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Cellular angiofibroma arising from the rectocutaneous fistula in an adult: A case report

World Journal of Clinical Cases 2024年第10期12卷 1778-1784页

作者： Hao-En Chen Yu-Yang Lu Ruei-Yu Su Hong-Hau Wang Chao-Yang Chen Je-Ming Hu Jung-Cheng Kang Kuan-Hsun Lin Ta-Wei Pu Department of surgery Taichung Armed Forces General HospitalTaichung 411Taiwan Department of surgery Tri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Department of Pediatrics Tri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Department of Pathology Tri-Service General HospitalNational Defense Medical CenterTaipei 105Taiwan Department of Pathology and Laboratory Medicine Taoyuan Armed Forces General HospitalTaoyuan 32551Taiwan Department of Radiology Tri-Service General Hospital Songshan BranchNational Defense Medical CenterTaipei 105Taiwan Division of Colon and Rectal surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of Colon and Rectal surgery Department of SurgeryTaiwan Adventist HospitalTaipei 105Taiwan Division of thoracic surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of Colon and Rectal surgery Department of SurgeryTri-Service General Hospital Songshan BranchNational Defense Medical CenterTaipei 105Taiwan

BACKGROUND Rectocutaneous fistulae are common.The infection originates within the anal glands and subsequently extends into adjacent regions,ultimately resulting in fistula development.Cellular angiofibroma(CAF),also known as an angiomy ofibroblastoma-like tumor,is a rare benign soft tissue neoplasm predominantly observed in the scrotum,perineum,and inguinal area in males and in the vulva in females.We describe the first documented case CAF that developed within a rectocutaneous fistula and manifested as a perineal mass.CASE SUMMARY In the outpatient setting,a 52-year-old male patient presented with a 2-year history of a growing perineal mass,accompanied by throbbing pain and minor scrotal abrasion.Physical examination revealed a soft,well-defined,non-tender mass at the left buttock that extended towards the perineum,without a visible opening.The initial assessment identified a soft tissue tumor,and the laboratory data were within normal ranges.Abdominal and pelvic computed tomography(CT)revealed swelling of the abscess cavity that was linked to a rectal cutaneous fistula,with a track-like lesion measuring 6 cm×0.7 cm in the left perineal region and attached to the left rectum.Rectoscope examination found no significant inner orifices.A left medial gluteal incision revealed a thick-walled mass,which was excised along with the extending tract,and curettage was performed.Histopathological examination confirmed CAF diagnosis.The patient achieved total resolution during follow-up assessments and did not require additional hospitalization.CONCLUSION CT imaging supports perineal lesion diagnosis and management.Perineal angiofibromas,even with a cutaneous fistula,can be excised transperineally.

关键词： Angiofibroma Perineal mass Rectocutaneous fistula Anorectal fistula Anal fistula Case report

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Treatment of benign rectal stricture caused by repeated anal insertion by endoscopy and balloon dilation:A case report

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World Journal of Gastrointestinal Endoscopy 2024年第2期16卷 91-97页

作者： Shih-Hung Liu Jung-Cheng Kang Je-Ming Hu Chao-Yang Chen Kuan-Hsun Lin Ta-Wei Pu Department of surgery Tri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of Colon and Rectal surgery Department of SurgeryTaiwan Adventist HospitalTaipei 105Taiwan Division of Colon and Rectal surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of thoracic surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of Colon and Rectal surgery Department of SurgerySongshan BranchTri-Service General HospitalNational Defense Medical CenterTaipei 105Taiwan

BACKGROUND Benign rectal strictures can be categorized as primary(disease-related)and secondary(surgical anastomosis-related).Secondary strictures arise from surgical complications,whereas primary strictures have diverse etiologies,including various inflammatory conditions.Benign strictures are usually managed by surgery and endoscopy.We present an unusual etiology of benign rectal stricture caused by the repeated insertion of foreign objects into the rectum for sexual purposes,resulting in rectal injury and subsequent chronic inflammation.CASE SUMMARY A 53-year-old man presented to the outpatient clinic of the Colorectal surgery Department with symptoms of chronic constipation and bloody stools.The patient previously experienced rectal injury due to foreign object insertion for sexual purposes.Colonoscopy revealed benign circumferential narrowing of the rectum.He underwent treatment by endoscopic argon plasma coagulation and balloon dilation and follow-up as an outpatient for 4 months.A colonoscopy at the end of the follow-up period revealed no evidence of rectal stricture relapse.CONCLUSION A history of rectal injury,followed by chronic inflammation,should be considered in patients with benign rectal strictures.Management with endoscopic argon plasma coagulation and balloon dilation can prevent the need for surgical resection of benign rectal strictures.

