International Journal of Surgery Case Reports最新文献

{"title":"Complex surgical management of right-sided infective endocarditis following ventricular septal defect closure with residual shunt and ascending aortic pseudoaneurysm: a case report.","authors":"Yuri Katsui, Yusuke Kato, Takuya Koyano, Naoki Konno, Norihiko Oka, Wataru Tatsuishi","doi":"10.1097/RC9.0000000000000983","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000983","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Right-sided infective endocarditis is an uncommon condition, especially in patients with surgically repaired congenital heart disease. A residual shunt after ventricular septal defect closure can act as a substrate for late-onset infection, but such cases are rarely reported. High-velocity jet flow from a residual shunt may contribute to endothelial injury and subsequent infection. Furthermore, differentiating a late pseudoaneurysm at a prior cannulation site from an infectious aortic aneurysm is essential for guiding the appropriate treatment strategy.</p><p><strong>Case presentation: </strong>A 49-year-old man with a history of ventricular septal defect closure in infancy presented with persistent fever and severe systemic inflammation. Transesophageal echocardiography demonstrated a highly mobile, filamentous vegetation measuring 12 × 56 mm attached to the tricuspid subvalvular apparatus. Contrast-enhanced computed tomography revealed multiple septic pulmonary emboli and a saccular protrusion along the anterior wall of the ascending aorta, suggestive of an ascending aortic pseudoaneurysm. Blood cultures yielded methicillin-susceptible <i>Staphylococcus aureus</i>. Following clinical improvement and multiorgan stabilization with targeted antimicrobial therapy, the patient underwent elective surgery on hospital day 49, including residual defect closure, tricuspid valve replacement with a mechanical prosthesis, and localized pseudoaneurysm repair using a Hemashield patch.</p><p><strong>Clinical discussion: </strong>This complex combination of pathologies highlights the pathophysiological impact of residual shunt-jet lesions. The clinical decision-making illustrates the challenges of balancing guideline recommendations for early surgery with the need for clinical stabilization.</p><p><strong>Conclusion: </strong>This case highlights the importance of lifelong follow-up in adult congenital heart disease and provides important considerations for individualized surgical planning in complex cardiovascular pathologies.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4483-4486"},"PeriodicalIF":0.6,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166267","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":"Emergency surgical management for complicated schistosomal massive splenomegaly with portomesenteric thrombosis and bowel ischemia: a case report.","authors":"Rasheed Altwiher, Ahmad Alzaid, Amir Othman, Yasser Alhabeeb, Mahabbah Fawaz Almarshdi, Yasmin Al-Shammari","doi":"10.1097/RC9.0000000000000984","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000984","url":null,"abstract":"<p><strong>Introduction: </strong>Schistosomal periportal fibrosis is a major cause of non-cirrhotic portal hypertension and massive splenomegaly. Rarely, superimposed portomesenteric venous thrombosis (PMVT) may precipitate bowel ischemia. Managing this combination in non-endemic settings presents significant diagnostic and therapeutic challenges. We report successful bowel salvage and definitive portal decompression during the same surgical course.</p><p><strong>Case presentation: </strong>A 43-year-old man with schistosomal periportal fibrosis and massive splenomegaly presented with partial PMVT-associated bowel ischemia. Following surgeon-led MDT evaluation, emergency laparotomy revealed an ischemic jejunal segment, which was completely salvaged after extensive adhesiolysis relieved severe splenic mesenteric traction. Concurrently, splenectomy and esophagogastric devascularization successfully addressed the underlying portal hypertension. After a 48-hour damage-control temporary closure, a second-look confirmed bowel viability. A postoperative Grade B pancreatic fistula resolved conservatively. The patient recovered completely, with long-term variceal regression.</p><p><strong>Conclusion: </strong>Definitive surgical management can complement emergency intervention in selected patients with advanced hepatosplenic schistosomiasis. Successful outcomes require timely surgeon-led multidisciplinary decision-making and careful damage-control surgical planning.