Asian Journal of Case Reports in Surgery

Surgical Management of an Extensive Axillary Cystic Hygroma in a 4 Day Old Neonate: A Case Report

2026-06-02T09:29:56+00:00

Cystic hygroma is a benign developmental malformation of the lymphatic system resulting from a lack of communication between the lymphatic and venous systems. Most common site of occurrence of a cystic hygroma is the neck (about 75%) followed by the axilla (20%) and about 1% in the mediastinum, groin and retroperitoneum. Small, simple cystic hygromas can be managed conservatively, whereas massive, complex cystic hygromas most often need surgical intervention. Patient-specific multidisciplinary approach, involving obstetrician, radiologist, paediatrician, paediatric surgeon (where available) and plastic surgeon, is advised in cases where extensive cystic hygromas are diagnosed pre-natally. Here we have a case of a neonate born with an extensive cystic hygroma in the left axillary region extending medially onto the chest wall upto the 8th rib and laterally till elbow that was managed via careful planning and surgical excision, while safeguarding the underlying muscular and neurovascular structures, followed by reconstruction.

Mcswain Type V Appendiceal Intussusception as a Lead Point in Infantile Ileocolic Intussusception: A Rare Case Report

2026-05-28T12:03:08+00:00

Both appendicitis and intussusception can have similar presentations which can pose diagnostic and therapeutic challenges. Appendiceal intussusception is a rare condition, particularly in infants, and may serve as a pathological lead point for ileocolic intussusception. While most early intussusceptions can be managed by non-surgical reductions, these appendiceal intussusceptions stand out as exceptions. Of the available literature, the youngest cases reported has been in 4-year old child and above. We report a 5-month-old male presenting with abdominal pain, red currant jelly stools, and a palpable abdominal mass. Imaging suggested ileo-colic intussusception, and surgical exploration revealed a markedly elongated appendix (~10 cm) acting as the lead point. Appendectomy with vice versa reduction of intussusception was performed successfully. This case highlights the importance of considering rare lead points in atypical presentations of intussusception in infancy.

Single-Incision Gasless Laparoscopic Management of Non-Parasitic Splenic Cyst: A Case Report

2026-06-01T09:48:23+00:00

Background: Non-parasitic splenic cysts are rare benign lesions that pose diagnostic and therapeutic challenges because of their varied etiology and clinical presentation. Recent advances in minimally invasive surgery, particularly single-incision gasless laparoscopy, have provided safer and cosmetically superior alternatives for spleen-preserving management. Splenic cysts possess an epithelial lining and often result from parasitic infection, whereas secondary splenic cysts (pseudocysts) lack an epithelial lining and typically arise secondary to trauma, infarction, or infection.

Aims: To describe the successful application of single-incision gasless laparoscopic fenestration for the management of a large non-parasitic splenic cyst in a young female patient, and to review the operative technique and clinical outcomes of this spleen-preserving minimally invasive approach.

Presentation of Case: A 19-year-old female presented with a two-month history of left upper abdominal discomfort. Imaging revealed an 8 × 8 cm cystic lesion at the superior pole of the spleen. Hydatid serology was negative, confirming a non-parasitic splenic cyst. Spleen-preserving laparoscopic fenestration via a single infraumbilical incision using a gasless technique was performed. Approximately 500 ml of serous fluid was aspirated and the anterior cyst wall was excised using a Ligasure device. The postoperative course was uneventful and the patient was discharged on the third postoperative day. Histopathology confirmed a splenic pseudocyst. At one-year follow-up, the patient was asymptomatic with no recurrence.

Discussion: Non-parasitic splenic pseudocysts are uncommon benign lesions increasingly managed with minimally invasive, spleen-preserving techniques. Single-incision gasless laparoscopic fenestration combines the cosmetic advantages of reduced port surgery with the physiological benefits of avoiding pneumoperitoneum-related hemodynamic and respiratory disturbances. This approach is particularly suited to superficially located cysts.

Conclusion: Single-incision gasless laparoscopic fenestration is a safe, effective, and cosmetically favorable approach for appropriately selected patients with non-parasitic splenic cysts. Careful patient selection, precise surgical technique, and diligent postoperative surveillance are essential to achieving optimal outcomes. This case report highlights significance of cosmetic minimally invasive spleen preserving approach for management of splenic cysts in a young female.

