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 1
Showing 1-24 articles out of 24 articles from the selected issue
  • Makoto Mitsusada, Yasushi Nakajima, Masamitsu Shirokawa, Kaoruko Seki, ...
    2012 Volume 32 Issue 1 Pages 13-18
    Published: January 31, 2012
    Released: March 27, 2012
    JOURNALS FREE ACCESS
    Of the patients with a blunt liver injury who were admitted to our hospital over a period of 2 years and 5 months, the subjects enrolled in the present study were 15 patients diagnosed with CT as having liver injury, and who underwent DIC-CT intended to diagnose intrahepatic biliary injury (IHBI) in its early stages. These 15 patients included 11 with a type IIIb injury and 4 with a type Ib injury. All of 5 patients with the type IIIb injury who underwent TAE were found to have some signs of IHBI on DIC-CT. Of these patients, 2 were found to have extrahepatic leakage and underwent local drainage; 1 also underwent ENBD and was discharged. Three patients were not found to have extrahepatic leakage even though they were found to have signs of IHBI; the 3 underwent conservative therapy with no other care and had a satisfactory course. In 6 patients with a type IIIb injury and without TAE, only 1 patient was found to have IHBI, but without extrahepatic leakage. Comparison of two groups, with or without TAE, in type IIIb injury, the former had a higher ISS and higher incidence of IHBI on DIC-CT. No TAE was needed and no sign of IHBI was found in type Ib injury patients. DIC-CT may, in cases of severe liver injury that might require TAE, help to diagnose IHBI in its early stages. Our strategy, namely performing an early examination and drainage when the extrahepatic biliary leakage is found, seemed to be adequate.
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  • Ryo Yamamoto, Hiroharu Shinozaki, Kenichi Kase, Junichi Sasaki, Kenji ...
    2012 Volume 32 Issue 1 Pages 19-23
    Published: January 31, 2012
    Released: March 27, 2012
    JOURNALS FREE ACCESS
  • Keitaro Tanaka, Junji Okuda, Keisaku Kondo, Keiko Asai, Hajime Kayano, ...
    2012 Volume 32 Issue 1 Pages 27-30
    Published: January 31, 2012
    Released: March 27, 2012
    JOURNALS FREE ACCESS
    The aim of this study was to evaluate the intraoperative complications in laparoscopic colorectal cancer surgery. From September 1993 to December 2009, laparoscopic surgery for colorectal cancer was performed in 1912 cases. The rate of conversion to open surgery due to intraoperative complications was 2.0% (39/1,912). To perform safe laparoscopic surgery, standardization of the procedure was the most important factor. In our institution, all the procedures of laparoscopic colorectal surgery were standardized in 2006. The rate of conversion in the group after standardization (0.8% (9/1,190)) was significantly lower than that before standardization (4.2% (30/722)). The main causes of conversion were massive bleeding (17 cases), problem with anastomosis (19 cases), injury of the colon (2 cases) and bowel ischemia (1 case). One of the advantages of laparoscopic surgery is to share the same operating field in the monitor for all operators. Performing laparoscopic operation with narration by the chief operator and checking by a colleague may be one of the measures to prevent intraoperative complications in laparoscopic surgery.
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  • Takatoshi Nakamura, Masahiko Watanabe
    2012 Volume 32 Issue 1 Pages 31-36
    Published: January 31, 2012
    Released: March 27, 2012
    JOURNALS FREE ACCESS
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  • Akihiro Kobayashi, Masaaki Ito, Yusuke Nishizawa, Masanori Sugito, Nor ...
    2012 Volume 32 Issue 1 Pages 37-42
    Published: January 31, 2012
    Released: March 27, 2012
    JOURNALS FREE ACCESS
    Indications for laparoscopic surgery in colorectal cancer are gradually expanding. We describe herein our views on laparoscopic colorectal cancer surgery, examine open conversion and its causes, and investigate accidental symptoms. Laparoscopic surgery must not result in reduction of the curability of the malignancy, and we do not hesitate to convert to open surgery in cases where an adequate operative field cannot be obtained due to progression. Our department had an open conversion rate of 5.3%, but there were no cases of open conversion caused by intraoperative accidental symptoms such as bleeding. However, left ureter injury and bleeding from the inferior mesenteric artery and vein as well as from around the surgical trunk have been observed. Possible intraoperative accidental symptoms were classified as follows, and their management and prevention methods were discussed: 1) bleeding; 2) intestinal or mesenteric injury; 3) damage to multiple organs; and 4) symptoms caused by mechanical failure. When performed uneventfully, laparoscopic surgery offers the merit of minimal invasiveness. Surgeons should aim to avoid postoperative complications by calmly managing any accidental symptoms that may occur.
