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 6
Showing 1-25 articles out of 25 articles from the selected issue
  • Eiji Ikeda, Masatoshi Kuroda, Hisashi Tsuji, Ryuji Hirai, Shoji Takagi ...
    2012 Volume 32 Issue 6 Pages 999-1005
    Published: September 30, 2012
    Released: January 08, 2013
    JOURNALS FREE ACCESS
    We reviewed 113 patients with resected obstructive colorectal cancer between January 2002 and February 2012. Emergency surgery was applied in patients with severe condition, long-term disease and rigid feces in the colon. Surgery was performed in the remaining mild condition patients within 7 days after decompression. Primary anastomosis was done in the cases in whom on table lavage was effective and who were suitable for anastomosis. Laparoscopic surgery was applied in patients with good working intraperitoneal space after decompression, excluding cases with several large, invaded or concomitant metastatic cancer of the lymph nodes. All cases were divided into 54 open surgery cases and 59 laparoscopic cases for assessment of morbidity and prognosis. There were no surgery-related deaths, and the laparoscopic conversion rate was 3.4%. The patients in the laparoscopic group, even at stage IV or higher, had significantly less operation time, less bleeding, fewer complications, and a shorter hospital staying after surgery compared with the patients in the open surgery group. We reported no difference in anastomotic leakage between the two groups and no bowel obstruction after surgery in the laparoscopic group (p<0.01). There was no difference in the overall five year survival rate between both groups. We concluded that our strategy of treatment for obstructive colorectal cancer was appropriate.
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  • Akihiro Mori, Masashi Nozaki, Noritsugu Ohashi, Nobutoshi Fushimi, Ats ...
    2012 Volume 32 Issue 6 Pages 1007-1012
    Published: September 30, 2012
    Released: January 08, 2013
    JOURNALS FREE ACCESS
    Aims: Transnasal esophagogastroduodenoscopy (TNE) has been reported to be less stressful to the cardiovascular system and tolerable in patients without sedation. Because of this, we considered that TNE may be safe and useful in emergency endoscopy. We assessed the feasibility, diagnostic capability and safety of emergency TNE (e-TNE) in the study. Methods: We performed TNE prospectively and sequentially under non-sedation in patients having an episode of upper gastrointestinal bleeding, and evaluated diagnostic capability and cardiovascular responses during e-TNE. Results: Emergency endoscopies were performed in 210 patients, among whom we could confirm the diagnosis in 203 patients (97%) (including 80 peptic-ulcer patients) with e-TNE. Endoscopic hemostases were performed in 58 patients, in which we accomplished the first hemostasis in 40 patients (69%) with TNE alone with an epinephrine injection. There were no significant cardiovascular changes or major complications during e-TNE. The rebleeding rate of e-TNE was 8% (3 patients). Conclusion: TNE in emergency cases appears to be sufficiently feasible and safe with good diagnostic capability. The procedure may be reasonable as an alternative for first look in emergency endoscopy.
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  • Yoshinori Oikawa, Michiya Bandou, Yuujirou Murata, Syouichi Hattori, M ...
    2012 Volume 32 Issue 6 Pages 1013-1019
    Published: September 30, 2012
    Released: January 08, 2013
    JOURNALS FREE ACCESS
    Between 2005 and 2010, we experienced 5 cases of torsion of the gallbladder, and examined useful findings for their preoperative diagnosis. We were able to diagnose 2 cases in 5 preoperatively, in which direct findings showing torsion of the gallbladder, such as the lack of contrast in the gallbladder wall on contrast-enhanced CT, the tapering and twisted cystic duct with coronal section image of contrast-enhanced CT, and disappearance of the bloodstream signal in the gallbladder wall on color Doppler sonography, were useful for the preoperative diagnosis. In addition, the following 7 factors were noted in all of 5 patients, including elderly female, lean figure, kyphosis, right hypochondrial pain in the physical examination, significant swelling of the gallbladder, floating gallbladder, and a high density area in the gallbladder wall suggesting hemorrhagic necrosis with an attenuation value ranging from 35 to 65 Hounsfield units on plain CT. It was thought that these were indirect findings seen with an increased frequency in torsion of the gallbladder. Our data suggested that, if these indirect findings were seen, they might lead to a preoperative diagnosis of torsion of the gallbladder when taken in combination with coronal section imaging on contrast-enhanced CT and color Doppler sonography.
