Surgical Case Reports最新文献

{"title":"Delayed Resolution of Hoarseness following Bronchial Artery Embolization for a Bronchial Artery Aneurysm: A Case Report.","authors":"Hideomi Ichinokawa, Kaori Shimizu, Hiroshi Ikeuchi, Yukio Watanabe, Kazuya Takamochi, Kenji Suzuki","doi":"10.70352/scrj.cr.26-0528","DOIUrl":"https://doi.org/10.70352/scrj.cr.26-0528","url":null,"abstract":"<p><strong>Introduction: </strong>Bronchial artery aneurysms (BAAs) are rare vascular lesions that require prompt treatment because of the risk of rupture, which can be life-threatening regardless of their size. Hoarseness caused by recurrent laryngeal nerve (RLN) palsy secondary to BAA is extremely uncommon, and delayed clinical improvement after treatment has rarely been reported. Herein, we report a case of a mediastinal BAA presenting with hoarseness that gradually resolved following bronchial artery embolization (BAE).</p><p><strong>Case presentation: </strong>A 73-year-old woman presented with hoarseness persisting for 8 months. Laryngoscopic examination revealed left vocal cord paralysis, and contrast-enhanced CT demonstrated a 36-mm mediastinal BAA associated with markedly dilated and tortuous bronchial arteries and bronchiectatic changes in the left lower lobe. The aneurysm was deemed to be responsible for compression of the left RLN. BAE was subsequently conducted using coil embolization of both the aneurysm sac and the feeding artery. The postoperative course was uneventful, and the patient was discharged on POD 3. Follow-up CT at 7 months revealed a reduction in aneurysm diameter from 36 to 25 mm, with near-complete disappearance of intra-aneurysmal blood flow. Hoarseness gradually improved during follow-up and completely resolved 17 months following embolization.</p><p><strong>Conclusions: </strong>RLN palsy caused by BAA is rare. Postoperative laryngoscopic confirmation of vocal cord motion was unavailable. However, this case demonstrates that hoarseness may gradually resolve long after endovascular treatment. Progressive aneurysm shrinkage following embolization may have gradually relieved compression of the RLN, thereby contributing to the delayed improvement in hoarseness. Therefore, long-term follow-up should be considered in patients with BAA presenting with hoarseness.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115179","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":"Robot-Assisted Reinforcement with a Free Pericardial Fat Pad for Double-Lumen Tube-Related Injury of the Left Main Bronchus Incidentally Detected during Lobectomy: A Case Report.","authors":"Michihito Toda, Tomohiro Yasukawa, Ryuhei Morita, Aya Yamamoto, Takashi Iwata","doi":"10.70352/scrj.cr.25-0815","DOIUrl":"10.70352/scrj.cr.25-0815","url":null,"abstract":"<p><strong>Introduction: </strong>Tracheobronchial injury associated with double-lumen tube (DLT) placement is rare and typically diagnosed postoperatively. Intraoperative detection of subtle airway lesions is extremely uncommon. We report a case of DLT-related injury of the left main bronchus that was incidentally detected during robot-assisted thoracic surgery (RATS) and successfully reinforced with a free pericardial fat pad.</p><p><strong>Case presentation: </strong>An 82-year-old man underwent robot-assisted left lower lobectomy and mediastinal lymph node dissection for suspected primary or metastatic lung cancer. During subcarinal lymph node dissection, a bronchial injury was identified at the distal end of the left main bronchus, at the junction between the membranous and cartilaginous portions. The bronchial wall showed a longitudinal laceration; the muscular layer was torn, but the mucosa remained barely intact. The balloon of the blue bronchial tube could be seen through the mucosa within the lumen. Bronchoscopy revealed a bronchial injury at the distal end of the left main bronchus, at the junction between the membranous and cartilaginous portions, likely caused by the DLT cuff. From the luminal side, mucosal redness and protrusion into the lumen-presumed to be caused by increased intrathoracic pressure-were observed, raising suspicion of disruption limited to the outer bronchial wall structures, such as the smooth muscle layer, with the mucosa spared. Following lobectomy, a free pericardial fat pad harvested from the anterior mediastinum was applied to the injured site with bioadhesive and sutured to be covered with mediastinal pleura. Postoperative bronchoscopy and CT revealed stable graft attachment without evidence of leakage or infection. The patient recovered uneventfully and was discharged on POD 7.