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4500-4504"},"PeriodicalIF":0.6,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171279","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":"Endovascular salvage of graft hepatic artery dissection with intrahepatic extension following right lobe living donor liver transplantation: a case report with literature review.","authors":"Manh V Nguyen, Quynh V Nguyen, Thanh V Le, Hieu T Le, Thang M Tran, Hoang A Ta","doi":"10.1097/RC9.0000000000000994","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000994","url":null,"abstract":"<p><strong>Introduction: </strong>Hepatic artery complications after liver transplantation are uncommon but potentially catastrophic because the biliary tree depends entirely on the arterial blood supply. Graft hepatic artery dissection (GHAD) is extremely rare following living donor liver transplantation (LDLT), and optimal management strategies remain unclear.</p><p><strong>Case presentation: </strong>A 68-year-old man with hepatocellular carcinoma and underlying alcohol-related cirrhosis underwent right-lobe LDLT. During donor hepatectomy, intimal dissection of the graft hepatic artery, extending deep into the liver parenchyma, was identified. After arterial reconstruction, intraoperative Doppler ultrasound demonstrated absent arterial flow. The abdomen was closed, and the patient was transferred for urgent endovascular intervention. Angiography confirmed compromised arterial inflow, and a drug-eluting stent was deployed across the arterial anastomosis, followed by catheter-directed thrombolysis using alteplase. Postoperatively, the patient developed intra-abdominal bleeding requiring emergency re-laparotomy for hemostasis. Despite this complication, hepatic arterial perfusion was successfully restored. Liver function gradually improved, and follow-up imaging confirmed adequate graft perfusion. The patient was discharged 3 weeks after transplantation with preserved graft function.</p><p><strong>Discussion: </strong>GHAD is a rare but serious vascular complication that may result in graft ischemia, biliary complications, and graft failure if not promptly treated. When surgical revision is not feasible, endovascular techniques - including stent placement and thrombolysis - can serve as effective salvage strategies. However, thrombolytic therapy carries a significant risk of hemorrhagic complications, requiring careful postoperative monitoring.</p><p><strong>Conclusion: </strong>Early diagnosis and multidisciplinary management are essential for the successful salvage of GHAD after LDLT.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4383-4388"},"PeriodicalIF":0.6,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170294","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":"Ectopic pancreas as a lead point for intussusception: case report and review of literature.","authors":"Arturo Javier Cavazos Castro, Diana Altamirano Montealvo, Harold Castro Anaya, José Asz Sigall, Horacio G Carvajal","doi":"10.1097/RC9.0000000000000993","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000993","url":null,"abstract":"<p><strong>Introduction: </strong>Intussusception due to a pathological lead point is uncommon in children, usually occurring in cases with atypical presentation, recurrence, or failed nonoperative reduction. We report the case of a boy with intussusception due to a heterotopic pancreas.</p><p><strong>Case presentation: </strong>We report the case of a 3-year-old boy who presented with acute abdominal pain, vomiting, and bloody stools. Ultrasonography demonstrated findings consistent with intussusception. After unsuccessful pneumatic reduction under fluoroscopic guidance, we performed an exploratory laparotomy. Manual reduction revealed a 1 × 1 × 1 cm pathologic lead point in the ileum, requiring segmental bowel resection. Histopathologic examination confirmed subserosal ectopic pancreatic tissue.</p><p><strong>Clinical discussion: </strong>Heterotopic pancreas is rarely found in the ileum. When present in the distal bowel, it may rarely serve as a pathological lead point for intussusception.</p><p><strong>Conclusion: </strong>Ectopic pancreatic tissue is an extremely rare cause of a pathological lead point in pediatric intussusception. Clinicians should consider an underlying lesion in intussusception patients with atypical presentation, recurrence, or unsuccessful nonoperative reduction, as surgical management allows for both definitive treatment and histopathological diagnosis.