Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine)
Online ISSN : 1882-4781
Print ISSN : 1340-2242
ISSN-L : 1340-2242
Volume 32 , Issue 7
Showing 1-26 articles out of 26 articles from the selected issue
  • -Our Experience-
    Akihiro Uno, Atsuko Fukazawa, Kazuhiko Fukumoto, Osamu Jindo, Keigo Ma ...
    2012 Volume 32 Issue 7 Pages 1137-1142
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
    Acute bowel obstruction due to advanced colorectal cancer represents an oncologic emergency requiring immediate surgical treatment. The postoperative morbidity and mortality rate is unacceptably high in emergency operations for colorectal obstruction because of the poor condition of the patient and intraoperative difficulties in handling bowel distention and fecal loading. The aim of this study was to review our experiences and outcomes in transanal tube decompression for malignant colorectal obstruction as a preoperative treatment. We retrospectively examined 75 patients with malignant colorectal obstruction over the past 11 years for whom transanal intubation and decompression was attempted. Placement of the drainage tube was successfully performed in 69 (92%) of 75 cases, whereas 6 patients underwent an emergency operation after unsuccessful transanal decompression. In 69 cases of successful placement of a drainage tube, one patient underwent an emergency operation because of insufficient decompression on the day following placement of the drainage tube. Another 2 patients required an emergency operation for bowel perforation due to pressure from the tip of the drainage tube. Sixty-one patients (92.4% of those with successful placement) had elective single-stage surgery. Our review suggested that transanal drainage tube decompression for malignant colorectal obstruction is useful for avoiding an emergency operation, and allows safer single-stage surgery in most cases.
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  • Kikuo Kanda, Ryukichi Akashi, Masahiko Hirota
    2012 Volume 32 Issue 7 Pages 1143-1149
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
    In this report, we describe the outcome of endoscopic therapy for acute cholangitis caused by bile-duct stones treated in our hospital from January 2006 through December 2010. Endoscopic treatments were performed in 235 patients. Although two 89-year-old women with respiratory disease died, conditions improved in more than 99% of patients following treatment with endoscopic biliary drainage (EBD) using a fine caliber tube stent. We investigated the relating factors between the clinical data and fasting period. The factors for a long-term fasting period were gallstone pancreatitis, body temperature, Charcot triad and systemic inflammatory response syndrome (SIRS). Therefore, coexistence of disorders of the respiratory system and gallstone pancreatitis should be included in the next edition of the Japanese Clinical Guidelines for Acute Cholangitis.
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  • Satoshi Koizumi, Shinjiro Kobayashi, Hiroyuki Negishi, Kazuhiro Miura, ...
    2012 Volume 32 Issue 7 Pages 1151-1156
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
  • Junichi Matsumoto, Takayuki Hattori, Hirotaka Yamashita, Shingo Hamagu ...
    2012 Volume 32 Issue 7 Pages 1159-1162
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
    The spleen is the most frequently injured abdominal organ. As compared with the liver, the spleen has a weaker parenchyma and is more prone to injury and to difficulty in achieving hemostasis of internal bleeding. Because bleeding is one of the spleen's weak points, transcatheter arterial embolization (TAE) should be performed when arterial injury has occurred without capsular disruption. Multi-detector array CT (MDCT) provides useful and important information for the selection of management in trauma. It provides information about injury to both the vessels and the parenchyma, and can show extravasation, pseudoaneurysm formation and capsular disruption. Classical classifications of organ injury and the revised classification by the Japanese Association for the Surgery of Trauma in 2008 do not contain information on of vascular injuries, which are now recognized as critical findings in management. Nakajima et al. suggested a new MDCT grading system for splenic injury in 2008 which is based on the system by Shanmuganathan and is aimed to correlate with injury management in primary trauma care.
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  • Jun Sasaki, Ryouhei Suzuki, Youhei Kitamura, Kazuaki Yokomizo, Yoshito ...
