International Journal of Surgery Case Reports最新文献

{"title":"Inflammatory myofibroblastic tumor of the psoas muscle presenting as a retroperitoneal mass: a case report.","authors":"Wail Alqatta, Shaima Alfaqeeh","doi":"10.1097/RC9.0000000000000929","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000929","url":null,"abstract":"<p><strong>Introduction: </strong>Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal neoplasm of intermediate biological potential characterized by myofibroblastic spindle-cell proliferation and a variable inflammatory infiltrate. Although IMT may arise in a wide range of anatomical locations, primary involvement of the psoas muscle is exceptionally uncommon and may present significant diagnostic challenges due to its nonspecific clinical and radiological features.</p><p><strong>Case presentation: </strong>A 29-year-old man presented with progressive left flank and left iliac fossa pain radiating to the back and left lower limb. Contrast-enhanced computed tomography (CT) revealed a 5.8 × 4.7 × 6.6 cm hypervascular intramuscular mass within the left psoas muscle, highly suspicious for a malignant retroperitoneal soft-tissue neoplasm. CT-guided core needle biopsy was inconclusive. Due to persistent symptoms and diagnostic uncertainty, the patient underwent complete surgical excision of the lesion. Histopathological examination demonstrated a spindle-cell proliferation with a prominent inflammatory infiltrate, while immunohistochemistry showed positivity for vimentin and smooth muscle actin with focal weak ALK-1 expression and a low Ki-67 proliferation index, confirming the diagnosis of IMT. Surgical margins were negative. The postoperative course was uneventful, and the patient remained free of recurrence at 5-month follow-up.</p><p><strong>Discussion: </strong>Primary IMT of the psoas muscle is extremely rare and may closely mimic malignant retroperitoneal tumors on clinical and radiological evaluation. Preoperative diagnosis is often difficult, and image-guided biopsy may be non-diagnostic. Definitive diagnosis relies on histopathological and immunohistochemical assessment, while complete surgical excision remains the treatment of choice for localized disease.</p><p><strong>Conclusion: </strong>IMT should be considered in the differential diagnosis of retroperitoneal and intramuscular soft-tissue masses, particularly in young adults. Complete surgical resection provides both definitive diagnosis and effective treatment, with favorable short-term outcomes when negative margins are achieved.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4297-4302"},"PeriodicalIF":0.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172068","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 interval laparoscopic appendectomy for walled-off perforated appendicitis during pregnancy: a case report.","authors":"Shinichiro Usuki, Kana Murakami, Anju Kawaguchi","doi":"10.1097/RC9.0000000000000911","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000911","url":null,"abstract":"<p><strong>Introduction: </strong>Acute appendicitis is the most common non-obstetric surgical emergency during pregnancy, with an incidence of approximately 0.067% (1 in 1493 pregnancies). Although prompt laparoscopic appendectomy is the standard treatment, optimal management of walled-off perforated appendicitis (WOPA) during pregnancy is unclear.</p><p><strong>Case presentation: </strong>A 28-year-old woman presented with a 1-week history of abdominal pain and fever at 9 weeks of gestation. Ultrasonography demonstrated an ill-defined right lower quadrant mass, and contrast-enhanced computed tomography revealed WOPA with a localized abscess clearly separated from the uterus. Following a multidisciplinary discussion with the obstetric team, initial nonoperative management (NOM) with intravenous antibiotics was considered because the patient was clinically stable and the inflammation was localized. The patient's symptoms resolved without complications, and she was discharged after 11 days. Elective laparoscopic interval appendectomy (IA) was successfully performed 9 weeks later, at 18 weeks of gestation during the second trimester. Only mild adhesions were observed intraoperatively, and the postoperative course was uneventful. The pregnancy progressed without any maternal or fetal complications.</p><p><strong>Discussion: </strong>In this case, delayed presentation, localized abscess formation, clinical stability, and anatomical separation of the inflammatory lesion from the uterus supported the initial conservative approach. Elective IA performed during the second trimester avoided technically demanding emergency surgery and was safely completed. This case, together with the limited published literature, suggests that staged management may be appropriate among carefully selected pregnant women.</p><p><strong>Conclusion: </strong>In carefully selected pregnant patients with WOPA, initial NOM followed by interval laparoscopic appendectomy may be safe and feasible. Additional case studies are required to establish the optimal management recommendations for this rare clinical condition.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4228-4231"},"PeriodicalIF":0.