</p><p><strong>Conclusions: </strong>RATS enabled early detection and safe repair of a subtle airway injury that otherwise may have been overlooked. Free adipose tissue reinforcement is a feasible option for managing DLT-related membranous thinning. This case highlights the risks of DLT-related airway injury and the safe management strategies achievable using RATS.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781122","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":"Inguinal Lymph Node Metastasis from a Sigmoid Stomal Cancer: A Case Report.","authors":"Kenji Shirakawa, Hironori Kobayashi, Takahiro Ishii, Kosuke Shibata, Norimasa Kuraoka, Kazuhiro Toyota, Raita Yano, Yasushi Hashimoto, Yoshihiro Sakashita, Yoshiaki Murakami, Katsunari Miyamoto","doi":"10.70352/scrj.cr.26-0363","DOIUrl":"10.70352/scrj.cr.26-0363","url":null,"abstract":"<p><strong>Introduction: </strong>Inguinal lymph node metastasis from colon adenocarcinoma is extremely rare. Cancer arising from a stoma is relatively rare, and cases with lymph node metastasis including inguinal lymph node metastasis are even rarer. Due to its rarity, there is no established surgical procedure for stomal cancer. Herein, we report a rare case of inguinal lymph node metastasis from a sigmoid stomal cancer, successfully treated by inguinal lymph node dissection.</p><p><strong>Case presentation: </strong>An 87-year-old man had undergone abdominoperineal resection for rectal cancer when he was aged 28 years. He was referred to our hospital due to complaints of swelling and bleeding from the colostomy. Colonoscopy revealed a hemorrhagic type 2 tumor at the colostomy site. Biopsy revealed a moderately differentiated tubular adenocarcinoma. The diagnosis was adenocarcinoma occurring from a sigmoid colostomy. We performed a laparoscopic sigmoid colectomy with D3 lymph node dissection and colostomy reconstruction. The pathological stage was pT2N0M0 (pStage I). Contrast-enhanced CT performed 6 months postoperatively demonstrated enlargement of the previously noted left inguinal lymph node. Left inguinal lymph node dissection was performed because inguinal lymph node metastasis from sigmoid stomal cancer was suspected. Histopathological examination revealed moderately differentiated tubular adenocarcinoma. Because the histological features resembled those of the primary stomal cancer, the lesion was diagnosed as inguinal lymph node metastasis from sigmoid stomal cancer. Twenty-two months after the surgery, he has survived without recurrence.</p><p><strong>Conclusions: </strong>This case represents the first reported case of inguinal lymph node metastasis from a sigmoid stomal cancer without abdominal wall or skin invasion. Altered lymphatic drainage associated with long-standing stoma construction may have contributed to the development of inguinal lymph node metastasis, which might be treated by inguinal lymph node dissection.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13572242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971460","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 Resection of Incidentally Detected Early-Stage Synchronous Duodenal and Jejunal Gastrointestinal Stromal Tumors in a Patient with Neurofibromatosis Type 1.","authors":"Kazuhide Urabe, Akihiko Oshita, Daisuke Takei, Meguri Tanimoto, Yasutomo Ojima, Tetsuya Kagawa, Masaki Inoue, Shosuke Kitamura, Keiji Hanada, Shuji Yonehara, Shinya Takahashi, Yasunobu Tanimoto","doi":"10.70352/scrj.cr.25-0830","DOIUrl":"10.70352/scrj.cr.25-0830","url":null,"abstract":"<p><strong>Introduction: </strong>Although gastrointestinal stromal tumors (GISTs) are more common in neurofibromatosis type 1 (NF1) than in sporadic disease, the role of screening has not been well established. This case report details the successful laparoscopic resection for duodenal and jejunal GISTs detected during a general health check-up in an asymptomatic early-stage patient.