Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine)
Online ISSN : 1882-4781
Print ISSN : 1340-2242
ISSN-L : 1340-2242
Volume 23 , Issue 5
Showing 1-23 articles out of 23 articles from the selected issue
  • Daisuke Komatsu, Shoichiro Koike, Toshiharu Kanai, Motohiro Mihara, To ...
    2003 Volume 23 Issue 5 Pages 709-712
    Published: July 31, 2003
    Released: September 24, 2010
    JOURNALS FREE ACCESS
    We retrospectively reviewed 57 patients with adhesive intestinal obstruction treated with hyperbaric oxygenation (HBO) alone at Matsumoto National Hospital from October 1999 through September 2002. All under performed HBO without short nasogastric long nasointestinal in tubation. Of the 57, 34 (60%) were men and 23 (40%) women aged 15 to 90 years (mean: 62.8 years). Over half (51%) of the obstructions occurred after surgery for cancer of the stomach and colorectum. Obstruction improved in 49 (86%), who underwent a mean 2.4 days of decompression. HBO failed in 8 (14%), and 5 were successfully decompressed with a long nasointestinal tube. Three ultimately required surgery. The single complication in 1 patient was slight earache. Patients with adhesive intestinal obstruction can thus safely under go trial HBO upon hospital admission.
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  • Hiroshi Kitamura, Noriyuki Akita, Norihiko Furusawa, Kenichi Tanaka, C ...
    2003 Volume 23 Issue 5 Pages 713-718
    Published: July 31, 2003
    Released: September 24, 2010
    JOURNALS FREE ACCESS
    We analyzed 102 consecutive patients with blunt abdominal trauma in skiing and snowboarding from 1997 to 2002. Abdominal injury in snowboarders was twice that in skiers (68: 34). Falls and collisions were also higher in snowboarding than in jumping in skiing (17: 14: 3). Falls were most frequent and jumping was almost equal in snowboarding to collisions (38: 13: 12). The organs most frequently injured in skiing were the kidney, followed by the liver and spleen (13: 7: 4). Those most frequently injured in snowboarding were the kidney, followed by the spleen and liver (29: 13: 5). Kidney and spleen injuries were more frequent in snowboarding than in skiing. Of the 102 patients, 33 were free of apparent abdominal organ injury. Of 17 splenic injuries, 10 underwent splenectomies; of those, 9 were snowboarders. In both groups, 30% suffered severe complicated extraabdominal injuries including hemopneumothorax, fracture of vertebra or extremities, and brain injury. In short snowboarder were more susceptible than skiers to severe abdominal organ injury such as splenic rupture.
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  • Atsushi Miyoshi, Seiji Sato, Yasuo Koga, Yuichiro Sakamoto, Yoshihiko ...
    2003 Volume 23 Issue 5 Pages 721-727
    Published: July 31, 2003
    Released: September 24, 2010
    JOURNALS FREE ACCESS
    We analyzed risk factors for severe complications after surgery for esophageal cancer, and studied the clinical features, diagnosis, and effects of blood perfusion on endotoxin shock (Et shock), a fetal complication. In univariate analysis, we selected diabetes mellitus, poor oral intake, positive germ culture, intraoperative blood transfusion, neoadjuvant therapy, and surgical duration as significant risk factors for postoperative severe complications. To prevent these complications, appropriate nutritional support is important for improving preoperative nutrition and immunocompetence. It was difficult to distinguish between Et shock and hypovolemic shock, since Et shock occurred on POD 1. Et shock was assumed to be caused by preoperative infection. It is thus useful in early diagnosis of Et shock to check whether patients have preoperative bacterial infection. Blood perfusion including PMX-DHP is effective in Et shock. Early application of blood perfusion and control of infection are strongly recommended for patients with Et shock after esophageal resection.
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  • Hideo Shimada, Osamu Chino, Takayuki Nishi, Hikaru Tanaka, Yoshifumi K ...
    2003 Volume 23 Issue 5 Pages 729-734
    Published: July 31, 2003
    Released: September 24, 2010
    JOURNALS FREE ACCESS
    Factors contributing to anastomotic failure after esophageal cancer surgery include the patient's general condition, local circumstances, the alternative organ used for restoring the gastrointestinal (GI) tract, and the route of the alternative organ. Advances in medical techniques and instruments cannot eliminate these complications in surgery requiring resection and restoration of the GI tract. Treatments vary in the degree of failure and the patient. Some cases can be managed with local maneuvers, but others require emergency surgery to eliminate the necrotic organ, and still others require drainage of mediastinal abscesses. We discuss the diagnosis of anastomotic failure and temporary appropriate maneuvers to keep the patient's general condition from deteriorating.