    2012 Volume 32 Issue 7 Pages 1163-1167
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
    The treatment strategies for traumatic splenic injuries have shifted from surgical intervention to nonoperative management (NOM) including conservative medical treatment and transcatheter arterial embolization (TAE). Recent advances in multi-detector CT allow rapid and accurate diagnosis of the injuries. In particular, arterial and equilibrium phase imaging enable the detection of the presence/absence of extravasation and pseudoaneurysms. Moreover, prompt and selective hemostasis can be achieved with the widespread use of TAE. Our success rate with NOM was 92.5%. However, surgical treatment was also performed in 22% of the total number of cases. TAE and surgical intervention were needed in 78% of gradeIIIb cases. Comprehensive evaluation of vital signs, contrast-enhanced CT images and associated injuries are important for diagnosis and treatment of traumatic splenic injuries.
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  • Kunihiro Shinjo, Koichi Sato, Hiroshi Maekawa, Mutsumi Sakurada, Hajim ...
    2012 Volume 32 Issue 7 Pages 1169-1173
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
    Non-operative management (NOM) of splenic injury has become the standard of care in hemodynamically stable patients. However, the criteria for NOM are a matter of debate. To determine the therapeutic limit of NOM, we performed a retrospective review of 38 trauma patients with splenic injury admitted between January 2000 and December 2009. In the initial treatment, 8 patients (21.1%) underwent surgical operations and 30 patients were treated with NOM. NOM was successful in 22 patients (73.3%). Bleeding-related factors correlated with NOM failure. Five patients (13.2%) died, and severe head injury was responsible for 4 of these deaths. Thus, most cases of splenic bleeding can be controlled by operation or angioembolization. Nevertheless, cases involving severe head injury show a high mortality rate.
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  • Kohei Morimoto, Junichi Matsumoto, Yoshiaki Ichinose, Takayuki Hattori
    2012 Volume 32 Issue 7 Pages 1175-1180
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
    The spleen is the solid organ most frequently injured in blunt abdominal trauma. The treatment of traumatic splenic injuries has changed substantially, from surgical to nonsurgical management because the use of multi-detector row CT (MDCT) has become widespread and Interventional Radiology techniques have also progressed. Transcatherter arterial embolization (TAE) is very effective for controlling arterial bleeding and less invasive than surgery. Familiarity with the adaptation, angiographic findings, strategy of embolization and embolic materials is mandated, and the complications associated with splenic arterial embolization should be understood. Threatening the life of patients must not be allowed by sticking to TAE, and to start TAE as soon as possible, it is important to organize both the IVR team and systematization of the hospital.
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  • Shinjiro Kobayashi, Satoshi Koizumi, Akiyoshi Noda, Masafumi Katayama, ...
    2012 Volume 32 Issue 7 Pages 1181-1185
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
    Pancreatic duct disruption accompanied by pancreatic trauma is very severe. When a patient's hemodynamic status is unstable in primary survey, an emergency operation is performed as resuscitation. The principle of treatment for pancreatic trauma with major pancreatic ductal injury is an operation. However, even if the pancreatic duct is injured, there will be some cases in which surgery can be avoided by using endoscopic stent placement. There were 3 cases of pancreatic injuries (type IIIb) in our hospital. As for the treatment method, the Letton & Wilson approach was applied in in 2 and endoscopic stent treatment in 1 case. All cases achieved remission and were discharged. Our treatment strategy for the traumatic injuries to the pancreas was useful. Furthermore, when interventional radiology and an operation can be performed, non-operative management (NOM) with an endoscopic pancreatic stent is one option for the treatment of pancreatic trauma with major pancreatic ductal injury.
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  • Tomohiro Funabiki, Motoyasu Yamazaki, Tomohiko Orita, Masayuki Shimizu ...
