Surgical Case Reports最新文献

{"title":"A Case of Graves' Disease in a Patient with Kartagener's Syndrome (Complete Visceral Inversion, Chronic Sinusitis, and Bronchiectasis).","authors":"Naoyoshi Onoda, Masashi Yamamoto, Hiroo Masuoka, Minoru Kihara, Takuya Higashiyama, Akihiro Miya, Kahoru Nishina, Akira Miyauchi","doi":"10.70352/scrj.cr.24-00437","DOIUrl":"10.70352/scrj.cr.24-00437","url":null,"abstract":"<p><strong>Introduction: </strong>Kartagener's syndrome (KS) is a rare disease characterized by a triad of situs inversus totalis, chronic sinusitis, and bronchiectasis. The disorder is caused by a hereditary genetic abnormality that impairs ciliary movement. Although aberrant pass course of the inferior laryngeal nerves due to visceral inversion should be considered during thyroid surgery in patients with KS, no report of surgical treatment for Graves' disease (GD) in patients with KS has been found to date.</p><p><strong>Case presentation: </strong>A Japanese male in his 40s was referred to our hospital for surgical treatment for drug-refractory GD. He was diagnosed to have KS by genetic alteration of the <i>DNAH5</i> gene as well as clinical triad. No abnormal branching in the mediastinal great vessels was identified in the present case, and left-sided non-recurrent inferior laryngeal nerve (NRLN) was not observed during surgery. Previous literature has demonstrated that the presence of a right-sided aortic arch and an anomalous branch of the left subclavian artery, as well as the absence of a left ductus arteriosus demonstrable on preoperative imaging studies, are prerequisites for the development of the extremely rare left-sided NRLN.</p><p><strong>Conclusion: </strong>We reported the first case of surgical treatment for GD in a patient with KS and discussed the preoperative diagnosis of NRLN.</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/PMC11832223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441964","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":"Pulmonary Lobectomy for Chronic Pulmonary Vein Occlusion after Catheter Ablation for Atrial Fibrillation: A Case Report and Literature Review.","authors":"Satoshi Suzuki, Nobuhiro Izumi, Kazuya Kishimoto, Hirotaka Kinoshita, Takuya Tanimura, Kantaro Hara, Hidetoshi Inoue, Takuma Tsukioka, Junichi Soh","doi":"10.70352/scrj.cr.24-0034","DOIUrl":"10.70352/scrj.cr.24-0034","url":null,"abstract":"<p><strong>Introduction: </strong>Pulmonary vein stenosis (PVS) is known as one of the chronic complications after catheter ablation for atrial fibrillation (AF). The endovascular approach is a less invasive treatment option for PVS, while pulmonary lobectomy is also chosen, especially for patients with pulmonary vein occlusion. Here, we present a case of pulmonary vein occlusion accompanied by pulmonary necrosis that was successfully treated by pulmonary lobectomy.</p><p><strong>Case presentation: </strong>A 65-year-old man underwent catheter ablation for AF along with administration of anticoagulants at his previous hospital. After treatment for 6 months, hemoptysis appeared, and chest computed tomography (CT) showed an infiltration shadow in the lower lobe of the left lung. The patient was admitted to the hospital, and antibiotic therapy was initiated. Despite 10 days of antibiotic therapy, there was no improvement, and the lung infiltration worsened. Therefore, on the 10th day of hospitalization, the patient was transferred to our institute. A bloody lavage fluid was obtained under a bronchoalveolar lavage, suggesting alveolar hemorrhage. Then, a contrast-enhanced chest CT scan confirmed a complete occlusion of the left inferior pulmonary vein with suspicion of pulmonary necrosis. We performed a left lower lobectomy under a video-assisted thoracic approach. The lower lobe of the left lung was dark red with a bad smell, and there was 500-ml bloody pleural fluid. Intraoperative transesophageal echocardiography showed no thrombus in the inferior pulmonary vein. The surrounding tissue of the occlusion area of pulmonary vein was sclerotic and inflammatory with firm adhesions to the vagus nerve. The inferior pulmonary vein was separated on the non-hardening peripheral side of the occlusion point using a stapler. Pathological examination confirmed multiple hemorrhagic infarctions in the parenchyma. The patient was discharged on the 8th postoperative day, and there was no recurrence of hemoptysis at 6 months postoperatively.