Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine)
Online ISSN : 1882-4781
Print ISSN : 1340-2242
ISSN-L : 1340-2242
Volume 39 , Issue 1
Showing 1-27 articles out of 27 articles from the selected issue
  • Hirotada Kittaka, Haruka Ino, Hiroshi Akimoto
    2019 Volume 39 Issue 1 Pages 023-027
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    The purpose of this study was to evaluate the safety and usefulness of our protocol including the early resumption of dietary intake on day 4 of hospitalization in patients treated with conservative therapy for gastric or duodenal perforation. Patients were allowed to resume dietary intake on day 4 provided they had no symptoms of peritoneal irritation or delayed fever, and without any upward tendency of their white blood cell count. In 28 patients treated conservatively for upper gastric perforation, the timing of dietary intake resumption was on day 4 of hospitalization (median), and 21 of those (75%) were allowed to resume dietary intake on day 4, following exactly our protocol. Two of the 28 needed conversion from conservative to surgical treatment, however, only one required conversion after starting dietary intake. Intraabdominal abscess formation was seen in two patients, but both were treated with antibiotics and drainage. The median hospital stay was 8 days which was much shorter than previous reports, and no death was seen. Consequently, resuming dietary intake on hospital day 4 is useful in shorting the hospital stay without increasing complications such as failure of conservative therapy and intraabdominal abscess formation.

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  • Koichi Inukai, Hirotaka Miyai, Nobuhiro Takashima, Minoru Yamamoto, Yo ...
    2019 Volume 39 Issue 1 Pages 029-032
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    【Background】The aim of this study was to evaluate the outcome of laparoscopic cholecystectomy (LC) for gallbladder torsion (GT). 【Patients and Methods】Between January 2011 and December 2017, 6 patients underwent LC for GT. During the same period, 157 patients underwent an emergency LC for acute cholecystitis (AC) following the Tokyo Guidelines, 2013. We evaluated the surgical outcome of LC for GT, compared with emergency LC for AC. 【Results】In the patients who underwent LC for GT, intraoperative time tended to be shorter, and intraoperative blood loss was almost the same. There was no case that required conversion to open cholecystectomy for GT. 【Conclusion】LC for GT is minimally invasive and has the same surgical outcome compared with the established LC for AC. LC for GT has therefore almost comparative utility when adapted for AC.

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  • Jun Masui, Masakazu Ikenaga, Yoshinao Chinen, Hiroaki Itakura, Hirotos ...
    2019 Volume 39 Issue 1 Pages 033-037
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    A 72-year-old female patient presented to a nearby hospital with a 3-day history of abdominal pain and vomiting. Her medical history included surgery for lower left thigh varicosities. She was diagnosed as having bowel obstruction, and was referred to our hospital. Physical examination revealed rebound tenderness in the entire abdomen. Blood examination revealed elevated levels of the acute inflammatory markers and evidence of renal function impairment; the serum protein C concentration was 63%, while that of protein S was below 10%. Abdominal CT revealed a distended small intestine and a rise in concentration of a small mesentery. As strangulated bowel obstruction was suspected, an emergent operation was performed, and dark red massive ascites was observed intraoperatively. As about a 100-cm segment of the ileum had become necrotic, partial resection of the ileum was performed. During the operation, we detected a thrombus in the mesoileal vein. Based on these findings, the patient was diagnosed as having superior mesenteric vein thrombosis. Postoperatively, she was administered anticoagulant therapy. Although it was difficult to decrease the size of the thrombus, it lysed without re-operation. We present this case to highlight the elevated risk of occurrence of superior mesenteric vein thrombosis in association with protein C and S deficiency, which is otherwise rare, along with a review of literature.