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  • Atsushi Miyamoto, Tadahumi Asaoka, Masakazu Ikenaga, Masayoshi Yasui, ...
    2012 Volume 32 Issue 6 Pages 1023-1026
    Published: September 30, 2012
    Released: January 08, 2013
    JOURNALS FREE ACCESS
    We investigated the present status of surgical site infection (SSI) in gastroenterological emergency surgery based on the surveillance data of our institute. The rate of SSI in the 217 patients studied was 31.3%, and it was significantly higher than that of the patients who underwent operations in scheduled procedures. Among the emergency procedures, the rate of SSI was more than 50% in the patients who were operated on for gastrointestinal perforation. The factors associated with SSI in the group of patients with gastrointestinal perforation were age and intraoperative blood loss, and age was the only independent risk factor for SSI in these patients according to a multiple logistic regression analysis.
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  • Yu Sawada, Hirotoshi Akiyama, Ryusei Matsuyama, Tomoko Wada, Itaru End ...
    2012 Volume 32 Issue 6 Pages 1027-1031
    Published: September 30, 2012
    Released: January 08, 2013
    JOURNALS FREE ACCESS
    Surgical site infection (SSI) is the most frequent post-appendectomy complication. SSI adversely affects the length of hospitalization, quality of life, other postoperative outcomes, and costs. We reviewed the prevention of SSI after surgery for acute appendicitis. It was previously reported that a wound protection device, laparoscopic approach, and synthetic absorbable sutures reduced the incidence of SSI after appendectomy, but SSI standardized guidelines for prophylaxis of SSI after appendectomy have not been established. We studied the risk factors of SSI in our hospitals which are included in the Yokohama Clinical Oncology Group. In a multivariate analysis, paramedian or midline incision (p=0.020), intraabdominal drain (p<0.001), and gangrenous appendicitis (p=0.001) were significant predictors of incisional SSI. Blood loss (p=0.018) and intraabdominal drain (p=0.002) were significant predictors of organ / space SSI. In some patients with gangrenous appendicitis, a device for protecting the wound was used. However, there was no significant difference in the rate of SSI between patients with or without such protection. Further study for the prevention of SSI after an appendectomy, especially in patients with gangrenous appendicitis, is required.
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  • Motoi Uchino, Hiroki Ikeuchi, Yoshio Takesue, Naohiro Tomita
    2012 Volume 32 Issue 6 Pages 1033-1039
    Published: September 30, 2012
    Released: January 08, 2013
    JOURNALS FREE ACCESS
    Purpose: Few studies have investigated the risk factors for surgical site infection (SSI) in patients with ulcerative colitis (UC) and no known precise evaluation of risk factors has been presented. We evaluated the influences of patient conditions on the occurrence of SSI following surgery for UC. METHODS: SSI in 192 UC patients restricted to wound class 2 and in 90 UC patients with urgent/emergency surgery was investigated. Possible risk factors for SSI were analyzed. RESULTS: The incidence of incisional SSI was 12.5% and that of organ/space SSI was 1.6% in patients with wound class 2. In a stepwise logistic regression model, total prednisolone 10,000 mg and ASA score3 were shown to be risk factors for incisional SSI. Incidences of incisional SSI and organ/space SSI in urgent/emergency surgery which increased significantly with a higher wound class were 31.1% and 6.7%, respectively. A multivariate analysis showed a wound class3 and preoperative prednisolone50 mg/day as risk factors for incisional SSI and Hartmann’s procedure for organ/space SSI. CONCLUSION: Our results indicate that a higher steroid dose is related to incisional surgical site infection in patients with ulcerative colitis. Emergency total colectomy with a mucous fistula in patients with a high wound class could be feasible rather than Hartmann’ procedure.
