International Journal of Surgery Case Reports最新文献

{"title":"Diagnostic and therapeutic challenges of a bilateral spigelian hernia: A case report with literature review.","authors":"Mohamed K Tounsi, Fatma Medhioub, Amal Benasr, Majd Makhbouch, Wissem Triki, Sami Bouchoucha","doi":"10.1097/RC9.0000000000000869","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000869","url":null,"abstract":"<p><strong>Background: </strong>Spigelian hernia (SH) is an uncommon abdominal wall defect, and its bilateral occurrence is exceptionally rare. Early diagnosis and surgical management are essential to prevent complications.</p><p><strong>Case presentation: </strong>We report the case of a 52-year-old woman presenting with bilateral SH, revealed by painful abdominal wall swelling and symptoms of bowel obstruction. A computed tomography (CT) scan confirmed the diagnosis of bilateral SH. A laparoscopic approach was initially attempted but was converted to open surgery due to significant hypercapnia. The hernias were repaired with a dual-sided mesh, and postoperative recovery was uneventful.</p><p><strong>Discussion: </strong>SH represent only 1-2% of abdominal wall hernias and are often misdiagnosed due to nonspecific clinical signs. CT imaging plays a key role in diagnosis. Surgical repair is the definitive treatment, with the laparoscopic approach offering lower morbidity and a shorter hospital stay.</p><p><strong>Conclusion: </strong>Bilateral SH is an exceptional presentation. Early imaging and prompt surgical intervention are crucial to avoiding strangulation.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4058-4061"},"PeriodicalIF":0.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170514","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":"Unilateral vocal cord paralysis following arthroscopic rotator cuff repair in the beach chair position: a case series.","authors":"Giyong Yoon, Jiwon Bak, Minsoo Kim","doi":"10.1097/RC9.0000000000000947","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000947","url":null,"abstract":"<p><strong>Introduction: </strong>Vocal cord paralysis (VCP) is a rare complication of endotracheal intubation. During shoulder surgery in the beach chair position, deliberate hypotension may compromise perfusion of laryngeal structures. This case series was conducted to describe the clinical characteristics of postoperative VCP in this setting and to explore the potential role of intraoperative hypotension as an underlying mechanism.</p><p><strong>Case presentations: </strong>This retrospective single-center case series included four consecutive female patients with hypertension who developed unilateral (left-sided) VCP after arthroscopic rotator cuff repair in the beach chair position under general anesthesia. Intraoperatively, mean blood pressure was maintained at low levels, with periods below 60 mmHg in all cases. Postoperatively, patients presented with hoarseness and aspiration. Laryngoscopic examination confirmed left-sided VCP in all cases, and laryngeal electromyography demonstrated recurrent laryngeal nerve neuropathy in two cases. All patients improved with conservative management, and no statistical analysis was performed given the descriptive nature of this case series.</p><p><strong>Discussion: </strong>Direct airway trauma, endotracheal tube malposition, and cuff overinflation were unlikely causes. Instead, reduced perfusion pressure related to head elevation and intraoperative hypotension may have contributed to ischemic injury of the recurrent laryngeal nerve. These findings suggest that postoperative VCP may involve factors beyond traditional mechanical airway-related mechanisms and warrant further investigation of perioperative hemodynamic influences.</p><p><strong>Conclusion: </strong>Shoulder surgery in the beach chair position combined with intraoperative hypotension may predispose patients to postoperative VCP. This case series extends previous observations by highlighting a potential association between intraoperative hemodynamic management and postoperative recurrent laryngeal nerve dysfunction. These findings underscore the potential importance of individualized intraoperative blood pressure management in reducing the risk of this complication. Further prospective studies are warranted to clarify the relationship between head elevation, regional perfusion, and laryngeal nerve injury during shoulder surgery.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"3984-3989"},"PeriodicalIF":0.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167793","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":"Fibrothecal tumors of the ovary: a case report.","authors":"Amine Chaabouni, Mohamed Foued Frikha, Nizar Kardoun, Ines Ben Hammouda, Nozha Toumi, Salah Boujelben","doi":"10.1097/RC9.0000000000000917","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000917","url":null,"abstract":"<p><strong>Introduction: </strong>Ovarian fibrothecal tumors are rare, benign neoplasms accounting for 1-4.7% of organic ovarian tumors, predominantly affecting postmenopausal women. This report highlights the diagnostic challenge and intraoperative management of a voluminous ovarian fibrothecal tumor presenting with atypical, purely mechanical symptoms.</p><p><strong>Presentation of case: </strong>A 67-year-old female presented with a 5-month history of progressive pelvic pain without endocrine manifestations. Clinical examination revealed a lateralized, mobile hypogastric mass exceeding 10 cm. Abdominopelvic computed tomography (CT) and pelvic magnetic resonance imaging (MRI) characterized a large, solid pelvic mass. A median laparotomy with bilateral Salpingo-oophorectomy was performed. Intraoperative frozen section analysis suggested a fibrothecoma, which was definitively confirmed by standard histopathological examination. The patient had an uneventful postoperative recovery.