Open Access Case Series

Morphology of Cardiac Myxoma: A Case Series with Review of Literature

Anand Deodhar, Dinesh Kulkarni

Asian Journal of Case Reports in Surgery, Page 79-84

Although rare, atrial myxomas constitute the most common benign cardiac tumors. Atrial myxoma presents a fascinating problem because of its rarity, manifestations and curability. Symptoms may be related to the hemodynamic effects of obstruction, to embolic phenomena or to systemic manifestations which may mimic collagen disease. Echocardiography is currently the most important noninvasive diagnostic modality available for imaging cardiac tumors. They have an excellent prognosis following surgical excision with occasional recurrence. We report eleven cases of atrial myxoma in seven females and four males of 14 - 66 year age group, with nine in left atrium and two in right atrium. Two-dimensional Color Doppler Echocardiography revealed pedunculated masses protruding into atrial chambers. All patients underwent successful surgical excision of the tumor and are asymptomatic since then. None of the patients had recurrence.

Open Access Case Report

Taenia Saginata: The Solitary Enemy

Amine Bachar, Taoufik Elabbassi, Harouna Bonkoukou Abdoulaye, Mohamed Rachid Lefriyekh

Asian Journal of Case Reports in Surgery, Page 1-3

We report the case of a 62-year-old female patient with no medical or surgical history, admitted for gastric adenocarcinoma. Its extension assessment was negative. She received 3 pre-operative chemotherapy courses and sent for total gastrectomy. Surgical exploration revealed a resectable gastric tumor without hepatic metastasis or peritoneal carcinosis. The enterotomy for restore continuity objectified the fortuitous discovery of a parasite type tænia saginata in the small bowel (Fig. 1). The patient was applied on praziquantel at a dose of 10 mg/kg.

Tapeworms are flatworms that can live as parasites in the human gastrointestinal tract. Taenia saginata are the intestinal solitary tapeworms for which humans are the only definitive hosts. She is found in many areas worldwide, but is most common in areas where consumption of undercooked beef is high.  Most people colonized with adult T. saginata are asymptomatic; those with symptoms complain of mild abdominal discomfort, loss of appetite, or change in stool pat-tern. Occasionally segments can enter the appendix, common bile duct, or pancreatic duct and cause obstruction. The length of adult worm is usually 5 m; however, it may reach up to 25 m.

Taenia infection usually is diagnosed by identifying eggs or proglottids in the stool and cellophane- tape swab to detect eggs as early as about three months after infection. Eosinophilia and elevation of serum IgE may be present. Serological tests are not routinely performed. PCR based methods, providing definite diagnosis and species discrimination. The most complications of taeniasis are including abdominal pain, obstruction, inflammation, and perforation of small bowel, appendix, and colon. The treatment is medical by antiparasitic (or dewormers) praziquantel type.

Open Access Case Report

Isolated Complete Cervical Tracheal Transection in Penetrating Neck Injury: A Unique Case

Misauq Mazcuri, Usama T. Ahmad, Pratikshya Thapaliya, Ambreen Abid, Nazish Sikander, Tanveer Ahmad

Asian Journal of Case Reports in Surgery, Page 4-9

Isolated penetrating neck injuries involving cervical trachea are rare. Cervical tracheal transection is life-threatening and may result in immediate death due to asphyxiation. Early recognition and maintenance of the airway followed by definitive repair are essential for survival. We report a 28-year-old male who presented to the emergency department with a penetrating neck injury. He was dyspneic and cyanosed with neck swelling. Air was gushing from the wound. He was immediately shifted to the operating room. Neck wound exploration revealed complete tracheal transection. The distal trachea was identified and controlled with stay sutures. The endotracheal tube was advanced into the distal trachea through an oral route across the 3 cm gap at the level of the suprasternal notch. Crossfield ventilation was achieved to first repair the posterior layer and then the anterior layer after establishing the airway through the oral cavity. End to end anastomosis was achieved with interrupted 3/0 vicryl. The postoperative course was uneventful and the patient was discharged on the 10th day after bronchoscopy.

