International Journal of Surgery Case Reports最新文献

{"title":"Two-stage laparoscopic management of De Garengeot hernia with gangrenous appendicitis: a case report and literature review.","authors":"Ata Maden, Ido Mizrahi","doi":"10.1097/RC9.0000000000000785","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000785","url":null,"abstract":"<p><strong>Introduction and importance: </strong>De Garengeot hernia (DGH), the presence of the appendix within a femoral hernia sac, is exceptionally rare, and acute appendicitis in this setting is even less common. Management is challenging, particularly regarding mesh placement in contaminated fields. This report describes the first two-stage laparoscopic repair with bilateral mesh placement for gangrenous DGH in a young patient.</p><p><strong>Case presentation: </strong>A 44-year-old woman presented with right-sided groin pain and swelling. Examination revealed a tender right inguinal mass without systemic signs. Computed tomography (CT) demonstrated a femoral hernia containing an inflamed appendix. Laparoscopy confirmed a gangrenous, non-perforated appendix and revealed a contralateral femoral defect. Appendectomy was performed, and repair was deferred due to contamination risk supported by positive peritoneal cultures. Four weeks later, elective laparoscopic transabdominal preperitoneal (TAPP) repair with bilateral polypropylene mesh was performed. Recovery was uneventful, and the patient remained asymptomatic at 6 months.</p><p><strong>Clinical discussion: </strong>DGH may lack typical appendicitis signs due to the confined femoral canal. CT is the most reliable diagnostic tool but provides preoperative diagnosis in only one-third of cases. The combination of gangrenous appendicitis, positive cultures, and a contralateral defect justified a staged approach. Mesh offers superior recurrence prevention but should be avoided in contaminated settings. Laparoscopy enabled safe appendectomy, complete abdominal evaluation, and later bilateral repair.</p><p><strong>Conclusion: </strong>Staged laparoscopic management is safe and effective for gangrenous DGH, permitting clean-field mesh repair and reducing recurrence risk.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4066-4070"},"PeriodicalIF":0.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170835","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 lesser omental hernia in a male patient following total colectomy.","authors":"Yoshihito Abe, Yukiharu Hiyoshi, Mayuko Ouchi, Katsuhiro Ogawa, Yuji Miyamoto, Masaaki Iwatsuki","doi":"10.1097/RC9.0000000000000952","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000952","url":null,"abstract":"<p><strong>Introduction and importance: </strong>A lesser omental hernia is a rare internal hernia in which intestinal loops become entrapped through a defect in the lesser omentum, potentially causing bowel obstruction. Its diagnosis is challenging because of nonspecific symptoms that resemble those of other gastrointestinal diseases. This report presents a case of lesser omental hernia following total colectomy.</p><p><strong>Case presentation: </strong>A 65-year-old male with a history of laparoscopic total colectomy for ulcerative colitis 4 years prior presented with acute abdominal pain and distension. Computed tomography (CT) revealed a closed-loop small-bowel obstruction, leading to emergency surgery. Intraoperatively, no adhesions were found, but nearly the entire small intestine had herniated through a small foramen in the lesser omentum, passing dorsally behind the stomach. The intestine was repositioned, and the foramen was sutured closed. The patient was discharged on postoperative day 15, with no recurrence observed at the 6-month follow-up examination.</p><p><strong>Clinical discussion: </strong>A lesser omental hernia may occur after colectomy due to iatrogenic disruption of the gastrocolic ligament. This case represented a type II hernia, with the small intestine prolapsing from the retrogastric space through a defect in the lesser omentum. A review of eight post-colectomy cases showed that all were type II. Diagnosis is difficult, but CT findings such as anteriorly displaced, dilated bowel loops and gastric distortion are key. Careful CT evaluation and intraoperative identification are essential for appropriate diagnosis and treatment.</p><p><strong>Conclusion: </strong>A lesser omental hernia can occur after total colectomy. CT imaging is valuable for diagnosis, and surgical intervention is often required.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4047-4050"},"PeriodicalIF":0.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170806","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":"Trapezius flap for reconstruction of malignant transformation of a chronic occipital burn scar with skull involvement in a 70-year-old man: a case report.","authors":"Abdul Ghafar Ghayur, Mohammad Shafiqi","doi":"10.1097/RC9.0000000000000982","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000982","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic burn scars may undergo malignant transformation into a Marjolin's ulcer, most commonly a squamous cell carcinoma. Advanced lesions involving the calvarium present significant oncologic and reconstructive challenges.