</p><p><strong>Conclusions: </strong>We successfully treated patients with pulmonary vein occlusion following catheter ablation through pulmonary lobectomy. While endovascular treatment is less invasive and remains the first choice for PVS, lobectomy should be considered in patients with complete occlusion, especially when accompanied by pulmonary necrosis, or in recurrent patients after endovascular treatment.</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/PMC11832220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441972","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":"Incidental T1a Gallbladder Cancer with Signet Ring Cell Carcinoma Following Laparoscopic Cholecystectomy: A Case Report.","authors":"Yoshihito Kitamura, Masakazu Hashimoto, Ryo Nagao, Makoto Shinohara, Keigo Nakashima, Yui Hattori, Michinori Hamaoka, Masashi Miguchi, Toshihiro Misumi, Nobuaki Fujikuni, Satoshi Ikeda, Yasuhiro Matsugu, Takashi Nishisaka, Hideki Nakahara","doi":"10.70352/scrj.cr.24-0078","DOIUrl":"10.70352/scrj.cr.24-0078","url":null,"abstract":"<p><strong>Introduction: </strong>Signet ring cell carcinoma (SRC) of the gallbladder is a rare type of gallbladder cancer. We report a case of SRC of the gallbladder that was characterized by the diffuse presence of SRC on the gallbladder mucosa and diagnosed after cholecystectomy.</p><p><strong>Case presentation: </strong>A 40-year-old man was referred to our department with upper abdominal pain and vomiting. Based on the findings of blood tests, computed tomography, and magnetic resonance imaging, acute cholecystitis was suspected, and emergency laparoscopic cholecystectomy was performed. Intraoperative findings showed mild inflammation. Although the tumor remained within the mucosa, tumor cell infiltration was suspected at the edge of cystic duct pathologically. Although additional endoscopic ultrasound and endoscopic retrograde cholangiography showed that horizontal extension into the residual cholecystic duct was suspected, there was no evidence of invasion into the common bile duct, lymph node metastasis, or distant metastasis. One and a half months after cholecystectomy, the patient underwent extrahepatic bile duct resection, lymph node dissection, and bile duct jejunal anastomosis. The postoperative course was uneventful, and the patient was discharged on the 10th postoperative day. Postoperative pathological analysis showed no obvious residual tumor tissue in the common bile duct or choledochal duct margins, and no metastasis in the submitted lymph nodes. Based on the above, a diagnosis of pT1aN0M0, pStage IA SRC was made. As no lymph node metastasis was observed, it was decided to follow up the patient without initiating postoperative chemotherapy, and the patient has been recurrence-free for 12 months after surgery.</p><p><strong>Conclusions: </strong>We describe an incidentally discovered case of intramucosal SRC diffusely spreading throughout the gallbladder after cholecystectomy for acute cholecystitis.</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/PMC11836008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459112","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":"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":"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":"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":"Laparoscopic Cholecystectomy for a Patient after Percutaneous Endoscopic Gastrostomy due to Myotonic Dystrophy: A Case Report and Literature Review.","authors":"Kei Naito, Takanori Konishi, Tsukasa Takayashiki, Shigetsugu Takano, Daisuke Suzuki, Nozomu Sakai, Isamu Hosokawa, Takashi Mishima, Hitoe Nishino, Kensuke Suzuki, Shinichiro Nakada, Masayuki Ohtsuka","doi":"10.70352/scrj.cr.25-0038","DOIUrl":"10.70352/scrj.cr.25-0038","url":null,"abstract":"<p><strong>Introduction: </strong>Percutaneous endoscopic gastrostomy (PEG) is commonly performed for enteral nutrition in patients with various diseases. However, there are few reports on abdominal surgeries for patients after PEG, and the tips for these procedures have not been established. Specifically, in laparoscopic surgeries of the upper abdomen, a gastrostomy can interfere with the surgical field. In addition, perioperative management of concomitant diseases that require PEG placement, including neuromuscular disorders, is required.