International Journal of Surgery Case Reports最新文献

{"title":"Extended intrathoracic chest wall tumor: A case report.","authors":"Brilliant, Muhammad Sabri","doi":"10.1016/j.ijscr.2024.110627","DOIUrl":"https://doi.org/10.1016/j.ijscr.2024.110627","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Solitary Fibrous Tumors (SFTs) of the chest wall are rare and present unique challenges, particularly when they recur and extend into the thoracic cavity. This case contributes to the limited surgical literature on the management of chest wall SFTs with significant intrathoracic involvement. Understanding the complexities and potential for recurrence in such cases is crucial for improving surgical outcomes and patient care.</p><p><strong>Case presentation: </strong>A 63-year-old woman presented with a recurrent mass in the upper left breast, initially treated surgically in 2018. The mass reappeared in 2021, causing pain and shortness of breath. Clinical examination revealed diminished breath sounds on the left side, and imaging studies identified a large, complex chest wall tumor with intrathoracic extension.</p><p><strong>Clinical discussion: </strong>The patient was diagnosed with a recurrent, extended intrathoracic chest wall SFT. She underwent thoracotomy for tumor resection, which was challenging due to dense vascular adhesions. The tumor was successfully removed with an estimated blood loss of 1100 mL. Postoperative recovery was uneventful, and histopathological analysis confirmed the diagnosis of SFT, with low proliferative activity on immunohistochemistry. The patient was discharged in good condition on postoperative day 7.</p><p><strong>Conclusion: </strong>This case highlights the importance of comprehensive imaging, meticulous surgical planning, and long-term follow-up in managing recurrent chest wall SFTs. The successful outcome reinforces the value of a multidisciplinary approach in treating rare and complex tumors. Vigilance in monitoring for recurrence and ensuring clear resection margins are essential take-away lessons from this case.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"125 ","pages":"110627"},"PeriodicalIF":0.6,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intestinal intussusception: Uncommon occurrence in a 25-year-old female: A case report.","authors":"Pouria Zangeneh, Masoud Saadat Fakhr, Kiana Rezvanfar, Poorya Gholami, Tohid Taghavi, Maryam Mohseni","doi":"10.1016/j.ijscr.2024.110626","DOIUrl":"https://doi.org/10.1016/j.ijscr.2024.110626","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Intestinal intussusception is an uncommon condition in adults, particularly in young females, where one segment of the intestine telescopes into an adjacent segment, leading to bowel obstruction and potential compromise of blood supply. This case report presents a rare instance of intestinal intussusception in a 25-year-old female.</p><p><strong>Case presentation: </strong>A 25-year-old female presented to the emergency department with severe, sudden-onset abdominal pain, nausea, and vomiting. Physical examination revealed a soft abdomen with tenderness and rebound tenderness initially in the right upper quadrant, which later migrated to the left upper quadrant, along with leukocytosis. Imaging studies, including X-ray, ultrasound, and contrast-enhanced computed tomography (CT) scan, demonstrated dilated intestinal loops, a \"bowel within bowel\" appearance suggestive of intussusception, and a right appendiceal cyst. The patient underwent surgical intervention after failing to respond to initial conservative management.</p><p><strong>Clinical discussion: </strong>Adult intussusception is rare, often presenting with non-specific symptoms that can delay diagnosis and treatment. Imaging modalities, particularly CT scans, are crucial for accurate diagnosis, localizing the intussusception, identifying lead points, and guiding management. While conservative management may be considered for uncomplicated small bowel intussusceptions, surgical intervention is typically recommended for symptomatic cases, large bowel involvement, or suspected malignancy.</p><p><strong>Conclusions: </strong>This case highlights the importance of maintaining a high index of suspicion for intussusception in adult patients presenting with abdominal symptoms, regardless of age or gender. Early recognition through appropriate imaging, such as contrast-enhanced computed tomography (CT), and prompt management, including timely surgical intervention when conservative treatment fails, is essential to optimize patient outcomes in this uncommon but potentially serious condition.