Surgical Case Reports最新文献

{"title":"Benign Cystic Mesothelioma of the Peritoneum Arising at the Greater Omentum in a 14-Year-Old Boy.","authors":"Yutaka Hirayama, Naruki Higashidate, Kengo Nakaya, Yasushi Iinuma","doi":"10.70352/scrj.cr.24-0085","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0085","url":null,"abstract":"<p><strong>Introduction: </strong>Mesothelioma arises from mesothelial cells. This tumor is very rare among pediatric abdominal neoplasms. We herein report an extremely rare case of acute abdomen with cystic mesothelioma of the peritoneum in a child.</p><p><strong>Case presentation: </strong>A 14-year-old boy was referred to our hospital for emergency surgery. Surgery revealed a primary tumor arising from the greater omentum. The tumor was macroscopically diagnosed as a benign omental lymphangioma and was resected en bloc with the greater omentum. A histopathological examination of the tumor revealed a simple columnar epithelium-like mesothelioma with poor cell-atypia. Immunohistochemical examination showed antibody reactivity in the cyst epithelium, including an anti-calretinin antibody. The final pathological diagnosis was a mesothelioma originating from the peritoneum.</p><p><strong>Conclusions: </strong>In pediatric cases diagnosed with cystic lymphatic malformation, the possibility of peritoneal mesothelioma needs to be considered and carefully confirmed or ruled out.</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/PMC12055440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014242","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 Induction Chemoimmunotherapy and Sleeve Lobectomy to Avoid Pneumonectomy for Central Squamous Cell Lung Cancer.","authors":"Ayaka Asakawa, Ryota Ishizawa, Yukitaka Sato, Yuya Ishikawa, Ryo Wakejima, Hironori Ishibashi, Kenichi Okubo","doi":"10.70352/scrj.cr.24-0069","DOIUrl":"10.70352/scrj.cr.24-0069","url":null,"abstract":"<p><strong>Introduction: </strong>Recently, neoadjuvant immunotherapy plus chemotherapy has been provided for patients with stage II-III resectable lung cancer. We report a case in which a pneumonectomy was avoided by administrating neoadjuvant chemoimmunotherapy.</p><p><strong>Case presentation: </strong>An 81-year-old man presented with a cough. Examination showed squamous cell lung cancer in the right lower lobe extending to the central side of the upper lobe, which would have required a pneumonectomy for complete resection. Neoadjuvant chemoimmunotherapy was administered to reduce the extent of pulmonary resection due to the patient's advanced age and impaired pulmonary function. Post-treatment examination showed tumor size reduction, and bronchoscopy showed disappearance of right upper bronchial erythema and persistent erythema of the bronchus intermedius. A sleeve right lower lobectomy was performed. Histopathological findings revealed complete resection of the cancerous lesion and a major pathological response.</p><p><strong>Conclusions: </strong>Sleeve lobectomy after preoperative chemoimmunotherapy for an elder patient with low pulmonary function was safe and efficient.</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/PMC11879256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558039","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":"Longitudinal Pancreatojejunostomy for Pancreaticodigestive Reconstruction in the Resection of Pancreatic Head Malignancy with Chronic Pancreatitis: A Case Report.","authors":"Hironori Hayashi, Yuichiro Furutani, Hiroaki Sugita, Kei Sugano, Takahiro Yoshimura, Tetsuro Oda, Daisuke Fujimori, Koichiro Sawada, Masanori Kotake, Kaeko Oyama, Shintaro Yagi, Takuo Hara","doi":"10.70352/scrj.cr.24-0015","DOIUrl":"10.70352/scrj.cr.24-0015","url":null,"abstract":"<p><strong>Introduction: </strong>With progress in pancreatic surgery, a preservation of residual organ function has become more important. Pancreatic malignancies are occasionally accompanied by chronic pancreatitis (CP) and pancreatolithiasis (PL). Longitudinal pancreatojejunostomy (LPJ) is reportedly a useful method of surgical management in cases of CP with PL. We describe a patient with pancreatic head intraductal papillary mucinous carcinoma (IPMC) concomitant with PL, who underwent subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) and LPJ for reconstruction.