</p><p><strong>Case presentation: </strong>A 64-year-old man with a PEG due to malnutrition from myotonic dystrophy was diagnosed with acute cholangitis and choledocholithiasis. After lithotomy during endoscopic retrograde cholangiopancreatography, the patient was scheduled for laparoscopic cholecystectomy for the cholelithiasis. Although the patient had myotonic dystrophy and limited respiratory function, his general condition was deemed acceptable for surgery. Given the potential risk of gastrostomy injury and the need to ensure sufficient working space, the location of the gastrostomy tube was preoperatively confirmed via a computed tomography scan, and precautions were taken to prevent injuries caused by port insertion, forceps manipulation, and pneumoperitoneum during the procedure. Ultimately, the gastrostomy did not interfere with manipulation around the gallbladder, and the surgery was completed without any complications. To manage myotonic dystrophy, general intravenous anesthesia with propofol was administered, with minimal use of muscle relaxants during surgery. Postoperatively, the patient was managed with high nasal flow to reduce respiratory workload, epidural anesthesia to prevent respiratory depression due to pain, and early initiation of aggressive physical therapy. The patient was discharged on postoperative day 4 without complications.</p><p><strong>Conclusions: </strong>Using appropriate surgical strategies, laparoscopic cholecystectomy may be safely performed for patients with myotonic dystrophy after PEG.</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/PMC11972851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796540","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":"Long-Term Survival after Curative Resection for Postoperative Dissemination of Pancreatic Ductal Adenocarcinoma: A Case Report.","authors":"Yoshitaka Shimamaki, Makoto Takahashi, Taku Higashihara, Tatsuya Hayashi, Yasuhiro Morita, Takeshi Azuma, Dai Inoue, Haruka Okada, Masayuki Ohtsuka","doi":"10.70352/scrj.cr.24-0022","DOIUrl":"10.70352/scrj.cr.24-0022","url":null,"abstract":"<p><strong>Introduction: </strong>Pancreatic ductal adenocarcinoma (PDAC) has a very poor prognosis and high mortality. The prognosis for recurrence after surgery is extremely poor. Resection for disseminations of PDAC is not recommended.</p><p><strong>Case presentation: </strong>The patient was a 69-year-old woman with a pancreatic tumor that was detected with computed tomography (CT) during a postoperative colon cancer checkup. She was suspected of having pancreatic body cancer without distant metastasis. Distal pancreatectomy with celiac axis resection was performed. Postoperative pathological examination revealed an invasive ductal adenocarcinoma with lymph node metastasis (pT4N1M0, stage III). Postoperatively, she received adjuvant chemotherapy containing gemcitabine and S-1 for 1 year and 4 months, and S-1 monotherapy for 1 year. Six years and 2 months after the initial surgery, her serum carbohydrate antigen 19-9 level elevated, and CT revealed soft tissue in front of the left kidney. Positron emission tomography/CT also revealed high fluorine-18 fluorodeoxyglucose uptake in the tissue. Accordingly, the patient was diagnosed with dissemination of PDAC. The patient was administered chemotherapy with gemcitabine and S-1. One year and 6 months after the diagnosis of dissemination, CT revealed reduction of the nodule. Therefore, we decided to eliminate this dissemination. A left nephrectomy and partial gastrectomy were performed. Histopathological examination confirmed dissemination of PDAC. The patient refused adjuvant chemotherapy. No evidence of recurrence has been observed for 13 years and 3 months since the initial surgery, and 5 years and 1 month since the resection of the dissemination.</p><p><strong>Conclusions: </strong>This case showed a recurrence of dissemination after radical PDAC surgery, and the patient showed long-term survival without recurrence after dissemination resection. Resection of dissemination may confer long-term survival in selected patients.</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/PMC11975445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804012","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}