International Journal of Surgery Case Reports最新文献

{"title":"When gas travels: a case report of partial Horner's syndrome from subcutaneous emphysema post-laparoscopic hiatal hernia repair.","authors":"Genaro E Herrera Cano, Anvesh Balabhadra, Sandhya Mehla","doi":"10.1097/RC9.0000000000000804","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000804","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative partial Horner's syndrome associated with subcutaneous emphysema after laparoscopic hiatal hernia repair has not been previously reported. In this particular case, this rare complication is due to compression of the cervical sympathetic plexus surrounding the carotid artery by subcutaneous emphysema.</p><p><strong>Case presentation: </strong>A 59 year-old female awoke postoperatively from laparoscopic hiatal hernia repair and complained of blurred vision in the left eye and difficulty opening it. This prompted the general surgery team to consult neurology. The patient was examined and underwent a workup for brainstem infarct, carotid artery aneurysm or dissection, and myasthenia gravis. The examination revealed complete left-sided ptosis with equal, round, and reactive pupils. MRI of the brain and myasthenia gravis laboratory workup were unremarkable. CT angiography of the neck revealed subcutaneous emphysema adjacent to the carotid arteries. The symptoms resolved on their own on the second postoperative day.</p><p><strong>Discussion: </strong>After exclusion of neurologic and ischemic vascular causes, transient partial Horner's syndrome was attributed to postoperative subcutaneous emphysema compressing the cervical sympathetic pathway. Although facial subcutaneous emphysema during laparoscopy has been described, its association with Horner's syndrome after laparoscopic hiatal hernia repair has not been reported. This case highlights a rare neurologic manifestation of a common perioperative complication.</p><p><strong>Conclusion: </strong>Recognition of postoperative subcutaneous emphysema as a benign cause of ptosis or partial Horner's syndrome may narrow the differential diagnosis and reduce unnecessary investigations. While prompt evaluation of time-sensitive neurologic events remains essential, this entity should be considered in atypical postoperative presentations, as gas may compress adjacent neurovascular pathways.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 9","pages":"3589-3592"},"PeriodicalIF":0.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898173","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":"Combination of stereo-electroencephalography and electrocorticography to manage mild malformation of cortical development with oligodendroglial hyperplasia and epilepsy (MOGHE): a case report.","authors":"Farzad Sina, Vahid Heidari, Helia Hemasian, Ali Zare Mehrjardi, Mahmoud Khaleghi Mehr, Armin Ariaei","doi":"10.1097/RC9.0000000000000885","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000885","url":null,"abstract":"<p><strong>Introduction: </strong>Mild malformation of cortical dysplasia with oligodendroglial hyperplasia and epilepsy (MOGHE) is a rare form of cortical malformation pathologically characterized by oligodendroglial proliferation and hypomyelination.</p><p><strong>Case presentation: </strong>Herein, we describe a 25-year-old patient with MOGHE in the right temporal lobe who has suffered from refractory epilepsy since 4 months of age, highlighting a remarkably delayed diagnosis. Magnetic resonance imaging (MRI) suggested cortical thickening and an abnormally low gyrification index in the frontotemporal region. A positron emission tomography (PET) scan reported right mesial temporal hypometabolism. The EEG findings revealed bilateral paroxysms of high-amplitude slow spike-waves with a frequency of 2.5-3 per second in the awake state and 1-1.5 per second in sleep, with a normal posterior dominant rhythm. The SEEG depicted involvement of the middle and inferior frontal gyri, temporal pole, medial temporal, and orbitofrontal regions, reflecting more extensive epileptogenic areas. Epilepsy surgery was performed to resect the right temporal lobe and portions of the frontal lobe. Pathology confirmed the presence of glial hyperplasia and abnormal neural migration. After 14 months, only occasional minor focal seizures were observed.</p><p><strong>Discussion: </strong>Temporal MOGHE lesions have previously been reported; however, in those cases, ictal patterns were limited to the lesion because of early diagnosis. In our case, delayed diagnosis resulted in the development of epileptogenic areas.</p><p><strong>Conclusion: </strong>In patients with delayed diagnosis, brain areas with a high epileptogenic index may be discordant with the locations of MRI hallmarks of MOGHE. It is hypothesized that a larger resection may help decrease seizure frequency. However, additional large-sample studies are needed to confirm this.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 9","pages":"3849-3857"},"PeriodicalIF":0.