Open Access Case Report

A Strangulated Right Inguinal Hernia Containing the Transverse Colon: An Unusual Case Report

Abdulaziz Aldhafar, Adel Mohammed, Mufeed Alwabari, Raghad Aldhafar

Asian Journal of Case Reports in Surgery, Page 10-13

A strangulated inguinal hernia is a common diagnosis in patients presenting with a painful groin mass. The sac of inguinal hernia mostly contains omentum or the small bowel. However, It may sometime contain an unusual content that affects surgical management. This is a rare case of strangulated right inguinal hernia containing the transverse colon and its surgical management.

Open Access Case Report

Rare Case of Accidental Ingestion of Tooth Brush: Endoscopic Retrieval

Basvaraj Teli, Jyoti Taneja

Asian Journal of Case Reports in Surgery, Page 36-39

Foreign body accidental ingestion of size 20 cm in length in a sane person is a rare phenomenon. We are here presenting a case of 50 year old male patient with accidental ingestion of toothbrush and its endoscopic retrieval with the help of polypectomy snare.

Open Access Case Report

Pancreatitis Secondary to Primary Hyperparathyroidism Complicating Pregnancy

Jithin Jagan Sebastian, Alfie J. Kavalakat, Sunil K. Menon, M. V. Suresh, M. K. Aneesh

Asian Journal of Case Reports in Surgery, Page 46-51

Aim: To highlight the need for definitive surgical management of a parathyroid adenoma when associated with pancreatitis during pregnancy.

Case Description: 24 year old primi at 28 weeks gestation presented with acute severe pancreatitis which was diagnosed to be secondary to primary hyperparathyroidism. She was first managed medically with calcitonin and then followed by parathyroidectomy during her 31st week. She developed pre-eclampsia in spite of parathyroidectomy. The mother and neonate did not suffer any significant morbidity.

Discussion: There is a dearth of information in treating complicated hyperparathyroidism in pregnancy owing to the rarity of such a presentation. There needs to be a consensus regarding its management as most cases reported have significant morbidity and mortality. Medical treatment does not seem to improve this significantly. Advances in surgical methods and the safety of anaesthesia have made surgical management more effective in these antenatal cases.

Conclusion: Pancreatitis secondary to hyperparathyroidism during pregnancy should be treated with surgery and medical management restricted to tide over the acute phase of the disease process.

Open Access Case Report

Therapeutic Aspect of Foramen Magnum Meningioma an Experience of Sub-Saharan Africa, about One Case and Review of the Literature

A. Diop, M. Malangu, I. Tine, S. Diouf, B. Lounceny Fatoumata, C. Mualaba

Asian Journal of Case Reports in Surgery, Page 52-56

Meningiomas of the foramen magnum (MFM) are a neurosurgical challenge due to their central and deep location and also their close relationship with the vital vasculonerveous structures that pass through the occipital hole. We report a case of a 62 year old patient complaining about spastic hemiparesis, in whom the clinical exam and Magnetic Resonance Imaging concluded with foramen magnum’s meningioma which presented a therapeutic challenge for us.

Open Access Case Report

Scrotal but Not Testicular Tumour, a Surgical Surprise- Angiomyofibroblastoma- A Case Report

C. H. Tejeswi Das, Ashish Sharma

Asian Journal of Case Reports in Surgery, Page 67-73

Introduction: Angiomyofibroblastoma is a rare condition that presents as a painless slowly progressing scrotal mass, and it can be misdiagnosed as a testicular tumor. Among para-testicular tumors, the most common benign tumors are lipomas, adenomatoid tumors and leiomyomas. The rarest benign tumor presented in this region is angiomyofibroblastoma. Among the para-testicular tumours, the angiomyofibroblastoma is rarer and in male individuals it is still rare.

