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 3
Showing 1-27 articles out of 27 articles from the selected issue
  • Tetsunobu Udaka, Naoya Matsumoto, Sumiharu Yamamoto, Hiroaki Asano, Ma ...
    2019 Volume 39 Issue 3 Pages 503-508
    Published: March 31, 2019
    Released: April 11, 2020
    JOURNALS FREE ACCESS

    Since a strangulated bowel obstruction occasionally progress to a serious condition, early and precise diagnosis in patients with symptoms related with bowel obstruction is important. In the present study, we aimed to identify indicators for the preoperative diagnosis of strangulated bowel obstruction. We divided 107 patients diagnosed intraoperatively as having bowel obstruction into 2 groups according to the presence of bowel ischemia. The clinical findings, laboratory and blood gas analysis data, and the findings of enhanced CT of the patients were evaluated. Univariate analysis indicated significant differences in the peritoneal irritation sign, white blood cell count (WBC), lactate dehydrogenase (LDH) levels, ascites, abnormal run of vessels, elevation of the mesentery density, closed loop obstruction, and reduced enhancement of the intestinal wall between the two groups. Multivariate analysis indicated closed loop obstruction (P<0.001). Evaluation of the peritoneal irritation sign, WBC, LDH levels, ascites, elevation of the mesentery density, and closed loop obstruction can be helpful for early diagnosis of strangulated bowel obstruction.

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  • Masato Shizuku, Hirotaka Maruyama
    2019 Volume 39 Issue 3 Pages 509-514
    Published: March 31, 2019
    Released: April 11, 2020
    JOURNALS FREE ACCESS

    We report herein on our review of the treatment policy followed at our hospital to treat intestinal obstructions in patients without a history of abdominal surgery. Few reports in the literature have described such cases. Between 2010 and 2016, 898 patients presented at our hospital with an intestinal obstruction. Among these 898 patients, 59 had no history of abdominal surgery. An operation was needed in 34 (57.6%) of these 59 patients, and an emergency operation was needed in 23 of these 34 patients (39.0%). The mean operation time for open surgery was 85.2 min (18 patients), and the mean operation time for laparoscopic surgery was 74.9 min (16 patients). The most frequent mechanism of obstruction in the 34 patients who underwent an operation was a band-type obstruction (14 patients, 41.2%). In contrast, among the 839 patients with a history of abdominal surgery, an operation was needed in 160 patients (19.1%), and an emergency operation was needed in 70 patients (8.3%). The mean operation time for open surgery was 96.6 min (130 patients), and the mean operation time for laparoscopic surgery was 125.9 min (30 patients). The most frequent mechanism of obstruction in the 160 patients who had previously undergone an operation was intestine/intestine-peritoneum/intestine-intestinal membrane adhesions (83 patients, 51.9%). In patients with intestinal obstruction, surgery was more frequently required in those without a history of abdominal surgery than in those with a history of abdominal surgery. However, technically challenging procedures were not required in patients without a history of abdominal surgery. Thus, laparoscopic surgery could be a good strategy in such cases.

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  • Makoto Ikenoue, Kosei Tashiro, Fumiaki Kawano, Shinsuke Takeno, Kunihi ...
    2019 Volume 39 Issue 3 Pages 515-518
    Published: March 31, 2019
    Released: April 11, 2020
    JOURNALS FREE ACCESS

    A 67-year-old female, previously treated for arterial fibrillation with warfarin, was transferred to our hospital because of sudden abdominal pain, nausea, and vomiting. A CT scan showed a superior mesenteric artery (SMA) obstruction and small bowel ischemia. She was treated with transcatheter arterial injection of urokinase, and abdominal exploration. Twenty cm of necrotic small intestine was resected and the color and motility of the remnant intestine was intact. Seven days after the first operation, she complained of abdominal pain and fever. No ischemic changes of the remnant small intestinal ischemia were detected on CT imaging, but a small intestinal enema revealed mucosal necrosis. We decided to carry out a second exploration. The remnant intestine exhibited good pulse, color, and motility, but its circumference was unclear and we detected a stricture during intraoperative endoscopy. The resection line was detected using endoscopy, followed by repeat resection, to obtain as short a remnant as possible. Based on the histopathological findings, the patient was diagnosed as having an ischemic stricture of the small intestine. We report herein on a case of ischemic stricture of the small intestine after SMA thrombosis. A small intestinal enema was useful for diagnosis, and we determined the resection line with intraoperative endoscopy.