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  • Kengo Hayashi, Hiroki Tawara, Kaichiro Kato, Masahiro Hada, Takuo Hara
    2019 Volume 39 Issue 1 Pages 039-042
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    An 80-year-old man was admitted our hospital with the chief complaint of abdominal pain. Abdominal CT showed a tumor each in the sigmoid colon and the rectum, and dilatation of the oral side of the sigmoid colon. We did not insert a transanal decompression tube because the rectal tumor also caused stenosis and the scope could not pass through the lesion. We performed an emergent colostomy and discharged the patient, with a plan for radical operation at a later date. However, the patient returned to the hospital with complaints of persistent stomachache and abdominal distention. CT revealed dilatation of the bowel segment between the sigmoid and rectal tumors. Colonoscopy revealed obstruction caused by the rectal cancer, and we inserted a transanal decompression tube. After achieving sufficient decompression of the bowel, we performed laparoscopic anterior resection. The patient was discharged 16 days after the operation. Reportedly, the incidence of multiple cancers is higher in the colorectum than in other organs; however, advanced colorectal cancers causing simultaneous occlusions are rare. Usually, a stoma decompresses the distended colon, but as our case illustrates, in the case of multiple cancers, attention should be paid to the tumor towards the anal side to prevent obstruction, or an early radical operation should be performed.

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  • Junichi Aburaki, Tomoharu Shimizu, Hiromichi Sonoda, Hiroyuki Ota, Tom ...
    2019 Volume 39 Issue 1 Pages 043-046
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    A 45-year-old woman was admitted to our hospital with a 2-h history with acute onset of acute abdominal pain and vomiting. Abdominal contrast-enhanced computed tomography showed trapped intestine in the region to the left of the uterus. Laparoscopic surgery was performed for uterine broad ligament hernia, and a segment of the intestine was found to have herniated into a defect of the left broad ligament. The intestine was released from the defect, and the discolored and incarcerated segment of the intestine measured approximately 20 cm long. The intestine was more closely observed through a small laparotomy. Blood flow was not evaluated, but a Photodynamic Eye (PDE) was used. The PDE showed adequate blood flow, therefore, bowel resection was not performed. The patient had an uncomplicated postoperative course. We encountered a rare case of an intestinal hernia through a defect in the broad ligament of the uterus. However, no objective evaluation criteria were followed to determine whether bowel resection should be performed or not. Therefore, further accumulation of cases is necessary.

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  • Sho Ueda, Masato Maeda, Ryohei Koreyasu, Kei Yonezawa
    2019 Volume 39 Issue 1 Pages 047-050
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    A 65-year-old man was hospitalized with sudden onset of abdominal pain that developed while he was on a business trip. He was diagnosed as having acute pancreatitis due to gallstones, which was initially mild, but became severe by third day of hospitalization. On the 51st day of hospitalization, we found an abscess around the right iliopsoas muscle and his hemodynamic and respiratory status became unstable. Hence, we performed emergency open necrosectomy on the same day. After the operation, he required multimodal therapy, including continuous hemodiafiltration, artificial respiration, and peritoneal lavage. On the 74th and 79th days after the operation, he developed hemorrhagic shock caused by intraperitoneal bleeding. We saved his life both times by successful intervention. At this time, we also observed fistulas in the jejunum and transverse colon, which were effectively treated by drainage and ileostomy. After a prolonged rehabilitation period, he was moved to another hospital on the 335th day after the operation. In recent years, reports have highlighted the importance of using a step-up approach when treating severe acute pancreatitis. On the other hand, our case shows that open necrosectomy is a valid approach for patients who require immediate treatment. Note, however, that expertise is needed for treating complications by this method.

