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Medicina
Special Issues
Diagnosis and Management Challenges in Difficult Surgical Cases
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Diagnosis and Management Challenges in Difficult Surgical Cases

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Surgery".

Deadline for manuscript submissions: 28 February 2025 | Viewed by 1605

Special Issue Editors

Dr. Dragoş Eugen Georgescu

E-Mail Website
Guest Editor
Department of Surgery, “Carol Davila” University of Medicine and Pharmacy/“Dr. I. Cantacuzino” Clinical Hospital, Bucharest, Romania
Interests: general surgery; surgical oncology; hepatobiliopancreatic surgery; gynecologic surgery
Dr. Vlad Pădureanu

E-Mail Website
Guest Editor
Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
Interests: genetic polymorphisms; inflammation; oxidative stress; sepsis; internal medicine; acute pancreatitis; diabetes mellitus; liver diseases; rheumatic disease
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Jānis Gardovskis

E-Mail Website
Guest Editor
Department of Surgery, Riga Stradins University, Riga, Latvia
Interests: general surgery; endocrine surgery; hereditary cancer

Special Issue Information

Dear Colleagues,

Difficult surgical cases present multifaceted challenges in both diagnosis and management. Essential for the progression and advancement of surgical practice is the capability to navigate the intricate path delineated by atypical cases, which pose challenges in establishing the right diagnosis and subsequently implementing therapeutic methodologies.

When confronted with the task of establishing an uncommon or infrequent diagnosis, the surgeon must assess various factors. This involves identifying atypical symptoms, utilizing the diagnostic resources available within their clinical setting, and determining the fundamental etiology of the disease. Nevertheless, it is imperative to conduct this work diligently while comprehensively evaluating the entire range of potential differential diagnoses.

The willingness to make crucial, occasionally high-stake decisions is imperative for the progression of both the patient's condition and the surgical framework in which the practitioner operates. Enabling this course of action entails assessing the severity of the illness, identifying the appropriate initial treatment site, and choosing the primary surgical intervention.

These challenges necessitate a multidisciplinary approach, leveraging advanced diagnostics, seeking specialized expertise, and staying abreast of cutting-edge research. Collaboration among specialized professionals, the implementation of innovative methodologies, and ongoing knowledge acquisition are particularly crucial, especially when conventional therapies demonstrate inefficacy.

Management of these cases poses hurdles in the face of treatment resistance, surgical complexities, and decision-making dilemmas, especially in cases where standard therapies prove ineffective.

Overcoming these challenges demands a comprehensive, adaptable, and patient-centric approach to ensure optimal outcomes in the realm of complex surgical cases.

Dr. Dragoş Eugen Georgescu
Dr. Vlad Pădureanu
Prof. Dr. Jānis Gardovskis
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • diagnosis
  • management
  • difficult surgical cases
  • challenges
  • personalized treatment

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Published Papers (2 papers)

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9 pages, 3752 KiB  
Case Report
Successful Management of Thyrocervical Trunk Aneurysm Ruptured into the Thoracic Cavity After Cesarean Section in Nonstable Patient with Neurofibromatosis Type I
by Nikola Mirković, Marko Prokić, Marija Novčić, Miloš Arsenijević, Snežana Sretenović, Dragan Knežević, Vojin Kovačević, Marija Šorak and Olivera Kostić
Medicina 2025, 61(1), 49; https://doi.org/10.3390/medicina61010049 - 31 Dec 2024
Viewed by 556
Abstract
Rupture of the thyrocervical trunk aneurysm into the thoracic cavity does not occur very often. It is an urgent condition due to hemorrhagic shock by massive hemothorax with potentially fatal consequences. Pregnancy and puerperium are additional risk factors for a rupture of the [...] Read more.
Rupture of the thyrocervical trunk aneurysm into the thoracic cavity does not occur very often. It is an urgent condition due to hemorrhagic shock by massive hemothorax with potentially fatal consequences. Pregnancy and puerperium are additional risk factors for a rupture of the thyrocervical trunk aneurysm in patients with neurofibromatosis and aneurysms. This is the first case of thyrocervical trunk aneurysm rupture after a Cesarean section in a patient with neurofibromatosis type I noted down in the literature. The patient, a 33-year-old woman with neurofibromatosis type I, three days after an already performed Cesarean section had acute pain in the left area of the neck, swelling, and a hematoma that progressed rapidly to respiratory distress, hemothorax, and hemorrhagic shock. Emergency endotracheal intubation was performed for airway control. Urgent computer tomography angiography procedure showed extracranial artery, thyrocervical trunk aneurysm rupture, and vertebral aneurysm without rupture. The patient was urgently and successfully treated by endovascular coil embolization of a ruptured thyrocervical trunk aneurysm and subsequently thoracic drainage for massive hemothorax. Postoperatively, her left neck pain decreased, after which she had no further neurologic deficits. The patient was discharged 10 days later. Thyrocervical trunk aneurysm rupture is a rare condition with a potential outcome of death which requires urgent intervention. Endovascular coil embolization is a minimally invasive, safe, and efficient treatment for patients with rupture of thyrocervical trunk aneurysm and following comorbidities. Full article
(This article belongs to the Special Issue Diagnosis and Management Challenges in Difficult Surgical Cases)
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11 pages, 3974 KiB  
Case Report
Bouveret’s Syndrome as a Rare Life-Threatening Complication of Gallstone Disease—A Surgical Problem: Two Case Reports
by Nebojsa S. Ignjatovic, Ilija D. Golubovic, Miodrag N. Djordjevic, Marko M. Stojanovic, Daniela A. Benedeto Stojanov, Jelena S. Ignjatovic, Jelena D. Zivadinovic and Sonja Golubovic
Medicina 2025, 61(1), 5; https://doi.org/10.3390/medicina61010005 - 24 Dec 2024
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Abstract
Introduction: Bouveret syndrome, a rare and often underdiagnosed variant of gallstone ileus, is characterized by the presence of a large gallstone impacted in the proximal duodenum, resulting in significant gastric outlet obstruction and aerobilia. Early identification of Bouveret syndrome is crucial for [...] Read more.
Introduction: Bouveret syndrome, a rare and often underdiagnosed variant of gallstone ileus, is characterized by the presence of a large gallstone impacted in the proximal duodenum, resulting in significant gastric outlet obstruction and aerobilia. Early identification of Bouveret syndrome is crucial for developing an appropriate surgical strategy. Case 1: A 76-year-old female underwent a contrast-enhanced abdominal CT scan, which revealed a cholecysto-duodenal fistula with a 3.9 cm × 4.0 cm × 4.0 cm gallstone located in the proximal duodenum, along with a distended, fluid-filled stomach and aerobilia. Intraoperatively, due to chronic inflammation and adhesion between the gallbladder and duodenum, a cholecystectomy and fistula repair were performed. Case 2: A 72-year-old female presented with a gastroduodenal passage obstruction confirmed by imaging, which identified a duodeno-biliary fistula. The radiological examination showed oval filling defects in the duodenal bulb consistent with Bouveret’s syndrome, with the largest stone measuring approximately 6 cm in diameter. An enterotomy was performed for stone extraction and was followed by cholecystectomy and duodenal repair with omentoplasty. Conclusions: Bouveret’s syndrome is a rare but clinically significant condition that should be considered in patients presenting with signs of upper gastrointestinal obstruction, particularly in those with a history of chronic cholelithiasis. Early recognition and prompt surgical intervention are essential for obtaining optimal patient outcomes. Full article
(This article belongs to the Special Issue Diagnosis and Management Challenges in Difficult Surgical Cases)
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