Successful Surgical Management Research Articles

Successful surgical management of a Salter-Harris type I fracture of the accessory carpal bone in a dog.

To describe the successful surgical management of a previously unreported Salter-Harris type I fracture of the accessory carpal bone in a dog. An 11-week-old intact female Golden Retriever-Poodle cross presented with a history of a marked left forelimb lameness following a suspected fall from a height. On physical examination, the patient demonstrated a severe left forelimb lameness and pain on palpation and range of motion of the left carpus. Orthogonal radiographs of the distal left forelimb demonstrated a type I Salter-Harris fracture of the accessory carpal bone with proximal displacement of the palmar fragment. The patient underwent open reduction and internal fixation wherein the fracture was reduced and stabilized with two 1.1-mm Kirschner wires. Postoperatively, the patient was initially managed with a carpal flexion bandage for 2 weeks and then a soft padded bandage was maintained until 4 weeks postoperatively. The patient recovered well and was walking and weight-bearing comfortably following removal of the carpal flexion bandage. Repeat radiographs performed 4 and 8 weeks postoperatively demonstrated adequate fracture healing but showed mild proximocaudal implant displacement. Implant removal was not performed, as the patient was doing well at home and the implant migration appeared static and was not causing clinical morbidity. To the authors' knowledge, this was the only reported case of a Salter-Harris fracture of the accessory carpal bone in a dog and the only described case of successful surgical stabilization.

Low-grade malignant peripheral nerve sheath tumour presenting as retroperitoneal spindle cell neoplasm.

Retroperitoneal spindle cell neoplasms are diagnostically challenging. Malignant peripheral nerve sheath tumours (MPNSTs) can sometimes present as sporadic primary retroperitoneal tumours. MPNSTs are usually high-grade and highly aggressive tumours and are associated with a poor prognosis. Low-grade MPNSTs are very rarely described. This current case report describes a case of sporadic primary low-grade MPNST presenting as retroperitoneal spindle cell neoplasm. The diagnosis, imaging and immunohistopathological findings, as well as its successful surgical management, are presented.

A successful surgical management for a thrombosed giant left coronary aneurysm with right ventricular fistula in a young patient.

Giant coronary aneurysm with ventricular fistula is rare. Due to the limited data from randomised clinical trials, therapeutic strategies for coronary aneurysms predominantly rely on on case series and anecdotal evidences. Reporting cases that provide practical experience in managing these aneurysms is therefore crucial. In this article, we report a rare case of a successful surgical management for a thrombosed giant left coronary aneurysm with right ventricular fistula, which is larger than any previously reported cases.

Successful management of a mixed epithelial and stromal renal tumor masquerading as lower pole renal cyst: A laparoscopic deroofing approach

AbstractBackgroundRenal cysts are common in clinical practice, but some may harbor rare pathological entities such as mixed epithelial and stromal tumors (MEST). Imaging studies are crucial for accurate diagnosis. While laparoscopic deroofing is an established approach for symptomatic renal cysts, encountering MEST within a cyst is uncommon.Case PresentationWe present the case of a 37‐year‐old female who presented with persistent left flank pain. Imaging revealed a large renal cyst in the lower pole of the left kidney, classified as Bosniak 2. Despite analgesia, the patient's symptoms persisted, leading to a laparoscopic deroofing procedure. Histopathological examination postprocedure revealed a MEST. The patient reported complete resolution of symptoms at the 3‐month follow‐up.ConclusionThis unique case presents the successful identification and surgical management of a MEST masquerading as a lower pole renal cyst through laparoscopic deroofing. It also contributes to the existing literature by highlighting the importance of considering rare pathological entities in the evaluation of renal cysts and the value of laparoscopic techniques in their management.

Successful surgical management of three mechanical complications of acute myocardial infarction: ventricular septal defect, severe mitral regurgitation and ventricular aneurysm

Successful surgical management of three mechanical complications of acute myocardial infarction: ventricular septal defect, severe mitral regurgitation and ventricular aneurysm

Lessons Learned From Three Patients Who Underwent Cesarean Section and Cardiac Valvular Surgery Simultaneously: Anesthesiologists’ Perspective

