Surgical Case Reports最新文献

{"title":"Hybrid Extended Totally Extraperitoneal Transversus Abdominis Release for Ruptured Incisional Hernia Etiologically Very Similar to Flood Syndrome: A Case Report.","authors":"Mariko Sambommatsu, Taketo Matsubara, Gen Shimada, Toshimi Kaido","doi":"10.70352/scrj.cr.24-00447","DOIUrl":"10.70352/scrj.cr.24-00447","url":null,"abstract":"<p><strong>Introduction: </strong>The rupture of an umbilical hernia, which is known as Flood syndrome, is a rare and life-threatening complication of liver cirrhosis. Herein, we report the successful repair of a ruptured incisional hernia accompanied by liver cirrhosis.</p><p><strong>Case presentation: </strong>A female in her 40s with a history of alcoholic cirrhosis and ruptured acute umbilical hernia treated by primary closure 6 months earlier presented with ascites leakage from abdominal skin. She was diagnosed with a ruptured incisional hernia accompanied by massive ascites. We started preoperative management with topical corticosteroids and oral diuretics. Nine months after the first visit, hybrid herniorrhaphy, extended totally extraperitoneal transversus abdominis release (eTEP-TAR) was performed. The patient has since been well without any sign of recurrence for 2 years.</p><p><strong>Conclusions: </strong>We experienced a successful treatment of a ruptured incisional hernia accompanied by liver cirrhosis. Preoperative management and surgical strategies are important for the treatment of ruptured incisional hernia and Flood syndrome.</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/PMC11836010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459095","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 Pleomorphic Adenoma and Ductal Carcinoma In Situ in the Same Mammary Gland.","authors":"Shiho Nagasawa, Koshi Matsui, Misato Araki, Emi Kanaya, Kohji Takagi, Ryo Muranushi, Yoshihiro Shirai, Toru Watanabe, Takeshi Miwa, Katsuhisa Hirano, Shinichi Sekine, Kazuto Shibuya, Isaya Hashimoto, Isaku Yoshioka, Kenichi Hirabayashi, Tsutomu Fujii","doi":"10.70352/scrj.cr.24-0100","DOIUrl":"10.70352/scrj.cr.24-0100","url":null,"abstract":"<p><strong>Introduction: </strong>Pleomorphic adenoma is a benign tumor that frequently occurs in the salivary glands; however, it occurs in the breast rarely. There have been few reports of breast cancer complicated by pleomorphic adenoma of the mammary gland.</p><p><strong>Case presentation: </strong>A 70-year-old woman was found to have a mass lesion in her left breast during a medical examination. A needle biopsy was performed, and a diagnosis of pleomorphic adenoma was made. We performed a partial mastectomy with a margin of several millimeters from the tumor. Pathological examination revealed a diagnosis of pleomorphic adenoma with ductal carcinoma in situ. The resection margin was sufficient, and the patient was followed up.</p><p><strong>Conclusions: </strong>Pleomorphic adenoma arising in the mammary gland is difficult to differentiate from adenomyoepithelioma, mucocele-like tumor, and metaplastic carcinoma. Since the tumor can become malignant, resection with a narrow margin is recommended, along with special efforts not to damage the capsule at diagnosis.</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/PMC11851019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504256","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":"Multiple Desmoplastic Small Round Cell Tumor in the Intestine: A Case Report.","authors":"Naoto Tsujimura, Mitsuyoshi Tei, Daisuke Umeda, Koki Ishimaru, Shoko Minamiura, Takehiro Yamamoto, Soichiro Mori, Kentaro Nishida, Yukihiro Yoshikawa, Masatoshi Nomura, Koki Tamai, Takuya Hamakawa, Daisuke Takiuchi, Hironao Yasuoka, Masanori Tsujie, Yusuke Akamaru","doi":"10.70352/scrj.cr.24-0135","DOIUrl":"10.70352/scrj.cr.24-0135","url":null,"abstract":"<p><strong>Introduction: </strong>Desmoplastic small round cell tumor (DSRCT) is a highly malignant sarcoma and an extremely rare tumor, predominantly found in the abdominal and pelvic regions. Here, we report the case of a patient who underwent surgical treatment for multiple desmoplastic round cell tumor in the intestine.</p><p><strong>Case presentation: </strong>A 38-year-old male patient visited our hospital after a health check revealed positive occult blood in his stool and a colonoscopy revealed tumors in descending colon and sigmoid colon. Biopsy results revealed poorly differentiated adenocarcinoma. Chest and abdominal enhanced computed tomography revealed 3 tumors from descending colon to sigmoid colon and numerous peritoneal disseminations. Based on these findings, we diagnosed multiple colon cancers and performed a laparoscopic left hemicolectomy. Hematoxylin-Eosin (H&E) staining showed that in all tumors, atypical cells with large and small swollen nuclei formed irregular solid nests of various sizes against a background of extensive desmoplastic or myxomatous stroma. Immunohistochemistry showed that tumor cells were AE1/3 (+), S-100 (-), Desmin (-), WT1 (-). Genetic analysis detected the Ewing's sarcoma and Wilms tumor fusion gene at another inspection agency. Histopathological examination identified desmoplastic small round cell tumor. The patient was discharged on the 19th postoperative day without postoperative complications. He will undergo chemotherapy at another hospital.