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168404","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":"Ergonomic modified port placement for laparoscopic cholecystectomy in situs inversus totalis: a case report and analysis of reported approaches.","authors":"Md Sumon Rahman, Masud Raihan Bappy, Antara Mobin Chowdhury, Muhammad Ishaq","doi":"10.1097/RC9.0000000000000934","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000934","url":null,"abstract":"<p><strong>Introduction: </strong>Situs inversus is a rare congenital condition characterized by the mirror-image reversal of organ placement. Performing laparoscopic cholecystectomy in patients with situs inversus poses unique ergonomic challenges due to altered anatomical orientation. This case report presents a successful laparoscopic cholecystectomy in a patient with situs inversus, highlighting technical considerations and ergonomic modified port placement.</p><p><strong>Case presentation: </strong>A 57-year-old male was a known case of situs inversus totalis (STT) for 15 years. Preoperative evaluation confirmed cholelithiasis, necessitating surgical intervention. Laparoscopic cholecystectomy was performed using a modified technique to accommodate the reversed anatomy and improve ergonomics for right-handed surgeons. The procedure was completed successfully without conversion. Intraoperatively, the gallbladder and biliary anatomy were mirror-imaged, and the gallbladder was hidden beneath a dense omental wrap due to inflammatory adhesions. Postoperative recovery was uneventful, and the patient was discharged on postoperative day 2 after drain removal.</p><p><strong>Discussion: </strong>Laparoscopic cholecystectomy in situs inversus requires understanding of reversed anatomy and adaptation of trocar placement and instrument handling. In this case, surgery was completed without complications, demonstrating the feasibility and safety of laparoscopic cholecystectomy using modified port placement. However, individual patient factors and surgeon expertise should be considered when selecting the optimal approach.</p><p><strong>Conclusion: </strong>Laparoscopic cholecystectomy can be safely performed in situs inversus with careful planning and modified technique. Although rare, situs inversus should be considered in patients with gallstone disease. This case highlights the need for individualized management, and further accumulation of experience may help refine ergonomic port strategies in SIT.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4270-4274"},"PeriodicalIF":0.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171869","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":"Pathological fractures revealing Langerhans cell histiocytosis in an elderly female: a rare case report.","authors":"Prashant Adhikari, Gaurav Bir Bajracharya, Deepak Shrestha, Bhaskar Raj Pant, Sandeep Bhandari","doi":"10.1097/RC9.0000000000000945","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000945","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Langerhans cell histiocytosis (LCH) is a rare clonal proliferative disorder of dendritic cells, predominantly affecting children. Adult-onset LCH is uncommon and often misdiagnosed due to its atypical presentation. Pathological fractures as the initial manifestation are particularly rare in older adults.</p><p><strong>Case presentation: </strong>We report a 63-year-old female who sustained a pathological femoral fracture following minor trauma, with radiographs revealing cortical thinning and lytic changes. Subsequent imaging demonstrated multifocal osseous lesions involving the pelvis, vertebrae, and long bones. Histopathology confirmed LCH by characteristic morphology with immunohistochemical positivity for CD1a, S100, CD45, and Langerin (CD207). The femoral fracture was stabilized with intramedullary interlocking (IMIL) nailing after biopsy of the lesion. Two months later, she sustained a pathological humeral fracture with similar radiological features, which was managed with IMIL nailing without repeat biopsy because the lesion was considered clinically and radiologically consistent with the previously confirmed diagnosis of LCH. Systemic therapy with cytarabine and prednisolone was initiated for single-system multifocal osseous LCH.</p><p><strong>Clinical discussion: </strong>This case highlights the importance of considering LCH in the differential diagnosis of pathological fractures in adults, despite its rarity in the elderly. The occurrence of sequential pathological fractures of two long bones illustrates the aggressive skeletal manifestations that may occur in adult single-system multifocal LCH. Histological confirmation with immunohistochemistry remains the diagnostic gold standard. Surgical stabilization with IMIL nailing provided stable fixation, allowing early rehabilitation while systemic therapy was initiated for progressive multifocal skeletal disease.</p><p><strong>Conclusion: </strong>Adult-onset multifocal skeletal LCH should be considered in patients presenting with pathological fractures after low-energy trauma. Early histological diagnosis, multidisciplinary management, appropriate fracture stabilization, and timely systemic therapy may facilitate fracture healing and functional recovery. Longer follow-up with systemic imaging is required to determine long-term disease control.