Surgical Case Reports最新文献

{"title":"Extra-Lobar Lung Sequestration Infarction That Caused Sudden Back Pain: An Adult Case of Surgical Resection.","authors":"Noriyoshi Sawabata, Isao Arai, Hisanori Hatano, Takashi Ito, Yuko Fukumoto, Takayuki Minoji, Kotaro Muranishi, Takahiko Nishigaki, Ken Konishi, Kazuyuki Matsushita, Kazunori Nakaguchi, Sadayuki Doi, Keishi Sugimoto","doi":"10.70352/scrj.cr.24-0032","DOIUrl":"10.70352/scrj.cr.24-0032","url":null,"abstract":"<p><strong>Introduction: </strong>Ischemia in extra-lobar pulmonary sequestration is rare and mostly occurs in childhood; it is uncommon in adults but can be progressive, necessitating surgical removal.</p><p><strong>Case presentation: </strong>A 37-year-old woman experienced sudden onset severe back pain and was initially diagnosed with pneumonia. Computed tomography revealed a 4.5 cm mass on the diaphragm and rapidly increasing pleural effusion. Emergency surgery confirmed a black mass that adhered to the diaphragm, which could be bluntly detached, but one was fixed in a cord shape that was detached by an energy device. Pathology showed significant hemorrhage and tissue destruction in extra-lobar pulmonary sequestration.</p><p><strong>Conclusions: </strong>Extra-lobar pulmonary sequestration infarction, which develops suddenly with pain as the main complaint, is rare and mainly seen in early childhood but can also occur in adults.</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/PMC11850078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493527","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":"Improvement in Recurrent Laryngeal Nerve Paralysis and Tracheal Deviation after Surgical Resection of a Mediastinal Parathyroid Cyst: A Case Report.","authors":"Minoru Sugihara, Hideyuki Kaida, Mai Sugiura, Chihiro Hara, Yuriko Okazaki, Hisashi Yokoi, Sawako Okamoto, Hirofumi Takenaka, Tetsuo Taniguchi","doi":"10.70352/scrj.cr.24-0083","DOIUrl":"10.70352/scrj.cr.24-0083","url":null,"abstract":"<p><strong>Introduction: </strong>Mediastinal parathyroid cyst is a rare cystic disease that involves the parathyroid tissue within its walls. This case report is the first to document a mediastinal parathyroid cyst with recurrent laryngeal nerve paralysis and tracheal deviation that improved after surgical resection.</p><p><strong>Case presentation: </strong>A 47-year-old man experienced hoarseness and dyspnea upon exertion for 1 month. Computed tomography revealed a mediastinal cystic lesion with a maximum diameter of 78 mm, compressing the trachea. Laryngofiberscopy suggested long-term left recurrent laryngeal nerve paralysis. Tumor resection was performed while preserving the left recurrent laryngeal nerve. The pathological examination led to the diagnosis of a mediastinal parathyroid cyst. Postoperatively, both tracheal deviation and recurrent laryngeal nerve paralysis improved.</p><p><strong>Conclusions: </strong>Surgical resection improved the tracheal deviation and recurrent laryngeal nerve paralysis caused by a mediastinal parathyroid cyst. Long-standing recurrent laryngeal nerve paralysis can improve, emphasizing the need for proactive surgical intervention and the importance of careful preservation of the recurrent laryngeal nerve.</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/PMC11850213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504259","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 Left Trisectionectomy for Intrahepatic Cholangiocarcinoma in a Patient with a Right-Sided Round Ligament: A Case Report.","authors":"Masashi Utsumi, Masaru Inagaki, Koji Kitada, Naoyuki Tokunaga, Koki Omoto, Naoki Onoda, Kosuke Yunoki, Hiroki Okabayashi, Ryosuke Hamano, Hideaki Miyaso, Yosuke Tsunemitsu, Shinya Otsuka, Rika Omote","doi":"10.70352/scrj.cr.24-0054","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0054","url":null,"abstract":"<p><strong>Introduction: </strong>A right-sided round ligament (RSRL) is a rare congenital anomaly characterized by the umbilical vein being connected to the right paramedian trunk. As it is associated with intrahepatic vascular anomalies, it poses special difficulties in hepatic resection, and an accurate understanding of those anomalies is indispensable.