</p><p><strong>Case presentation: </strong>A man in his 70s was referred to our hospital with a pancreatic head tumor. He had been treated for CP, diabetes mellitus, and chronic kidney disease. Imaging revealed a cystic pancreatic head tumor with a solid component that was histologically confirmed as IPMC. In addition, multiple calcifications suggestive of PL were observed in the pancreatic body and tail. SSPPD and LPJ were performed to excise the PL as much as possible and preserve the residual pancreatic function. The postoperative course was uneventful, and no abdominal symptoms or tumor recurrences were observed for approximately 8 months after surgery.</p><p><strong>Conclusion: </strong>This patient with IPMC with residual pancreatic PL was treated with SSPPD and LPJ to maximize the residual pancreatic function and reduce the occurrence of postoperative pancreatitis.</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/PMC11905986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625968","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 Rare Case of Ampullary Carcinoma with Complete Duodenal Obstruction as the Initial Manifestation.","authors":"Yuta Kakizaki, Akefumi Sato, Yoshitaka Enomoto","doi":"10.70352/scrj.cr.25-0020","DOIUrl":"https://doi.org/10.70352/scrj.cr.25-0020","url":null,"abstract":"<p><strong>Introduction: </strong>Obstructive jaundice is often the first symptom of ampullary carcinoma, with a straightforward preoperative diagnosis. We report a rare case of ampullary carcinoma without jaundice as the initial symptom.</p><p><strong>Case presentation: </strong>A 53-year-old man was admitted with abdominal distension and recurrent vomiting. Esophagogastroduodenoscopy revealed a complete duodenal obstruction without malignant findings. Computed tomography revealed wall thickening in the second portion of the duodenum. The common bile duct and main pancreatic duct were not dilated. As there was no evidence of malignancy, we performed gastrojejunostomy as a bypass to improve the symptoms. Five months later, follow-up blood examinations showed elevated total bilirubin levels, and computed tomography revealed persistent thickening of the duodenal wall with exacerbated dilation of common bile duct and main pancreatic duct. Mucosal biopsies from the oral and anal sides of the stenosis revealed no malignancy. Due to a strong suspicion of malignant disease and difficulty in preoperative biliary drainage, we performed pancreatoduodenectomy. Pathological examination revealed mucinous adenocarcinoma with submucosal and subserosal invasion of the duodenum. We finally diagnosed this case as ampullary carcinoma.</p><p><strong>Conclusions: </strong>The possibility of malignancy should be considered even in cases of duodenal obstruction that have not been diagnosed as malignant after repeated close examination.</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/PMC12014226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014240","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":"Renal Artery Stent-Graft Implantation Using the Retrograde Approach in a Patient Who Developed a Renal Artery Aneurysm after Thoracoabdominal Aortic Repair.","authors":"Yutaka Matsubara, Tadashi Furuyama, Toshihiro Onohara","doi":"10.70352/scrj.cr.24-0121","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0121","url":null,"abstract":"<p><strong>Introduction: </strong>Herein, we report a patient who underwent stent-graft implantation using the retrograde approach for a renal artery aneurysm.</p><p><strong>Case presentation: </strong>The patient was a 48-year-old man who underwent total arch replacement, thoracoabdominal aortic repair, aortic root replacement, and thoracic endovascular aortic repair for Marfan syndrome. A right renal artery aneurysm developed at the prosthetic graft anastomosis during observation. First, stent-graft implantation using the antegrade approach was performed. However, the delivery system could not be advanced to the right renal artery because of prosthetic graft kinking. Therefore, the procedure was discontinued. Next, the retrograde approach was used. A right hypochondral oblique incision was made. The right renal artery was exposed with the retroperitoneal approach, and a stent graft was retrogradely inserted into the renal artery and deployed between the prosthetic graft and the distal right renal artery to cover the aneurysm. The patient was followed up for 3 years after the surgery, and he did not develop any aneurysm.