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  • Sumiya Ishigami, Futoshi Miyazono, Shoji Natsugoe, Shuichi Hokita, Tak ...
    2003 Volume 23 Issue 5 Pages 735-739
    Published: July 31, 2003
    Released: September 24, 2010
    JOURNALS FREE ACCESS
    We analyzed postoperative complications after gastric cancer surgery and discuss whether to treat these complication invasively or noninvasively. When postoperative complications are critical correct diagnosis must be made using procedures such as CT and US. We evaluated patients' conditions from vital signs and physical findings before deciding whether or not to undertake invasive treatment. Almost all postoperative gastric surgery complications can be treated noninvasively. Some may be fatal without reoperation. We cannot overemphasize the need to keep fatal postoperative complications in mind and to conduct proper gastric surgery. We should not wait too long postoperatively before decide on invasive treatment for potentially fatal complications.
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  • Kazuo Hirose, Yoshiki Satoh, Makoto Murakami, Yasuo Hirono, Hiroyuki M ...
    2003 Volume 23 Issue 5 Pages 741-748
    Published: July 31, 2003
    Released: September 24, 2010
    JOURNALS FREE ACCESS
    Anastomotic leakage occurred in 66 (9.1%) out of 724 patients who underwent gastrectomy for gastric cancer, 13 of these patients (19%) developed serious complications, including organ failure and/or massive intracorporeal bleeding. All the patients with serious complications had undergone a total gastrectomy, and most of them had stage III or IV tumors, had undergone D2-D3 lymph node dissection, and had received a combined resection of the pancreas or spleen or a curative resection. Of these 13 patients, five suffered massive intracorporeal bleeding and were successfully treated and cured by early surgical drainage and emergent hemostatic procedures, including surgical ligature or transarterial embolization (TAE) using interventional radiology. Two of the patients developed bleeding again and required retreatment using TAE and surgical drainage. The other eight patients suffered organ failure (5, respiratory; 1, renal; and 2, multiple organs). Six of these patients were cured by surgical drainage and adequate therapy for the specific organ failure, such as mechanical ventilation or renal dialysis. However, the other two patients who had a high operative risk and stage III or IV tumors died in hospital of multiple organ failure from the sepsis of a herpes zoster infection or grave aspiration pneumonia. The present results suggested that most patients with serious complications following anastomotic leakage can be cured by prompt and adequate treatment. However, to prevent the complications, safe and adequate operations should be performed based on a precise assessment of the tumor stage and the patient's preoperative condition.
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  • Yasuyuki Sugiyama, Yoshihiro Kawaguchi, Chihiro Tanaka, Nobuhisa Matsu ...
    2003 Volume 23 Issue 5 Pages 749-756
    Published: July 31, 2003
    Released: September 24, 2010
    JOURNALS FREE ACCESS
    We analyzed early postoperative complications in 385 colorectal cancer patients who underwent surgery. Emergency laparotomy was conducted in 13 due to anastomotic leakage in 8, ileus in 3, and ischemic colitis and idiopathic duodenal perforation in 1 each. Signs and symptoms of anastomotic leakage occurred earlier in 8 patients who underwent laparotomy compared 13 treated conservatively. C-reactive protein or leukocyte counts were higher in laparotomy than in conservative treatment. In emergency surgery for anastomotic leakage, drainage and diverting loop colostomy were done in 4 patients with relatively small leaking sites, drainage and end colostomy after removal of the anastomsis in 2 patients with noticeable separation of anastomotic sites, and drainage alone in 2 patients whose leakage sites were unclear. We first attempted to decompress the intestine by long tubes in 6 ileus patients, but radiological imaging studies showed simple obstruction in 3, resulting in elective surgery. In conclusion, correct judgment should be made promptly upon indications for surgery immediately after signs and symptoms of postoperative complications are observed.
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  • Masako Hiramatsu, Keiji Suga, Kazuhiro Sumiyoshi, Haruto Nishimura, No ...