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  • Seiichiro Yoshikawa, Masaki Fukunaga, Yoshifumi Lee, Kunihiko Nagakari ...
    2012 Volume 32 Issue 1 Pages 43-47
    Published: January 31, 2012
    Released: March 27, 2012
    JOURNALS FREE ACCESS
    Laparoscopic surgery is a useful procedure because it is minimally invasive, provides good cosmesis, early recovery, and less pain. However, once a complication occurs, all advantages are completely lost. Every effort must therefore be made to avoid complications. To avoid complications during laparoscopic surgery, maintaining a good surgical field of view and prevention of bleeding are important. We studied the management of operative bleeding in advanced laparoscopic surgery based on our experiences of laparoscopy-assisted gastrectomy and laparoscopy assisted colectomy.
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  • Hirochika Makino, Chikara Kunisaki, Yusuke Izumisawa, Motohiko Tokuhis ...
    2012 Volume 32 Issue 1 Pages 49-55
    Published: January 31, 2012
    Released: March 27, 2012
    JOURNALS FREE ACCESS
    Aim: To clarify the predictive factors for the surgical complications of laparoscopy-assisted distal gastrectomy (LADG), surgical outcomes were evaluated. Methods: Between April 2002 and December 2007, 152 patients with preoperatively diagnosed early gastric cancer who underwent LADG were enrolled. Visceral (VFA) and subcutaneous fat areas (SFA) were assessed with Fat Scan software. The predictive factors for surgical complications of LADG were evaluated with univariate and logistic regression analyses. Results: Of 152 patients, conversion to open surgery due to uncontrollable bleeding was observed in nine male patients, and postoperative complications were detected in seven male and one female patient (four anastomotic leakage, two intraabdominal abscess, one pancreatic fistula, and one lymphorrhea). High body mass index (BMI) and high VFA independently predicted conversion to open surgery and postoperative complications. No significant difference was observed in the BMI between male and female patients. However, VFA was significantly higher, operation time was longer, blood loss was greater, and SFA was lower in male than in female patients. Conclusions: High BMI and high VFA can predict technical difficulties during laparoscopic gastric surgery and postoperative complications. Particularly, LADG should be performed cautiously to prevent surgical complications for male patients with a high VFA.
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  • Shinya Tanimura, Naoki Hiki, Soya Nunobe, Takeshi Kubota, Takeshi Sano ...
    2012 Volume 32 Issue 1 Pages 57-62
    Published: January 31, 2012
    Released: March 27, 2012
    JOURNALS FREE ACCESS
    Laparoscopic gastrectomy procedures for gastric cancer have been increasing in number in Japan, because the skill of the procedure has been spread among many institutions. It is thought to be very important to prevent and reduce intraoperative accidents and postoperative complications. In this paper, we present the pitfalls and troubleshooting problems associated with laparoscopic gastrectomies for gastric cancer.
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  • Naoyuki Toyota, Keiji Sano
    2012 Volume 32 Issue 1 Pages 63-70
    Published: January 31, 2012
    Released: March 27, 2012
    JOURNALS FREE ACCESS
    Operative complications are reviewed in 1,064 patients with laparoscopic cholecystectomy performed in our institution during the latest 13 years. Biliary injury occurred in eight patients (0.75%), and injury of other organs in five (0.47%). The injury sites of the biliary tract are the common bile duct in two (one with concomitant injury in the left hepatic duct), the common hepatic duct in two (one with concomitant injury in the right hepatic duct), the right hepatic duct in two, and the peripheral biliary branch around the gallbladder bed in three. Conversion to laparotomy was selected in five, three cases of bilio-biliary anastomosis and two of bilio-enteric anastomosis. To avoid these biliary complications, the biliary system should be carefully investigated before the operation. If an anomaly is detected and is expected to cause biliary injury, endoscopic naso-biliary (or naso-gallbladder) drainage should be performed for the intraoperative cholangiography and tube-guided dissection around the bile duct. In all five cases with injury to other organs (small intestine in two, duodenum in two, and stomach in one), salvage was done under laparotomy. Careful insertion of the first trocar with a mini-laparotomy and the prohibition of blind handling should be kept in mind for prevention.