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  • Yuki Nagata, Jun Kadono, Shunsuke Motoi, Takashi Tasaki, Yutaka Imoto
    2019 Volume 39 Issue 3 Pages 519-523
    Published: March 31, 2019
    Released: April 11, 2020
    JOURNALS FREE ACCESS

    【Background】A sodium hyaluronate carboxymethylcellulose bioresorbable membrane (Seprafilm®) is used frequently to prevent postoperative adhesions. It has been considered as an efficient and a safe tool. We report herein on a case of an enterocutaneous fistula caused by Seprafilm®-induced intestinal adhesions. 【Case presentation】A 79-year-old male was admitted to our department with an enterocutaneous fistula 42 days after the graft replacement for an abdominal aortic aneurysm. Seprafilm® had been placed at the time of the previous operation. A repeat laparotomy demonstrated dense adhesions between the small intestine and the abdominal wall. The enterocutaneous fistula and the adhered intestine were resected en-bloc. The pathological examination of the resected small intestine showed diffuse subserosal fibrosis with multinuclear giant cells containing a clear foreign body. It was suggested that a paradoxical inflammatory reaction to Seprafilm® caused the dense adhesions.【Conclusion】It should be kept in mind that Seprafilm® may also cause dense adhesions.

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  • Satoshi Nishizawa, Satoshi Kiyota, Genichi Kanazawa, Kunihiro Katsurag ...
    2019 Volume 39 Issue 3 Pages 525-529
    Published: March 31, 2019
    Released: April 11, 2020
    JOURNALS FREE ACCESS

    A 33-year-old woman was admitted to our hospital with a half a year history of intermittent abdominal pain followed by intensifying abdominal pain and vomiting. An abdominal computed tomography scan showed multiple tumors of various sizes with fat density in the jejunum and intussusception which appeared to be caused by the tumors. We diagnosed intestinal intussusception and performed laparoscopic surgery. The intussusception was reduced by laparoscopic surgery. We subsequently resected the jejunum including lipomatosis via a small laparotomy. The resected specimen contained multiple yellow and soft tumors which were diagnosed histopathologically as intestinal lipomatosis. Reports on intussusception caused by jejunal lipomatosis are rare, so we report herein on this case.

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  • Issei Kawakita, Masaaki Zaitsu, Ryuta Ueda, Yuka Tanaka, Hirohumi Kon
    2019 Volume 39 Issue 3 Pages 531-534
    Published: March 31, 2019
    Released: April 11, 2020
    JOURNALS FREE ACCESS

    A 68-year-old man who had abdominal pain in the right lower-quadrant was admitted to a local hospital. A foreign body was detected in the ileocecal area, and he was referred to our hospital for additional treatment. Abdominal computed tomography showed a foreign body with linear high density in the appendix, and inflammatory changes around the appendix. Emergency laparoscopic surgery was performed. After identifying that the perforated appendix had been caused by the foreign body together with an abscess, a laparoscopic appendectomy was performed. The foreign body subsequently turned out to be a fish bone. There are no reports about laparoscopic appendectomies for perforation of the appendix by fish bones. The good result in our case suggested that laparoscopic appendectomy might be a useful treatment for perforation of the appendix caused by a fish bone.

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  • Keiko Shiomi, Keita Kojima, Atsuko Tsutsui, Takahiro Yamanashi, Masano ...
    2019 Volume 39 Issue 3 Pages 535-539
    Published: March 31, 2019
    Released: April 11, 2020
    JOURNALS FREE ACCESS

    A 19-year-old man was admitted to our hospital following sudden onset of intractable lower abdominal pain, diarrhea and vomiting. Abdominal contrast-enhanced CT revealed a closed loop sign, but no clear ischemic changes. Pan-peritonitis appeared with muscle guarding, and emergency surgery was performed. Intraoperatively, we found that the ileum was compressed by a herniation of cord-like tissue growing from Meckel’s diverticulum to the small intestine. With resection of only this tissue, simple repositioning was manually possible, so a diverticulectomy was performed. Histopathological examination of the resected cord-like tissue revealed an artery, vein and nerve, so a mesodiverticular vascular band was diagnosed. Ileus caused by Meckel’s diverticulum is rare, but should be considered when ileus is encountered in a patient with no history of surgery.