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  • Yukihiro Higashi, Hirotoshi Maruo
    2019 Volume 39 Issue 1 Pages 051-054
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    A man in his 80’s was diagnosed as having lower rectal cancer, and abdominoperineal resection (APR) with sigmoid colon colostomy was performed via a retroperitoneal approach. Multiple metastatic tumors were identified in the liver, and chemotherapy was administered with the FOLFIRI regimen postoperatively. Twenty months after the surgery, the patient was admitted to our hospital with left lower abdominal pain. Twelve hours after his hospital admission, bleeding was observed from his colostomy. Emergent colonoscopy revealed sigmoid colon necrosis with mucosal shedding in a 3-cm segment proximal to the colostomy. We diagnosed the condition as ischemic colitis of the necrotizing type, and emergency operation was performed. We resected the necrotic portion of the colon, including the colostomy, and constructed a new colostomy. In this case, we considered that one of the important risk factors for the ischemic colitis was blood flow disturbance due to resection of the sigmoid colon via the retroperitoneal route, with poor extensibility, in addition to other risk factors in the patient, such as advanced age, hypertension, chemotherapy for tumor metastasis.

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  • Manabu Nakamura, Katsuhiko Ishizaka, Jun Nakayama
    2019 Volume 39 Issue 1 Pages 055-058
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    A 76-year-old woman was rushed to our hospital because of vomiting and severe abdominal pain. Blood examination revealed evidence of obstructive jaundice. Abdominal CT showed a swollen gallbladder containing gallstones, fluid in the abdominal cavity on the right side, and a stone in the papillary region. Enhanced CT demonstrated active extravasation of contrast into the gallbladder lumen in the arterial phase and perforation of the gallbladder neck, but no findings suggestive of a gallbladder tumor. Based on a diagnosis of a perforated gallbladder caused by intracholecystic hemorrhage, an urgent subtotal cholecystectomy with cholecystomucoclasis was performed. Histological examination showed T1b carcinoma in the whole resected specimen, and also an ulcer of the gallbladder neck with artery exposure. Because of the high probability of development of peritoneal metastasis, the patient was administered postoperative chemotherapy, without additional surgery. She died of peritoneal metastasis 20 months after the operation.

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  • Takehiro Shimada, Junko Tanaka, Hideaki Kojima, Kazuya Hirukawa, Taiki ...
    2019 Volume 39 Issue 1 Pages 059-062
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    A 49-year-old man presented with a history of lower abdominal pain and hiccup. He had no history of any previous surgery. Abdominal computed tomography (CT) confirmed axial torsion and marked dilatation of the mobile cecum. We diagnosed the patient as having cecal volvulus by additional three-dimensional image reconstruction of the CT images, and conducted emergency surgery on the same day. Four trocars were inserted for the surgery. Caecocolic torsion was confirmed and ileocolectomy was performed laparoscopically. The patient recovered well and was discharged 5 days later. At present, 8 months after the surgery, he remains free of recurrence. Preoperative diagnosis is often difficult for cecal volvulus, and there are few reports of laparoscopic surgery. We report a case of preoperative diagnosis and successful laparoscopic surgery performed with preoperative three-dimensional reconstruction of images.

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  • Jun Tauchi, Akihiro Murata, Akishige Kanazawa, Sadatoshi Shimizu, Shin ...
    2019 Volume 39 Issue 1 Pages 063-067
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    An 87-year-old woman visited our hospital complaining of abdominal pain. On physical examination, the lower abdomen was distended and there was tenderness in the same region. Abdominal CT revealed massive ascites and a poor contrast effect of a wide range of the intestine. Suspecting an intestinal hernia with strangulated obstruction of the small intestine, we performed emergency surgery. We could find no obvious malrotation, but a hernial orifice, 5 cm in size, corresponding to the inferior duodenal fossa of Treitz, was noted. The intestine passed via the hernial orifice from the free abdominal cavity into the hernial sac, which was on the dorsal aspect of the mesentery of the colon on the right side; it ran into the hernia sac then passed the hernia gateorifice? again in the opposite direction. The small intestine caught in the hernia sac was strangulated at the hernia orifice and a 200-cm segment was found to be ischemic. Therefore, we resected the necrotic segment of the small intestine. We made the diagnosis of a right paraduodenal hernia with strangulated obstruction of the small intestine. In many cases of this disease, emergency operation is needed because of symptomatic intestinal obstruction. Because strangulated obstruction of the small intestine sometimes develops, it is considered necessary to perform surgical treatment at the time of diagnosis.