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4167-4173"},"PeriodicalIF":0.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170287","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":"Peripheral ossifying fibroma mimicking oral Kaposi's sarcoma in an immunosuppressed patient with Behçet's disease: a case report.","authors":"Y Sibari, A Bouzidi, S Chbicheb","doi":"10.1097/RC9.0000000000000843","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000843","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Kaposi's sarcoma (KS) is an HHV-8-associated angioproliferative neoplasm occurring preferentially in immunosuppressed individuals, with oral involvement documented in up to 65% of HIV/AIDS patients. Several benign reactive gingival lesions, including peripheral ossifying fibroma (POF), may clinically mimic oral KS, creating a significant diagnostic challenge. In patients with established systemic KS, newly detected oral lesions carry a high risk of diagnostic anchoring bias, making HHV-8 (LANA-1) immunohistochemistry indispensable for definitive diagnosis.</p><p><strong>Presentation of case: </strong>A 57-year-old male with Behçet's disease under long-term corticosteroid therapy (15 mg/day) and histologically confirmed cutaneous KS was referred for a painless gingival nodule evolving over 6 years. Intraoral examination revealed a well-demarcated, firm, pink, non-bleeding nodular lesion on the lingual mandibular gingiva, without bone involvement on panoramic radiography. The atypical clinical presentation prompted complete surgical excision under local anesthesia. Histopathology demonstrated a benign fibrocellular proliferation with focal mineralized deposits consistent with POF. HHV-8 LANA-1 immunohistochemistry, performed on the Autostainer Link 48 DAKO platform using the EnVision K5007 system, showed absent HHV-8 expression, definitively excluding oral KS. Healing was uneventful with no recurrence at 6 months.</p><p><strong>Clinical discussion: </strong>The coexistence of systemic KS and iatrogenic immunosuppression introduced a powerful cognitive prior - diagnostic anchoring bias - directing clinical reasoning toward mucosal KS despite four atypical features: pink coloration, firm consistency, absence of spontaneous bleeding, and 6-year indolent evolution. Negative HHV-8 immunostaining was decisive, confirming that oral lesions in KS patients are not necessarily mucosal disease. This case reinforces the principle that histopathological and immunohistochemical analysis must systematically override clinical gestalt in this setting.</p><p><strong>Conclusion: </strong>Early biopsy combined with HHV-8 (LANA-1) immunohistochemistry is essential when evaluating oral nodular lesions in immunosuppressed patients with established KS, to prevent diagnostic anchoring bias and avoid unnecessary oncologic investigations.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4081-4086"},"PeriodicalIF":0.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171243","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":"Jejunal mesenteric cyst presenting as acute midgut volvulus in a child: a rare cause of surgical abdomen.","authors":"Shital Bhaisare, Madhav Waghmare","doi":"10.1097/RC9.0000000000000949","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000949","url":null,"abstract":"<p><strong>Introduction: </strong>Mesenteric cysts are defined as benign intra-abdominal tumors located in the mesentery. Mesenteric cysts are rare intra-abdominal lesions in children and are often asymptomatic. Acute midgut volvulus secondary to a mesenteric cyst is an exceptionally uncommon presentation that requires prompt surgical intervention to prevent bowel ischemia.</p><p><strong>Case presentation: </strong>An 8-year-old boy was referred from the pediatric department with acute abdominal pain and recurrent bilious vomiting. Clinical examination revealed around 20 × 20 cm size cystic lump involving whole abdomen. Contrast-enhanced computed tomography demonstrated a large mesenteric cyst associated with midgut volvulus. The patient underwent emergency exploratory laparotomy, which confirmed a huge mesenteric cyst causing volvulus of proximal jejunum. Complete excision of the cyst along with resection of the involved bowel segment was performed, followed by primary bowel anastomosis. The postoperative course was uneventful, and the patient recovered well.</p><p><strong>Conclusion: </strong>Mesenteric cysts may rarely present as a surgical emergency due to volvulus, intestinal obstruction, or bowel ischemia. Early recognition and timely surgical management are essential for favorable outcomes.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4337-4340"},"PeriodicalIF":0.