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  • Mototsugu Matsunaga, Tetsuya Aizawa, Takuya Noguchi, Nobuhiro Kubo, Ts ...
    2012 Volume 32 Issue 1 Pages 71-74
    Published: January 31, 2012
    Released: March 27, 2012
    JOURNALS FREE ACCESS
    We report on a case of a mobile cecum with ileus caused by internal herniation. A 91-year-old woman was admitted to our hospital with vomiting and lower abdominal pain. An abdominal CT scan revealed a strangulated ileus and an emergency operation was performed. The intraoperative findings revealed that the ileocecal region was not fixed to the retroperitoneum. Laparotomy showed that the vermiform appendix was firmly adherent to the mesentery of the small intestine and the ileum was rotated. Since the patient had a mobile cecum, after releasing the rotation, she underwent an appendectomy and cecopexy between the cecum and the retroperitoneum. The postoperative course was uneventful and she has had no recurrence after the operation. The mobile cecum is not uncommon and we should thus keep this condition in mind in the diagnosis of ileus.
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  • Sho Sato, Kazutaka Narui, Hirohito Fujikawa, Tsutomu Hayashi, Toru Kub ...
    2012 Volume 32 Issue 1 Pages 75-78
    Published: January 31, 2012
    Released: March 27, 2012
    JOURNALS FREE ACCESS
    A 38-year-old woman visited our hospital because of abdominal pain and nausea within a day of onset of the symptoms. She was menstruating at that time. We found diffuse abdominal tenderness and elevated inflammatory reaction. A CT scan revealed a dilated intestine and ascites so that we diagnosed her as having strangulated ileus and performed an emergency operation. In the operation, we found that there was 200mL of bloody ascites and adhesion of the terminal ileum with the sigmoid colon and rectum 10cm from Bauhin's valve. We performed adhesiotomy and found a sharp bend in the ileum. We resected the bent ileum and performed an end to end anastomosis. The postoperative course was uneventful and the patient was discharged from the hospital 12 days after the operation. Pathological findings revealed diffuse endometrial tissue from the submucosa to the subserosa of the ileum, so we diagnosed it as ileal endometriosis. After the operation, we performed colonoscopy but there was no anomaly in the sigmoid colon and rectum. The preoperative diagnosis was strangulated ileus because of the physical findings and bloody ascites, but no blood circulation disorder was noted. The pathological diagnosis was ileal endometriosis which was not consistent with the preoperative diagnosis, so it is an interesting case. We report on this case, together with some bibliographic comments.
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  • Yutaka Takano, Masanori Ohdaira
    2012 Volume 32 Issue 1 Pages 79-82
    Published: January 31, 2012
    Released: March 27, 2012
    JOURNALS FREE ACCESS
    The patient was a 31-year-old woman who had undergone 2 cesarean sections. She was referred to our hospital with a tender abdominal mass. She was examined and followed up as an outpatient, but her pain increased, and the development of severe symptoms of ileus necessitated emergency admission to the hospital. An abdominal CT revealed distended small intestinal loops in the median ventral area of the pelvic cavity and a small amount of ascites. The contrast enhancement was favorable for the intestinal tract, and the patient was diagnosed as having simple intestinal obstruction. The mass formation was not clear. An intestinal tube was inserted, which did not result in any improvement; therefore surgery was performed. The small intestine was found to be firmly adherent to the mass, with adhesiolysis being difficult to perform; therefore, the mass was removed en bloc with the small intestinal segment containing it. Examination of the resected mass revealed a towel inside the mass. The towel had entered the small intestine and was surrounded by the intestinal lumen, the mesentery, and the greater omentum. We believe that the towel may have been left behind at the time of the cesarean section.
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  • Manabu Nakamura, Katsuhiko Ishizaka
    2012 Volume 32 Issue 1 Pages 83-86
    Published: January 31, 2012
    Released: March 27, 2012
    JOURNALS FREE ACCESS
    A 68-year-old man with a one-week history of right lower abdominal pain, vomiting and diarrhea visited our emergency room because of severe right lower abdominal pain. The physical examination revealed abdominal distention, tenderness and muscular defense in the entire abdomen. Maximal tenderness was noted in the right lower quadrant. Upright X-ray films of the chest and abdomen showed free air under the right diaphragm and calcification in the right lower abdomen. Abdominal CT showed a gas-containing abscess with calcification in the pericecal region, a small amount of ascites and intra-abdominal free air. In addition, CT images showed a lesion suspected of being a tumor because of marked thickening of the wall of the cecum. We performed an ileocecal resection with lymph node dissection under a suspected diagnosis of a rupture of the pericecal abscess due to acute appendicitis or a cecal tumor. The intraoperative and histopathological findings were gangrenous appendicitis with appendiceal calculi. The pneumoperitoneum might have been caused by rupture of the gas-producing pericecal abscess.