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898024","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 intervention and management of biliary atresia in a 4-month-old infant: a case report.","authors":"Mohammad Shafiqi, Mujtaba Yama","doi":"10.1097/RC9.0000000000000888","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000888","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Biliary atresia (BA) is a progressive fibro-obliterative disorder of the biliary tract that causes cholestasis, cirrhosis, and liver failure if left untreated. Kasai portoenterostomy (KP) is the standard initial treatment, with better outcomes when performed early. We report a rare case of successful surgical management of late-presenting BA at 4 months of age in a resource-limited setting.</p><p><strong>Case presentation: </strong>A 4-month-old girl presented with persistent jaundice, pale stools, dark urine, and hepatomegaly. She had previously been treated for neonatal hepatitis without improvement. Laboratory evaluation showed conjugated hyperbilirubinemia (total bilirubin 18.8 mg/dL, direct bilirubin 17.2 mg/dL). Ultrasonography demonstrated an atretic gallbladder and a triangular cord sign suggestive of BA. Due to limited access to advanced diagnostic modalities, the diagnosis was established based on clinical, laboratory, ultra-sonographic, and intraoperative findings. Extended hilar dissection and a wide Roux-en-Y hepatic portoenterostomy were performed. Postoperative management included corticosteroids and ursodeoxycholic acid. Progressive improvement in liver function tests and clinical status was observed, with complete resolution of jaundice during follow-up.</p><p><strong>Clinical discussion: </strong>Although KP performed within 60-90 days provides the best outcomes, selected late-presenting patients may still achieve successful bile drainage. This case emphasizes the importance of careful patient selection, meticulous surgical technique, and optimized postoperative management, even beyond the traditional therapeutic window.</p><p><strong>Conclusion: </strong>Delayed presentation should not automatically exclude infants with BA from surgical treatment. Early recognition, referral, and appropriate surgical management remain essential to improve outcomes in late-presenting cases.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 9","pages":"3915-3919"},"PeriodicalIF":0.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898070","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":"Multicentric metachronous giant cell tumor of the femur: a rare case report and review of the literature.","authors":"Christopher Paul, Jimmy Olomi","doi":"10.1097/RC9.0000000000000890","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000890","url":null,"abstract":"<p><strong>Background: </strong>Giant cell tumor of bone (GCTB) is a benign but locally aggressive osteolytic neoplasm that most commonly presents as a solitary lesion in long bones. Multicentric GCTB is rare, comprising fewer than 1% of all cases, and metachronous involvement of two distinct regions within the same bone is exceptionally uncommon.</p><p><strong>Case presentation: </strong>We report the case of a 22-year-old man who initially presented with a 2-year history of right knee pain. Radiologic and histopathologic evaluation confirmed a Campanacci grade III GCTB of the distal femur, which was treated with intralesional curettage, polymethylmethacrylate augmentation, and adjuvant radiotherapy. Seven months later, he developed new-onset right hip pain. Imaging revealed a separate osteolytic lesion of the proximal femur. Histopathology confirmed a second GCTB lesion, establishing the diagnosis of multicentric metachronous disease.</p><p><strong>Clinical discussion: </strong>The development of a second histologically confirmed GCTB within the same femur shortly after treatment of the primary lesion represents a rare diagnostic and therapeutic challenge. Distinguishing metachronous multicentric disease from intramedullary skip lesions and metastatic or metabolic bone disease is critical, as management and prognosis differ substantially. The recommended treatment for GCTB is curettage, but this may not be possible when the lesion is located in the proximal femur.</p><p><strong>Conclusion: </strong>This case highlights an exceptionally rare presentation of a metachronous, multicentric GCTB occurring in different regions of the same long bone. Vigilant long-term radiologic surveillance is essential.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 9","pages":"3905-3909"},"PeriodicalIF":0.