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 6
Displaying 1-24 of 24 articles from this issue
  • Hiroki Ikeuchi, Hiroki Nakano, Motoi Uchino, Takashi Inoue, Masafumi N ...
    2003 Volume 23 Issue 6 Pages 853-858
    Published: September 30, 2003
    Released on J-STAGE: September 24, 2010
    JOURNAL FREE ACCESS
    The aim of this study is to delineate the treatment of acute emergencies that occur in patients with Crohn'sdisease, throngh an evaluation of the outcome of the disease performed retrospectively in over 30 emergencyoperative procedures in our hospital. These included free perforation, intra-abdominal abscess, intestinalhemorrhage, and intestinal obstruction. Jejunal-ileal free perforation, hemorrhage and intestinal obstructionare best managed with segmental intestinal resection and primary anastomosis. In perforated Crohn'scolitis, we performed segmental colonic resection with fecal diversion. Treatment of intra-abdominalabscesses should initially be attempted by echo-guided or computed tomography-guided percutaneousdrainage followed by subsequent definitive resection. The patients in whom drainage of the abscess couldnot be performed needed emergency intestinal resection and fecal diversion. Controversy still exists withregard to the validity of primary anastomosis. A temporary stoma in Crohn's disease has receivedconsiderable attention, particularly if the patient is in poor general health, for example in a state of shockat the time of the operation or having undergone long term steroid treatment. The most important factorsinfluencing the outcome are the choice of the appropriate timing for surgery and the procedure performed.
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  • Fujio Ogawa, Ryoji Fukushima, Tsuyoshi Inaba, Takashi Ogihara, Kota Iw ...
    2003 Volume 23 Issue 6 Pages 859-864
    Published: September 30, 2003
    Released on J-STAGE: September 24, 2010
    JOURNAL FREE ACCESS
    The purpose of this study was to evaluate the indications and effectiveness of conservative treatment forperforated duodenal ulcers. The following criteria for perfoming conservative treatment for perforatedduodenal ulcers were prospectively applied to cases from April, 1996 to Octover, 2002: 1) no severeunderlying disease and a generally stable condition; 2) localized peritonitis (peritoneal signs limited to theupper abdomen); 3) no or a small amount of ascitic fluid collection determined by ultrasonography orcomputed tomography; and 4) within 12 hours after the onset of perforation. Twenty-seven cases met thecriteria, and of these, twenty-five were treated successfully. In a all patients, the presence of a perforatedduodenal ulcer was confirmed by endoscopic examination on admission. A delayed emergency operationwas performed in two cases. In one case, muscle guarding and peritoneal signs persisted 24 hours afteradmission and laparoscopic surgery was performed. However, the operative findings revealed that theperforation site was already sealed, which indicated that surgery was not needed in this particular patient.In another case, surgery was performed 12 hours after admission because of progression of peritoneal signs, decreased WBC to 2, 500, increase in ascitic fluid and development of acidosis. We conclude that conservativetreatment is effective for the majority of patients with perforated duodenal ulcers under the criteriashown above with careful observation.
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  • Shinju Arata, Masayuki Iwashita, Junya Ishikawa, Yoshio Tahara, Naoto ...
    2003 Volume 23 Issue 6 Pages 865-873
    Published: September 30, 2003
    Released on J-STAGE: September 24, 2010
    JOURNAL FREE ACCESS
    Various artificial liver support systems were developed for the purpose of the removal of the toxic factorsin acute liver failure. Though CHDF and HDF are chosen at present to remove ammonia and middle-sizedmolecules which have been thought to be responsible for hepatic coma, we introduced on-line HDF from thepoint of the case of handling, high efficiency and economical benefits. On-line HDF was carried out safelywithout infectious complications and it was useful for improvement in the level of consciousness of thepatients even under conditions in which the abolition of liver function had been estimated. The dosedependenteffects of on-line HDF recognized in treatment for renal replacement are expected also in thetreatment of acute liver failure. On the other hand, the frequency of the plasma exchange supplementingplasma proteins, especially coagulation factors, is limited by the health insurance costs and that obstructsgiving adequate treatment to assist liver function. This is a major problem which should be open to publicdiscussion.
