Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine)
Online ISSN : 1882-4781
Print ISSN : 1340-2242
ISSN-L : 1340-2242
Volume 33, Issue 1
Displaying 1-26 of 26 articles from this issue
  • Yukihiro Minagawa, Osamu Shimooki, Chihiro Tohno, Tsutomu Tohsya, Masa ...
    2013 Volume 33 Issue 1 Pages 15-22
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
    JOURNAL FREE ACCESS
    Abdominal trauma associated with the poorest treatment results is critical liver damage due to external blunt trauma such as damage to the suprahepatic veins abbreviated to (IIIb+JHV below) at the complicated deep damage to the Japanese Association for the Surgery of Trauma liver damage classification (it abbreviates to IIIb type liver damage below), and IIIb type liver damage. We experienced 24 cases of liver injury at the Northern Iwate Coast and examined the treatment strategies based on 24 cases of traumatic hepatic injury in critical care centers located in depopulated area such as the authors' institution. Our results showed that the optimum medical treatment strategy for critical hepatic injuries depended on training a multidisciplinary team including a digestive organ surgeon, a vascular surgeon a radiologist with a JATEC attendance history, a nurse with a JPTEC attendance history and so on. Our results also suggested that the positive use of autologous blood recovery subsystems, such as the ability of institutions to establish urgent transfusion procedures and the use of Cell Saver®, was important.
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  • Noriko Nakamura, Yuichi Yamashita, Takamitsu Sasaki
    2013 Volume 33 Issue 1 Pages 23-29
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
    JOURNAL FREE ACCESS
    There have been many lawsuits regarding the medical treatment of acute abdomen. The present study investigated precedents over the last 10 years about Cholelithiasis, Cholecystitis, lcute pancreatitis,strangulation ileus and appendicitis. Hospital-related accidents were observed in 23 cases associated with diagnostic and testing, time for surgery, treatment and surgical technique. In this survey, the “Clinical Guidelines for Acute Pancreatitis”, and the “Japanese Evidenced-Based Medicine for Acute Cholangitis” were used. Medical care should always be delivered taking these clinical guidelines into consideration. Medical standards in line with the appraisal results have been shown. Maintenance and improvement of the quality of the appraisal are requested.
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  • -Mainly form Oncological Viewpoint-
    Harunobu Sato, Koji Masumori, Yoshikazu Koide, Tomonari Noro, Katsuyuk ...
    2013 Volume 33 Issue 1 Pages 31-38
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
    JOURNAL FREE ACCESS
    We studied the clinicopathological characteristics of colorectal cancer with perforation in comparison with non-perforation cases, and treatment strategy for colorectal cancer with perforation. T4 cancers and cancers with massive venous invasion fell significantly into the perforation than the non-perforation group. Stage IV caner was seen more in cases with perforation than in non-perforation cases (p=0.08). The perforation occurred at the tumor site in 7 patients, at the oral site of cancer in 7, and at the anal site in 1. One-staged curative resection was performed in 5 patients, and two-staged curative resection was performed in 4. The operative time was longer, and blood loss during curative resection was more in the two-staged than in the one-staged resections. Recurrence occurred in 1 patient with stage II cancer, and in 3 patients with stage IIIa cancer. These four patients with recurrence after curative surgery had peritoneal or subcutaneous dissemination, accompanying cancer spread due to large bowel perforation. However, hematogenous or lymphatic recurrence was also seen in 4 patients including one patient who underwent a curability B resection. More lymph node dissections were seen in non-recurrence cases after curative resection (average: 19.8) than in recurrence cases (average: 6.3). It was believed that primary resection and proper lymph node dissection contributed to prevention of hematogenous or lymphatic recurrence and improvement of prognosis for the patients with large bowel perforation related to colorectal cancer.
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  • Masamichi Yokoe, Shuichiro Umemura, Katsumi Hayashi, Etsuro Orito, Tos ...