</p><p><strong>Conclusions: </strong>Renal artery stent graft implantation using the retrograde approach can be a treatment option for renal artery aneurysms in patients with a hostile abdomen.</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/PMC12014509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047852","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 Unique Case of Intra-Abdominal Diffuse Lymphangiomatosis Mimicking a Pseudomyxoma Peritonei.","authors":"Andreas R R Weiss, Georg F Weber, Maximilian Brunner, Robert Grützmann, Abbas Agaimy, Christian Krautz","doi":"10.70352/scrj.cr.24-0037","DOIUrl":"10.70352/scrj.cr.24-0037","url":null,"abstract":"<p><strong>Introduction: </strong>Localized cystic lymphangiomas (CL) are rare benign tumors deriving from the lymphatic system. CL is diagnosed more frequently in children than in the adult population and, although commonly affecting the cervical and axillary regions, can develop in various parts of the body. Abdominal cystic lymphangioma (ACL) comprises less than 5% of all CL cases.</p><p><strong>Case presentation: </strong>A 35-year-old female patient with a history of benign appendectomy in childhood was transferred to our tertiary center for the operative management of a suspected extensive pseudomyxoma peritonei (PMP). In accordance with the multidisciplinary team discussion, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy was planned. Intraoperatively, a typical \"jelly belly\" with high disease burden throughout the abdominal cavity and the small pelvis was found. A multi-visceral resection with complete cytoreduction (CCR 0) was performed. The postoperative histopathological findings revealed a diffuse, partially cystic lymphangiomatosis involving the peritoneum extensively without evidence of PMP or malignancy.</p><p><strong>Conclusions: </strong>ACLs are uncommon in the adult population, and diffuse peritoneal involvement is even rarer. Surgical management with complete resection is the preferred treatment option. Other benign cysts, as well as infectious diseases and malignancy, should be considered during the preoperative workup.</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/PMC11865471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524502","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 Treatment with Induction Therapy and Surgery for Mediastinal Carcinoma of Unknown Primary.","authors":"Yasushi Sakamaki, Naoya Takada, Yuya Kogita, Nanami Hiraiwa","doi":"10.70352/scrj.cr.24-0011","DOIUrl":"10.70352/scrj.cr.24-0011","url":null,"abstract":"<p><strong>Introduction: </strong>Carcinoma of unknown primary (CUP) is rarely located in the mediastinum. Most cases are revealed to be metastatic lymph node carcinoma, which carries a poor prognosis. The optimal treatment for CUP confined to the mediastinum is yet to be established, and the long-term outcome of induction therapy in combination with surgery for mediastinal CUP is unclear.</p><p><strong>Case presentation: </strong>A 46-year-old man with no history of malignancy was diagnosed with anterior mediastinal adenocarcinoma through biopsy. The patient underwent chemoradiation for the tumor, which was initially suspected as invasive T4 lung cancer. After a favorable response to presurgical therapy, the tumor was deemed more likely a mediastinal tumor, and it was completely resected simultaneously with the thymus, the partial left lung, and the partial left innominate vein. The tumor contained histologic features identifiable as a lymph node tissue and lacked any thymic tissue, which led to the final diagnosis as metastatic lymph node adenocarcinoma; however, its origin was unknown. No signs of recurrence were detected for 13 years after surgery.</p><p><strong>Conclusions: </strong>Our case suggests that even patients with mediastinal CUP deemed an advanced disease can achieve long-term survival after undergoing induction therapy and definitive surgery.