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  • Yusuke Ito, Mototaka Inaba, Kouji Amano, Yohei Ieki, Yasuyuki Hayashi, ...
    2012 Volume 32 Issue 6 Pages 1041-1044
    Published: September 30, 2012
    Released: January 08, 2013
    JOURNALS FREE ACCESS
    We retrospectively examined surgical site infection (SSI) in patients undergoing surgery for the perforation of the lower intestinal tract. We divided them using the Hinchey classification. From Apr. 2007 to Oct. 2010, 60 cases were examined. The rate of occurrence of SSI was stage I 30%, stage II 25%, stage III 75%, and stage IV 81.8%. To reduce the occurrence of SSI, we suggest that it is important to treat patients according to their respective Hinchey classification. It is difficult to avoid the occurrence of SSI in patients at stage III and IV. We need to consider a special management in these patients, such as delayed primary closure or one layer suture using stainless steel.
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  • Kimihiro Igari, Takanori Ochiai, Shigeru Yamazaki, Yoshinori Inoue
    2012 Volume 32 Issue 6 Pages 1045-1049
    Published: September 30, 2012
    Released: January 08, 2013
    JOURNALS FREE ACCESS
    Surgical site infection (SSI) is a major source of morbidity after emergency abdominal surgery in elderly patients. We retrospectively reviewed 165 patients over 80 years old, who had undergone emergency abdominal surgery at Ohta Nishinouchi General Hospital between April 2003 and March 2009, in whom we investigated the occurrence of SSI, and evaluated the risk factors for SSI. The significant variables identified by univariate analyses were serum albumin, creatinine and procedure of ostomy. Multivariate analyses identified an ostomy procedure as an independent risk factor of SSI. We should consider the potential of a higher occurrence rate of SSI if the an ostomy procedure is performed in elderly patients.
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  • Takaaki Fujii, Toshinaga Sutoh, Hiroki Morita, Reina Yajima, Toshihide ...
    2012 Volume 32 Issue 6 Pages 1051-1056
    Published: September 30, 2012
    Released: January 08, 2013
    JOURNALS FREE ACCESS
    We have assessed the factors that would be most predictive of postoperative incisional surgical site infection (SSI) in colorectal surgery and have previously demonstrated that the risk of incisional SSI increases with obesity, and that the most useful predictor of incisional SSI is the thickness of the subcutaneous fat (TSF), as evaluated by preoperative CT. Based on this finding, we have recently attempted a closure technique in surgery for the obese in which a subcutaneous drain is inserted for the prevention of incisional SSI. We have assessed the utility of a subcutaneous drain for preventing incisional SSI in patients undergoing colorectal surgery who are at high risk for incisional SSI, including patients with obesity (thick subcutaneous fat tissue, <20 mm) and those undergoing emergency operations. In this review, we summarize the effectiveness of subcutaneous drains for preventing incisional SSI in patients with thick subcutaneous fat or following an emergency operation in colorectal surgery, and we propose incisional SSI surveillance for obese patients, which should lead to a further reduction in incisional SSIs.
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  • Takayuki Naruse, Makoto Murakami, Yusuke Fujimoto, Katsuji Sawai, Mits ...
    2012 Volume 32 Issue 6 Pages 1057-1060
    Published: September 30, 2012
    Released: January 08, 2013
    JOURNALS FREE ACCESS
    [Introduction] Since the incidence of lower intestinal perforation is high in the elderly, except for appendicitis, and can be aggravated in many cases, superficial SSI tends to be made light of. In this study, we investigated the usefulness of subcutaneous drainage to prevent superficial SSI. [Subjects and Methods] In this retrospective study, we analyzed 73 patients who underwent a surgical operation for small and large intestinal perforations between January 2007 and June 2011: 26 and 47 in groups with and without subcutaneous drainage, respectively. The subcutaneous drain used was a closed-suction type in all patients:Jackson-Pratt in 15, JVAC in 6, and SB bag in 5. [Results] Superficial SSI occurred in 3/26 (11.5%) and 20/47 (42.6%) in the groups with and without drainage, respectively, showing a significant difference (p<0.05). [Discussion] It is problematic that the discovery of superficial SSI can be delayed because many patients have severe infection. The prevention of superficial SSI is important because it is not only problematic during hospitalization, but it also may cause abdominal wall incisional hernia in the future. Subcutaneous drainage after surgery of contaminated and unclean wounds may be effective to prevent superficial SSI.