</p><p><strong>Discussion: </strong>Unlike classic literature reports that frequently associate fibrothecomas with estrogenic symptoms or Meigs' syndrome, this case was distinguished by isolated mass effect. The voluminous size (>10 cm) of the solid mass raised preoperative suspicion for malignancy, demonstrating that imaging alone is insufficient for definitive characterization. This case emphasizes the critical role of intraoperative frozen section in the surgical decision-making process.</p><p><strong>Conclusion: </strong>Ovarian fibrothecoma can present atypically without hormonal symptoms. Intraoperative frozen section is paramount in managing large ovarian masses, as it allows surgeons to immediately confirm benignancy, tailor the surgical extent, and avoid unnecessary radical procedures in postmenopausal women.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4207-4210"},"PeriodicalIF":0.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168943","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":"Proximal jejunal perforation by an ingested toothpick: a rare case report.","authors":"Ghazi Lâamiri, Jasser Rchidi, Hazem Beji, Amal Khsiba, Mahdi Bouassida, Hassen Touinsi","doi":"10.1097/RC9.0000000000000809","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000809","url":null,"abstract":"<p><strong>Introduction: </strong>Toothpick ingestion is a rare event that may cause gastrointestinal perforation, abscess, or peritonitis. Jejunal involvement is exceptionally uncommon.</p><p><strong>Case presentation: </strong>A 45-year-old man, previously operated on for appendicular peritonitis, presented with generalized abdominal pain and vomiting. A CT scan revealed pneumoperitoneum with a linear foreign body perforating the proximal jejunum. Laparoscopy showed diffuse peritonitis and a toothpick perforating the antimesenteric border 70 cm from the duodenojejunal flexure. Conversion to laparotomy was required because of adhesions and contamination. The toothpick was extracted, and primary repair with lavage and drainage was performed. The postoperative course was uneventful, with discharge on day 4.</p><p><strong>Discussion: </strong>Jejunal perforation by an ingested toothpick is exceedingly rare and often misdiagnosed. CT remains the most reliable diagnostic tool despite the radiolucent nature of wood. Early surgery is crucial to avoid sepsis.</p><p><strong>Conclusion: </strong>Prompt recognition and surgical management ensure excellent outcomes.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4077-4080"},"PeriodicalIF":0.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166679","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":"Chronic scrotal hematocele in an elderly patient: a case report in a tertiary hospital.","authors":"Edouard Karume Rugendabanga, Mbongnu Morane, Hamis Juma Isaka, Ezekiel Petro, Martin Edgar Chikelea","doi":"10.1097/RC9.0000000000000948","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000948","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Chronic scrotal hematocele is an uncommon condition that typically results from the organization of a long-standing hematoma within the tunica vaginalis. We report a rare case of chronic scrotal hematocele.</p><p><strong>Case presentation: </strong>An 86-year-old man presented with a 4-year history of a progressively enlarging, painless right scrotal mass associated with a sensation of heaviness. Physical examination revealed a large, hard, non-tender, non-reducible mass with negative transillumination. Serum tumor markers were within normal limits. A right radical orchiectomy was performed via an inguinal approach. Intraoperative findings revealed a thickened, calcified tunica vaginalis containing dark, \"chocolate-colored\" fluid and a necrotic testicle.</p><p><strong>Discussion: </strong>This case illustrates the diagnostic dilemma posed by a chronic hematocele presenting in an elderly patient. The history of inguinal surgery likely led to occult trauma and slow, recurrent bleeding over many years. The use of an inguinal surgical approach adheres to oncologic principles, effectively managing both the benign final diagnosis and the pre-operative suspicion of cancer.</p><p><strong>Conclusion: </strong>Chronic hematocele should be considered in the differential diagnosis of any long-standing, hard scrotal mass, particularly in patients with a history of inguinoscrotal surgery. While imaging and tumor markers are valuable adjuncts, definitive diagnosis and treatment often require surgical exploration, even in the absence of imaging.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4189-4195"},"PeriodicalIF":0.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165398","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 repair of a penetrating right atrial gunshot injury via right posterolateral thoracotomy in a resource-limited hospital: a case report.","authors":"Issam Alkhayer, Mohammad Alaa Aldakak, Youssef Abbas","doi":"10.1097/RC9.0000000000000955","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000955","url":null,"abstract":"<p><strong>Background: </strong>Penetrating cardiac injuries are uncommon but frequently fatal, particularly after gunshot wounds. Diagnosis may be challenging when pleural bleeding predominates, and pericardial fluid is minimal because blood may decompress through a pericardial defect into the thoracic cavity.