    2012 Volume 32 Issue 7 Pages 1187-1193
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
    We examined retrospectively 28 consecutive patients with bowel and mesenteric injuries in a 54-month period. Of the 19 blunt trauma patients, 13 (68%) were injured in a trafficaccident. A CT scan was obtained in 18 patients prior to surgery and extraluminal air was seen in only 6 cases (33%). Of three hemodynamically stable patients with neither extraluminal air nor extravasation from the mesenteric artery as seen on CT, two underwent diagnostic laparoscopy, and one had a repeat CT scan after 20 hours, and they were all diagnosed correctly. Of the 9 penetrating injury cases, 8 cases underwent a CT scan. Two cases with small abdominal wall damage and hemodynamically stability also underwent diagnostic laparoscopy. In hemodynamic unstable patients we should perform laparotomy as soon as possible, but if the patient is hemodynamic stable, we should perform diagnostic laparoscopy (or diagnostic peritoneal lavage) and CT scan, to reduce the nontherapeutic laparotomy. Transcatheter arterial embolization is effective in controlling mesenteric artery-related bleeding, but was not performed in the present study because bowel injuries could not be ruled out based on only CT scan data.
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  • Kimio Asagiri, Naoko Komatsuzaki, Motomu Yoshida, Yoshinori Koga, Shin ...
    2012 Volume 32 Issue 7 Pages 1195-1200
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
    We have experienced 23 cases (27 sites) of children with abdominal trauma at our hospital during the past ten years. The present study analyzed the results of treatment in these patients and discussed optimal treatment strategies. Even in children with abdominal trauma it was possible to perform interventional radiology (IVR) safely. Trauma severity was significantly worse in patients receiving IVR than in the non-IVR group, but within the IVR-treated group there was no significant difference in severity between patients who did or did not receive transarterial embolization (TAE). However, it took significantly less time for those receiving TAE to be taken to the angiography room compared with the non-TAE group, and close communication with the patients' previous doctor allowed TAE to be performed more expeditiously. In the case of abdominal trauma to children, rapid and accurate evaluation is of the utmost importance. To achieve this, it is essential that emergency physicians, pediatric surgeons, and radiologists pool their respective knowledge and skills when treating such patients. Further, it is necessary to develop an organizational structure that can respond to any emergency on a 24-hour basis.
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  • Tomoyuki Ohta, Nobuyasu Kano, Hiroshi Kusanagi, Masaki Ohashi, Takeshi ...
    2012 Volume 32 Issue 7 Pages 1201-1207
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
    Life-threatening trauma has decreased due to the improvement in the rate of wearing seat belts. On the other hand, blunt abdominal trauma due to seat belt has increased. The style of the trauma has attracted enough attention to be called ‘seat belt injury’. Due to the submarine phenomenon, a seat belt shifts to the abdomen, and organs in the abdominal cavity can be sandwiched between the abdominal wall and the vertebral body, and the seat belt injury occurs. We present here in two patients with seat belt injury that we experienced in our hospital. We demonstrate the mechanism of seat belt injury, the difference in damage caused by the kind of the seat belt, and the traffic rules about the seat belt in Japan. When we treat any traffic injury patient, we should always have coexistence of the intestinal tract damage in mind. Furthermore, we should keep it in mind that an intestinal tract explosion or an intestinal tract stenosis can occur at late onset after injury. In addition, we should usually deepen our understanding about the operative techniques specific to a variety organs because seat belt injury may cause the multiple organ damage other than the intestinal tract damage. In particular, injuries to the duodenum, pancreas, and diaphragm can be easily overlooked and we often pay the price later for having overlooked such injuries and their treatment.
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  • Sonofu Taketani, Fumitake Hata, Shingo Kitagawa
    2012 Volume 32 Issue 7 Pages 1209-1212
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
    We report herein on a stab wound to the abdomen. A 34-year-old female came to the emergency room with a knife wound to the abdomen following a suicide attempt. No abnormalities were reported following an enhanced CT scan. However, CT after stabography demonstrated that the abdominal wall had been penetrated, so a diagnostic laparoscopy was performed which ruled out intra-abdominal organ injury. CT with stabography and diagnostic laparoscopy are effective to decide on the appropriate therapeutic strategy for stab wounds.