Presentation: Presenting concern was a 40-year gentleman presenting with painless scrotal mass for 1½ year with normal tumor markers. Ultrasonography, a large intrascrotal cavity mass was revealed. Exploration of the scrotum and high inguinal orchidectomy was done after proper consent. Histopathology and immuno-histo-chemistry of this extratesticular mass revealed angiomyofibroblastoma with CD 34+ DESMIN++++ ER++ S 100--

Discussion: Only less than 25 such cases have been reported earlier all over the world. Among the tumors occurring in the scrotum, angiomyofibroblastoma-like tumors are benign mesenchymal formations. Genital AMFB’s (Angiomyofibroblastoma) has partially myxoid proliferation that demonstrated considerable variation in cellular density, but it also possesses two integral components: blood vessels and stromal cells. All AMFB’s (Angiomyofibroblastoma) showed immunoreactivity for vimentin, desmin, actin and estrogen receptor protein.

Conclusion: The purpose of the current study is to be increased the knowledge regarding a very rare paratesticular tumor, angiomyofibroblastoma, keeping it as a differential diagnosis for scrotal tumors. The detailed study of this rare benign tumour helps to add to the previous such case reports and helps in making of specific management protocols so as the treatment of such tumours will become easier to the future cases.

Open Access Case Report

Difficult Surgical Aspect of a Compressive Hemangioma of the Cavernous Sinus in a Neurosurgical Setting in Senegal: About a Case and Review of the Literature

A. B. Thiam, F. Athoumane, M. Malangu, C. Mualaba, M. Faye, M. C. Ba, S. B. Badiane

Asian Journal of Case Reports in Surgery, Page 74-78

Cavernous sinuses Hemangiomas (CSH) are rare benign extra-axial tumours, mainly affecting middle-aged women. Symptoms vary, but are usually due to a mass effect and include headaches, changes in vision and paralysis of the cranial nerves [1]. They account for 13% of all intracranial cavernous Hemangiomas, 3% of all benign tumours in the Cavernous sinus zone, 2% of all tumours in the cavernous sinus zone and 0.4% to 2% of intracranial vascular malformations. The occurrence of hemangioma within the cavernous sinus is rare. They do not cross the dural limits of the corpus cavernosum and can reach large sizes without symptoms. In the published literature, several short series describe the management of HSC, but despite advances in surgical techniques, they continue to pose a formidable challenge to surgical management, primarily because of the critical neurovascular environment. Current therapeutic modalities include microsurgical resection, fractional radiotherapy and stereotactic radiosurgery; total resection is curable but can be at the cost of intraoperative bleeding and new cranial nerve deficits [2,3]. Here we describe the clinical presentation, imaging results and difficult surgical management of a patient with cavernous sinusHemangioma enveloping the cavernous segment of the carotid artery, which made surgical resection difficult.

Open Access Case Report

Bile Culture Results of Benign Biliary Obstruction: No Evidence of Infection and Prolonged Antibiotic Use

Saadhi Ikhdin, Putra David Perdana

Asian Journal of Case Reports in Surgery, Page 85-89

Aims: To identify the presence of organism growth in bile culture to determine the need forprolonged antibiotic use.

Case Description: We reported five cases of benign biliary obstruction due to common bile duct stone. All patients presented with abdominal pain in the right upper quadrant for months. On physical examination, tenderness in the right upper quadrant of the abdomen and positive murphy sign were found. The ultrasound examination showed the presence of bile stones in all patients and multiple bile stones in two patients. Cholecystectomy, either laparotomy or laparoscopy, was performed on all patients, and the bile was aspirated for culture examination. The culture examination results of all patients showed that there was no growth of organisms. All patients were not administered post-operative antibiotic therapy, and there were no surgical site infections and post-operative morbidity reported.

Discussion: There was no growth of organisms in the bile; therefore, antibiotics were not administered to all patients. The absence of postoperative antibiotics did not lead to an increase in postoperative infections. Avoiding unnecessary use of antibiotics will reduce the side effects of antibiotics.