关键词： Chronic rectal inflammation Colonoscopy Benign rectal stricture Foreign body insertion Rectal injury Case report

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Formation of a rare curve-shaped thoracolith documented on serial chest computed tomography images:A case report

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World Journal of Clinical Cases 2023年第10期11卷 2329-2335页

作者： Fu-Chieh Hsu Tsai-Wang Huang Ta-Wei Pu Department of surgery Tri-Service General HospitalTaipei 114Taiwan Division of thoracic surgery Department of SurgeryTri-Service General HospitalTaipei 114Taiwan Division of Colon and Rectal surgery Department of SurgeryTri-Service General HospitalTaipei 114Taiwan

BACKGROUND Thoracolithiasis is a rare benign condition that manifests with one or more small nodules in the pleural cavity.In most cases,it is asymptomatic and found incidentally on chest imaging or during thoracic surgery.The thoracolithiasis formation process is rarely documented.Herein,we present a case of a rare,large,curve-shaped thoracolith,the formation of which was documented on serial computed tomography(CT)images.CASE SUMMARY A 46-year-old male patient who denied any prior systemic disease was evaluated due to intermittent right-sided lateral chest pain lasting for a year.Chest radiography and CT revealed a circumscribed calcified nodule measuring 3.5 mm in the right lower lung lobe.Nodule biopsy revealed fungal infection,which was treated with antifungal medication.After 2 years of follow-up,the patient developed intermittent chest discomfort caused by pleural adhesions,and underwent video-assisted thoracic surgery with pneumolysis.Postoperatively,he developed empyema,which fully resolved with antibiotic therapy.Thereafter,he was followed up at the outpatient clinic and underwent chest CT twice per year.Over time,we observed thickening of the right distal pleura near the lower posterior mediastinum,and several sporadic calcified nodules with gradually increasing intensity,which eventually merged into a single calcified curve-shaped thoracolith measuring approximately 9 cm in length during the 5-year follow-up.CONCLUSION This study documented the formation of a rare thoracolith shape observed for the first time.

关键词： Thoracolithiasis Thoracolith Pleural stone Intrathoracic calculus Pleurolith Case report

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Rare solitary splenic metastasis from a thymic carcinoma detected on fluorodeoxyglucose-positron emission tomography:A case report

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World Journal of Clinical Cases 2022年第15期10卷 5072-5076页

作者： Yueh-Hsun Tsai Kuan-Hsun Lin Tsai-Wang Huang Department of surgery Tri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of thoracic surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan

BACKGROUND Thymic carcinoma is a rare,aggressive tumor arising from the thymus.In less than 7%of patients with thymic carcinoma,extrathoracic metastases occur in the extrathoracic lymph nodes,liver,and bone.Isolated splenic metastasis can occur but is very uncommon.To date,only 2 cases of splenic metastases from thymic carcinoma have been reported.CASE SUMMARY A 45-year-old man presented with chronic cough,dyspnea,persistent hoarseness and unintentional weight loss 17 kgs in 6 mo.Neck magnetic resonance imaging revealed a large,lobulated,soft-tissue mass measuring 5.4 cm×6.6 cm×3.8 cm which involved the left superior mediastinum and supraclavicular fossa.Chest computed tomography(CT)revealed a confluent and lobulated soft tissue mass encased the right brachiocephalic artery,right and left carotid arteries,and left subclavian artery in the mediastinum.A fluorodeoxyglucose-positron emission tomography was arranged for malignancy survey.The image revealed intense fluorodeoxyglucose avidity in a soft tissue lobulated mass occupying the superior mediastinum,over the cystic lesion in the spleen and in few enlarged nodules over the left supraclavicular fossa.CT-guided biopsy of the thymic mass and the ultrasound-guided biopsy of the splenic lesion were consistent with a thymic carcinoma with splenic metastasis.The patient was diagnosed of thymic carcinoma,cT2N2M1b,stage IVb.CONCLUSION A fluorodeoxyglucose(FDG)-positron emission tomography(PET)scan can provide a useful diagnostic value in conjunction with pathological result in evaluating tumor staging.Our case emphasizes the utility of FDG-PET for metastasis detection in thymic carcinoma.