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  • Takeshi Endo, Chifumi Fukuda, Katsuhiro Shinohara, Masafumi Ito
    2012 Volume 32 Issue 7 Pages 1213-1215
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
    A 50-year-old woman was admitted to our hospital because of abdominal pain (especially the lower abdomen) and vomiting. She had given birth to one daughter with natural delivery 20 years previously. CT imaging showed a stricture in the small intestine caused by the supportive tissue in the left side of the uterus. Therefore, the diagnosis of an internal hernia near the left broad ligament of the uterus was obtained, and an abdominal operation was performed. Intra-abdominally, we saw a large amount of hemorrhagic ascites with the loss of 3cm in the left broad ligament of the uterus and the necrosis in small intestines of about 90cm. We excised the necrotic small intestine and closed up the loss of the ligament.
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  • Hirotsugu Morioka, Akihiro Miki, Keita Fukuyama, Yasuhide Ishikawa
    2012 Volume 32 Issue 7 Pages 1217-1219
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
    Spigelian hernias are very rarely encountered, accounting for 0.12^2% of all abdominal hernias. We report herein on a case of incarcerated Spigelian hernia repaired with the ULTRAPROTM Hernia System (UHS). A 75-year-old man presented with left lower abdominal pain. He had a history including both a gastrectomy and a bilateral inguinal hernioplasty. Abdominal computed tomography showed an incarcerated lower abdominal wall hernia lateral to the left rectus abdominis muscle. Reduction of the hernia content by hands was impossible, therefore an emergency operation was indicated. Operative findings showed that the hernia orifice was located in the Spigelian aponeurosis with a lateral extension to the internal oblique muscle. We applied UHS, a light-weight, partially absorbable mesh device, for the repair. The underlay patch was positioned in the preperitoneal space and the onlay patch above the Spigelian aponeurosis and the internal oblique muscle, while the connector obliterated the hernia orifice. The patient's postoperative course was uneventful, and the pain was minimal. We conclude that UHS is a useful device for Spigelian hernia repair.
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  • : Report of a Case and a Review of Atraumatic Splenic Ruptures in the Japanese Literature
    Kazuhiko Fukumoto, Takanori Sakaguchi, Takanori Hiraide, Yasushi Shiba ...
    2012 Volume 32 Issue 7 Pages 1221-1225
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
    A 53-year-old man visited our hospital with sudden left upper abdominal pain and no history of trauma. Slight elevation of serum liver enzyme levels alone was observed in the blood biochemistry. Enhanced abdominal CT showed intra-abdominal fluid collection with a rupture at the lower pole of the spleen and extravasation of the contrast medium. Splenic arteriography revealed the presence of small aneurysms in the spleen. Based on the patient's medical record and normal findings of both hematology and imaging, a splenectomy was performed under the diagnosis of atraumatic splenic rupture (ASR). On pathological examination, the presence of pseudoaneurysms in the spleen accompanied with disruption of the arterial media was confirmed without neoplasm or inflammation. The final diagnosis was, therefore, a spontaneous splenic rupture. The patient was discharged on day 9 after surgery without complications. The small arterial disorders seen in this patient may have the potential to induce an atraumatic splenic rupture in cases without any clinical background. We herein report on this rare case of spontaneous splenic rupture with a Japanese literature review.
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  • : 37 Cases in Our Hospital
    Taeko Sasaki, Noriaki Kameyama, Masato Tomita, Hiroaki Mitsuhashi, Nob ...
    2012 Volume 32 Issue 7 Pages 1227-1230
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
    Treatment for groin hernia is usually elective surgical repair, however, strangulated hernias require an emergency operation because of the high morbidity and possible mortality in elderly patients. We operated on 37 cases of incarcerated or strangulated groin hernia from January 2007 to June 2011. During this term, 586 cases of groin hernia were operated on in our hospital. Thirty-seven cases included 23 indirect inguinal hernias, 2 direct inguinal hernias, 11 femoral hernias and 1 of unknown cause. Thirty-one of the 37 cases required immediate operation and there were 11 cases of strangulated hernia that led to excision of organs, namely 7 of the bowel and 4 of the omentum. For those cases in whom the period from the start of subjective symptoms to the hospital visit was 6 hours or less, no excision of organs was required. In contrast, in 6 of 14 cases in which this period was over 24 hr, resection of organs was required. The doctors who are examining patients with acute abdomen should palpate the inguinal area, for hernias. Moreover, public education is necessary regarding groin hernias, including incarcerated and strangulated hernias.