    2003 Volume 23 Issue 5 Pages 757-763
    Published: July 31, 2003
    Released: September 24, 2010
    JOURNALS FREE ACCESS
    Between January 1996 and December 2002, a total of 1974 patients underwent surgery for different gastrointestinal malignancies at our institution. Twenty-eight patients (1.4%) suffered significant postoperative (post op) hemorrhages. Post-op hemorrhage was more common after surgeries for biliary and gastric cancers (5.5% and 2.1% respectively). Patients with post-op hemorrhage could easily be divided into two groups, depending on the underlying etiology. The early group experienced hemorrhages during the first three days after surgery; the causes of these hemorrhages were partly attributable to the surgical technique. In the late group, however, the hemorrhages occured mainly after the first post op week (day 14. 3±9.8 days) and were mostly related to an underlying intraabdominal sepsis secondary to anastomotic insufficiency and fistula formation. The overall mortality rate in the late group was significantly higher (57.1%) than that in the early group. Most of the late group patients presented with sentinel bleeding before severe hemorrhage. The mortality rate was decreased if an aggressive approach was adopted at the first sign of bleeding (83.3% vs. 16.7%). These results suggest that an aggressive approach should be immediately adopted if sentinel bleeding occurs.
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  • Toshiharu Furukawa
    2003 Volume 23 Issue 5 Pages 765-771
    Published: July 31, 2003
    Released: September 24, 2010
    JOURNALS FREE ACCESS
    Patient self-determination is regarded as a basic human right in constitutional law. Patients with gastrointestinal cancer must therefore be informed, using concrete statistic data, about the effectiveness and risks of surgery and the posibility of alternative conservative treatment. Although surgeons have the right and duty to recommend to their patients what they view as the most suitable treatment, they must obtain the patient's consent before attempting them. The right of cancer patients to select treatment less invasive than surgery cannot be over emphasized.
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  • Atsumori Hamahata, Shunji Hasegawa, Shinsuke Seta, Shin Kojima, Yoshih ...
    2003 Volume 23 Issue 5 Pages 773-777
    Published: July 31, 2003
    Released: September 24, 2010
    JOURNALS FREE ACCESS
    A 51-year-old male man who consulted a physician in a nearby clinic for right lower abdominal pain was confirmed by abdominal ultrasound examination to have an elastic hard mass in the lower right abdomen. Ileocecal intussusception due to neoplastic disease. The tumor in the lower right abdomen had disappeared when he came to our hospital. Barium enema showed a tumor with a coiled-spring sign in appendiceal intussusception. Colonoscopy showed a hemispherical tumor projecting into the cecum, suggesting appendiceal intussusception or vermiform appendix. We conducted ileocecal resection. The resected specimen was diagnosed as type B appendiceal intussusception in which the orifice of the vermiform appendix was open and part of the base of the vermiform appendix reversed, forming a hemispherical tumor. The cause of appendiceal intussusception remains unknown. Although appendiceal intussusception is rare disease, it should be considered as a possible cause of ileocecal intussusception.
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  • Special Considerations on the Surgical Procedure of Choice
    Atsushi Ota, Nobuyasu Kano, Motoji Fukazawa, Seizan Tanabe, Futoshi Og ...
    2003 Volume 23 Issue 5 Pages 779-783
    Published: July 31, 2003
    Released: September 24, 2010
    JOURNALS FREE ACCESS
    A 62-year-old man admitted for a perforated upper gastric ulcer with abscess formation around the spleen underwent emergency laparotomy for irrigation and drainage. After being discharged from the hospital, he was readmitted for recurrence of the abscess. An ulcer developed and uncontrollable massive bleeding required surgical treatment. We locally resected the affected upper stomach based on his general condition and existence of the abscess. The postoperative course was uneventful.
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  • Takashi Ooki, Yoshifumi Tanahashi, Izumi Takeyoshi, Michio Maemura, Te ...
    2003 Volume 23 Issue 5 Pages 785-788
    Published: July 31, 2003
    Released: September 24, 2010
    JOURNALS FREE ACCESS
    We present two cases of intussusception of the small intestine presumably triggered by an ileus tube. In case 1, a 53-year-old man underwent partial excision of the small intestine due to strangulation ileus and splinting enforcement by an ileus tube. Gastric discharge increased from postoperative day (POD) 7. Abdominal computed tomography and ultrasonography indicated intussusception of the small intestine. Emergency surgery on POD 27 showed antegrade intussusception at the anal side of the anastomosis. Since intestinal intussusception could not be manually repaired, we partially resected the small intestine. In case 2, a 68-year-old man underwent partial resection of the small intestine due to repetitive ileus, and an ileus tube was used as an intestinal splint. Following removal of the ileus tube, he experienced lower left abdominal tenderness on POD 5. Abdominal computed tomography and ultrasonography indicated intestinal intussusception, and thus abdominal reexposure was done on POD 6. Antegrade intussusception was observed at the anal side of the anastmosis and successfully repaired via the conventional Hutchinson's method. In both patients, no obvious cause of intussusception was observed. Computed tomography and ultrasonography were useful in preoperatively diagnosing intussusception.