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  • Yasuhiko Nagano, Shinji Togo, Kenichi Matsuo, Daisuke Morioka, Kuniya ...
    2003 Volume 23 Issue 6 Pages 877-881
    Published: September 30, 2003
    Released on J-STAGE: September 24, 2010
    JOURNAL FREE ACCESS
    Between 1992 and 2000, 313 hepatic resections without choledocojejunal anastomosis were performed atour institute. Postoperative hemorrhage developed in 6 patients (1.9%). Reoperation was performed in 4patients, and follow-up therapy was chosen in 2, in whom hepatic failure developed, and one of whom, diedwithin three months of the operation. Postoperative hemorrhage was closely related to intraoperativebleeding, operative time, and the weight of the specimen. Bleeding points were the cut surface of the liver, adrenal grand, diaphragm, and sternum. To prevent postoperative hemorrhage, fresh frozen protein (FFP) and vitamin K were preopratively administered in patients with coagulopathy, and efforts should be madeto decrease the average blood loss and transfusion requirement. Confirmation of hemostasis is absolutelyand constantly required intraoperatively. Reoperation for hemostasis should be undertaken as soon aspossible when the volume of blood loss has not decreased within a few hours postoperatively, regardless ofwhether the amount of blood loss is small or large.
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  • Takahito Kodama, Hisafumi Kinoshita, Masao Hara, Kazunori Nishimura, S ...
    2003 Volume 23 Issue 6 Pages 883-889
    Published: September 30, 2003
    Released on J-STAGE: September 24, 2010
    JOURNAL FREE ACCESS
    Intraperitoneal hemorrhagesp (IPH) is a serious complication after pancreatoduodenectomy (PD) and its treatment strategy is still controversial. This study aimed to evaluate the surgical and nonsurgicaltreatments for IPH after PD. Patients: Of 407 patients who underwent PD, 13 patients (3.2%) whomanifested postoperative IPH were enrolled in this study. Of these, 6 patients suffered from bile ductcarcinoma, 4 had carcinoma of the pancreatic head, and 3 had carcinoma of the papilla Vater. Results: Thebleeding site was confirmed in ten patients and included the pancreatic stump in four, the hepatic artery infour and the superior mesenteric artery in two patients. These were identified intraoperatively in seven, angiographically in two and by autopsy in one patient. Treatments for IPH consisted of surgical treatmentin eight, transcatheter arterial embolization (TAE) in two and conservative treatment in three patients. Two patients in the surgical treatment group (25.0%), both TAE patients (100%) and one of the conservativelytreated patients (33.3%), recovered successfully. Conclusion: The outcome of surgical treatment forIPH was discouraging. TAE, whenever possible, seems to be preferable, as it is more effective in identifyingthe bleeding site and for interventional hemostasis for IPH after PD.
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  • Yukihiko Karasawa, Ken Ishimura, Masanobu Hagiike, Keiichi Okano, Fumi ...
    2003 Volume 23 Issue 6 Pages 891-898
    Published: September 30, 2003
    Released on J-STAGE: September 24, 2010
    JOURNAL FREE ACCESS
    Eight patients who suffered massive bleeding following hepato-biliary-pancreatic surgery participated inthis study. Angiography was performed in 5 cases. In 2 of the 5 cases, bleeding was successfully controlledusing an interventional radiological technique (transcatheter arterial embolization). Relaparotomy wasperformed in 6 cases, of whom 5 patients died from severe complications (eg. DIC, MOF), although bleedingwas controlled in 3 cases. The mortality of the reoperation for bleeding associating with pancreatic leakagewas 100% (4/4). The patients with pancreatic leakage showed sentinel bleeding within 6 days beforemassive hemorrhage occurred. A timely interventional approach should be selected for the treatment ofbleeding after hepato-biliary-pancreatic surgery as a life-saving proudest. Moreover, proper drainage isabsolutly required at the time of the pancreatic leakage.