    2013 Volume 33 Issue 1 Pages 39-44
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
    JOURNAL FREE ACCESS
    Under DPC (diagnosis procedure combination) circumstances in Japan, especially for acute pancreatitis, it is said that many hospitals will have reduced income, according to a report from the pancreatitis research group of the Ministry of Health, Labour and Welfare (MHLW) of Japan, 2009. We thought we should better understand the current situations of medical income and expenditure associated with acute pancreatitis in an Emergency and Critical Care Medical Center, and we should elucidate the problems of an inadequate system. We retrospectively evaluated 39 cases that were coded for the DPC system under the code name of acute pancreatitis. The total balance of all cases ran into the red to the tune of-JPY 4704660. 16 cases (41.0%), with a loss being seen in 23 cases (59.0%). In the profit cases the average amount was (JPY) 29954.3 with an average loss of (JPY) 225388.3 in the other unprofitable cases. Under the MHLW severity assessment of acute pancreatitis, mild cases accounted for 31 (79.5%) and severe cases for 8 (20.5%). A loss was made in 16 cases of mild acute pancreatitis and 7 cases of severe pancreatitis. The mean length of hospital stay was 11.8 days in the profitable cases and 22.7 days for those cases in which a deficit was seen. Severe pancreatitis cases have a tendency to create a negative balance under the current DPC/PDPS system. To avert the risk of hospitals going into the red financially as far as the treatment of acute pancreatitis patients is concerned, readjustment of the severity assessment of the current DPC system is required.
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  • Gaku Akiyama, Dai Uematsu, Hiroki Okubo, Shunsuke Kawai, Takeshi Haseg ...
    2013 Volume 33 Issue 1 Pages 47-53
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
    JOURNAL FREE ACCESS
    During emergency surgery for an acutely incarcerated femoral hernia, intestinal resection may often be needed. Tension-free hernia repair with the use of a mesh is generally avoided in the case of intestinal resection, due to the risk of mesh infection, so a Mcvay repair or pure tissue repair is usually performed. However, it is obvious that tension-free hernia repair with a mesh is a more desirable operation than pure tissue repair, since most elective hernia surgeries not involving strangulation are performed using mesh. We report herein on a novel treatment strategy, which may enable the surgeon to repair the hernia with mesh in all cases, even if strangulation is recognized, and that endoscopic surgery is very useful for minimally invasive surgery. First, the condition of the intestine is verified laparoscopically. If indicated, intestinal resection is performed via an extended 3-cm umbilical incision. Hernia repair is then performed with an anterior approach without injuring the peritoneum, which stands between the mesh and the abdominal cavity. Consequently, the risk of mesh infection is minimized, as is the risk of complications associated with elective hernia surgery.
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  • Seiichiro Yoshikawa, Masaki Fukunaga, Yoshifumi Lee, Kunihiko Nagakari ...
    2013 Volume 33 Issue 1 Pages 55-59
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
    JOURNAL FREE ACCESS
    Colonoscopy has a small, but serious risk of colonic perforation. Iatrogenic perforation of the colon is the most feared complication of colonoscopy. Basically, iatrogenic colonic perforations have been treated with an emergency operation. In order to avoid further patient trauma and surgical stresses, laparoscopic treatment is feasible. At our hospital, emergency laparoscopic surgery is performed on patients with iatrogenic colon perforation as long as that they can be placed under general anesthesia with sufficient informed consent. We prudently indicate this procedure for iatrogenic colonic perforations. From January 1995 through March 2013, there were 14 patients who underwent laparoscopic surgery for iatrogenic colonic perforation at our institution. The surgery time was shorter and the amount of bleeding was smaller than a control group. There were no significant differences in the postoperative stay between the iatrogenic perforation group and the control group. Further, there was no significant difference in the incidence of postoperative complications between the two groups. The results of the present study showed no statistically significant differences in the clinical course soon after surgery between the iatrogenic perforation and control groups, thus suggesting that emergency laparoscopic surgery can be performed on iatrogenic perforated cases with sufficient preoperative assessment and well skilled operation by experienced laparoscopic surgeons.