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  • Hiroaki Omori, Hiroshi Asahi, Takashi Irinoda, Kazuyoshi Saito
    2003 Volume 23 Issue 5 Pages 789-793
    Published: July 31, 2003
    Released: September 24, 2010
    JOURNALS FREE ACCESS
    We report of a case of ileal endometriosis with small bowel obstruction (SBO). A47-year-old woman referred for lower abdominal pain on May 29, 1999, underwent intestinal tract decompression with a long intestinal tube. Enterography showed no remarkable stenotic lesions in the small intestine and small bowel movement was notably slow. Abdominal computed tomography showed a cystic mass near the uterus and intestinal dilation in the lower abdomen. Emergency laparotomy was done under a preoperative diagnosis of rupture of the left ovarial cyst with paralytic ileus. We found a rupture of a left chocolate cyst and flexions, adhesions, and intestinal wall thickness in the ileum. During surgery, she suffered cardiac arrest followed by ventricular tachycardia (VT), but recovered completely immediately after prompt resuscitation. We segmentally resected the ileum. The lesion was diagnosed pathologically as ileal endometriosis. Hypokalemia caused by severe diarrhea was thought to be the main reason for VT occurred during surgery. Her postoperative course was uneventful and she was discharged on postoperative day 19. It is very difficult to diagnose endometriosis of the small intestine preoperatively because this disease rarely involves the small intestine or SBO. This disease must be kept in mind, however, when a woman is diagnosed with ileus origin.
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  • Satoru Tobinaga, Kouji Akasu, Shuichi Sajima, Hideo Matsuo, Tadashi Yo ...
    2003 Volume 23 Issue 5 Pages 795-798
    Published: July 31, 2003
    Released: September 24, 2010
    JOURNALS FREE ACCESS
    A 78-year-old man referred for acute abdomen was found on physical examination to have a soft abdomen without distension, generalized severe pain, and weak bowel sounds. Abdominal X-ray did not show an abnormal silhouette. Electrocardiography showed arterial fibrillation. When conservative therapy did not relieve abdominal pain, we conducted emergency CT and selective angiography of the superior mesenteric artery (SMA), which showed occlusion of the middle colonic artery. Under a diagnosis of SMA embolism, we conducted emergency surgery 34.5 hours after onset. Intraoperative findings showed no intestinal necrosis, so we conducted embolectomy at the furcation of the middle colic artery without intestinal resection. Acute SMA embolism as seen in this case is very rarely treated successfully with vascular reconstruction alone after 34.5 hours has elapsed. The intestinal golden time is thus influenced bythe site and spread of occlusion or the condition of mesenteric circulation.
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  • Hideyuki Ubukata, Gyou Motohashi, Takeshi Nakachi, Teruhiko Kasuga, Mo ...
    2003 Volume 23 Issue 5 Pages 799-803
    Published: July 31, 2003
    Released: September 24, 2010
    JOURNALS FREE ACCESS
    An 82-year-old male seen for lower abdominal pain was found to have no abdominal free air in abdominal plain radiography and abdominal computed tomography (CT). No definitive preoperative diagnosis was possible but his condition was within the definition of systemic inflammatory response syndrome (SIRS) and his physical findings suggested panperitonitis. In laparotomy, we found the sigmoid colon necrotic for 18cm and a hole in the bowel wall. Supply artery pulsation was good, eliminating embolism of the inferior mesenteric artery as a cause. We resected the necrotic colon and made a stoma with the descending colon. After surgery, he gradually recovered and oral intake was started on postoperative day (POD) 12. On POD 14, however, his general condition suddenly worsened and he died within 2 hours. We suspect that the cause of death complication by pulmonary infarction. Transient and strictive ischemic colitis are generally treated conservatively and the prognosis is good. The gangrenous type, although it is less frequent, progresses immediately to panperitonitis so its prognosis is poor and emergency surgery is needed. In nonperforative cases, in particular, preoperative diagnosis is very difficult. Two important factors in prompt diagnosis of this condition are the recognition of SIRS and physical findings. The complication of postoperative pulmonary infarction should thus be taken into consideration.