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4418-4423"},"PeriodicalIF":0.6,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167734","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":"Primary large-cell neuroendocrine carcinoma of the submandibular gland arising from a long-standing benign tumor: case report.","authors":"Dorra Chiboub, Ameni Amri, Nadia Romdhane, Imen Zoghlami, Ehsen Ben Brahim, Chiraz Mbarek","doi":"10.1097/RC9.0000000000000918","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000918","url":null,"abstract":"<p><strong>Background: </strong>Large-cell neuroendocrine carcinoma (LCNEC) is an aggressive malignancy that commonly arises in the lungs. Primary salivary gland involvement is exceptional, presenting a major diagnostic challenge in differentiating it from metastatic pulmonary disease.</p><p><strong>Case presentation: </strong>A 62-year-old man presented with a right submandibular mass that had been stable for 16 years before rapidly expanding. Imaging revealed a massive 11 cm necrotic submandibular tumor with disseminated pulmonary and hepatic metastases. Following partial debulking, pathology revealed a high-grade neuroendocrine tumor (Ki-67 index 85%) arising alongside a benign mesenchymal component. Immunohistochemistry showed diffuse CD56 positivity and TTF-1 negativity.</p><p><strong>Discussion: </strong>While histology mimics pulmonary variants, the dominant pre-existing cervical mass and chronologic evolution strongly suggest a primary salivary origin, likely representing malignant transformation of a benign lesion.</p><p><strong>Conclusion: </strong>This case highlights the rare phenomenon of primary salivary LCNEC developing within a long-standing benign mass. It underscores the importance of including high-grade neuroendocrine carcinoma in the differential diagnosis of rapidly expanding salivary lesions.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4223-4227"},"PeriodicalIF":0.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167973","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":"Osteoid osteoma of the talus adjacent to the subtalar joint: a rare location and diagnostic challenge.","authors":"Hao Han, Long Yang, Xiangjun Qin, Qi Lu, Guangchao Cao","doi":"10.1097/RC9.0000000000000987","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000987","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Osteoid osteoma is a common benign bone tumor, but lesions located in the talus, especially those adjacent to the subtalar joint, are relatively rare and prone to misdiagnosis. Its clinical and imaging manifestations are often atypical, which can lead to delayed diagnosis and inappropriate conservative treatment. Accurate imaging evaluation and appropriate surgical management are critical for symptom relief and functional recovery.</p><p><strong>Case presentation: </strong>We present a 20-year-old male with chronic left ankle pain that worsened at night and with weight-bearing. Initial MRI suggested bone marrow edema and ligament injury, leading to a misdiagnosis of ankle synovitis and sprain. Subsequent CT clearly identified a 5-mm nidus at the medial inferior margin of the left talus. The patient underwent open resection with intraoperative CT-guided K-wire localization. Postoperative histopathological examination confirmed osteoid osteoma. At the 1-year follow-up, the patient was pain-free and had fully resumed daily activities.</p><p><strong>Clinical discussion: </strong>Talar osteoid osteoma is prone to misdiagnosis because its symptoms resemble those of ankle sprain, synovitis, or impingement. CT is the gold standard for detecting the nidus, while MRI frequently shows nonspecific bone marrow edema. Surgical excision remains a reliable treatment method. CT-guided K-wire localization improves accuracy, minimizes bone damage, and ensures complete resection, avoiding incomplete ablation and the recurrence risk associated with percutaneous radiofrequency ablation.</p><p><strong>Conclusion: </strong>Osteoid osteoma of the talus is a rare but significant cause of chronic ankle pain and is easily misdiagnosed. CT is essential for early and accurate diagnosis. For juxta-articular lesions, CT-guided K-wire localization followed by open resection is safe and effective, completely relieving symptoms and achieving good long-term outcomes.