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  • Tetsuya Shirota, Satoshi Asai, Takuya Yamaguchi, Ryou Tanaka, Takuji M ...
    2012 Volume 32 Issue 1 Pages 87-89
    Published: January 31, 2012
    Released: March 27, 2012
    JOURNALS FREE ACCESS
    We report on a case diagnosed as eosinophilic enteritis on the basis of findings obtained during an emergency laparoscopy-assisted small intestine resection for an intestinal obstruction with ascites of unknown cause. A 62-year-old woman was admitted to our hospital for abdominal pain and vomiting, with fullness and tenderness observed in the lower abdomen. A hematological examination revealed an elevated white blood cell count, while the eosinophil count was normal. Abdominal CT visualized marked intestinal dilatation and ascites in the pouch of Douglas. Therefore we suspected that the patient had peritonitis caused by strangulation ileus and she underwent emergency laparoscopic exploration. An intraperitoneal search found an induration about 1.5cm in size with marked reddening in the ileum. Since a tumorous lesion was undeniable, a small abdominal section was made to perform laparoscopy-assisted surgery. Microscopic examination of the resected specimen showed eosinophilic enteritis of the predominantly transmural type. The postoperative course was favorable.
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  • - Our Countermeasures to Such Cases as One of the Hospitals with Secondary Emergency Medical Care -
    Shigeru Fujisaki, Ryouichi Tomita, Motoi Takashina, Tadatoshi Takayama
    2012 Volume 32 Issue 1 Pages 91-95
    Published: January 31, 2012
    Released: March 27, 2012
    JOURNALS FREE ACCESS
    Our hospital provides secondary emergency medical care, which can deal with emergency surgery, mechanical ventilation, and adsorption of blood endotoxins, as necessary during the course of hospitalization. Few patients who need tertiary emergency care are carried by ambulance to our hospital. Concerning acute abdomen, among patients who are carried to our hospital as secondary emergency, however, some cases have a serious underlying disease, such as cirrhosis. We experienced two cases of acute abdomen, which were transported by ambulance to our hospital during the night, without information on concomitant liver cirrhosis. Peritonitis with liver cirrhosis is prone to deterioration. Even if a patient is in a stable condition on arrival, it is necessary to recognized the hidden disease quickly. We report on the standard operating procedure as to how a secondary medical facility deals with these patients.
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  • A Case Report
    Syuji Tagami, Ippei Murata, Kazuki Shimizu, Yukari Kobayashi, Yoshikaz ...
    2012 Volume 32 Issue 1 Pages 97-100
    Published: January 31, 2012
    Released: March 27, 2012
    JOURNALS FREE ACCESS
    A 33-year old male was transferred to the ER of our institution by ambulance after a head-on vehicle collision. Initial physical examination did not reveal any abnormal findings in the patient's abdomen except pressure marks from the seatbelt and the patient was released with a diagnosis of contusions of the chest and abdomen. Later, the patient returned to the hospital with increasing abdominal pain. Tenderness was observed at the patient's lower left abdomen. An abdominal CT scan with contrast-enhancement showed small amounts of ascites and exiguous free air at the upper left quadrant. Thickening of the jejunal wall adjacent to the free air was also noted and an operation was performed with the diagnosis of traumatic perforation of the small intestine. Laparoscopic examination identified a perforation at the jejunum approximately 20cm distal to the Treitz ligament. Several other damaged areas were observed but were limited to the serosa of the jejunum around the Treitz ligament. The perforation was restored from a small incision at the upper abdomen under direct vision. The patient recovered and was discharged 6 days after the operation. Traumatic perforation of the small intestine is rare and difficult to locate pre-operatively. The present case suggested that laparoscopic evaluation prior to surgical repair helps determine the location of a perforation.
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  • Yasuhiro Ito, Tomoyuki Irino, Tomohisa Egawa, Shinobu Hayashi, Atsushi ...