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  • (Laparoscopic Hassab's Operation)
    Tomohiko Akahoshi, Morimasa Tomikawa, Hirofumi Kawanaka, Ken Shirabe, ...
    2013 Volume 33 Issue 1 Pages 61-66
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
    JOURNAL FREE ACCESS
    Laparoscopic devascularization of the upper stomach and splenectomy (Lap-Dev+Sp), known as Hassab's operation, is technically difficult in patients with portal hypertension because of the possibility of hemorrhage and enlarged collateral vessels. Laparoscopic-or Hand-assisted laparoscopic Dev+Sp was undertaken in 21 patients as a salvage treatment for endoscopic-resistant esophagogastric varices between 2000 and 2011. LigaSure Atlas or EnSeal was used for devascularization of the vessels. An autosuture device was applied to dissect the splenic hilum and left gastric and enlarged short gastric vessels. Since January 2005, we have adopted a standardized laparoscopic surgery (LS) approach to include the following three points: hand-assisted laparoscopic surgery (HALS) should be performed in patients with splenomegaly (> or=1,000mL), perisplenic collateral vessels, or a Child-Pugh score of 9 or more. Our results have revealed that the vessel sealing system we developed and HALS significantly reduced the intraoperative blood loss. Our findings therefore suggest that laparoscopic devascularization of the upper stomach and splenectomy is currently a more feasible and effective surgery in patients with portal hypertension.
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  • Masayuki Shimizu, Ryo Yamamoto, Shokei Matsumoto, Tomohiro Funabiki, M ...
    2013 Volume 33 Issue 1 Pages 67-71
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
    JOURNAL FREE ACCESS
    Diagnosis of strangulation is important for the management of small bowel obstruction (SBO). In case of SBO with strangulation, emergency surgery is necessary. Laparoscopic surgery may be an alternative procedure for strangulated SBO if the patient's respiratory and hemodynamic conditions are stable and adequate working space can be maintained after inflation of the abdomen. Among cases of emergency laparoscopic surgery on preoperative diagnosis of strangulated SBO, single band obstruction is the most common etiology and bandlysis is the most frequent procedure used. In case of suspicion of strangulated SBO, unnecessary laparotomy can be avoided by performing laparoscopic surgery Up till the present we have accumulated data from 29 emergency laparoscopic surgeries we have performed for SBO. The conversion rate was 24%, morbidity was 14 %, and intraoperative enterotomy was observed in two cases. We consider that these results can be acceptable. Emergency laparoscopic surgery for SBO is a safe and feasible procedure if the indication is limited to appropriate patients.
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  • Eiji Ikeda, Masatoshi Kuroda, Hisashi Tsuji, Ryuji Hirai, Shoji Takagi ...
    2013 Volume 33 Issue 1 Pages 73-79
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
    JOURNAL FREE ACCESS
    As we think laparoscopic surgery contributes to the recovery after abdominal emergency operations, we apply laparoscopic coloproctectomy in abdominal emergency cases. We experienced 89 cases of laparoscopic coloproctectomy for acute abdomen (69 large bowel obstruction cases, 17 peritonitis cases, 2 cases with large intestinal bleeding and 1 ischemic colitis case) in the past 11 and a half years. On the basis of the indication of elective laparoscopic coloproctectomy, we apply emergency laparoscopic colo-proctectomy for cases of decompressed large bowel obstruction with intraperitoneal working space, localized and/or iatrogenic panperitonitis with empty intestine after mechanical bowel preparation and large intestinal bleeding or ischemic colitis for those patients in a hemodynamically and generally stable condition. Principally for the emergency cases, we operate in the same way as the elective cases, but we should well recognize the special attention required associated with emergency laparoscopic coloproctectomies. The rate of conversion to open surgery was 2.2% and the rate of pure-laparoscopic surgery was 59.6%. The result of all cases of 10 benign bowel obstruction, peritonitis, large intestinal bleeding and ischemic colitis were acceptable. Both the results of the operation and the cancer prognosis were acceptable in the 59 cases of cancer associated with large bowel obstruction at the same time. The laparoscopic coloproctectomy is useful for the acute abdomen within strict indication limits.
