Surgical Case Reports最新文献

{"title":"Confluence Stones at the Junction of the Cystic Duct and an Aberrant Anterior Sectoral Bile Duct: A Case Report.","authors":"Takeshi Kawai, Yuichiro Kato, Naoya Yamaguchi, Fumitoshi Mizutani, Jiro Kawakami, Naoya Torii, Tomohiko Murakami, Ryoichi Shimizu, Hirotaka Ito","doi":"10.70352/scrj.cr.26-0430","DOIUrl":"https://doi.org/10.70352/scrj.cr.26-0430","url":null,"abstract":"<p><strong>Introduction: </strong>Confluence stones usually arise when gallstones impacted in the cystic duct migrate toward the biliary confluence. Surgical treatment can be technically demanding because of chronic inflammation and distorted anatomy. Confluence stones at the junction between the cystic duct and an aberrant bile duct are extremely rare. We report a successfully treated case of confluence stones arising at the junction of the cystic duct and an aberrant anterior sectoral bile duct with a communicating accessory bile duct.</p><p><strong>Case presentation: </strong>A 38-year-old woman presented with abdominal pain, and biliary stones were detected. Magnetic resonance cholangiopancreatography demonstrated an aberrant anterior sectoral bile duct draining independently into the common bile duct. Biliary stones were identified both within this duct and at its junction with the cystic duct. Endoscopic retrograde cholangiography confirmed the biliary anatomy and additionally revealed a communicating accessory bile duct between the anterior and posterior sectoral ducts. The stones within the distal portion of the aberrant duct were removed endoscopically, but the impacted confluence stones could not be extracted. Therefore, open surgery was performed. After exposure of the junction, the confluence stones were removed through a semicircumferential incision. Complete stone clearance was confirmed by intraoperative cholangioscopy and cholangiography. The patient was discharged on POD 11 with no bile leakage. At 14 months postoperatively, she remained asymptomatic and had experienced no episodes of cholangitis.</p><p><strong>Conclusions: </strong>We report a rare case of confluence stones arising at the junction of the cystic duct and an aberrant anterior sectoral bile duct. Preoperative assessment of the drainage territory and intraoperative evaluation of the duct diameter, ischemia, and tissue fragility are essential for appropriate and safe repair of the bile duct defect. The repair strategy should not rely on presumed bypass flow through a communicating accessory bile duct because its functional capacity cannot be reliably predicted.</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/PMC13682856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149239452","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":"Life-Saving Emergency Decompression via a Clamshell Approach for Cardiac Arrest Caused by Hemorrhage of a Giant Mediastinal Ectopic Thyroid: A Case Report.","authors":"Minori Ono, Yui Watanabe, Takeo Togo, Yusuke Nakano, Ken Onodera, Hirotsugu Notsuda, Sakiko Kumata, Tetsuto Takeda, Takuya Ikushima, Tatsuaki Watanabe, Takaya Suzuki, Takashi Hirama, Hisashi Oishi, Yoshinori Okada","doi":"10.70352/scrj.cr.26-0494","DOIUrl":"https://doi.org/10.70352/scrj.cr.26-0494","url":null,"abstract":"<p><strong>Introduction: </strong>Mediastinal ectopic thyroid tissue is rare and is usually asymptomatic. Intratumoral hemorrhage causing acute mediastinal compression and cardiac arrest is extremely uncommon. We report a case of cardiac arrest caused by hemorrhage of a giant mediastinal ectopic thyroid, successfully managed with venoarterial extracorporeal membrane oxygenation (VA-ECMO) and emergency surgical decompression by tumor removal.</p><p><strong>Case presentation: </strong>A 71-year-old woman with a long-standing anterior mediastinal tumor was transferred to our hospital because of dyspnea and shock after a fall. Contrast-enhanced CT revealed a giant anterior mediastinal tumor occupying the left hemithorax, with active extravasation and marked mediastinal deviation. Transarterial embolization was performed; however, she developed cardiac arrest shortly after embolization, presumably due to rapid tumor enlargement and severe mediastinal compression caused by intratumoral hemorrhage. Cardiopulmonary resuscitation was immediately initiated, and VA-ECMO was established. Emergency tumor removal and hemostasis were performed through a 4th-intercostal clamshell incision. The tumor occupied almost the entire left thoracic cavity and was extensively adherent to the chest wall and mediastinum, with particularly firm adhesion to the left brachiocephalic vein. The tumor was removed with combined resection of the left brachiocephalic vein. Histopathological examination revealed benign ectopic thyroid tissue without malignant findings. The postoperative course was complicated by bleeding, infection, acute kidney injury, and prolonged impaired consciousness. Postoperative hypothyroidism was identified after pathological confirmation of ectopic thyroid tissue, and levothyroxine replacement was initiated. The patient was transferred to a rehabilitation hospital on POD 72 and is currently living at home 1 year after surgery.