Surgical Case Reports

Bimanual Use of Articulating Laparoscopic Instruments (ArtiSential) in Pediatric Surgery: A Report of Three Cases

Yushi Kaisyakuji, et al.

INTRODUCTION: Articulating laparoscopic instruments such as ArtiSential have been developed to overcome the limited range of motion associated with conventional straight instruments, particularly in narrow operative fields. While robot-assisted surgery provides highly precise manipulation, its introduction in pediatric surgery remains limited due to high cost and restricted insurance coverage. We introduced bimanual use of ArtiSential in pediatric minimally invasive surgery as a potential alternative to robotic assistance and evaluated its feasibility and technical advantages.

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A Case of Acquired Hemophilia A Following Robot-Assisted Minimally Invasive Esophagectomy

Shota Eguchi, et al.

INTRODUCTION: Acquired hemophilia A (AHA) is a rare but potentially fatal bleeding disorder that arises suddenly in individuals without a prior history of bleeding tendency. It is often associated with malignant disease and can present with severe hemorrhagic complications. Reports of AHA occurring in the postoperative course of esophageal cancer surgery are extremely limited, and the safety of immune checkpoint inhibitors (ICIs) in patients with a history of AHA remains uncertain. This case highlights both the diagnostic and therapeutic challenges of AHA and provides novel insight into the safe administration of ICIs in a patient with recurrent esophageal cancer following remission of AHA.

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A Rare Case of Mucinous Carcinoma Arising in Association with an Intraductal Papilloma

Haruka Yamasaki, et al.

INTRODUCTION: Intraductal papilloma (IDP) is a benign breast lesion that accounts for 3%–6% of core biopsy diagnoses. It is considered a high-risk precursor due to its association with atypia, ductal carcinoma in situ, and invasive carcinoma. Although IDP-NOS (not otherwise specified) rarely progresses to invasive cancer, IDP with atypia carries a higher risk of malignant transformation.

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Free Flap Reconstruction for Gastrocnemius Muscle Necrosis to Avoid Above-Knee Amputation

Hikaru Watanabe, et al.

INTRODUCTION: Below-knee amputation is functionally superior to above-knee amputation, and preservation of the knee joint is essential for optimal mobility. In below-knee amputation, muscular coverage of the tibial stump and proper shaping for prosthesis fitting are key factors in functional recovery. If primary muscle coverage is not feasible, free flap reconstruction may be required to achieve these goals.

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Radiation-Induced Angiosarcoma Following Breast Surgery: A Case Report

Mutsumi Hayashi, et al.

INTRODUCTION: Radiation-induced angiosarcoma of the breast is a rare but aggressive secondary malignancy that develops several years after breast surgery and adjuvant radiation therapy. Because of its poor prognosis and diagnostic challenges, early recognition and complete surgical excision are essential for optimal management.

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A Rare Case of Ascending Necrotizing Mediastinitis following Perforated Appendicitis: A Case Report

Ju Hun Lee, et al.

INTRODUCTION: Necrotizing fasciitis (NF) is a rapidly progressing soft-tissue infection associated with high mortality. While descending necrotizing mediastinitis (DNM) from cervical infections is well characterized, ascending necrotizing mediastinitis (ANM) originating from intra-abdominal sources is extremely rare.

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Usefulness of Transparent Illumination Device in Esophageal Atresia for the Detection of the Distal Esophagus

Yoshimasa Uematsu, et al.

INTRODUCTION: Pure esophageal atresia without a tracheoesophageal fistula (Gross type A) is technically demanding, particularly with respect to intraoperative identification of the distal esophageal pouch. Biologically transparent illumination (BTI) devices have been used to visualize nasogastric tubes in pediatric patients; however, their application during esophageal reconstruction has not been reported.

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Aortic Arch Mural Thrombus Concurrent with Deep Surgical-Site Infection after Colorectal Cancer Surgery in an Enhanced Recovery after Surgery Program: A Case Report

Shuto Nakashima, et al.

INTRODUCTION: Aortic mural thrombus (AMT) in a non-atherosclerotic aorta is rare but potentially catastrophic and may be difficult to distinguish from septic aortic pathology when it occurs alongside a deep postoperative infection. Enhanced recovery after surgery (ERAS) shortens hospital stay and shifts the recognition of serious complications to the early post-discharge period. We report the case of a patient who underwent colorectal cancer surgery within an ERAS protocol who developed a large AMT on POD 10, coincident with Streptococcus anginosus-positive deep surgical-site infection (SSI) but without bacteremia or aortitis on imaging.

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En Bloc Resection and Vascular Reconstruction for Cecal Cancer Involving the Right Common Iliac Artery and Inferior Vena Cava in a Super-Elderly Patient: A Case Report

Takumi Kato, et al.

INTRODUCTION: Complete resection with negative margins (R0) is associated with favorable outcomes in patients with locally advanced colorectal cancer. When tumors invade major vessels, such as the iliac artery or inferior vena cava, curative surgery requires vascular resection and reconstruction, which can be technically demanding.

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Laparoscopic Exploration for Penetrating Abdominal Trauma Caused by Deer Antlers: A Case Report

Atsushi Yoda, et al.

INTRODUCTION: Penetrating abdominal trauma poses a major challenge in trauma surgery, with most cases resulting from knives or firearms. This report describes a rare case caused by deer antlers and highlights the role of diagnostic laparoscopy.

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Multiple Coronary Artery Aneurysms and Coronary–Pulmonary Artery Fistula Associated with Vieussens’ Arterial Ring

Akito Kuwano, et al.

INTRODUCTION: Vieussens’ arterial ring (VAR) is a vascular anomaly characterized by a communication between the conus branch of the right coronary artery (or the isolated conus artery) and the left anterior descending artery. Pathological changes of VAR, including dilation or aneurysmal formation, are exceedingly rare, and the mechanisms underlying these changes have yet to be elucidated.

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A Rare Case of Asymptomatic Insulinoma with Mesocolonic Lymph Node Metastases and Long-Term Stability

Chie Kitami, et al.

INTRODUCTION: Malignant insulinomas are rare, and lymph node metastases are particularly uncommon in small, low-grade tumors. We report an asymptomatic insulinoma of the pancreatic body with multiple lymph node metastases confined to the transverse mesocolon, which remained radiologically stable for at least 3 years prior to the diagnosis. This case highlights the potential for metastatic disease, even in indolent insulinomas.

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