</p><p><strong>Case presentation: </strong>A 25-year-old man sustained a penetrating chest gunshot wound during wartime and presented to a resource-limited hospital in hemorrhagic shock with a massive right hemothorax. Right tube thoracostomy immediately drained approximately 900 mL of blood, but he remained hemodynamically unstable. Computed tomography demonstrated a large retained right hemothorax with only a small pericardial effusion, raising suspicion of cardiac injury with decompression into the pleural space. Emergency right posterolateral thoracotomy was selected because the injury pattern was predominantly right-sided and sternotomy equipment was unavailable. Exploration revealed a 3-cm laceration of the anterior right atrial wall near the base of the right atrial appendage, together with injuries to the right middle and lower lobes. Atrial bleeding was controlled with digital pressure and repaired using a running 4-0 polypropylene suture. The pulmonary injuries were sutured, the pericardial space was evacuated and left open for pleural drainage, and a chest tube was placed. Recovery was uncomplicated, and the patient was discharged on postoperative day 6.</p><p><strong>Discussion: </strong>Minimal pericardial effusion does not exclude major cardiac injury when a pericardial breach permits decompression into the hemithorax. Persistent shock and a compatible wound trajectory should prompt urgent operative exploration.</p><p><strong>Conclusion: </strong>Right posterolateral thoracotomy may provide effective exposure for definitive right atrial repair when sternotomy is not feasible.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4355-4359"},"PeriodicalIF":0.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165848","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":"Prehospital emergency response in a partial hand amputation with ulnar artery transection: a case report.","authors":"Stephanie Givens, Jeffrey Elian, Nazir Adam","doi":"10.1097/RC9.0000000000000799","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000799","url":null,"abstract":"<p><strong>Introduction: </strong>Approximately 50% of preventable trauma fatalities are associated with a lack of hemorrhage control and occur in the prehospital environment. The application and efficacy of traditional hemostatic techniques, such as tourniquets, gauze packing, and impregnated dressings, are frequently limited by factors including pain, risk of ischemia, wound configuration, and challenges associated with removal at definitive care.</p><p><strong>Case report: </strong>We report the prehospital application of a hemostatic flowable biopolymer, Traumagel, in a 46-year-old male presenting with a partial hand amputation and complete transection of the ulnar artery. Following tourniquet application and initial hemostasis, Traumagel was deployed, permitting the safe release of the tourniquet, restoration of distal perfusion, and significant pain relief during a prolonged evacuation. The gel was removed in the operating room, and the arterial and metacarpal repairs were completed without complications or tissue loss.</p><p><strong>Discussion and conclusion: </strong>This case exemplifies the seamless integration of hemostatic agents in conjunction with a tourniquet for the management of moderate-to-severe hemorrhage in a remote trauma environment. This prompt and comprehensive intervention for hemorrhage control in a remote location was crucial to an excellent patient outcome.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4042-4046"},"PeriodicalIF":0.6,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170941","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":"Perioperative considerations for total knee arthroplasty in a patient with situs inversus totalis: a case report.","authors":"Lei Xu, Qianheng Jin, Wen Ju, Lei Li, Ruixing Hou, Jihui Ju","doi":"10.1097/RC9.0000000000000862","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000862","url":null,"abstract":"<p><strong>Introduction: </strong>Situs inversus totalis is a rare congenital condition characterized by complete mirror-image transposition of the thoracic and abdominal organs. Although situs inversus totalis is commonly discussed in cardiothoracic and abdominal surgery, its implications for orthopedic procedures, such as total knee arthroplasty, remain poorly described.</p><p><strong>Case presentation: </strong>A woman in her late 60s presented with progressive right knee pain due to degenerative joint disease. Computed tomography incidentally revealed situs inversus totalis. Following multidisciplinary evaluation, a right total knee arthroplasty was performed under general anesthesia using standard surgical techniques without modification. The intraoperative and postoperative courses were uneventful, and the patient achieved satisfactory functional recovery at 1-year follow-up.</p><p><strong>Discussion: </strong>This case demonstrates that situs inversus totalis does not alter knee anatomy or the technical execution of total knee arthroplasty. However, reversed visceral and cardiac laterality may complicate perioperative cardiopulmonary assessment and monitoring if unrecognized. The primary value of this report lies in highlighting situs inversus totalis as a perioperative risk modifier rather than a surgical contraindication.