Surgical Case Reports最新文献

{"title":"Repair of Main Pancreatic Duct Injury during Surgery for Congenital Biliary Dilatation in a Child: A Case Report.","authors":"Hiroshi Nouso, Takuo Noda, Hiroshi Okano, Terutaka Tanimoto","doi":"10.70352/scrj.cr.26-0244","DOIUrl":"https://doi.org/10.70352/scrj.cr.26-0244","url":null,"abstract":"<p><strong>Introduction: </strong>In surgery for congenital biliary dilatation, it is essential to minimize residual intrapancreatic bile duct tissue to prevent future complications, such as intrapancreatic stones and carcinogenesis. However, dissection of the intrapancreatic bile duct is technically demanding and may result in injury to the main pancreatic duct. As a result, very few cases have been reported regarding the management of this complication in pediatric patients. We present a pediatric case of intraoperative main pancreatic duct injury and describe its surgical management.</p><p><strong>Case presentation: </strong>A 3-year-old girl was diagnosed with congenital biliary dilatation. During excision of the intrapancreatic bile duct, a small ductal lumen with clear fluid leakage was identified. Contrast imaging through the ductal lumen revealed the entire main pancreatic duct, confirming the diagnosis of intraoperative pancreatic duct injury. Because the anatomical relationship between the injured site and the distal main pancreatic duct toward the papilla was obscured, repair was undertaken with concern for an accidental division of the pancreaticobiliary junction. A 3-Fr short catheter was inserted into the pancreatic duct as an internal stent to secure pancreatic juice drainage. The injured duct was anastomosed to the remnant intrapancreatic bile duct using 7-0 absorbable sutures, and the repair site was covered with surrounding connective tissue. External drainage was placed adjacent to the repair site. She developed a transient postoperative pancreatic fistula, which resolved with conservative management. No episodes of pancreatitis or pancreatic stone formation were observed during 6 years of follow-up.</p><p><strong>Conclusions: </strong>Intraoperative recognition of main pancreatic duct injury and establishment of a secure pancreatic drainage route using an internal stent can lead to favorable outcomes. This case provides practical insight into the management of a rare but serious complication during pediatric surgery for congenital biliary dilatation.</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/PMC13634930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115155","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":"Planned Distal Pancreatectomy and Splenectomy for Pancreatic Tail Necrosis and Splenic Infarction after Embolization for Gastric Ulcer-Induced Splenic Artery Perforation: A Case Report.","authors":"Yasutaka Saito, Kazuki Masiko, Taichiro Ueda, Yoshiaki Hara","doi":"10.70352/scrj.cr.26-0385","DOIUrl":"https://doi.org/10.70352/scrj.cr.26-0385","url":null,"abstract":"<p><strong>Introduction: </strong>Splenic artery perforation secondary to gastric ulcer is a rare but life-threatening cause of upper gastrointestinal bleeding. Splenic artery embolization (SAE) can provide rapid hemorrhage control, but delayed ischemic complications involving the pancreatic tail and spleen are uncommon.</p><p><strong>Case presentation: </strong>A woman in her 70s presented with hematemesis and profound hemorrhagic shock. Contrast-enhanced CT showed active extravasation from the splenic artery adjacent to the posterior gastric wall. During emergency SAE, coils were deployed across the bleeding point, but persistent extravasation required additional embolization with a 1:2 mixture of N-butyl-2-cyanoacrylate (NBCA) and lipiodol. Final angiography confirmed hemostasis with preservation of the dorsal and great pancreatic arteries. CT on hospital day 2 showed no apparent pancreatic ischemic change. On day 11, newly developed hypoattenuating areas involving the pancreatic tail and part of the spleen were detected, suggestive of ischemic changes. The patient had no abdominal pain or overt clinical deterioration. Laboratory abnormalities that had improved by day 8 showed a secondary increase on day 11, with a white blood cell count of 12200/μL, C-reactive protein level of 3.90 mg/dL, and serum amylase level of 456 U/L. Planned distal pancreatectomy and splenectomy were selected after individualized assessment of the pancreatic and splenic ischemic changes, together with a residual splenic hilar aneurysmal lesion and suspected posterior gastric wall penetration. Pathological examination confirmed pancreatic necrosis and splenic infarction. No postoperative pancreatic fistula or other major postoperative complication occurred, and the patient was discharged on hospital day 38 after rehabilitation.