</p><p><strong>Conclusions: </strong>We experienced a very rare case of DSRCT. DSRCT is a fatal disease that primarily affects adolescent and young adult males. Currently, there is no proven treatment. More case reports are essential to improve management of this disease.</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/PMC11873736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543584","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":"Omental Torsion Diagnosed and Treated with Single-Incision Laparoscopic Surgery in 2 Pediatric Patients: A Case Report.","authors":"Shohei Maekawa, Masafumi Kamiyama, Chisato Fujita, Daishi Takao, Kiyoaki Sumi, Kimihiko Watanabe, Kazunori Masahata","doi":"10.70352/scrj.cr.24-0021","DOIUrl":"10.70352/scrj.cr.24-0021","url":null,"abstract":"<p><strong>Introduction: </strong>Omental torsion (OT), caused by twisting of the greater omentum around its axis, leading to reduced blood supply to the distal aspect of the omentum and tissue infarction, is a rare disease that manifests clinically as acute abdominal pain. Accurate preoperative diagnosis is difficult. Here, we present 2 pediatric patients diagnosed and treated using computed tomography (CT).</p><p><strong>Case presentation: </strong>Case 1, a 14-year-old boy, had abdominal pain for 3 days. Upon referral to our hospital due to worsening pain, CT revealed an intra-abdominal fatty mass extending into high-density lesions in the fat tissue. Due to severe peritoneal irritation, emergency single-incision laparoscopic surgery was performed. Secondary OT was diagnosed as the greater omentum was twisted by the cord-like tissue, continuing from the greater omental infarction to the lesser omentum. Partial omentectomy, including the ischemic portion, was performed. Case 2, an 11-year-old boy, was referred with suspected appendicitis due to right lower abdominal pain for 2 days. CT revealed a whirling sign in the greater omentum and high-density lesions in the fat tissue. The patient was in good condition, and the peritoneal irritation was unclear; therefore, conservative treatment was initiated. However, symptoms did not improve after 48 h and single-incision laparoscopic surgery was performed, revealing a twisted necrotic omental mass diagnosed as primary idiopathic greater OT. Partial omentectomy, including the ischemic portion, was performed.</p><p><strong>Conclusions: </strong>CT scan aids in preoperative diagnosis of OT, for which single-incision laparoscopic surgery is a less invasive and useful therapy. Early surgical intervention is warranted when conservative treatment fails.</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/PMC11832222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441970","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":"Mesenteric SMARCA2-Deficient Yet SMARCA4-Preserved Aggressive Undifferentiated Tumor: A Case Report.","authors":"Ichiro Tamaki, Koichi Kitagawa, Hidetaka Kozai, Yoshikuni Yonenaga, Takashi Nitta","doi":"10.70352/scrj.cr.24-0070","DOIUrl":"10.70352/scrj.cr.24-0070","url":null,"abstract":"<p><strong>Introduction: </strong>The SWItch Sucrose Non-Fermentable (SWI/SNF) chromatin remodeling complex, which includes components such as SMARCA4 and SMARCA2, regulates gene expression by controlling chromatin compaction and accessibility in an ATP-dependent manner. These components are also implicated in carcinogenesis. Thoracic SMARCA4-deficient undifferentiated tumor is a recently introduced category in the fifth edition of the WHO classification in 2021, typically exhibiting rhabdoid morphology in adults. In contrast, rhabdoid tumors occurring within the abdominal cavity in adults are rare and sporadic, with limited detailed documentation, making them relatively less understood compared to their thoracic counterparts.</p><p><strong>Case presentation: </strong>A man in his 70s was admitted to our hospital with a chief complaint of fever. He was diagnosed with a mesenteric solid tumor measuring 6 cm in maximum diameter. Shortly after the hospitalization, bowel obstruction became evident, accompanied by the rapid tumor progression, and then surgical treatment was attempted. A soft, bulky tumor situated in the mesentery accompanied by extensive tumor dissemination was found intraoperatively. The tumor was resected along with the obstructed terminal ileum, aiming to restore intestinal patency and obtain tissue samples. Histopathologically, the tumor represented morphological features resembling a rhabdoid tumor along with a high Ki67 labeling index (50%). Immunohistochemistry revealed SMARCA2 deficiency with preserved SMARCA4 expression. The absence of Claudin-4 expression further supported the diagnosis of a mesenteric SMARCA2-deficient yet SMARCA4-preserved undifferentiated tumor. The patient succumbed 20 days after surgery due to aggressive peritonitis carcinomatosis.</p><p><strong>Conclusions: </strong>To the best of our knowledge, this is the first case report of a mesenteric undifferentiated tumor with rhabdoid cytomorphology due to SWI/SNF chromatin remodeling complex deficiency caused by isolated SMARCA2 deficiency. The tumor, in our case, arose in the abdominal organs and appears to share a similar oncogenic process with the category of thoracic SMARCA4-deficient undifferentiated tumors in the WHO classification. Further research is required to improve our understanding of its clinical features, underlying mechanisms, and optimal management strategies.