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  • Shodai Mizuno, Yuki Seo, Ryo Nishiyama, Noriaki Kameyama, Yoshinobu Ak ...
    2019 Volume 39 Issue 1 Pages 069-072
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    A 76-year-old man with schizophrenia hospitalized in a psychiatric hospital for many years presented with stomachache. Abdominal CT showed colonic obstruction, findings consistent with sigmoid colon cancer and multiple liver metastases, and he was referred to our hospital. We tried to insert a long transanal tube, but misinsertion of the guidewire caused colonic perforation, and we scheduled emergency surgery. However, the patient refused operation, and we administered conservative medical treatment. About 10 days later, he suddenly said he wanted receive surgery, so we performed a transverse colostomy. Two days after the surgery, he pulled the stoma, which resulted in stomal prolapse of the transverse colon with the mesentery. We performed emergency surgery and reconstruction of the colostomy. At our hospital, while we pay attention to the special postoperative care needed for patients with psychiatric disorders, we had not considered self-removal of colostomy. Thus, in the postoperative care of patients with psychiatric disorders, possible self-removal of a colostomy by the patient should also be borne in mind.

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  • Masashi Tsunematsu, Hiroya Enomoto, Kazuo Kitagawa, Michiaki Watanabe, ...
    2019 Volume 39 Issue 1 Pages 073-077
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    An 86-year-old female presented to our institute with diarrhea, vomiting and disturbance of consciousness. At the time of arrival, the patient was in a state of shock. Enhanced abdominal computed tomography demonstrated thickening of the transverse colonic wall and marked dilatation of the small intestine and colon. The patient was diagnosed as having obstructive colitis (OC) due to transverse colon cancer and septic shock due to bacterial translocation, and was taken to the operating room for urgent laparotomy. The operative findings were consistent with the preoperative diagnosis. In addition, a wide range of blood flow-defective were seen in the small intestine. Therefore, we diagnosed non-occlusive mesenteric ischemia (NOMI) caused by OC and performed extensive small intestinal resection, right hemicolectomy and jejunostomy. The patient recovered and was discharged on day 82 post-surgery. This case is extremely interesting from the point of view of identifying the mechanism underlying the development of this condition. Prompt laparotomy should be considered as one of the important treatment strategies for patients with severe disease and in poor physical condition.

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  • Tomohiko Yagi, Norimitu Tanaka, Tomoko Tsumura, Naohiro Okada, Asuna S ...
    2019 Volume 39 Issue 1 Pages 079-081
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    A 61-year-old woman presented with a 3-day history of abdominal and hypochondrial pain. Blood examination revealed increases in the levels of inflammatory markers. Abdominal CT showed a 30-mm long metallic foreign object, like a wire, which had penetrated the greater curvature of the gastric antrum. The patient had lost her dental metal wire few days earlier. We diagnosed peritonitis complicating gastric perforation caused by the dental metal wire. Since the object was a curved wire and almost be out of gastric parietal, we performed laparoscopic surgery and not endoscopy. We picked out the wire and covered the hole with omentum. The patient was discharged from the hospital 7 days later. Herein, we report a case of gastric perforation caused by an orthodontic appliance that was successfully treated by laparoscopic surgery.

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  • Atsushi Tanikawa, Tatsuya Hayashi
    2019 Volume 39 Issue 1 Pages 083-087
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    An 85-year-old woman with a history of open appendectomy presented with a 10-hour history of vague abdominal pain. Physical examination revealed abdominal tenderness and a scar in the right lower abdomen. Abdominal contrast-enhanced computed tomography showed a caliber change of the ileum in the same region. She was diagnosed as having adhesive small bowel obstruction and a transnasal ileus tube was inserted for decompression of the bowel. On day 2 after the insertion, a small-bowel contrast study through the ileus tube showed severe stenosis of the diseased ileum. An emergent laparoscopic surgery was performed, which revealed the incarcerated 20-cm-long segment of the ileum on the lateral-dorsal aspect of the cecum. The necrotic small bowel was resected. The patient was discharged on day 7 after surgery. We report the case of lateral paracecal hernia causing small bowel obstruction.