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  • Toshihiro Suzuki, Hitoshi Kubota, Hideaki Suzuki, Eiji Hayashi, Shusak ...
    2012 Volume 32 Issue 6 Pages 1061-1064
    Published: September 30, 2012
    Released: January 08, 2013
    JOURNALS FREE ACCESS
    We report herein on a case of torsion of the gallbladder that was preoperatively diagnosed with abdominal computed tomography and MRCP. An 82-year-old woman was admitted to our hospital with acute right upper quadrant pain. CT showed a massively distended floating gallbladder, but it was not enhanced. Moreover, MRCP showed tapering interruption of the cystic duct and deviation of the gallbladder. Based on these findings, we diagnosed torsion of the gallbladder, and emergency laparoscopic surgery was performed. The gallbladder had fallen into a gangrenous state, and was twisted 180 degrees clockwise along its longitudinal axis. After the gallbladder was untwisted, a laparoscopic cholecystectomy was easily performed. Due to the improvement of imaging, preoperative diagnosis is more accurate than before. It is important to keep this disease in mind. Since torsion of the gallbladder is caused by a floating gallbladder, laparoscopic cholecystectomy is recommended because of less adhesion.
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  • Soutoku Someya, Michinaga Takahashi, Shinji Goto, Syun Sato, Mitsuhisa ...
    2012 Volume 32 Issue 6 Pages 1065-1069
    Published: September 30, 2012
    Released: January 08, 2013
    JOURNALS FREE ACCESS
    We report herein on two cases of gallstone ileus. Patient 1: A 65-year-old woman visited our hospital because of nausea. Abdominal computed tomography revealed a pigeon egg-sized, stone-like foreign body in the distal ileum, causing intestinal obstruction. Gallstone ileus was suspected, and treated conservatively. Seven days after admission, the stone was evacuated in feces. Because subsequent radiological gastrointestinal series, endoscopy, and MRCP showed cholecysto-duodenal fistula, the patient was finally diagnosed as having gallstone ileus. Patient 2:An 85-year-old man was referred to our hospital complaining of vomiting and lower abdominal pain. A large gallbladder stone was identified, and abdominal computed tomography revealed an incarcerated pigeon egg-sized gall stone at the horizontal duodenum with disappearance of the gallbladder stone. Endoscopy showed a spherical gallstone which was incarcerated at the horizontal duodenum. An attempt to remove the stone via an endoscopic technique was unsuccessful. The patient was diagnosed as having gallstone ileus, and was treated conservatively. The stone in the horizontal duodenum was propelled to the distal small intestine 7 days after admission. Because the stone was stuck in the mid ileum on the 11th post-admission day, the patient underwent lithotomy by incising the ileum via a small laparotomy. He was discharged from the hospital on the 26th postoperative day. Although the the stone in these two cases was almost identical, one needed an operation and other did not.
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  • Hiroyuki Koami, Shinichiro Kameyama, Tomonari Ishimine, Tsutomu Isa
    2012 Volume 32 Issue 6 Pages 1071-1074
    Published: September 30, 2012
    Released: January 08, 2013
    JOURNALS FREE ACCESS
    We report herein on one case of preoperative diagnosis of a strangulated hernia through a defect in the broad ligament, followed by surgery. The patient was a female in her 40's with lower abdominal pain and vomiting. She was referred to our hospital for an additional checkup. Computed tomography demonstrated a dilated small bowel loop in the pelvis, and mesentery of the small bowel had impacted left head side of the uterus. A strangulated hernia was suspected. Laparotomy revealed that a 20-cm length of the ileum had herniated into the defect in the left broad ligament, and was resected followed by end-to-end anastomosis and closure of the defect. The patient was discharged after 10 days. Although we diagnosed the condition preoperatively, but were unable to avoid resection of the intestine. It is thought with the choice of diagnostic therapy that an open laparoscopy is more useful in an early stage to avoid resection of intestine for cases of ileus without any history of laparotomy.