</p><p><strong>Case presentation: </strong>An 80-year-old man visited a health clinic with the chief complaint of jaundice. Hyperbilirubinemia and impaired liver function were detected upon laboratory examination. Therefore, the patient was referred to our hospital for further examination and treatment. Contrast-enhanced computed tomography (CT) demonstrated dilatation of the intrahepatic bile ducts and the presence of a hypovascular tumor of 30 mm in size in the left lateral segment of the liver. The anterior branch of the portal vein (PV) formed a right-sided umbilical portion of the PV and was connected to the round ligament. This anomaly is known as an RSRL. The round ligament was located to the right of the gallbladder. Three-dimensional (3-D) CT of the PV clearly illustrated the independent ramification of the posterior branch and the subsequent bifurcation of the anterior branch and the left PV. Endoscopic, nasogastric biliary drainage was performed to treat the patient for obstructive jaundice, and endoscopic retrograde cholangiopancreatography demonstrated severe stenosis of the hilar bile duct. Biopsies of the stenotic bile ducts were suggestive of adenocarcinoma. The root of the posterior branch of the bile duct was intact from the cancer. The preoperative diagnosis was intrahepatic cholangiocarcinoma (T4N0M0, stage III B), according to the <i>American Joint Committee on Cancer Staging System</i>, 8th edition. Left trisectionectomy with extrahepatic bile-duct resection and hepaticojejunostomy was performed. The histological diagnosis of the tumor was intrahepatic cholangiocarcinoma (large duct type, 5.5 × 4.5 cm). The final pathological stage was T4N1M0, stage 3B. Three months after surgery, the patient was doing well without recurrence.</p><p><strong>Conclusions: </strong>The anatomy of patients with an RSRL should be evaluated in detail before surgery, especially when curative hepatic resection is performed for intrahepatic or perihilar cholangiocarcinoma.</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/PMC11868873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542869","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":"Ileal Pouch Cancer Detected More than 30 Years after Restorative Proctocolectomy for Ulcerative Colitis.","authors":"Tetsuhiro Urashima, Kenji Tatsumi, Nao Obara, Eiichi Nakao, Sayumi Saito, Koki Goto, Hirosuke Kuroki, Kazutaka Koganei, Akira Sugita","doi":"10.70352/scrj.cr.25-0021","DOIUrl":"10.70352/scrj.cr.25-0021","url":null,"abstract":"<p><strong>Introduction: </strong>The standard surgical treatment for ulcerative colitis (UC) is proctocolectomy with hand-sewn ileoanal pouch anastomosis (hand-sewn IPAA) or stapled ileal pouch anastomosis (stapled IPAA). The occurrence of cancer in the ileal pouch after surgery for UC is rare, and a consensus on surveillance for ileal pouch cancer has not been reached. We report a case of ileal pouch cancer diagnosed by pouchoscopy 33 years after restorative proctocolectomy with IPAA for UC.</p><p><strong>Case presentation: </strong>A middle-aged man presented with positive fecal occult blood. The patient had undergone restorative proctocolectomy with IPAA for UC 33 years ago. Pouchoscopy had been performed every 2-3 years in the last 10 years. In April a year ago, he tested positive for fecal occult blood, and pouchoscopy revealed an ulcerative lesion and flat elevation in the ileal pouch on the proximal side of the ileoanal anastomosis. Targeted biopsies of the ulcerative lesion revealed low-grade dysplasia (LGD). After 4 months, pouchoscopy also showed an increase in the size of the flat elevation, but targeted biopsies of this lesion also showed LGD. One year later in August, endoscopic examination for hematochezia showed a full circumferential raised lesion with a white coat and mucus draining from a fistula near the anastomosis at the same site. Pathological examination identified adenocarcinoma in the ileal mucosa. The preoperative diagnosis was ileal pouch cancer after restorative proctocolectomy with IPAA for UC, cT4bN2M0 stage IIIB (UICC-TNM, 8th), and he underwent excision of the ileal pouch body and the ileoanal anastomosis. Pathological examination showed mucinous carcinoma in the ileal mucosa with chronic inflammation. The postoperative stage was pT3N0M0 stage IIA; no postoperative chemotherapy was administered, and at 6 months postoperatively, the patient remained recurrence free.