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  • Shigeru Kikuchi, Yuichi Akama, Kimiyoshi Shimanuki, Kazuhide Ko, Ryota ...
    2019 Volume 39 Issue 1 Pages 089-093
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    A 41-year-old man with a history of having undergone laparoscopic total colectomy for familial adenomatous polyposis presented to our hospital with the chief complaints of abdominal pain and nausea. Computed tomography showed dilatation of the small intestine and the superior mesenteric artery (SMA) got over the stomach through the lesser curvature. Thus, the SMA was located on the ventral aspect of the stomach. The intestinal obstruction was immediately relieved by insertion of a long nasointestinal tube. A review of the patient’s history revealed that he had previously presented with multiple episodes of obstruction, presumably caused by the same mechanism. Therefore, we decided to perform elective surgery. Intraoperatively, a 5-cm defect of the lesser omentum was found, and the small intestine was found herniating through this defect. This segment of the small intestine was not dilated. The intestine was pulled back within the abdomen, and the defect of the lesser omentum was sutured. The postoperative course of the patient was unremarkable, and at the 15-month postoperative follow-up, the patient was found to have made favorable progress. Lesser omental hernia is rare, but suturing of the defect may represent effective therapy. Further studies and more cases are needed to optimize the therapeutic strategy.

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  • Tsunehiro Matsubara, Tomoki Kobayashi, Hideki Matsuba, Min Kanamori, S ...
    2019 Volume 39 Issue 1 Pages 095-098
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    We report on a very elderly patient with postoperative jejunal intussusception. A 93-year-old female patient was admitted to our hospital with lower abdominal pain, and abdominal CT revealed ileus due to an incarcerated right obturator hernia. Emergency surgery was performed. On day 3 post-surgery, the patient developed paralytic ileus, and a long intestinal tube was inserted for relief of the postoperative paralytic ileus. However, the ileus failed to improve. On day 9 post-surgery, the patient developed high fever (39℃). Enhanced abdominal CT revealed the target sign in the left abdomen. We diagnosed jejunal intussusception and performed a second operation. We detected antegrade intussusception with necrosis 60 cm distal to the Treitz ligament and performed partial resection of the ileum. The patient made steady progress after the second operation.

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  • A Blind Spot in Interval Appendectomy
    Takahiro Higashi, Shinichirou Maehara
    2019 Volume 39 Issue 1 Pages 099-103
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    Appendiceal carcinoma is a relatively rare disease, but recently the frequency of interval appendectomy procedures for cases of appendicitis with expected advanced inflammation and abscess formation in the appendix area has been increasing. The patient reported here was a 35-year-old woman who was referred to us with suspected acute appendicitis, as her chief complaint was right lower abdominal pain. Abdominal CT revealed acute appendicitis accompanied by appendiceal abscess formation and the patient was treated with antibiotics as a bridge to interval appendectomy. Although there was a trend towards improvement, the patient’s symptoms of abdominal pain and fever worsened on the fourth day of hospitalization, and urgent laparoscopic appendectomy was performed. Histopathological examination revealed findings of a well-differentiated adenocarcinoma of the appendix invading the submucosal layer. The stump was negative. Thereafter, ileocecal resection with D2 lymphadenectomy was performed, and the patient has shown no evidence of relapse since the surgery. The decision for interval appendectomy may delay resection in cases of cancer, therefore, even in young people, it is necessary to determine the appropriate treatment policy bearing in mind the possibility of appendiceal cancer.