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  • Masaru Matsushima, Kenichi Takahashi, Yuji Funayama, Akihiro Yasumoto, ...
    2012 Volume 32 Issue 7 Pages 1231-1234
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
    A 71-year-old woman visited our emergency department with abdominal pain and vomiting starting the night of December 25, 2010. On arrival, her abdomen was distended and peritoneal irritation was present. Plain abdominal x-ray showed air-fluid levels. Computed tomography of the abdomen revealed wall thickening of the small intestine, dilatation of the proximal small intestine, and moderate-volume ascites. An emergency laparotomy was performed under a diagnosis of ileus. Serous ascites was found in the peritoneal cavity. The small intestine was greatly dilated with wall thickening at three portions between 306cm and 404cm distal from the ligament of Treiz. Food residues were incarcerated in one of these portions, suggesting dietary ileus. The small intestine (approximately 1m) was partially resected. Postoperatively, the patient was found to have eaten raw squid before this episode. Serum testing for anti-Anisakis IgG and IgA antibody titer was positive and parasitic bodies of Anisakis were confirmed histopathologically. Her postoperative course was uneventful and she was discharged 14 days after the operation. Small intestinal anisakiasis is relatively rare and difficult to diagnose definitively. When a patient presents with acute abdomen accompanied by ileus, small intestinal anisakiasis should be included among the differential diagnoses and surgery should be considered.
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  • Jun Okamura, Michiko Kitagawa, Yoshihisa Suminaga
    2012 Volume 32 Issue 7 Pages 1235-1238
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
    Isolated gallbladder injury due to blunt trauma is a rare entity, and in particular there are only a few reported cases of intramural gallbladder hematoma. We report herein on our case of intramural gallbladder hematoma which was successfully treated with conservative treatment. A 15-year-old schoolboy soccer player was admitted to the emergency department with acute abdominal pain after falling on the soccer ball. On admission, he had stable vital signs and examination of his abdomen disclosed slight right hypochondrial pain without peritoneal signs. Blood analysis showed slight elevation of hepatic enzyme and biliary tract enzyme levels but neither leukocytosis nor anemia. Abdominal CT showed gallbladder wall thickening and an intramural hematoma. His clinical symptoms were stable, so a conservative treatment approach was adopted. His clinical course was uneventful and he was discharged 6 days after injury. In an imaging examination 1 month after injury, the gallbladder wall was still thickening but there was no intramural hematoma, and at 3 months after injury, imaging still showed no abnormal findings.
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  • Yukihiro Minagawa, Osamu Shimooki, Chihiro Tohno, Tsutomu Tohsya, Masa ...
    2012 Volume 32 Issue 7 Pages 1239-1242
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
    Non-occlusive mesenteric ischemia (NOMI) is a condition in which an ischemic lesion occurs in the digestive tract in the absence of organic blockage in a major artery, and is typically associated with a poor prognosis. We report herein on the case of a 76-year-old female patient who was examined at the emergency center with abdominal pain as the main complaint. An abdominal CT scan revealed free gas and ascites, but no blockage in the superior mesenteric artery. The patient was diagnosed as having diffuse peritonitis caused by gastrointestinal perforation and was admitted to surgery for an emergency abdominal operation. During the operation it was found that a large volume of excreta had leaked out intra-abdominally, and perforation was found in the sigmoid colon. A macular, discontinuous, black discoloration presented in the sigmoid colon, uterus and serous membrane of the urinary bladder, suggesting ischemia; a similar finding of continuous ischemia was made for the serous membrane in the whole area of the small intestine, approximately 30cm from the end of the ileum. The pathological finding revealed perforation in the diverticulum of the sigmoid colon, while the small intestine presented with hemorrhage in the serous membrane, blood congestion in the submucosa, and necrosis. These findings led to a diagnosis of NOMI.
