Abstract Gastrointestinal lipomas are rare benign tumors whose clinical relevance increases when they exceed 4 cm, raising the risk of mechanical obstruction or vascular compromise. Highlighting this atypical presentation is crucial: early recognition enables prompt segmental resection, preventing critical vascular compromise while definitively excluding synchronous malignancy. The report of this case is essential to optimize the approach to atypical presentations and ensure timely surgical treatment. In this study, we present a case of a giant lipoma in the jejunum which caused intussusception and volvulus of the small bowel.
Mediastinal ectopic parathyroid adenomas are an uncommon cause of primary hyperparathyroidism and a frequent source of failed cervical exploration. We report three patients with deeply located mediastinal adenomas treated using minimally invasive thoracoscopic approaches-two robot-assisted (RATS) and one video-assisted (VATS). Preoperative localization was achieved with SPECT/CT and, when required, 18F-fluorocholine PET/CT, enabling accurate identification of lesions in para-aortic and aortopulmonary regions. Complete excision was confirmed in all cases by intraoperative parathyroid hormone monitoring according to the Miami criterion. One patient developed a minor pneumothorax; no major complications occurred. All patients achieved a durable biochemical cure. These cases highlight the role of multimodal imaging and demonstrate that minimally invasive thoracoscopic surgery represents a safe and effective treatment option for complex mediastinal ectopic parathyroid adenomas, with the choice of surgical approach tailored to lesion characteristics and surgical expertise.
Unplanned staged resection for primary intra-axial tumors is rarely described in adults. A 54-year-old man with a left parietal high-grade glioma underwent decompressive craniectomy with attempted cytoreduction; an intraoperative hypertensive crisis triggered refractory venous hemorrhage and progressive cerebral edema, forcing the procedure to stop. He recovered neurologically (GCS 15) and returned 85 days later for a second-stage left parietal lobectomy using neuronavigation and sodium fluorescein-enhanced visualization, gross total resection, no complications. In high-grade glioma, hemodynamic instability need not preclude a complete resection; staging the procedure after physiological recovery appears to be a safe route when the initial operation cannot continue.
Visceral artery pseudoaneurysm is a rare, potentially fatal complication of post-sleeve gastrectomy (LSG) staple-line leak. We report a 36-year-old woman who presented with a proximal staple-line leak, managed with laparoscopic washout and endoscopic stenting. During apparent clinical improvement, she experienced sentinel haemorrhage on postoperative Day 30, initially attributed to stent-related mucosal trauma. Catastrophic haemorrhage ensued 2.5 hours later. Endoscopy revealed a clot-filled stent without a mucosal source; computed tomography angiography (CTA) identified a 20 × 18 × 13 mm splenic artery pseudoaneurysm within the perigastric collection. Proximal coil angioembolization achieved complete exclusion without splenic infarction. The patient made a full recovery and was discharged home on postoperative Day 42. This case illustrates a potentially fatal vascular complication arising during active leak management. A splenic artery pseudoaneurysm must be actively sought in any upper gastrointestinal bleeding during post-LSG leak management, and CTA must exclude a vascular source before attributing bleeding to stent-related mucosal trauma.
Cholecystocutaneous fistula (CCF) is a rare complication of gallbladder disease, in which an epithelialized tract forms between the gallbladder and skin. Its incidence has fallen with modern imaging, antibiotics and early cholecystectomy; an increasingly recognised cause is percutaneous gallbladder drainage. Definitive treatment is cholecystectomy with en bloc tract excision, but management of high-risk patients is poorly defined. We report a CCF arising 8 months after image-guided percutaneous drainage of a pericholecystic abscess in a 91-year-old nursing home resident with multiple comorbidities. Given high operative and anaesthetic risk, the fistula was managed conservatively with a stoma appliance and multidisciplinary support. At 3 months she remained well, with a matured, intermittently draining fistula and spontaneous gallstone extrusion. To our knowledge this is the first iatrogenic CCF reported in a nonagenarian, and the first with serial photographic documentation of its evolution, supporting conservative containment as a safe, patient-centred alternative to surgery.
