Case reports: Advancing knowledge of rare or unusual medical conditions

A case report is a detailed description of a single patient (or sometimes a small series of related or similar cases) with an unusual disease or complication [1]. The clinical stories help inform healthcare and represent a timely way for advancing medical scientific knowledge of rare medical conditions, and documenting diagnostic challenges and individualised management strategies [2]. Case reports provide information on seldom encountered situations which are not amenable to clinical trials or longitudinal observational studies.

With regard to rare conditions, this journal has published a case report of a benign cervical mass leading to prolapse in a woman with Proteus syndrome [3]. This genetic condition has an estimated incidence of less than one in a million. It presents with progressive overgrowth of various types of tissue, such as epithelial, connective and endothelial tissue. The case report will raise awareness of the need for gynecological assessment in women with Proteus syndrome. Furthermore, advances in medical care mean that clinicians are now managing obstetric and gynecological conditions in women who would not have survived into adulthood. In the absence of guidelines, case reports are an invaluable resource.

With regard to unusual complications, Case Reports in Women's Health has published reports of the presentation, diagnosis and management of unexpected postoperative problems. An example is a case report of peritoneal hernia following abdominal hysterectomy [4]. The woman presented to the emergency unit with abdominal distension and pain, and lack of bowel movement or flatus on day 4 following total abdominal hysterectomy of a leiomyomatous uterus estimated to be 18 weeks in size. CT imaging showed a small segment of small intestine herniating through the peritoneum but still contained by the fascia. Surgical management was prompt and successful. Case reports such as these provide valuable examples as to how disease and complications from standard procedures can present and be swiftly managed.

Writing case reports is also of educational benefit to early-career healthcare professionals. It allows them to develop academic writing skills, critical thinking, the principles of medical publishing and publication ethics. Case reports need to adhere rigorously to the CARE guidelines [5,6] and it is an absolute requirement to document that the patient or an approved legal representative has consented to publication [7]. Patients consenting to publication are providing the gift of their unique experience to science [8]. Consent should be obtained by a person involved in the patient's care, and they must be suitably qualified and trained to do so. Furthermore, at least one of the authors of case reports should have been involved in patient care. It is crucial that patient privacy is respected and any personal identifiers, including name, identification numbers, date of birth, locations and dates of treatment are excluded from the manuscript and images. These requirements are contained in the 2017 revision of the CARE guidelines for case reports [9]. Images need to be cropped to eliminate unwanted detail. Finally, authors should consider the potential harm and distress to patients and their families of publication of case reports with details being easily accessible worldwide and not confined to the shelves of medical libraries [8]. Publication of treatments or complications of treatments that are illegal in their home/treatment country could lead to legal action against the managing medical practitioners and/or patients and their families. Authors need to realize that the above issues are considered during peer review.

To conclude, the unique snapshots of clinical experience detailed in case reports provide valuable material for education of healthcare professionals with teaching and learning from a narrative.