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All Journal Sriwijaya Journal of Surgery Open Access Indonesian Journal of Medical Reviews
Suryo Wahyu Raharjo
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Health Professions Medicine & Pharmacology

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An Unusual Presentation of Pancreatic Neuroendocrine Carcinoma in a Young Woman: A Case Report Iman Hakim Wicaksana; Suryo Wahyu Raharjo
Sriwijaya Journal of Surgery Vol. 8 No. 1 (2025): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v8i1.117

Abstract

Introduction: Pancreatic neuroendocrine tumors (PNETs) are rare neoplasms arising from the endocrine cells of the pancreas. They are typically diagnosed in older adults, with a peak incidence between 70 and 74 years. PNETs in young adults are uncommon and often present with non-specific symptoms, leading to delays in diagnosis and treatment. Case presentation: We report the case of a 22-year-old woman who presented with a large, non-functional PNET located in the tail of the pancreas. The patient initially complained of vague abdominal discomfort, nausea, and vomiting. Imaging studies revealed a large, heterogeneous mass in the left upper quadrant. The patient underwent a distal pancreatectomy, and histopathological examination confirmed the diagnosis of a poorly differentiated pancreatic neuroendocrine carcinoma. Conclusion: This case highlights the challenges in diagnosing PNETs in young adults. Clinicians should maintain a high index of suspicion for PNETs in young patients presenting with abdominal symptoms, even in the absence of classic hormonal syndromes. Early diagnosis and surgical intervention are crucial for improving outcomes in these patients.
Delayed Traumatic Diaphragmatic Hernia Presenting as Pneumothorax: A Case Report Iman Hakim Wicaksana; Suryo Wahyu Raharjo
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 3 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i3.708

Abstract

Traumatic diaphragmatic hernias (TDHs) are a serious complication of both blunt and penetrating trauma, often requiring prompt surgical intervention. While most TDHs present acutely, a subset of cases may have a delayed presentation, posing diagnostic and management challenges. This case report describes a 66-year-old woman who developed a delayed left-sided TDH following a motor vehicle accident, initially misdiagnosed as pneumothorax. A 66-year-old female presented to our hospital with complaints of severe left-sided chest pain and progressive dyspnea four days after a motor vehicle accident. Initial assessment at another hospital revealed rib fractures and pneumothorax, for which a chest tube was inserted. However, her respiratory symptoms persisted, prompting further evaluation. A chest X-ray and subsequent thoracoabdominal CT scan revealed a large left-sided diaphragmatic hernia with herniation of abdominal viscera into the thoracic cavity. The patient underwent emergency laparotomy and diaphragmatic hernia repair with primary closure. Postoperatively, the patient's symptoms improved significantly, and she was discharged home with complete resolution of her complaints. In conclusion, this case highlights the importance of maintaining a high index of suspicion for TDH in patients with a history of trauma, even in the absence of initial suggestive findings. Delayed presentation of TDH can occur, and a thorough evaluation, including imaging studies, is crucial for accurate diagnosis and timely management.
Acinar Gland Hyperplasia Masquerading as Pancreatic Head Carcinoma: A Case Report on a Diagnostic and Surgical Dilemma Prima Maulana Cahyo Nugroho; Suryo Wahyu Raharjo
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 5 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i5.785

Abstract

The preoperative differentiation of benign from malignant pancreatic head masses presents a significant clinical challenge. While pancreatic ductal adenocarcinoma (PDAC) is the primary concern, rare benign pathologies can be radiologically and clinically indistinguishable from cancer, leading to diagnostic uncertainty and complex surgical decisions. A 61-year-old male presented with a classic triad of obstructive jaundice, significant weight loss, and right upper abdominal pain. A contrast-enhanced computed tomography (CT) scan of the abdomen revealed a solid mass in the head of the pancreas, causing concomitant dilation of the common bile and pancreatic ducts—the "double duct sign." These findings were highly suggestive of pancreatic head carcinoma, prompting a decision for surgical intervention. The patient underwent a standard pancreaticoduodenectomy (Whipple procedure). Surprisingly, the final histopathological examination of the resected specimen revealed no evidence of malignancy. The diagnosis was benign acinar gland hyperplasia. The postoperative course was complicated by a delayed post-pancreatectomy hemorrhage from a gastroduodenal artery pseudoaneurysm, which was successfully managed with minimally invasive transarterial embolization (TAE). In conclusion, acinar gland hyperplasia is an exceedingly rare benign condition that can precisely mimic the clinical and radiological features of pancreatic cancer. This case underscores the current limitations of preoperative diagnostics and affirms that aggressive surgical management is justified in patients with a high suspicion of malignancy, as the risk of withholding surgery for a potentially curable cancer outweighs the risk of resecting a benign lesion. Furthermore, it highlights that the Whipple procedure carries a significant risk of life-threatening complications, such as delayed hemorrhage, irrespective of the underlying pathology, necessitating vigilant postoperative care.
Co-Authors Iman Hakim Wicaksana Prima Maulana cahyo Nugroho