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  • Yasuhiro Ishiyama, Noriyuki Inaki, Masanori Kotake, Masaru Kurokawa, H ...
    2013 Volume 33 Issue 1 Pages 81-84
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
    JOURNAL FREE ACCESS
    The indication of laparoscopic surgery in elective situations has become popular, and is furthermore now accepted in emergency surgery. Between January 2010 and December 2011 laparoscopic surgery for acute abdominal case was performed on 269 consecutive patients in the Department of Gastroenterological Surgery of the Ishikawa Prefectural Central Hospital. We undertook 269 operative cases; 202 cases of appendectomy, 24 cases of ileus, and 37 cases of gastroenterological perforation. Laparoscopic surgery for emergency cases has increased year by year. Laparoscopic surgery in cases of acute abdomen can be safely performed, and has now been considered as acceptable. In educating young surgeon it would be useful to include the performance of laparoscopic surgery in cases of acute abdomen.
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  • Tetsuya Shirota, Takuya Yamaguchi, Mikio Nanbara, Satoshi Asai, Takuji ...
    2013 Volume 33 Issue 1 Pages 85-90
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
    JOURNAL FREE ACCESS
    [Purpose] Laparoscopic surgery is the first choice for acute abdomen in our department following our exclusion criteria. We report herein on the usefulness of laparoscopic surgery for patients with small-bowel disorders that have developed into acute abdomen. [Subjects] From October 2008 to January 2012, we analyzed 23 patients with a small-bowel disorder that had developed into acute abdomen and who underwent laparoscopic surgery with regard to diagnosis, operative procedures, and complications. [Results] The responsible lesion was identified during the laparoscopic procedure in 17 of the patients. For the operative procedure, 7 underwent total laparoscopic surgery, 10 laparoscopic-assisted surgery, and 6 transitioned to open abdominal surgery, predominantly because of a poor operative field due to intestinal distention and adhesion. Four subjects developed postoperative complications that were not related to the laparoscopic procedures. [Conclusion] Laparoscopic surgery for a small-bowel disorder that develops into an acute abdomen was found useful for identifying the responsible lesion along with implementation of our exclusion criteria for the procedure. The patients were well managed in a less invasive and safe manner.
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  • -A Case Report-
    Yasunori Nishida, Yusuke Takahashi, Kotaro Sasahara
    2013 Volume 33 Issue 1 Pages 91-94
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
    JOURNAL FREE ACCESS
    We report herein on a case of strangulated ileus due to an intersigmoid hernia in a 55-year-old woman, who visited our emergency room complaining of persistant low abdominal pain and nausea. Abdominal CT showed a loop-shaped small bowel in the left lower abdominal quadrant. Based on the diagnosis of strangulated ileus, we performed laparoscopic surgery; a 10-cm loop of small bowel was incarcerated in the intersigmoid fossa. We extracted the small bowel, and sutured the fossa employing a laparoscopic approach. Bowel resection was not required. The patient was discharged from the hospital on the 6th day after surgery. Intersigmoid hernias are rare, and preoperative diagnosis is difficult in many cases. The laparoscopic approach is recommendable in the early diagnosis and treatment of intersigmoid hernias.
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  • Masaya Suzuhigashi, Masashi Higashimoto, Hiroshi Higashi, Yuji Takebay ...