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172241","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":"Aortic occlusion requiring surgery in a patient with autoimmune hemolytic anemia and severe anemia: a case report.","authors":"Andrew William, Danang H Limanto, Melissa V Ariyanto, Maxwell S S Atmaja","doi":"10.1097/RC9.0000000000000905","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000905","url":null,"abstract":"<p><strong>Introduction: </strong>Aortoiliac occlusive disease (AIOD) often requires urgent revascularization to prevent chronic limb-threatening ischemia (CLTI). The coexistence of autoimmune hemolytic anemia (AIHA) complicates surgical planning due to increased transfusion risks and unstable hemoglobin levels. Understanding the interplay between AIHA and AIOD is crucial, as delayed intervention can lead to irreversible ischemic damage.</p><p><strong>Presentation of case: </strong>A 72-year-old man presented with leg pain and bilateral lower-limb weakness. His medical history included type 2 diabetes mellitus and suspected AIHA. Physical examination revealed necrosis in the first, second, and fourth toes of the left foot, consistent with CLTI classified as Fontaine stage IV. Laboratory findings showed severe anemia, hyperglycemia, leukocytosis, and hypoalbuminemia. CT angiography confirmed aortoiliac occlusion. Despite a suboptimal hemoglobin response to transfusion with leukodepleted packed red blood cells due to suspected AIHA, urgent revascularization was performed. The patient underwent aortoiliac endarterectomy followed by an aortobifemoral bypass using a Y-graft. Postoperative examination revealed good bilateral femoral pulses, indicating successful revascularization.</p><p><strong>Discussion: </strong>The management of AIOD with AIHA presents a clinical dilemma. AIHA may reduce the effectiveness of perioperative transfusions, yet delaying surgery risks the progression of ischemia. Anatomical bypass to the femoral arteries restores proximal blood flow and addresses the dual concerns of thrombus progression and limb salvage.</p><p><strong>Conclusion: </strong>Despite the hematologic challenges posed by the suspicion of AIHA, revascularization through aortobifemoral bypass remains a viable and effective treatment for CLTI caused by AIOD. This case highlights the importance of timely intervention and careful perioperative management in patients with complex comorbidities.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4133-4136"},"PeriodicalIF":0.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170177","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":"H-type anorectovaginal fistula with anterior ectopic anus in a 15-month-old girl: a case report.","authors":"Zubair Mohamed Dahir Sed, Badrudin A Warsame","doi":"10.1097/RC9.0000000000000909","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000909","url":null,"abstract":"<p><strong>Introduction and importance: </strong>H-type anorectovaginal fistula is a rare anorectal malformation characterized by an abnormal communication between the rectum and vagina despite a normally formed or near-normal anus. Diagnosis may be delayed due to the absence of obvious external anatomical abnormalities, making clinical recognition essential, particularly in resource-limited settings.</p><p><strong>Case presentation: </strong>We report a 15-month-old girl presenting with fecal vaginal discharge and chronic constipation since early infancy. Clinical examination revealed an anterior ectopic stenotic anus with vaginal fecal contamination, consistent with H-type anorectovaginal fistula. Diagnosis was established clinically due to clear findings and financial constraints limiting access to advanced imaging modalities. Abdominal radiography demonstrated a loaded rectosigmoid colon, while abdominal ultrasonography was normal. The patient underwent limited posterior sagittal anorectoplasty with fistula division and reconstruction. The postoperative course was uneventful, and bowel management was initiated early. At 2-year follow-up, the patient demonstrated age-appropriate continence based on clinical assessment and parental reporting consistent with expected developmental stage, with no recurrence or complications.</p><p><strong>Clinical discussion: </strong>H-type anorectovaginal fistula is an uncommon variant of anorectal malformations and may present diagnostic challenges due to subtle external findings. Management remains controversial because of anatomical variability; however, posterior sagittal anorectoplasty provides direct access for precise anatomical correction. In selected patients, single-stage repair without diversion can achieve favorable outcomes when conditions are optimal.</p><p><strong>Conclusion: </strong>Careful clinical evaluation remains the cornerstone of diagnosis in rare anorectal malformations. Individualized surgical management based on anatomy and reconstructive principles can achieve good functional outcomes even in resource-limited environments.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4232-4236"},"PeriodicalIF":0.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167773","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":"Obturator hernia misdiagnosed as inguinal incarceration: a case of postoperative small-bowel perforation and subcutaneous fecal emphysema.","authors":"Anas Derkaoui, Tarik Deflaoui, Intissar Aissi, Abdelali Guellil, Rachid Jabi, Mohammed Bouziane","doi":"10.1097/RC9.0000000000000844","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000844","url":null,"abstract":"<p><strong>Introduction and importance: </strong>An obturator hernia is a rare condition accounting for less than 1% of abdominal wall hernias. Due to its deep pelvic location and nonspecific clinical presentation, it is frequently misdiagnosed, most often as an inguinal hernia. Delayed or incorrect diagnosis may result in bowel ischemia and perforation.