Calcified chondroid mesenchymal neoplasm (CCMN) is a rare chondroid matrix-producing tumour characterized by distinctive histopathology and recurrent FN1-receptor tyrosine kinase gene fusions. Reported cases have predominantly involved the distal extremities and temporomandibular joint, with no previously reported spinal cases. We present the first reported spinal epidural lesion morphologically consistent with CCMN. A 40-year-old male presented with progressive mid-thoracic back pain after a self-reported febrile illness. Imaging demonstrated a T10-T12 posterior/right calcified epidural lesion causing severe canal stenosis and cord compression. The patient underwent T9-T12 laminectomy and decompression. Intraoperatively, a white, highly adherent epidural mass rather than purulent material was encountered. Histopathology revealed a calcified spindle cell lesion with chondroid differentiation morphologically consistent with CCMN. Follow-up magnetic resonance imaging at 12 months demonstrated no significant residual canal stenosis, and the patient remained asymptomatic at 18-month clinical follow-up. Recognition of CCMN in this location is important when more common spinal pathologies are suspected.
Colonic lipomas are uncommon benign submucosal tumours that are usually asymptomatic, but large lesions may act as a lead point for intussusception. We report a 36-year-old woman admitted with 2 days of epigastric pain and vomiting. Inflammatory markers were mildly raised and contrast-enhanced computed tomography showed a colo-colic intussusception of the transverse colon with an endoluminal fat-density mass as the lead point, without proximal distension. Because of the risk of bowel ischaemia she underwent urgent laparotomy; the intussusception reduced spontaneously and a right hemicolectomy with ileocolic anastomosis was performed. Recovery was uneventful and she was discharged on the fourth postoperative day. Histopathology confirmed a benign pedunculated lipoma (5.5 cm) with surface ulceration and no malignancy. Set against the published literature, this case shows that colonic lipoma should be considered in adult intussusception and that resection is both diagnostic and curative.
Hidradenoma papilliferum (HAP) is a rare benign adnexal tumor of apocrine differentiation, typically occurring in the vulvar or perianal region of women. We report an exceptionally rare case of HAP arising from the lacrimal caruncle, with only one similar case previously documented in the ophthalmic literature. A 61-year-old woman presented with a 3-month history of a painless, vascularized reddish mass over the right caruncle. Complete surgical excision was performed without complications. Histopathological examination revealed a well-circumscribed lesion with papillary and glandular architecture, fibrovascular cores, and a characteristic bilayered epithelium with apocrine features, consistent with HAP and without evidence of malignancy. This case highlights the importance of considering HAP in the differential diagnosis of caruncular tumors and confirms surgical excision as curative.
Virtual surgical planning (VSP) and patient-specific implants (PSIs) are increasingly used to translate digital orthognathic plans to surgery with greater precision, particularly in surgery-first orthognathic (SFO) protocols where pre-surgical orthodontics no longer absorbs planning error. We report two SFO cases managed at a single centre using VSP, customized cutting guides, and titanium PSIs. Case 1 was a 19-year-old male with maxillary hypoplasia and mandibular hyperplasia treated by Le Fort I osteotomy, vertical ramus osteotomy, and genioplasty. Case 2 was a 30-year-old female with facial asymmetry from unilateral mandibular hyperplasia treated by Le Fort I osteotomy, bilateral sagittal split osteotomy, and mandibular contouring. Both achieved satisfactory functional, occlusal, and aesthetic outcomes at six months without major complications. Maxillary PSI fixation supported predictable plan transfer in both cases, whereas mandibular management still required case-specific strategies. We discuss this pattern in light of current literature.
Gastroduodenal tuberculosis is uncommon, and duodenal perforation is exceptional. A 25-year-old man from rural Tanzania presented with generalized peritonitis after prolonged epigastric symptoms, weight loss, night sweats, and household tuberculosis exposure. Emergency laparotomy showed destructive pyloroduodenal perforation with insufficient viable tissue for local repair; distal gastrectomy and Roux-en-Y gastrojejunostomy were performed. Persistent high-output pancreatic-type drainage and progressive jaundice prompted relaparotomy, which demonstrated pancreaticoduodenal destruction and loss of distal biliary continuity. A tailored salvage pancreaticoduodenectomy was required. Histology showed necrotizing granulomatous duodenitis extending into peripancreatic fat and gallbladder serosa while sparing pancreatic acini and gallbladder mucosa. Antituberculous treatment was started, and the patient was well at 3 months. Pancreaticoduodenectomy is not standard treatment for duodenal tuberculosis but may exceptionally be unavoidable when lesser procedures cannot restore source control and anatomical continuity.