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  • Takayuki Tohma, Yasuyuki Okabe, Daigo Inada, Koji Suzuki
    2019 Volume 39 Issue 1 Pages 105-107
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    A Japanese woman in her 80s fell down the stairs in her home and was immediately transported to a hospital. She was diagnosed as having traumatic pelvic ring fracture. She was hypotensive and therefore transferred to our hospital for further treatment. On admission, she was found to be in severe hemorrhagic shock. Then we performed emergent transcatheter arterial embolization (TAE) for the bilateral internal iliac arteries, followed by external skeletal fixation of the pelvic ring. On day 2, her hemoglobin level decreased and contrast-enhanced CT showed a contrast blush in front of the injured sacrum. Emergent angiography showed massive bleeding from the medial sacral artery, for which we performed TAE with metallic coils. Her clinical course after the TAE was uneventful. The median sacral artery is one of the pelvic arterial branches but is rarely injured by pelvic fracture. We herein report a case successfully treated with TAE.

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  • Kumiko Sekiguchi, Akihisa Matsuda, Takeshi Matsutani, Nobutoshi Hagiwa ...
    2019 Volume 39 Issue 1 Pages 109-112
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    Case 1 was a 74-year-old man. One year eleven months after thoracoscopic esophageal surgery for esophageal cancer and open gastric tube reconstruction via the posterior mediastinal route, he visited our hospital complaining of abdominal pain. Abdominal plain X-ray and CT revealed incarceration of the small intestine in the left thoracic cavity. We diagnosed esophageal hiatal hernia, reduced the small intestine laparoscopically, and sutured the hiatus. Case 2 was a 79-year-old man. He had undergone thoracoscopic esophageal surgery for esophageal cancer and laparoscopic gastric tube reconstruction via the posterior mediastinal route. Two months after the surgery, he presented with the complaints of chest pain, dyspnea and melena. Imaging examination revealed prolapse of the transverse colon into the left thoracic cavity. We sutured the hiatus and fixed the gastric tube laparoscopically. Diaphragmatic hernia after esophageal surgery for esophageal cancer is relatively rare, but there is a certain risk of its being severe, even if it is asymptomatic, and it must be regarded as an indication of surgery. Laparoscopic repair of hiatal hernia after esophageal cancer surgery has been reported previously in only 8 cases in Japan. Laparoscopic repair is a useful procedure for hiatal hernia owing to its minimally invasive nature and ease of securing an adequate surgical field.

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  • Min Kanamori, Shinichi Mizuno, Hideki Matsuba, Tomoki Kobayashi, Tsune ...
    2019 Volume 39 Issue 1 Pages 113-117
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    A 53-year-old woman without a previous history of abdominal surgery presented to our hospital with abdominal pain, a day after eating 12 rice cakes. She reported severe pain across the entire abdomen, and abdominal physical examination revealed signs of peritoneal irritation. Abdominal computed tomography (CT) showed a large high-density mass in the stomach and jejunum, as well as dilatation of the jejunum. Another mass (considered to be the rice cakes) was identified in the small intestine. Based on the aforementioned findings, the patient was diagnosed as having bowel obstruction caused by rice cakes, and she was hospitalized. Her symptoms were relieved by nil-by-mouth instruction and gastrointestinal decompression using a nasogastric tube. Subsequently, she resumed her food intake and was discharged from the hospital. Bowel obstruction has been reported to be caused by various food items. Patients developing bowel obstruction following intake of rice cakes usually present with severe abdominal pain and signs of peritoneal irritation. Therefore, perforated peritonitis is usually suspected in such patients, who subsequently undergo unnecessary surgery. However, this condition can be easily diagnosed by CT and conservative management should be considered first. We report a case of bowel obstruction in a patient following the intake of rice cakes and also present a review of the literature.