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  • Takashi Hiromatsu, Kenji Kobayashi, Shunsuke Ota
    2003 Volume 23 Issue 5 Pages 805-809
    Published: July 31, 2003
    Released: September 24, 2010
    JOURNALS FREE ACCESS
    Perforative gastric cancer is relatively rare and treatment results are generally miserable. We treated four cases of perforative gastric cancer in the last decade. These cases accounted for 9.8% of 41 cases of perforation of the upper digestive tract and for 23.5% of 17 cases of gastric perforations in the same period. This suggests the need to consider the possibility of malignancy when gastric perforations are encountered. Tumors were located in the L region in two cases, in the M region in one case, and in the U region in the remaining case. The perforation was located on the anterior wall or on the lesser curvature. Distal gastrectomy was done in all cases. Gross tumor appearance was type 3 in three cases and type 2 in one. Pathological study showed poorly differentiated adenocarcinoma in two cases, moderately differentiated adenocarcinoma in one case, and well-differentiated adenocarcinoma in one case. Because no correct diagnosis of perforative gastric cancer was made in any of these cases, intraoperative histological examination is necessary for accurate diagnosis. Perforative gastric cancer requires curative surgery if possible.
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  • Kaname Ishii, Genichi Nishimura, Takashi Fujimura, Koichi Shimizu, Tet ...
    2003 Volume 23 Issue 5 Pages 811-814
    Published: July 31, 2003
    Released: September 24, 2010
    JOURNALS FREE ACCESS
    We report a case of hernia through an iliac crest defect. A 66-year-old woman noticed a growing mass at the donor site of an iliac bone graft that appeared 4 years after anterior-posterior spine fusion for kyphosis of the thoracic spine. Pelvic X-ray showed a defect of the left iliac bone. Pelvic computed tomography confirmed the defect and herniation of bowel. The mass was diagnosed as a hernia through the iliac bone defect, necessitating surgery due to the risk of ileus. Intraoperatively, we found a hernia sacthrough the defect containing a reduced sigmoidcolon. The defect was repaired using soft tissue and Marlex mesh inserted into subdermal tissue. Follow-up for 18 months showed no recurrence of the hernia.
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  • Seiichi Shinji, Takashi Tajiri, Masao Miyashita, Kiyonori Furukawa, Hi ...
    2003 Volume 23 Issue 5 Pages 815-819
    Published: July 31, 2003
    Released: September 24, 2010
    JOURNALS FREE ACCESS
    A 61-year-old man underwent distal gastrectomy through an upper median incision to treat duodenal ulcer perforation in August 1995. An incisional hernia about 10cm in diameter developed in May 1996 and was followed up. On September 4, 2002, the incisional hernia ruptured during a bowel movement, causing massive small intestine escape and necessitding emergency surgery. The abdominal wall contained an open 10×20cm wound. The blood flow to the small intestine exposed through the wound was not disturbed. The escaped small intestine was returned to the abdominal cavity, which was then cleaned by repeated saline flushing, and abdominal skin temporarily closed. On September 30, he underwent abdominoplasty. After suturing the peritoneum, we sutured the posterior and anterior layers of the rectus abdominis sheath in each layer using Marlex meshTR. The postoperative course was uneventful. Incisional hernia is a common complication of abdominal surgery. We describe rupured incisional hernia successfully treated using twostaged surgery.
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  • Yuji Shingu, Masaki Terasaki, Yasutomo Goto, Yasuhiro Kuramiya, Seiji ...
    2003 Volume 23 Issue 5 Pages 821-826
    Published: July 31, 2003
    Released: September 24, 2010
    JOURNALS FREE ACCESS
    A 81-year-old man admitted for lower right abdominal pain and a mass and suspected of appendiceal mucocele in ultrasonography and abdominal CT findings ran a high-grade fever on hospital day 1, suggesting the possibility of acute appendicitis with abscess formation and necessitating emergency surgery. Laparotomy showed the appendix to be swollen to 85×65mm and twisted clockwise 540 degrees at the root of the appendix. Appendectomy was done after releasing torsion. The resected specimen showed the appendix to be filled with mucin. Pathological findings showed the appendiceal wall to have hemorrhagic, congestive, and inflammatory chnages but without malignancy. These results indicated torsion of the appendiceal mucocele. To our knowledge, torsion of the appendiceal mucocele is rare, with only 9 reports in the Japanese literature, including our case. We present the case and bibliographic comments.