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  • Eiji Yamamura, Motoyasu Yamazaki, Yasuhiro Ito, Tomohiro Funabiki, Tom ...
    2012 Volume 32 Issue 7 Pages 1243-1245
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
    A 74-year-old female visited the emergency outpatient department because of repeated vomiting after undergoing an extended hysterectomy for pre-existing endometrial cancer. Slight tenderness was observed in the right hypogastrium, and an X-ray examination of the abdomen revealed localized mild intestinal dilation. She was diagnosed as having a strangulated ileus on the basis of the abdominal CT findings, and emergency surgery was performed. The small intestine formed dilated loops because of a cord-like structure, which ran along the right external iliac artery. This structure was confirmed to be the right external iliac vein. We were able to reposition the incarcerated and dilated bowel manually. We think that an internal hernia was caused by straying of the small intestine into the gap present between the external iliac vein and external iliac artery, and this resulted in the strangulated ileus formation.
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  • : A Case Report
    Hisatake Matsumoto, Shinichi Mizuno, Masayuki Hibino, Eiji Nishigaki, ...
    2012 Volume 32 Issue 7 Pages 1247-1250
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
    A 36-year-old female presented to the hospital with fever and abdominal pain. Pronounced tenderness was observed in her right lower quadrant and physical examination showed abdominal defence and rebound tenderness. Biochemical blood testing showed that the C-reactive protein revel was elevated. A high and low echogenic lesion was found in her right lower quadrant with abdominal ultrasound (US) examination. Computed tomography (CT) showed a space-occupying lesion with fat density in the same abdominal area seen with US examinations. On the basis of the clinical findings, the initial possible diagnosis was appendicitis although the appendix was not clearly detectable on either US or CT examination. An emergency laparotomy was performed. In the abdominal cavity there was a large volume of hemorrhagic ascites and the right part of the greater omentum showed a necrotic change due to the omental torsion. On the other hand her appendix did not appear to be inflamed. Consequently partial resection of the greater omentum was performed. The cause of this torsion was unclear from the intraoperative findings.
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  • Hiroko Hashikata, Ken Shimada, Koichi Yamamoto, Sadataka Asakuma, Yuic ...
    2012 Volume 32 Issue 7 Pages 1251-1254
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
    A 61-year-old-man who had drunk too much alcohol and fell down some stairs outdoors was transferred to a nearby hospital. Based on the CT findings, the patient was suspected as having intra-abdominal hemorrhage and was transferred to our emergency center. On examination, he was diagnosed as having gallbladder injury, and careful observation was decided on. Five days after the trauma, he exhibited peritoneal irritation. Abdominal enhanced computed tomography demonstrated suspected late rupture of the gallbladder, and an emergency laparotomy was performed. Bile-like peritoneal fluid was found in the abdomen. Cholecyhe stectomy and intraoperative cholangiography was performed, revealing no rupture of the gallbladder or damage to the bile duct. The cause of bile peritonitis was believed to be biliary oozing through avulsion of the cholecystic mucosa. The gallbladder is usually protected from trauma. In this case, due to the patient's state of inebriation, the tonicity of the abdominal wall was weak and he was unable to defend himself when he fell. Moreover, it was supposed that an increase of the internal pressure in the gallbladder and bile duct resulting in filling up of the gallbladder and contraction of the sphincter of Oddi brought about the resulting gallbladder injury.
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  • Kaori Tanaka, Makoto Yamada, Tsuneaki Hato, Satoshi Matsui
    2012 Volume 32 Issue 7 Pages 1255-1258
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
    This report presents a case of necrotic ischemic colitis which spread to involve the total colon from which the patient was able to survive following surgical treatment. An 81-year-old male was admitted to the hospital because of severe abdominal pain. Abdominal CT scan showed a dilated colon filled with a lot of feces, so he was diagnosed as having constipation. CT on the next morning showed a dilated colon filled with fluid. Sigmoid colon fiberoscopy revealed ischemic changes of the sigmoid colon. The abdominal pain worsened, the abdominal muscular defense became harder and the patient went into shock, so an emergency operation was performed. Laparotomy revealed massive bloody ascites and the large intestine was necrotic from the cecum to the sigmoid colon, so a total colectomy was conducted. The gangrenous area was found to have migrated from the cecum to the terminal ileum during surgery, which mandated an additional excision of the terminal ileum and construction of an ileostomy. The patient was finally diagnosed as having necrotic ischemic colitis based on the histological findings.