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  • Takuto Uyama, Tatsuya Tazaki, Shinnosuke Uegami, Mohei Kohyama, Masaru ...
    2019 Volume 39 Issue 3 Pages 541-544
    Published: March 31, 2019
    Released: April 11, 2020
    JOURNALS FREE ACCESS

    A 32-year-old man was admitted to our hospital with an injury caused by a burst of compressed air in the anus. The patient complained of severe abdominal distension and pain immediately thereafter. A computed tomography scan revealed a pneumoperitoneum but did not reveal the puncture site. Percutaneous drainage via needle puncture was performed to decompress the abdomen. A laparotomy was performed, which disclosed a perforation involving the transverse colon and a wide serosal laceration of the contralateral colonic mesentery. Emphysema was noted in the mesentery from the ascending colon to the sigmoid colon. Because it was difficult to identify all damaged sites on the mesenteric side, a subtotal colectomy was performed. A temporary ileostomy was performed, and a mucous fistula was made in the remaining sigmoid colon. An ileal-sigmoid colon anastomosis was performed on the 74th day post-operatively and the ostomy was closed. In the treatment of a colon injury caused by compressed air, it is necessary to systematically explore the lower gastrointestinal tract for punctures during surgery.

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  • Jun Masui, Masakazu Ikenaga, Yoshinao Chinen, Hiroaki Itakura, Masami ...
    2019 Volume 39 Issue 3 Pages 545-548
    Published: March 31, 2019
    Released: April 11, 2020
    JOURNALS FREE ACCESS

    A 79-year-old man presented at a local hospital with the chief complaints of postprandial epigastric pain and vomiting. He had no history of open abdominal surgery. He was referred to our hospital for the treatment of suspected bowel obstruction. Upon arrival, the patient perceived referred pain on pressure in the epigastric region, but symptoms of peritoneal irritation were not apparent. Blood test results indicated an inflammatory response with elevated lactic acid. Abdominal CT findings revealed poor contrast in the small intestinal wall, proximal small intestinal enlargement, and ascites. We suspected strangulated bowel obstruction and performed emergency open abdominal surgery, which revealed slightly bloody ascites with funicular adhesion of the greater omentum and mesentery. The small intestine was intussuscepted into this site; it was also strangulated and necrotic for a 60-cm long stretch; therefore, we performed a partial resection of the small intestine. The patient progressed well postoperatively and was discharged on hospital day 9. It is often challenging to confirm a preoperative diagnosis of strangulated bowel obstruction in the absence of an open surgery history. Our patient’s condition was caused by an internal hernia of the greater omentum that had become funicular. When bowel obstruction occurs in patients without an open surgery history, the possibility of the condition being caused by a greater omentum funicular object that is unlikely to cause abdominal symptoms should be taken into consideration when determining the patient’s eligibility for surgery.

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  • Yasuhiro Ikegawa, Junichiro Nakagawa, Hiroshi Hino, Noboru Kato, Tomoh ...
    2019 Volume 39 Issue 3 Pages 549-553
    Published: March 31, 2019
    Released: April 11, 2020
    JOURNALS FREE ACCESS

    A 83-year-old woman was transferred to a local hospital with abdominal pain. A contrast-enhanced CT scan revealed intraabdominal hemorrhage and left gastroepiploic artery aneurysms, so she was transferred to our hospital for treatment. Although we tried transcatheter arterial embolization, we could not complete the procedure because of the meandering nature and narrowing of the blood vessel. We therefore performed an emergency abdominal operation. The operative findings showed intraabdominal hemorrhage which reached 2,200mL and two aneurysms of the left gastroepiploic artery. We resected a part of the greater omentum including the aneurysms. Recently, transcatheter arterial embolization is often successfully performed for the rupture of intraabdominal arterial aneurysms, but the life of the patient in the present study was saved with an emergency abdominal operation.