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4517-4522"},"PeriodicalIF":0.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168075","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":"Solitary splenosis mimicking retroperitoneal tumor: a case report.","authors":"Wen-Jia Liu, Qing-Da Wang, Lou-Zong Sun, Gui-Gang Qiu, Nan Yang","doi":"10.1097/RC9.0000000000001012","DOIUrl":"https://doi.org/10.1097/RC9.0000000000001012","url":null,"abstract":"<p><strong>Introduction: </strong>Splenosis is a rare benign disorder characterized by autotransplantation of splenic tissue after splenic trauma or splenectomy. Isolated retroperitoneal splenosis is extremely uncommon and can be easily misdiagnosed as a malignant neoplasm, which may lead to unnecessary surgical procedures.</p><p><strong>Case presentation: </strong>A 38-year-old woman with a history of traumatic total splenectomy 6 years earlier was admitted with acute right upper abdominal pain. Imaging examinations showed cholecystolithiasis, choledocholithiasis, and a 2.2 cm solid mass in the right retroperitoneum at the upper pole of the right kidney, which was initially considered a neoplastic lesion. Laparoscopic resection was performed, and pathological examination confirmed splenosis.</p><p><strong>Clinical discussion: </strong>Retroperitoneal splenosis tends to show nonspecific imaging features similar to those of malignant tumors. For patients with a history of splenic injury or splenectomy, splenosis should be routinely included in the differential diagnosis of retroperitoneal masses. 99mTc-labeled heat-damaged red blood cell scintigraphy serves as a reliable noninvasive method for preoperative confirmation.</p><p><strong>Conclusion: </strong>Isolated splenosis in the right retroperitoneum at the upper pole of the right kidney is a very rare entity that mimics a retroperitoneal tumor. Splenosis should be suspected in patients with prior splenic trauma or splenectomy who present with unusual soft-tissue masses to avoid misdiagnosis and redundant surgery.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4473-4476"},"PeriodicalIF":0.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168826","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 a low-grade appendiceal mucinous neoplasm in a patient with autosomal dominant polycystic kidney disease: a case report.","authors":"Masaya Aizawa, Shingo Tsujinaka, Yoh Kitamura, Yuuri Hatsuzawa, Tomoya Miura, Toru Nakano","doi":"10.1097/RC9.0000000000000953","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000953","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Appendiceal mucinous neoplasms (AMNs) are rare, and preoperative diagnosis can be challenging, particularly when other abdominal cystic diseases coexist. Autosomal dominant polycystic kidney disease (ADPKD), which is characterized by multiple cystic formations, can complicate both differential diagnosis and surgical planning.</p><p><strong>Case presentation: </strong>A 77-year-old man with ADPKD and chronic renal failure was referred to our hospital following a positive fecal occult blood test during an evaluation for anemia. Colonoscopy revealed a large submucosal tumor-like elevation in the cecum, obscuring the appendiceal orifice. Non-contrast computed tomography showed multiple abdominal cysts and a low-attenuation lesion protruding into the cecal lumen with tubular extension outside the cecum. An AMN was suspected, although the potential for malignancy and pseudomyxoma peritonei could not be completely excluded. Despite concerns that the cysts might limit the operative view, pneumoperitoneum provided adequate visualization since the cysts were primarily retroperitoneal. Laparoscopic ileocecal resection with D2 lymph node dissection and primary ileocolic anastomosis was completed without tumor rupture. No ileostomy was created. The postoperative course was uneventful. Histopathological examination confirmed a low-grade AMN. No recurrence was observed 9 months postoperatively.</p><p><strong>Clinical discussion: </strong>This case underscores the challenge of differentiating AMNs from other cystic lesions in patients with ADPKD and suggests that cyst distribution may influence the surgical approach and exposure.</p><p><strong>Conclusion: </strong>Laparoscopic surgery may be a feasible option for patients with multiple abdominal cystic diseases when the cysts are predominantly located in the retroperitoneum.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4315-4319"},"PeriodicalIF":0.