Surgical Case Reports最新文献

{"title":"Robotic Segmentectomy in a Patient with a Displaced Left Upper Division Bronchus and Fused Fissure.","authors":"Hironobu Wada, Ryo Karita, Yuki Hirai, Yuki Onozato, Toshiko Kamata, Hajime Tamura, Takashi Anayama, Ichiro Yoshino, Shigetoshi Yoshida","doi":"10.70352/scrj.cr.25-0039","DOIUrl":"10.70352/scrj.cr.25-0039","url":null,"abstract":"<p><strong>Introduction: </strong>In thoracic surgery, anatomical anomalies and a fused fissure can cause inaccurate intraoperative recognition of anatomy and lead to accidental injury of pulmonary vessels and bronchi that should be preserved. A displaced left upper division bronchus (B¹⁺²⁺³), also known as a left eparterial bronchus, is a rare anomaly that can present in combination with abnormal pulmonary arteries positioning and lobulation. Herein, we report a case of lung cancer in S¹⁺² of the left fused lung that was successfully resected by robotic left upper division segmentectomy following a detailed preoperative simulation using 3-dimensional computed tomography.</p><p><strong>Case presentation: </strong>A female octogenarian presented for the treatment of simultaneous bilateral lung cancer. Three months after surgery for right lung cancer, a surgery for left lung cancer was performed. Preoperative computed tomography identified several broncho-arterial anomalies and a completely fused fissure, including a displaced left upper division bronchus and a pulmonary artery running anteriorly to the left main bronchus, similar to those in the right lung. Robotic left upper division segmentectomy with lymph node dissection was performed using a \"hilum first, fissure last\" approach with fine dissection of the hilar structures and minimal bleeding. The postoperative course was uneventful.</p><p><strong>Conclusions: </strong>Preoperative simulation and robotic-assisted thoracoscopic surgery enabled the safe and precise anatomical pulmonary segmentectomy for a patient with lung cancer, despite several bronchial and arterial anomalies, including a displaced left upper division bronchus.</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/PMC11949726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754575","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":"Successful Conversion Surgery for Locally Advanced Pancreatic Neuroendocrine Carcinoma: A Case Report.","authors":"Yuuko Tohmatsu, Mihoko Yamada, Nobuyuki Ohike, Tomoko Norose, Hidemasa Kubo, Ryo Ashida, Katsuhisa Ohgi, Shimpei Otsuka, Yoshiyasu Kato, Hideyuki Dei, Katsuhiko Uesaka, Takashi Sugino, Teiichi Sugiura","doi":"10.70352/scrj.cr.24-0064","DOIUrl":"10.70352/scrj.cr.24-0064","url":null,"abstract":"<p><strong>Introduction: </strong>Pancreatic neuroendocrine carcinoma (panNEC) is a poorly differentiated, highly malignant neoplasm with an extremely poor prognosis. This tumor often presents as locally advanced or unresectable at the initial diagnosis.</p><p><strong>Case presentation: </strong>A 72-year-old woman presented to our hospital with weight loss. A computed tomography scan showed an enhanced tumor measuring 32 mm in the pancreatic head region, with contact to the common hepatic artery over 180°. The pathological findings from the specimens obtained via endoscopic ultrasonography-guided fine-needle aspiration identified small cell-type NEC with extensive necrosis, leading to a diagnosis of locally advanced unresectable panNEC. Accordingly, she began a course of carboplatin and etoposide therapy. After 7 courses, given the significant shrinkage of the tumor, we performed a pancreatoduodenectomy as a conversion surgery. Pathological examination revealed a localized, residual nodule of NEC, consisting mainly of large neoplastic cells, with carcinoma <i>in situ</i> components scattered within and around the nodule. In addition, the diffuse membrane expression of somatostatin receptor 2 was observed in NEC components. Each component showed the same type of <i>KRAS</i> mutation (p.G12V) and was considered to originate from a single primary tumor in the pancreas. She received 3 courses of the same regimen as adjuvant chemotherapy and has remained recurrence-free for 24 months.</p><p><strong>Conclusion: </strong>This is a rare case of successful conversion surgery for locally advanced, unresectable panNEC after chemotherapy, providing several important histopathological and molecular insights.</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/PMC11933743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710939","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":"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":"Hilar Cholangiocarcinoma with Para-Aortic Lymph Node Metastasis Treated with Chemoimmunotherapy and Conversion Surgery: A Case Report.","authors":"Yuma Yasui, Koichi Kimura, Norifumi Iseda, Yoshinari Nobuto, Hiroko Yano, Yuichiro Kajiwara, Takuro Watanabe, Fang Cao, Michiko Amano, Takaaki Tanaka, Hironori Ochi, Nobuaki Azemoto, Kazuhito Minami, Ryosuke Minagawa, Tomoyuki Yokota, Takashi Nishizaki","doi":"10.70352/scrj.cr.25-0023","DOIUrl":"10.70352/scrj.cr.25-0023","url":null,"abstract":"<p><strong>Introduction: </strong>Cholangiocarcinoma (CC) has a poor prognosis and few treatment options. Conversion surgery for unresectable CC has been frequently reported; however, there are almost no reports of conversion surgery after durvalumab plus gemcitabine and cisplatin therapy. In this study, we report the case of a patient with unresectable hilar CC who received durvalumab plus gemcitabine and cisplatin therapy and achieved a pathological complete response after conversion surgery.