</p><p><strong>Case presentation: </strong>A 47-year-old female was diagnosed with NF1 during childhood. Abdominal ultrasonography performed during a general health check-up revealed a mass near the liver, in the region extending from the duodenal bulb to the hepatoduodenal ligament. Contrast-enhanced CT revealed the presence of a second mass in the jejunum. No clinical symptoms or findings, such as anemia or obstruction, were observed. Laparoscopic surgery was performed for both diagnostic and therapeutic purposes. Based on intraoperative findings, enucleation was selected for the periduodenal tumor partially attached to the duodenal wall, and partial intestinal resection was performed for the jejunal lesion. Capsule rupture did not occur in either tumor. Histopathology confirmed a 2.5-cm duodenal GIST and a 3.5-cm jejunal GIST. Both tumors showed a mitotic count of <1 per 50 high-power fields and were classified as belonging to the low-risk group according to established recurrence risk systems. The patient is currently under surveillance with no recurrence observed 2 years and 7 months postoperatively.</p><p><strong>Conclusions: </strong>This case report describes an asymptomatic, early-stage duodenal and jejunal GISTs associated with NF1 that was successfully treated by minimally invasive laparoscopic surgery. Although routine screening is not currently recommended and a single case cannot establish its benefit, this case suggests a potential role for risk-based early detection strategies in selected patients.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13100507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781662","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 Low Anterior Resection with Ureterectomy and Ileal Ureter Interposition for Ureter-Invading Locally Recurrent Rectal Cancer: A Case Report.","authors":"Takumi Yamamoto, Yusuke Kitagawa, Hisanori Miki, Jun Watanabe, Yosuke Fukunaga","doi":"10.70352/scrj.cr.26-0394","DOIUrl":"10.70352/scrj.cr.26-0394","url":null,"abstract":"<p><strong>Introduction: </strong>Locally recurrent rectal cancer (LRRC) with ureteral invasion is surgically demanding because curative-intent resection often requires en bloc ureterectomy, and urinary diversion may be considered. Although ileal interposition for ureteral reconstruction can preserve renal function when direct ureterocystostomy or uretero-ureterostomy is not possible, reports of this procedure for LRRC remain scarce.</p><p><strong>Case presentation: </strong>An 81-year-old man underwent laparoscopic high anterior resection for rectosigmoid adenocarcinoma (pT3N1bM0, pStage IIIB) in March 2020, and adjuvant chemotherapy was not administered because of the patient's preference. Twenty months later, a metachronous liver metastasis was detected and resected by laparoscopic partial hepatectomy. Surveillance imaging in 2023 revealed an approximately 20-mm tumor consistent with recurrence located anterior to the left iliac bifurcation, involving the left ureter at the common iliac crossing and causing hydronephrosis, for which percutaneous nephrostomy was performed for decompression. The tumor was RAS-mutant, BRAF wild-type, and microsatellite stable. FOLFOX plus bevacizumab was selected as a standard systemic treatment option for recurrent colorectal cancer with RAS mutation, but the treatment was discontinued due to toxicity, mainly fatigue. Because the disease remained confined to the pelvis without distant metastasis on PET/CT and first-line chemotherapy became difficult to continue, curative-intent resection was planned. Curative-intent laparoscopic low anterior resection with en bloc ureterectomy was performed. Because tension-free ureterocystostomy or uretero-ureterostomy was considered difficult due to limited tissue mobility, a short-segment isoperistaltic ileal ureter interposition was constructed. Postoperative paralytic ileus resolved conservatively (Clavien-Dindo grade II). The urinary catheter, ureteral stent, and nephrostomy tube were removed on PODs 8, 32, and 49, respectively, without deterioration of renal function. No adjuvant therapy was administered. The patient remained free of clinical and radiological recurrence 12 months after surgery.</p><p><strong>Conclusions: </strong>Laparoscopic salvage resection with en bloc ureterectomy and ileal ureter interposition may be a feasible renal-preserving option for selected patients with ureter-invading LRRC.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921043","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 Anterior Gastropexy with a Technical Modification Using the Round Ligament for Internal Hernia of the Stomach after Sigmoid Colostomy: A Case Report.","authors":"Takahiro Saito, Susumu Fukahori, Koji Hontani, Takashi Kuroda, Sato Nishida, Tomoya Matsuda, Taku Maejima, Seiichi Minami, Masahiro Hagiwara, Satoshi Hirano","doi":"10.70352/scrj.cr.26-0393","DOIUrl":"10.70352/scrj.cr.26-0393","url":null,"abstract":"<p><strong>Introduction: </strong>Internal hernia involving the stomach associated with a sigmoid colostomy is extremely rare. The hernia defect is typically located between the colostomy limb and the left abdominal wall. Because only a few cases have been reported, no standardized management strategy has been established, particularly in patients in whom immediate colostomy closure is not appropriate.