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 6
Showing 1-37 articles out of 37 articles from the selected issue
  • Kengo Kai, Masahiro Kai, Shunichi Tanaka, Atsushi Nanashima
    2019 Volume 39 Issue 6 Pages 999-1005
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    The subjects were 22 patients with hepatic portal venous gas (HPVG) findings who were treated at our hospital. We compared Group A, in which surgery was ultimately indicated (including preoperative deaths), with Group B, which received successful conservative treatment. We then examined the surgical indications for patients with HPVG in the emergency room. CT findings such as extrahepatic portal venous gas (85.7% vs. 25.0%, P=0.0083), pneumatosis intestinalis (64.3% vs. 12.5%, P=0.0310), and ascites (78.6% vs. 25.0%, P=0.0260) were significantly more common in Group A. The appearance of extrahepatic portal venous gas, pneumatosis intestinalis, and ascites on CT findings might be important objective indicators of a need for surgery in patients with HPVG.

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  • Tomoharu Miyashita, Tetsuo Ohta, Ryosuke Gabata, Mitsuyoshi Okazaki, H ...
    2019 Volume 39 Issue 6 Pages 1009-1016
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    Many elderly people are suffering from lifestyle-related diseases such as diabetes, hypertension and dyslipidemia. The presence of lifestyle-related diseases is recognized as a significant prognostic factor for postoperative complication in elderly patients. Postoperative complications are also directly related to poor surgical outcomes in the elderly. Quality initiatives with great potential for improving surgical outcomes in elderly patients should target the prevention of perioperative complication. Modulating the gut environment may play a central role in therapy because the target organ in the perioperative period is the gut. We have devised a combined therapy with Glutamine/BCAA and symbiotics in the perioperative period for elderly patients undergoing high risk surgery. We also have performed rehabilitation and nutritional support perioperatively which have all been shown to reduce breakdown of muscle mass, reduce catabolism and insulin resistance due to surgical injuries and reduce postoperative complications. We concluded that this bundle therapy, aimed at improving the gut environment during the perioperative period, may help to prevent postoperative surgical complication in elderly patients.

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  • Nobuhiro Takiguchi, Yoshihiro Nabeya, Toru Tonooka
    2019 Volume 39 Issue 6 Pages 1017-1023
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    The pros and cons of gastrectomy for extremely elderly gastric cancer patients are not clear. We clarified the real clinical practice for gastric cancer patients with 85 years or older (EEGC) and examined the short and long-term results of gastrectomy in these patients. ①We analyzed 208 EEGC patients who visited our hospital. There were 36 patients who underwent surgery, 71 patients who had endoscopic submucosal resection (ESD), 23 chemotherapy patients, 28 cases who received best supportive care, and 68 patients who did not receive any treatment. Four non-curative ESD cases did not undergo additional gastrectomy. Gastrectomy was not performed for 23 patients with advanced gastric cancer and 30 patients with early gastric cancer due to dementia, comorbidity, poor PS, patient refusal, doctor’s decision and so on. ②We analyzed 46 EEGC gastrectomy patients regarding their characteristics and short and long-term results. Thirty-eight patients had preoperative comorbidities such as cardiovascular disease (58.7%), history of malignant tumor (21.7%), respiratory disease (17.4%), and so on. Reduced surgery for lymph adenectomy and gastrectomy area were often performed. Postoperative complications occurred in 20 cases. One patient died within 30 days after surgery. The 3-year survival rates were 34.1% overall, and 62.5% in pStage Ⅰ patients. All causes of death in pStage Ⅰ were other diseases. In conclusion, gastrectomy for EEGC patients was often avoided due to comorbidity and balance of surgery effectiveness. Even if it was possible to overcome the perioperative period for gastrectomy, we could not find the data affirming aggressive surgical treatment in terms of the prognosis.

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  • Naoki Kubo, Norihiko Furusawa, Hitoshi Masuo, Masaru Terada
    2019 Volume 39 Issue 6 Pages 1025-1029
    Published: September 30, 2019
    Released: August 13, 2020
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    The symptoms of appendicitis in the elderly are often atypical, and the deterioration rate is high. We enrolled 236 patients aged 15 years or older treated for acute appendicitis at our hospital from May 2011 to August 2017. We classified those aged 70 years or older into the elderly group and those aged 69 years or younger into the non-elderly group. There were significantly more cases of abscess formation in the elderly group. There was no significant difference in the complication rate of surgical site infection between the elderly and non-elderly groups in the surgical treatment group. By choosing the conservative treatment for those cases in which the appendicitis became serious, it appeared to decrease the postoperative complications in the elderly patients who would normally be at high risk for complications. In the elderly, appendicitis is often severe at presentation, but conservative treatment for highly inflamed appendicitis may be useful in reducing postoperative complications.