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  • Transhepatic Biliary Drainage (RTBD) Following Pancreatoduodenectomy
    Makoto Sasaki, Masato Furukawa, Yuji Tokunaga
    2003 Volume 23 Issue 6 Pages 899-904
    Published: September 30, 2003
    Released on J-STAGE: September 24, 2010
    JOURNAL FREE ACCESS
    One hundred twenty-five patients underwent pancreatoduodenectomy (PD) over a 22 year period, 6 of whom suffered from pancreatojejunostomy insufficiency following PD. In 1 of the 6 patients, intraabdominalbleeding from rupture of pseudoaneurysm and haemobilia caused by retrograde transhepatic biliary drainage (RTBD) also occurred. Critical hemorrhage could be well managed twice, however, with transcatheterarterial embolization (TAE) procedures. Complete drainage of the intraabdominal cavity and decompressionof the jejunal limb by continuous suction through the RTBD tube were useful for treatment of leakagein the pancreatojejunostomy. In case of bleeding at the abdominal drain or RTBD tube associated withstomal insufficiency, immediate arteriography is important to diagnose the rupture of pseudoaneurysms andto achieve hemostasis by arterial embolization.
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  • Report of a Case Successfully Managed with Operative Hemostasis
    Tadashi Yokoyama, Kaku Egami, Koji Sasajima, Masayuki Miyamoto, Yosiha ...
    2003 Volume 23 Issue 6 Pages 905-909
    Published: September 30, 2003
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    The patient was a 59 years old man, who was diagnosed as having cancer of the head of the pancreas, and a pancreatoduodenectomy was performed. The postoperative course had been uneventful until shock caused by intra-abdominal hemorrhage occurred on the 16th postoperative day. At laparotomy, a causative injury of the common hepatic artery was found, and it was repaired. Re-bleeding occurre 11 days after the second surgery, however, and the third surgery was performed. The bleeding locus was the same as the previous one, and it was fixed with a transfixing ligation of the common hepatic artery since the vascular wall was severely damaged. Postoperatively, mild impaired liver function was seen, but it recovered within 3 weeks. The patient was discharged on the 88th day from the initial surgery.
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  • Abdominal Bleeding Due to Disintegration in Reconstructions of both the Hepatic Artery and Portal Vein 12 Days after Extended Left Lobectomy for Hilar Cholangiocarcinoma
    Masato Koseki, Masahiko Miyata, Toru Kitagawa, Toshinori Ito
    2003 Volume 23 Issue 6 Pages 911-917
    Published: September 30, 2003
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    Background: Selecting the treatment of choice for postoperative life-threatening massive abdominalhemorrhage has been difficult. Case: A 65-year-old woman underwent extended left lobectoy together withreconstruction of both the hepatic artery and portal vein in the treatment for hilar cholangiocarcinoma. Herpostoperative course was stable except for a trivial bile leakage from an intraabdominal drainage tube untila sudden copious intra-abdominal hemorrhage followed by shock occurred on the twelfth postoperative day. An emergency celiotomy was performed immediately. Bleeding was caused by breakdown of both theanastomosis sites of the hepatic artery and portal vein accompanied with thrombus. The cholangiojejunostomywas intact. The hepatic artery was ligated and the portal vein was reconstructed with interpositionof a saphenous vein graft using the portocaval bypass technique. The postoperative course was uneventfuland proceeded well without hypoxic liver failure, and the patient was discharged. This case suggests thatceliotomy should be considered first rather than IVR in some special cases, such as those showing a suddendeterioration.
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  • A Unique Case Involving 8 Polysurgeries
    Hideaki Ishikawa, Takeshi Miwa, Akihiro Toyosaka, Tatsuya Ando, Katsuy ...