</p><p><strong>Case presentation: </strong>A woman in her 70s underwent a laparoscopic Hartmann's procedure with sigmoid colostomy for obstructive sigmoid colon cancer with para-aortic lymph node metastasis. On POD 9, the patient developed acute abdominal distension and vomiting. CT revealed marked gastric dilatation due to incarceration of the stomach in the space between the colostomy limb and the left lateral abdominal wall. Nasogastric decompression relieved the incarceration, and elective laparoscopic surgery was performed 4 days later to prevent recurrence. Because the remaining sigmoid colon was short and colostomy reconstruction would have required mobilization of the splenic flexure, anterior gastropexy was performed using a technical modification in which the prepyloric antrum was fixed to the round ligament of the liver, while the gastric body was fixed to the upper abdominal wall using nonabsorbable barbed sutures. The postoperative course was uneventful. The patient subsequently received systemic chemotherapy, followed by para-aortic lymph node dissection, during which no adhesiolysis involving the stomach or gastropexy site was required. No colostomy revision, fixation of the colostomy limb, or closure of the lateral defect was performed because staged colostomy closure was planned. Colostomy closure was subsequently recommended, but the patient declined additional surgery. No recurrence was observed during 24 months of follow-up.</p><p><strong>Conclusions: </strong>Internal hernia involving the stomach after sigmoid colostomy is extremely rare, and its optimal management remains unclear. Laparoscopic anterior gastropexy with a technical modification using the round ligament may be a feasible and minimally invasive option in selected patients, potentially maintaining physiological gastroduodenal alignment and avoiding excessive angulation of the gastric outlet.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115194","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":"Adult Descending Colon Duplication Mimicking Colon Cancer: A Rare Case Report.","authors":"Shosaburo Oyama, Shuichi Tobinaga, Kazuto Shigematsu, Yoshihito Shibata","doi":"10.70352/scrj.cr.26-0089","DOIUrl":"10.70352/scrj.cr.26-0089","url":null,"abstract":"<p><strong>Introduction: </strong>Intestinal duplication is a rare congenital anomaly characterized by the presence of a segment of intestinal tissue containing both mucosal and muscular layers adjacent to the normal alimentary tract. Intestinal duplication is most commonly diagnosed in infancy and is rarely observed in adults. Colonic duplications are particularly uncommon and may be difficult to distinguish from malignancy. Herein, we report a rare case of an adult descending colon duplication that was suspected preoperatively to be colon cancer.</p><p><strong>Case presentation: </strong>A 75-year-old man with a history of surgery for prostate cancer and a left inguinal hernia was referred to our department of gastroenterological surgery. Preoperative abdominal CT revealed a circumferential mass in the descending colon. Colonoscopy revealed a circumferentially elevated lesion approximately 30 cm from the anal verge with luminal narrowing that prevented scope passage. A biopsy revealed no malignancy. Owing to intestinal stenosis caused by the mass and suspicion of malignancy, we performed a laparoscopic left hemicolectomy with D3 lymph node dissection. Intraoperatively, the mass was adhered to 4 segments of the small intestine, necessitating partial small bowel resection. Histopathological examination revealed a tubular structure on the serosal side of the native colon lined with colonic-type mucosa and possessing its own muscularis propria, continuous with the normal colonic wall. These findings were consistent with intestinal duplication. The postoperative course was uneventful, and the patient was discharged on the 13th POD. No recurrence was detected on follow-up CT at 18 months postoperatively.</p><p><strong>Conclusions: </strong>Colonic duplication in adults is extremely rare and may mimic colorectal carcinoma on imaging and endoscopy. Surgical resection provides both definitive diagnosis and curative treatment.