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

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The advent of double–balloon endoscopy (DBE) has enhanced the precision of small–intestinal neoplasm diagnosis and enabled preoperative diagnosis. Laparoscopy–assisted surgery for small–intestinal neoplasms allows direct visualization, appropriate resection and safe anastomosis with low–invasiveness. We report a case of laparoscopy–assisted jejunal resection for jejunal gastrointestinal mesenchymal tumor (GIMT) preoperatively diagnosed by DBE. A 56–year–old woman complaining of abdominal pain and vomiting was referred to our hospital with radiographic evidence of jejunal obstruction. DBE revealed a well–defined smooth jejunal submucosal tumor. CT showed a homogeneous low–density mass of 6 cm in diameter inside and outside the jejunal lumen. Laparoscopy–assisted surgery was conducted for suspected jejunal GIMT. The tumor was found outside the jejunal lumen. A trocar incision was extended to exteriorize the jejunum, and a limited jejunal resection and anastomosis was performed. GIMT, smooth muscle type (leiomyoma), was diagnosed by histopathological and Immunohistochemical examination. Postoperative course was favorable, with no complications, and less pain than conventional surgery.

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A 59–year–old woman was refered to our hospital because of the stricture of the main pancreatic duct, which was detected by screening ultrasonography for her lumbago in another hospital. Pancreatic enzymes and tumor markers were normal. Endoscopic retrograde pancreatography showed a stricture of the main duct at the body of pancreas without irregularity. Only endoscopic ultrasonography revealed a mass–like lesion in the parenchyma around the stricture site. Because we were not able to deny possibility of small carcinoma, the pancreatic body including the lesion was segmentally resected. Intraoperative frozen section denied neoplastic lesion, and so, the pancreatic tail was preserved. Histological findings of the resected specimen revealed mild hypertrophy of the ductal wall and infiltration of the inflammatory cells without any evidence of malignancy or pancreatitis. Pancreatic ductal stricture has been regarded as the early manifestation of neoplasms or pancreatitis, and so on, but the benign focal inflammatory change like this case has scarcely been reported.

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