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  • Hiroshi Matsuo, Mitsuharu Kokubo, Tetsuya Kondo, Hajime Mikamo
    2003 Volume 23 Issue 5 Pages 827-830
    Published: July 31, 2003
    Released: September 24, 2010
    JOURNALS FREE ACCESS
    A 43-year-old man admitted for abdominal pain had suffered abdominal pain developing over four hours. Physical examination showed abdominal distension, whole abdominal tenderness, and muscular rigidity. The White blood count was significantly high and CRP negative. Abdominal CT showed free air and ascites in the upper portion of the abdominal cavity and a low-density mass at Douglas' pouch. Anal bleeding was recognized and a piece of string hung out of the anus. Emergency laparotomy based on a diagnosis of rectal perforation by a transanal foreign body showed serous bloody ascites and a baby bottle in the pelvic cavity that had perforated the anterior rectal wall. We directly closed the rectum with a covering colostomy. When asked how the bottle had become thus situated, he repeated only that it had ponetrated the insertedanus by accident when he slipped in the bath. Six months later, the colostomy was closed.
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  • Takeshi Aoki, Yasushi Wada, Satoru Yokoyama, Gumpei Yoshimatsu, Hisano ...
    2003 Volume 23 Issue 5 Pages 831-835
    Published: July 31, 2003
    Released: September 24, 2010
    JOURNALS FREE ACCESS
    We report a rare case of cecal volvulus in an elderly patient. An 85-year-old woman seen at a clinic for abdominal pain was found in abdominal computed tomography to have medium amount of ascites and a giant colonic gas shadow. Under the diagnosis of intestinal obstruction, she was referred to us for surgical intervention. Plain abdominal X-ray film showed giant intestinal gas evidence at the left lower abdomen, necessitating emergency surgery under a diagnosis of intestinal obstruction due to colonic cancer. Laparotomy showed the ileocecal region to be unfixed to the retroperitoneum and twisted clockwise by 360 degrees, yielding a diagnosis of cecal volvulus. Because the lesion showed necrotic change, we conducted ileocecal resection. The postoperative course was uneventful. Although cecal volvulus is rare as a cause of intestinal obstruction, these cases are expected to increase, requiring consideration of cecal volvulus as a differential diagnosis in intestinal obstruction in the elderly.
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  • Hiroaki Yanagimoto, Sohei Satoi, Yasushi Koike, Naoyoshi Terakawa, Yus ...
    2003 Volume 23 Issue 5 Pages 837-842
    Published: July 31, 2003
    Released: September 24, 2010
    JOURNALS FREE ACCESS
    Sepsis and multiple organ failure (MOF) are important causes of hospital mortality. Acute lung injury (ALI) is nonspecific acute inflammation resulting from severe biological response to overwhelming direct or indirect stress to the lung. It is associated most often with sepsis, aspiration, or multiple trauma. A systemic inflammatory response in the host appears to be a clinical step in ALI pathogenesis. Blood purification removes of a wide range of middle-molecular-weight substances and endotoxins and cytokines, and efficiently expels excessive water related to tissue edema. Its use may reduce systemic inflammatory response and eliminate excessive water within extravascular segments. Advances in surgical procedures and postoperative management have led to increasing selection of surgery in elderly patients or compromised hosts, increasing the incidence of sepsis without evidently infectious focus. We report three cases of ALI following postoperative sepsis successfully treated with blood purification.
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  • Masashi Uramatsu, Yoshihisa Saida, Jiro Nagao, Makoto Takase, Katsutak ...
    2003 Volume 23 Issue 5 Pages 843-847
    Published: July 31, 2003
    Released: September 24, 2010
    JOURNALS FREE ACCESS
    We report a case of obstructive rectal cancer with left ventricular insufficiency treated operatively after using a stent endoprosthesis for colorectal cancer (SECC). A 66-year-old man with dyspnea suffering from atrial fibrilation, ischemic heart disease, and diabetes mellitus was admitted and diagnosed with ileus by abdominal radiography. Ultrasound cardiography showed a left ventricular ejection fraction of 29%. We conducted a colonoscopy to determine the cause of ileus and found obstructive rectal cancer. We conductel SECC and his clinical condition improved. After SECC and medical intervention, his general condition was improved. We conducted Hartmann's method after mechanical preparation with PEG. The patient did well postoperatively and was discharged an postoperative day 37. We recommend SECC in ileus to improve the general condition of patients.
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