Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons)

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We report a very rare case of ureterocolic fistula caused by colonic diverticulitis in a 52-year-old man. The patient was readmitted for sigmoidectomy and closure of a colostomy 12 month after the initial surgical procedure which had consisted of temporary transverse colostomy, lavage, and drainage for diffuse peritonitis caused by colonic diverticulitis. Physical examination at the time of the second admission revealed pneumaturia and an infected surgical scar in the lower abdomen. A double-contrast barium enema and fistulography through the surgical scar showed fistulas between the skin, sigmoid colon, and left ureter. Since the left kidney was functioning, sigmoidectomy with preservation of the left ureter was performed. Because of the severe adhesion, the location of the fistula could not be identified. We were able to dissect the severe adhesion guided by a palpable ureteral stent and to avoid damaging the ureter, even though the ureterocolic fistula was transected during the dissection. The postoperative course was uneventful and on postoperative day 14 the ureteral catheter was removed and the patient discharged.

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We report a case of small hepatic angiomyolipoma (AML) in which we preoperatively identified the color Doppler ultrasound (US) and CO2-US angiography characteristics. A 49-year-old woman was found to have a liver tumor 13 mm in diameter in segment V by abdominal US and computed tomography (CT), but it was difficult to make a definite diagnosis of the tumor by conventional imaging studies. Color Doppler US revealed a pulsating arterial afferent tumor vessel and constant efferent flow from the tumor. US angiography demonstrated heterogeneous positive enhancement of the tumor immediately after injection of CO2 and the contrast enhancement perisisted for 600 seconds. The results in this case show that US angiography and color Doppler US are extremely useful for diagnosing small hepatic nodules.

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A 34-year old man presented with gradually increasing abdominal distension and persistent pain after a motorcycle accident. Abdominal ultrasonography showed free fluid throughout the peritoneal cavity, and exploratory paracentesis yielded bloody ascitic fluid. Abdominal computed tomography and magnetic resonance imaging demonstrated massive ascites and a large multilocular cystic mass containing a hematoma in the retroperitoneum. Abdominal angiography suggested extravasation from a small branch of the gastroduodenal artery on the surface of an avascular multicystic mass. Laparotomy revealed traumatic rupture of the retroperitoneal cystic tumor, and the tumor was completely resected. Pathological examination of the resected specimen led to a diagnosis of cystic lymphangioma. Retroperitoneal lymphangioma is usually asymptomatic, and traumatic hemoperitoneum has never been reported as the initial manifestation.

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