    2003 Volume 23 Issue 6 Pages 919-925
    Published: September 30, 2003
    Released on J-STAGE: September 24, 2010
    JOURNAL FREE ACCESS
    A 7-year girl underwent percutaneous transhepatic cholangiodrainage (PTCD) preoperatively because ofmoderate cholangitis and liver dysfunction due to pancreaticobiliary maljunction (PBM) with congenitalbile duct dilatation (CBD), requiring preoperative blood transfusion due to hemobilia from the PTCD tube.She bled high frequently after hepaticojejunostomy and underwent reoperations 6 times in 3 weeks of thefirst operation, requiring blood transfusion of about 30, 000ml. Bleeding occurred at the remaining outer wallof the choledochal cyst and the jejunal loop of the Roux-Y leg. This suggests that bleeding was diffuse anddue to a bleeding tendency with localized DIC. Bleeding was basically stopped by resecting the jejunal loopof the Roux-Y leg in the 6th reoperation. After 6 months, rehepaticojejunostomy was successful in a 7th reoperation. At present 20 years later, she is alive and well with normal liver function.
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  • Yu Watarai, Narishige Yamada, Masato Tamaki, Nobuyasu Kano
    2003 Volume 23 Issue 6 Pages 927-930
    Published: September 30, 2003
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    Removal of a sewing needle which had somehow lodged in the peritoneum of a 3-year-old boy was succesfully performed laparoscopically. The foreign body was found by accident on an abdominal X-ray. There was no previous history of the patient having undergone laparotomy or examinations. An upper gastrointestinal series of X-rays and CT revealed a needle lodged in the patient's peritoneal cavity. Laparoscopic retrieval was performed with the 3-port method. Using an image scope, we found the needle which was in the omentum. The needle was easily removed with laparoscopic forceps. It took only 23 minutes to finish the operation. The patient had an uneventful postoperative course and was discharged from our hospital on the 3rd day after the operation.
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  • Shigeru Kiyama, Yoshifumi Katagiri, Yoshihiko Katou, Hiromichi Mimoto, ...
    2003 Volume 23 Issue 6 Pages 931-934
    Published: September 30, 2003
    Released on J-STAGE: September 24, 2010
    JOURNAL FREE ACCESS
    We herein report a case of a ruptured abscess caused by penetrated sigmoid diverticula with gas in the intrahepatic portal system. A 55-year-old man was referred to the hospital because of left lower abdominal pain and fever. On physical examination, there were signs of peritoneal irritation, strongest in the left lower abdomen. Abdominal CT scan revealed gas in the hypertrophic sigmoid mesocolon, which suggested the penetration of the sigmoid diverticula. He underwent conservative treatment with fasting and antibiotics and complete relief of the symptoms was obtained. On the 15th day after admission, he developed a severe abdominal pain and fever. Repeated CT scan revealed increased gas in the mesocolon with gas in the intrahepatic portal system. Laparotomy revealed pan-peritonitis due to rupture of an abscess in the sigmoid mesocolon. The sigmoid colon and the abscess were resected via a Hartmann procedure. The resected specimen revealed sigmoid diverticula penetrating into the abscess in the mesocolon, which had perforated into the free abdominal cavity. The patient's postoperative course was uneventful. Although most gas formation in the intrahepatic portal system is caused by a disturbance in thecuveulation or dilatation of the intestine, this reported case had neither of these conditions. This rare case is the 5th case in the Japanese literature of gas formation in the portal system caused by gas-produced bacteremia.
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  • Naoharu Mori, Masanori Iwase
    2003 Volume 23 Issue 6 Pages 935-938
    Published: September 30, 2003
    Released on J-STAGE: September 24, 2010
    JOURNAL FREE ACCESS
    We treated a case of spontaneous rupture of the rectum with transanal intestinal prolapse. A 88-yearold woman was admitted for prolapse of the intestine through the anus. Abdominal CT scan showed penetration of the intestine into the rectum. Under a diagnosis of perforation of the rectum, the patient underwent an emergency surgery. There was no contamination in the peritoneal cavity on laparotomy. After repositioning the intestinal tract in the peritoneal cavity, we conducted simple closure of a rupture in the ventral portion of the rectosigmoid colon. No inflammatory change was observed around the rupture. The patient had an uneventful postoperative course and was discharged on the 15th postoperative day.