</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/PMC11867736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524503","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 Inflammatory Myofibroblastic Tumor in the Abdominal Wall with Anaplastic Lymphoma Kinase and Whole Exome Sequencing Analysis.","authors":"Yuya Takahata, Shoichi Hazama, Toshiyuki Fujii, Masahiro Kitahara, Keisuke Hino, Kiwamu Okita, Hiroaki Nagano, Ryouichi Tsunedomi, Hiroshi Hashiyada, Kembu Nakamoto","doi":"10.70352/scrj.cr.25-0181","DOIUrl":"10.70352/scrj.cr.25-0181","url":null,"abstract":"<p><strong>Introduction: </strong>Inflammatory myofibroblastic tumors (IMTs) are rare mesenchymal neoplasms characterized by spindle cell proliferation and inflammatory infiltration, but with an unclear etiology. Although IMTs most commonly arise in the lungs, extrapulmonary cases have been documented at various anatomical sites. Approximately 50% of IMTs harbor anaplastic lymphoma kinase (ALK) rearrangements; however, the genetic landscape of ALK-negative cases remains largely unknown. We report a rapidly growing IMT in the right rectus abdominis muscle and present whole-exome sequencing (WES) findings that revealed novel genetic mutations beyond ALK rearrangements.</p><p><strong>Case presentation: </strong>A 38-year-old woman with no significant medical history presented with a rapidly enlarging mass in the right lower abdomen. Computed tomography showed a well-defined tumor on the dorsal side of the right rectus abdominis muscle exhibiting progressive enhancement. Fine-needle biopsy initially suggested the presence of proliferative fasciitis. Owing to rapid tumor growth from 40 to 61 mm within 3 months, laparoscopic surgical resection was performed, including a portion of the posterior sheath and rectus abdominis muscle. Pathological examination confirmed the presence of an IMT and revealed spindle cell proliferation, nuclear atypia, and inflammatory infiltration. Immunohistochemical analysis revealed positivity for smooth muscle actin (SMA) and ALK, partial positivity for desmin, and negativity for cluster of differentiation 34 (CD34) and cytokeratin, compatible with an IMT. WES identified 7 genetic mutations, none of which have been previously reported for IMT in the catalogue of somatic mutations in cancer (COSMIC) database, suggesting novel genetic associations.</p><p><strong>Conclusions: </strong>This case highlights a rare and rapidly growing IMT in the rectus abdominis muscle and underscores the value of molecular analysis in understanding the pathogenesis of IMT. Identification of novel mutations through WES expands the genetic landscape of IMT and may provide insights into tumorigenesis and potential therapeutic targets. Further research is required to explore the clinical implications of these mutations in IMT progression and 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/PMC12268362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660248","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":"Early Liver Metastasis from Early Gastric Adenocarcinoma with a Small Neuroendocrine Carcinoma Component: A Case Report.","authors":"Takahisa Hirano, Michitaka Honda, Soshi Hori, Hirohito Kakinuma, Ryuya Yamamoto, Kazuki Nishino, Masatoshi Noda, Hidetaka Kawamura, Nobuyasu Suzuki, Yoshinao Takano, Noriyuki Uesugi, Tamotsu Sugai","doi":"10.70352/scrj.cr.25-0296","DOIUrl":"10.70352/scrj.cr.25-0296","url":null,"abstract":"<p><strong>Introduction: </strong>Gastric neuroendocrine carcinoma (NEC) is a rare histological subtype of gastric malignancy. A small NEC component may coexist with gastric adenocarcinoma, making preoperative diagnosis challenging. Currently, no established treatment strategies exist for cases in which an NEC component is identified only in postoperative pathological findings.