Open Access Case Report

A Rare Case Report of a Young Adult Male Patient Presenting with Angiosarcoma of the Mucogingival Mandible

Septiani Rizka Vinkan, Soewoto Widyanti

Asian Journal of Case Reports in Surgery, Page 5-9

Aims: To report a rare case of angiosarcoma in young adult patient, the flow of diagnosis, and management of the case.

Case Description: We reported a 36-year-old male came to the Surgical Oncology Division, Department of Surgery, Dr. Moewardi Hospital Surakarta with a lump in the molar region of his right mandible. Intraoral examination revealed a reddish soft humped oval mass with a necrotic portion. Wide excision was performed with histopathological results indicating angiosarcoma and chemoradiotherapy was planned. The patient did not check up because of the Covid-19 pandemic until one month later as the mass grew back quickly and bled easily. The second-wide excision was performed, and the histopathological results of necrotic tissue fragments and extensive bleeding were obtained; pleomorphic spindle cells, low cytoplasm, crude chromatin, and mitotic nuclei tended to be an angiosarcoma confirmed by positive CD31 immunohistochemical result. One week after the second excision, the mass was found to regrow, and the patient had metastases to the lung and liver. The patient died within 3 months of the diagnosis.

Discussion: Intraoral angiosarcoma is extremely rare. Angiosarcoma is aggressive with frequent local recurrence and distant metastases. Its progression is influenced by several factors, including age.

Conclusion: Angiosarcoma is a rare tumor and has a high rate of progression at a young age. Angiosarcoma of the oral soft tissue is very rare. Early diagnosis and prompt and precise treatment are fundamental to increasing survival rates.

Open Access Case Report

Anterior Abdominal Vulnus Sclopetarium (Gunshot Wound) with Incidental Intra Luminal Bullet: A Case Report

Hidayanto Taufik, Budhi Ida Bagus

Asian Journal of Case Reports in Surgery, Page 13-18

Introduction: Gastric perforation is one of the most common abdominal emergencies. That perforation can be caused by penetrating or blunt trauma. Injuries to the stomach are associated with the highest mortality of all hollow viscus injuries. Penetrating trauma leading to gastric perforation is more common than blunt trauma. In gastric perforation, gastric juice flows out to the abdominal cavity causing peritonitis which can develop into sepsis if remains untreated.

Case Presentation: A patient presented with abdominal pain in almost all regions of the abdomen. A 0.4-cm gunshot wound was found on the right side of the abdomen, with decreased bowel sound, pressure pain in all abdominal regions, and positive muscular defense. On abdominal x-ray imaging, the bullet was located in the abdominal cavity. On the anteroposterior view, it was projected on the right side of L2-3 vertebrae, 15.3 cm from the marker, and in the lateral view, the bullet was projected on L4-5 vertebrae, 16.8 cm from the marker. The bullet penetrates the stomach and caused an entry wound but no exit wound was found while the bullet found in the intestine. Operation findings a 0.4-cm air rifle bullet in ascending colon.

Management and Outcome: Exploratory laparotomy with primary suture of gastric perforation, bullet extraction from ascending colon, and primary repair of ascending colon were performed.

Discussion: Exploratory laparotomy is still the main surgical procedure of choice for patients with gastric perforation. Exploration is carried out with full visualization of the anterior surface of the pylorus to the esophago-gastric junction. The posterior surface of the stomach is freed from the gastro-colic ligament allowing exploration of the minor sac.

Open Access Case Report

Small Bowel Intussusception after Feeding Jejunostomy: A Rare Complication of a Common Procedure

Shahbaz H. Faridi, Noha Rehman, Yugant Gupta, Sarthak S. Chaudhary, Bushra Siddiqui

Asian Journal of Case Reports in Surgery, Page 19-23

Feeding jejunostomy is a surgical procedure in which a tube is inserted inside the lumen of the proximal part of jejunum to provide enteral nutrition to the patient. It is associated with few complications; small bowel intussusception is one of its rarest complications reported in the literature. We report a case of a 45 year old male patient who presented to us with complaints of absolute dysphagia due to carcinoma of esophagus for which we performed feeding jejunostomy for palliation. The procedure was uneventful and he was discharged when he tolerated the feed through the jejunostomy tube. 3 days later he developed features of intestinal obstruction and computed tomography of abdomen revealed the diagnosis of jejunojejunal intussusception. Laparotomy was done and the finding of jejunojejunal intussusception was confirmed at the feeding jejunostomy site with feeding tube acting as the lead point. Surgical reduction of intussusception was done and feeding jejunostomy was revised. Owing to the rare complication of intussusception in a commonly done surgical procedure this case is being reported here.

Open Access Case Study

Orbital Subperiosteal Abscess in Paediatric a Case Report

M. S. Syauqi, I. P. Tang

Asian Journal of Case Reports in Surgery, Page 1-4

Orbital infections and their complications are mainly managed by ophthalmologists. Nevertheless, there are few cases which are better co-managed with otorhinolaryngologist (ORL) counterparts. Such example included the orbital subperiosteal abscess in which certain area of the orbit can be drained by a trained ORL surgeon. Infections in paediatric require prompt diagnosis and aggressive treatment to avoid complications. We reported a case of a rapidly progress right orbital cellulitis complicated with subperiosteal abscess involving a 5years old boy in a tertiary medical centre.

Open Access Case Study

Loosen Zipfix: A Case Report

B. Anand Kumar, I. M. Ishamuddin, H. Hairulfaizi, A. R. M. Ramzisham

Asian Journal of Case Reports in Surgery, Page 10-12

Traditional primary sternal closure after cardiac surgery by steel wire cerclage is the standard technique for most centers worldwide. There is an increase usage of other methods, namely the zipfix (DePuy Synthes CMF, West Chester, Pa), as an alternative to standard wire cerclage, which claimed to be of superior functionality and outcome. We share our experience in using zipfix in one of our patients post Coronary Artery Bypass Grafting (CABG) Surgery, in which the latch within locking mechanism became loose nine months after surgery. The aim of this case report is to shed light on the usage of zipfix. We believe that the incidence of tear and wear of mechanical device, zipfix is under reported.