Background: Cardiac valvular disease constitutes a challenge during pregnancy. Herein, we present our experience with three patients who underwent caesarean section and cardiac valvular surgery simultaneously. The purpose of this case series was to outline the clinical characteristics and to highlight the surgical/anesthesiologic pitfalls to be considered in patients who will undergo cardiac valvular surgery and caesarean section simultaneously. Methods: This retrospective case series was implemented using data extracted from the medical files of three patients who underwent cardiac valvular surgery and caesarean section in the obstetrics and gynecology and cardiovascular surgery departments of our tertiary care center. Demographic data, history, echocardiographic findings, surgical and anesthesiologic techniques as well as perioperative information and therapeutic outcomes were recorded. Results: Three pregnant women with an average age of 33.67 years were diagnosed with various cardiac valvular pathologies on the 3rd trimester. Owing to their diminished cardiac reserves and clear indications for cesarean section, the patients underwent cardiac valvular surgery subsequent to the cesarean section. Procedures were completed successfully on all patients and mothers and infants were discharged after a maternal follow-up in intensive care unit. Conclusion: We suggest that cardiac valve surgery can be performed simultaneously just after cesarean section in selected cases. Risks and benefits must be analyzed well prior to the decision making for the absolute necessity of the invasive procedure. Close collaboration between disciplines, well equipped referral centers, trained personnel and increased awareness on possible complications are the key points for successful surgical management of pregnant women with cardiac valve disease.

Management of a Complex Fistula Involving Abdominal Wall, Small Bowel, Colon, and Bladder.

Successful surgical management of a chronic complex abdominal fistula requires thoughtful pre-operative evaluation and planning and often benefits from a multi-disciplinary approach. Initially, attention is focused on controlling sepsis and ensuring adequate hydration and electrolyte replacement. Next, efforts to optimize nutrition and engage the patient in prehabilitation are prioritized. Simultaneously, imaging is used to gain detailed assessment of anatomy. We present a challenging case involving a Jackson-Pratt (JP) drain from prior surgery causing a complex intra-abdominal fistula. The JP drain traversed multiple small bowel loops and the sigmoid colon before terminating in the bladder. Management required multi-disciplinary coordination involving colorectal surgery and urology. The patient's definitive surgery included anterior resection, colostomy takedown, right colectomy, three small bowel resections, and bladder repair. The use of JP drains after abdominal surgery is not without risk. Clinicians should have standardized indications for placement of JP drains and consistent protocols regarding timing of removal.

Presentation and Management of Thyroid Hydatid Cyst: A Comprehensive Systematic Review of the Literature

Introduction Hydatid cysts of the thyroid gland, though rare, pose a diagnostic and therapeutic challenge. This systematic review summarizes current knowledge on the presentation, diagnosis, and management. Methods A systematic review of the published studies of thyroid hydatid cysts was conducted. The included studies of thyroid hydatid cysts had the following properties: 1) The thyroid infection was confirmed by diagnostic modalities, surgical findings, or histopathology. 2) The case presentation was provided in the study. 3) The cyst(s) were originally located or adhered to the thyroid and did not rupture into it from the other adjacent structures or organs. Results Overall, 39 studies were compatible with the inclusion criteria. Turkey had the highest case occurrence (36%). Female predominance (59%) and a mean age of 38.33 years were observed. Mass (79.5%) was the most common symptom, followed by hoarseness of voice (4%). Serology (18.75% positive) and ultrasound (77.5%) were primarily used for diagnosis. Surgery was the mainstay of treatment (96%), with total thyroidectomy (32.6%) and left hemithyroidectomy (16%) being the most common approaches. No recurrence was reported in the follow-up period (0%). Conclusion This review highlights the rarity, clinical presentation, diagnosis, and successful surgical management of thyroid hydatid cysts. Further research is needed to optimize diagnostic methods and explore alternative treatment options.

Successful surgical management of a superior cerebellar artery aneurysm in a patient with Marfan syndrome: illustrative case.

Marfan syndrome, a connective tissue disorder, poses unique challenges in neurosurgery, given the fragility of vascular structures. Superior cerebellar artery (SCA) aneurysms in patients with the syndrome are rare and present distinct surgical difficulties, necessitating innovative approaches. A 29-year-old male with Marfan syndrome presented with a subarachnoid hemorrhage from a ruptured SCA aneurysm. Given the lack of a defined aneurysm neck and the small diameter of the SCA, standard clipping and endovascular therapies were unsuitable. A microsurgical approach using microsutures was successfully employed, effectively managing the aneurysm while preserving the parent artery. This case underscores the efficacy of the microsuture technique in complex neurosurgical scenarios, particularly in patients with connective tissue disorders such as Marfan syndrome. The adaptability of surgical strategies, as demonstrated in this case, is crucial for achieving successful outcomes in patients with unique anatomical challenges.