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  • Hiroyuki Tsukayama, Norio Noguchi
    2019 Volume 39 Issue 3 Pages 555-558
    Published: March 31, 2019
    Released: April 11, 2020
    JOURNALS FREE ACCESS

    We present three cases of delayed intestinal obstruction after blunt abdominal trauma, and review cases reported in Japan including our 3 cases. Two men and a woman, ages ranging from 28 to 89 years, were diagnosed with mesenteric injury based on CT scan findings. Despite apparent successful conservative observation, intestinal obstruction developed 3〜23 days after the accident in all three patients. All patients required a laparotomy due to intestinal stenosis, which was diagnosed with fluoroscopy using contrast medium through a long intestine tube or CT scan. In two patients, partial resection of the small intestine was performed. In the third patient case, a synechotomy on its own without any bowel resection was performed. Histopathological findings showed inflammatory cell infiltration of the subserosal layer and mesenterium, which led to cicatricial stenosis. These patients illustrate that delayed intestinal obstruction due to irreversible fibrosis formation and cicatrization can cause unsuccessful conservative therapies. Therefore, early surgery should be considered when a patient complains of ileus after any blunt abdominal trauma.

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  • Shinya Hara, Yutaro Yamamoto, Norihiro Hokimoto, Nobuyuki Tanida
    2019 Volume 39 Issue 3 Pages 559-562
    Published: March 31, 2019
    Released: April 11, 2020
    JOURNALS FREE ACCESS

    A 68-year-old woman with rheumatoid arthritis, being treated with prednisolone (7.5 mg/day) and methotrexate (4mg/week), was suspected to have a perforation of the colon based on abdominal computed tomography. She underwent resection of the perforated part of the transverse colon and colostomy. Postoperatively, she developed septic shock requiring a multidisciplinary treatment regimen including continuous hemodiafiltration. Her symptoms resolved, and she was discharged on day 26. She complained of abdominal pain again 125 days after discharge, and imaging showed air in the mesenterium near the stoma. There was a perforation measuring 2.5 cm at the oral side of the transverse colon stoma which had been created during the initial treatment. She underwent right hemicolectomy and ileostomy. The postoperative course was favorable, and she was discharged on day 18. Both lesions were diagnosed as idiopathic perforation of the colon based on neither of the pathological specimens showing any evidence of vasculitis or ulceration. To our knowledge, only 5 cases with multiple idiopathic perforations of the colon have been reported in Japan. Clinicians should be aware of the possibility of perforation recurrence.

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  • Tomoaki Bekki, Hiroshi Okuda, Ryosuke Hirohata, Tomoyuki Abe, Masahiro ...
    2019 Volume 39 Issue 3 Pages 563-566
    Published: March 31, 2019
    Released: April 11, 2020
    JOURNALS FREE ACCESS

    A 69-year-old man visited the Emergency Department at Onomichi General Hospital with upper abdominal and low back pain. Contrast-enhanced abdominal computed tomography revealed a low-density tumor suggestive of a lipoma in the right lower abdomen. We could not identify any findings other than the tumor that could explain the patient’s pain. There was no evidence of a hiatal hernia and/or gastritis on upper gastrointestinal endoscopy. Abdominal pain recurred with resumption of food/meal intake; however, his pain improved with medication. We performed a semi-emergency open operation. No ascites was observed in the abdominal cavity. The tumor was located in the small bowel mesentery without any invasion of other organs. We performed mesenteric tumor excision, and the patient was discharged on postoperative day 5 without any complications. No abdominal pain was observed postoperatively. A mesenteric lipoma may cause bowel obstruction; therefore, early diagnosis and prompt surgical intervention are important. Notably, recurrence has been reported in a few cases despite complete tumor excision. Thus, careful follow-up is important.