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  • Kenichirou Katou, Katuhiko Motegi, Rieko Nakamura, Kentarou Sirasaka, ...
    2003 Volume 23 Issue 6 Pages 939-943
    Published: September 30, 2003
    Released on J-STAGE: September 24, 2010
    JOURNAL FREE ACCESS
    It is difficult to diagnose retroperitoneal hematoma in the early stage. It is also rare that retroperitoneal hematoma occurs with symptoms of shock. A 71-year-old man was admitted to our hospital with chest pain. He was diagnosed as having acute myocardial infarction, and underwent percutaneous transluminal coronary angioplasty (PTCA). Ten hours later, his blood pressure decreased. We could not recognize any subcutaneous hematoma around the puncture site, and the patient did not have any particular symptom. Abdominal computed tomography revealed a giant retroperitoneal hematoma. The laboratory data showed anemia. Anti-coagulation therapy was discontinued and a blood transfusion was perfomed. We waited until the patient's general condition stabilized and perfomed an operation. Intraoperative findings nevealed that blood had leaked into the femoral vessel sheath from the puncture site and flowed into the retroperitoneal space. We should recognize that, even after appropriate cardiac catheterization or PTCA, retroperitoneal hematoma can still occur accompanied with shock.
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  • Kazunari Mori, Masakazu Sasaki, Yosifumi Sakata, Tomoo Shimomura
    2003 Volume 23 Issue 6 Pages 945-949
    Published: September 30, 2003
    Released on J-STAGE: September 24, 2010
    JOURNAL FREE ACCESS
    We report a case of splenic infarction caused by splenic vein thrombosis with paroxysmal nocturnal hematuria (PNH). A 52-year-old man consulted us for subacute left upper abdominal pain on January 16, 1999. He had been admitted to the Depatment of Internal Medicine on January 12, 1999, because of anemia and thrombocytopenia. Before admission he had had attacks of fever on January 2 and January 8 and had taken over-the-counter cold medicine. Ultrasonography and plain CT on January 14 demonstrated slight left pleural effusion and moderate splenomegaly, which had been noticed several years before. The dynamic CT on January 16 revealed that the spleen was not enhanced and the splenic vein could not be traced near the spleen. A splenectomy was performed on January 16 with a preoperative diagnosis of splenic infarction. The spleen, 882g in weight, was infarcted and a partially organized splenic venous thombosis was found at the splenic hilus. The patient had not noticed any hematuria, but the Ham test and the sugar water test, which were performed postoperatively, revealed that the patient was suffering from PNH. Research has shown that thrombosis is a common complication of PNH but, to date in Japan, only a few cases of splenic infarction due to PNH have been reported. We suspect that this case of splenic infarction was caused by PNH.
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  • Ichiro Tomita, Toru Kono, Masahiro Yamada, Naoyuki Chisato, Akitoshi K ...
    2003 Volume 23 Issue 6 Pages 951-955
    Published: September 30, 2003
    Released on J-STAGE: June 03, 2011
    JOURNAL FREE ACCESS
    A 75-year-old woman was admitted to our hospital on 8th March 2001 with severe abdominal peritonitis due to rectal perforation. We operated urgently with a rectal resection and a permanent colostomy. The patient was developing septic shock, so we administered substantial doses of dopamine and noreninephrine for her poor blood circulation. We performed endotoxin elimination (PMX) and continuous hemofiltration (CHF) for her sepsis. The dosage of norepinephrine was maintained, and enabled control of the patient's blood pressure, urine volume and systemic edema. We conclude that PMX and CHF therapy is effective to improve the hemodynamic state following cardiac failure due to lower intestinal perforation.
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  • Jun Tanabe, Takashi Abe, Tamotsu Hayashi, Shigeo Wada, Masahide Oshita ...