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13121040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781704","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":"Nodular Regenerative Hyperplasia Suggested by Noninvasive Findings during Adjuvant Trastuzumab Emtansine Therapy for Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer.","authors":"Hideyuki Yamada, Rikiya Nakamura, Shouko Hayama, Reina Okuya, Keiko Oshida, Masaki Oshida, Hideyuki Hashimoto, Yasushi Ito, Yoshito Ota, Atushi Yoshii, Takahito Masuda, Akinobu Araki, Kentaro Sudo","doi":"10.70352/scrj.cr.26-0344","DOIUrl":"10.70352/scrj.cr.26-0344","url":null,"abstract":"<p><strong>Introduction: </strong>Trastuzumab emtansine (T-DM1) is the standard adjuvant therapy for patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer with residual invasive disease after neoadjuvant chemotherapy. It is generally well tolerated. However, nodular regenerative hyperplasia (NRH), presenting as newly detected hepatic nodules, is a rare hepatic adverse event of T-DM1 that requires differentiation from liver metastasis. Here, we report a patient with HER2-positive breast cancer who developed new hepatic nodules during adjuvant T-DM1 therapy; NRH was suspected based on noninvasive findings.</p><p><strong>Case presentation: </strong>A 58-year-old woman was referred for the evaluation of a right breast mass. Her past medical history was notable only for first-degree atrioventricular block, and her mother had a history of colon cancer. Imaging showed a 3.2-cm mass, and core needle biopsy revealed an invasive ductal carcinoma that was hormone receptor-positive and HER2-positive; the clinical stage was cT2N0M0 (stage IIA). She received neoadjuvant dose-dense doxorubicin/cyclophosphamide, followed by docetaxel plus trastuzumab and pertuzumab, and then underwent breast-conserving surgery with a sentinel lymph node biopsy. Residual invasive disease was identified (pathological complete response was not achieved). After whole-breast irradiation, T-DM1 and an aromatase inhibitor were administered as adjuvant therapy. After T-DM1 initiation, grade 1 transaminase elevation and grade 1 or 2 thrombocytopenia developed. Following 9 cycles of T-DM1, gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced MRI demonstrated new nodules in hepatic segments III and IV. Various hepatic lesions, including liver metastases and primary hepatic tumors, were considered in the differential diagnosis, but the imaging findings were atypical. T-DM1-associated NRH was also considered; however, at the patient's request, a liver biopsy was not performed, and the lesions were followed up with imaging. The patient completed 14 cycles of T-DM1. Post-treatment imaging revealed mild splenomegaly and a coarse hepatic parenchymal texture, suggestive of mild portal hypertension, while the hepatic nodules remained stable. One year after the completion of T-DM1, her liver enzyme levels and platelet counts improved, and there was no evidence of breast cancer recurrence.</p><p><strong>Conclusions: </strong>When new hepatic nodules develop during adjuvant T-DM1 therapy, T-DM1-associated NRH should be considered in the differential diagnosis. Although histological confirmation is required for a definitive diagnosis, noninvasive findings such as thrombocytopenia, splenomegaly, atypical EOB-MRI findings, and lesion stability may raise suspicion of NRH and help distinguish it from liver metastases.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040557","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":"Pylorus-Preserving Pancreatoduodenectomy for Ampullary Carcinoma after Esophagectomy with Retrosternal Ileocolonic Interposition: A Case Report.","authors":"Yutaro Naka, Hisashi Murakami, Takuma Okada, Satoshi Okubo, Masaru Matsumura, Masako Ikemura, Masaki Ueno, Junichi Shindoh, Masaji Hashimoto","doi":"10.70352/scrj.cr.26-0356","DOIUrl":"10.70352/scrj.cr.26-0356","url":null,"abstract":"<p><strong>Introduction: </strong>Pancreatoduodenectomy after esophagectomy with an ileocolonic interposition is technically challenging because perfusion of both the remnant stomach and the interposed ileocolonic conduit must be preserved. Although pancreatic head resection after proximal gastrectomy or gastric conduit reconstruction has been reported, pylorus-preserving pancreatoduodenectomy (PPPD) after an ileocolonic interposition has not been previously reported. We report a case of PPPD after an ileocolonic interposition in which both the right gastroepiploic vessels and the middle colic arterial arcade were preserved, and intraoperative indocyanine green (ICG) fluorescence imaging was used to confirm adequate perfusion.