Surgical Case Reports最新文献

{"title":"Two Cases of Small Intestinal Follicular Lymphoma Presenting with Intestinal Stricture.","authors":"Akihiro Nakamura, Syuichi Komori, So Murai, Shiori Shibata, Hideyuki Oyama, Kazuhiro Kijima, Yoshikuni Harada, Gaku Kigawa, Takahiro Umemoto, Takafumi Ogawa, Kuniya Tanaka","doi":"10.70352/scrj.cr.25-0108","DOIUrl":"10.70352/scrj.cr.25-0108","url":null,"abstract":"<p><strong>Introduction: </strong>Primary gastrointestinal follicular lymphoma (FL) rarely causes intestinal stricture. We report two cases of small intestinal FL presenting with stricture.</p><p><strong>Case presentation: </strong>Case 1: A 63-year-old man presented with small intestinal obstruction. CT demonstrated ileal wall thickening and enlarged lymph nodes. Partial ileal resection confirmed primary ileal FL, immunohistochemically positive for CD10, CD20, and BCL-2. Case 2: A 79-year-old woman with a 7-year history of jejunal strictures underwent right hemicolectomy for ascending colon cancer and partial jejunal resection. Pathologic examination showed concurrent jejunal FL and colon adenocarcinoma. Immunohistochemical findings were the same as in Case 1. In both patients, postoperative positron-emission tomography-CT showed no residual lymphoma. Both were monitored clinically without chemotherapy.</p><p><strong>Conclusions: </strong>These cases highlight an unusual presentation of follicular lymphoma as a cause of intestinal stricture. Surgical resection provided diagnostic clarity and relief of symptoms. Postoperative treatment was tailored to individual patient characteristics and residual disease status.</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/PMC12183004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476771","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":"Curative Resection of Locally Advanced Colon Cancer that Invading the Common Iliac Artery by Creating an Extra-Anatomical Arterial Bypass: A Case Report.","authors":"Tatsuki Noguchi, Yosuke Fukunaga, Toshio Takayama, Takashi Sakamoto, Shimpei Matsui, Toshiki Mukai, Tomohiro Yamaguchi, Manabu Takamatsu, Takashi Akiyoshi","doi":"10.70352/scrj.cr.25-0125","DOIUrl":"10.70352/scrj.cr.25-0125","url":null,"abstract":"<p><strong>Introduction: </strong>Although complete resection during radical surgery is a crucial prognostic factor for locally advanced colorectal cancer, achieving it is often difficult when the tumor invades the iliac artery system. Herein, we report a successful case requiring resection of the common iliac vessels and vascular reconstruction using a femoral-femoral arterial bypass (F-F bypass), with a comparison to 4 previous cases involving F-F bypass.</p><p><strong>Case presentation: </strong>A 47-year-old male presented with advanced cecal cancer involving the right external iliac artery and vein, right femoral nerve, right ureter, right psoas muscle, and right iliacus muscle. He received systemic chemotherapy with a vascular endothelial growth factor inhibitor for 20 months, and percutaneous drainage of a psoas abscess was performed at a previous hospital. Following these interventions, he was referred to our hospital for radical resection. An F-F bypass was performed prior to abdominal surgery, and en bloc resection of the cecal cancer was subsequently achieved, encompassing the common iliac vessels, femoral nerve, iliacus muscle, psoas muscle, and ureter. The patient showed no signs of recurrence, graft infection, or occlusion 2 years postoperatively.</p><p><strong>Conclusions: </strong>This case demonstrates the potential of systemic chemotherapy followed by radical resection with extra-anatomical arterial bypass in achieving favorable long-term outcomes and satisfactory short-term results.</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/PMC12197852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508375","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":"Descending Necrotizing Mediastinitis as a Deadly Complication Following Laparoscopic Sleeve Gastrectomy: A Case Report.","authors":"Kengo Kadoya, Kotaro Wakamatsu","doi":"10.70352/scrj.cr.25-0213","DOIUrl":"10.70352/scrj.cr.25-0213","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic sleeve gastrectomy is a standard and safe surgical procedure for patients with morbid obesity. A potential complication is piriform fossa injury, which can occur during calibration tube insertion. We encountered a case of descending necrotizing mediastinitis, a serious and progressive infection originating from a piriform fossa injury that was potentially exacerbated by diabetes.</p><p><strong>Case presentation: </strong>A female patient with morbid obesity (body mass index, 41 kg/m²) and a heavy smoking habit underwent laparoscopic sleeve gastrectomy and was discharged without any immediate postoperative complications. Six weeks later, the patient presented with severe chest and back pain that required continuous fentanyl injection for pain management. Initially, staple line leakage, commonly observed after sleeve gastrectomy, was suspected. However, her condition progressively worsened, and she was admitted to the ICU. An enhanced abdominal CT scan extending to the cervical region revealed a cervical abscess extending to the lower mediastinal region. The patient was diagnosed with descending necrotizing mediastinitis. Given the rarity of this disease, we hypothesized that her smoking habits exacerbated the piriform fossa injury caused by the calibration tube used during gastrectomy. Following the diagnosis, emergency abscess drainage surgery was performed, and the patient was successfully treated.