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  • Takashi Ikebe, Katsuyuki Mayumi, Takayoshi Nishioka, Genya Hamano, Tak ...
    2012 Volume 32 Issue 6 Pages 1075-1078
    Published: September 30, 2012
    Released: January 08, 2013
    JOURNALS FREE ACCESS
    The patient was a 39-year-old woman. At the age of 37 years, she underwent a radical hysterectomy and intravaginal irradiation for cervical cancer. When she visited her neighborhood hospital with complaints of right lower abdominal pain and fever in February 2010, she was diagnosed as having acute appendicitis. She was then referred to our department. Severe tenderness and peritoneal irritation were found in the right lower quadrant. Abdominal computed tomography revealed a 7×4-cm cyst in the right iliac fossa. An enhanced inflammatory response was indicated by a white blood cell count of 17,700 cells/mm3 and C-reactive protein levels of 7.1 mg/dL. Based on these findings, acute appendicitis with a retroperitoneal abscess was diagnosed, and surgery was performed. Laparoscopic observations revealed a hen’s egg-sized mass with mild inflammation of the covering peritoneum in the right iliac fossa. The mass, which was laparoscopically resected, was a unilocular cyst containing pus-like fluid. The appendix vermiformis was normal and left untreated. A histopathological examination indicated a simple cyst, and cytology of the content fluid did not reveal any malignant cells. A bacterial culture grew Streptococcus agalactiae. Tumors arising from the retroperitoneum account for only 0.2% of tumors occurring in the human body. Although the resection of cystic tumors including those in the retroperitoneum is considered preferable, some studies report that a watchful-waiting strategy can be applied in cases without subjective symptoms. In our case, the cyst was infected, contributing to abdominal pain. Thus, the cyst was laparoscopically resected.
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  • Toru Terabayashi, Kiyoshi Hiramatsu, Yoshito Okada, Kengo Kimura, Hiro ...
    2012 Volume 32 Issue 6 Pages 1079-1082
    Published: September 30, 2012
    Released: January 08, 2013
    JOURNALS FREE ACCESS
    A 69-year-old man, complaining of abdominal pain, was admitted to our hospital. He has a past history of gastrectomy for a hemorrhagic gastric ulcer 30 years previously. We performed an emergency operation, as abdominal enhanced CT revealed a “target sign” of the small intestine in the left, upper abdomen, which represented the ongoing intussusception of the jejunum. We found that the reconstruction after gastrectomy had been made in the Billroth II manner with a Braun’s anastomosis, and that the efferent distal jejunum from the Braun's anastomosis had invaginated the afferent loop toward the remnant stomach through the Braun's anastomosis in a retrograde fashion. No lesions, such as tumors, likely to cause the intussusceptions could be recognized. A Hutchinson procedure was performed. The patient’s postoperative course was uneventful without recurrence. We report herein on this rare case of retrograde intussusception of the jejunal loop through a Braun’s anastomosis, and review the relevant Japanese literature.
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  • Kazuhiro Mikagi, Masafumi Yasunaga, Yuhei Kitasato, Munehiro Yoshitomi ...