    2013 Volume 33 Issue 1 Pages 95-98
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
    JOURNAL FREE ACCESS
    Bottles are most frequent rectal foreign bodies in Japan. We report a case of transanal intrarectal foreign body extraction using a pneumatic powered drill, Surgairtome II®. A 51-year-old man was admitted to our hospital with a yoghurt bottle that had been inserted via the anus for erotic purposes. He had tried to extract the object through the anus himself, but all efforts had failed. An anorectal examination revealed that the foreign body was stuck 5cm from anal verge. Under spinal anesthesia, manual extraction was attempted, but the extraction efforts were unsuccessful. We made a 5mm hole in the bottom of the bottle with the pneumatic drill, and could remove it smoothly using a pair of right angle forceps. The foreign body was 8cm in width and 9cm in length. The postoperative course was uneventful. Our method is a feasible technique for removing a bottle from the rectum.
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  • Shogo Tanaka, Kanji Ishihara, Yukiko Kurashima, Kohichi Ohno, Takatsug ...
    2013 Volume 33 Issue 1 Pages 99-103
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
    JOURNAL FREE ACCESS
    An 86-year-old female with a left inguinal hernia consulted our hospital for fever. She was able to swallow solid food. Physical examination revealed diffuse peritonitis, and the left inguinal hernia was reducible without pain. Abdominal computed tomography demonstrated a small amount of free air and the left inguinal hernia, however, the site of perforation could not be detected. No foreign body was demonstrated in the abdominal cavity and gastrointestinal tract. An urgent laparotomy was performed for panperitonitis. As a toothpick was discovered in the pouch of Douglas and perforation of jejunum had occurred where it had herniated to the left groin, resection of the jejunum was performed. Repair of left inguinal hernia was performed 6 days after the operation. Thereafter, her family suggested that she might have injected several wooden foreign bodies, such as a toothpick or stick, 2 days prior to the consultation. Computed tomography performed 8 days after the laparotomy demonstrated a linear area of high density in the cecum, leading to a diagnosis of a residual foreign body. The high density linear area had moved to the transverse colon on computed tomography performed 13 days after the laparotomy. We performed endoscopic removal of a wooden stick 15 days after the laparotomy. The patient was discharged from our hospital 22 days after the laparotomy. For ingestion of foreign bodies, we must ask detailed questions of a patient or their family about the patient's condition, and should perform routine computed tomography postoperatively even if the postoperative course is uneventful.
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  • Genki Tsukuda, Noboru Yokoyama, Masayuki Isozaki, kai Matsuo, Kouji No ...
    2013 Volume 33 Issue 1 Pages 105-109
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
    JOURNAL FREE ACCESS
    A 54-year-old man was brought to an emergency hospital with severe diarrhea, malnutrition, and had difficulty in walking. Because a gastrocolic fistula was suspected based on upper gastrointestinal endoscopy and enema examination, the patient was referred and admitted to our hospital. Upper gastrointestinal endoscopy revealed a fistula on the posterior wall of the gastric angle, and the endoscope was easily inserted into the colon. Moreover, the cecum and rectum were observable through the fistula. There was a paucity of findings suggestive of malignancy, and histopathological examination also revealed no evidence of malignancy. Thus, we diagnosed a gastric ulcer penetrating the transverse colon, resulting in fistula formation. Due to extreme malnutrition, parenteral and enteral nutrition was provided. However, no improvement was observed, and surgery was thus planned. The stomach, transverse colon, and small intestine were partially resected. Histopathological examination of the resected specimens revealed no malignant findings, and a gastrocolic fistula due to a gastric ulcer was thus confirmed. We describe herein this gastrocolic fistula caused by a benign gastric ulcer with an analysis of 20 Japanese cases, including our present case, along with a literature review.
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  • Kazuyuki Oishi, Akihito Kozuki, Kento Kumon, Huminori Teraishi, Toshio ...
    2013 Volume 33 Issue 1 Pages 111-116
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
    JOURNAL FREE ACCESS
    We report herein on a case of sigmoid colon cancer with intussusception prolapsing through the anus. An 89-year-old woman, diagnosed as having a rectal prolapse was admitted to our hospital because of anal pain, prolapse, and hematochezia. Pelvic CT imaging revealed a target-like lesion in the rectum, and the sigmoid colon was invaginated into the rectum. The intussusception could not be reduced preoperatively. Therefore, a sigmoidectomy via Hartmann's method was performed after reduction by resection of the anterior wall. The patient's postoperative course was uneventful. The cancer was graded as pathologic stage I (pMP, N0, M0). Adult sigmoid colon cancer with intussusception prolapsing through the anus is rare, with only 40 cases reported in Japan.