</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/PMC11863095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516783","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 Hypoglycemia Diagnosed by Neuropsychiatric Symptoms after Distal Gastrectomy and Total Colectomy.","authors":"Kota Okuno, Masahiro Niihara, Shohei Fujita, Tadashi Higuchi, Hiroki Harada, Marie Washio, Mikiko Sakuraya, Koshi Kumagai, Takeo Sato, Takafumi Sangai, Yusuke Kumamoto, Takeshi Naitoh, Keishi Yamashita, Naoki Hiki","doi":"10.70352/scrj.cr.24-0099","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0099","url":null,"abstract":"<p><strong>Introduction: </strong>Hypoglycemia can lead to significant adverse effects, including cognitive impairment, fatigue, convulsions, and even loss of consciousness in severe cases. Recent reviews also associate hypoglycemia with severe outcomes, such as mortality, dementia, and cardiovascular events. In gastrointestinal surgery, postoperative hypoglycemia related to dumping syndrome is well documented after gastric procedures. However, hypoglycemia in patients who have undergone both gastrectomy and total colectomy is rare, and the underlying mechanisms and effective management strategies remain unclear.</p><p><strong>Case presentation: </strong>The patient, a 46-year-old woman diagnosed with chronic intestinal pseudo-obstruction (CIPO), had a medical history of distal gastrectomy with Billroth-I reconstruction and colostomy. Recently, she underwent total colectomy, after which she began experiencing symptoms of unexplained malaise, depression, and cognitive decline. She received treatment with medication at a neuropsychiatric department to address these symptoms, but they persisted. Strong anxiety and fatigue led her to engage in frequent drug overdose. She then presented to our hospital. Given her history of gastrointestinal surgery, we considered the possibility of nocturnal hypoglycemia and performed continuous glucose monitoring (CGM), which showed marked hypoglycemia. Nutritional therapy to control hypoglycemia effectively improved her condition, resolving drug overdose behavior completely and reducing the dosage of her psychotropic medications by half.</p><p><strong>Conclusion: </strong>This case highlights the diagnostic utility of CGM and the effectiveness of nutritional management in treating hypoglycemia after total colectomy in addition to gastrectomy and provides new insights into the management of similar postoperative cases.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11906528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650769","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":"Salvage Lung Resection of Aspergilloma Mimicking Tumor Regrowth after Immune Checkpoint Inhibitor Therapy for Stage IV Squamous Cell Lung Cancer: A Case Report.","authors":"Takahiro Utsumi, Haruaki Hino, Yuki Takeyasu, Natsumi Maru, Hiroshi Matsui, Yohei Taniguchi, Tomohito Saito, Takayasu Kurata, Koji Tsuta, Tomohiro Murakawa","doi":"10.70352/scrj.cr.24-0096","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0096","url":null,"abstract":"<p><strong>Introduction: </strong>Recent advancements in chemotherapy, including immune checkpoint inhibitors, sometimes achieve complete remission in cases of stage IV lung cancer. On the other hand, immune-related adverse events may occur despite showing successful oncological effects. Herein, we report a rare case of a patient who underwent salvage lung resection after immune checkpoint inhibitor therapy for stage IVB lung cancer, which led to confirmed not only complete pathological remission but also complications with aspergilloma as a result of powerful effect for chemotherapy with immune checkpoint inhibitors.</p><p><strong>Case presentation: </strong>A 71-year-old woman was diagnosed with stage IVB squamous cell carcinoma of the lung located in the right upper lobe, accompanied by distant organ metastases in the thoracic vertebrae and right adrenal gland. Because the tumor shrank after systemic cytotoxic chemotherapy plus immune checkpoint inhibitor therapy, a partial response was considered to have been achieved clinically, and chemotherapy was discontinued afterward. After 5 months, however, the primary lesion gradually regrew, and tumor regrowth was highly suspected. A bronchoscopic biopsy revealed <i>Aspergillus</i> organism infection other than lung cancer. As local recurrence could not be completely ruled out, salvage thoracoscopic right upper lobectomy with hilar lymph node dissection was performed uneventfully. The pathological diagnosis was pulmonary aspergilloma without residual cancer (pathological complete remission). After the surgery, an antifungal agent was administered for half a year and no obvious cancer recurrence or fungal relapse was detected over 1.5 years.</p><p><strong>Conclusion: </strong>A salvage lung resection via thoracoscopic surgery was considered a feasible procedure. However, preoperative imaging does not always provide clear evidence of residual cancer, especially after chemotherapy with immune checkpoint inhibitors, as seen in the current patient. Therefore, salvage surgery should be considered comprehensively for selected patients with downstaged or relapsed lung cancer based on close image findings.</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/PMC11907164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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

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

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