</p><p><strong>Conclusions: </strong>Giant mediastinal ectopic thyroid tissue can cause fatal circulatory collapse when complicated by intratumoral hemorrhage. Although the patient was in a critical condition, she was successfully rescued by VA-ECMO followed by emergency decompression through surgical tumor removal.</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/PMC13696104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149273204","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 Novel Approach of Pericardial Suspension Method Combined with Tracheobronchial Stent Placement: A Life-Saving Case for Right Main Bronchial Stenosis.","authors":"Ryota Nagashima, Aki Fujiwara-Kuroda, Masato Aragaki, Kichizo Kaga, Tatsuya Kato, Naofumi Shinagawa","doi":"10.70352/scrj.cr.25-0477","DOIUrl":"10.70352/scrj.cr.25-0477","url":null,"abstract":"<p><strong>Introduction: </strong>There is no consensus regarding surgery and endotracheal treatment for bronchial stenosis. We report a case of right main bronchus stenosis treated using a novel approach of mediastinal mobilization with pericardial suspension.</p><p><strong>Case presentation: </strong>A 57-year-old woman who developed radiation pneumonitis after postoperative radiation therapy for left breast cancer was admitted to our hospital due to worsening respiratory distress over 2 years. Chest CT revealed severe stenosis of the right main bronchus owing to lung destruction and scoliosis. Although isolated lung ventilation using a double-lumen tube was initiated, the ventilation was unstable. The patient underwent surgery, including sternal elevation using the Nuss technique, mediastinal mobilization using pericardial suspension, and tracheobronchial stenting to ameliorate bronchial stenosis.</p><p><strong>Conclusions: </strong>After surgery, oxygenation was no longer required. This novel pericardial suspension technique fundamentally corrects the extrinsic mediastinal shift, serving as an essential prerequisite for safe stenting against secondary tracheobronchomalacia in adult cases.</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/PMC12861686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146107147","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 Gastric Aberrant Pancreas Causing Bleeding from a Gastric Ulcer.","authors":"Tsuyoshi Saito, Hirotaka Miyai, Ryutaro Kato, Ryosuke Niwamoto, Shuhei Ueno, Masahiro Kimura, Shuji Takiguchi","doi":"10.70352/scrj.cr.25-0520","DOIUrl":"10.70352/scrj.cr.25-0520","url":null,"abstract":"<p><strong>Introduction: </strong>An aberrant pancreas is pancreatic tissue lacking anatomical and vascular continuity with the normal pancreas. It typically occurs in the gastrointestinal tract, especially in the stomach, duodenum, and small intestine. Most cases are asymptomatic and discovered incidentally during imaging or surgery. Gastric aberrant pancreas rarely presents with bleeding, making diagnosis and treatment decisions challenging.</p><p><strong>Case presentation: </strong>A 34-year-old man presented with epigastric pain and melena. Endoscopy at a local hospital revealed a submucosal tumor (SMT) with active bleeding at the greater curvature of the stomach. After admission, further imaging and endoscopic ultrasonography showed a 20-mm low-echo mass in the submucosa and muscularis propria with ulceration. Histopathology of a biopsy confirmed aberrant pancreatic tissue. Due to progressive anemia from ulcer bleeding, laparoscopic partial gastrectomy was performed. The SMT was completely resected, and the postoperative course was uneventful. Pathological examination confirmed a Heinrich type I aberrant pancreas.</p><p><strong>Conclusions: </strong>Most cases of aberrant pancreas are asymptomatic; however, in this case, a preoperative diagnosis of gastric submucosal aberrant pancreas was made by endoscopic examination and puncture aspiration cytology because of the relatively rare bleeding symptoms. In this case, laparoscopic partial gastrectomy was performed to control bleeding.