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  • Kazushi Suzuki, Yusuke Uno, Takeo Kawahara
    2013 Volume 33 Issue 1 Pages 117-122
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
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    We performed a single-incision laparoscope-assisted sigmoidectomy for recurrent sigmoid volvulus in two patients. (Case 1) A 67-year-old man visited our hospital, complaining of abdominal pain. Abdominal X-ray and computed tomography revealed volvulus of the sigmoid colon, and a reduction procedure was performed colonoscopically. The patient was discharged from the hospital, but he sought medical attention again 5 days later for abdominal pain. As recurrence of the sigmoid volvulus was diagnosed, the patient underwent single-incision laparoscope-assisted sigmoidectomy performed through a small incision in the umbilical region. The patient was discharged on post-operative day 10 with an uneventful postoperative course. (Case 2) A 55-year-old man visited our hospital, complaining of abdominal pain. He had been hospitalized with sigmoid volvulus at another hospital one and a half years previously. Because of the recurrence of sigmoid volvulus, the patient underwent single-incision laparoscope-assisted sigmoidectomy. The patient was discharged on post-operative day 7, and the postoperative course was uneventful. The single-incision operation for this disease does not require any special instruments and can be performed safely, we therefore suggest this approach as an alternative therapeutic option for signoid volvulus.
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  • : A Case Report
    Ayako Imai, Shinya Karakida, Toshio Sasaki
    2013 Volume 33 Issue 1 Pages 123-126
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
    JOURNAL FREE ACCESS
    Adnexal torsion is relatively common, but isolated torsion of the fallopian tube is rare. We report herein on a case of isolated torsion of the fallopian tube causing acute pelvic pain. A 30-year-old woman was admitted to our emergency department with a chief complaint of right lower abdominal pain. Vaginal ultrasound, enhanced computed tomography, and magnetic resonance imaging showed bilateral adnexal masses and normal ovaries. Two days of conservative management did not improve her condition. We therefore gave her an emergency probe laparotomy. The laparotomy confirmed the diagnosis of isolated torsion of the right fallopian tube. We performed a right tubectomy, left salpingostomy, and bilateral surgical adhesiolysis. The histological specimens revealed a hemosalpinx with necrosis. The patient's postoperative course was satisfactory. Isolated torsion of the fallopian tube is an uncommon event. However, prompt surgical intervention may allow for preservation of the tube. Familiarity with this uncommon clinicopathologic entity will help clinicians evaluate the differential diagnosis of acute lower abdominal/pelvic pain in female patients.
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  • Yasuo Yoshinaga, Akira Miyabe, Takashi Sakamoto, Hideki Katagiri, Tada ...
    2013 Volume 33 Issue 1 Pages 127-129
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
    JOURNAL FREE ACCESS
    A 65-year-old man with severe symptosis presented to the emergency room with a 1-month history of abdominal pain and a 3-day history of anorexia. On admission, he was in shock and showed upper abdominal tenderness, rebound tenderness and muscle guarding. Abdominal computed tomography (CT) revealed irregular regions of gas and fluid collection in the lesser sac. Emergency surgery was performed after the patient was diagnosed as having gastrointestinal perforation into the lesser sac causing septic shock. During surgery, an abscess was identified in the lesser sac extending from the first portion of the duodenum to the left colonic flexure. Quick exploration did not reveal any gastrointestinal perforation during the surgery. However, the surgery needed to be terminated because of hypotension and instability. Only a drainage of the lesser sac was performed. After surgery, gastroduodenoscopy revealed a duodenal ulcer in the posterior wall of the first portion of the duodenum. Furthermore, a connection between the lesser sac and the first portion of the duodenum was confirmed by contrast studies through the lesser sac drain, which led to the diagnosis of a lesser sac abscess resulting from a duodenal ulcer perforation.