    2012 Volume 32 Issue 1 Pages 101-104
    Published: January 31, 2012
    Released: March 27, 2012
    JOURNALS FREE ACCESS
    Liver cysts are a common disease without symptoms and clinical problems. We report on a case of an infected liver cyst associated with cholangitis and cholecystitis. A 74-year-old woman visited our hospital with fever, right hypochondrial pain and abdominal compression. Abdominal ultrasonography and enhanced CT revealed an infected liver cyst, cholangitis and cholecystitis. We performed an endoscopic retrograde cholangiopancreatography and stenting, and the patients symptoms rapidly improved. On day two after the admission, she had a fever of 38°C and upper abdominal pain. Percutaneous transhepatic drainage of the cyst was therefore performed. A catheter was inserted into the cyst. The symptoms resolved and the patient left our hospital on day four after the drainage. We remove a drainage catheter because of no fever and pain. An infected liver cyst is rare and the process of infection in these cysts is not clear. We therefore suggest further study in many cases.
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  • Hiroshi Nagata, Hirotaka Honjo, Tomoyuki Ohta, Shigetoshi Yamada, Nobu ...
    2012 Volume 32 Issue 1 Pages 105-107
    Published: January 31, 2012
    Released: March 27, 2012
    JOURNALS FREE ACCESS
    A 78-year-old female had a history of an open total gastrectomy and Roux-en-Y reconstruction for gastric cancer two years prior to admission. She was transferred to our medical center with the chief complaint of acute abdominal pain with vomiting. Contrast-enhanced abdominal CT demonstrated a lack of bowel-wall enhancement from the Roux limb to the transverse colon with interruption of the superior mesenteric artery. We performed an emergency laparotomy under the diagnosis of superior mesenteric arterial occlusion and found a herniation of the small intestine into the space dorsal to the Roux limb. The reduction of the herniation restored the blood flow and intestinal resection was avoided. The mesentric ischemia was probably caused by the torsion of the superior mesentric artery. The lesson is that an internal hernia is one of the important complications of Roux-en-Y reconstruction and it can present as acute mesentric ischemia.
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  • Takeshi Matsutani, Hiroshi Yoshida, Akira Matsushita, Hiroshi Maruyama ...
    2012 Volume 32 Issue 1 Pages 109-113
    Published: January 31, 2012
    Released: March 27, 2012
    JOURNALS FREE ACCESS
    A 74-year-old man underwent a total gastrectomy, partial resection of the lower esophagus via light thoracotomy, an intrathoracic esophagojejunal anastomosis, and Roux-en-Y reconstruction. Six months after surgery, he was admitted to the hospital because of dysphagia. Upper gastrointestinal endoscopy revealed an esophagojejunal anastomotic stricture. During the dilatation with an endoscopic balloon, the patient suddenly complained of chest pain and dyspnea. Mucosal injuries on the anastomosis were found, clinically suggesting an esophageal rupture. The left respiratory sound disappeared by auscultation with stethoscope. A chest CT scan revealed a left tension pneumothorax. Chest drainage was performed via the fourth intercostal space on the anterior axillary line, and the symptoms were reduced. After drainage for three weeks, the pneumothorax was improved, and the chest drainage tube removed. On the follow-up upper gastrointestinal endoscopy, the damaged mucosa on the anastomosis was restored, and the patient was able to ingest well. This case report indicated that the tension pneumothorax had been caused by an iatrogenic esophagus perforation after endoscopic balloon dilatation of the anastomotic stricture.
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  • Kazuyuki Yamamoto, Katsuhiko Murakawa, Misa Noguchi, Toru Koide, Yoshi ...
    2012 Volume 32 Issue 1 Pages 115-119
    Published: January 31, 2012
    Released: March 27, 2012
    JOURNALS FREE ACCESS
    We report on a case of ruptured aneurysm of the posterior superior pancreaticoduodenal artery (PSPDA). A 70-year-old man visited the emergency room at our hospital with abdominal pain and vomiting. Computed tomography (CT) of the abdomen showed hemorrhagic ascites around the liver and the retroperitoneal cavity. Emergency angiography revealed 2 aneurysms in the PSPDA; therefore, embolization was immediately performed. The patient was then treated conservatively. His general condition improved, and he was discharged on the 13th day after admission. In the treatment of a ruptured aneurysm of the pancreaticoduodenal artery, transarterial embolization (TAE) is the first treatment of choice after diagnosis because it is less invasive than operative treatment. Here, we report on a case in which application of TAE for a PSPDA aneurysm rupture saved the patient's life. We also review 98 cases reports on pancreaticoduodenal artery (PDA) aneurysms and the treatment for them in the Japanese literature.