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898208","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":"Solid pseudopapillary neoplasm of the pancreas: a rare tumor case report.","authors":"Ana C Moreira, Daniela Lira, Maria Costa, Maria Reigota, Filipe Ribeiro, Joana Noronha","doi":"10.1097/RC9.0000000000000903","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000903","url":null,"abstract":"<p><strong>Introduction: </strong>Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumor, accounting for about 0.3-2.7% of pancreatic neoplasms. It mainly affects young women aged 20-40 years and usually presents as an asymptomatic abdominal mass. Although typically indolent, approximately 15% exhibit malignant potential. Complete surgical resection is curative in most cases.</p><p><strong>Presentation of the case: </strong>A 28-year-old woman was referred for a general surgery consultation due to a suspected adrenal gland mass that had been monitored in her country of origin. The patient was asymptomatic, with normal laboratory results and negative tumor markers. Due to an allergy to iodinated contrast, magnetic resonance imaging was performed, confirming findings compatible with an encapsulated pancreatic lesion measuring 112 × 86 × 80 mm. Elective laparoscopic surgery revealed a well-defined mass in contact with the pancreatic tail that was completely excised without complications. Histopathological examination confirmed a solid pseudopapillary neoplasm, with strong β-catenin staining and negative surgical margins. The patient remains asymptomatic under regular follow-up, with no recurrence to date.</p><p><strong>Discussion: </strong>SPN is a low-grade malignant tumor with an excellent prognosis after complete resection. Diagnosis may be challenging due to overlap with other pancreatic masses, particularly in contrast-restricted studies, and confirmation via β-catenin immunohistochemistry is pivotal. Surgical excision is both diagnostic and therapeutic.</p><p><strong>Conclusion: </strong>Although rare, SPN should be considered in young women with pancreatic masses. Early recognition and complete surgical removal offer curative outcomes and excellent long-term survival. Minimally invasive, parenchyma-sparing techniques should be considered safe and effective options, particularly in young patients.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 9","pages":"3929-3933"},"PeriodicalIF":0.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897992","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":"3D-printed navicular replacement for giant cell tumor: a case report on a feasible indication and surgical outcome.","authors":"Tran Quang Sang Nguyen, Nhat Anh Luong, Duc Huy Le, Sy Quyen Nang Vo, Trung Hieu Pham, Trung Dung Tran","doi":"10.1097/RC9.0000000000000551","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000551","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Giant cell tumor of the navicular is extremely rare and difficult to manage due to the complex biomechanics of the midfoot. Conventional curettage carries a high recurrence risk. This report presents a feasible approach using total navicular replacement for a giant cell tumor, offering a solution for achieving both oncologic control and functional reconstruction.</p><p><strong>Case presentation: </strong>A 32-year-old man presented with progressive midfoot pain and a Campanacci grade II giant cell tumor confined to the navicular. Imaging showed near-complete osteolysis with an intact cortex. A patient-specific titanium implant was designed using virtual surgical planning, incorporating porous surfaces and fixed screw trajectories for talocuneiform fusion. En bloc excision of the navicular and implantation of the custom device were performed through a medial approach. Postoperative recovery was uneventful. By 2 years, the patient was pain-free, exhibited a normal gait, and achieved excellent functional scores, with imaging confirming osseointegration and no recurrence.</p><p><strong>Clinical discussion: </strong>While three-dimension (3D print implants are increasingly used in complex foot and ankle reconstructions, their application for primary bone tumors in the midfoot has not been previously reported. This case demonstrates that custom implants can provide stable midfoot restoration when conventional grafting or curettage is insufficient. Advantages include precise anatomical matching and reliable fixation; however, cost and long-term durability remain considerations.</p><p><strong>Conclusion: </strong>Total navicular replacement using a custom 3D-printed implant achieved excellent 2-year oncologic and functional outcomes in this rare giant cell tumor case. This technique represents a viable and innovative reconstructive option for select midfoot tumors.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 9","pages":"3297-3302"},"PeriodicalIF":0.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898041","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":"Adenosquamous carcinoma of the cervix: a case report from a resource-limited setting.","authors":"Charles Malisaba Posite, Dieumerci Kaseso, Salomon Kabeza, Samuel Tumwesigire","doi":"10.1097/RC9.0000000000000895","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000895","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Adenosquamous carcinoma of the cervix (ASCC) is a rare, aggressive histological variant representing 1.8% to 5% of cervical malignancies. It is generally associated with a poorer prognosis than squamous cell carcinoma. In resource-limited settings, systemic barriers often preclude standardized multimodal management, necessitating management decisions shaped by limited resources. This case is presented following the SCARE criteria.