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  • Yota Tanahashi, Akira Umemura, Keisuke Koeda, Kiyoharu Takashimizu, Sa ...
    2019 Volume 39 Issue 3 Pages 567-570
    Published: March 31, 2019
    Released: April 11, 2020
    JOURNALS FREE ACCESS

    An 82-year-old man who had undergone laparoscopic total gastrectomy and antecolic Roux-en-Y reconstruction for early-stage gastric cancer 3 years previously visited our hospital with abdominal pain and vomiting. Abdominal computed tomography revealed dilatation, thinning, pneumatosis intestinalis, and closed loop formation in the ascending jejunal limb. We diagnosed strangulation with a small bowel obstruction and performed emergency surgery. During the surgery, we found that the ascending jejunal limb was obstructed by a band of tissue between the appendix epiploica of the transverse colon and jejunal mesentery. We transected the band and resected the ascending jejunal limb from the anal side of the esophagojejunostomy to the anal side of the Roux-en-Y limb and then reconstructed it as before. The patient’s hospital stay was prolonged because of aspiration pneumonia and malnutrition, but we transferred him to another hospital to continue dysphagia rehabilitation 41 days postoperatively. We have not seen any reports of strangulations with small bowel obstruction of the ascending jejunal limb after gastrectomy in the previous 10 years;therefore, to the best of our knowledge, this is the first case report of this condition. We have discussed and reported on this case with some reviews of the pertinent literature.

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  • Hitoshi Ono, Hidenori Takahashi, Ayami Sasaki, Masaru Nomura, Kazuyosh ...
    2019 Volume 39 Issue 3 Pages 571-574
    Published: March 31, 2019
    Released: April 11, 2020
    JOURNALS FREE ACCESS

    A 53-year-old man developed diarrhea, vomiting, and left-sided abdominal pain. Abdominal plain computed tomography (CT) revealed dilation of the small intestine, accumulation of intestinal contents, and ascites. He was admitted to our hospital with the diagnosis of severe gastroenteritis. On the 6th day post admission, CT suggested strangulated ileus secondary to a transmesosigmoid hernia. Contrast-enhanced CT revealed worsening dilation of the enhanced loops of the small intestine. On the 8th day, we performed an emergency operation under the suspected diagnosis of a transmesosigmoid hernia. Laparotomy revealed an oval defect measuring 3 cm in diameter in the sigmoid colon. Approximately 110 cm of the small intestine was observed to have herniated through the defect from the outside of the sigmoid colon. The herniated intestine was not necrotic, and the oval defect was closed. A few reports have described patients with a transmesosigmoid hernia, which is difficult to diagnose preoperatively. A transmesosigmoid hernia should be considered among the differential diagnoses of strangulated ileus in patients without a history of surgery. Prompt surgery is important.

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  • Masao Uemura, Yasutomo Nagasue, Taihei Soma, Kazuyuki Hayashida
    2019 Volume 39 Issue 3 Pages 575-578
    Published: March 31, 2019
    Released: April 11, 2020
    JOURNALS FREE ACCESS

    A 20-years-old woman was taken into the local emergency hospital after being involved in a traffic accident. Her vital signs were unstable at that time, and contrast enhanced computed-tomography (CT) scan revealed liver injury (type ⅢB) as well as subarachnoidal bleeding and mesenteric injury. After transcatheter arterial embolization for the liver, her vital signs stabilized. Intensive management for severe multiple organ injury was still needed, so she was brought to our hospital. Follow-up CT scan on arrival revealed an increased amount of abdominal hemorrhage needing diagnosis for the site of bleeding. We chose to perform a diagnostic laparoscopy because the patient was young and her vital signs were stable on arrival. Right hepatic lobe injury was found, but neither active bleeding nor a bile leakage was observed. The serosal injury on the transverse colon was fixed with a serosa: muscular layer suture. After aspirating the hematoma and inserting drains, the procedure was done. She had a good post-operative course and was eventually transferred back to the original hospital. We report herein on the efficacy of a diagnostic laparoscopy for a liver trauma patient.