</p><p><strong>Conclusions: </strong>NBCA-assisted SAE can achieve rapid hemostasis in life-threatening splenic arterial bleeding, but post-embolization surveillance remains important. This case illustrates that management of post-SAE ischemic changes should be individualized and that planned surgery in a clinically stable patient should be based on the overall clinical and anatomical context.</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/PMC13682857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149239449","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":"Minimally Invasive Cardiac Surgery for Spontaneous Coronary Artery Dissection.","authors":"Rena Usui, Wataru Uchida, Tsubasa Yazawa, Akihiko Usui, Masato Mutuga","doi":"10.70352/scrj.cr.26-0063","DOIUrl":"10.70352/scrj.cr.26-0063","url":null,"abstract":"<p><strong>Introduction: </strong>Published evidence on coronary artery bypass grafting for spontaneous coronary artery dissection (SCAD) is limited, and the optimal surgical strategy for SCAD has not yet been established. We herein report a case of SCAD treated with minimally invasive cardiac surgery coronary artery bypass grafting (MICS-CABG). This is the first case of SCAD treated with MICS-CABG in the literature.</p><p><strong>Case presentation: </strong>The patient was a 50-year-old man who was admitted to the emergency room with sudden chest pain. Emergent coronary angiography revealed double-lumen findings in the left main trunk (LMT). We diagnosed him with SCAD and decided to treat him conservatively. However, his troponin I (5549 pg/mL) and creatine kinase (533 U/L) levels increased, and coronary CTA (CCTA) revealed that the true lumen of the LMT was compressed to 75% stenosis on the next day. We performed MICS-CABG with the left internal thoracic artery (LITA) anastomosed to the left anterior descending branch via a small left thoracotomy, because the myocardial infarction was impending. The operation time was 182 min, and intraoperative blood loss was 368 mL. The postoperative course was uneventful. The SCAD lesion improved completely, and the LITA was patent on re-evaluation 3 months after surgery.</p><p><strong>Conclusions: </strong>In patients with a relatively stable hemodynamic status, MICS-CABG is a feasible and effective therapeutic approach for SCAD.</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/PMC13128497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821185","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":"Pathological Complete Response Achieved with Colorectal Cancer-Based Chemotherapy for Locally Recurrent Cecal Neuroendocrine Carcinoma after Surgery: A Case Report.","authors":"Kana Kajisako, Taro Tanabe, Naho Nishibayashi, Sachiko Ishida, Suguru Ogihara, Takahiro Hobo, Koji Kobayashi, Hirokazu Toshima, Ken Shimada, Noboru Yokoyama, Haruhiro Inoue","doi":"10.70352/scrj.cr.25-0633","DOIUrl":"10.70352/scrj.cr.25-0633","url":null,"abstract":"<p><strong>Introduction: </strong>Primary neuroendocrine carcinoma (NEC) of the colon is extremely rare, accounting for only 0.2% of all colorectal malignancies, and is associated with a poor prognosis. Early diagnosis is often challenging, as endoscopic biopsies are frequently misinterpreted as adenocarcinoma. Although platinum-based regimens such as etoposide plus cisplatin or irinotecan are commonly used, no standard chemotherapy protocol has been established. We report a case of locally recurrent cecal NEC that responded remarkably to a colorectal cancer-based chemotherapy regimen, achieving a pathological complete response.</p><p><strong>Case presentation: </strong>A 52-year-old man presented with severe anemia. Imaging and colonoscopy revealed a cecal tumor initially diagnosed as adenocarcinoma. He underwent laparoscopic right hemicolectomy with lymph node dissection. Final pathology revealed NEC, staged as pT3N2aM0, Stage IIIB. Adjuvant etoposide-cisplatin chemotherapy was initiated. Three months postoperatively, carcinoembryonic antigen (CEA) rose to 44.4 ng/mL, and CT demonstrated a perianastomotic peritoneal nodule and lymphadenopathy, consistent with recurrence. Considering the adenocarcinoma component in the primary tumor and elevated CEA, chemotherapy was switched to a colorectal cancer-based regimen: FOLFOXIRI plus bevacizumab. After 7 cycles, both radiologic regression and normalization of CEA levels were achieved. Resection of the recurrent lesions confirmed a pathological complete response with no residual tumor cells.</p><p><strong>Conclusions: </strong>To the best of our knowledge, this is the first reported case of cecal NEC achieving pathological complete regression with a colorectal cancer-based chemotherapy regimen. Our findings indicate that colorectal NEC may respond not only to platinum-based regimens but also to colorectal cancer-based regimens. Furthermore, CEA levels may serve as a clinically relevant biomarker to guide chemotherapy selection in this setting.