A 76-year-old female with complex cardiovascular history requiring multiple open and transcatheter interventions presented with recurrent ventricular tachycardia (VT) and multiple implantable cardioverter-defibrillator (ICD) shocks. Her VT persisted despite maximal medical therapy. She underwent two left stellate ganglion blocks, which provided temporary VT suppression. She was found to have significant cardiomegaly and a large chronic descending aortic dissection on pre-operative workup, which did not require acute intervention. Given her persistent symptoms, she underwent bilateral robotic sympathectomy. She tolerated the procedure without complication and remained without ICD shocks at her 6-month clinic visit.
Penile strangulation is a time-critical emergency in which delayed intervention risks vascular compromise and tissue injury. Management is heterogenous, varying with device characteristics, duration of incarceration, and severity of effects. We report a man in his seventies with penile strangulation caused by a metallic ring at the distal shaft, immediately proximal to the glans. Bedside removal (lubrication, topical 50% dextrose gel, and standard ring-cutter use) were unsuccessful owing to device rigidity. Given persistent entrapment, urinary difficulty, and evolving ischaemic changes, urgent operative removal was performed under general anaesthesia. Intraoperative findings included marked distal oedema, glans congestion, and early ischaemic changes, with resolution after division and removal. This case highlights the limitations of bedside intervention with rigid devices and the value of timely operative escalation. As a single case, these observations are intended to raise clinical awareness rather than establish generalizable escalation criteria, which would require larger, systematic series.
Single anastomosis sleeve ileal (SASI) bypass is an emerging bariatric procedure; some patients face complications such as severe bile reflux, requiring conversion. In this context, the surgical goal is to substantially reduce exposure of the stomach and gastroesophageal junction to bile acids to prevent early complications. We present a 46-year-old man with class III obesity (body mass index 54.6 kg/m2) who 10 days after an uneventful SASI bypass, developed intense, persistent, refractory reflux. A diagnostic endoscopy revealed an extensive accumulation of biliary reflux in the gastric lumen, prompting reintervention. During anesthetic induction, the patient aspirated bile, causing acute respiratory distress. After intraoperative stabilization, the team proceeded without further incident, converting the single-loop configuration to a Roux-en-Y transit bipartition, resolving gastroesophageal reflux disease (GERD). This case underscores the need to incorporate prevention maneuvers during anesthetic induction in patients with severe GERD to avoid aspiration, and the importance of anticipating high anesthetic risk in these individuals.
We report a case of a naturally-developed reverse shoulder joint following a proximal humeral fracture sustained at the age of 16 years and managed non-operatively. Over time, progressive post-traumatic remodelling resulted in an inversion of the native glenohumeral anatomy, resembling the biomechanical configuration of a reverse shoulder arthroplasty as originally described by Grammont. The humeral head remodelled into a concave socket-like structure, while the glenoid progressively assumed a convex articulation. At 46 years of follow-up, the patient demonstrated an unusual pattern of glenohumeral osteoarthritis but remained pain-free, with a functional shoulder (Constant score 69). To our knowledge, this is the first reported case of a post-traumatic native reverse shoulder joint resulting from an adolescent proximal humeral fracture with long-term follow-up.
Carbon fiber-reinforced polyetheretherketone (CFR-PEEK) materials are radiolucent and produce fewer metallic artifacts during radiological examinations, making them a subject of growing interest as osteosynthesis materials in the field of orthopedics. However, clinical reports on carbon intramedullary nails are still limited, and there are few reports on postoperative complications. The present case report describes a 55-year-old female patient who sustained an unstable intertrochanteric fracture of the left femur and underwent open reduction and internal fixation using a CFR-PEEK intramedullary nail. Ultimately, within just 6 months after the initial surgery, varus deformity developed at the fracture site, resulting in failure of the junction between the intramedullary nail and the lag screw, and necessitating revision surgery involving total hip arthroplasty.