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"125 ","pages":"110626"},"PeriodicalIF":0.6,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arteriovenous malformation associated with trophoblastic retention post-cesarean section: A case report and review.","authors":"Houssine Oukili, Abdelhamid Benlghazi, Meryem Benmoussa, Oussama Outaghyame, Moulay Mehdi Elhassani, Jaouad Kouach","doi":"10.1016/j.ijscr.2024.110620","DOIUrl":"https://doi.org/10.1016/j.ijscr.2024.110620","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Uterine arteriovenous malformations are a rare but potentially life-threatening condition. They may be congenital or acquired and should be suspected in cases of severe or persistent uterine hemorrhage.</p><p><strong>Case presentation: </strong>We present the clinical case of a 32-year-old woman who suffered from bleeding after a spontaneous miscarriage. Uterine arteriovenous malformation with trophoblastic retention was suspected on ultrasound and Doppler examination. Magnetic resonance imaging confirmed the diagnosis, leading to embolization of both uterine arteries, followed by operative hysteroscopy to remove the retained tissue, with a favorable outcome.</p><p><strong>Clinical discussion: </strong>Uterine arteriovenous malformation is rare, with fewer than 100 cases reported in the literature (1). It is a potentially fatal condition due to the heavy bleeding that patients may experience. Color Doppler ultrasound (US) is a non-invasive method for initially diagnosing this rare condition, which can be confirmed by diagnostic angiography. A conservative approach or embolization is the preferred treatment to avoid hysterectomy in patients of childbearing age.</p><p><strong>Conclusions: </strong>This case report emphasizes the use of ultrasound and MRI to diagnose a uterine AVM in a patient of childbearing age who presented with post-partum retention of products. It also showcases our experience with embolization in this patient, which allowed her to preserve her fertility.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"125 ","pages":"110620"},"PeriodicalIF":0.6,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The surgical management of a diabetic patient with gallbladder duplication complicated by acute cholecystitis: Case report.","authors":"Abdulaziz Alqahtani, Abdulaziz Alshehri, Ibrahim Hazazi, Abdullah Alkhaldi, Hassan Alyami","doi":"10.1016/j.ijscr.2024.110577","DOIUrl":"https://doi.org/10.1016/j.ijscr.2024.110577","url":null,"abstract":"<p><strong>Background: </strong>Duplication of the gallbladder is a rare occurrence and seldom detected before surgery but can complicate the procedure, potentially leading to a higher likelihood of converting to open surgery and encountering complications. Symptoms, when present, typically relate to gallstone disease and cholecystitis. We report a unique case of a diabetic patient with duplicate gallbladder complicated by acute cholecystitis, which was effectively treated through laparoscopic cholecystectomy.</p><p><strong>Presentation of case: </strong>A 51-year-old man with well-managed diabetes presented with right upper quadrant pain worsened by fatty meals. Initially diagnosed with acute acalculous cholecystitis, he was treated conservatively with antibiotics and pain relief. Recurrent symptoms led to cholecystostomy tube insertion, offering temporary relief. Subsequent imaging identified a double gallbladder with inflammatory changes, confirmed by magnetic resonance cholangiopancreatography. Elective laparoscopic cholecystectomy was performed, revealing an inflamed double gallbladder with a unique arterial supply. Histopathology showed inflammation without malignancy, and the procedure was complication-free.</p><p><strong>Discussion: </strong>Reporting this case of gallbladder duplication in a diabetic patient suffering from acute cholecystitis is important due to its rarity and surgical management challenges it presents. This case offers valuable insights into handling complex biliary anatomies, highlights the necessity for customized surgical techniques and thorough perioperative care, and enriches the medical literature by adding knowledge about uncommon surgical situations.</p><p><strong>Conclusion: </strong>The case presented highlights the successful surgical management of acute cholecystitis in a diabetic patient with gallbladder duplication. Despite the anatomical complexity, laparoscopic techniques proved effective in achieving successful surgical outcomes with minimal invasiveness and reduced postoperative complications.