</p><p><strong>Case presentation: </strong>A 70-year-old man presented with a chronic non-healing occipital ulcer that developed 2 years after a full-thickness thermal burn caused by boiling water. The injury had been managed only with repeated dressings, resulting in complete scalp alopecia and persistent ulceration. Biopsy confirmed basaloid squamous cell carcinoma, and computed tomography demonstrated occipital bone invasion without intracranial extension or distant metastasis. Wide oncologic excision of the scalp and involved calvarium was performed until healthy dura was exposed. The resulting defect was reconstructed using a pedicled lower trapezius myocutaneous flap. Histopathology confirmed basaloid squamous cell carcinoma with involvement of the deep resection margin. At a 6-month follow-up, the flap remained viable, with satisfactory wound healing and no clinical evidence of recurrence.</p><p><strong>Clinical discussion: </strong>Reconstruction of extensive posterior scalp defects with calvarial involvement is technically demanding. Although free tissue transfer is often preferred for large scalp defects, regional flaps remain valuable in elderly patients or when microsurgical reconstruction is not feasible. In this case, the pedicled lower trapezius myocutaneous flap provided reliable vascularized tissue, durable coverage of the exposed dura, and satisfactory functional and reconstructive outcomes.</p><p><strong>Conclusion: </strong>Early biopsy of chronic burn scars is essential to detect malignant transformation. The pedicled lower trapezius myocutaneous flap represents a safe and effective reconstructive option for extensive occipital scalp defects following oncologic resection with calvarial involvement.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4505-4511"},"PeriodicalIF":0.6,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167058","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":"Arthroscopic resection of a lateral bipartite talus with anterior talofibular ligament capsuloligamentous repair: a rare case report.","authors":"Andi Praja Wira Yudha Luthfi, Filbert Nathaniel Winoto, Karina Sylvana Gani, Mitchel Mitchel, Erica Kholinne","doi":"10.1097/RC9.0000000000000940","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000940","url":null,"abstract":"<p><strong>Background: </strong>Bipartite talus (talus bipartitus) is a rare anatomical variant characterized by separation of the talus into two fragments. Most reported cases involve the posterior talar process, whereas a lateral bipartite talus is exceptionally uncommon.</p><p><strong>Case presentation: </strong>A 42-year-old man presented with chronic lateral ankle pain and a palpable bony prominence. Radiographs and computed tomography demonstrated a well-corticated fragment separated from the talar body, consistent with a bipartite talus. Arthroscopic excision of the fragment was performed. Intraoperatively, the anterior talofibular ligament (ATFL) was found to be attached to the fragment; therefore, arthroscopic Broström capsuloligamentous repair using an all-suture anchor was subsequently performed to restore lateral ankle stability. At the 18-month follow-up, the patient demonstrated marked symptomatic improvement with restoration of daily activities, improved functional scores, and no evidence of residual fragment or postoperative instability.</p><p><strong>Discussion: </strong>A bipartite talus may mimic a fracture nonunion or an accessory ossicle, making advanced imaging important for diagnosis. In this case, the fragment was located laterally, with involvement of the ATFL footprint. Arthroscopy enabled minimally invasive fragment excision and simultaneous ligament repair.</p><p><strong>Conclusion: </strong>Lateral bipartite talus is an exceptionally rare condition that may mimic other fracture-related conditions and compromise lateral ankle stability because of the ATFL attachment. Arthroscopic fragment excision combined with ATFL capsuloligamentous repair was a feasible, minimally invasive treatment with favorable clinical outcomes.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4275-4279"},"PeriodicalIF":0.6,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171714","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":"Myxoma of the round ligament mimicking femoral hernia: a diagnostic surprise in the operating room.","authors":"Imen Ben Ismail, Rime Amari, Mouna Mlika, Marwen Sghaier, Hakim Zenaidi, Saber Rebii","doi":"10.1097/RC9.0000000000001005","DOIUrl":"https://doi.org/10.1097/RC9.0000000000001005","url":null,"abstract":"<p><strong>Introduction: </strong>Groin swellings in adult women are most commonly attributed to inguinal or femoral hernias. However, rare neoplasms arising from the round ligament of the uterus may present with similar clinical features, posing significant diagnostic challenges. Myxomas are benign mesenchymal tumors characterized by an abundant myxoid stroma, but their occurrence in the round ligament is exceedingly rare.