</p><p><strong>Case presentation: </strong>A 64-year-old multiparous female presented to a tertiary hospital in Uganda with a multi-month history of dyspareunia and post-coital bleeding. Physical examination revealed an ulcerated cervical lesion; however, HPV DNA screening was unavailable. The patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histopathology revealed a 3.0 cm mass with dual squamous and glandular differentiation, staged as pT1b1 Nx Mx according to the AJCC eighth edition. Due to a lack of equipment, radical lymphadenectomy and adjuvant radiotherapy were not performed. A 5-year surveillance plan was proposed for postoperative follow-up.</p><p><strong>Clinical discussion: </strong>This case highlights the gap between basic care and enhanced international standards for cervical malignancies in women. The Nx status reflects incomplete nodal staging in a resource-limited setting. Lack of equipment limited the ability to provide appropriate, screening-based surgical management, making prospective postoperative surveillance necessary.</p><p><strong>Conclusion: </strong>ASCC necessitates early detection and standardized multimodal care, objectives that are frequently precluded by infrastructure constraints in Sub-Saharan Africa. Improving outcomes for such aggressive histologies requires a concerted global effort to expand access to HPV vaccination, DNA-based screening, and equitable radiotherapy infrastructure. This may improve the likelihood of curative treatment in resource-constrained environments.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 9","pages":"3920-3924"},"PeriodicalIF":0.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898053","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 distal gastrectomy with simultaneous hiatal repair for gastric cancer associated with a paraesophageal hernia containing the small intestine: a case report.","authors":"Yusuke Matsune, Mikio Makuuchi, Shiori Yokoi, Osamu Uemichi, Kosuke Yamada, Takeshi Aoki","doi":"10.1097/RC9.0000000000000897","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000897","url":null,"abstract":"<p><strong>Introduction: </strong>Simultaneous resection of gastric cancer and repair of a paraesophageal hernia (PEH) are rarely reported. In older patients, marked anatomical distortion may make oncologic resection, hernia repair, and reconstruction technically challenging. We report a case of gastric cancer with concomitant type IV PEH managed by laparoscopic distal gastrectomy and simultaneous hiatal repair.</p><p><strong>Case presentation: </strong>An 82-year-old man presented with epigastric discomfort. He had a history of endoscopic submucosal dissection for early gastric cancer, chronic obstructive pulmonary disease, and mild cognitive decline. Esophagogastroduodenoscopy revealed a type-1 antral tumor, and biopsy showed well-differentiated tubular adenocarcinoma. Computed tomography demonstrated small-intestinal herniation into the mediastinum through a markedly enlarged hiatus, consistent with type IV PEH. Laparoscopic distal gastrectomy with D1 lymphadenectomy and simultaneous hiatal repair was performed. After reduction of the herniated intestine, the crura were approximated with nonabsorbable sutures. Billroth II reconstruction was selected to minimize anastomotic tension under the distorted anatomy. Transient postoperative pneumonia and cognitive decline were managed conservatively.</p><p><strong>Clinical discussion: </strong>This case illustrates the technical challenges of treating gastric cancer complicated by type IV PEH in an older patient. Laparoscopy provided clear visualization of the enlarged hiatus and facilitated safe reduction and repair. Billroth II reconstruction helped reduce anastomotic tension in the setting of altered anatomy.</p><p><strong>Conclusions: </strong>Laparoscopic distal gastrectomy with simultaneous hiatal repair may be feasible in patients with gastric cancer and concomitant type IV PEH. Careful reconstruction, selection, and perioperative management of frailty-related complications are essential in older patients.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 9","pages":"3925-3928"},"PeriodicalIF":0.