Successful surgical management of polyostotic costal fibrous dysplasia—a case report

Successful surgical management of polyostotic costal fibrous dysplasia—a case report

Suprainguinal fascia iliaca plane block for surgical anesthesia of thigh: A case report for excision of a giant mass

Suprainguinal plane block was defined by Hebbard in 2009 for postoperative analgesia purposes. It is aimed to block the femoral nerve, lateral femoral cutanaeus nerve and obturator nerve. In this case, we presented the successful surgical management of suprainguinal block in excision of a mass in the thigh. During the surgery, which lasted 80 minutes, additional analgesic was needed only during the femur curettage. Postoperative pain scores were low and the patient was discharged the next day.

Successful surgical management of ventricular septal perforation following left ventricular free wall rupture due to acute myocardial infarction: a case report

BackgroundThe mechanical complications associated with acute myocardial infarction can be fatal. We report a life-saving case of a very elderly patient with consecutive mechanical complications of acute myocardial infarction.Case presentationA 90-year-old woman was transferred to our hospital for emergency care due to chest pain. She underwent emergency percutaneous coronary intervention of the left anterior descending branch and was diagnosed with acute myocardial infarction and intra-aortic balloon pumping insertion was performed. After returning to the intensive care unit, she experienced chest pain and went into shock. Echocardiography showed left ventricular free wall rupture, and percutaneous cardiopulmonary support was established. Emergency left ventriculoplasty was performed for the left ventricular free wall rupture. A ventricular septal perforation was observed on postoperative day 9, and its closure through right ventriculotomy was performed on postoperative day 10. On the 128th postoperative day, the patient was transferred to the hospital for rehabilitation.ConclusionsA 90-year-old patient with consecutive left ventricular free wall rupture and ventricular septal perforation after acute myocardial infarction was successfully managed with two surgeries.

Successful surgical management of total anomalous pulmonary ve-nous return in a pediatric patient

Successful surgical management of total anomalous pulmonary ve-nous return in a pediatric patient

Successful Surgical Management of Giant Mediastinal Teratoma – A Case Report of a Difficult Case without Any Post-Operative Complication

Introduction. Mediastinal teratoma is a rare germ cell tumor, located in anterior mediastinum and is lack of population-based study. It usually occurs in the age of 20-40 years, accounting for 15% of anterior mediastinal masses in adults and 25% of anterior mediastinal masses in children. It is frequently diagnosed accidentally on chest imaging due to its asymptomatic nature. Hereby, we presented a case of giant anterior mediastinum teratoma with complete surgical excision without any post-operative complication. This case is unique due to its uneventful result after excision. From our literature research, we successfully avoid the potential post operative complications of resecting this tumor such as bleeding, wound dehiscence and even death. It is due to early diagnosis, treatment and good intraoperative management of lesion & hemodynamics. Case Report. A 21-year old male was referred from pulmonologist oncologist to our Thoracic Surgical Unit with complains of dyspnea and chest pain. Physical examination showed no lung sounds in (R) hemithorax and was dull to percussion, ictus cordis shifted 2 fingerbreadths towards left-side. Chest X-ray showed a large well-defined lesion in (R) hemithorax and chest CT-scan with contrast showed hypodense mass on (R) hemithorax adhering & compressing the lung, diaphragm, pericardium & chest wall, with estimation size of 60 x 20 x 12 cm, lesion displaced the heart. Patient was then treated with complete surgical excision and found a huge cystic tumor with a size of 60 x 20 x 12 cm adhering to all parts of (R) lung, diaphragm and pericardium. He underwent (R) pneumonectomy due to adhesion. Histologic examination was consistent with mature teratoma. Patient showed no complication after surgery and was discharged uneventfully from our hospital after 5 days. Discussion. Approximately 95% of benign teratomas arise in the anterior mediastinum. The tumor grows progressively, mostly asymptomatic, dyspnea and substernal chest pain are the most common symptoms if present. Productive Cough of hair or sebum is a pathognomonic sign. Chest radiograph typically reveals a well-circumscribed anterior mediastinal mass that often protrudes into one of the lung, they are usually large at the time of diagnosis. Complete surgical excision is a treatment of choice of mediastinal teratoma, which can be performed through median sternotomy or thoracotomy or thoracoscopy. Some patients require additional procedures (eg, lobectomy, pericardiectomy) for complete tumor resection. Conclusion. There is still limited data on mediastinal teratoma. Early referral & treatment show good prognosis. Benign Mediastinal Teratomas was tricky to be diagnosed, when it is diagnosed, it is usually very large in size. Complete Surgical Excision can be performed safely without any complications.