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  • Takafumi Kusaba, Keizaburo Maruyama
    2019 Volume 39 Issue 3 Pages 579-581
    Published: March 31, 2019
    Released: April 11, 2020
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    A 70-year-old female visited our emergency room on foot, following dyspnea which had gradually worsened after she was involved in car accident. A left traumatic diaphragmatic laceration was recognized on CT examination. The dyspnea gradually worsened, so we undertook an emergency laparotomy. Intraoperative findings revealed a defect at the center of the left diaphragm with a diameter of 8 cm, accompanied by prolapse of the stomach into the left thorax. We reduced the escaped stomach and observed the thoracic cavity and the abdominal cavity, but no damage other than the left diaphragm laceration was found. The defect in the left part of the diaphragm was directly sutured closed. The patient’s postoperative course was uneventful. We report hereon on this example of a traumatic diaphragmatic injury accompanied by prolapse of the stomach into the thorax with a review of the pertinent literature.

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  • Yoshihiro Sakano, Kenta Furukawa, Masahiro Tanemura, Manabu Mikamori, ...
    2019 Volume 39 Issue 3 Pages 583-586
    Published: March 31, 2019
    Released: April 11, 2020
    JOURNALS FREE ACCESS

    Gallbladder torsion leads to vascular insufficiency, resulting in rapid necrosis of the gallbladder. We present two patients with gallbladder torsion, who underwent an emergency single-incision laparoscopic cholecystectomy (SILC). 【Case 1】 A 90-year-old woman was admitted as an emergency to our hospital with severe upper abdominal pain and fever. Subsequently, we diagnosed her illness as gallbladder torsion through enhanced abdominal CT findings and magnetic resonance cholangiopancreatography (MRCP). An emergency cholecystectomy was performed using the single-incision laparoscopic technique. 【Case 2】 A 74-year-old woman was admitted as an emergency to our hospital with similar symptoms as described in Case 1. Subsequently, we diagnosed her illness as acute cholecystitis. An emergency SILC was performed. Both patients underwent emergency surgeries (SILC) and both were discharged with a good clinical course.

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  • Tadatoshi Oe, Hirohiko Onoyama
    2019 Volume 39 Issue 3 Pages 587-590
    Published: March 31, 2019
    Released: April 11, 2020
    JOURNALS FREE ACCESS

    A 56-year-old man complained of a 3-day history of epigastralgia and vomiting. He was admitted to our hospital because the pain had increased and had extended to his entire abdomen. Upon admission, tenderness and muscular defense across the entire abdominal region was observed. An enhanced abdominal CT scan revealed a gas-containing jejunal mesenteric abscess and multiple diverticula of the small intestine. The patient was diagnosed as having panperitonitis caused by penetration of the jejunal diverticulum in the mesentery. Emergency surgery revealed purulent ascites and a 9-cm jejunal mesenteric abscess. The mesenteric abscess was located about 35 cm distal from the ligament of Treitz and had perforated into the abdomen. We performed a partial resection of the jejunum. The resected specimen revealed a jejunal diverticulum penetrating the mesentery. With the exception of Meckel’s diverticulum, penetration or perforation of the small intestinal diverticulum is rare. This condition has a high mortality rate because it is difficult to diagnose preoperatively. We report herein on a case of panperitonitis caused by penetration of the jejunal diverticulum that was successfully diagnosed preoperatively.

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  • Masahiro Fukada, Kaori Tanaka
    2019 Volume 39 Issue 3 Pages 591-594
    Published: March 31, 2019
    Released: April 11, 2020
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    The patient was a 78-year-old man diagnosed as having diverticula of the entire colon who experienced three episodes of diverticular bleeding that had started two years previously. He visited us again with a chief complaint of melena, was diagnosed as having diverticular bleeding in the sigmoid colon, and was hospitalized. He was discharged after hemostasis was achieved, but bleeding recurred two weeks later. He was therefore considered as a candidate for surgery. Refractory diverticular bleeding was found in the entire colon, and we judged a subtotal colectomy to be necessary. To avoid postoperative dyschezia, we used an operative method that preserved the ileocecal region and obtained good results in terms of his postoperative bowel habits. Diverticula of the entire colon are rare, but surgery is necessary in cases of repeated bleeding. In such cases, subtotal colectomy with preservation of the ileocecal junction is thought to be useful.