</p><p><strong>Case presentation: </strong>We report the case of a 61-year-old man who underwent emergency open surgery at another institution for a presumed strangulated right inguinal hernia with placement of prosthetic mesh. No operative report was available regarding intraoperative findings, bowel assessment, or mesh positioning. Eight days later, the patient presented with progressive abdominal distention, respiratory distress, and extensive subcutaneous emphysema involving the cervical and thoracic regions. A CT scan demonstrated pneumoperitoneum, bilateral pneumothorax, pneumomediastinum, and an incarcerated obturator hernia with small-bowel ischemia and a suspected perforation. Emergency laparotomy revealed a perforated ileal loop associated with extensive fecal contamination tracking through fascial planes in proximity to the previously placed mesh. Segmental bowel resection with double stoma, obturator defect closure, and drainage were performed. The postoperative course was favorable.</p><p><strong>Clinical discussion: </strong>This case illustrates several rare and clinically relevant issues: (1) an obturator hernia mimicking an inguinal hernia; (2) a complex postoperative course with bowel perforation in the context of recent mesh repair; and (3) extensive subcutaneous fecal emphysema with thoracic extension. However, in the absence of operative documentation from the initial surgery, it remains impossible to determine with certainty whether the obturator hernia was initially unrecognized, whether ischemia evolved secondarily, or whether the perforation occurred independently in the postoperative period. This uncertainty highlights the importance of caution in attributing postoperative complications to a single causal mechanism when complete clinical data are unavailable.</p><p><strong>Conclusion: </strong>Obturator hernia remains a diagnostic challenge in emergency surgery. In cases of persistent postoperative obstruction after groin hernia repair, alternative diagnoses should be considered. This case also underlines the importance of complete operative documentation and close postoperative follow-up. Subcutaneous fecal emphysema represents an exceptionally rare but severe manifestation of gastrointestinal perforation.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4051-4054"},"PeriodicalIF":0.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168633","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 laparoscopic management of idiopathic sclerosing encapsulating peritonitis: a case report.","authors":"Hazem Beji, Laaribi Aymen, Laamiri Ghazi, Yassine Selmene, Mahdi Bouassida, Hassen Touinsi","doi":"10.1097/RC9.0000000000000748","DOIUrl":"https://doi.org/10.1097/RC9.0000000000000748","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Idiopathic sclerosing encapsulating peritonitis (SEP), also termed \"abdominal cocoon syndrome,\" is an extremely rare cause of intestinal obstruction characterized by the encasement of small-bowel loops within a fibrous membrane. Although SEP has traditionally been treated by laparotomy, laparoscopy has emerged as a safe alternative when feasible.</p><p><strong>Case presentation: </strong>We describe a 32-year-old man with no significant past medical history who presented with acute abdominal pain and vomiting. An abdominal computed tomography (CT) scan demonstrated clustered ileal loops enveloped by a dense capsule, suggestive of SEP. Emergency laparoscopic surgery was performed, confirming a thick fibrous membrane surrounding the distal ileum. Careful adhesiolysis and excision of the capsule were achieved without bowel resection. The patient recovered uneventfully and was discharged on the second postoperative day.</p><p><strong>Clinical discussion: </strong>SEP is categorized as primary (idiopathic) or secondary. Idiopathic SEP remains exceedingly rare. Diagnosis is challenging preoperatively due to nonspecific clinical features, but CT findings may suggest the characteristic \"cocoon sign.\" Surgery remains the mainstay of treatment, consisting of adhesiolysis and excision of the encapsulating membrane. Conservative management can be considered as the initial approach in patients presenting without signs of severity. Emerging reports support laparoscopy as a viable alternative to laparotomy, offering faster recovery and lower morbidity.</p><p><strong>Conclusion: </strong>This case illustrates the feasibility and safety of laparoscopic management of idiopathic SEP. Minimally invasive surgery should be considered whenever expertise is available, as it provides effective treatment with reduced morbidity.</p>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"138 10","pages":"4055-4057"},"PeriodicalIF":0.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171256","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}