</p><p><strong>Case presentation: </strong>A 70-year-old man was diagnosed with hilar CC (cT3N1M0, Stage III C) based on biopsy of the common bile duct stenosis and computed tomography (CT) and magnetic resonance cholangiopancreatography scans. Initially, a right lobe hepatectomy and subtotal stomach-preserving pancreatoduodenectomy were planned. However, there were concerns about an insufficient functional remnant liver volume. Trans-ileocolic portal embolization of the right portal vein branch was performed. On a preoperative CT scan 1 month later for liver volumetry, swelling of the para-aortic lymph nodes was observed, which was judged as distant metastasis, and radical resection could not be performed. After 8 courses of durvalumab plus gemcitabine and cisplatin therapy, vanishing fluorodeoxyglucose accumulation in the para-aortic lymph nodes was observed on positron emission tomography-CT. The possibility of resection was reevaluated, and a right lobe hepatectomy and extrahepatic biliary reconstruction were performed as conversion surgeries. Histological examination confirmed the absence of residual tumors or lymph node metastases. Ten months after surgery, the patient was free of recurrence.</p><p><strong>Conclusions: </strong>Chemoimmunotherapy with durvalumab as a first-line treatment for unresectable CC has shown promising results. Immunotherapy with durvalumab, followed by conversion surgery, may improve the prognosis of patients with unresectable CC.</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/PMC11925595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671051","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":"A Robotic Pancreaticoduodenectomy Case Involving a Meandering Main Pancreatic Duct Coursing Posterior to a Replaced Common Hepatic Artery and in Front of the Portal Vein.","authors":"Yui Sawa, Yosuke Inoue, Kosuke Kobayashi, Atsushi Oba, Yoshihiro Ono, Hiromichi Ito, Yu Takahashi","doi":"10.70352/scrj.cr.24-0184","DOIUrl":"10.70352/scrj.cr.24-0184","url":null,"abstract":"<p><strong>Introduction: </strong>Anatomical anomalies, such as branches of the celiac artery and superior mesenteric artery (SMA), and pancreatic malformations, including the annular pancreas, are important during pancreaticoduodenectomy (PD). Here, we report a case of an anomaly of the artery and main pancreatic duct (MPD) in which the pancreatic parenchyma surrounded the replaced common hepatic artery (rCHA), and the meandering main pancreatic duct (MMPD) ran behind the rCHA.</p><p><strong>Case presentation: </strong>A 71-year-old woman was diagnosed with intraductal papillary mucinous neoplasm (IPMN) of pancreatic body and the dilation of MPD to 13 mm, which was a factor of high-risk stigmata. Preoperative computed tomography (CT) showed that the rCHA branched from the superior mesenteric artery (SMA) and the pancreatic parenchyma surrounded the rCHA. Moreover, the MPD meandered and ran behind the rCHA. PD was performed. At the time of dissection between the rCHA and pancreatic parenchyma, we had to divide not only the cranial part of the pancreatic parenchyma along the rCHA but also the MPD. The postoperative course was uneventful.</p><p><strong>Conclusion: </strong>This is the first report of the rCHA surrounded by pancreatic parenchyma and MMPD running behind the rCHA and in front of the portal vein.</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/PMC11936723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721304","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":"Axillo-Femoral Bypass Followed by Pelvic Exenteration for Locally Advanced Sigmoid Colon Cancer Invading the Common Iliac Artery.","authors":"Moe Enari, Kay Uehara, Takeshi Yamada, Aitsariya Mongkhonsupphawan, Sho Kuriyama, Yasuyuki Yokoyama, Hiromichi Sonoda, Yuji Maruyama, Yosuke Ishii, Hiroshi Yoshida","doi":"10.70352/scrj.cr.24-0001","DOIUrl":"10.70352/scrj.cr.24-0001","url":null,"abstract":"<p><strong>Introduction: </strong>Initially, unresectable locally advanced colorectal cancers are still not uncommon. Despite recently developed systemic treatment has extended the survival of patients with unresectable and recurrent disease, surgical resection offers the chance for a cure or long-term survival. Recently, with improvement in the safety of major vascular reconstruction, several reports have suggested that extended pelvic tumor resection with vascular reconstruction with curative intent can be performed safely; however, the indications for arterial vascular reconstruction remain controversial and are reported with a literature review.</p><p><strong>Case presentation: </strong>A 73-year-old male patient whose fever was greater than 40° was admitted to the emergency department of our hospital. Computed tomography (CT) revealed a large mass on the left side of the aortic bifurcation, and a diagnosis of unresectable sigmoid colon cancer was made (cT4bN1M0). The tumor had substantially invaded the iliopsoas muscle and intramuscular abscess, left hydronephrosis due to left ureteral invasion, invasion of the left common and external iliac artery, and congestive edema of the left leg were observed. Transverse colostomy and left nephrostomy were created and percutaneous drainage of the iliopsoas abscess was performed. Four cycles of FOLFOX + bevacizumab were administered after the systemic infection had resolved. The tumor volume decreased, and no new lesions were observed. The patient underwent left axillo-femoral bypass followed by total pelvic exenteration, combined left common and external iliac artery resection, and right ureterocutaneostomy. His postoperative course was uneventful. Pathology revealed ypT4b (bladder) N0M0, ypStage II disease. The patient was followed without adjuvant chemotherapy and had no recurrence as of 10 months after surgery.</p><p><strong>Conclusions: </strong>We experienced a case of total pelvic exenteration combined with the common and external iliac artery and reconstruction via axillo-femoral bypass. When treating complicated cases that cannot be cured by a single operation, it is necessary to carefully consider the optimal pathway for radical resection and to be very familiar with perioperative treatment and reconstructive methods.</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/PMC11936760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721308","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}