</p><p><strong>Conclusion: </strong>Although ileal pouch cancer is rare, it can occur after a long period following ileal pouch surgery for UC. Endoscopic surveillance for ileal pouch cancer should be performed for early diagnosis and radical resection, especially if ileal pouch cancer occurs more than 10 years after the onset of UC.</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/PMC11911229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650788","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 Multimodal Approach Utilizing Balloon Occlusion for Postpancreatectomy Hemorrhage: A Case Report.","authors":"Aya Maekawa, Takafumi Sato, Satoshi Tsuchiya, Kosuke Kobayashi, Atsushi Oba, Yoshihiro Ono, Hiromichi Ito, Yosuke Inoue, Kiyoshi Matsueda, Yu Takahashi","doi":"10.70352/scrj.cr.24-0014","DOIUrl":"10.70352/scrj.cr.24-0014","url":null,"abstract":"<p><strong>Introduction: </strong>Postpancreatectomy hemorrhage (PPH) is a life-threatening complication following pancreaticoduodenectomy, requiring prompt and accurate diagnostic and therapeutic measures to ensure patient survival.</p><p><strong>Case presentation: </strong>A 79-year-old man underwent robot-assisted pancreaticoduodenectomy for suspected intraductal papillary mucinous carcinoma. Postoperatively, he developed a pancreatic fistula and major bile leak, leading to a hemorrhagic event on postoperative day 6. Initial stabilization was achieved with intravenous fluids and blood transfusions, followed by emergent angiography, which identified bleeding from the gastroduodenal artery (GDA) stump. Due to the short length of the remaining GDA, simple embolization of the GDA stump was considered inadequate. Given the anatomy of the short proper hepatic artery (PHA) and its immediate bifurcation into the left and right hepatic arteries, coil embolization was feared to cause infarction of the entire liver, and even with stenting, the left hepatic artery (LHA) would have to be sacrificed. Temporary balloon occlusion of the common hepatic artery (CHA) was used to stabilize the hemodynamics, serving as a bridge to surgical intervention to maintain hepatic blood flow. Although it was an emergency laparotomy, intraoperative CHA balloon occlusion created a controlled environment, allowing for precise localization and effective management of the hemorrhage. The root of the GDA was ligated, and hepatic blood flow was preserved. The choledochojejunostomy leak was repaired by re-anastomosis. The patient was discharged following successful conservative management of the pancreatic fistula. Eight months post-intervention, follow-up imaging confirmed preserved hepatic arterial flow.</p><p><strong>Conclusion: </strong>This case underscores the efficacy of a multidisciplinary approach in managing delayed PPH in hemodynamically stable patients. Comprehensive angiographic assessment, combined with temporary CHA balloon occlusion for bleeding control and meticulous surgical hemostasis, offers a viable strategy ensuring immediate and mid-term patient well-being.</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/PMC11879257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558049","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":"Ilio-Iliac Arteriovenous Fistula Secondary to a Ruptured Right Common Iliac Artery Aneurysm and Anomalous Anatomy of Inferior Vena Cava Resulting in an Arteriovenous Shunt Formation with Right-sided Cardiac Failure: A Case Report.","authors":"Yuki Shirai, Aya Saito, Chiharu Tanaka, Yuki Moriyama, Yuya Ito, Kazuyuki Ishibashi, Noboru Motomura","doi":"10.70352/scrj.cr.24-0094","DOIUrl":"10.70352/scrj.cr.24-0094","url":null,"abstract":"<p><strong>Introduction: </strong>An ilio-iliac arteriovenous fistula (IIAVF) secondary to the rupture of a common iliac artery aneurysm (CIAA) is rare. Sudden arteriovenous shunting and subsequent fistula enlargement can result in acute cardiac failure. Immediate diagnosis and treatment are required; however, the clinical symptoms differ from those of a free wall rupture of an aortic aneurysm, making a quick diagnosis difficult. Thus, we reported the case of a patient with severe right-sided cardiac failure, due to an arteriovenous shunt formation secondary to an IIAVF who underwent an artificial blood vessel replacement with favorable results.