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  • Keita Minowa, Kenichiro Takashina, Katsumi Shimomura
    2019 Volume 39 Issue 1 Pages 119-122
    Published: January 31, 2019
    Released: March 24, 2020
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    We treated 3 patients with gallbladder volvulus who presented to our hospital because of abdominal pain. Although physical examination and blood tests suggested a mild clinical presentation, all returned with worsening of the abdominal pain and were diagnosed as having gallbladder torsion preoperatively or postoperatively. Case 1: A 21-year-old man presented to our hospital with right-sided abdominal pain. Based on the findings of computed tomography (CT), he was diagnosed as having gallbladder volvulus, and we performed laparoscopic cholecystectomy. Case 2: An 86-year-old woman was referred to a previous hospital with right-sided abdominal pain and was transferred to our hospital the following day for further detailed examination. CT revealed gallbladder volvulus, and she underwent laparotomy. Case 3: A 92-year-old woman visited a previous hospital with right-sided abdominal pain and was transferred to our hospital the following day with suspected ileus based on the findings of CT. We performed a laparotomy, and made the diagnosis of gallbladder volvulus. Gallbladder volvulus is rare in clinical practice and is therefore difficult to diagnose based on physical examination and blood tests. Imaging tests are more useful for establishing a preoperative diagnosis. If we could diagnose this condition preoperatively, laparoscopic surgery could be performed.

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  • Ryo Nonomura, Junya Noguchi, Tomoe Moriguchi, Takayuki Tanoue, Toshihi ...
    2019 Volume 39 Issue 1 Pages 123-127
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    The patient was a 48-year-old man admitted to our hospital with the chief complaints of fever and epigastric pain. Contrast-enhanced abdominal computed tomography (CT) revealed a tumor with an 80-mm abscess in contact with the stomach and transverse colon. Following drainage of the abscess, endoscopic ultrasound was performed and the patient was diagnosed as having a primary gastric submucosal tumor. Laparotomy was performed, and the tumor was removed based on the intraoperative findings by local excision of the stomach and partial resection of the transverse colon, along with combined resection of a part of the rectus abdominis muscle. Histopathological examination of the resected specimen revealed that the tumor was composed of spindle cells showing positive nuclear staining for β-catenin, and we made the diagnosis of intraperitoneal mesenteric desmoid tumor. Surgical resection is considered as the first treatment option for desmoid tumors as they show a propensity for malignant transformation. However, desmoid tumors are also known to be associated with a high risk of local recurrence, necessitating sufficient postoperative follow-up. Desmoid tumors are rare ; in particular, there have been few reports on intraperitoneal mesenteric desmoid tumors without any associated factors, with only 18 reports from Japan. Among these, the tumor was associated with peritonitis in only 3 cases, including our case presented here.

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  • Koichi Inukai, Shuhei Uehara, Eri Tsuji, Yosuke Kitayama, Keisuke Nono ...
    2019 Volume 39 Issue 1 Pages 129-132
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    We report a case of transverse colon perforation occurring 24 years after kidney transplantation. A 62-year-old man was transported to our hospital complaining of acute abdominal pain. He had undergone cadaveric kidney transplantation 24 years earlier and was receiving immunosuppressive treatment with prednisolone and cyclosporine. Colonic perforation was suspected by the findings of abdominal computed tomography. Emergent surgery was performed, with surgical drainage and construction of a double-barrel colostomy. Postoperatively, antibiotic therapy and blood purification therapy were initiated for septic shock with acute kidney injury. The patient was discharged from the intensive care unit on the 18th postoperative day without complications.

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  • Koji Matsushita, Toshimasa Yatsuoka, Fumiki Okamoto, Chifumi Fukuda, N ...
    2019 Volume 39 Issue 1 Pages 133-136
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    Ingestion of foreign matter can cause gastrointestinal perforation. Herein, we report a case of small-intestinal perforation caused by a toothpick. Diagnosis was difficult because the patient had no recollection of having accidentally ingested any foreign matter and no foreign matter or free air was recognized on imaging examination. The patient, an 81-year-old woman was admitted with abdominal pain and vomiting. Physical examination revealed abdominal tenderness and muscle guarding. The white blood cell count was 13,700/μL, and the serum C-reactive protein was elevated to 13.0mg/dL. Computed tomography revealed ascites, but no foreign matter or free air was observed. Therefore, the cause of the acute generalized peritonitis could not be identified. Emergency diagnostic laparoscopy was performed on the day of admission and a toothpick was found stuck in the terminal ileum. Therefore, the diagnosis was made of a small-intestinal perforation caused by a misdirected toothpick. Partial resection of the small intestine was performed. Thus, diagnostic laparoscopy was beneficial for identification of the cause of the acute generalized peritonitis of unknown origin. When the cause of acute generalized peritonitis cannot be identified clinically, minimally invasive diagnostic laparoscopy should be considered for the purpose of diagnosis and treatment.