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898229","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 repair of complete right main bronchial transection after blunt chest trauma: a case report.","authors":"Youssef Abbas, Mohammad Alaa Aldakak, Yamama Abo Dakka, Bassel Ibrahim, Wasfi Sahloul, Mohammed Ali Aljibawi","doi":"10.1097/RC9.0000000000000889","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000889","url":null,"abstract":"<p><strong>Background: </strong>Tracheobronchial injury following blunt chest trauma is an uncommon but potentially fatal condition that is frequently underrecognized because of nonspecific early findings. Right main bronchial injuries are particularly important because they often occur near the carina and may present with persistent pneumothorax, pneumomediastinum, extensive subcutaneous emphysema, and failure of lung re-expansion after tube thoracostomy.</p><p><strong>Case presentation: </strong>We report the case of a 16-year-old, previously healthy male who sustained blunt chest trauma after a wall collapsed onto him. He presented with severe respiratory distress, agitation, chest pain, cyanosis, and profound hypoxemia. Chest radiography demonstrated a complete right-sided pneumothorax with a fallen lung sign. Emergency computed tomography confirmed a complete right-sided pneumothorax, marked pneumomediastinum, and a contralateral pulmonary contusion. Despite right-sided chest tube insertion, a massive, continuous air leak persisted, and the right lung failed to re-expand adequately.</p><p><strong>Case discussion: </strong>Emergency right thoracotomy revealed bulging mediastinal pleura and complete transection of the right main bronchus just proximal to its bifurcation. The proximal and distal bronchial stumps were mobilized and repaired using an interrupted end-to-end bronchial anastomosis, followed by pleural flap reinforcement. Intraoperative air-leak testing was negative, and complete right lung re-expansion was achieved. This case highlights the classic but often overlooked diagnostic clues of major tracheobronchial injury and supports early lung-preserving repair when viable tissue is present.</p><p><strong>Conclusion: </strong>Complete right main bronchial transection should be suspected following blunt chest trauma when a pneumothorax is associated with pneumomediastinum, a massive, persistent air leak, and failure of lung re-expansion after tube thoracostomy. Prompt recognition and emergency primary repair can restore airway continuity, preserve the lung, and result in satisfactory clinical respiratory recovery.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 9","pages":"3900-3904"},"PeriodicalIF":0.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898061","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 Swiss flag through the chest: a case report of a rare transmediastinal impalement.","authors":"Jonathan Schumacher, Gyoergy Lang, Isabelle Opitz, Didier Schneiter","doi":"10.1097/RC9.0000000000000873","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000873","url":null,"abstract":"<p><strong>Introduction: </strong>Management of transmediastinal penetrating injuries (TMI) is challenging. We report an educational flagpole-related case.</p><p><strong>Case presentation: </strong>A 61-year-old woman arrived at our trauma center after a boating accident resulting in transthoracic impalement from a fall onto a flagpole. She was hemodynamically stable, fully conscious, and without additional injuries. Chest X-ray showed an approximately 30-cm foreign body penetrating the thorax from the left and ending paramediastinally on the right, suggesting mediastinal and pulmonary involvement. CT confirmed that the flagpole entered through the left third intercostal space (ICS), traversed the left upper lobe and mediastinum near the aortic arch and between the trachea and esophagus, and ended in the right lung. Bronchoscopy and esophagoscopy excluded endoluminal injury. A clamshell thoracotomy was performed via the fourth ICS and was extended to the flagpole entry site. The flagpole penetrated both upper lobes and the mediastinum near the aortic arch. It was carefully withdrawn, and a minor adventitial injury to the aortic arch was identified. Pulmonary lacerations and a left upper lobe segmental artery were sutured. Tracheal exploration revealed no injury. She was extubated 7 hours postoperatively, remained in the ICU for three days, and was discharged after an uneventful 18-day stay. Follow-up showed no complications.</p><p><strong>Clinical discussion: </strong>Unlike common thoracic injuries, TMIs often require surgery due to the frequent involvement of critical organs. This case illustrates that stable patients benefit from detailed CT and endoscopic assessment to guide operative strategy. Controlled flagpole shortening enabled CT imaging. Clamshell thoracotomy provided optimal exposure of all involved structures.</p><p><strong>Conclusion: </strong>This TMI case highlights the importance of cautious shortening of impaling objects that exceed CT gantry limits and the critical role of multidisciplinary trauma management.</p><p><strong>Graphical abstract available at: </strong>https://links.lww.com/IJSCR/A126.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 9","pages":"3889-3894"},"PeriodicalIF":0.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898064","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}