</p><p><strong>Case presentation: </strong>A 30-year-old woman presented with a 1-year history of a progressive, painless swelling in the left groin. Clinical examination revealed a soft, reducible mass located below the inguinal ligament, leading to a preoperative diagnosis of uncomplicated femoral hernia. No imaging was performed. Surgical exploration via an inguinal approach revealed no femoral or inguinal hernia. Instead, a well-encapsulated, gelatinous mass measuring 5 cm was identified, arising from the round ligament. Complete excision of the mass with the involved segment of the ligament was performed. Histopathological examination demonstrated abundant myxoid stroma containing scattered stellate and spindle cells without atypia or mitoses, consistent with a benign myxoma of the round ligament. The postoperative course was uneventful, and no recurrence was observed at the 3-month follow-up.</p><p><strong>Discussion: </strong>This case highlights the diagnostic complexity of groin swellings in women and underscores the importance of maintaining a broad differential diagnosis. When intraoperative findings deviate from expectations, the surgeon must be prepared to adapt the operative plan and ensure histopathologic confirmation.</p><p><strong>Conclusion: </strong>Round ligament myxoma is an exceptional clinical entity that can mimic a femoral hernia. Awareness of such rare pathologies aids appropriate perioperative management and accurate diagnosis.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4468-4472"},"PeriodicalIF":0.6,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166656","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":"Coexisting focal nodular hyperplasia and diffuse hepatic metastases from an ileal neuroendocrine tumor: a case report and literature review.","authors":"Olfa Ghannei, Hamza Sboui, Mayada Ben Trimech, Soumaya Ben Amor","doi":"10.1097/RC9.0000000000000978","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000978","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Focal nodular hyperplasia (FNH) is a benign liver lesion usually associated with vascular abnormalities. Neuroendocrine tumors (NETs), on the other hand, frequently metastasize to the liver and typically appear as hypervascular lesions. The coexistence of FNH and diffuse hepatic metastases from an ileal NET is exceptionally rare and represents a major diagnostic challenge because both entities may present as hypervascular liver lesions, potentially leading to misdiagnosis and inappropriate management.</p><p><strong>Case presentation: </strong>A 56-year-old woman with a history of epilepsy treated with sodium valproate presented with progressive right upper quadrant pain and abdominal distension. Imaging showed a large hepatic lesion suggestive of FNH along with multiple hypervascular liver nodules suspicious for metastases. A CT-guided liver biopsy demonstrated metastatic well-differentiated NET with a Ki-67 index below 2%. Laboratory tests revealed elevated chromogranin A and urinary 5-hydroxyindoleacetic acid levels. The patient also had chronic diarrhea and moderate tricuspid regurgitation consistent with carcinoid syndrome. A ^68 Ga-DOTANOC positron emission tomography/computed tomography localized the primary tumor to the ileum. The integration of radiological, functional, and histopathological findings enabled accurate diagnosis and appropriate therapeutic planning. Surgical resection of the primary tumor was performed, followed by long-acting octreotide therapy. The patient remained clinically stable, with no progression of the hepatic lesions during follow-up.</p><p><strong>Clinical discussion: </strong>The presence of multiple hypervascular liver lesions in patients with NETs raises important diagnostic issues, especially when benign and malignant lesions coexist. This case demonstrates the value of integrating hepatobiliary magnetic resonance imaging (MRI), histopathological confirmation, and functional imaging to accurately distinguish FNH from metastatic disease and to guide appropriate therapeutic management.</p><p><strong>Conclusion: </strong>The coexistence of FNH and diffuse liver metastases from an ileal NET is rare. This case highlights the pivotal role of a multimodal diagnostic approach combining hepatobiliary MRI, functional imaging, and targeted histopathological confirmation to distinguish benign from malignant hypervascular liver lesions, avoid diagnostic pitfalls, and optimize patient management.