</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/PMC12872675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146143628","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":"Spontaneous Regression of Intrahepatic Adenocarcinoma after Needle Biopsy: A Case Report and Literature Review.","authors":"Koetsu Inoue, Tatsunori Bandai, Naota Okabe, Masahiro Hiruta, Hisashi Oshiro, Yuki Mizusawa, Hidetoshi Aizawa, Yuhei Endo, Fumiaki Watanabe, Hiroshi Noda, Toshiki Rikiyama","doi":"10.70352/scrj.cr.25-0613","DOIUrl":"10.70352/scrj.cr.25-0613","url":null,"abstract":"<p><strong>Introduction: </strong>Spontaneous tumor regression (STR) is a rare phenomenon in which cancer cells partially or completely disappear without treatment. We report a case of intrahepatic cholangiocarcinoma demonstrating STR following endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA).</p><p><strong>Case presentation: </strong>A 77-year-old male presented with acute cholecystitis 1 day after percutaneous coronary intervention for acute myocardial infarction. Conservative treatment and endoscopic retrograde gallbladder drainage were performed due to antiplatelet therapy. Cytology of bile juice unexpectedly revealed adenocarcinoma. Further imaging, including CT and mapping biopsy, failed to detect a tumor. Laparoscopic cholecystectomy with gallbladder bed resection showed no histological evidence of malignancy. Four months later, surveillance CT revealed a 15 × 15 mm lesion in segment 3 of the liver. EUS-FNA confirmed adenocarcinoma. Laparoscopic left lateral resection was performed; however, no viable cancer cells were identified, and the lesion was replaced by epithelioid granulomas. Immunohistochemistry demonstrated dense infiltration of CD8-positive cytotoxic T cells, suggesting an immune-mediated regression of the tumor.</p><p><strong>Conclusions: </strong>This case highlights the possibility of tumor regression in intrahepatic adenocarcinoma following EUS-FNA, potentially triggered by an immune response.</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/PMC12862458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146114261","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":"Evaluation of Remnant Esophageal Perfusion Using Indocyanine Green Fluorescence Imaging during Ivor Lewis Esophagectomy after Total Pharyngolaryngectomy: A Case Report.","authors":"Shirou Kuwabara, Kazuaki Kobayashi, Natsuru Sudo, Masanori Nobuhiro, Gen Tomizawa, Yoh Kajiyama, Kohei Sato, Jun Yamamoto","doi":"10.70352/scrj.cr.25-0737","DOIUrl":"10.70352/scrj.cr.25-0737","url":null,"abstract":"<p><strong>Introduction: </strong>Head and neck cancer frequently coexists with synchronous or metachronous esophageal cancer, owing to shared carcinogenic exposures such as alcohol and tobacco use. In patients undergoing esophagectomy after total pharyngolaryngectomy (TPL), surgical reconstruction poses significant challenges due to dense adhesions and altered cervical anatomy. The McKeown procedure requires cervical manipulation, demanding careful preservation of the tracheal stoma and free jejunal graft blood supply. In contrast, the Ivor Lewis procedure eliminates the need for cervical maneuver but necessitates an intrathoracic anastomosis between the gastric conduit and the remnant esophagus. This raises concerns regarding potential ischemia of the remnant esophagus, particularly after prior TPL, in which proximal blood supply may be compromised. We report a case of successful robot-assisted Ivor Lewis esophagectomy after TPL, in which intraoperative indocyanine green (ICG) fluorescence imaging was used to confirm sufficient blood supply in the remnant esophagus and to ensure a safe anastomosis.</p><p><strong>Case presentation: </strong>A 73-year-old man with a history of TPL for hypopharyngeal cancer, endoscopic submucosal dissection for gastric and esophageal cancer, and colon resection for descending colon cancer was diagnosed with a new esophageal squamous cell carcinoma during routine surveillance endoscopy. Contrast-enhanced CT revealed no lymph node or distant metastasis (cT1bN0M0, Stage I). Considering his prior TPL and the absence of cervical lymph node involvement, a robot-assisted Ivor Lewis esophagectomy with intrathoracic gastric conduit reconstruction was planned without cervical manipulation. Intraoperative ICG fluorescence imaging demonstrated adequate perfusion of the remnant esophagus (about 45 mm), confirming its viability and allowing safe esophagogastric anastomosis. The postoperative course was uneventful, and the patient was discharged on POD 12. Histopathological examination revealed moderately differentiated squamous cell carcinoma invading the lamina propria mucosa (pT1aN0M0, Stage IA). The patient remains disease-free 2 years postoperatively.