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"125 ","pages":"110577"},"PeriodicalIF":0.6,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Basilar invagination and atlantoaxial dislocation as a complication of severe dystrophic cervical kyphosis correction in neurofibromatosis type 1: Report of a rare case and review of literature.","authors":"Seyed Reza Mousavi, Majid Reza Farrokhi, Keyvan Eghbal, Mohammadhadi Amir Shahpari Motlagh, Hamid Jangiaghdam, Fariborz Ghaffarpasand","doi":"10.1016/j.ijscr.2024.110599","DOIUrl":"https://doi.org/10.1016/j.ijscr.2024.110599","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Neurofibromatosis type 1 (NF1) affects the musculoskeletal system as well as the cervical spine. It is associated with severe, progressive cervical kyphosis. Surgical intervention is the treatment of choice to avoid neurological impairment and malalignment.</p><p><strong>Case presentation: </strong>We herein report an 11-year-old NF-1 patient with severe cervical kyphosis and intact neurological status. We applied five days of cervical traction followed by surgery utilizing the combined cervical approach (posterior release, anterior corpectomy and reconstruction, and posterior cervicothoracic instrumentation). In one-year follow-up, atlantoaxial dislocation (AAD) and basilar invagination (BI) were detected in neuroimagings. The complication was corrected by adding C1 to the previous construct via unilateral C1 lateral mass screw, contralateral C1 sublaminar hook, unilateral C3 and contralateral C4 sublaminar hook insertion, fixed with contoured rods medial to previous rods. This led to the correction of the AAD and the BI and the patients remained neurologically intact.</p><p><strong>Clinical discussion: </strong>Severe cervical kyphosis in the setting of NF-1 is progressive and carries a considerable risk of neurologic compromise. Surgical intervention is thus necessary.</p><p><strong>Conclusion: </strong>The combined approach with complete spinal column reconstruction is the surgical approach of choice. However, complete curve correction to near-normal lordosis carries the risk of proximal junctional failure (PJF).</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"125 ","pages":"110599"},"PeriodicalIF":0.6,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modification of the modified Graham patch repair for duodenal perforation using the gastrocolic ligament: Two case reports.","authors":"Saamia Shaikh, Erica Kozorosky, Megha Mehta, Osama Elsawy","doi":"10.1016/j.ijscr.2024.110614","DOIUrl":"https://doi.org/10.1016/j.ijscr.2024.110614","url":null,"abstract":"<p><strong>Introduction: </strong>Gastroduodenal perforations are relatively common surgical emergencies with mortality rates as high as 40%. The Graham patch repair is one surgical approach but may need to be modified when the patient lacks viable omentum. The gastrocolic ligament can be utilized to repair these perforations for coverage.</p><p><strong>Presentation of cases: </strong>Case 1: A 77-year-old female with a complex history presented with severe abdominal pain and was found to have pneumoperitoneum on CT scan. She was found to have a first segment duodenal perforation. We employed a modified Graham patch omentopexy utilizing the gastrocolic ligament to repair the defect. She recovered well with no complications. Case 2: A 65-year-old male with multiple myeloma presented with chemotherapy intolerance and diffuse abdominal pain. CT scan demonstrated pneumoperitoneum. Upon surgical exploration, he was noted to have a 1 cm anterior duodenal perforation. He had almost no viable omentum and therefore underwent a modified Graham patch repair using the gastrocolic ligament. He recovered well with no complications.</p><p><strong>Discussion: </strong>There have been reports of patients with gastroduodenal perforation with suboptimal omentum who underwent modified repair with the falciform ligament or a jejunal serosal patch repair. The gastrocolic ligament was found to be an effective alternative for our cases. This approach is an attractive one due to its relative ease and effectiveness.</p><p><strong>Conclusion: </strong>We described the use of the gastrocolic ligament as an alternative approach for gastroduodenal perforation in patients with suboptimal omentum. Further studies are needed to assess long term postoperative outcomes and establish best practices.