</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/PMC12883284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146150702","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 Intraperitoneal Onlay Mesh Plus Repair of a Hernia Adjacent to a Vesicocutaneous Urinary Diversion: A Case Report.","authors":"Takahiko Omameuda, Masaru Koizumi, Makiko Tahara, Yoshiyuki Inoue, Hiroyuki Kitabayashi, Atsushi Miki, Mikio Shiozawa","doi":"10.70352/scrj.cr.26-0323","DOIUrl":"10.70352/scrj.cr.26-0323","url":null,"abstract":"<p><strong>Introduction: </strong>Hernias occurring adjacent to a urinary diversion are extremely rare, and their classification and optimal surgical management have not yet been established.</p><p><strong>Case presentation: </strong>A 76-year-old man presented with a hernia adjacent to a vesicocutaneous urinary diversion after undergoing laparoscopic abdominoperineal resection for rectal cancer combined with robot-assisted radical prostatectomy, resulting in sigmoid colostomy and vesicocutaneous fistula formation. Laparoscopic repair was performed using the intraperitoneal onlay mesh (IPOM) plus technique. After primary fascial closure, a trimmed composite mesh was placed with adequate overlap and fixed using a modified fixation strategy combining non-absorbable tacks and absorbable sutures. Tacking was deliberately avoided in the anatomically hazardous region adjacent to the external iliac vessels, and fixation in this area was achieved using superficial sutures only. The postoperative course was uneventful, with no recurrence or mesh-related complications during the 18-month follow-up.</p><p><strong>Conclusion: </strong>Laparoscopic IPOM plus repair may be a feasible option for hernias adjacent to a vesicocutaneous urinary diversion when primary fascial closure and safe mesh fixation can be achieved with careful consideration of pelvic anatomy and adjacent neurovascular structures. However, further accumulation of cases and long-term follow-up are required to establish its safety.</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/PMC13306551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345691","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":"Spontaneous Regression of Poorly Differentiated Carcinoma in the Transverse Colon with Deficient Mismatch Repair: A Case Report and Review.","authors":"Daisuke Takeyama, Fumiaki Mizuno, Takashi Suzuki, Atsushi Nakamura, Tohru James Harata, Seiji Chubachi","doi":"10.70352/scrj.cr.26-0180","DOIUrl":"10.70352/scrj.cr.26-0180","url":null,"abstract":"<p><strong>Introduction: </strong>Spontaneous regression (SR) of colorectal cancer (CRC) is exceptionally rare. The SR of malignant tumors occurs in approximately 1 in 80000-100000 cases, and CRC accounts for <2% of all spontaneous malignancy regressions. Recent studies have suggested that immunological mechanisms, particularly those related to deficient mismatch repair (dMMR) and high-frequency microsatellite instability, may play an important role in such tumor regressions.</p><p><strong>Case presentation: </strong>A 68-year-old woman was referred to our hospital after a positive fecal occult blood test. Colonoscopy revealed a 12-mm nonpolypoid lesion (IIa + IIc) in the transverse colon. Biopsy specimens showed poorly differentiated carcinoma without glandular formation or mucin production, accompanied by marked tumor-infiltrating lymphocytes (TILs). Immunohistochemistry was negative for CK20, CDX2, and neuroendocrine markers. The majority of TILs were CD3-positive lymphocytes. CT revealed no lymph node involvement or distant metastasis (cT1bN0M0). Laparoscopic partial colectomy of the transverse colon with D3 lymphadenectomy was performed 50 days after biopsy. Macroscopically, the resected specimen showed only a small scar-like lesion, and histological examination revealed no residual carcinoma. All dissected lymph nodes were tumor-free. Additional immunohistochemical analysis of the biopsy specimen showed loss of MLH1 and PMS2 expression, consistent with a dMMR status. These findings highlighted the possibility of medullary carcinoma, but a definitive diagnosis was not possible due to the limited biopsy samples. The postoperative course was uneventful, and no recurrence was observed during the 18 months of follow-up period without adjuvant therapy.</p><p><strong>Conclusions: </strong>We report an extremely rare case of SR of poorly differentiated CRC with dMMR and marked TILs. Enhanced tumor immunogenicity associated with dMMR and immune activation may contribute to CRC regression.</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/PMC13283752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148302281","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":"Parathyroid Carcinoma Disseminated Following Endoscopically-Assisted Surgery: A Case Report.","authors":"Yoko Omi, Yuki Yamanashi, Tomoyoshi Nakai, Juro Yanagida, Yusaku Yoshida, Naoko Ito, Tomoko Yamamoto, Yoji Nagashima, Kiyomi Horiuchi","doi":"10.70352/scrj.cr.26-0159","DOIUrl":"10.70352/scrj.cr.26-0159","url":null,"abstract":"<p><strong>Introduction: </strong>Endoscopically assisted surgery for parathyroid tumors has provided excellent cosmetic results and has been covered by Japan's national insurance system since 2016. However, careful handling is essential because parathyroid tumor cells can easily disseminate.