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  • Shingo Ito, Yoshio Sakai, Masaya Kawai, Kiichi Sugimoto, Makoto Takaha ...
    2019 Volume 39 Issue 3 Pages 595-599
    Published: March 31, 2019
    Released: April 11, 2020
    JOURNALS FREE ACCESS

    A 75-year-old male patient was admitted to our hospital with a history of a fever of 40℃ and right lumbar pain. He was treated with antibiotics at our hospital under the diagnosis of diverticulitis. Enhanced computed tomography of the abdomen revealed a superior mesenteric venous thrombosis (SMVT). Absence of peritoneal irritation symptoms suggested that intestinal necrosis was unlikely. Thrombolytic therapy was performed with urokinase infusion through a catheter in the superior mesenteric artery (SMA) and systemic heparinization. The patient was discharged after conservative treatment 30 days after hospitalization. Lifelong thromboprophylaxis with warfarin was started to prevent recurrence, and the patient was asymptomatic five months after discharge from the hospital. The coagulation and fibrinolysis parameters of this patient were normal and we considered this case as a primary SMVT. We report herein on a rare case of a SMVT successfully treated with interventional radiology.

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  • Takeshi Nakamura, Jiro Ouchida, Shinsuke Kubo, Yuhei Kawasaki, Takahir ...
    2019 Volume 39 Issue 3 Pages 601-604
    Published: March 31, 2019
    Released: April 11, 2020
    JOURNALS FREE ACCESS

    A 34-year-old man was transported by ambulance to our emergency room following a fall down some stairs in his home due to loss of consciousness. He was in shock, and a contrast CT scan showed dissection of the celiac artery and rupture of an aneurysm of the splenic artery with active bleeding. Intra-aortic balloon occlusion (IABO) was performed and an emergency operation was carried out. The control of hemorrhage by IABO was effective, and we could ligate both the proximal and distal splenic arteries associated with the splenic aneurysm. The total balloon occlusion time was 55 minutes and the total bleeding volume was 8,652 mL. Because of hypothermia and acidosis, the operation was finished without splenectomy. The contrast CT scan taken on the following day showed good collateral blood flow in both the splenic artery and common hepatic artery. The patient was discharged in good condition on the 15th postoperative day. Splenic aneurysm rupture related to isolated spontaneous celiac artery dissection has been rarely reported, and preoperative IABO insertion was effective for hemorrhage control of the splenic aneurysm rupture.

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  • Hideki Shimaoka, Tatsuya Okamoto, Yuki Shin, Ippei Yamana, Yasuo Sakam ...
    2019 Volume 39 Issue 3 Pages 605-608
    Published: March 31, 2019
    Released: April 11, 2020
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    The occurrence rate of intussusception in adults is lower compared to that in children. In most cases, the presenting part is complicated with organic diseases and often requires surgery. In this study, we report on a case of intussusception with an introverted Meckel diverticulum as the presenting part, on which we carried out laparo-endoscopic single-site surgery using a ZigZag incision. The patient was a 31-year-old male. He presented with a chief complaint of abdominal pain. After detailed evaluations, a diagnosis of intussusception of the small intestine was made and endoscopic reduction was performed on the same day, followed by elective surgery. A ZigZag incision was made in the umbilical region, upon which a telescoped bowel was identified under laparscopic view and removed from the body. Reduction was performed using the Hutchinson procedure. Upon finding a tumor in the presenting part, a portion of the small intestine was resected. From the pathological examination findings, the presenting part was diagnosed as demonstrating Meckel diverticulum. In recent years, there have been increasing reports on surgery under laparoscopic views for introverted Meckel diverticulum. Laparoendoscopic single-site surgery with a ZigZag incision is therefore considered to be an excellent technique in terms of operability and esthetic outcome.

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  • Yoshitake Endo, Hirohiko Onoyama, Seigo Sha, Takenori Itohara
    2019 Volume 39 Issue 3 Pages 609-611
    Published: March 31, 2019
    Released: April 11, 2020
    JOURNALS FREE ACCESS