</p><p><strong>Case presentation: </strong>A 78-year-old man presented at our hospital with fatigue. Contrast-enhanced CT revealed a localized ampullary tumor with upstream dilatation of the common bile duct and main pancreatic duct, without distant metastases or significant lymphadenopathy. Eight years earlier, he had undergone thoracoabdominal esophagectomy with 3-field lymph node dissection and retrosternal ileocolonic interposition for esophageal squamous cell carcinoma in our hospital. In that setting, perfusion of the remnant stomach depended on the right gastroepiploic vascular territory, whereas the interposed ileocolonic conduit was supplied by the middle colic arterial arcade. Therefore, PPPD was planned with preservation of both vascular territories. Careful dissection enabled preservation of the gastroduodenal artery, right gastroepiploic vessels, and the mesentery carrying the middle colic vessels. Intraoperative ICG fluorescence imaging confirmed adequate perfusion of both the remnant stomach and the ileocolonic conduit. The postoperative course was uneventful, and the patient was discharged on POD 14. Histopathological examination revealed an ampullary adenocarcinoma (pT2N0M0, stage IB). The patient remained alive without recurrence 18 months after surgery.</p><p><strong>Conclusions: </strong>This case demonstrates that PPPD after esophagectomy with an ileocolonic interposition is feasible in select patients. Preservation of both the right gastroepiploic vessels and the middle colic arterial arcade is essential to maintain perfusion of the remnant stomach and the ileocolonic conduit. Intraoperative ICG fluorescence imaging is useful for the real-time confirmation of perfusion in both vascular territories.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040571","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 Requiring Differential Diagnosis of Synovitis, Acne, Pustulosis, Hyperostosis, Osteomyelitis Syndrome in the Evaluation of Bone Lesions in Early Breast Cancer.","authors":"Mayuka Mori, Masayuki Kikuchi, Rika Miyabe, Hidenori Kita, Junko Kobayashi, Koji Atsuta, Tsunehiro Shintani","doi":"10.70352/scrj.cr.25-0822","DOIUrl":"10.70352/scrj.cr.25-0822","url":null,"abstract":"<p><strong>Introduction: </strong>Synovitis, Acne, Pustulosis, Hyperostosis, Osteomyelitis (SAPHO) syndrome is a rare disorder characterized by bone lesions that primarily affect the anterior thoracic wall. These lesions can be difficult to differentiate from bone metastases of malignant tumors. Reports of SAPHO syndrome complicating breast cancer are scarce, necessitating careful diagnostic consideration.</p><p><strong>Case presentation: </strong>An 81-year-old woman with a past history of palmoplantar pustulosis presented with of a mass in her right breast. After a biopsy and diagnosis of mucinous carcinoma of the right breast, CT and bone scintigraphy were performed to check for distant metastases. This screening revealed multiple sclerotic bone lesions and abnormal radiotracer uptake, including a bull's head sign at the sternoclavicular joint, a feature distinguishing it from breast cancer bone metastases. Considering her history of skin lesions, clinical course, and characteristic imaging findings, a multidisciplinary team concluded that these bone lesions were not distant metastases but due to SAPHO syndrome. After partial mastectomy of the right breast and sentinel lymph node biopsy, the patient underwent adjuvant therapy with no recurrence at 16 months post-procedure.</p><p><strong>Conclusions: </strong>In early-stage breast cancer, particularly mucinous carcinoma, which has a low metastatic risk, multiple bone lesions should not be deemed bone metastases based on imaging findings alone. Integrating clinical information, including prior anterior thoracic lesions and skin symptoms, can reduce invasive testing and unnecessary treatment. This case demonstrates the importance of considering SAPHO syndrome as a key differential diagnosis in the management of breast cancer.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13111938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781719","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}