    2003 Volume 23 Issue 6 Pages 957-960
    Published: September 30, 2003
    Released on J-STAGE: September 24, 2010
    JOURNAL FREE ACCESS
    A 23-year-old male was admitted to Osaka Police Hospital with the symptom of acute abdominal pain. He was suspected to have ileus, from plain abdominal X-ray findings. Abdominal computed tomography (CT) and ultrasonography revealed an 8cm×4cm tumor-like lesion with intestinal loops in the pelvic cavity. A barium enema revealed a severe stenosis of the sigmoid colon in the same portion. These findings suggested strongly mesenteric panniculitis of the sigmoid colon. The patient underwent a series of conservative treatments including bowel rest and the administration of antibiotics. Follow-up CT at about one month after admission showed that the lesion had disappeared completely. Mesenteric panniculitis should be included in the differential diagnosis of acute abdominal pain in young patients. As such patients can recover in a short period with conservative therapy, surgery should not be indicated promptly.
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  • Tsukasa Kinjo, Hiroki Sunagawa, Hiromitsu Aoki, Tadashi Nishimaki
    2003 Volume 23 Issue 6 Pages 961-965
    Published: September 30, 2003
    Released on J-STAGE: September 24, 2010
    JOURNAL FREE ACCESS
    Although a gastrointestinal perforation is normally regarded as an indication for an emergency operation, we experienced a rare case in which we were able to avoid an operation by cautious observation. An 8-year-old boy who fell from the top of a horizontal bar was referred to our hospital because of abdominal pain and non-bilious vomiting. Upon admission, upper abdominal pain with localized mild peritoneal irritation was noted. Abdominal CT with oral contrast medium and echo revealed a small amount of ascites in the pelvis without any free air or leakage of the contrast medium. Although an intestinal perforation was suspected, we treated him conservatively because his general condition was good. Three days after admission, his abdominal symptoms completely disappeared with only the symptom of fever remaining. Four days later, oral intake was started and five days thereafter, a plain X-ray film showed contrast medium pooling in the rectovesical pouch. At that time, only fever was noted without any abdominal symptoms, and thus conservative treatment was continued. Eight days after admission, the fever disappeared and the patient was discharged from hospital ten days after admission.
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  • Takayuki Tajima, Kyoei Morozumi, Hiroshi Miyazaki, Akio Furukawa, Mako ...
    2003 Volume 23 Issue 6 Pages 967-971
    Published: September 30, 2003
    Released on J-STAGE: September 24, 2010
    JOURNAL FREE ACCESS
    A 70-year-old man presented with lower abdominal pain and was referred to our hospital. A fist-sized mass was palpable in the lower right quadrant of the abdomen, suggesting an abscess. His clinical condition indicated the systemic inflammatory response syndrome (SIRS). We drained this mass and removed 15ml of pus. Fistulography showed that the abscess drained into the sigmoid colon. Severe inflammatory changes were found at the apex of the appendix, and the fistula ran through the abscess to the sigmoid colon. We performed an appendectomy and a partial sigmoidectomy, detecting inflammatory cell invasion in the resected appendix and sigmoid colon. We concluded that this appendiceal-sigmoid fistula had been caused by appendicitis.
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  • Kouji Shinmura, Hirofumi Gonda, Yuuji Fujii, Hideki Sakurai, Eiichirou ...
    2003 Volume 23 Issue 6 Pages 973-976
    Published: September 30, 2003
    Released on J-STAGE: September 24, 2010
    JOURNAL FREE ACCESS
    A 34-year-old woman presented at our hospital with right upper abdominal pain. She had given birth 3 days previously. Abdominal ultrasonography and CT revealed a swollen gallbladder, and a thickened wall of the fundus. She was diagnosed as having acute cholecystitis, and a laparoscopic cholecystectomy was performed immediately. There was no torsion of the gallbladder, which was strangulated by a thin funicle at the middle of the body, and dark-red in color at the fundus. It was speculated that strangulated cholecystitis caused by a funicle resulted in necrotic cholecystitis.
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  • Junya Arakaki, Manabu Kudaka, Masahito Yamazato, Syusaku Haneji, Takas ...