    2012 Volume 32 Issue 6 Pages 1083-1086
    Published: September 30, 2012
    Released: January 08, 2013
    JOURNALS FREE ACCESS
    A 71-year-old man who had undergone percutaneous transhepatic biliary drainage (PTBD) for obstructive jaundice in another hospital was admitted to our hospital for further evaluation and treatment. He was diagnosed as having distal bile duct cancer, and underwent a pancreaticoduodenectomy. On the 11th postoperative day, he developed fever and vomiting, without signs of peritoneal irritation or acidosis. Abdominal ultrasound demonstrated high-intensity echoes moving in the portal vein. CT showed branching radiolucencies in the peripheral intrahepatic portal vein branches, gastric dilatation, and gastric emphysema. Portal venous gas due to increased intragastric pressure was diagnosed. Since his condition was stable, he was conservatively treated with gastric decompression and antibiotic therapy. Portal venous gas disappeared the next day, and he resumed oral nutrition one week later. His subsequent clinical course was uneventful. We report herein on a patient who developed portal venous gas after pancreaticoduodenectomy, and was successfully treated conservatively.
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  • Hisashi Kuroda, Naruki Higashidate, Masahiko Nakano, Masaya Tanaka, Ka ...
    2012 Volume 32 Issue 6 Pages 1087-1091
    Published: September 30, 2012
    Released: January 08, 2013
    JOURNALS FREE ACCESS
    The case in question involved a 67-year-old male. Due to diabetes and high blood pressure, the patient was undergoing internal medical treatment. The patient habitually consumed alcohol and had recently increased his intake. In the course of one evening, the patient became aware of upper abdominal pain and was referred to our hospital by a local physician the following morning. En route to hospital, the patient presented with shock, respiratory failure and systemic inflammatory response syndrome (SIRS). Tenderness and muscular defense were observed in the upper abdomen. Fat necrosis of the transverse mesocolon, inflammation and an extensive retroperitoneal space extending to the inferior pole of the right kidney and emphysema in the omental sac were observed on the CT imaging from the previous physician. Three prognostic factors and CT Grade 2 were determined according the criterion for determination of the severity of acute pancreatitis. The imaging showed no perforation in the upper gastrointestinal tract and a diagnosis of sever acute pancreatitis complicated by emphysema was reached, prompting the performance of an emergency surgical procedure. The findings of the procedure revealed peripancreatic fat necrosis, infectious effusion and pneumoretroperitoneum. Procedures performed included drainage of the omental sac and pancreatic bed. Necrotic tissue and blood cultures revealed klebsiella oxytoca. The post-operative progress was smooth and the patient was transferred to the care of a local physician on the 59th day after surgery. Reports of acute pancreatitis complicated by emphysema from the early stages of the appearance of symptoms are rare and this case is reported together with a limited review of the literature.
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  • Byonggu An, Tomoyuki Mizukuro, Kyozo Hashimoto, Yoshihiro Endo
    2012 Volume 32 Issue 6 Pages 1093-1096
    Published: September 30, 2012
    Released: January 08, 2013
    JOURNALS FREE ACCESS
    We report herein on a case of ileus due to incarceration of the small intestine into a reconstructed pelvic floor after abdominoperineal resection of the rectum. A 58-year-old male underwent abdominoperineal resection for advanced rectal cancer. On day 6 post-surgery, the patient complained of epigastralgia and nausea; X-ray films revealed post-operative ileus. He was managed with long intestinal tube decompression, but the ileus did not improve. Plain pelvic computed tomography showed a space occupied lesion (SOL) 4cm in diameter under the reconstructed pelvic floor. During surgery done at this time, it was found that a portion of the small intestine located 10cm proximal to the terminal ileum was incarcerated into the reconstructed pelvic floor. The small intestine was decompressed, and the pelvic floor was reconstructed. The incarcerated small intestine could be preserved as it was not necrotic. The patient's post-clinical course was uneventful and chemotherapy was started.
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  • Kenichi Nakamura, Masato Ohyama, Norihiko Yamamoto, Mamoru Shimada, Hi ...
