American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

ACS CRS Featured Case Reports

Each issue of ACS Case Reviews in Surgery will highlight a case report that is hand-selected by Editor in Chief Gerald Isenberg, MD, FACS, FASCRS, for its uniqueness and significant contributions in advancing the field of surgery and the current surgical literature.

Volume 2, Issue 4

April 2019

Abdominal Pain: The Double Trouble!!!
Suhani, MS, FACSa; Rajinder Parshad, MS,DNBb; Ankur Goyal, MBBS, MDc; Prasenjit Das, MBBS, MDd; Raju Sharma, MBBS, MDe; Govind K. Makharia, MBBS, MDf

Mesenteric cystic masses are an uncommon entity seen in surgical practice. They usually occur as single lesion and an independent entity. Surgical excision in such scenarios is often curative. However, preoperatively, they may pose a diagnostic dilemma and may mimic other mesenteric masses, like lymph node cavitation or cystic mesenteric metastasis. This featured case report describes an unusual case of a young adult gentleman who has multiple cystic lymphangioma scattered throughout the small bowel mesentery in the background of celiac disease and associated with hemolytic anemia and autoimmune hepatitis.

Volume 2, Issue 3

February 2019

A Chilling Reminder of Winter Recreational Injuries: Laceration of the Internal Jugular Vein at an Ice Hockey Game
Asad J. Choudhry, MBBS; Mohamed D. Ray-Zack, MBBS; Moustafa Younis, MBBS; Ramoncito David, MD; Matthew C. Hernandez, MD; Johnathon M. Aho, PhD; Martin D. Zielinski, MD

Hockey is an environment that is prone to injury, and hockey players are at risk for neck injuries when skate blades become airborne or in a position of movement that allows for contact with the neck of another player. That said, lacerations to the neck from ice skates are extremely rare, and the management of such life-threatening injuries is extraordinary sparse in the literature. This case details the management of a penetrating injury to zone II of the neck.

Volume 2, Issue 2

November 2018

Diagnosis and Treatment of Appendiceal Mucormycosis
Kristin M. Krupa, MD; and Jason P. Tomsic, DO

Mucormycosis is a rare and aggressive infection most commonly diagnosed in immunosuppressed patients. A high mortality rate is associated with this infection, and mortality increases in the setting of disseminated infection. The following case report by Krupa and Tomsic describes a case of appendiceal mucormycosis treated with prompt surgical and medical intervention, in a 21-year-old female who was immunosuppressed due to chemotherapy for recent relapse of acute myelogenous leukemia (AML).

Volume 2, Issue 1

August 2018

An Unusual Case of Fibromatosis of the Breast with Numerous Intraductal Papillomas
Yitian Liu, MD; George Thomas Budd, MD; and Mita Patel, MD

Fibromatosis, a benign desmoid tumor of the breast, is a rare diagnosis that constitutes less than 0.2 percent of all primary breast tumors. Even rarer is fibromatosis with numerous intraductal papillomas. The following Liu et al case report discusses the complexities of appropriate workup as well as management of this disease in a previously healthy 18‐year‐old woman. To date, no report of intraductal papillomas within the fibromatous tissue, as presented in this case, has been published.

Volume 1, Issue 6

June 2018

Congenital Epulis: Unusual Etiology of Airway Obstruction and Feeding Failure in a Newborn
Cody L. Mullens, BS; Luke J. Grome, MD; Shilpa S. Vishwanath, MD; Harold J. Williams, MD; and Aaron C. Mason, MD, FACS, FAAP

Congenital epulis (CE) is a rare lesion of the newborn gingiva or alveolar mucosa. Tumor sequelae may include polyhydramnios during the prenatal period as well as respiratory obstruction and feeding failure postnatally. CE remains largely underreported in the medical literature, and this illustrative report discusses the origin of these rare tumors, their diagnosis, and their appropriate treatment modality. Ideally, surgeons will be able to use the information in this report to promptly identify and surgically intervene in order to minimize morbidity in this rare patient population.

Volume 1, Issue 5

March 2018

Management of a Complex Multifocal Intraductal Papillary Mucinous Neoplasm
Hardaway JC; Kanitra JJ; Kurane PH; Kavuturu S

The Fukuoka and European consensus guidelines are the current standard for the management of IPMNs, but it is important to realize that these guidelines are not exhaustive and that surgeons must rely upon clinical judgment and a mutual decision-making process involving the patient and surgeon in some circumstances. This case presents a patient with DM and a single first-degree relative with pancreatic adenocarcinoma who elected for total pancreatectomy outside of consensus guidelines.

Volume 1, Issue 4

January 2018

The "No-Zone" Approach to Penetrating Neck Trauma
Ryan B. Fransman MD, Faris K. Azar MD, William Mallon, MD, Abhinav Nalluri, BS, Joseph V. Sakran, MD, MPH, MPA, Elliott R. Haut, MD, PhD

The rapid and accurate management of penetrating neck trauma is crucial to preventing the high potential morbidity and mortality associated with this injury type. With the advent of high resolution cross-sectional imaging, a "no zone" approach to penetrating neck trauma is becoming more accepted. The featured report below describes the case of a 35-year-old male presenting with neck trauma and highlights the advantages of the "no zone" approach.

Volume 1, Issue 3

December 2017

Postpartum Bowel Perforation after Normal Vaginal Delivery without History of Inflammatory Bowel Disease
Laffoon AN, Knijnikov A

Ischemia complicates up to 42 percent of bowel perforations and increases the mortality in these patients significantly. Bowel perforation is a very rare occurrence in any postpartum patient, but it can be seen more commonly following a Caesarean section than following a normal vaginal delivery. This case presents a previously healthy, 22-year-old female with no surgical history who developed a perforation of the right mid-colon five days post-normal vaginal delivery.

Volume 1, Issue 2

September 2017

Use of Extracorporeal Membrane Oxygenation (ECMO) for Refractory Hypercarbic Respiratory Failure Due to a Severe Inhalation Burn Injury
Spanier MJ, Jara CB, Carter DW, Groom RC, Rappold JF

Extracorporeal membrane oxygenation has evidence supporting its use in hypoxemic respiratory failure; however, most published experience has been in medical and burn patients with hypoxemia as the indication for therapy.

Volume 1, Issue 1

June 2017

Primary Hyperparathyroidism Presenting as Hypercalcemic Crisis
Wachtel H, Sadow PM, MD, PhD, Phitayakorn R, Parangi S

Hypercalcemic crisis is an infrequent presentation of primary hyperparathyroidism. This case report clearly describes the clinical features and management of hypercalcemic crisis as well as the important features of primary hyperparathyroidism.