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Laparoscopic Resection of a Splenic Artery Aneurism with Spleen Preservation
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Case Reports in Surgery publishes case reports and case series related to all aspects of surgery. Topics include but are not limited to oncology, trauma, gastrointestinal, vascular, and transplantation surgery.
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Case Reports in Surgery maintains an Editorial Board of practicing researchers from around the world, to ensure manuscripts are handled by editors who are experts in the field of study.
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Retained Surgical Sponge Presenting Four Decades Later as a Rapidly Growing Soft Tissue Mass
Retained surgical items continue to occur despite widespread implementation of prevention systems such as the surgical count, which has limited utility owing to its reliance on human performance. The most important risk factors for these events are poor communication in the operating room and inconsistent adherence to protocol. New technologies show efficacy in preventing retained surgical items and partially mitigating the poor reliability of the manual count. Additionally, efforts to address systemic and environmental sources of error have demonstrated success in reducing the incidence of retained surgical items. Here, we present the surprising case of a patient with a retained surgical sponge presenting as a soft tissue mass four decades after his surgery.
Primary Osteosarcoma of the Breast in a Patient Treated Previously for Invasive Ductal Carcinoma: An Unusual Presentation of a Very Rare Primary Breast Malignancy
Primary osteogenic sarcoma of the breast is a rare clinical entity with few cases described in the literature. Unfortunately, the prognosis for these patients is poor when compared to invasive carcinomas of the breast. We report a case of a 58-year-old female who developed a primary osteogenic sarcoma of the breast five years after being treated for invasive carcinoma of the ipsilateral breast without the use of radiotherapy.
Solid Pseudopapillary Neoplasm of the Pancreas with High-Grade Malignant Transformation Involving p16-RB Pathway Alterations
Solid pseudopapillary neoplasm (SPN) of the pancreas has generally been regarded as a low-grade malignant tumour that preferentially develops in young women and can have a good prognosis with surgery. Among the few patients who have died from metastatic SPN are mostly those whose tumours harbour an undifferentiated component characterized by diffuse sheets of cells with increased nuclear atypia and proliferative index. We herein report a case of an aggressive, fatal, solid pseudopapillary neoplasm (SPN) of the pancreas in a 63-year-old woman complaining of epigastric pain. Despite having undergone surgical resection for a 10 cm pancreatic mass and multiple liver metastases, the patient later died due to uncontrollable metastases 36 months after the initial surgery. Histological examination showed that the tumour displayed unusual high-grade malignant features, showing diffuse sheets of cells with increased nuclear atypia and proliferative activity, along with conventional low-grade malignant features. The tumour was subsequently recognized as an SPN with foci of high-grade malignant transformation according to the 2010 World Health Organization classification. Immunohistochemical studies revealed that p16-RB pathway alterations contributed to the high-grade malignant transformation. The present case report suggests the necessity for developing diagnostic and treatment methods targeting p16 and RB for high-grade variants of SPN.
Retroperitoneal Cecal Perforation Resulting from Obstructive Ascending Colon Adenocarcinoma
Most colorectal cancer patients in the early stages of the disease do not display any alarming symptoms. A total percentage of 9-27% of colorectal cancer patients present with acute abdomen, bowel obstruction, perforation, or bleeding. Perforation as the first presentation of the disease is seen in no more than 2.6-10% of patients. Intestinal perforation may be found on either the site of the tumor or on a more proximal site, caused by distention of the bowel due to peripheral obstruction. This is a case of a 75-year-old female patient who presents in the emergency department with retroperitoneal cecal perforation due to an obstructing tumor of the ascending colon. She underwent an emergency right hemicolectomy and washout of the retroperitoneal space. The cecum is not an unusual site of distention and subsequent perforation in the case of colonic obstruction, especially in the presence of a competent ileocecal valve. While the mechanism of diastatic cecal perforation is well described, it is the first time in the literature that this does not occur on the anterior surface of the organ. In our case, cecal perforation presents as a retroperitoneal abscess without peritoneal spillage. Nonetheless, it still carries a grim prognosis and urgent surgical intervention is needed.
Inflammatory Fibroid Polyp in a 48-Year-Old Male: A Rare Cause of Intussusception
Inflammatory fibroid polyp is a neoplastic condition affecting the gastrointestinal tract and particularly the gastric antrum. It is virtually a benign submucosal mass comprising mesenchymal cells and numerous small blood vessels with inflammatory cells and commonly eosinophils. Patients with inflammatory fibroid polyps usually present clinically with mechanical intestinal obstruction with or without intussusception. Herein, we present a case of a 48-year-old male with a known history of schizophrenia who presented with mechanical intestinal obstruction following intussusception due to inflammatory fibroid polyp involving the proximal jejunojejunal part of the jejunum.
A Case of Torsion of the Gallbladder Suspected with SPECT-CT: Review and Recommendations
Torsion or volvulus of the gallbladder is a rare situation that rapidly progresses to gangrene and linked with a poor prognosis, even death, if unrecognized and untreated. An interesting and rare case of gallbladder volvulus in which diagnosis was obtained by comparing CT images and HIDA scan with SPECT-CT is presented. Relevant literature is reviewed, and recommendations are outlined.
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