</p><p><strong>Conclusions: </strong>Ivor Lewis esophagectomy can be safely performed after TPL when careful intraoperative evaluation of remnant esophageal perfusion is undertaken. ICG fluorescence imaging provides a simple and reliable method for assessing blood supply, helping to prevent ischemic complications. This technique may expand the surgical options for patients requiring esophagectomy following TPL.</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/PMC12929068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147310495","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":"Solitary Fibrous Tumor of the Greater Omentum with Intratumoral Infarction: A Case Report.","authors":"Takumi Funo, Hidetaka Kawamura, Yukitoshi Todate, Noriyuki Uesugi, Toshiyuki Saginoya, Nobuyasu Suzuki, Tamotsu Sugai, Michitaka Honda","doi":"10.70352/scrj.cr.26-0098","DOIUrl":"10.70352/scrj.cr.26-0098","url":null,"abstract":"<p><strong>Introduction: </strong>Solitary fibrous tumors (SFTs) are rare mesenchymal tumors with rich vascularity that rarely arise from the greater omentum. Many cases of SFT are asymptomatic and discovered incidentally; however, symptomatic cases may occur when complications such as intratumoral infarction develop. We report a case of an SFT originating from the greater omentum, complicated by intratumoral infarction.</p><p><strong>Case presentation: </strong>A 71-year-old woman presented to the emergency department with a 2-day history of worsening abdominal pain. Laboratory testing revealed elevated inflammatory markers, with a white blood cell count of 17.0 × 10³/μL and C-reactive protein level of 11.34 mg/dL. Contrast-enhanced CT demonstrated an approximately 80-mm, relatively homogeneous abdominal mass with poor internal enhancement. MRI showed uniformly low signal intensity on T1-weighted images and a heterogeneous mixture of intermediate and low signal intensity on T2-weighted images. Diffusion-weighted imaging revealed hyperintensity corresponding to the intermediate T2-signal area, whereas the T2-low-signal regions remained hypointense. Conservative management was initiated, resulting in a gradual improvement of abdominal pain and inflammatory markers. On hospital day 8, laparotomy was performed, and the tumor, arising from and continuous with the greater omentum, was completely resected. Pathology demonstrated intratumoral infarction, and immunohistochemical findings confirmed the diagnosis of an SFT. The postoperative course was uneventful, and no recurrence was observed.</p><p><strong>Conclusions: </strong>SFTs arising from the greater omentum may develop intratumoral infarction, presenting with acute abdominal pain and inflammatory responses. Cross-sectional imaging modalities, such as CT and MRI, can assist in identifying this uncommon pathological condition.</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/PMC13222725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144769","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":"Stomal Outlet Obstruction Caused by Torsion of the Stomal Limb Associated with Fecal Loading after End Colostomy: A Case Report.","authors":"Sho Nambara, Koji Ando, Tetsuro Kawazoe, Shotaro Korehisa, Yasuo Tsuda, Tomonori Nakanoko, Eiji Oki, Tomoharu Yoshizumi","doi":"10.70352/scrj.cr.26-0337","DOIUrl":"https://doi.org/10.70352/scrj.cr.26-0337","url":null,"abstract":"<p><strong>Introduction: </strong>Stoma-related complications after colostomy include obstruction, prolapse, and parastomal hernia. However, torsion of the stomal limb associated with fecal loading in the proximal colon has rarely been reported.</p><p><strong>Case presentation: </strong>A 55-year-old woman with a history of rectal cancer underwent multiple surgeries, including pelvic exenteration with a permanent end colostomy via an intraperitoneal route. Nine days after discharge following hepatectomy and inguinal lymph node dissection, she presented with abdominal pain and cessation of stool output. CT revealed obstruction at the stomal outlet. Decompression through the stoma using a drainage tube was attempted but failed. Emergency surgery was performed. Intraoperatively, no significant adhesions were observed. The proximal colon was markedly dilated and filled with feces. An elongated transverse colon and a mobilized splenic flexure had descended into the pelvis, and the fecal loading may have contributed to torsion of the stomal limb at the outlet. Reduction of the colon from the pelvis resolved the torsion. Fecal contents were evacuated via the stoma, and no bowel resection was required. The postoperative course was uneventful, and the patient was discharged on the 5th day after surgery. No recurrence was observed during the short-term follow-up.