关键词： Thymic carcinoma Splenic metastasis Positron emission tomography Extrathoracic metastases Mediastinal tumor Case report

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Thoracoscopy in Cameroon: Indications, Technics and Short Term Results

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Surgical Science 2024年第4期15卷 278-288页

作者： Guy Aristide Bang Richard II Mbele Fabrice Stephane Arroye Betou Arlette Joelle Moukitek Banaken Amos Bella Ela Charles Mve Mvondo Arthur Essomba Department of surgery and Specialities Faculty of Medicine and Biomedical Sciences Yaound&#233 I University Yaound&#233 Cameroon Department of surgery and Specialities Yaound&#233 Teaching Hospital Yaound&#233 Cameroon General surgery service Mvog-Ada District Hospital Yaound&#233 Cameroon Department of Cardiothoracic and Vascular surgery Laquintinie Hospital Douala Cameroon Department of Cardiothoracic and Vascular surgery Yaound&#233 General Hospital Yaound&#233 Cameroon Cardiac Center Shisong St. Elizabeth Catholic General Hospital Shisong Kumbo Cameroon

Introduction: Thoracoscopy is a video-assisted surgical approach that mirrors the techniques used in thoracotomy. Our aim is to map the current state of thoracoscopy practice in Cameroon’s hospitals. Methods: This was a descriptive study that collected both retrospective and prospective data over 57 months across four hospitals in Cameroon. It included 13 patients and focused on variables such as socio-demographic factors, clinical profiles, surgical procedures, and postoperative follow-up. Results: Thirteen patients, predominantly male (84.6%, n = 11), with a mean age of 37.5 ± 16 years, were enrolled. Alcohol use (61.5%) and smoking (38.5%) were the most common past histories. The major complaints were dyspnea (84.6%) and chest pain (58.3%). The primary surgical procedure was clot-free thoracoscopy in 30.8% of cases, mainly for persistent hemothorax (41.8%). Most surgeries were elective (76.9%) and performed under general anesthesia with selective intubation (61.5%). The most common approach was single-port thoracoscopy (U-VATS) (76.9%), with no reported difficulties;however, one intraoperative incident occurred and was successfully treated. Drainage was performed systematically in all patients, and one case required conversion to open surgery. Postoperative complications were minor (Clavien-Dindo grade I) and mainly consisted of pain, with a mortality rate of 15.4%. No significant association was found between risk factors and the occurrence of complications or postoperative mortality. Conclusion: Thoracoscopy, a novel approach in our context, primarily focuses on minor thoracic surgeries.

关键词： Thoracoscopy Single-Port Hemothorax Cameroon

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Relationship between intralobar pulmonary sequestration and type A aortic dissection:A case report

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World Journal of Clinical Cases 2023年第15期11卷 3658-3663页

作者： Yi-Jie Wang Ying-Yi Chen Gang-Hua Lin Department of surgery Tri Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of thoracic surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of General surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan

BACKGROUND Pulmonary sequestrations often lead to serious complications such as infections,tuberculosis,fatal hemoptysis,cardiovascular problems,and even malignant degeneration,but it is rarely documented with medium and large vessel vasculitis,which is likely to result in acute aortic syndromes.CASE SUMMARY A 44-year-old man with a history of acute Stanford type A aortic dissection status post-reconstructive surgery five years ago.The contrast-enhanced computed tomography of the chest at that time had also revealed an intralobar pulmonary sequestration in the left lower lung region,and the angiography also presented perivascular changes with mild mural thickening and wall enhancement,which indicated mild vasculitis.The intralobar pulmonary sequestration in the left lower lung region was long-term unprocessed,which was probably associated with his intermittent chest tightness since no specific medical findings were detected but only positive sputum culture with mycobacterium avium-intracellular complex and Aspergillus.We performed uniportal video-assisted thoracoscopic surgery with wedge resection of the left lower lung.Hypervascularity over the parietal pleura,engorgement of the bronchus due to a moderate amount of mucus,and firm adhesion of the lesion to the thoracic aorta were histopathologically noticed.CONCLUSION We hypothesized that a long-term pulmonary sequestration-related bacterial or fungal infection can result in focal infectious aortitis gradually,which may threateningly aggravate the formation of aortic dissection.