</p><p><strong>Conclusions: </strong>This is the 1st reported case of descending necrotizing mediastinitis as a fatal complication of laparoscopic sleeve gastrectomy, which was identified and treated successfully owing to the timely and expanded use of an enhanced CT scan that included the cervical region. Traditionally, the cervical area has not been routinely examined when diagnosing complications following abdominal surgery, underscoring the importance of a comprehensive imaging approach from the neck to the abdomen to detect complications after sleeve gastrectomy.</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/PMC12197851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508376","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":"Curatively Resected Mesenteric Lymph Node Recurrence of Ewing Sarcoma.","authors":"Ayaka Tachikawa, Kazushige Kawai, Akira Dejima, Sakiko Nakamori, Hiroki Kato, Soichiro Natsume, Misato Takao, Hiroshi Shiratori, Daisuke Nakano, Toru Motoi, Toshihide Hirai","doi":"10.70352/scrj.cr.25-0386","DOIUrl":"10.70352/scrj.cr.25-0386","url":null,"abstract":"<p><strong>Introduction: </strong>We report herein a rare case of Ewing sarcoma that metastasized to the mesenteric lymph nodes.</p><p><strong>Case presentation: </strong>The patient was a 40-year-old female with Ewing sarcoma of the 1st lumbar vertebra, which was treated with chemotherapy and stereotactic radiotherapy. No local recurrence or distant metastasis was observed during the first 3-year follow-up period after treatment. Three years later, she presented to the emergency department with muscle weakness. A 60-mm lesion in the right parieto-occipital lobe of the brain and a 40-mm tumor in the small bowel mesentery were detected. Emergency craniotomy confirmed a cerebral metastasis of the Ewing sarcoma. The patient subsequently underwent 6 cycles of ifosfamide (IFM) monotherapy, which reduced the mesenteric tumor to 10 mm in size. Surgical resection was performed with clear margins. Histopathological examination of the mesenteric lymph nodes confirmed the findings of the emergency craniotomy. The patient continues to receive IFM monotherapy as adjuvant chemotherapy. Although brain metastases developed at postoperative months 1, 6, and 10, no intra-abdominal recurrence was observed during the 1-year surveillance period.</p><p><strong>Conclusions: </strong>While Ewing sarcoma can metastasize to isolated distant lymph nodes, oligometastases can be treated with surgical resection.</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/PMC12370414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969846","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":"Intraoperative Pneumatocele Formation during Liver Transplantation for Polycystic Liver Disease: Successful Non-Operative Management.","authors":"Satoshi Takada, Shinichi Nakanuma, Renta Kobori, Takahiro Araki, Kazuki Kato, Abdulrahman Nasr, Ryohei Takei, Daisuke Saito, Kaichiro Kato, Mitsuyoshi Okazaki, Isamu Makino, Shintaro Yagi","doi":"10.70352/scrj.cr.25-0341","DOIUrl":"10.70352/scrj.cr.25-0341","url":null,"abstract":"<p><strong>Introduction: </strong>Liver transplantation for polycystic liver disease (PLD) poses significant intraoperative risks due to the presence of a massively enlarged liver. We report a rare case of intraoperative pneumothorax and pneumatocele formation during total hepatectomy, which was successfully managed with a non-operative approach.</p><p><strong>Case presentation: </strong>A female patient in her 40s with a history of autosomal dominant polycystic kidney disease presented with progressive liver cyst enlargement (Gigot type III, Qian classification Grade 4), which led to decreased activities of daily living and intracystic hemorrhage. The patient underwent a deceased-donor liver transplantation. During mobilization of the liver from the right side of the diaphragm, the patient experienced sudden onset of pneumothorax. Incision of the diaphragm revealed a cystic structure containing a hematoma, suggesting pneumatocele formation. The pneumatocele was not resected during the ongoing operation; instead, thoracic drainage was performed as the primary intervention. Postoperatively, no air leakage was observed, and the thoracic drain was successfully removed on POD 12. The pneumatocele, which measured approximately 10 × 10 × 7 cm, showed no signs of infection, and was monitored without additional surgical intervention. On POD 19, a fever prompted further evaluation, and CT-guided cyst aspiration for culture was performed, which revealed no evidence of infection. Acute T-cell-mediated rejection was observed on POD 27, and a steroid pulse was administered, but even after that, the pneumatocele gradually decreased in size without any signs of infection.