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  • Nobuaki Hoshino, Yoshihisa Shibata, Takehito Kato
    2012 Volume 32 Issue 1 Pages 121-124
    Published: January 31, 2012
    Released: March 27, 2012
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    We report on a case of a periappendicular abscess due to late-onset mesh infection after an inguinal hernia repair. A 69-year-old man came to our hospital with right inguinal swelling and pain. A tension-free mesh hernioplastry had been performed for a right inguinal hernia five years and ten months previously. On physical examination, the patient's right hernia repair inguinal scar was reddish and tender. Computed tomography revealed a right inguinal phlegmon and an abscess between the appendix and the plug. The patient was treated with antibiotics for one week but the abscess cavity did not get any smaller, so we resected the appendix and removed the plug and the abscess. Culture of the abscess revealed Bacteroides sp. The pathological examination revealed inflammation of the granulation tissue around the plug and no inflammation of the appendix. Our diagnosis was a periappendicular abscess due to late-onset mesh infection. The patient recovered uneventfully.
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  • Mayuko Shibata, Ken Shimada, Tasuku Hanajima, Hiroshi Kawamata2, Yuich ...
    2012 Volume 32 Issue 1 Pages 125-128
    Published: January 31, 2012
    Released: March 27, 2012
    JOURNALS FREE ACCESS
    A 79-year-old man with abdominal pain and vomiting as the chief complaints was brought to our hospital. Abdominal findings were mild tenderness in the lower right abdomen without peritoneal irritation. Abdominal CT did not show free air in the abdominal cavity. Although the patient underwent conservative treatment, abdominal findings worsened and CRP levels increased on day 2, and, hence, surgery was performed. Mass lesions and perforation were confirmed in the ileum. A diagnosis of perforative peritonitis due to ileac tuberculosis was made based on pathological examination of an isolated preparation. Enteric tuberculosis associated with perforation is rare in senior citizens, and the associations with malnutrition and a decrease in immunity were suggested for the patient. It was thought that the possibility of tuberculosis always warrants consideration when evaluating immunocompromised patients or those with a history of tuberculosis.
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  • Naoya Fukuda, Toshihiko Kuwatani, Masatoshi Kadoya, Tetsuro Takebayash ...
    2012 Volume 32 Issue 1 Pages 129-133
    Published: January 31, 2012
    Released: March 27, 2012
    JOURNALS FREE ACCESS
    A 51-year-oldman suffered an abdominal bruise because of a work-related accident and was brought to our ER. 1 hour after the injury, abdominal CT suggested intraperitoneal and retroperitoneal bleedings. Five hours after the injury, CT showed active bleeding, so an emergency laparotomy was performed. The intraoperative findings confirmed traumatic duodenal transection (TDT), intraperitoneal and retroperitoneal bleedings and transverse colon necrosis. End-to-end anastomosis of the duodenum and a right hemicolectomy were performed. On postoperative days 28, a second surgery was performed because of an anastomotic leak, gallbladder necrosis and a biliopancreatic fistula. The patient was discharged on postoperative days 78. To date, only 18 cases of TDT have been reported in Japan. The circumstance of injury were mainly traffic accidents. An emergency laparotomy was performed in 9 cases within 6 hours after the injury. Among 18 cases, performed end-to-end anastomosis of the duodenum was performed in 6 cases, duodenojejunostomy in 4, end-to-end anastomosis of duodenum in 6, and pancreaticoduodenectomy or duodenal diverticulization in 2 cases. 15 cases were rescued among the 18 cases. In conclusion, it is possible to save the lives of TDT patients by performing the appropriate operation.
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  • Nao Tamada, Hideaki Goto, Yoshihiro Yamaguchi
    2012 Volume 32 Issue 1 Pages 135-139
    Published: January 31, 2012
    Released: March 27, 2012
    JOURNALS FREE ACCESS
    We report herein on a rare case of idiopathic perforation of the transverse colon. A 76-year-old female was hospitalized with abdominal pain and hemorrhagic stools. An abdominal CT showed free air and fluid in the intraperitoneal space. We immediately performed emergency surgery under the diagnosis of perforation of the colon. A perforation on the opposite side of the mesentery of the transverse colon and a large amount of feces in the abdominal cavity were found. A Hartmann operation was performed. Due to septic shock, the patient needed intensive care. The histopathological findings revealed idiopathic perforation of the colon. We have concluded that idiopathic perforation of transverse colon is one of the causes of diffuse peritonitis.
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