</p><p><strong>Case presentation: </strong>We herein report the case of a 34-year-old woman who developed widespread dissemination of parathyroid carcinoma after endoscopic resection. She initially underwent endoscopically assisted left thyroid lobectomy for an intrathyroidal parathyroid tumor, which was later diagnosed as a carcinoma. Four years later, multiple cervical recurrences and pulmonary metastases were observed. Extensive cervical tumor resection was performed, including <i>en bloc</i> removal of the invaded structures, followed by resection of lung metastases. Despite temporary improvement, the disease progressed. Genomic profiling revealed a <i>CDC73</i> mutation and high tumor mutation burden. Pembrolizumab therapy achieved temporary stabilization but was eventually ineffective. The patient died during palliative care.</p><p><strong>Conclusions: </strong>This case highlights the risk of tumor cell dissemination in parathyroid surgery when capsular integrity is compromised. While this risk exists regardless of the surgical approach, certain technical factors associated with endoscopically assisted procedures may increase the likelihood of inadvertent capsular injury. Complete <i>en bloc</i> resection during the initial operation is essential for parathyroid carcinoma, because incomplete resection leads to poor prognosis. When carcinoma is suspected intraoperatively, surgeons should consider open surgery. Comprehensive genomic profiling may provide therapeutic options such as immune checkpoint inhibitors for recurrent or metastatic cases.</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/PMC13171186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147942638","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":"Upfront Surgery for c-Stage IIIB Non-Small Cell Lung Cancer with an Abnormally High Preoperative Serum Carcinoembryonic Antigen Level: A Case Report.","authors":"Ryuki Tsunemi, Ryusuke Sumiya, Shinsuke Uchida, Mariko Fukui, Takeshi Matsunaga, Aritoshi Hattori, Takuo Hayashi, Kazuya Takamochi, Kenji Suzuki","doi":"10.70352/scrj.cr.25-0707","DOIUrl":"10.70352/scrj.cr.25-0707","url":null,"abstract":"<p><strong>Introduction: </strong>Carcinoembryonic antigen (CEA) is one of the most widely used tumor markers in clinical practice. In non-small cell lung cancer, elevated preoperative serum CEA levels have been reported to be associated with a poor prognosis.</p><p><strong>Case presentation: </strong>A 43-year-old man with primary lung cancer of the right upper lobe was referred to our hospital. Initial blood tests revealed a markedly elevated serum CEA level of 1160.0 ng/mL. Chest CT identified a 55-mm tumor in the right hilar region, with enlargement of the right hilar and prevascular (#3a) lymph nodes (c-T3N2M0, Stage IIIB according to the Union for International Cancer Control tumor-node-metastasis classification, 8th edition). The patient underwent a type A extended sleeve lobectomy and pulmonary vein transposition. However, due to suspected pulmonary venous return failure, a right completion pneumonectomy was performed on POD 7. The patient's serum CEA levels returned to the normal range within 2 months postoperatively. He has remained recurrence-free for more than 4 years since the surgery.</p><p><strong>Conclusions: </strong>This case highlights that upfront surgery may be a valid treatment option in selected patients with c-Stage IIIA or IIIB disease, even in the presence of an abnormally high preoperative serum CEA level.</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/PMC13341278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412865","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":"Strangulated Small Bowel Obstruction Involving the External Iliac Artery after Pelvic Lymph Node Dissection: A Case Report on Stepwise Intraoperative Decision-Making to Prevent Vascular Injury.","authors":"Tomoyasu Kashiwagi, Yoshiaki Fujimoto, Yuya Ono, Takuma Izumi, Yukihiko Aoyagi, Fumihiko Hirai, Rintaro Yoshida, Takuya Honboh, Noboru Harada, Hiroyuki Itoh, Noriaki Sadanaga, Tomoharu Yoshizumi","doi":"10.70352/scrj.cr.26-0300","DOIUrl":"10.70352/scrj.cr.26-0300","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative anatomical-space-related internal herniation/strangulation after pelvic lymph node dissection (PLND) is uncommon but may be associated with a risk of inadvertent injury to major vessels or urinary tract-related structures.