</p><p><strong>Conclusions: </strong>A pneumatocele is an uncommon but important consideration during liver transplantation for PLD, potentially resulting from barotrauma related to abrupt changes in intrathoracic pressure during hepatectomy and mechanical ventilation. Considering the risk of infection in immunosuppressed patients, close monitoring is essential. On the contrary, surgical resection also carries the risk of pulmonary or bronchial fistulae; therefore, careful consideration is required. This case demonstrates that non-operative management with careful observation can be an effective strategy 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/PMC12414612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024308","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":"Pancreatic Pseudocyst Filled with Biliary Stones Mimicking a Pancreatic Groove Tumor: A Case Report.","authors":"Hiromitsu Imataki, Masaoki Hattori, Akihiro Hirata, Akihiro Tomida, Jumpei Shibata, Marika Suzuki, Hideharu Shintomi, Motoi Yoshihara, Tomoaki Takeyama, Yoshikazu Mizoguchi","doi":"10.70352/scrj.cr.25-0202","DOIUrl":"10.70352/scrj.cr.25-0202","url":null,"abstract":"<p><strong>Introduction: </strong>Reports of fistulas in the common bile duct caused by pancreatic pseudocysts have increased. However, to the best of our knowledge, no prior report has described pseudocysts filled with microbiliary stones that were difficult to differentiate from neoplastic lesions.</p><p><strong>Case presentation: </strong>A 64-year-old man presented with groove pancreatitis attributable to heavy alcohol consumption and a hypovascular mass in the groove area with duodenal bleeding. The lesion, which was initially considered a pancreatic groove tumor with groove pancreatitis, was treated with subtotal stomach-preserving pancreaticoduodenectomy. However, a post-surgical pathological analysis revealed that it was a pancreatic pseudocyst in the groove area containing bilirubin calcium stones and pancreatic stones.</p><p><strong>Conclusions: </strong>Cases comprising fistula formation in the common bile duct are rare. A pancreatic pseudocyst that formed a fistula with the common bile duct was suspected in the present case. This case was unique because the pseudocyst was filled with microbiliary stones. This report highlights the difficulty in differentiating a pseudocyst filled with bilirubin calcium stones from a neoplastic lesion and underscores the importance of the accurate diagnosis and management of this rare pathology.</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/PMC12426864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065526","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":"Massive Lymphedema in the Calf Complicated by Severe Skin Fibrosclerosis.","authors":"Kotaro Suehiro, Hiroyuki Takasu, Seiko Fujino, Takasuke Harada, Makoto Samura, Yuriko Takeuchi, Takahiro Mizoguchi, Hiroshi Kurazumi, Ryo Suzuki, Kimikazu Hamano","doi":"10.70352/scrj.cr.25-0375","DOIUrl":"10.70352/scrj.cr.25-0375","url":null,"abstract":"<p><strong>Introduction: </strong>Lymphedema is generally managed with conservative therapy. However, in cases of severe fibrosclerotic lymphedema, debulking surgery is required, although rarely. We present a case of massive lymphedema in the left calf complicated by severe skin fibrosclerosis that was successfully managed with debulking surgery.</p><p><strong>Case presentation: </strong>A 58-year-old woman presented to our clinic with bilateral leg swelling, which was particularly massive in the left calf. She could hardly walk independently and experienced cellulitis 2 to 4 times a year. The patient was admitted, and aggressive decongestion with compression therapy was attempted initially. However, this was unsuccessful due to severe skin hardening caused by abnormal dermal thickening. We then performed partial subcutaneous tissue resection and wrapping with the redundant skin, but this resulted in extensive skin necrosis. Finally, resection of the whole skin and subcutaneous tissue down to the deep fascia in the left calf was performed, followed by split-thickness skin grafting harvested from the left thigh. At present, one year after the surgery, the patient is capable of performing light exercise and has not experienced a recurrence of cellulitis.</p><p><strong>Conclusions: </strong>When preoperative conservative therapy is unsuccessful due to severe skin fibrosclerosis, earlier surgical intervention, including debulking, is beneficial in the management of massive lymphedema.</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/PMC12404784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993350","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":"Late Open Conversion with Graft Replacement after Endovascular Aortic Repair along with Removal of a Giant Ovarian Tumor: A Case Report.","authors":"Takuma Mikami, Daisuke Akashi, Chikara Shiiku","doi":"10.70352/scrj.cr.25-0014","DOIUrl":"10.70352/scrj.cr.25-0014","url":null,"abstract":"<p><strong>Introduction: </strong>There are many reports of late open conversion after endovascular aortic repair (EVAR). Herein, we report the case of an octogenarian patient with a giant ovarian tumor who underwent ovarian tumor resection and open conversion with graft replacement simultaneously via laparotomy.