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  • Taketo Sasaki, Kiminori Takano, Seichiro Yamamoto, Ryo Nakanishi, Yusu ...
    2019 Volume 39 Issue 1 Pages 137-140
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    A 76-year-old male patient underwent laparoscopic cholecystectomy for acute cholecystitis, and intraoperatively, bile juice and small stones contaminated the peritoneal cavity. He was discharged uneventfully, but had to be re-admitted for intra-abdominal abscess caused by the gallstone spillage, and underwent laparoscopic abscess drainage on day 74 postoperatively. The abscess cavity with black stones was successfully drained and the patient recovered well, without any recurrence of the abscess. With the implementation of the Tokyo Guidelines for the Management of Acute Cholangitis and Cholecystitis 2013, cases of early laparoscopic cholecystectomy for acute cholecystitis have been increasing. In general, control of the complications of intraperitoneal gallstone spillage proves challenging, but laparoscopic abscess drainage is a minimally invasive technique as compared to open surgery and is more useful for enabling recovery from damage than percutaneous abscess drainage.

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  • Kaoru Katano, Takahisa Yamaguchi, Tomoharu Miyashita, Mitsuyoshi Okaza ...
    2019 Volume 39 Issue 1 Pages 141-144
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    A 59-year-old man who was receiving direct oral anticoagulant (DOAC) therapy for portal vein thrombosis complicating alcoholic liver cirrhosis admitted to a hospital with sudden onset of upper abdominal pain, nausea and syncope. As abdominal computed tomography (CT) showed hemorrhage of the gallbladder with intraperitoneal bleeding, the patient was shifted to our hospital. After admission, the patient went into a shock state and developed abdominal distension;abdominal physical examination revealed muscle guarding in the upper abdomen. With rapid fluid infusion and catecholamine administration, the patient recovered from the shock. Enhanced abdominal CT revealed a gallbladder stone, extravasation from the wall of the gallbladder and perforation, and emergency surgery was performed. The fundus of the gallbladder was perforated, with hemorrhage from the perforation. Partial cholecystectomy was performed. We made the final diagnosis in this case of hemorrhage associated with cholecystitis due to gallbladder stone, in a patient with alcoholic liver cirrhosis receiving DOAC therapy.

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  • Hayato Suzuki, Kenta Doden, Mari Shimada, Hirotaka Kitamura, Noriyuki ...
    2019 Volume 39 Issue 1 Pages 145-148
    Published: January 31, 2019
    Released: March 24, 2020
    JOURNALS FREE ACCESS

    A 23-year-old man with a history of Ehlers-Danlos syndrome (EDS) was injured in a car accident and transported to our emergency medical center. Upon examination, he was diagnosed as having left-sided pneumothorax, multiple left-sided rib fractures, right lung contusion, and splenic injury. He was hospitalized for follow-up. However, 8 hours after the injury, he showed worsening abdominal pain and signs of peritoneal irritation. A second computed tomography revealed intestinal perforation and pan-peritonitis. Emergency laparotomy was performed, he was diagnosed as having a jejunal injury, and the intestinal perforation was closed with sutures. His postoperative course was favorable. He resumed water intake on the day 3 after surgery, resumed meal intake on day 5, and was discharged on day 12. Surgery and perioperative management require close attention in patients with EDS, because these patients are vulnerable to bleeding and rupture of their viscera. Additionally, the possibility of delayed intestinal perforation should not be ignored.

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