关键词： Intralobar pulmonary sequestration Acute aortic dissection Medium and large vessel vasculitis Infection Case report

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Malignant pleural mesothelioma mimics thoracic empyema: A case report

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World Journal of Clinical Cases 2023年第35期11卷 8372-8378页

作者： Ya-Hsin Yao Yen-Shou Kuo Department of General Medicine Tri-Service General HospitalNational Defense Medical CenterTaipei 114202Taiwan Division of thoracic surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114202Taiwan

BACKGROUND thoracic empyema and malignant pleural mesothelioma(MPM)are distinct medical conditions with similar symptoms,including cough,chest pain,and breathing difficulty.We present a rare MPM case mimicking thoracic empyema.Physicians must consider MPM risks for patients exposed to building material who exhibit lobulated pleural effusions,indicating thoracic empyema.CASE SUMMARY A 68-year-old retired male construction worker suffered from shortness of breath and chest tightness over 10 d,particularly during physical activity.A poor appetite and 4 kg weight loss over the past 3 wk were also reported.Chest images and laboratory data concluded a tentative impression of empyema thoracis(right).Video-assisted thoracic surgery with decortication and delobulation(right)was conducted.The pathological report yielded an MPM diagnosis.Refractory pleural bilateral effusions and respiratory failure developed postoperatively,and the patient died three weeks after the operation.CONCLUSION thoracic empyema and MPM are distinct medical conditions that can present similar symptoms,and video-assisted thoracic surgery facilitates an accurate diagnosis.Empyema-mimicking presentations and postoperative refractory pleural effusion may indicate a poor MPM outcome.

关键词： thoracic empyema Malignant pleural mesothelioma Video-assisted thoracic surgery Case report

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Benefits of laparoscopy-assisted ileostomy in colorectal cancer patients with bowel obstruction

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世界临床病例杂志 2023年第24期11卷 5660-5665页

作者： Yi-Jie Wang Kuan-Hsun Lin Jung-Cheng Kang Je-Ming Hu Chao-Yang Chen Ta-Wei Pu Department of surgery Tri Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of thoracic surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of Colon and Rectal surgery Department of SurgeryTaiwan Adventist HospitalTaipei 105Taiwan Division of Colon and Rectal surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of Colon and Rectal surgery Department of SurgerySongshan branchTri-Service General HospitalNational Defense Medical CenterTaipei 105Taiwan

BACKGROUND Ileostomies are commonly performed after colon and rectal surgeries.Laparoscopy-assisted ileostomy with adhesion lysis may have potential benefits over conventional open surgery.AIM To compare the outcomes of laparoscopy-assisted and conventional ileostomies.METHODS Data from 48 consecutive patients who underwent ileostomy at our institution between May 2021 and May 2022 were retrospectively analyzed.The groups comprised 26 and 22 patients who underwent laparoscopic ileostomy(laparoscopic group)and conventional ileostomy(conventional group),respectively,performed by a single surgeon.Patient demographics,operative characteristics,postoperative outcomes,and 30-d morbidities and mortality rates were analyzed.RESULTS The two groups had comparable mean ages,sex distributions,American Society of Anesthesiologists scores,and body mass indices.However,the laparoscopic group showed similar operative time,better visualization for adhesion lysis,and lower visual analog scale scores than the conventional group.CONCLUSION Laparoscopy-assisted ileostomy is a safe and efficient method that produces lower visual analog scale scores,better intraoperative visualization for effective adhesion lysis,and similar operative time compared with conventional ileostomy.