Conclusion: In our clinical practices, we found no evidence of bacterial colonization in this benign biliary obstruction case. Bile culture can be performed to determine antibiotic use, thereby avoiding unnecessary use of antibiotics.

Open Access Case Report

Unexpected Site of Hydatid Cyst, in Thigh- A Case Report

Ch. Tejeswi Das, Siddharth Tamaskar, Ch. Suneetha, M. Manisha

Asian Journal of Case Reports in Surgery, Page 101-106

Introduction: Hydatid cyst is a parasitic disease common in India. Usual locations of the cyst are the lungs and liver. The occurrence of the hydatid cyst in other locations is rare.

Presentation: The presenting concern is a 10-year-old girl with a painless swelling in lower 1/3rd of the right thigh on the posterior side. Clinical examination is suggestive of a palpable cystic swelling which is involving the muscle underlying it. USG and CT of thigh revealed a cystic swelling in the Biceps femoris muscle with high suspicion of hydatid cyst. Pre-operative albendazole was used followed by complete removal of the cyst and the use of albendazole postoperatively.

Discussion: Hydatid cyst most commonly utilizes oxygen for growth, but skeletal muscle contains Lactic acid. Hence occurrence of cyst in skeletal muscle is rare. Ultrasound has a sensitivity of 100% in typical cases and is diagnostic. Computed tomography provides better information about cyst. Though chemotherapy is controversial, Preoperative and postoperative chemotherapy shown to decrease the incidence of recurrent disease. Excision in one piece with total cystectomy is the ideal process. Early treatment is mandatory to avoid local and general complications that are directly related to duration of cyst.

Conclusion: This case report helps us to keep hydatid cyst a differential diagnosis of intramuscular cystic swelling and treat accordingly. The presence of this cyst in unusual locations makes diagnosis and treatment challenging and more interesting. Timely diagnosis, timely intervention and chemotherapy is required to prevent intra operative complications and recurrence. This case study helps in making a specific management protocol and adds up to the previous case reports.

Open Access Case Study

Retained Rectal Foreign Body: A Case Report

Viraj Panda, Faiz Manzar Ansari

Asian Journal of Case Reports in Surgery, Page 14-21

Background: Rectal foreign body is not an uncommon presentation in the surgical emergency. Its incidence is increasing especially in the Asian urban population. Patients are embarrassed and reluctant to seek medical care thereby delaying management. They have a varied presentation and depending on the size, position of the foreign object and whether there is rectal perforation or not, different approaches may be chosen to remove it.

Case Presentation: Here, we present a young Indian urban male who came to the emergency with complaints of inability to remove a foreign body that he inserted per rectally. Abdominal x-ray did not reveal a foreign body. Non-Contrast Enhanced Computed Tomography (NCCT) showed a foreign body in the rectum and sigmoid colon. Manual removal via proctoscopy and sigmoidoscopy failed. The patient underwent laparotomy, colostomy and removal of the foreign body with subsequent primary repair of the colotomy. Patient was symptomatically relieved and followed up with abdominal x-ray which showed no air under diaphragm. Patient was discharged on post-operative day-8  (POD-8).

Conclusion: A careful history and physical examination with a high index suspicion of perforation is necessary. A creative approach to removal and appropriate short term follow-up to detect delayed perforation are important in a case of retained rectal foreign body.

Open Access Case Study

A Congenital Fronto-ethmoidal Encephalocele in a Female: A Case Report

Ouassime Kerdoud, Abd El Hamid Jehri, Faiçal Slimani, Abdessamad Naja

Asian Journal of Case Reports in Surgery, Page 22-27

Encephalocele is defined as the protrusion of cranial contents beyond the normal confines of the skull. They may contain meninges (meningocele), brain tissue, and meninges (meningoence-phalocele), or they may communicate with the ventricles (meningoencephalocystocele). We report the case of 39 years old patient with congenital frontoethmoidal encephalocele. Through trans-facial approach resection of nonfunctional brain tissue was performed then the dural defect was repaired. The nasal deformity was corrected using the cement to provide dorsal nasal support from the nasal bones, the orbit's inner walls, to the lateral nasal cartilage. The absence of recurrence marked the patient's follow-up. This case is presented for its rarity.