</p><p><strong>Conclusion: </strong>Total knee arthroplasty can be safely performed in patients with situs inversus totalis using standard techniques. Heightened perioperative awareness and structured team communication are essential to minimize avoidable risk and ensure patient safety during routine orthopedic procedures.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4095-4098"},"PeriodicalIF":0.6,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168878","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":"Strategic wound and nutritional management for short bowel syndrome and wound dehiscence following non-occlusive mesenteric ischemia: a case report.","authors":"Kenichiro Yambe, Shingo Tsujinaka, Yoh Kitamura, Tomoya Miura, Kei Nakagawa, Toru Nakano","doi":"10.1097/RC9.0000000000000913","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000913","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Non-occlusive mesenteric ischemia (NOMI) is life-threatening and may require extensive bowel resection, resulting in short bowel syndrome (SBS), nutritional deficiencies, and impaired wound healing. Severe wound dehiscence further complicates postoperative management, and reports describing this sequence are limited. This report highlights coordinated, phase-oriented management in an immunocompromised patient.</p><p><strong>Presentation of case: </strong>An 81-year-old female receiving immunosuppressive therapy underwent emergency Hartmann's procedure for perforated sigmoid diverticulitis. Postoperative septic shock required vasopressor support. On postoperative day (POD) 9, NOMI was diagnosed, necessitating subtotal small bowel resection and total colectomy, leaving approximately 70 cm of jejunum with an end jejunostomy. Extensive wound dehiscence developed by POD 21. Management included debridement, povidone-iodine sugar paste, 4 weeks of negative-pressure wound therapy with instillation, and trafermin. Complete secondary-intention closure without skin grafting was achieved by POD 90. Enteral and oral nutrition were gradually introduced while parenteral support was continued, and the high-output stoma was controlled with antidiarrheal agents and proton-pump inhibitors. The patient was transferred for rehabilitation on POD 120. At 15 months, she remained well, tolerated a regular diet, and required parenteral nutrition only on weekends.</p><p><strong>Clinical discussion: </strong>Delayed NOMI should be considered after septic shock despite transient hemodynamic stabilization. Phase-oriented wound care, staged nutritional escalation, and stoma output control supported secondary-intention healing without reconstructive surgery in a patient with SBS-related malnutrition.</p><p><strong>Conclusion: </strong>Coordinated wound and nutritional management may enable sustained recovery after NOMI complicated by SBS, high-output stoma, and extensive wound dehiscence.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4237-4242"},"PeriodicalIF":0.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171627","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 management of a 23-cm hemorrhagic adrenal pseudocyst presenting with acute inflammatory symptoms: a case report.","authors":"Amir Monshizadeh, Amirhossein Latif, Narjes Mohammadzadeh, Ali Asadollahi-Amin, Mohammad Reza Azimi Aval, Fezzeh Elyasi Nia","doi":"10.1097/RC9.0000000000000921","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000921","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Adrenal pseudocysts are rare cystic adrenal lesions that may present incidentally or with symptoms related to hemorrhage or mass effect. Giant hemorrhagic adrenal pseudocysts are uncommon and can mimic malignant intra-abdominal cystic masses.</p><p><strong>Presentation of case: </strong>A 48-year-old woman presented with severe abdominal pain, fever, abdominal distention, and dyspnea. Laboratory studies showed leukocytosis and elevated C-reactive protein. Contrast-enhanced CT demonstrated a 23 × 20 × 18 cm well-demarcated, thin-walled cystic mass in the right hemiabdomen and retroperitoneum, containing homogeneous low-attenuation fluid (9 Hounsfield units) without solid components or abnormal enhancement. Marked mass effect with leftward displacement of abdominal structures was observed. Plasma-free metanephrines were normal, tumor markers were within normal limits, and hydatid serology was negative. Due to persistent symptoms, laparoscopic exploration was performed. Controlled decompression yielded 4000 mL of hemorrhagic fluid without gross spillage, followed by complete laparoscopic excision. Operative time was 90 minutes with minimal blood loss. The patient was discharged on postoperative day 3. Histopathology confirmed a hemorrhagic adrenal pseudocyst.</p><p><strong>Clinical discussion: </strong>Giant adrenal pseudocysts may present with acute inflammatory features and significant mass effect, closely simulating malignant disease. Careful radiologic assessment and appropriate preoperative biochemical evaluation are essential before intervention. In selected patients with benign imaging features, laparoscopic resection with controlled decompression may be feasible even for lesions exceeding 20 cm.</p><p><strong>Conclusion: </strong>Laparoscopic resection with controlled decompression may be feasible for carefully selected giant adrenal pseudocysts when imaging and biochemical evaluation do not suggest malignant or functional disease, while maintaining oncologic caution.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4174-4178"},"PeriodicalIF":0.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166739","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}