We report 2 cases of severe acute pancreatitis treated by arterial infusion therapy using a reservoir. Case 1: A 40-year-old woman who had a stone removel from the common bile duct developed severe acute pancreatitis 10 days after surgery. We instituted continuous arterial infusion (CAI) of a protease inhibitor and antibiotics into the splenic artery using a reservoir and continued this for 15 days, after which her signs and symptoms improved, and she was discharged 53 days after CAI. Case 2: A 60-year-old man with upper abdominal pain was found in computed tomography (CT) to have severe acute pancreatitis. We instituted CAI of a protease inhhibitor and antibiotics into the splenic artery and the gastroduodenal artery using a reservoir, continuing protease inhibitor infusion 13 days and antibiotics 5 days. After CAI, the patient's abdominal pain and high fever improved to where he could eat 20 days after CAI. Few such cases require CAI using a reservoir to treat severe acute pancreatitis, but this is very useful in these cases, entailing less possibility of bleeding and infection and enathing easy patient management. The reservoir lightens their physical burden and enables them to have infusions as needed.

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A 70-year-old man seen for abdominal pain and diarrhea at the end of March 2000 was initially treated unsuccessfully with medication at the Department of Internal Medicine, then transferred to the Department of Emergency Medicine on March 31. Hematological examination showed an increased leukocyte count (12, 300/μl). Bowel obstruction was found in plain abdominal radiography. Abdominal computed tomography (CT) showed swelling of part of the small intestine. Based upon these findings, he was diagnosed with ileus and an ileus tube was inserted, after which he soon was free of pain and diarrhea, and his leukocyte count returned to normal. He was unable to have a bowel movement, however, and intestinal fluid from the ileus tube did not decrease. Radiography using contrast medium through the ileus tube showed absolute occlusion. We conducted surgery for intestinal stenosis on day 9 after admission. Laparotomy showed diverticulum of the ileum about 80 cm orally from the ileocecal valve. We partially excised the ileum, including the diverticulum. The protuberance of the intestine was pathologically confirmed to be Meckel's diverticulum. The ileal wall adjacent to the diverticulum was thickened due to inflammation, causing absolute occlusion of the internal lumen. No adhesion, strangulation, or distortion of the intestine and no malignant tumor were found. The cause of ileus in this case cannot be classified based on the Rutherford classification, so we diagnosed it as a rare case of ileus due to Meckel's diverticulum.

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We report a case of colitis caused by enterohemorrhagic Escherichia coli (EHEC) O-157: H7 requiring emergency surgery for concomitant peritonitis. A 61-year-old woman admitted for diarrhea, abdominal pain and hematemesis on September, 2001 was found in abdominal computed tomography (CT) to have edematous changes in the ascending colon. Supportive therapy was ineffective. CT 3 days after admission showed edematous changes had expanded in the colon and massive ascites and pleural effusion occurred, necessitating emergency right hemicolectomy for progressive peritonitis. The postoperative course was uneventful. Serological bacterial agglutination assay (BA) antibody titers to O-157 antigen was positive 3 days after admission, whereas fecal culture at admission and after surgery showed no abnormality. Caution should therefore be paid to possible rapid O-157 colitis progress without abnormality in fecal cultures.

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