Open Access Case Study

Neurofibroma Arising in Ectopic Breast Tissue: A Unique Case Report

Cammarata Roberto, Cammarata Antonio

Asian Journal of Case Reports in Surgery, Page 28-35

Neurofibromas are benign nerve sheath tumours which occur in the dermis or subcutis with a variable distribution on the body surface. Accessory breast tissue results from incomplete involution of the embryologic mammary ridge. We report a case of a 63-year postmenopausal multiparous woman who presented to our department with a lump in the lower left abdominal quadrant near a supernumerary nipple. An abdominal ultrasound confirmed the presence of a 20mm mass and describes it as a hypo-anechoic neoformation below the accessory nipple in the context of likely breast parenchyma. A large local excision of the lesion was therefore planned. A final histologic diagnosis of neurofibroma arising in accessory breast tissue was made. This case report describes for the first time a case of a neurofibroma arising on ectopic breast tissue.

Open Access Case Study

Unilateral Condylar Hyperplasia in a Male: A Case Report

Ouassime Kerdoud, Faiçal Slimani

Asian Journal of Case Reports in Surgery, Page 40-45

Mandibular condylar hyperplasia (MHC) is defined as an overgrowth of the mandibular condyle resulting in facial asymmetry and occlusal alterations. It is manifested by pain and temporomandibular dysfunction. When it remains active, the asymmetry and occlusal alterations remain progressive. The etiology of condylar hyperplasia remains uncertain. Elevated condylectomy, joint disc replacement, and orthognathic surgery are surgical methods used to correct and process condylar hyperplasia. We report the case of a 19-year-old man who complained of pain in the right preauricular region. The pain has lasted for about one year, and there was no history of trauma; A diagnosis of mandibular condylar hyperplasia was conducted and treated by superior condylectomy. This case is presented for its rarity.

Open Access Case Study

Nonobstructing Nonrefluxing Congenital Left Giant Megaureter with Ipsilateral Renal Dysplasia in a 6-year-old Male Child: A Case Report and Literature Review

D. K. Shah, Kamlesh Soni, Krupal M. Patel, Shreyansh Patel, Renish Padshala, Shivani Chaudhary

Asian Journal of Case Reports in Surgery, Page 57-61

Background: A 6-year-old male child was admitted for lower abdominal mass. USG (Abdomen and pelvis), MCUG, CT-IVP, and MR – Urography diagnosed a left sided nonobstructing and non-refluxing, congenital giant megaureter (CGM) with left renal dysplasia. DTPA scan was suggestive of no visually and quantitatively appreciable function seen in left kidney. At surgery, dilated tortuous left megaureter and small left kidney was found. Left nephroureterectomy was done.

Conclusion: CGM is a rare condition. The physical examination and radioimaging are essential for the diagnosis of CGM. The appropriate treatment methods should be based on patient’s specific condition and investigations.

Open Access Case Study

Acute Abdomen: A Rare Presentation of Breast Cancer

A. Anniestan, K. B. Galketiya, A. B. Jayathilake, E. R. I. A. N. D. Ranasinghe, P. B. Hewavithana

Asian Journal of Case Reports in Surgery, Page 62-66

With increased awareness, established screening programs and investigating early of symptoms, breast cancer is often detected at early stages. But some present with local and/or distant metastasis. Few have unusual presentations.

This case history is of a patient with breast cancer who presented with an acute abdomen, a paraneoplastic syndrome.