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4430-4435"},"PeriodicalIF":0.6,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168926","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":"Immediate lipofilling in fat-augmented latissimus dorsi flap for breast reconstruction: a versatile and fully autologous option. Case report and technical considerations.","authors":"Roberta Boffo, Stefano Uderzo, Bruno Lo Sapio, Mario Faenza, Alfredo Borriello","doi":"10.1097/RC9.0000000000000980","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000980","url":null,"abstract":"<p><strong>Introduction: </strong>The latissimus dorsi (LD) flap is a well-established option for breast reconstruction because of its reliable vascular pedicle and technical versatility. However, its main limitation is the relatively limited volume it provides, which has traditionally required the addition of a prosthetic implant to achieve adequate breast projection and symmetry. In selected patients with small- to moderate-sized breasts, the fat-augmented latissimus dorsi (FALD) flap may overcome this limitation by combining the LD flap with fat grafting.</p><p><strong>Presentation of case: </strong>We present the case of a patient who underwent a skin-sparing mastectomy with nipple-areolar complex excision. Immediate reconstruction was performed using an LD flap combined with intraoperative fat grafting. Fat harvested from the flanks was purified by decantation and injected during flap insetting into the mastectomy pocket. The postoperative course was uneventful, and the esthetic outcome was satisfactory, with good symmetry and volume preservation.</p><p><strong>Discussion: </strong>The FALD technique demonstrates significant reconstructive potential in selected cases, and performing lipofilling during the same operative session may also help reduce the need for staged revision procedures. This approach may also provide a secondary esthetic benefit by coupling breast reconstruction with body contouring. Despite its demonstrated advantages and favorable safety profile, FALD remains underutilized in current clinical practice.</p><p><strong>Conclusions: </strong>The FALD technique has proven to be a fully autologous, effective, and safe option for immediate breast reconstruction and deserves broader adoption, especially in cases in which implants or free flaps are not desirable or feasible.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4403-4407"},"PeriodicalIF":0.6,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166857","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":"Intravascular bullet embolization: a multicenter three-case series and literature review.","authors":"Carlos Andres Muñoz, Adolfo González Hadad, Alejandro Burgos, José Julián Serna, Diego Rivera Arbeláez, Juan Pablo Carbonell","doi":"10.1097/RC9.0000000000000933","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000933","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Intravascular bullet embolization (IBE) is a rare but potentially life-threatening complication of penetrating trauma. It may present as either arterial or venous embolization and is most commonly associated with low-velocity, small-caliber gunshot wounds (GSWs). Diagnosis is often challenging, and management remains controversial because of the limited evidence available to guide therapeutic decision-making.</p><p><strong>Case presentation: </strong>We present a multicenter case series of three patients with venous bullet embolization treated using a hybrid endovascular-surgical approach. In all three cases, the projectile was successfully captured using endovascular techniques; however, definitive retrieval required a venotomy because of the projectile's diameter. All three patients had favorable clinical outcomes, with no procedure-related complications and complete functional recovery during follow-up.</p><p><strong>Clinical discussion: </strong>IBE should be suspected when the number of entry and exit wounds is inconsistent with the expected ballistic trajectory. Imaging studies play a pivotal role in confirming the diagnosis and in planning the therapeutic strategy. Although management remains controversial and should be individualized, advances in endovascular techniques have expanded the minimally invasive options for foreign-body retrieval. Our case series illustrates that although endovascular capture of the projectile may be technically feasible, definitive retrieval may still require a venotomy when the projectile's diameter precludes endovascular removal.</p><p><strong>Conclusion: </strong>IBE is a rare complication of penetrating trauma that requires a high index of clinical suspicion for timely diagnosis. When technically feasible and supported by appropriate expertise and resources, an endovascular approach may be considered as an initial retrieval strategy. Management should be individualized according to the type of embolization, projectile characteristics, anatomical location, the patient's clinical condition, and the anticipated risk-benefit balance of intervention.