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"125 ","pages":"110614"},"PeriodicalIF":0.6,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Six year natural progression of a clinically monitored retroperitoneal schwannoma: A case report","authors":"Elizabeth Kruse ,&nbsp;Allye Gardner ,&nbsp;Eduardo Vaca ,&nbsp;Megan McNally","doi":"10.1016/j.ijscr.2024.110622","DOIUrl":"10.1016/j.ijscr.2024.110622","url":null,"abstract":"<div><h3>Introduction and importance</h3><div>Schwannomas arise from Schwann cells, which make up the neural sheath of peripheral nerves. These tumors are usually seen in the head, neck and flexor surfaces, but can arise in the retroperitoneal space on rare occasions. This case gives the unique opportunity to watch the long term progression and speed of growth of this rare tumor and the development of symptoms over time.</div></div><div><h3>Case presentation</h3><div>Here, we describe the interesting case of a retroperitoneal Schwannoma discovered incidentally that was then monitored over the course of six years. After the tumor grew from 2.4 × 2.2 cm to 5.4 × 5.2 cm over this time, symptoms such as abdominal pain, nausea, constipation, increased urinary frequency, and left leg paresthesia arose, prompting for removal of the tumor. On follow-up two weeks later, the patient reported resolution of symptoms.</div></div><div><h3>Clinical discussion</h3><div>Treatment for this tumor is either immediate excision or the “watch and wait” method, as this tumor has a low rate of malignant transformation. The tumor discussed in this case had a higher rate of growth before removal when compared to other studies examining retroperitoneal Schwannoma development.</div></div><div><h3>Conclusion</h3><div>The “watch and wait” method of treatment for this benign tumor is effective, but it is important to ensure the patient is aware that the tumor will likely continue to grow. Given this, the patient should be informed of possible mass effect symptoms to monitor for.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"126 ","pages":"Article 110622"},"PeriodicalIF":0.6,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142723757","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 cecal pole resection for LAMN a case report.","authors":"Olexandr Usenko, Yaroslav Voitiv, Kropelnytskyi Vladyslav, Borysenko Andrii, Vladyslav Makarov, Romasko Ivan","doi":"10.1016/j.ijscr.2024.110625","DOIUrl":"https://doi.org/10.1016/j.ijscr.2024.110625","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Low-grade appendicular mucinous neoplasms are rare. In contrast to other malignant tumors, they lack the ability for infiltrative growth or lymph node metastasis, but intraperitoneal mucin spread may lead to a life-threatening condition, known as a pseudomyxoma peritonei.</p><p><strong>Case presentation: </strong>Patient, a 47-year-old female, with complaints of a palpable mass in her right inguinal area, presented to our clinic. After a clinical workup, which included computer tomography, magnetic resonance imaging, and colonoscopy, a preliminary diagnosis of LAMN was established. Laparoscopic cecal pole resection was performed. A pathological examination confirmed the diagnosis of LAMN. Patient was followed up for six months after the surgery, at which point a contrast-enhanced CT scan was obtained with no pathological findings.</p><p><strong>Clinical discussion: </strong>Mucinous neoplasms of the appendix are a group of tumors in which mucin accumulates within the lumen of the appendix and while this type of neoplasia cannot spread hematologically, extramural mucin may lead to pseudomyxoma peritonei. Not long ago, a right hemicolectomy was accepted as a radical treatment method. Nowadays various studies have shown that laparoscopic appendectomy may be a safe option in patients with mucin, confined to the lumen of the appendix. This case holds educational value due to the detailed course of the disease presented and justified clinical decisions.</p><p><strong>Conclusion: </strong>LAMN is a rare type of neoplasm. When confined to the lumen of the appendix, it lacks the ability for infiltrative growth and lymph node metastasis. Appropriate treatment in case of a contained disease is surgical removal.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"125 ","pages":"110625"},"PeriodicalIF":0.6,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carpal tunnel release using the KnifeLight technique: An alternative to endoscopic approach?","authors":"Omar Fadili ,&nbsp;Mohammed Khodja ,&nbsp;Mohammad Reza Azarpira","doi":"10.1016/j.ijscr.2024.110609","DOIUrl":"10.1016/j.ijscr.2024.110609","url":null,"abstract":"<div><h3>Introduction and importance</h3><div>Carpal tunnel syndrome (CTS) is caused by compression of the median nerve, leading to both sensory and motor dysfunction in the hand. Traditional open carpal tunnel release (CTR) is a proven treatment but often results in longer recovery times, visible scarring, and postoperative issues like pillar pain. Endoscopic techniques, while reducing recovery time and limiting incision size, present risks such as incomplete ligament release and possible nerve injury. This underscores the need for a surgical approach that combines the advantages of both methods while minimizing their downsides.