A156 INCIDENCE OF MALIGNANT GASTRIC OUTLET OBSTRUCTION IN PATIENTS WITH PANCREATIC CANCER UNDERGOING FOLFIRINOX THERAPY

Abstract Background Malignant gastric outlet obstruction is a morbid complication of pancreatic cancer. There is currently a lack of epidemiology data characterizing its incidence and outcomes in patients with unresectable pancreatic head cancer undergoing chemotherapy with leucovorin, fluorouracil, irinotecan, and oxaliplatin (FOLFIRINOX). Determining the incidence of MGOO in this context is crucial for developing effective management strategies. Aims We aim to ascertain the incidence of MGOO in patients with pancreatic cancer treated with FOLFIRINOX. Secondary objectives include evaluating the clinical outcomes of MGOO. The primary endpoint was the rate of malignant gastric outlet obstruction, defined as clinical evidence of MGOO confirmed with axial imaging and/or endoscopy. Secondary endpoints included the length of hospitalization for MGOO and the rate of successful endoscopic or surgical management. Methods This was a retrospective, single-center study including patients with pancreatic head cancer treated with FOLFIRINOX between January 1, 2017, and December 31, 2022, who did not undergo surgical resection. Patients were excluded if they had pancreatic cancer located in the neck, body, and/or tail of the pancreas, had predominantly cystic cancer, had an oncological resection, had a prophylactic surgical gastrojejunostomy, or had metastatic cancer to the pancreas. Results Overall, 44 patients with pancreatic head cancer (40.90% female, mean age 59.3 ± 8.5 years) were included. There was no statistically significant difference in tumor staging between MGOO and No-MGOO patients: overall, 6.8% borderline, 40.9% metastatic, and 52.3% locally advanced. The incidence of MGOO in patients with pancreatic head cancer was 36.36%. Patients who never developed MGOO experienced significantly shorter unplanned hospitalizations (mean ± SD: 20.8 ± 18.30 days) compared to those with MGOO (mean ± SD: 50.33 ± 41.22 days; p = 0.0175). The mean number of FOLFIRINOX cycles received was 7.2 (±5.43) for patients without MGOO and 8.1 (±5.81) for patients with MGOO (p = 0.6152). Among patients with MGOO (n=12), management strategies included EUS-guided gastrojejunostomy (43.75%), duodenal stent placement (31.25%), and medical management (25%). Conclusions Our contemporary data suggest a high rate of MGOO (36%) in patients with advanced pancreatic head cancer undergoing FOLFIRINOX treatment. The development of MGOO was associated with longer total hospitalization when compared to patients who never developed MGOO. Our study underscores the significant negative impact of MGOO with further research needed to elucidate better management strategies including better endoscopic or surgical prophylactic measures. Funding Agencies CIHR

Acromioclavicular Ganglion Cyst: A Rare Case Report

Acromioclavicular Ganglion Cyst: A Rare Case Report

Isolated rupture of the lateral collateral ligament of the knee: A case report

Isolated lesions of the lateral collateral ligament (LCL) are rare and occur mainly in cases of concomitant lesions of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL) and multi ligament lesions of the knee. We report the case of a 40-year-old woman who had an accident with direct impact on her knee. Initially, she was treated with a conservative attitude, but due to persistent varus knee pain, an MRI showed a total rupture of the LCL. We decided to treat it surgically with an IT band autograft measuring 16x2 cm. LCL rupture is a very rare event, usually occurring with concomitant injury to the ACL, PCL and other knee ligaments. It is potentially responsible for the painful instability and varus disorder of the knee, which increases compressive forces on the medial knee joint. Early preoperative diagnosis is recommended to prevent these complications. The aim is to present a successful surgical management of LCL rupture.

Combined humerus capitulum and olecranon fractures: Surgical intervention in a saber-related injury

This report outlines the successful surgical management of a 30-year-old taxi driver with concurrent humerus capitulum and olecranon fractures due to a saber assault. The intervention involved decontamination, ulnar nerve exploration, and osteosynthesis, leading to a favorable outcome with restored joint function. This case underscores the significance of timely and comprehensive surgical approaches in complex fractures.

Post-Intubation Tracheoesophageal Fistula: Surgical Management by Complete Cervical Tracheal Transection.

We report successful surgical management of post-intubation tracheoesophageal fistula (TEF) in an adult patient requiring long-term mechanical ventilation. A complete tracheal transection without tracheal resection, via an anterior cervical approach, followed by direct closure of tracheal and esophageal defect, and interposition of muscle flap between the suture lines and tracheal reconstruction was performed. In selected cases, this surgical procedure may be a viable alternative to traditional techniques used to treat post-intubation TEF via the anterior or lateral cervical approach.

Successful Surgical Management of a Perforated Duodenal Ulcer Within an Incarcerated Paraesophageal Hernia

Successful Surgical Management of a Perforated Duodenal Ulcer Within an Incarcerated Paraesophageal Hernia