Surgical Case Reports最新文献

{"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}

{"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}

{"title":"Serous endometrial carcinoma metastatic to the sigmoid colon masquerading as a primary colon cancer detected by bowel obstruction.","authors":"Taiga Shimura, Naoko Fukushima, Kazuto Tsuboi, Toshimasa Suzuki, Tetsuya Kajimoto","doi":"10.1186/s40792-024-02073-8","DOIUrl":"10.1186/s40792-024-02073-8","url":null,"abstract":"<p><strong>Background: </strong>The majority of colorectal malignancies are primary tumors. Secondary tumors are rare, and colorectal metastasis from endometrial carcinoma is exceptionally uncommon. We report a case of serous endometrial carcinoma that metastasized to the sigmoid colon, initially presenting as a primary colon carcinoma due to bowel obstruction.</p><p><strong>Case presentation: </strong>A 79-year-old woman presented with abdominal distention and constipation. Five years earlier, she had undergone an open total hysterectomy with bilateral salpingo-oophorectomy for endometrial serous carcinoma. A colonoscopy revealed stenosis encircling the entire sigmoid colon. Abdominal computed tomography demonstrated irregular wall thickening in the sigmoid colon with enhanced regional lymph node enlargement and upstream bowel dilatation. Peritoneal dissemination in the pelvis was also noted. To relieve the obstruction, two self-expanding metal stents were inserted. Subsequently, due to the presumed diagnosis of sigmoid colon carcinoma with peritoneal dissemination, an open left hemicolectomy with resection of the peritoneal dissemination was performed. Histopathological examination identified the colon tumor and peritoneal dissemination as metastatic serous endometrial carcinoma. Immunohistochemical studies showed the tumor cells were negative for CK7, CK20, and CDX2. No chemotherapy was administered, and 6 months post-operation, no recurrence was observed.</p><p><strong>Conclusions: </strong>Metastasis of endometrial carcinoma to the colon is extremely rare. Diagnosing a colon tumor as a metastasis from endometrial carcinoma is challenging during preoperative examinations. Therefore, in patients with a history of endometrial carcinoma, the possibility that the primary site might be the uterus should be considered.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"10 1","pages":"273"},"PeriodicalIF":0.7,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11602879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740521","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":"Simplified technique in total pancreatectomy with islet cell autotransplantation after Frey's procedure: a case report.","authors":"Ryo Oikawa, Nobuyuki Takemura, Masayuki Shimoda, Mai Nakamura, Fuminori Mihara, Fuyuki Inagaki, Norihiro Kokudo","doi":"10.1186/s40792-024-02066-7","DOIUrl":"10.1186/s40792-024-02066-7","url":null,"abstract":"<p><strong>Background: </strong>The selection of the surgical approach for chronic pancreatitis (CP) is determined by various factors including inflammatory location, presence of pancreatic duct dilatation, or possibility of cancer. Total pancreatectomy (TP), with or without islet cell autotransplantation, is considered for patients with refractory CP after the failure of other surgical treatments. Considering the increasing incidence of CP requiring surgical treatment, the number of cases in which TP is performed after previous surgical treatment is expected to increase.</p><p><strong>Case presentation: </strong>We reported a case of TPIAT in a patient with alcoholic CP who had previously undergone Frey's procedure. During the operation, the sufficient length of the elevated jejunal loop for pancreaticojejunostomy in Frey's procedure allowed it to be used directly for biliary jejunostomy during TP. In addition, jejunojejunostomy from the previous operation could be used, and these methods contributed to simplifying the operative procedure. We need open hemostasis on post-operative day (POD) 1and a percutaneous drainage tube replacement for an intraperitoneal abscess on POD 24. The patient was discharged from the hospital on POD 37 with normal serum C-peptide level, which suggests favorable insulin secretion from transplanted islets, and the epigastric pain that suffered her preoperatively resulted in a dramatic improvement.</p><p><strong>Conclusions: </strong>When performing the Frey's procedure, the elevated jejunal loop and Y-anastomosis jejunal loop with sufficient length allow them to be used directly for the reconstructions in the possible subsequent TP.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"10 1","pages":"272"},"PeriodicalIF":0.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11602881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142732907","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":"Treatment of a left inguinal hernia with incarceration of the scope during colonoscopy: a case report and literature review.","authors":"Ryo Numoto, Kohei Taniguchi, Yoshiro Imai, Mitsuhiro Asakuma, Hideki Tomiyama, Shinya Fujiwara, Yoshihiko Nakanishi, Takuya Hamaguchi, Shinsuke Masubuchi, Hitoshi Inoue, Masaru Kawai, Takashi Kinoshita, Shinsho Morita, Michihiro Hayashi, Sang-Woong Lee","doi":"10.1186/s40792-024-02072-9","DOIUrl":"10.1186/s40792-024-02072-9","url":null,"abstract":"<p><strong>Background: </strong>Colonoscopy is widely performed. However, reports of colonoscopic incarceration within inguinal hernias are rare. Incarceration during colonoscopy is a critical condition, and attempting forced reduction may exacerbate complications; therefore, a careful approach is required. Here, we present a case of colonoscopic incarceration of a left inguinal hernia that was successfully reduced under fluoroscopic guidance, followed by elective endoscopic surgery.