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"3996-4010"},"PeriodicalIF":0.6,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167553","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":"Robotic approach for OHVIRA syndrome: case report of an early diagnosis in a prepubertal girl.","authors":"Adriano Luis Gomes, Larissa Café Teixeira, Isabela Cristina Semensato Carloni, Alexandre Cesar Santos, Luiz G Freitas Filho","doi":"10.1097/RC9.0000000000000623","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000623","url":null,"abstract":"<p><strong>Introduction: </strong>OHVIRA (obstructed hemivagina with ipsilateral renal agenesis) syndrome, also known as Herlyn-Werner-Wunderlich syndrome, is a rare congenital anomaly of the female urogenital tract characterized by uterus didelphys, an obstructed hemivagina, and ipsilateral renal agenesis. It is typically diagnosed at puberty due to cyclic pelvic pain or hematocolpos. Early recognition in childhood is uncommon but may prevent serious complications.</p><p><strong>Case presentation: </strong>We describe a 1-year-old girl in whom OHVIRA syndrome was incidentally identified during imaging performed for unrelated findings. Ultrasonography and magnetic resonance imaging demonstrated right renal agenesis, uterine duplication, and an obstructed hemivagina. Diagnostic endoscopy confirmed vaginal duplication with a right atretic hemivagina and absence of the right ureteral orifice, suggesting an ectopic ureteral insertion. The patient underwent robotic-assisted right nephroureterectomy, partial hysterectomy, and excision of the right hemivagina without complications. She was discharged on postoperative day 2 and remains asymptomatic after 1 year of follow-up.</p><p><strong>Clinical discussion: </strong>Early identification of OHVIRA syndrome is essential to prevent complications such as infection, pelvic abscess, endometriosis, and infertility. Robotic surgery offers excellent visualization, precise dissection, and safe reconstruction, particularly in deep pelvic regions. Compared with conventional approaches, it provides reduced postoperative pain, shorter hospital stays, and faster recovery.</p><p><strong>Conclusion: </strong>Robotic-assisted surgery represents a safe and minimally invasive approach for the management of OHVIRA syndrome, even in very young patients, ensuring complete anatomical correction with minimal morbidity and rapid recovery.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4037-4041"},"PeriodicalIF":0.6,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169926","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 conservative management of high-grade renal injury in a polytrauma patient: a rare case report.","authors":"Toqa ِAbu Arqub, Bessan Huraini, Shahd Sholi, Hamzah Etkaidek, Alaa Alazzeh","doi":"10.1097/RC9.0000000000001008","DOIUrl":"https://doi.org/10.1097/RC9.0000000000001008","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Simultaneous high-grade renal and splenic trauma is rare and challenges the limits of non-operative management (NOM). High-grade renal injuries with collecting-system extravasation, especially when associated with severe splenic laceration, represent scenarios in which clinical decisions must rely primarily on physiologic stability rather than injury grade alone.</p><p><strong>Case presentation: </strong>An 18-year-old hemodynamically stable male presented 4 hours after a bicycle fall onto his left flank, with severe flank pain and gross hematuria. Computed tomography (CT) imaging revealed AAST Grade IV renal trauma with collecting-system involvement, together with concurrent Grade IV splenic laceration and associated nondisplaced rib fractures. The patient was managed with close ICU observation, multimodal analgesia, and serial monitoring. Diagnostic laparoscopy excluded ongoing intraperitoneal bleeding. A left double-J ureteric stent and intraperitoneal drain were placed for urinary diversion and controlled drainage. No nephrectomy, splenectomy, or splenic artery embolization was required. The patient improved steadily and was discharged in stable condition.</p><p><strong>Clinical discussion: </strong>Serial imaging demonstrated resolution of the perinephric hematoma and identified a nonenhancing, infarcted lower renal pole with preserved global renal function. Mild hydronephrosis, present while the stent was in place, resolved completely following elective removal. This case aligns with current NOM principles, showing that stability-guided conservative strategies with targeted minimally invasive interventions can safely preserve organs even in combined high-grade solid-organ injuries.</p><p><strong>Conclusion: </strong>Structured NOM involving ICU surveillance, temporary urinary diversion, selective minimally invasive procedures, and coordinated multidisciplinary care successfully preserved both renal and splenic function in this combined high-grade trauma case. The outcome supports stability-based decision-making over routine operative intervention and reinforces the safety and effectiveness of individualized conservative pathways in complex blunt abdominal trauma.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4496-4499"},"PeriodicalIF":0.6,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170423","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}