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  • Tetsuji Yoshikawa
    2019 Volume 39 Issue 6 Pages 1031-1035
    Published: September 30, 2019
    Released: August 13, 2020
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    【Objective】Treatment of acute cholangitis and cholecystitis has been standardized as a result of existing guidelines, but determining a standard treatment for the elderly is sometimes difficult. The aim of the current study was to examine elderly patients with acute cholangitis who were age 85 and over, the so-called super elderly. 【Methods】Subjects were 43 super elderly patients with acute cholangitis and 46 patients with the same condition under the age of 85 (younger elderly patients). Aspects such as condition upon admission, initial symptoms, treatment selected, and outcome were examined. 【Results】Patients in the super elderly group were in poorer general condition than in the younger elderly and had a number of comorbidities. They accounted for many of the patients who had to be followed conservatively. This approach was often chosen at the family’s behest because of the patient’s age or reduced activities of daily living (ADL). The super elderly patients also had a significantly longer duration of hospitalization. 【Conclusion】The number of super elderly patients with acute cholangitis and acute cholecystitis will increase in the future. In response, a treatment strategy that incorporates social factors such as family as well as the patient’s condition needs to be selected.

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  • Michihiro Saito, Hiroaki Shigoka, Katsushige Gon, Junya Tokuhisa, Taka ...
    2019 Volume 39 Issue 6 Pages 1037-1042
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    In the recently aging society, the incidence of acute cholangitis with common bile duct stones is increasing in the elderly, and the approach requiring biliary drainage for the elderly is also increasing. In addition, with the rapid advance in the aging society, cases of super-old age have a tendency to increase. Endoscopic biliary drainage (EBD) is the first choice for treatment of acute cholangitis in the elderly, and it is also regarded as a safe and effective treatment for the elderly as is the case in younger patients. However, for those frail elderly patients with decreased organ function, endoscopic treatment may be a big burden on their circulatory and respiratory system. Therefore, endoscopic treatment should be performed with caution, taking into account the specific risks and possible adverse events for the elderly. Furthermore, it is important to determine individual appropriate treatment flexibly by considering not only the age but also the general condition and underlying comorbidities of each individual.

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  • Daisuke Goto
    2019 Volume 39 Issue 6 Pages 1043-1047
    Published: September 30, 2019
    Released: August 13, 2020
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    Acute cholangitis may be usually cured with rapid biliary drainage. However, in elderly patients, sepsis leads to disseminated intravascular coagulation (DIC) in those patients in a serious condition, and biliary drainage alone does not necessarily improve the condition. From April 2011 to February 2018, we performed emergency biliary drainage in 35 elderly patients with acute cholangitis complicated with DIC. We evaluated the clinical outcome of administration of recombinant human soluble thrombomodulin alpha (rTM) (n=19) compared with anticoagulation therapy (n=15) for treatment of acute cholangitis complicated with DIC. No significant difference was observed in the patient backgrounds between the two groups. No significant difference was observed in the DIC score up to day 5, but the score after day 7 was significantly lower in the rTM group (2.1 vs. 3.6, P<0.05). The cure rate of DIC at day 5 was significantly higher in the rTM group (89.5% vs. 56.3%, P<0.05). The results of the present study demonstrated that rTM may rapidly cure acute cholangitis complicated with DIC and improves performance status even in the elderly patients.

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  • Yunosuke Suzuki, Hiroaki Uda, Shoichiro Ito, Mai Miyazaki, Taizo Hayas ...
    2019 Volume 39 Issue 6 Pages 1049-1052
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    A 95-year-old female patient presented to our hospital with loss of appetite and vomiting. She was diagnosed as having small bowel obstruction, but the cause was not immediately apparent. Therefore, she was admitted for further investigation. After 8 days of hospitalization, the symptoms had not improved, so double balloon endoscopy was performed. Endoscopic examination resulted in perforation and thus an emergency operation was needed. On laparotomy, investigation showed aplasia of the major omentum on the left side of the transverse colon, from which the red-closed loop (approximately 50 cm in length) jejunum had become incarcerated in the anomalous defect (approximately 2 cm in diameter) of the lesser omentum. We treated the internal hernia, and found the perforation site 20 cm distal to the ligament of Treitz. We then sutured the perforation site and closed the omental defect, followed by jejunostomy. Because lesser omental hernias are a rare condition, we report herein on our case, and conduct a review of the relevant literature.

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  • Nobuaki Ishihara, Shiro Kawamura, Natsuko Yamauchi, Naoki Harada
    2019 Volume 39 Issue 6 Pages 1053-1056
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    A 45-year-old woman was admitted to our hospital with a fever and epigastralgia. She had peritoneal irritation and the blood test showed increased WBC and CRP. We suspected this case to be a ruptured infectious gastrointestinal stromal tumor based on the enhanced CT scan imaging, and she underwent an emergency operation. A tumor, 9.2 centimeters in diameter, was found in the mesentery of the transverse colon and pus oozed out from a hole on the tumor. Tumorectomy including the resection of a part of the horizontal portion of duodenum, intraperitoneal drainage and an ileostomy were performed. Pathological findings revealed a desmoid tumor. We experienced a relatively rare case of acute peritonitis caused by a ruptured abscess of a mesenteric desmoid tumor. Because desmoid tumors tend to infiltrate locally and recur frequently after resection, it is important to achieve as complete a resection as possible.