</p><p><strong>Case presentation: </strong>An 86-year-old woman underwent EVAR 7 years ago. After surgery, persistent type II endoleaks from the lumbar arteries were detected. The diameter of the aneurysmal sac gradually increased. Although we attempted to perform coil embolization of the lumbar arteries one year ago, the procedure was unsuccessful, and type II endoleaks persisted, further dilating the aneurysmal sac. One month earlier, the patient experienced lower abdominal pain, which was thought to be a symptom of an ovarian tumor. Surgery to remove the ovarian tumor was considered. Although open conversion was considered, laparotomy was difficult due to the presence of the giant ovarian tumor. Therefore, we decided to perform open conversion with aortic graft replacement in addition to salpingo-oophorectomy. Surgery was performed via a median laparotomy, and graft replacement of the infrarenal abdominal aortic aneurysm was performed after salpingo-oophorectomy. The postoperative course of the patient was uneventful, and she was discharged.</p><p><strong>Conclusions: </strong>We performed a salpingo-oophorectomy and late open conversion with graft replacement after EVAR in an octogenarian patient with a giant ovarian tumor and achieved favorable results.</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/PMC12404785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993363","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":"Liver Transplantation for Metabolic Dysfunction-Associated Steatotic Liver Disease after Pancreaticoduodenectomy.","authors":"Takeshi Kano, Ryugen Takahashi, Nobuhisa Akamatsu, Yujiro Nishioka, Yuichiro Mihara, Akihiko Ichida, Takeshi Takamoto, Yoshikuni Kawaguchi, Kiyoshi Hasegawa","doi":"10.70352/scrj.cr.25-0264","DOIUrl":"10.70352/scrj.cr.25-0264","url":null,"abstract":"<p><strong>Introduction: </strong>Steatotic liver disease (SLD) may develop in some patients after pancreaticoduodenectomy (PD), but no cases requiring liver transplantation (LT) have been reported to date. Here, we present two cases in which LT was performed for decompensated liver cirrhosis (LC) after PD.</p><p><strong>Case presentation: </strong>Case 1 was a 53-year-old man with obesity, metabolic-associated SLD (MASLD), and diabetes mellitus. The patient underwent PD for an intraductal papillary mucinous neoplasm. His liver function worsened and he developed decompensated LC 6 years later, eventually requiring LT. Due to poor mobility of the jejunal limb caused by severe adhesions and the presence of a pancreatojejunostomy, a choledochojejunostomy was performed at the more distal site of the common bile duct than usual. He developed hemobilia and biliary leakage but was discharged on POD 107. Liver function has been good for 2 years after LT without MASLD recurrence, although endoscopic treatment is periodically required for biliary stricture. Case 2 was a 46-year-old man with obesity, SLD, and a history of excessive alcohol consumption. The patient underwent PD for duodenal cancer. Five years later, he developed decompensated LC, which required living-donor LT. For biliary reconstruction, a new jejunal limb was created and elevated. He was discharged on POD 79. He has repeatedly developed cholangitis, but his liver function has been good for 6 years without SLD recurrence.</p><p><strong>Conclusions: </strong>Steatohepatitis can worsen following PD and may lead to decompensated LC, ultimately requiring LT. Therefore, screening for steatohepatitis and its risk factors prior to PD is essential, and prophylaxis should be considered. LT after PD presents surgical challenges and biliary reconstruction with some procedural modifications.</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/PMC12422816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041265","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":"Severe Mitral Stenosis and Regurgitation Due to Bioprosthetic Valve Failure with Massive Pannus.","authors":"Ryota Hara, Sho Torii, Joji Ito, Yohei Ohno, Minoru Tabata","doi":"10.70352/scrj.cr.24-0095","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0095","url":null,"abstract":"<p><strong>Introduction: </strong>Bioprosthetic valve failure after mitral valve replacement is a well-recognized phenomenon, with pannus overgrowth being one notable cause. The standard treatments include redo surgical mitral valve replacement and the less invasive transcatheter treatment, mitral valve-in-valve. However, the feasibility and safety of performing mitral valve-in-valve when pannus overgrowth has reduced the valvular opening to a mere pinhole remains uncertain.</p><p><strong>Case presentation: </strong>A 76-year-old woman, who had previously undergone mitral valve replacement, was admitted for congestive heart failure. Severe mitral stenosis and severe mitral regurgitation were diagnosed using transthoracic echocardiography. During redo mitral valve replacement, we observed that the prosthetic valve leaflets on the left atrial side were almost entirely covered with pannus tissue, leaving only a central pinhole for blood flow. Macroscopic and microscopic examination of the bioprosthesis revealed accordion-like leaflet deformation on the ventricular side.</p><p><strong>Conclusions: </strong>Although the transcatheter valve-in-valve procedure is recognized as a less invasive treatment option for degenerated biological valves, in certain cases such as ours, open surgery becomes imperative as the most appropriate 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/PMC12014392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027964","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}