</p><p><strong>Case presentation: </strong>A 77-year-old man with a history of robot-assisted radical cystectomy with ileal conduit diversion and PLND presented with severe abdominal pain. Contrast-enhanced CT revealed a closed-loop small bowel obstruction (SBO) with suspected strangulation adjacent to the right external iliac artery. Emergency laparotomy revealed extensive ischemic and necrotic changes of the small bowel in the right pelvis. Gentle reduction was first attempted but was unsuccessful. Because the constricting structure could not be adequately identified and was considered to potentially involve critical structures requiring preservation, premature direct release or forceful division was avoided. Because direct visualization of the dorsal pelvic structures was limited, CT images were re-reviewed intraoperatively to confirm that the urinary diversion-related structures were separate from the clearly nonviable target bowel. Initial intraloop bowel transection was then performed within the nonviable segment to reduce tension and improve visualization, allowing subsequent identification of the right external iliac artery as the constricting structure. Approximately 230 cm of small bowel was resected based on bowel viability, while more than 200 cm of small bowel was preserved. The artery was preserved and fixed to the pelvic wall. The postoperative course was uneventful.</p><p><strong>Conclusions: </strong>This case highlights a postoperative anatomical-space-related internal herniation/strangulation after PLND. When strangulated SBO occurs adjacent to a major vessel or other critical structures, premature direct release of an inadequately identified constricting structure should be avoided. In selected cases in which gentle reduction is impossible, initial intraloop bowel transection may be considered as a limited bail-out option only after confirming that the clearly nonviable target bowel is anatomically separate from urinary diversion-related structures. This approach may reduce tension and improve visualization for subsequent identification of the constricting structure.</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/PMC13293625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148332967","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":"Small-Intestinal Metastasis from Breast Cancer Presenting with Gastrointestinal Bleeding: A Case Report.","authors":"Ryo Hamaoka, Takahiko Kawate, Yoshiya Horimoto, Yoichi Koyama, Kayono Onishi, Kyoko Orimoto, Natsuki Uenaka, Hiroki Kusama, Yasuyuki Kagawa, Tomoya Tago, Yoshitaka Utsumi, Eiichi Sato, Hiroshi Kaise, Takashi Ishikawa","doi":"10.70352/scrj.cr.25-0814","DOIUrl":"10.70352/scrj.cr.25-0814","url":null,"abstract":"<p><strong>Introduction: </strong>Gastrointestinal metastases from breast cancer are rare, especially in the small intestine, and diagnosis is often difficult due to nonspecific symptoms and limited detectability with standard endoscopy. Intestinal bleeding, although uncommon, may become clinically significant. We report a case of recurrent triple-negative breast cancer in which persistent anemia during sacituzumab govitecan (SG) therapy was attributed to small-bowel metastasis, and small-bowel evaluation using capsule endoscopy and balloon-assisted enteroscopy led to the diagnosis after standard upper and lower endoscopy failed to identify the source of bleeding.</p><p><strong>Case presentation: </strong>A 50-year-old woman with recurrent triple-negative breast cancer underwent multiple systemic treatments before receiving sacituzumab govitecan. From treatment initiation, grade 3 anemia persisted despite transfusion support. Blood test findings indicated ongoing blood loss, including normocytic features with preserved marrow activity. Positive fecal occult blood prompted capsule endoscopy and balloon-assisted enteroscopy, which revealed a protruding jejunal lesion with active bleeding. Biopsy confirmed metastatic breast cancer. Because endoscopic hemostasis was difficult to achieve, laparoscopic partial small-bowel resection was subsequently performed. Histopathology of the resected specimen demonstrated multiple transmural lesions, many of which were suggestive of nodal metastases. Postoperatively, anemia resolved without transfusion, and SG therapy was successfully resumed after surgery.</p><p><strong>Conclusions: </strong>Small-intestinal metastasis causing bleeding is difficult to diagnose due to its nonspecific clinical presentation, and dedicated small-bowel evaluation is essential when standard endoscopy fails to identify the bleeding source.</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/PMC13078317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147691970","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}