Ileosigmoid knotting is one of the rarest emergencies, occurring when the sigmoid colon or ileum wraps around the base of the other, obstructing the flow. It is considered a rare cause of intestinal obstruction. Clinical signs and symptoms are nonspecific, making preoperative diagnosis challenging. Delays in diagnosis and management may lead to bowel necrosis or peritonitis. Here, we present the case of a 37-year-old male who presented with severe abdominal pain, initially misdiagnosed as adhesive bowel obstruction. ISK was diagnosed intra-operatively.
Meconium periorchitis is an uncommon but well-documented phenomenon by which intra-abdominal meconium reaches the scrotum via a patent processus vaginalis. This classically presents in a child first as a soft hydrocele, and later as a firm scrotal mass once calcification of the meconium occurs. We report a case of a 6-month-old boy with exam findings suspicious for perinatal testicular torsion who was taken for surgical exploration and found to have a meconium fecalith located inferior to the testicle and outside of the tunica vaginalis within the gubernaculum. The fecalith was excised and orchidopexy was performed. Meconium periorchitis needs to be considered in the differential diagnosis of pediatric scrotal masses. Overlooking this often-benign condition may lead to unnecessary surgery, potentially resulting in compromise of the testicle due to deliberate removal or unintended iatrogenic injury.
An 89-year-old woman who had previously undergone cementless hemiarthroplasty for a left femoral neck fracture sustained a Vancouver type C periprosthetic femoral fracture with radiographic features suggestive of an atypical femoral fracture. Both attempts at internal fixation resulted in nonunion accompanied by plate failure. Given the well-fixed stem and the anticipated difficulty of stem extraction owing to severe proximal femoral cortical thinning, we elected to perform megaprosthetic reconstruction. Immediate full weight-bearing was permitted postoperatively, and the patient was discharged home seven weeks after surgery. In elderly patients in whom osseous union is improbable and preservation of functional independence through early weight-bearing is paramount, megaprosthetic reconstruction represents a viable salvage option.
Early-onset colorectal cancer (EOCRC) is increasingly recognized, particularly in low- and middle-income countries where patients often present with advanced disease. We describe a case series of three patients under 30 years managed at a tertiary referral centre in northern Tanzania. All presented after prolonged symptoms, including rectal bleeding, altered bowel habits, abdominal pain, and weight loss. Two patients had rectosigmoid tumors, while one had a right-sided lesion. Histopathology demonstrated mucinous adenocarcinoma in two cases and adenocarcinoma not otherwise specified in one case. One patient had a family history suggestive of hereditary predisposition. Management included surgical intervention, frequently with stoma formation, and chemotherapy where feasible. Outcomes were poor, including one postoperative mortality and one case requiring palliative chemotherapy. Delayed presentation, limited diagnostic resources, and restricted oncology services significantly impacted care. EOCRC in this setting demonstrates aggressive disease and poor prognosis, highlighting the need for early diagnosis and improved cancer care infrastructure.
Desmoplastic melanoma (DM) is a rare variant of malignant melanoma characterized by spindle cell proliferation within dense collagenous stroma and atypical immunohistochemical profile. Intraoral involvement is exceedingly uncommon and poses diagnostic and therapeutic challenges. We report the case of a male patient in his fourth decade presenting with enlarging right orofacial mass associated with extensive soft tissue and osseous infiltration. Histopathological evaluation revealed infiltrative spindle cell neoplasm with focal melanin pigment and limited expression of conventional melanocytic markers, requiring integrated diagnostic approach. The patient underwent radical en bloc resection followed by immediate reconstruction using anterolateral thigh free flap. Adjuvant systemic therapy was not administered; however, it was evaluated within multidisciplinary tumor board. At 12-month follow-up, no locoregional recurrence was observed. This case underscores diagnostic complexity of intraoral DM and highlights importance of multidisciplinary oncologic approach in optimizing management outcome.
