Surgical Case Reports

Perioperative Management of Hereditary Antithrombin Deficiency in a Patient Undergoing Minimally Invasive Thoracic Surgery: A Case Report

Hiromitsu Domen, et al.

INTRODUCTION: Hereditary antithrombin deficiency is a rare congenital disorder associated with an increased risk of venous thromboembolism, particularly during high-risk situations such as surgery. Effective perioperative anticoagulation management is critical to prevent thromboembolic complications in these patients.

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Bladder Herniation through the Obturator Foramen Treated with Laparoscopic Transabdominal Preperitoneal Repair Using a Contralateral 3D Max Mesh: A Case Report

Ryozan Naito, et al.

INTRODUCTION: Obturator hernia is an uncommon condition. With the widespread adoption of laparoscopic surgery, incidental detection of obturator hernias has become increasingly frequent. Bladder herniation through the obturator foramen is extremely rare, with only 14 cases reported to date. Herein, we describe a rare case of obturator bladder hernia successfully repaired via the laparoscopic transabdominal preperitoneal (TAPP) approach, highlighting a novel technical modification.

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Immune Checkpoint Inhibition as a Novel Strategy for Microsatellite Instability-High Duodenal Adenocarcinoma: A Report of Three Cases

Kojiro Shirabe, et al.

INTRODUCTION: Duodenal adenocarcinoma (DA) is an extremely rare malignancy, accounting for less than 1% of all gastrointestinal cancers. Most cases are diagnosed at an advanced stage, making curative resection difficult and leading to a poor prognosis. Recent advances in tumor immunology have identified microsatellite instability-high (MSI-H) and deficient mismatch repair (dMMR) as predictive biomarkers for immune checkpoint inhibitors (ICIs). However, clinical evidence regarding their efficacy in DA remains limited. We report 3 cases of MSI-H/dMMR DA.

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Laparoscopic Cholecystectomy for Acute Cholecystitis in a Patient with Acquired Hemophilia A: A Case Report of Perioperative Hemostatic Management with Plasma Exchange

Koki Yasui, et al.

INTRODUCTION: Acquired hemophilia A (AHA) is a rare but potentially life-threatening bleeding disorder caused by autoantibodies against coagulation factor VIII (FVIII). Surgery in patients with AHA is challenging because of the substantial risk of severe perioperative hemorrhage. However, no consensus has been reached on the optimal perioperative hemostatic strategies, especially for urgent surgical settings that require rapid correction of coagulation function, because of the rarity of this condition.

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Pancreatic-Type Acinar Cell Carcinoma of the Duodenum: A Case Report and Literature Review

Daisuke Shirai, et al.

INTRODUCTION: Acinar cell carcinoma (ACC) is a rare malignant tumor arising from pancreatic exocrine cells. While it typically originates in the pancreas, ectopic occurrences, especially in the duodenum, are extremely uncommon. Few reports exist of duodenal ACC, particularly those presenting as large tumors.

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Resection of Esophageal Carcinosarcoma with Residual Sarcoma Post-Chemoradiotherapy: A Case Report

Ryo Shibayama, et al.

NTRODUCTION: Esophageal carcinosarcoma is a rare malignancy with both carcinomatous and sarcomatous components. Radical resection is the treatment of choice; however, there is disagreement about whether to perform perioperative chemotherapy or chemoradiotherapy. We report a case of radical resection of esophageal cancer with a residual sarcomatous component in the operative specimen following chemoradiotherapy for suspected esophageal carcinosarcoma.

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Conversion Surgery Following Durvalumab Plus Tremelimumab in Unresectable Hepatocellular Carcinoma with Para-Aortic Lymph Node Metastases: A Case of Complete Hepatic Response and Lymphatic Resistance

Sunao Uemura, et al.

INTRODUCTION: Recent advances in immune checkpoint inhibitor (ICI) therapy have made conversion surgery possible in selected patients with unresectable hepatocellular carcinoma (uHCC); however, outcomes in cases with extrahepatic spread remain unclear.

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Spermatic Cord Walthard Cyst as Inguinal Mass: CT/MRI and Immunohistochemical Correlation

Rintaro Sakamoto, et al.

INTRODUCTION: Walthard cell nests are benign urothelial-like rests whose cystic transformation results in Walthard cysts. Their occurrence in male paratesticular structures is rare and can mimic urothelial or mesothelial disease.

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A Case of Grade 4 Hyperglycemia Induced by Capivasertib and Successfully Managed with Early Insulin Intervention

Yuki Nomoto, et al.

INTRODUCTION: Capivasertib, a protein kinase B (AKT) inhibitor, has demonstrated robust efficacy against hormone receptor–positive, human epidermal growth factor receptor type 2–negative advanced breast cancer, particularly in patients with AKT pathway mutations. However, serious metabolic complications such as hyperglycemia and diabetic ketoacidosis (DKA) have been reported. This case report describes capivasertib-induced hyperglycemia to support the development of safe treatment and monitoring strategies. The case is notable because early detection and timely intervention following the rapid onset of grade 4 hyperglycemia resulted in a favorable clinical course without long-term glycemic complications.

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Effusion Reduction after Early Trastuzumab Deruxtecan Therapy for Unresectable HER2-Low Breast Cancer in an Older Patient: A Case Report

Ayaka Akabane, et al.

INTRODUCTION: In recent years, HER2-low breast cancer has emerged as a distinct subtype, and the anti-HER2 antibody–drug conjugate trastuzumab deruxtecan (T-DXd) has become a promising treatment option. We report the case of an older patient with advanced HER2-low breast cancer resistant to endocrine therapy, who demonstrated a favorable clinical response to the early introduction of T-DXd.

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A Case of Unresectable Advanced Esophageal Cancer with Recurrent Pneumatosis Intestinalis and Portal Venous Gas during Chemotherapy with Immune Checkpoint Inhibitors

Hiroki Tashiro, et al.

INTRODUCTION: Esophageal squamous cell carcinoma is an aggressive malignancy often diagnosed at an advanced stage. Immune checkpoint inhibitors (ICIs), such as pembrolizumab, have shown promising outcomes for improving survival. Although rare, immune-related adverse events (irAEs) associated with ICI therapy, such as pneumatosis intestinalis (PI) and portal venous gas (PVG), can be fatal.

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Successful Bentall Surgery in a Moyamoya Disease Patient with Intraoperative Brain Protection via IABP-Induced Pulsatile Flow and CO2 Management during Cardiopulmonary Bypass

Kazuma Handa, et al.

INTRODUCTION: Moyamoya disease is an occlusive cerebrovascular disorder in which maintaining cerebral blood flow during cardiac surgery is challenging. No reports have described Bentall surgery in such patients. We present a successful case using an integrated brain protection strategy combining intra-aortic balloon pumping (IABP)-induced pulsatile flow, carbon dioxide management, and moderate hypothermia.

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