关键词： Laparoscopy Ileostomy Colorectal cancer Bowel obstruction Tissue adhesion Retrospective study

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Rib Osteosynthesis for Sub-Acute Management of a Flail Chest in a Tertiary Centre in a Low-Middle Income Country of Sub-Saharan Africa: Case Report at Douala Laquintinie Hospital

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Open Journal of thoracic surgery 2024年第1期14卷 1-16页

作者： Fabrice Stéphane Arroye Betou Nyankoue Mebouinz Ferdinand Guy Aristide Bang Kobe Folkabo Zephany Banga Nkomo Douglas Moussa Seck Diop Abdoul Lahad Mbeng Marcella Derboise Christelle Biyouma Noel Essomba Souleyman Diatta Handy Eone Daniel Arthur Essomba Hassan Ndiaye Maurice Aurelien Sosso Department of surgery and Specialties Faculty of Medicine and Biomedical Sciences (FMBS) University of Yaoundé (UYI) Yaoundé Cameroon Department of surgery and Affiliated Disciplines Douala Laquintinie Hospital Douala Cameroon Department of surgery and Specialties Yaoundé General Hospital Yaoundé Cameroon Department of surgery and Specialties Faculty of Medicine and Pharmaceutical Sciences (FMPS) University of Dschang Dschang Cameroon service de Chirurgie Thoracique et Cardiovasculaire Centre Hospitalier Universitaire de Fann Faculté de Médecine de Pharmacie et d’Odontologie Université de Cheikh Anta Diop Dakar Sénégal UFR des Sciences de la Santé Ziguinchor Sénégal

Background: Costal fracture surgical is still a debate, therefore we shall select between early and delay surgical management. Case Report: We are reporting two cases of post road traffic clash delay ribs fractures osteosynthesis involving a 63-year-old man with multistage fractures on the left and pulmonary pinning of one of the costal arches, complicated by a homolateral haemothorax and a 41-year-old man with a bilateral flail chest. Conclusion: The simple postoperative course and the immediate postoperative improvement in the patient’s clinical respiratory condition enabled us to discuss the time frame for management, in this case the indication for early or later surgery.

关键词： Flail Chest Fixation Plate Rib Fracture Osteosynthesis

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Is anoplasty superior to scar revision surgery for posthemorrhoidectomy anal stenosis?Six years of experience

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World Journal of Clinical Cases 2022年第22期10卷 7698-7707页

作者： Yu-Tse Weng Kuan-Jung Chu Kuan-Hsun Lin Chun-Kai Chang Jung-Cheng Kang Chao-Yang Chen Je-Ming Hu Ta-Wei Pu Division of Plastic and Reconstructive surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan National Defense Medical Center Taipei 114Taiwan Division of thoracic surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of Plastic and Reconstructive surgery Department of SurgeryZuoying BranchKaohsiung Armed Forces General HospitalKaohsiung 813Taiwan Division of Colon and Rectal surgery Department of SurgeryTaiwan Adventist HospitalTaipei 105Taiwan Division of Colon and Rectal surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of Colon and Rectal surgery Department of SurgerySongshan branchTri-Service General HospitalNational Defense Medical CenterTaipei 105Taiwan

BACKGROUND Anal stenosis is a rare but frustrating condition that usually occurs as a complication of hemorrhoidectomy.The severity of anal stenosis can be classified into three categories:mild,moderate,and severe.There are two main surgical treatments for this condition:scar revision surgery and anoplasty;however,no studies have compared these two approaches,and it remains unclear which is preferrable for stenoses of different severities.AIM To compare the outcomes of scar revision surgery and double diamond-shaped flap anoplasty.METHODS Patients with mild,moderate,or severe anal stenosis following hemorrhoidectomy procedures who were treated with either scar revision surgery or double diamond-shaped flap anoplasty at our institution between January 2010 and December 2015 were investigated and compared.The severity of stenosis was determined via anal examination performed digitally or using a Hill-Ferguson retractor.The explored patient characteristics included age,sex,preoperative severity of anal stenosis,preoperative symptoms,and preoperative adjuvant therapy;moreover,their postoperative quality of life was measured using a 10-point scale.Patients underwent proctologic follow-up examinations one,two,and four weeks after surgery.RESULTS We analyzed 60 consecutive patients,including 36 men(60%)and 24 women(40%).The mean operative time for scar revision surgery was significantly shorter than that for double diamondshaped flap anoplasty(10.14±2.31[range:7-15]min vs 21.62±4.68[range:15-31]min;Psurgery than after anoplasty(2.1±0.3 vs 2.9±0.4 d;Psurgery other tha

关键词： Anal canal Anoplasty Scar revision Stenosis surgery-induced tissue adhesions Surgical flaps

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