</p><p><strong>Case presentation: </strong>A 71-year-old male patient presented to our hospital with polypnea and palpitations. Initial early-phase computed tomography (CT) revealed a 60-mm-in-diameter right CIAA and an inferior vena cava (IVC) dilatation. Severe congestive heart failure, due to an arteriovenous shunt formation secondary to an IIAVF was diagnosed. The massive shunt of blood flowed from the right common iliac artery (CIA) to the right common iliac vein (CIV). He underwent an emergency open abdominal aortic replacement. The IVC ran anomalously anterior to the giant right CIAA and strongly adhered to the IVC and right CIV. Two guidewires were inserted from the bilateral femoral veins into the IVC intraoperatively. Moreover, an occlusion balloon was inserted into the right CIV. Thus, bleeding from the fistula was well-controlled by the time of aneurysm opening. The proximal side of the artificial graft was anastomosed to the abdominal aorta, while the right and left peripheral branches of the prosthesis were anastomosed to the right external iliac artery and left CIA, respectively.</p><p><strong>Conclusions: </strong>We reported the case of a giant right CIAA that directly created a shunt into the right CIV. Contrast-enhanced CT is a useful method for confirming the working diagnosis of an IIAVF. In particular, in cases of IVC anomalies or strong perivenous tissue adhesions, bleeding can be controlled using devices, such as occlusion balloons and a meticulous surgical plan.</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/PMC11836012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459096","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":"Rare Metastatic Mesothelioma Occupying Intra-Atrial Cavity, Released by an Emergency Surgery: A Case Report and Literature Review.","authors":"Tomohiro Takano, Shuta Sato, Ichiro Ito, Manabu Yamamoto, Katsuaki Tsukioka, Yu Matsumura, Tetsuya Kono","doi":"10.70352/scrj.cr.24-0176","DOIUrl":"10.70352/scrj.cr.24-0176","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiac surgery for cardiovascular-associated mesothelioma has a poor prognosis. However, life-saving surgery is unavoidable to maintain circulation. This report describes a case in which metastatic intracardiac mesothelioma triggered sudden respiratory failure, which was reduced by surgical resection.</p><p><strong>Case presentation: </strong>An 81-year-old man with a history of asbestos exposure presented to our hospital with sudden onset of dyspnea. Prior to this event, the pleura was involved in an epithelial malignancy, which was immunohistochemically negatively stained with anti-D2-40, WT-1, or anti-calretinin antibodies, which are positive markers of mesothelioma. Transthoracic echocardiography revealed a fragile and mobile tumor occupying the right atrium, and the patient was admitted for surgical tumorectomy. The operation was performed urgently using a cardiopulmonary bypass via a full sternotomy. The pericardium is grossly intact and does not adhere to the heart. A 3 × 5 cm tumor was tightly attached to the right atrium and was large enough to fit into the tricuspid valve. Therefore, the entire margin of the tumor stem attachment was resected from the lateral wall of the right atrium. Although the resected tumor was not positive for any of the three histopathological markers of mesothelioma, <i>CDKN2A</i> co-deletion revealed by fluorescence in situ hybridization led to a diagnosis of malignant mesothelioma.</p><p><strong>Conclusions: </strong>Surgical removal of intracardiac tumors that cause circulatory and respiratory instability is essential for the prevention of sudden death, regardless of prognostic determinants. This case demonstrates that mesotheliomas can metastasize to the endocardium. Even when nuclear atypia and negative results for immunohistochemical tests for the three mesothelioma markers suggest carcinoma, mesothelioma should still be considered and <i>p16/CDKN2A</i> co-deletion should be evaluated.