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  • Hirofumi Kon
    2012 Volume 32 Issue 7 Pages 1259-1262
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
    Case 1 was a female in her 70's with 5-year hemodialysis history who visited the Department of Cardiology in our hospital for evaluation of coronary artery calcification and a thoracic aortic aneurysm. She underwent a computed tomography (CT) scan because free air was discovered on chest X-ray imaging. A CT scan revealed diverticulosis of the sigmoid colon and free air. We performed emergency surgery under the diagnosis of sigmoid colon diverticulosis with perforation. Diverticulosis with associated pus was observed in the sigmoid colon, and we performed Hartmann's operation. The patient was discharged on postoperative day 30. Case 2 was a male in his 70's with a 9-year hemodialysis history who visited the Department of Cardiovascular Surgery in our hospital for the purpose of a periodic inspection after coronary artery bypass graft surgery. The patient complained of low grade fever and general fatigue at that time and was admitted to the Department. A CT scan revealed diverticula of the sigmoid colon, which had collapsed, and fluid mixed with air in the pouch of Douglas. We performed emergency surgery under the diagnosis of sigmoid colon diverticulosis with perforation. Intraoperatively a perforated diverticulum was observed in the sigmoid colon, and we performed Hartmann's operation. The patient was discharged on day 104, although he needed continuous hemodiafiltration, direct hemoperfusion with polymyxin B immobilized fiber and long-term respirator management. These two abdominal findings were is very mild, so that, based on them, we did not diagnose gastrointestinal perforation at first. It is considered that chronic dialysis patients, particularly the elderly, might lack clinical manifestations such as abdominal pain, and therefore careful attention is necessary.
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  • Sho Sato, Shigeru Yamagishi, Kouichi Haruta, Atsushi Ishibe, Kenichi M ...
    2012 Volume 32 Issue 7 Pages 1263-1266
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
    We report herein on a 63-year-old-woman with a past history of multiple liver and renal cysts and who was undergoing hemodialysis for chronic renal failure. She visited our ER because of vomiting, when abdominal distention, swelling of the liver and the Howship-Romberg sign were noted. Abdominal CT revealed soft tissue which had invaginated the right obturator foramen, a dilated intestine and retained bowel fluid, so that she was diagnosed as having ileus due to a right obturator hernia and we performed an emergency operation. Intraoperatively, multiple liver and renal cysts obscured the operative view, because of which we simply released the invagination and finished the operation. On the 23rd day after the discharge from the hospital, she noted lower abdominal pain, and visited our ER again. Abdominal CT revealed recurrence of the right obturator hernia and we performed an emergency operation within a day. We took a preperitoneal approach and covered the obturator foramen and the myopectineal orifice with a Kugel Patch. There are few case reports of obturator hernia repair with a Kugel Patch, therefore it may be useful to report this operation for recurrent cases.
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  • Kenichi Inaoka, Takaya Miwa, Tomoki Fukuoka
    2012 Volume 32 Issue 7 Pages 1267-1269
    Published: November 30, 2012
    Released: March 08, 2013
    JOURNALS FREE ACCESS
    A 77-year-old woman visited our hospital because of a right lower abdominal wall swelling. She had a fist-sized induration in the right lower abdominal wall. Laboratory studies showed inflammation. Abdominal CT findings showed abdominal wall abscesses, and we performed percutaneous drainage. We surmised that the wall abscess had formed due to a perforated appendix, so we drained the abscess as much as possible and cleaned it. On the 14th day, we performed an operation. Intraoperatively we found an incarcerated appendix in right inguinal fossa, so an appendectomy and drainage were carried out. We report herein on this rare case of abdominal wall abscess duo to acute appendicitis in an inguinal hernia, with some bibliographical comments.
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