    2012 Volume 32 Issue 6 Pages 1097-1101
    Published: September 30, 2012
    Released: January 08, 2013
    JOURNALS FREE ACCESS
    A 72-year-old man with no history of surgery was referred for abdominal pain and vomiting which had lasted for ten days. Abdominal CT revealed dilatation of the small intestine with contrast enhancement of the small intestine. We conducted conservative long-tube therapy under the diagnosis of ileus, but failed to treat the condition, so an operation was performed. An oval defect approximately 4cm in diameter was found in the mesentery of the transverse colon and the part of the jejunum 100cm distal to the Treitz ligament had invaginated and adhered to the defect. The invaginated intestine was reduced but stenosis was severe, so we performed a partial resection of the jejunum and the defect of the mesentery was closed by suturing. We report herein on a case of rare transverse mesocolon hernia with a review of the literature.
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  • Shoji Hirajima, Hisashi Ikoma, Hiromichi Ishii, Yusuke Yamamoto, Ryo M ...
    2012 Volume 32 Issue 6 Pages 1103-1106
    Published: September 30, 2012
    Released: January 08, 2013
    JOURNALS FREE ACCESS
    In a 61-year-old male, duodenal perforation occurred following endoscopic submucosal dissection (ESD) for early duodenal cancer. On the same day, an emergency laparotomy was performed. For repair, a T-tube measuring 13 mm in diameter was inserted into the 3-cm perforation site at the descending limb of the duodenum. Seven days after surgery, an intraperitoneal hemorrhage was seen due to leakage at the repair site. Hemostasis under laparotomy and duodenojejunostomy was performed. Subsequently, multiple abscesses involving the dorsal side of the right kidney to chest wall/mediastinum developed. At the same site, emphysema related to air infusion on endoscopic treatment was also observed. An oblique incision was established in the right ventral region 19 days after the initial surgery, and open-drainage of the retroperitoneal cavity was conducted. The patient was admitted to the ICU. Under mechanical ventilation, manual lavage was performed for 32 days. Subsequently, the abscess cavity gradually reduced, and the patient was discharged 195 days after the initial surgery. Advances in endoscopic techniques have increased the number of patients for whom endoscopic treatment is indicated. With this tendency, the incidence of complications, which had been low, has also increased. In this study, we report on a patient in whom post-ESD duodenal perforation resulted in retroperitoneal abscess, and review the literature.
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  • Manabu Nakamura
    2012 Volume 32 Issue 6 Pages 1107-1111
    Published: September 30, 2012
    Released: January 08, 2013
    JOURNALS FREE ACCESS
    A 74-year old woman who underwent open surgery because of gastric cancer and cholecystolithiasis, turned out to have liver cirrhosis on an intraoperative liver biopsy and suffered from an anastomotic stenosis.From the 24th postoperative day, the patient had a slight fever, appetite loss and vomiting. On postoperative day 40, abdominal X-ray showed bowel obstructive ileus and severe stenosis at the proximal jejunum was detected with small intestinal radiography. On the following day, abdominal CT revealed thrombosis in the superior mesenteric vein, portal vein and the proximal branch of jejunal vein. Since CT did not show intestinal necrosis, conservative therapy with urokinase and heparin was started systemically. The affected jejunum was serially examined with intestinal contrast studies. Six months after surgery, a jejuno-jejunostomy was performed because of a marked stenosis in the jejunum. The blood coagulation studies were within normal limits.
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  • Yukihiro Tatekawa
    2012 Volume 32 Issue 6 Pages 1113-1118
    Published: September 30, 2012
    Released: January 08, 2013
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    Adnexal torsion is an uncommon but important cause of low abdominal pain in women, and differentiation from other causes of an acute abdomen is often difficult. Diagnosis and surgical intervention tend to be delayed because of the nonspecific symptoms. This paper presents four female children with uterine adnexal torsion diagnosed and treated with laparoscopic surgery. They were 4, 5, 13 and 9 years old, and suffered from torsion of the right normal ovary, the right ovarian teratoma, the right parovarian cyst, and the left parovarian cyst, respectively. They complained of abdominal pain and vomiting, but blood examinations did not show any characteristic findings. The durations from the onset of the symptoms to operation were 2 days, 3 days, 3 days, and 5 days, respectively. Preoperative radiological examinations consisted of abdominal ultrasound, computed tomography, and magnetic resonance imaging, which showed suspected torsion of the normal ovary and the ovarian tumor, but the torsion of the parovarian cyst was initially diagnosed with laparoscopic surgery. Laparoscopic surgery is recommended as not only a diagnostic procedure but also a treatment strategy without complications for patients with uterine adnexal torsion.