</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/PMC11872738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543587","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":"Efficacy of Arterial Embolization prior to Pancreaticoduodenectomy for Pancreatic Arteriovenous Malformation: A Case Report.","authors":"Ryota Kiuchi, Takanori Sakaguchi, Toshiki Kawabata, Osamu Jindo, Akihiro Uno, Atsuko Fukazawa, Keigo Matsumoto, Junichi Kaneko, Daijiro Suzuki, Yoshihisa Ookawa, Kenshi Kawamura, Shioto Suzuki, Shohachi Suzuki","doi":"10.70352/scrj.cr.24-0117","DOIUrl":"10.70352/scrj.cr.24-0117","url":null,"abstract":"<p><strong>Introduction: </strong>Pancreatic arteriovenous malformation is a rare disease characterized by abnormal vascular connections between arteries and veins. Despite the risk of increased intraoperative blood loss due to abundant blood flow, surgical resection remains the only curative modality for pancreatic arteriovenous malformation. We present a case of pancreatic arteriovenous malformation in which subtotal stomach-preserving pancreaticoduodenectomy was successfully performed following selective arterial embolization to reduce intraoperative blood loss.</p><p><strong>Case presentation: </strong>A 53-year-old Southeast Asian man was referred to our hospital with abdominal pain. Contrast-enhanced computed tomography revealed enhancement of the pancreatic head and superior mesenteric vein in the early arterial phase, suggesting the presence of an arteriovenous malformation. Maximum intensity projection images and angiography revealed arterial branches from the gastroduodenal artery and superior mesenteric artery to the arteriovenous malformation, subsequently draining into the portal venous circulation. We supposed that abdominal pain resistant to medical treatment was due to the pancreatic arteriovenous malformation, and surgical resection was deemed necessary. Subtotal stomach-preserving pancreaticoduodenectomy was safely performed on the day after arterial embolization of pancreatic arterial branches to reduce intraoperative blood loss. The procedure resulted in an intraoperative blood loss of 336g. The patient was discharged on the 16th postoperative day with no complications and has not experienced abdominal pain since.</p><p><strong>Conclusions: </strong>Selective arterial embolization prior to pancreaticoduodenectomy against pancreatic arteriovenous malformation is a safe and feasible procedure to reduce intraoperative blood loss.</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/PMC11925642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671047","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 Surgical Repair of Adult Anomalous Origin of the Left Main Coronary Artery from the Pulmonary Artery Complicated by a Mass in the Left Atrial Appendage: A Case Report.","authors":"Takashi Harada, Hironobu Morimoto, Yuki Echie, Daisuke Futagami, Keijiro Katayama, Shogo Mukai, Takaya Ozawa","doi":"10.70352/scrj.cr.24-0066","DOIUrl":"10.70352/scrj.cr.24-0066","url":null,"abstract":"<p><strong>Introduction: </strong>An anomalous origin of the left coronary artery (LCA) from the pulmonary artery (PA) (ALCAPA) is a rare congenital abnormality associated with high rates of early infant mortality and sudden death in adults.</p><p><strong>Case presentation: </strong>A 56-year-old woman with acute left lower extremity arterial occlusion was diagnosed with an adult ALCAPA with a mass in the left atrial appendage. Preoperative echocardiography revealed left ventricular hypokinesis posteroinferior to the lateral wall and moderate mitral valve regurgitation, with a mass in the left atrial appendage. Coronary angiography revealed ALCAPA and dilatation of both coronary arteries. Myocardial scintigraphy revealed infarction of the posteroinferior wall and severe ischemia of the lateral wall of the left ventricle. We occluded the LCA entry from the inside of the PA and performed a left internal thoracic artery-to-left anterior descending artery (LITA-LAD) bypass, mitral annulus