Open Access Case Study

Paediatric Ectopic Papillary Thyroid Carcinoma: A Unique Case

Shu Lih Lau, Kishanti Balachandran, Sadhana Mahamad

Asian Journal of Case Reports in Surgery, Page 90-95

Cancer arising from ectopic thyroid is extremely rare, with papillary thyroid carcinoma being the most common type. We report a case of 17-year-old girl who presented with right neck swelling with right supraclavicular swelling. Preoperatively, she was diagnosed with benign right multinodular goiter and right supraclavicular ectopic thyroid based on her ultrasound-guided fine-needle aspiration results but postoperatively, her histopathology result showed primary papillary thyroid carcinoma. Most of the paediatric neck swelling may be benign, but possible diagnosis of malignancy should not be left behind.

Open Access Case Study

Functional Wharton’s Duct Remnant Post-Submandibular Gland Resection with Sialadenitis

Najlaa Raihana Juhari, Chong Aun Wee

Asian Journal of Case Reports in Surgery, Page 96-100

Wharton’s duct remnant post-submandibulectomy is generally assumed functionless as the duct was ligated intraoperatively. There are well-documented surgical complications related to submandibular gland excision for non-neoplastic diseases, particularly sialadenitis, mucocele and sialolithiasis formation. However, little is known of the risk factors for developing these complications despite the absence of gland. Herein, we present the case of a 57-year-old woman who presented with a chronic, painless viscous mucopurulent secretion from a ‘left-behind’ patent Wharton’s duct on the left floor of her mouth, one year after excision of the left submandibular gland. Based on the clinical assessment, a diagnosis of sialadenitis of the left Wharton’s duct remnant was made. She was treated successfully with a two-week course of oral antibiotics. A likely mechanism for the disorder and associated risk factors are hereby discussed.

Open Access Case Study

Inaugural Orbital Metastasis of a Mediastinal-Pulmonaryadenocarcinoma

Bajjouk Salma, Bouchaar Mounia, Guerroum Hind, Haddougui Soukaina, Essadki Nabil, Reda Karim, Oubaaz Abdelbarre

Asian Journal of Case Reports in Surgery, Page 107-111

Orbital metastases are a rare disease entity compared to choroidal metastases, and they are only rarely the first of a primary cancer. The primary tumor is often breast cancer, prostate cancer and then lung cancer. Orbital metastases generally induce an isolated exophthalmos, which appears rapidly. Orbito-cerebral MRI is the imaging method of choice for the diagnosis of orbital metastases. But a fine needle biopsy of the orbital mass is the most reliable method to confirm the diagnosis. Unfortunately, the vital prognosis is poor and the treatment will be palliative.

We report the case of a 67-year-old male patient, chronically smoking, who presented with an inaugural orbital metatasis from pulmonary adenocarcinoma. Ocular metastasis was revealed in our patient by exophthalmos associated with reduced visual acuity. Unfortunately, the patient died after a few weeks, testifying to the poor prognosis of these orbital metastases.

Open Access Case Study

Sternalis Muscle- Rare Presentation in Routine Surgical Practice

Theebanraja Ramalingam, Maya Mazuwin Yahya, Siti Rahmah Bt Hashim Isa Merican, Wan Zainira Wan Zain, Zaidi Zakaria

Asian Journal of Case Reports in Surgery, Page 112-116

During routine mastectomy dissection of an anterior chest wall mass, a unilateral appearance of the right sternalis muscle (SM) was observed. It originated from the sternal part of the right sternocleidomastoid muscle (SCM). The right SM muscle fibres travelled down inferior laterally and inserted on the ipsilateral 5th–7th ribs and the aponeurosis of the external oblique muscle. The innervation to the muscle could be traced to the 4th, 5th, and 6th anterior intercostal nerves. Awareness of the location of the sternalis will help medical doctors avoid misdiagnosis during mammography or misjudgement during breast surgery. Because of its superior attachment to the SCM, clinicians need to be aware of such an anomaly.