</div></div><div><h3>Surgical technique and Case presentation</h3><div>This article introduces a minimally invasive surgical technique for CTR using the KnifeLight instrument. The procedure involves a small incision and integrates a light source for improved visualization. This setup enables precise division of the transverse carpal ligament, reducing the risk of damage to surrounding structures. Each step of the procedure is detailed, highlighting its advantages over both traditional open and endoscopic CTR.</div></div><div><h3>Clinical discussion</h3><div>The KnifeLight technique enables more controlled and accurate ligament release, resulting in reduced scarring and quicker recovery. Initial data indicate that patients experience less postoperative discomfort and shorter rehabilitation compared to traditional CTR. This method's precision also reduces the risk of complications, such as nerve damage or incomplete ligament release. The KnifeLight procedure represents a promising middle ground between open and endoscopic CTR. It combines the visual clarity and precision of open surgery with the benefits of a smaller incision and quicker recovery typical of endoscopic methods. The built-in light source enhances visualization, ensuring both patient safety and effective ligament release. However, further comparative studies are needed to fully assess its long-term outcomes and potential complications.</div></div><div><h3>Conclusion</h3><div>The KnifeLight technique for carpal tunnel release offers a strong alternative to both open and endoscopic CTR methods. It minimizes scarring, shortens recovery time, and improves overall patient outcomes, making it a potential future standard for treating CTS. Further research and broader clinical adoption are necessary to confirm its long-term efficacy and safety.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"125 ","pages":"Article 110609"},"PeriodicalIF":0.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649279","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":"Consecutive disruption of intrahepatic bile ducts after ABO-incompatible living-donor re-liver transplantation: A case report.","authors":"Akihiko Soyama, Baglan Askeyev, Takanobu Hara, Hajime Matsushima, Tomohiko Adachi, Susumu Eguchi","doi":"10.1016/j.ijscr.2024.110606","DOIUrl":"10.1016/j.ijscr.2024.110606","url":null,"abstract":"<p><strong>Introduction: </strong>Hyperacute rejection leading to hepatic necrosis or intrahepatic bile duct stricture in ABO incompatible living-donor liver transplant (ABO-i LDLT) has been reported many times. With the advent of rituximab, the incidence of these complications has decreased significantly. However, consecutive biliary disruption after ABO-i LDLT has rarely been reported.</p><p><strong>Presentation of case: </strong>A female in her 50s with blood type A was admitted to our hospital for ABO-i LDLT due to failure of a graft (refractory ascites [Child-Pugh C(10), MELD 9]) that had been primarily transplanted 20 years ago from her ABO-identical father. Since the living donor was her husband with blood type B, rituximab was administered for ABO-i re-LDLT. After the LDLT, the patient recovered quickly despite bile leakage at the biliary anastomosis. Subsequently, the bile duct of the graft liver was serially disrupted with a bile lake, which required multiple instances of biliary drainage. A liver biopsy was performed and did not show any C4d staining on 195 post-transplant days. The patient ultimately developed sepsis due to cholangitis and expired at 11 months after the re-LDLT and finally C4d was positive on post-mortem biopsy.</p><p><strong>Discussion: </strong>Advances in ABO-i LDLT, particularly with rituximab, have reduced complications, but consecutive bile duct disruption remains challenging. Despite positive donor-specific antibody, early rejection markers were absent, suggesting complex mechanisms of complication.</p><p><strong>Conclusion: </strong>We herein report a rare case as an important observation that may aid in preventing and treating potentially fatal complications after ABO-i LDLT.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"125 ","pages":"110606"},"PeriodicalIF":0.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}