The Thai Journal of Surgery

A Rare Case of Tailgut Cyst Turning into Mucinous Adenocarcinoma: Case Report

2025-02-20T11:41:33+07:00

A tailgut cyst is an embryological remnant of the posterior intestine and is usually benign in nature. Malignant transformation is very rarely seen. We report a case of a tailgut cyst transforming into a mucinous adenocarcinoma. An 18-year-old gentleman presented to our healthcare center with progressive pain and heaviness in the lower abdomen and lower back for 1 year. Contrast-enhanced computed tomography reveals a cystic mass in the presacral region. The patient underwent transabdominal excision of the cyst in toto, and histopathological evaluation revealed mucinous adenocarcinoma. The patient underwent adjuvant chemo-radiotherapy, and after one year, contrast-enhanced computed tomography revealed no residual or recurrence. Tailgut cysts carry the risk of fecal incontinence, fecal fistula, neurogenic bladder, and malignant transformation. Hence, complete excision followed by adjuvant treatment is advised. Excision can be done by transabdominal, posterior (Presacral/ Pre-coccygeal), or combined approach.

Diagnosis and Management of Isolated Tracheoesophageal Fistula: A Case Report

2024-12-18T15:02:11+07:00

Isolated tracheoesophageal fistula (TEF) or H-type TEF is a rare congenital malformation of the esophagus in which a fistula between the lower trachea and the membranous part of the esophagus may lead to choking precipitated by feeding. Because of its rareness, diagnosis and surgical management of this anomaly can be challenging. A 2-month-old male infant presented with frequent cough and occasional choking during breastfeeding, beginning from his 3 days of life. At 2 weeks of age, the infant developed tachypnea and fever and was diagnosed with aspiration pneumonitis. His symptoms improved after feeding via an NG tube. An esophagogram at the local hospital suspected a tracheoesophageal fistula with a faint shadow of the fistulous tract, 2 centimeters above the clavicular level. With a high index of suspicion, the child was scheduled for a rigid tracheo-bronchoscopy. After the fistula, located 2 centimeters above the carina, was identified and catheterized, a transcervical division of the fistula was performed. The child had an uneventful postoperative course and could catch up with standard growth within six months of follow-up.

Neuroendocrine Tumor, A Rare Cause of Adult Intussusception: A Case Report

2024-12-24T13:20:34+07:00

Adult intussusception is a rare condition occurring only in about 5% of adults. When it occurs, it usually involves a pathological lead point, which may be benign or malignant. The malignant conditions are commoner, with adenocarcinoma taking the lead. Preoperative diagnosis is usually challenging due to the absence of the classical signs, among which is the passage of red-currant jelly stool that is present in children. We present a 49-year-old man with ileocolic intussusception as a result of a neuroendocrine tumor.

Efficacy of Preoperative Single Dose Intravenous Dexamethasone in Laparoscopic Cholecystectomy: A Randomized Double-Blind Placebo-Controlled Trial

2024-12-13T11:06:16+07:00

Background: Postoperative pain following laparoscopic cholecystectomy (LC) is complex and influenced by multiple factors. Dexamethasone has been investigated for its potential to reduce postoperative pain and nausea, but its efficacy remains controversial.

Materials and Methods: This prospective, randomized, double-blind, controlled trial included 108 patients undergoing elective LC. Patients were randomly assigned to receive either 5 mg dexamethasone (study group) or 1 ml normal saline (control group) 1–2 hours before surgery. Postoperative pain was assessed using the Visual Analog Scale (VAS) at 0, 2, 6, 12, and 24 hours. Data on analgesic use, postoperative nausea and vomiting (PONV), complications, and length of hospital stay were also collected. Statistical analyses were conducted using SPSS, with a p-value < 0.05 considered significant.

Results: No statistically significant differences in VAS scores were observed between the dexamethasone and control groups at any time point. Morphine use was similarly low in both groups (2.0 ± 2.9 mg vs. 2.2 ± 3.6 mg, p > 0.05), with about half of the patients requiring no morphine. PONV was less frequent in the dexamethasone group (5.7% vs. 11.1%), but the difference was insignificant. Length of hospital stay was identical in both groups (2.3 ± 0.5 days).