Enterobius Vermicularis: A Rare Presentation as Acute Appendicitis

2026-06-01T12:23:36+00:00

Enterobius vermicularis (pinworm) is a common intestinal helminth infection worldwide, particularly in developing regions. Although typically associated with mild gastrointestinal symptoms, its role in acute appendicitis remains controversial, with reports suggesting it may mimic or contribute to appendiceal inflammation.

We report the case of an 18-year-old female who presented with persistent lower abdominal pain, nausea, and anorexia. Clinical findings raised suspicion of acute appendicitis; however, ultrasonography was unremarkable and did not reveal definitive features of appendiceal inflammation. Despite negative imaging results, persistent symptoms necessitated surgical intervention.

Diagnostic laparoscopy and appendectomy were performed. Intraoperatively, the appendix was found to be inflamed and dilated, and a live E. vermicularis worm was observed emerging from the appendiceal lumen following transection, confirming appendiceal enterobiasis. Histopathology showed nonspecific chronic inflammatory changes. The patient received postoperative anti-helminthic therapy with albendazole and had an uneventful recovery with complete symptom resolution.

This case highlights the diagnostic challenge of parasitic appendiceal disease, particularly when routine laboratory and imaging findings are inconclusive. It underscores the importance of considering helminthic infection in patients with atypical presentations of suspected appendicitis, especially in endemic and resource-limited settings.

Uncommon Isolated Unilocular Splenic Hydatid Cyst: A Case Report

2026-06-02T10:20:24+00:00

Background: Hydatid disease is a parasitic infection commonly affecting the liver and lungs, while isolated splenic involvement is rare. Unilocular splenic hydatid cysts are uncommon and often present with nonspecific clinical symptoms, making diagnosis challenging.

Aims: To report a rare case of isolated unilocular splenic hydatid disease and to demonstrate the safety, feasibility, and clinical outcomes of a minimally invasive, spleen-preserving laparoscopic approach, including operative technique and perioperative management.

Presentation of Case: A 29-year-old male presented with a one-year history of dull, intermittent left hypochondrial pain. Imaging revealed a 5 × 4 cm unilocular cystic lesion at the superior pole of the spleen with internal septations and daughter cysts, classified as Gharbi Type II (WHO CE3b). Despite negative IgG serology, imaging characteristics were strongly suggestive of splenic hydatid disease. Following five days of preoperative albendazole therapy, laparoscopic spleen-preserving partial peri-cystectomy was performed using hypertonic saline as a scolicidal agent. Blood loss was minimal, and the postoperative course was uneventful. Histopathology confirmed an acellular laminated membrane with brood capsules and hydatid sand. At 12-month follow-up, the patient was asymptomatic with no evidence of recurrence.

Discussion: Isolated splenic hydatid disease accounts for less than 2% of all hydatid cases. Diagnosis relies on a combination of imaging and serology, though serological tests may be negative in up to 40% of splenic cases. Laparoscopic partial peri-cystectomy, combined with perioperative albendazole and meticulous intraoperative technique to prevent spillage, offers outcomes comparable to open surgery while preserving splenic immunological function.

Conclusion: Splenic hydatid disease warrants a high index of clinical suspicion, particularly in endemic regions. Laparoscopic management represents a safe and effective minimally invasive option, offering the dual advantages of spleen preservation and reduced postoperative morbidity when performed with meticulous technique and appropriate perioperative medical therapy.

Gastric Necrosis: An Unexpected Complication of Transaretrial Embolization in a Critically Ill Poly Trauma Patient

2026-06-04T09:39:18+00:00

Transarterial embolization (TAE) is an effective minimally invasive procedure used for the management of gastrointestinal bleeding in hemodynamically unstable patients. Although the procedure has a high technical success rate, ischemic complications such as gastric necrosis are extremely uncommon because of the rich vascular supply of the stomach. We report a rare case of gastric necrosis following TAE for a pseudoaneurysm of the right gastroepiploic artery in a 22-year-old polytrauma patient. The patient sustained multiple traumatic injuries following a fall from a train and subsequently developed hemorrhagic shock, disseminated intravascular coagulation (DIC), septic shock, and multiorgan dysfunction requiring extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT). Despite successful embolization with coils, the patient developed progressive gastric ischemia and necrosis requiring emergency total gastrectomy with Roux-en-Y esophagojejunostomy. The patient gradually recovered and was discharged on follow-up. This case highlights the importance of considering ischemic complications after TAE in critically ill trauma patients with severe coagulopathy, vasopressor dependence, and prolonged hypoperfusion. Early recognition and timely surgical intervention are essential for improving patient outcomes.