cancer, are extremely rare. Diagnosis is challenging due to the lack of specific symptoms and the absence of distinctive radiological features that can differentiate metastatic lesions from primary gallbladder tumors.</p><p><strong>Case presentation: </strong>An 81-year-old male was diagnosed as early gastric cancer and underwent endoscopic submucosal dissection and additional laparoscopic proximal gastrectomy for residual tumor and lymph node metastasis 5 years prior. Following adjuvant chemotherapy, the patient underwent multiple interventions for metastatic disease, including liver resection for liver metastasis of segment 2/3, radiofrequency ablation for liver metastasis of segment 5/6, and lobectomy of the right middle lobe for lung metastasis. During follow-up, a nodular lesion was newly detected at the gallbladder fundus through computed tomography. Diagnostic imaging, including endoscopic ultrasonography and Gd-EOB-DTPA, suggested a potential gallbladder cancer with sub-serosal lesion. We performed an extended cholecystectomy lymph node dissection, and pathological examination revealed the tumor to be a gallbladder metastasis from the original gastric cancer, confirmed through immunohistochemical staining.</p><p><strong>Conclusions: </strong>We herein report a rare case of metachronous gallbladder metastasis from gastric cancer. Preoperative diagnosis of gallbladder metastasis is challenging due to its radiological similarity to primary gallbladder cancer.</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/PMC12207098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529584","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":"Surgical Case of Metachronous Occurrence of Intracholecystic Papillary Neoplasm in the Remnant Cystic Duct 19 Years after Cholecystectomy.","authors":"Hiroki Kanno, Kenjiro Date, Yoshinao Kinjyo, Takeshi Aoyagi, Shota Yamashiro, Eishi Iwaoka, Ko Shigemura, Koichiro Shimonaga, Takao Tsukahara, Ryo Ichikawa, Hiroyuki Nakane, Kanako Kurata, Gentaro Hirokata, Yoshihiko Sadakari, Masahiko Taniguchi","doi":"10.70352/scrj.cr.24-0175","DOIUrl":"10.70352/scrj.cr.24-0175","url":null,"abstract":"<p><strong>Introduction: </strong>Intracholecystic papillary neoplasm (ICPN) is a recently identified disease characterized by papillary pre-invasive neoplasm of the gallbladder. Despite its characterization, the natural history of ICPN remains elusive. Furthermore, a few cases of metachronous ICPN in the remnant biliary system have been documented. Here, we report a surgical case involving metachronous ICPN in the remnant cystic duct 19 years post-cholecystectomy for primary ICPN.</p><p><strong>Case presentation: </strong>A 77-year-old man presented to our hospital with general fatigue and jaundice. He had previously undergone an open cholecystectomy and lithotomy for gallbladder cancer and common bile duct stones 19 years earlier. Blood tests revealed elevated levels of hepatobiliary enzymes and tumor markers. Both computed tomography and magnetic resonance imaging indicated dilatation of the intrahepatic and common bile ducts, and an enhanced nodule was observed in the common hepatic duct. Intraductal ultrasonography identified a papillary tumor infiltrating the distal bile duct from the common hepatic duct. Brush cytology subsequently helped confirm adenocarcinoma. Consequently, the patient was diagnosed with Bismuth type 1 perihilar cholangiocarcinoma and underwent subtotal stomach-preserving pancreaticoduodenectomy. Histological examination revealed the tumor as pancreatobiliary-type ICPN associated with invasive carcinoma, which had originated in the remnant cystic duct and invaded the common hepatic duct. A retrospective review of the resected gallbladder specimens from 19 years earlier confirmed ICPN according to the current classification, establishing this as a metachronous occurrence of ICPN.</p><p><strong>Conclusions: </strong>These findings suggest that ICPN can recur as metachronous lesions in the remnant biliary system after resection of primary lesion, highlighting the necessity of sustained, long-term biliary surveillance following primary lesion 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/PMC12207100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529602","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":"Asymptomatic Splenic Infarction Following Total Gastrectomy: A Case Report.","authors":"Atsuhito Takagi, Takashi Maeda, Satoshi Kobayashi, Atsushi Sekimura, Takehiro Takagi, Takuya Mishina, Yuya Hibino","doi":"10.70352/scrj.cr.25-0148","DOIUrl":"10.70352/scrj.cr.25-0148","url":null,"abstract":"<p><strong>Introduction: </strong>Splenic infarction is a disease that develops as a result of a thrombotic predisposition. Most areas of malperfusion are usually small and unnoticeable. However, when massive infarction occurs, it is often diagnosed after the onset of clinical symptoms, such as abdominal pain or fever. In contrast, asymptomatic postoperative extensive splenic infarction is occasionally observed. Although conservative management is generally the first-line treatment for splenic infarction, surgical intervention is indicated in cases complicated by splenic abscess or rupture. Some reports suggest that extensive splenic infarction may result in atrophy or complete loss of the spleen over time.