    We report herein on two cases of small intestinal perforation after examination for an intestinal obstruction using Gastrografin. Case 1; A 56-year-old female was admitted under a diagnosis of intestinal obstruction after a total gastrectomy for gastric cancer. The intestinal obstruction was improved with conservative therapy. A follow-through examination with Gastrografin to evaluate the passage showed stenosis of the intestine. After 2 days, she had abdominal pain and abdominal distension. She underwent an emergency operation under the diagnosis of an intestinal perforation. The operative findings comprised a pin-hole perforation at the oral side of the stenosis. Case 2; In a 76-year-old male, intestinal obstruction was caused by adhesion after distal gastrectomy for gastric cancer. An intestinal tube was inserted for decompression of the intestine. After adequate decompression, Gastrografin was used to evaluate the passage. Next day, he went into shock with a diagnosis of intestinal perforation and underwent an emergency operation. An intestinal perforation similar to that in case 1 was found at the oral side of the stenosis. However, although both patients underwent successful emergency surgery, they died of sepsis. We report herein two important cases of intestinal perforation caused by Gastrografin.

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  • Daishi Naoi, Yuichi Aoki, Kazuma Rifu, Tetsuya Shiozawa, Chuji Sekiguc ...
    2019 Volume 39 Issue 3 Pages 613-616
    Published: March 31, 2019
    Released: April 11, 2020
    JOURNALS FREE ACCESS

    A 29-year-old man presented with lower abdominal pain without peritoneal signs and fever. Meckel’s diverticulitis was diagnosed on computed tomography (CT) imaging. There were no peritoneal signs despite widespread inflammation around the diverticulum on the CT scan. He was treated nonoperatively with antibiotics. Interval diverticulectomy was then performed with single incision laparoscopy-assisted surgery. The diverticulum was located 90cm from the ileocecal valve and an extracorporeal wedge resection was performed. The postoperative course was uneventful and the patient was discharged on postoperative day 7. Pathological examination showed Meckel’s diverticulitis with ectopic gastric tissue. Due to improvements in diagnostic imaging, Meckel’s diverticulitis was diagnosed preoperatively. Laparoscopic interval diverticulectomy has been rarely reported to date.

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  • Shunsuke Fujisawa, Nobuhisa Takase, Nobuaki Yamasaki, Kazuya Mimura, K ...
    2019 Volume 39 Issue 3 Pages 617-620
    Published: March 31, 2019
    Released: April 11, 2020
    JOURNALS FREE ACCESS

    A 78-year-old Japanese man who had been admitted to our hospital presented with sudden nausea, and upper abdominal pain. There was no abdominal surgical history. Abdominal CT revealed the dilatation of the small bowel and caliber change in the ileum. We diagnosed his condition as an intestinal obstruction in the ileum, and although we performed intestinal decompression using a transnasal ileus tube, it was not effective. Finally, we performed a laparotomy to resolve the intestinal obstruction. Intraoperative finding showed an intestinal obstruction entrapped between the mesodiverticular band (MB) of Meckel’s diverticulum and the ventral mesentery. We resolved the intestinal obstruction with the MB. Furthermore, we simultaneously resected Meckel’s diverticulum. There was no evidence of necrosis. The resected specimen of the MB histologically contained the remnant of the vitelline vessels. A case of ileus obstruction caused by the MB of Meckel’s diverticulum with histological confirmation is extremely rare. We therefore report herein on a case of MB-related intestinal obstruction with histological confirmation and share this case as important evidence for further embryological understanding.

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  • Kiyomitsu Kuwahara, Fumiya Fukui, Shinji Nishino, Hiroyuki Sugita
    2019 Volume 39 Issue 3 Pages 621-624
    Published: March 31, 2019
    Released: April 11, 2020
    JOURNALS FREE ACCESS

    An 81-year-old woman underwent an appendectomy with abdominal irrigation for perforating appendicitis. She visited our hospital complaining of right abdominal pain 2 months after the surgery. Computed tomography revealed a high density area in the right abdomen, and an abdominal abscess was suspected. Antibiotics (levofloxacin) were administered to the patient. One week later, abdominal pain was not relieved, so we performed curettage of the abdominal abscess. During the operation, we detected granulation tissue inside the abscess in the paracolic gutter. Postoperatively, based on the histopathological findings, we diagnosed the patient’s condition as abdominal actinomycosis after surgery for perforating appendicitis. We could not resect those granulation tissues completely, so we administered antibiotics (amoxicillin) to the patient for 6 months. Actinomycosis should be considered in the management of an abdominal abscess after surgery for perforating appendicitis.

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