    2003 Volume 23 Issue 6 Pages 977-980
    Published: September 30, 2003
    Released on J-STAGE: September 24, 2010
    JOURNAL FREE ACCESS
    A 24 year old male presented with abdominal pain, nausea and vomiting on May, 2001 and was admitted to our hospital because of increased abdominal pain. An abdominal X-ray showed small intestinal gas, a niveau image, and an oval shadow 4 cm in size containing several small radiolucent masses at the right flank. An abdominal computed tomogram also showed a foreign body in the small intestine consistant with the abdominal X-ray findings. The patient was diagnosed as having foreign body ileus. A detailed history was obtained from him again which revealed that he had swallowed marijuana seeds wrapped in a condom. An emergency operation was performed on the same day. The ileum contained a hard mass 3×5cm in size which was removed through an enterotomy, and which fumed out to be the marijuana seeds wrapped in the condom.
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  • Toshio Iino, Kumiko Kato, Yoshihiko Takao, Sadao Anazawa, Yoji Yamazak ...
    2003 Volume 23 Issue 6 Pages 981-983
    Published: September 30, 2003
    Released on J-STAGE: September 24, 2010
    JOURNAL FREE ACCESS
    A 20-year-old female was admitted with the complaint of right lower abdominal pain and diarrhea. Physical examination revealed a large, tender mass in the right lower abdomen. Abdominal ultrasonography showed a target-like appearance. Under the diagnosis of intussusception, a contrast enema was performed, and the mass was easily reduced. It was considered to be an intussusception of the ileo-colic type. On postoperative day 2, no abdominal sympton was observed. On postoperative day 3, the stool culture on admission revealed Escherichia coli O157.
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  • Ryutaro Mori, Koichiro Misuta, Ryusei Matsuyama, Satoshi Hasegawa, Shi ...
    2003 Volume 23 Issue 6 Pages 985-989
    Published: September 30, 2003
    Released on J-STAGE: September 24, 2010
    JOURNAL FREE ACCESS
    A 68-year-old man had been diagnosed as having myocardial infarction, and had received anticoagulant therapy. He noticed tarry stools, and began to complain of abdominal pain and nausea with anemia two days after admission. The thickness of the intestine revealed by an abdominal CT scan suggested mesenteric ischemia, and an emergency operation was performed. Intraoperative findings confirmed, regional necrosis of the small intestine extending 3m 30cm from a point 10cm distal from Treitz's ligament. We made a diagnosis of nonocclusive mesenteric infarction (NOMI), totally resected the necrotic small intestine, and made ileal and jejunal stomas. After the improvement of the patient's general condition, we performed a staged operation with the closure of the stomas on the 39th postoperative day. Consequently, the patient could take food orally, and he was discharged on the 79th day after the first operation. Amyloidosis was considered as the possible cause of NOMI from the results of the histopathological data.
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  • Yoshiharu Nakamura, Takashi Tajiri, Kaku Egami, Moto Kashiwabara, Hide ...
    2003 Volume 23 Issue 6 Pages 991-994
    Published: September 30, 2003
    Released on J-STAGE: September 24, 2010
    JOURNAL FREE ACCESS
    We considered a strategy for the diagnosis and treatment of obturator hernia from 3 incarcerated cases. Case 1, an 80-year-old female, was admitted for sudden onset of vomiting with right femoral inside tenderness. Case 2, a 77-year-old female, was admitted for mechanical ileus with left coxa pain. The patient had been complaining of pain on either side of the coxa alternately for 2 years. Both cases were immediately diagnosed as incarcerated obturator hernia by computed tomography (CT). Case 3, a 96-year-old female with senile dementia, had a sudden attack of mechanical ileus during treatment for heart failure. Although no local symptoms, including the Howship-Romberg sign, were shown, the patient was diagnosed as having an obturator hernia from the CT findings. All 3 cases were repaired with a mesh inlay via an intra-abdominal approach. Case 2 was identified laparoscopically as having a contralateral complicating obturator hernia with an inguinal hernia.
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