</p><p><strong>Case presentation: </strong>A 65-year-old woman presented with chronic epigastric pain and was diagnosed with gastric cancer through upper gastrointestinal endoscopy. The endoscopy revealed an ulcerated mass at the lesser curvature of the middle gastric body, and a biopsy confirmed a moderately differentiated adenocarcinoma. A laparoscopic distal gastrectomy was initially planned. However, the surgical approach was converted to an open total gastrectomy because of the spread of the tumor to the greater curvature of the gastric body and enlargement of the distal lymph nodes of the splenic artery, which were not included in the planned lymphadenectomy. Postoperatively, the patient experienced no abdominal pain or fever. However, on POD 7, blood tests revealed elevated hepatobiliary enzymes, and a contrast-enhanced CT (CECT) scan showed a loss of flow in the splenic artery and vein, leading to a diagnosis of extensive splenic infarction. A follow-up CECT scan 3 months later revealed a notable reduction of the splenic parenchyma over time.</p><p><strong>Conclusions: </strong>This is a rare case of asymptomatic, extensive splenic infarction incidentally diagnosed following total gastrectomy and successfully treated with conservative 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/PMC12352957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875347","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":"Nipple-Sparing Mastectomy and Immediate Breast Reconstruction with da Vinci SP Surgical System: The First Case in Japan.","authors":"Yuko Kijima, Munetsugu Hirata, Yumika Nakazawa, Kazuya Shimmura, Naoki Hayashi, Ryunosuke Kijima, Yoshikazu Inoue, Hiroshi Nishioka, Ichiro Uyama","doi":"10.70352/scrj.cr.24-0187","DOIUrl":"10.70352/scrj.cr.24-0187","url":null,"abstract":"<p><strong>Introduction: </strong>Nipple-sparing mastectomy (NSM) has been increasingly used therapeutically for breast cancer patients in whom the nipple-areolar complex is not involved, being associated with better esthetic results and QOL than skin-sparing mastectomy. Robotic nipple-sparing mastectomies (R-NSM) using da Vinci SP surgical system (Intuitive Surgical, Sunnyvale, CA, USA) with immediate breast reconstruction (IBR) has been reported as a suitable surgical treatment for early breast cancers. We present a patient who underwent R-NSM and IBR, with excellent results. To our knowledge, this is the 1st reported case of R-NSM and IBR using the da Vinci SP surgical system in Japan.</p><p><strong>Case presentation: </strong>We performed R-NSM for a 41-year-old Japanese woman with cTisN0M0 breast cancer. NSM and IBR to place a tissue expander (TE) into the post-pectoral pocket were performed using the da Vinci SP surgical system with the double bipolar method.</p><p><strong>Conclusions: </strong>This is the 1st reported case of R-NSM using da Vinci SP surgical system in Japan.</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/PMC12370413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969808","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":"Surgical Management of a Giant Mediastinal Schwannoma Associated with Neurofibromatosis Type 1: A Case Report.","authors":"Shin-Nosuke Watanabe, Daisuke Kimura, Kengo Tani, Takahiro Sasaki, Shuta Kimura, Chisaki Muto, Tsubasa Kato, Masahito Minakawa","doi":"10.70352/scrj.cr.25-0150","DOIUrl":"10.70352/scrj.cr.25-0150","url":null,"abstract":"<p><strong>Introduction: </strong>Neurogenic tumors commonly develop in the posterior mediastinum in both pediatric and adult patients. In patients with neurofibromatosis type 1, distinguishing benign schwannomas from malignant peripheral nerve sheath tumors is challenging. In this study, we aimed to present the surgical management of a giant schwannoma that required differentiation from a malignant peripheral nerve sheath tumor.</p><p><strong>Case presentation: </strong>A 15-year-old boy presented with a large right mediastinal mass discovered on chest radiography at high school admission. Subsequent contrast-enhanced CT of the chest showed the development of a large tumor (16.0 × 12.5 × 11.8 cm) occupying approximately two-thirds of the right thoracic cavity, with atelectasis of the lower lobe of the right lung. The patient was histopathologically diagnosed with a benign schwannoma associated with neurofibromatosis type 1 through a thoracoscopic biopsy of the tumor and had received oral selumetinib at 50-70 mg/day for 11 months. Surgical excision was performed because of tumor progression and suspected malignant transformation. Right posterolateral thoracotomy with the opening of the 6th intercostal space was performed by extending the anterior skin incision along the abdominal rectus muscle and separating the 6th costal cartilage and diaphragmatic margin along the chest wall. The tumor was completely removed by resecting numerous adhesions between the tumor and the surrounding tissues and coagulating several nutrient vessels that flowed into the tumor, while resecting the lower lobe of the lung. The postoperative course was uneventful. The pathological examination revealed no malignancy. Subsequent contrast-enhanced CT of the chest revealed no residual tumors.</p><p><strong>Conclusions: </strong>Posterolateral thoracotomy with the separation of the costal cartilage and diaphragmatic margin along the chest wall could achieve safe surgery for a giant mediastinal schwannoma.</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/PMC12377975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969813","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}