plasty, and resection of the mass together with the left atrial appendage. Because of residual myocardial blood flow from the collateral vessels, we cooled the temperature to 28°C to induce cardiac arrest. Postoperative coronary angiography indicated a good LITA-LAD flow and improvement in left ventricular contractility. Myocardial scintigraphy revealed improvement in ischemia. Pathological examination revealed that the mass in the left atrial appendage was a thrombus. The patient's postoperative course was uneventful. She was discharged on postoperative day 16 and was given oral warfarin as anticoagulation therapy. Six months later, the follow-up evaluation was uneventful, and the patient was free of any symptoms of heart failure.</p><p><strong>Conclusions: </strong>We encountered a very rare case of ALCAPA complicated by a left intra-atrial mass following acute lower extremity artery occlusion. We performed LITA-LAD bypass, mitral annulus plasty, and resection of the mass along with the left atrial appendage. Due to residual myocardial blood flow from the collateral circulation, we cooled the temperature to 28°C in preparation for inducing cardiac arrest. The postoperative course was uneventful.</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/PMC11936759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721315","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 simultaneous pancreatoduodenectomy and living donor liver transplantation for biliary cancer complicated with congenital biliary dilatation.","authors":"Tsuyoshi Shimamura, Masaaki Watanabe, Yasuyuki Koshizuka, Ryoichi Goto, Norio Kawamura, Tatsuya Orimo, Hirofumi Kamachi, Toshiya Kamiyama, Tomoko Mitsuhashi, Taizo Hibi, Akinobu Taketomi","doi":"10.1186/s40792-024-02068-5","DOIUrl":"10.1186/s40792-024-02068-5","url":null,"abstract":"<p><strong>Background: </strong>In patients with pancreaticobiliary maljunction complicated by congenital biliary dilatation, the pancreatic enzyme flows back into the bile, leading to bile duct carcinogenesis. Although the biliary tract resection and reconstruction is well documented to decrease the rate of malignancy, cancer occurrence has been reported in the residual intrahepatic or intrapancreatic bile duct, even after resection. We report a case of multiple biliary tract cancers in the liver complicated by congenital biliary dilatation, whose tumor lesions were resected en bloc without disconnecting the biliary tract by simultaneous pancreatoduodenectomy and living donor liver transplantation.</p><p><strong>Case presentation: </strong>A 27-year-old woman presented with epigastric discomfort. Examination indicated multiple biliary tract cancers complicated by congenital biliary dilatation. Computed tomography scan revealed three papillary tumors in the right hepatic duct with increased ¹⁸F-FDG accumulation on positron emission tomography. Contrast-enhanced ultrasound revealed another lesion in the left hepatic duct. Adenocarcinoma cells were detected using bile and choledochal brush cytology. Tumors resection by right lobectomy or trisegmentectomy of the liver and extrahepatic bile duct resection indicated a high risk of postoperative liver failure; the residual liver volumes were calculated only 277 ml or 176 ml, respectively. In addition, tumor recurrence owing to bile leakage during the surgery and carcinogenesis from the remaining bile duct were concerned. Pancreatoduodenectomy was performed without disconnecting the biliary tract, and the tumors were resected en bloc with the whole liver. The left lobe liver graft from the husband was then transplanted. After 5 years of adjuvant treatment with tegafur/gimeracil/oteracil potassium, she remained in remission eight and half years after the surgery.</p><p><strong>Conclusions: </strong>Given the mechanism and development of cancer in the congenital biliary dilatation, simultaneous pancreatoduodenectomy and liver transplantation may be considered, especially in the case of young patients.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"10 1","pages":"274"},"PeriodicalIF":0.7,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772533","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}