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  • Ryo Seishima, Yoshimasa Shimizu, Yoshifumi Takenaka, Takayuki Furuuchi ...
    2012 Volume 32 Issue 6 Pages 1119-1122
    Published: September 30, 2012
    Released: January 08, 2013
    JOURNALS FREE ACCESS
    While driving, a 22-year-old female was involved in a collision with another car, and was injured by the steering wheel. She was admitted to our hospital with right upper abdominal pain. Computed tomography of the abdomen showed a 5cm sized hematoma at the dorsum of the duodenal second portion. The patient’s clinical course was uneventful until the 9th hospitalization day when she vomited. A nasogastric tube was inserted, and an upper gastrointestinal series showed significant stenosis at the duodenal second portion. Twenty-eight days of conservative therapy did not improve the stenosis, and an endoscopic dilatation was done. There was no bleeding or perforation after dilatation, and the patient was discharged with no symptoms. Delayed duodenal stenosis associated with blunt trauma is relatively rare, and a surgical intestinal anastomosis is the only way to treat when conservative therapy is not effective. Although there is a risk of bleeding or perforation in endoscopic dilation, it could be the 1st choice for treatment.
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  • Hirotoshi Maruo, Takanori Hiraide, Yukihiro Higashi, Hajime Yonekawa
    2012 Volume 32 Issue 6 Pages 1123-1126
    Published: September 30, 2012
    Released: January 08, 2013
    JOURNALS FREE ACCESS
    A 58-year-old man had been bedridden due to the long-term sequelae of cerebral infarction. Loss of appetite, constipation and weight-loss were present for two weeks prior to presenting at the hospital for disturbance of consciousness. Abdominal X-ray and computed tomography revealed large quantities of free intraperitoneal gas but no signs of peritoneal irritation were observed. Emergency surgery was performed under the strong suspicion of gastrointestinal perforation. On laparotomy, findings of peritonitis were limited and a pinhole perforation was observed in the sigmoid colon. No visible lesions were present in the perforated region and idiopathic perforation of the colon was diagnosed. Surgery comprised suture closure of the perforation, peritoneal lavage and drainage. Idiopathic large intestine perforation often takes a critical course accompanied by fecal peritonitis; however, the present patient was a rare case in which no symptoms of peritonitis were present and severe illness was avoided as only gas had leaked into the peritoneal cavity from the small perforation.
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  • Minoru Oshima, Akihiro Kondo, Keiichi Okano, Yasuyuki Suzuki
    2012 Volume 32 Issue 6 Pages 1127-1131
    Published: September 30, 2012
    Released: January 08, 2013
    JOURNALS FREE ACCESS
    A 74-year-old female was admitted for sudden abdominal pain and vomiting with a diagnosis of acute abdomen. The physical examination revealed tenderness over the entire abdomen with a slight peritoneal irritation sign. An abdominal X-ray image showed widespread dilatation of the small intestine with gas. Enhanced computed tomography revealed massive ascites and decreased enhancement in a long segment of the small intestine. Emergency operation was performed with a suspected diagnosis of small bowel strangulation and obstruction. The laparotomy revealed a strangulated and gangrenous loop of the ileum and cecum. A 160-cm length of the ileocolic segment was proved to be incarcerated into a small 18×20cm mesenteric defect, which was located in the mesentery 180cm from the Treitz ligament. Small bowel strangulation due to mesenteric hiatus hernia was diagnosed and a partial resection of the gangrenous intestine was performed. Mesenteric hiatus hernia is a rare condition, in particular in elderly. Only a few cases in elderly patients have been reported so far. Surgical intervention should be performed immediately when this condition is suspected.
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