{"title":"Meckel's Diverticulum Mimicking a Postoperative Flange with Acute Intestinal Obstruction and Midgut Volvulus: A Case Report.","authors":"Stéphane Kohpe Kapseu, Venant Tchokonte-Nana","doi":"10.70352/scrj.cr.24-0079","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0079","url":null,"abstract":"<p><strong>Introduction: </strong>The interest of this case lies in the exceptional and rare character of the observed association.: Meckel's diverticulum (MD) mimicking a postoperative flange complicated by acute intestinal obstruction and malrotation by midgut volvulus.</p><p><strong>Case presentation: </strong>A 17-year-old black male student, with a body mass index of 28 kg/m² was admitted to the emergency department of a 4th category rural hospital, with paroxystic abdominal pain and vomiting. Medical history revealed an abdominal surgery for an umbilical hernia 3 years earlier. There was no malformation such as imperforate anus, Hirschsprung's disease, esophageal tracheal fistula, or cardiac anomaly in the medical history. An abdominal X-ray confirmed an acute intestinal obstruction showing hydroaeric levels. The diagnosis of acute intestinal obstruction on a flange was retained. A median laparotomy was performed; a solid mass-like lengthy structure mimicking postoperative flange was seen associated with midgut volvulus, while a malposition of the intestine was observed with a mesenteric band, as well as a hyperemic appendix. A 90° rotation stop of the midgut also called a complete common mesentery was in place; we then carried out a Ladd procedure. Morpho-pathological examination of the surgical specimens revealed the following: richly vascularized fibro-adipose tissues with no evidence of malignancy in the diverticular specimen, and acute pan-appendicitis with no evidence of malignancy in the appendicular specimen. The patient started to ingest food orally on the third postoperative day, and he was discharged uneventfully on the fifth day.</p><p><strong>Conclusion: </strong>MD, although generally a tubular structure, may sometimes appear as a non-tubular mass during clinical examination. Intestinal obstruction due to MD associated with midgut volvulus is exceptional. Management of this association should be based on accurate knowledge of the morpho-embryological specificities during gut development.</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/PMC11868803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543581","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 Total Proctocolectomy for Familial Adenomatous Polyposis with Multiple Colorectal Cancers Using the Hugo RAS System.","authors":"Yu Yoshida, Yuki Aisu, Yoshiro Itatani, Koya Hida, Ryosuke Okamura, Masahiro Maeda, Nobuaki Hoshino, Hisatsugu Maekawa, Atsushi Ikeda, Keiko Kasahara, Hiromitsu Kinoshita, Shigeo Hisamori, Shigeru Tsunoda, Kazutaka Obama","doi":"10.70352/scrj.cr.25-0035","DOIUrl":"10.70352/scrj.cr.25-0035","url":null,"abstract":"<p><strong>Introduction: </strong>Experience with the Hugo RAS system in robot-assisted colorectal surgery is limited. This is particularly noticeable when focusing on complex procedures, such as total proctocolectomy (TPC). This study aimed to demonstrate the feasibility and safety of using the Hugo RAS system for TPC.</p><p><strong>Case presentation: </strong>A 27-year-old woman with multiple colorectal cancers with a background of familial adenomatous polyposis underwent robot-assisted TPC, including lymph node dissection of the entire colorectal region using the Hugo RAS system. The robotic procedure was divided into 3 steps: 1) Trendelenburg position to perform ascending colon complete mesocolic excision (CME) to the hepatic flexure, 2) descending colon CME and total mesorectal excision with D3 lymph node dissection, and 3) flat position to perform central vessel ligation along the superior mesenteric artery. After undocking, the specimen was extracted transanally, and an ileal pouch was constructed from a small laparotomy at the umbilical incision, followed by ileal pouch-anal anastomosis. The operative time was 632 min, and the estimated blood loss was minimal. The postoperative period was uneventful.</p><p><strong>Conclusions: </strong>Robot-assisted TPC using the Hugo RAS system is safe and feasible. The flexibility of Hugo, which is carried by a modular-type surgical robot with multiple independent arms, enables safe and effective advanced procedures.</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/PMC11946455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731639","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}