Surgical Case Reports最新文献

{"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":"Thoracic Endovascular Aortic Repair Using Stent Grafts in Japan.","authors":"Akihiko Usui, Rena Usui, Shunsuke Nakata","doi":"10.70352/scrj.ed.25-2001","DOIUrl":"10.70352/scrj.ed.25-2001","url":null,"abstract":"<p><p>A stent-graft technique was developed by Parodi et al. and has been used clinically for thoracic endovascular aortic repair (TEVAR) since the 1990s. We evaluated how the new stent-graft technology contributed to expanding aortic surgery and improving surgical outcomes of aortic surgery. TEVAR was performed in a limited number of institutes in the early 2000s and was greatly enhanced by the approval of commercially available stent grafts in 2008. Its performance increased steadily thereafter, with 0 cases performed in 1999, 1658 in 2009, and 6461 in 2019. The ratio of TEVAR was 0% in 1999, which increased to 13.9% in 2009 and 28.5% in 2019, respectively. TEVAR has greatly contributed to the improvement of surgical outcomes, especially in non-dissection ruptured aneurysms and type B acute aortic dissection. TEVAR was performed in 53% of ruptured aneurysms, and the 30-day mortality rate improved to 13.9% in 2019 due to a 30-day mortality rate of 12.5% in TEVAR. The effect of TEVAR was more remarkable in patients with acute type B aortic dissection, where the 30-day mortality rate was 5.7%, and the procedure was performed in 75% of cases. The overall 30-day mortality rate improved to 7.0% for all patients with type B acute aortic dissection in 2019. The expansion of TEVAR using stent grafts greatly increased the number of aortic surgeries and played a significant role in improving surgical outcomes. Stent-graft technology has influenced the field of aortic surgery.</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/PMC11835547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459416","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":"Anterior Mediastinal Lymph Node Metastasis of Intrahepatic Cholangiocarcinoma: A Case Report and Literature Review.","authors":"Tomoaki Tabata, Ryusuke Saito, Takeki Taniguchi, Kyohei Kasuda, Naruhito Takido, Hiroyuki Ogasawara, Yoshihiro Shono, Muneyuki Matsumura, Kengo Sasaki, Atsushi Fujio, Kazuaki Tokodai, Takanori Morikawa, Michiaki Unno, Takashi Kamei","doi":"10.70352/scrj.cr.24-0025","DOIUrl":"10.70352/scrj.cr.24-0025","url":null,"abstract":"<p><strong>Introduction: </strong>Intrahepatic cholangiocarcinoma (ICC) is the second most common liver malignant tumor with a poor prognosis. Lymph node (LN) metastasis is found in 15% of ICC at the time of initial diagnosis. However, the LN metastasis to the anterior mediastinum is extremely rare. Herein, we report a case of anterior mediastinal LN metastasis of ICC.</p><p><strong>Case presentation: </strong>The patient is a 74-year-old man who had surgery for cervical esophageal cancer. During follow-up, a low-density hepatic tumor and swollen LNs in the anterior mediastinum were detected. The tumor of the liver was diagnosed as ICC by needle biopsy. Excisional biopsy of the LN was performed and the diagnosis was metastasis of ICC. Because the prognosis of the patient with ICC Stage IVB is poor, the patient received 8 courses of chemotherapy. Although the new lesion appeared next to the main tumor, these tumors were located in the left liver. In addition, it was difficult for the patient to continue the chemotherapy due to the renal dysfunction. Hepatectomy with lymphadenectomy was performed. The patient survives without recurrence for 9 months after surgery. This is the first report of anterior mediastinal metastasis of ICC without any other organ involvement.</p><p><strong>Conclusions: </strong>Metastasis to the anterior mediastinum of hepatic tumor can be explained by the system that lymphatic fluid running under the capsule of the liver drains to the anterior mediastinal LNs through the coronary ligament. Metastasis of ICC to mediastinal LNs can occur when the tumor is located at the surface of the liver. Excisional biopsy is effective in determining the accurate disease stage and the treatment strategy.</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/PMC11842124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468929","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":"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}

{"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":"A Catheter-Guided Technique for Second Branchial Cleft Fistula Excision in Infants: A Case Report.","authors":"Akio Kawami, Yudai Goto, Yuri Nemoto, Tomohiro Aoyama, Kouji Masumoto","doi":"10.70352/scrj.cr.25-0013","DOIUrl":"https://doi.org/10.70352/scrj.cr.25-0013","url":null,"abstract":"<p><strong>Introduction: </strong>Second branchial cleft (SBC) fistulas are the most common branchial cleft anomalies and typically present in infancy or early childhood. While complete surgical excision is the standard treatment, surgical challenges in younger children arise because of narrower fistula tracts and inadequate visualization, which increase the risk of complications and recurrence.</p><p><strong>Case presentation: </strong>We report the case of a 6-month-old boy with an SBC fistula who presented with persistent mucoid discharge from a right cervical orifice. Fistulography confirmed the presence of a complete SBC fistula. At 9 months of age, a fistulectomy was performed using a 28-gauge peripherally inserted central venous catheter (PICC) as a guide to identify the entire fistula tract. The catheter facilitated the precise identification of the fistula tract, saline irrigation, dissection under endoscopic guidance, and confirmation of the internal end by creating a knot at the catheter tip. The tract was excised completely without any complications. The patient recovered uneventfully and showed no recurrence at 6 months postoperatively.</p><p><strong>Conclusions: </strong>Complete surgical resection remains the gold standard for SBC fistulas. However, anatomical challenges in younger children limit the applicability of various intraoperative tools and techniques. The use of a small-diameter catheter as a guide to identify an entire fistula tract is a valuable approach that overcomes these challenges, enhances surgical precision, and reduces the risk of complications and recurrence.</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/PMC11961233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765156","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}