</p><p><strong>Conclusions: </strong>Torsion of a mobile stomal limb associated with fecal loading should be considered as a rare cause of stomal outlet obstruction, particularly when conservative decompression is ineffective. In patients with an elongated and mobile colon, appropriate bowel management may be important to prevent fecal retention and recurrence.</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/PMC13485458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798072","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":"Fiber-Guided Red Light-Emitting Diode Localization of an Esophageal Blind End in Long-Gap Esophageal Atresia Surgery: A Case Report.","authors":"Hiroki Kanamori, Tomonori Tsuchiya, Yasuhiro Kondo, Atsuki Naoe, Shunsuke Watanabe, Toshihiro Yasui, Eri Ogawa, Mikihiro Inoue","doi":"10.70352/scrj.cr.25-0543","DOIUrl":"10.70352/scrj.cr.25-0543","url":null,"abstract":"<p><strong>Introduction: </strong>Esophageal atresia (EA) Gross type A is a congenital malformation in which both the upper and lower esophagus have blind ends without a tracheoesophageal fistula. The gap between the segments is often long (long-gap EA), making intraoperative localization challenging. We report a case in which the lower esophageal blind end was readily localized using Tumguide (Otsuka Pharmaceutical Factory, Tokushima, Japan), a device that transmits biologically transparent red light from a light-emitting diode (LED) through an optical fiber.</p><p><strong>Case presentation: </strong>The patient was a 2-month-old girl diagnosed at birth with EA Gross type A. A gastrostomy was performed shortly after birth, and esophageal lengthening with the Howard procedure was carried out over the following month. At 2 months of age, she underwent delayed primary esophageal anastomosis. At the start of surgery, the Tumguide was inserted through the gastrostomy site into a Salem Sump gastric drainage tube. The device provided clear localization of the lower esophageal blind end, minimizing the need for dissection of surrounding tissues.</p><p><strong>Conclusions: </strong>Fiber-guided red LED illumination, using Tumguide, enabled safe and straightforward intraoperative localization of the esophageal blind end in long-gap EA Gross type A. This approach minimized the need for dissection, thereby reducing the risks of injury to surrounding tissues and postoperative complications such as anastomotic stricture and leakage.</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/PMC12928987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147285157","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":"<i>BRCA2</i> Reversion Mutation after Neoadjuvant Dose-Dense EC and Dose-Dense Paclitaxel in Triple-Negative Breast Cancer: A Case Report and Literature Review.","authors":"Hajime Hikino, Asa Otani, Yoshinari Makino","doi":"10.70352/scrj.cr.25-0632","DOIUrl":"10.70352/scrj.cr.25-0632","url":null,"abstract":"<p><strong>Introduction: </strong><i>BRCA</i> reversion mutations are known mechanisms of acquired resistance to poly (ADP-ribose) polymerase inhibitors (PARPis) and platinum agents. However, their clinical emergence without such therapies is rarely reported.</p><p><strong>Case presentation: </strong>We describe a 44-year-old woman with early-stage triple-negative breast cancer carrying a germline <i>BRCA2</i> mutation who developed a <i>BRCA2</i> reversion mutation after neoadjuvant dose-dense epirubicin and cyclophosphamide (EC) followed by dose-dense paclitaxel, without prior PARPi or platinum exposure. She underwent modified radical mastectomy and achieved a good pathological response; however, she developed early systemic recurrence, including leptomeningeal metastasis, 7 months postoperatively. Comprehensive genomic profiling of the residual breast tumor revealed a <i>BRCA2</i> reversion mutation (allele frequency: 6.7%) that restored the open reading frame. We speculate that the genomic instability in the tumor may have induced a spontaneous reversion mutation early in the disease course.</p><p><strong>Conclusions: </strong>This case suggests that a <i>BRCA2</i> reversion mutation can arise early, even before PARPi or platinum exposure. Serial monitoring of <i>BRCA</i> status may help predict therapeutic resistance in patients with germline <i>BRCA</i>-mutated breast cancer.</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/PMC13000465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499982","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}