</p><p><strong>Case presentation: </strong>A 74-year-old man presented for colonoscopy at a primary care clinic and was referred to our hospital for the incarceration of the colonoscope within the inguinal hernia. On arrival, the colonoscope remained in situ through the anus. Laboratory tests and imaging studies confirmed the absence of perforation. Manual pressure was applied under fluoroscopic guidance to successfully reduce the hernia and allow for scope extraction. No evidence of perforation was revealed in the follow-up fluoroscopic examination using a gastrografin enema. Six weeks later, the patient underwent definitive surgery for total extraperitoneal hernia repair.</p><p><strong>Conclusions: </strong>A complication of colonoscopy is the incarceration of the colonoscope within the inguinal hernia, particularly in older men. Therefore, inquiring about the patient's history of inguinal hernia, particularly those accompanied by scrotal swelling, besides assessing the surgical history before performing a colonoscopy, is critical. Furthermore, recent trends include attempts at incarceration reduction under fluoroscopic guidance, with emergency surgery reserved for irreducible cases.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"10 1","pages":"270"},"PeriodicalIF":0.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11589046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716747","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 report of type II Floyd tracheal agenesis with staged tracheal and alimentary reconstructions.","authors":"Yukiko Tani, Naruhiko Murase, Takazumi Kato","doi":"10.1186/s40792-024-02069-4","DOIUrl":"10.1186/s40792-024-02069-4","url":null,"abstract":"<p><strong>Background: </strong>Tracheal agenesis is a rare and lethal congenital airway anomaly. In particular, very few patients with type II Floyd tracheal agenesis experience long-term survival. We present the case of a male infant who was diagnosed with type II disease, underwent staged reconstruction and was discharged home with a tolerance for oral intake.</p><p><strong>Case presentation: </strong>The patient was delivered via emergency cesarean section at 33 week gestation due to fetal distress. Initial attempts to intubate the trachea failed, but ventilation was successfully achieved through esophageal intubation, prompting suspicion of tracheal agenesis with a tracheoesophageal fistula. The diagnosis was confirmed via CT and laryngoesophagoscopy. On the same day, abdominal esophageal banding and gastrostomy were performed. For long-term management, staged operations, including pseudotracheostomy, internal and external stenting of the trachealized esophagus, and reconstruction of the alimentary tract, were performed. Despite being discharged home with a tolerance for oral intake, the patient experienced cardiac arrest at 41 months due to tracheal tube displacement.</p><p><strong>Conclusions: </strong>Early detection of tracheal agenesis in postnatal patients experiencing respiratory distress is crucial. Type II Floyd tracheal agenesis remains challenging because of the absence of a trachea and the narrow diameter of the tracheoesophageal fistula.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"10 1","pages":"271"},"PeriodicalIF":0.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11589053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716627","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":"Sudden-onset gastrointestinal bleeding in a young adult: diagnostic and therapeutic challenges of a Dieulafoy's lesion in the jejunum.","authors":"Shikhar Tripathi, Rakesh Narayanagowda, Sri Aurobindo Prasad Das, Sunila Jain, Samiran Nundy","doi":"10.1186/s40792-024-02064-9","DOIUrl":"10.1186/s40792-024-02064-9","url":null,"abstract":"<p><strong>Background: </strong>A Dieulafoy's lesion in the jejunum is at an uncommon site but may be the cause of massive gastrointestinal bleeding. It is characterized by a large, tortuous submucosal artery that erodes the overlying epithelium and presents diagnostic and therapeutic challenges due to its atypical location and presentation.</p><p><strong>Case: </strong>A 30-year-old male presented with sudden onset syncope and the passage of 200-300 ml of red blood-mixed stool. With no major comorbidities, he had hypotension with a blood pressure of 80/50 mmHg, necessitating immediate transfusion of three units of packed red blood cells (PRBCs). Initial endoscopic evaluations, including an UGI endoscopy and colonoscopy, failed to locate the bleeding source. CT angiography identified an active bleed from the first jejunal branch leading to coil embolization. Persistent symptoms prompted capsule endoscopy, revealing angioectasia in the proximal jejunum. Despite haemoclip application and a total of 11 units of blood transfused, his symptoms persisted. He then underwent laparoscopic resection of the jejunal segment containing the polyp, followed by extracorporeal jejuno-jejunal anastomosis. Histopathology confirmed a benign polyp with central ulceration, consistent with a Dieulafoy's lesion.</p><p><strong>Conclusions: </strong>Advanced diagnostic techniques like CT angiography and capsule endoscopy played a pivotal role in localizing the bleeding source. Surgical intervention proved curative when less invasive methods failed. The patient's postoperative course was uneventful, highlighting the efficacy of a multidisciplinary approach. A high index of suspicion and a multidisciplinary approach are essential for successful outcomes.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"10 1","pages":"269"},"PeriodicalIF":0.7,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11582246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142688837","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}