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  • Tsutomu Iwata, Masatoshi Isogai, Tohru Harada, Yuji Kaneoka, Keitaro K ...
    2013 Volume 33 Issue 1 Pages 131-135
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
    JOURNAL FREE ACCESS
    Case 1: An 83-year-old woman was admitted to our hospital complaining of abdominal pain and nausea. Contrast-enhanced abdominal computed tomography showed the small intestine trapped bilaterally between the pectineus muscle and external obturator muscles. An emergency operation was performed. It was found that the ileum was incarcerated through the left obturator foramen 30cm from the terminal ileum 30cm thereafter the ileum was incarcerated through the right obturator foramen. After the reduction of the incarcerations, both of the hernia hilia were closed with the ovarium. Case 2: A 79-year-old woman was admitted to our hospital complaining of nausea and right femoral pain. Contrast-enhanced abdominal computed tomography showed the small intestine was trapped bilaterally between the pectineus muscle and external obturator muscle. An emergency operation was performed. It was found that the ileum was incarcerated via the right obturator foramen 120cm from the terminal ileum and the ischemic ileum was resected. The left side of the incarcerated obturator hernia was resolved spontaneously. After the reduction of the incarceration, both of the hernia hilia were closed with a mesh plug via the extraperitoneal approach. Obturator hernia is sometimes encountered as a cause of intestinal obstruction. However, synchronous bilateral obturator hernias are rare.
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  • Masaaki Hidaka, Mitsutoshi Matsuo, Ryuichiro Suto, Ryuichi Murakami, K ...
    2013 Volume 33 Issue 1 Pages 137-140
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
    JOURNAL FREE ACCESS
    An 81-year-old woman presented with a left inguinal abscess with the exudation of pus. She arrived at the hospital on foot. An examination revealed a low blood pressure at 79mmHg, an increased pulse rate of 128/min, elevated white blood count, elevated C-reactive protein, but with no acidosis. Abdominal CT showed an inguinal abscess with a left femoral hernia (Richter type). The patient underwent emergency surgery. The abscess and the hernia sac from the femoral ring were opened and the small intestine was perforated with an incarceration in a case of Richter's hernia. The perforated small intestine was resected through the opened inguinal ligament without contamination of the abdominal cavity, and the femoral ring and inguinal ligament were repaired. The abscess cavity was debrided, and the abscess cavity was repaired with an anterolateral thigh flap pedicled with the lateral femoral circumflex artery. The patient recovered immediately with intensive care, and was discharged 39 days after surgery. The anterolateral thigh flap with the lateral femoral circumflex artery was effective for the wide skin defect following femoral hernia repair with an inguinal abscess.
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  • Yasuyuki Kawai
    2013 Volume 33 Issue 1 Pages 141-144
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
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    A Morgagni hernia is a rare diaphragmatic hernia. We present herein on a case in a 73-year-old woman who underwent laparoscopic repair of a recurrent Morgagni hernia with an expanded polytetrafluoroethylene (ePTFE) sheet. The Morgagni hernia had been repaired with direct suture under the laparoscope eight years previously. An abnormal shadow was seen during chest radiography during a medical check-up, and the patient was referred to our hospital. Chest CT imaging indicated a diagnosis of recurrent Morgagni hernia. Laparoscopic repair was performed. As the area around the hernia was weak, a patch repair was performed with a ePTFE sheet cut to the size of the hernia. As ePTFE sheet can be easily trimmed to the appropriate size, its usefulness in laparoscopic hernia repair is suggested.