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171196","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":"Bilateral giant pulmonary hydatid cysts in a toddler presenting as severe pneumonia: a risk-adapted staged surgical approach.","authors":"Davood Salehi, Negin Rostamzadeh, Samin Rostamzadeh","doi":"10.1097/RC9.0000000000001004","DOIUrl":"https://doi.org/10.1097/RC9.0000000000001004","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary hydatid disease is common in endemic regions, yet bilateral giant cysts in toddlers are exceptionally rare and may mimic severe pneumonia. Their management is challenging, particularly in physiologically vulnerable children.</p><p><strong>Case presentation: </strong>We report a 32-month-old girl presenting with fever, progressive cough, and severe respiratory distress. Imaging revealed four large pulmonary hydatid cysts-three in the left lung and one in the right-complicated by superimposed bacterial infection and hypoxemia. Albendazole therapy (15 mg/kg/day) was initiated, and a risk-adapted, staged surgical plan was selected due to low body weight, poor nutritional status, and limited respiratory reserve. The patient underwent left thoracotomy with cyst excision and capitonnage, followed by right thoracotomy 3 months later, after clinical improvement and weight gain. Recovery was uneventful, and no recurrence was observed during follow-up.</p><p><strong>Conclusion: </strong>This case highlights the diagnostic challenges of bilateral giant pulmonary hydatid cysts in toddlers and supports staged thoracotomy as a physiologically tailored strategy to minimize perioperative respiratory risk in compromised pediatric patients.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4487-4491"},"PeriodicalIF":0.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168161","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":"Non-alcoholic Wernicke encephalopathy following pancreaticoduodenectomy (Whipple procedure): a case report and review of the literature.","authors":"Ricardo Mitsuru Hanada-Angulo, Frank Young-Tabusso","doi":"10.1097/RC9.0000000000000989","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000989","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Wernicke encephalopathy (WE) is an acute neurological emergency caused by thiamine deficiency. It is uncommon after pancreaticoduodenectomy and may be overlooked when postoperative metabolic disturbances coexist.</p><p><strong>Presentation of case: </strong>A 66-year-old woman underwent pancreaticoduodenectomy for a duodenal neoplasm. Her postoperative course was complicated by pancreatic fistula, extended-spectrum beta-lactamase-producing <i>Escherichia coli</i> infection, impaired oral intake, and prolonged nutritional support. During the third to fourth postoperative weeks, she developed fluctuating encephalopathy, bradylalia, and horizontal nystagmus. Serum thiamine was 1.2 µg/dL (reference range: 2.8-8.5 µg/dL), and magnetic resonance imaging showed periaqueductal T2/fluid-attenuated inversion recovery hyperintensity. Hypoosmolar hyponatremia with clinical euvolemia and preserved thyroid and adrenal function was considered compatible with probable postoperative syndrome of inappropriate antidiuretic hormone secretion, although urinary biochemical confirmation was unavailable. Intravenous thiamine 500 mg every 8 hours for 3 days, followed by 250 mg daily for 5 days, produced partial improvement within 24-72 hours. At 3-month follow-up, the neurological manifestations had resolved.</p><p><strong>Clinical discussion: </strong>Pancreaticoduodenectomy and its complications can accelerate thiamine depletion within a broader spectrum of postoperative nutritional and metabolic disturbances. The oculomotor findings, low serum thiamine, characteristic imaging findings, and treatment response supported a diagnosis of WE. Hyponatremia probably contributed to the altered mental status but did not explain the ocular signs or periaqueductal lesions.</p><p><strong>Conclusion: </strong>WE should be considered in postoperative patients with nutritional compromise and new neurological or oculomotor findings. Parenteral thiamine should not be delayed while awaiting confirmation, and coexisting electrolyte disorders should be corrected cautiously.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4523-4526"},"PeriodicalIF":0.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171651","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}