</p><p><strong>Case presentation: </strong>An 82-year-old man underwent esophagogastroduodenoscopy during a routine health checkup and was diagnosed with early-stage gastric cancer. The lesion was a superficial tumor, 30 mm in diameter, located on the lesser curvature of the cardia. Biopsy revealed well-differentiated adenocarcinoma. The patient subsequently underwent laparoscopic proximal gastrectomy with D1+ lymph node dissection. Histopathological examination of the resected specimen revealed adenocarcinoma with an NEC component, accounting for approximately 10% of the tumor. The pathological stage was T1bN1M0 (Stage IB), and the patient did not receive adjuvant chemotherapy. Five months after the surgery, the patient developed anorexia and weight loss. CT revealed multiple liver tumors. Diagnostic laparoscopy with excisional biopsy of the liver lesion was performed, revealing no peritoneal dissemination. Histopathological examination confirmed that the liver tumors were metastatic NEC, indicating hepatic recurrence of gastric NEC. Given the patient's rapidly deteriorating condition and a performance status of 3-4, aggressive chemotherapy was deemed inappropriate, and palliative care was initiated. The patient died of the primary disease 8 months after surgery.</p><p><strong>Conclusions: </strong>A small NEC component may be undetectable preoperatively. The prognosis of mixed tumors is dictated by the malignancy of the NEC component rather than its tumor burden. Therefore, clinicians should consider NEC-equivalent adjuvant chemotherapy and intensive surveillance.</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/PMC12463468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186728","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 Acute Pancreatitis after Pancreatectomy in Grade C Leading to Walled-Off Necrosis Successfully Treated with Necrosectomy by Retroperitoneal Approach.","authors":"Makoto Shinohara, Masakazu Hashimoto, Ryo Nagao, Michinori Hamaoka, Masashi Miguchi, Nobuaki Fujikuni, Satoshi Ikeda, Yasuhiro Matsugu, Hideki Nakahara","doi":"10.70352/scrj.cr.24-0002","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0002","url":null,"abstract":"<p><strong>Introduction: </strong>Grade B or C post-pancreatectomy acute pancreatitis (PPAP) is associated with a higher incidence of postoperative complications and mortality. The reason for this is the activation of proteolytic processes that can lead to pancreatic destruction and the activation of systemic reactions that can have adverse consequences such as systemic inflammatory response syndrome, sepsis, and death. We report a case of a patient with Grade C PPAP with walled-off necrosis (WON) who was successfully treated with necrosectomy using a step-up approach.</p><p><strong>Case presentation: </strong>A 73-year-old man was referred to our hospital with elevated biliary enzymes. Results of blood tests, computed tomography (CT), and magnetic resonance imaging led to the diagnosis of distal bile duct cancer. He underwent a pyloric ring-sparing pancreaticoduodenectomy with lymph node dissection. Postoperative P-AMY (pancreatic amylase) was high at 1766 U/L, and contrast-enhanced CT showed increased density of peripancreatic fatty tissue and fluid accumulation on the pancreatic resection surface, leading to the diagnosis of postoperative pancreatitis and pancreatic fistula. On postoperative day (POD) 9, continuous washing with saline solution was started through the drain at the pancreatic anastomosis. Contrast-enhanced CT showed increased fluid retention in the pancreatic body tail. On POD 43, endoscopic ultrasonography drainage was performed for pancreatic necrosis encapsulated in the retroperitoneum; however, the patient self-extracted the drainage tube. On POD 50, CT-guided drainage was performed for a retroperitoneal subcapsular abscess. On POD 69, the patient underwent necrotomy with guided retroperitoneal drainage, a drain was inserted, and continuous flushing was performed. On POD 76, fecal discharge was observed from the drain, and drainage and enterography were performed; a fistula with the colon was confirmed, and an ileal bifurcation colostomy was performed on the same day. On PODs 83, 85, and 100, endoscopic necrotomy was performed through a retroperitoneal incision wound because a contrast-enhanced CT showed a residual abscess on the gastric dorsum. The patient's general condition improved, and his inflammatory response also improved. On POD 139, the patient was transferred for rehabilitation.</p><p><strong>Conclusion: </strong>We describe a case of successful postoperative nutritional management and necrosectomy for Grade C PPAP leading to WON.</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/PMC11868872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543577","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}