Conclusion: Dexamethasone did not significantly reduce postoperative pain or morphine use in LC patients with low baseline pain scores. Although PONV was less frequent in the dexamethasone group, the difference was not statistically significant. Future studies with larger sample sizes and standardized postoperative care are needed to clarify its role in LC pain management.

Factors Associated with Thyroid Surgery Complications at Maharat Nakhon Ratchasima Hospital

2025-03-04T17:39:02+07:00

Background: Thyroidectomy is one of the most frequently performed operations for thyroid disease. Thyroidectomy was associated with increased morbidity and even mortality. Potential major complications of thyroid surgery include bleeding (0.3-1%), injury to the RLN (4- 6.6%) if the nerve is not identified), hypoparathyroidism (2-53%), hypothyroidism (5-41.9%), thyrotoxic storm (< 0.5%), injury to superior laryngeal nerve (0-25%), and infection (1-2%). This study assessed the current understanding of factors predicting such complications following thyroidectomy.

Objectives: To investigate factors associated with complications in thyroid surgery.

Materials and Methods: We performed a retrospective analysis of all patients aged > 15 years who underwent thyroid surgery for any thyroid disease at our institution between October 2022 and September 2023. Data was analyzed regarding demographics, clinical features, operative details, postoperative complications, and histopathology results of tissue specimens.

Results: A total of 278 patients were identified, comprising 187 females (67.26%) and 91 males (32.74%). 106 surgical complications were observed in 77 patients (27.7%). The most common complication in the study was hypocalcemia, occurring in 54 cases (19.4%). This was followed by hoarseness in 42 cases (15.1%). The final model revealed that subtotal/total thyroidectomy had a strong and significant association with complications (adjusted RR: 4.15; 95% CI: 2.63-6.55; p < 0.001). Similarly, a disease duration exceeding 10 years (adjusted RR: 1.46; 95% CI: 1.09–1.97; p = 0.012) and thyroid nodule weight exceeding 200 gm. was also statistically significant adjusted RR: 2.11; 95% CI: 1.05-4.24; p = 0.035).

Conclusion: The postoperative complications of thyroid surgery were associated with the subtotal/total thyroidectomy, a disease duration exceeding 10 years, and thyroid nodule weight exceeding 200 gm. Therefore, special caution must be exercised in patients with these characteristics.

Management and Outcome of Fournier Gangrene in a Nigeria Hospital

2025-02-13T10:55:29+07:00

Background: Fournier gangrene is a polymicrobial soft tissue infection of the genito-perineal region of the body. It is relatively rare but life-threatening.

Objective: This study aimed to discuss the management and outcome of Fournier gangrene.

Materials and Methods: The records of patients managed as cases of Fournier gangrene between 2020 and 2024 were retrieved from the hospital medical record department. The information collated from these files includes socio-demographic data, clinical features, modality, and treatment outcome. Descriptive analysis was done using SPSS version 23.

Results: Although 15 patients were admitted and managed as Fournier gangrene, only 13 patients had complete data and were analyzed. The age distribution was between 21-80 years, with a mean of 41.1 ± 15.7 SD. All the patients were male, and all of them presented in emergency with clinical features of sepsis identified in 3 patients. The wound culture of the remaining 7 patients (53.8%) could not be retrieved. The investigated subjects ' Fournier gangrene severity index (FGSI) score showed a range of 2-12 with a mean of 7.6 ± 3.1 SD. Concerning definitive wound care, six patients (46.2%) had spontaneous wound closure due to the relatively small size of the defect. Five patients (38.5%) had primary wound closure under spinal anesthesia. The remaining two patients with FGSI scores of 9 and 11 underwent reconstructive procedures: scrotal advancement flaps + gracilis muscle flap + split-thickness skin graft.

Conclusion: The average FGSI score was 7. There was no mortality. The most commonly involved part was the scrotum, while the rarest was the penis. Prompt response and adequate resuscitation are required for good outcomes, as observed in this study.