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  • Naoki Kubo, Toshiyuki Sato, Takeomi Hanaoka, Yugo Iwaya
    2013 Volume 33 Issue 1 Pages 145-150
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
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    A 90-year-old man was treated in the orthopedic surgery department of our hospital for a femoral neck fracture. He experienced abdominal pain and vomiting. Laboratory tests revealed leukocytosis and elevated C-reactive protein levels. Computed tomography (CT) examination showed the presence of gas in the hepatic portal vein and gastric wall. We diagnosed phlegmonous gastritis on the basis of the esophagogastroendoscopic findings. Enterococcus faecalis and Staphylococcus hominis were cultured from a biopsy specimens obtained from the stomach. The patient's clinical symptoms improved, and the abdominal endoscopic and CT examination findings normalized following the administration of antibiotics. Acute phlegmonous gastritis with hepatic portal venous gas is a rare case, and to the best of our knowledge, there have been only 6 other similar reported cases. We report herein on a case of acute phlegmonous gastritis with hepatic portal venous gas and review the relevant literature.
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  • Kenta Kobayashi, Sho Otuki, Tokuko Hosoya, Hideaki Murase, Yoshihiro U ...
    2013 Volume 33 Issue 1 Pages 151-154
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
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    A 21-year-old woman with no previous history was admitted for small bowel obstruction to another hospital. On the next day, she was transferred to our hospital because of the possibility of strangulated ileus. We placed an indwelling ileus tube with the result that the abdominal distention was resolved after decompression. Despite this, the disease proved resistant to conservative therapy, and we decided on surgical intervention. The laparoscopy findings showed an agglomerated portion of the ileocecal area, suggestive of endometriosis, thus we performed an ileocecal resection. The postoperative course was uneventful. The patient was discharged on the 7th postoperative day. Pathological findings showed that endometrial epithelium had infiltrated the ileocecal muscle layer. The same findings were seen at the ascending colon serosa. Laparoscopic surgery is an efficacious procedure for diagnosis and treatment for patients with an intestinal obstruction, who have no history of abdominal operations.
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  • Osamu Jindou, Shohachi Suzuki, Hideto Ochiai, Akihiro Uno, Atsuko Fuka ...
    2013 Volume 33 Issue 1 Pages 155-160
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
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    An 85-year-old man was referred to the emergency our hospital with left hypochondralgia. Abdominal CT revealed a multilocular cystic lesion filled with a blood clot and a 25mm diameter splenic pseudoaneurysm at the splenic hilum. The pseudoaneurysm which had ruptured into pancreatic pseudocysts was successfully treated with transcatheter arterial embolization (TAE). The patient's abdominal symptoms gradually diminished and the huge pancreatic pseudocyst was removed with elective distal pancreatectomy and splenectomy, three weeks after TAE. The patient's postoperative course was uneventful during a 28-month follow-up. We suggest that elective radical surgery after TAE is safe and recommendable in the management of splenic pseudoaneurysms which have ruptured into pancreatic pseudocysts.
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  • Shoichiro Mukai, Hideto Sakimoto, Masatoshi Kouchi, Seiichi Shimizu, S ...
    2013 Volume 33 Issue 1 Pages 161-165
    Published: January 31, 2013
    Released on J-STAGE: April 17, 2013
    JOURNAL FREE ACCESS
    We describe herein an adrenal pheochromocytoma that spontaneously ruptured and caused abdominal compartment syndrome (ACS) with the subsequent death of the patient. Spontaneous rupture of a pheochromocytoma is extremely rare, moreover, the prognosis can be very poor. A 49-year-old man arrived at our hospital by ambulance with sudden severe abdominal pain. Abdominal contrast-enhanced CT imaging revealed a hemorrhaging left adrenal mass surrounded by a massive hematoma. Cannulation during angiography for embolization destabilized the patient's blood pressure. We suspected a pheochromocytoma and proceeded conservatively because intravascular embolization is contraindicated for this condition. However, hypovolemic shock had developed and CT imaging indicated continuous bleeding and ACS. Intravascular embolization was followed by the surgical arrest of bleeding and abdominal decompression. Despite adjunctive post-operative therapeutic modalities such as continuous hemodiafiltration, the patient died of multiple organ failure on the 6th postoperative day.
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