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  • Takeshi Miwa, Toshifumi Watanabe, Yu Hashimoto, Makoto Nakura, Koichi ...
    2019 Volume 39 Issue 6 Pages 1057-1060
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    We report herein on a case of a patient with recurrent bowel obstruction due to an intra-abdominal band who was diagnosed and treated with exploratory laparoscopy. The patient was a man in his 50s who had been diagnosed as having a bowel obstruction at another hospital 2 years prior with no apparent cause of the obstruction. He had recurrent symptoms of bowel obstruction, which resolved with fasting 1.5 years prior to the surgery. We performed detailed examinations but were unable to identify the cause of the obstruction, and the patient was being monitored on follow-up visits. Since the symptoms were recurrent, we performed exploratory laparoscopy. The examination revealed a band of adhesion from the greater omentum to the descending colon, and the distal part of the ileum was compressed by the band. We separated the band laparoscopically. Although the patient had prolonged intestinal paralysis postoperatively, this symptom improved with conservative management. The patient no longer experienced recurrent abdominal pain, and achieved stable oral intake. Our findings suggest that exploratory laparoscopy is an effective option for patients who present with recurrent abdominal pain of unknown cause as the procedure is minimally invasive and enables accurate diagnosis of treatable conditions in order to initiate appropriate treatments.

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  • Yoshihito Masuoka, Yamato Ninomiya, Hitoshi Hara, Souji Ozawa
    2019 Volume 39 Issue 6 Pages 1061-1064
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    A 21-year-old man without a history of abdominal surgery was referred to us from a nearby doctor due to abdominal pain. Abdominal computed tomography showed ascites and a whirling appearance of the superior mesenteric vessels without the presence of malrotation of the intestine or abdominal masses;thus, the patient was diagnosed as having a primary small bowel volvulus. Symptoms were relieved gradually over time, and the patient complained of slight abdominal pain 11 hours after onset. He underwent urgent hospitalization, and conservative treatment was chosen. Symptoms were fully resolved by the next morning, and abdominal computed tomography and ultrasonography revealed spontaneous resolution of the small bowel volvulus. No recurrence was noted during 1 year after the discharge. A primary small bowel volvulus is, although rare, an acute abdomen condition, often requiring emergency surgery. We report herein on a rare case of spontaneous resolution of a primary small bowel volvulus.

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  • Kentaro Nakamoto, Satoru Takemura, Yasuhiro Sakurai, Takeo Nishimori
    2019 Volume 39 Issue 6 Pages 1065-1067
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    A 63-year-old man visited our hospital with bloody stools. He was admitted because abdominal CT showed an intussusception with an ascending colon tumor. Colonoscopy revealed the ascending colon tumor and the intussusception was reduced by pushing the tumor using forceps. Histological findings from the tumor biopsy demonstrated a lipoma and an elective laparoscopic partial colectomy was carried out. The resected tumor measured 5 cm and the histologically confirmed diagnosis was a lipoma. The patient’s postoperative course was favorable and he was discharged on postoperative day 8. Colon lipomas with intussusception are a good indication for laparoscopic surgery after the intussusception has been reduced non-invasively.

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  • Tomohiro Muronoi, Eiji Hira, Moeka Watahiki, Shunsuke Kuramoto, Kazuyu ...
    2019 Volume 39 Issue 6 Pages 1069-1074
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    We present herein on a 20-year-old man, who was involved in a motorcycle accident. He was admitted to our hospital under the suspicion of internal bleeding within the abdominal cavity. Contrast enhanced computed tomography (CT) revealed a traumatic abdominal wall hernia along with the rupture of the right abdominal oblique muscles and the transverse abdominal muscle. The CT examination also showed right kidney injury and ascending colonic mesenteric injury, which were managed conservatively to prevent further complications. On the 5th day of his admission, a hernia repair was performed through the anterior side with fascial closure and mesh placement. Fourteen cases of traumatic abdominal wall hernia have been reported in the literature since laparoscopic surgery was first reported in Japan. Reflecting on the relationship between the time from injury to the onset of symptoms and the operative methods chosen in the cases of early repair, we sutured the abdominal wall fascia via the anterior approach, and laparoscopic surgeries were performed for the delayed onset cases. In the present case, the abdominal wall fascia was sutured with the anterior approach, and good results were obtained. Early treatments have been reported involving the anterior approach facilitating fascial closure for traumatic abdominal wall hernia, which might lead to improvement of quality of life. The timing and the operative methods should be chosen taking the onset of symptoms and the comorbidity into consideration.

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  • Yujin Kato, Kiminori Takano, Yasushi Kaneko, Mai Tsutsui, Yukio Sato, ...
    2019 Volume 39 Issue 6 Pages 1075-1078
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    A 70-year-old male had been repeatedly hospitalized for gastrointestinal bleeding from a refractory duodenal ulcer from 2 years previously. He had a history of chronic renal failure, thus a contrast CT scan had not been conducted. He was brought to our hospital with loss of consciousness (LOC) with high-degree anemia (Hb 4.5 g/dL), and endoscopic hemostasis was conducted against his hemorrhagic duodenal ulcer. This time contrast CT scan images were obtained after hospitalization, and a dilated hypervascular lesion was found in the pancreatic head, following which a pancreatic arteriovenous malformation (PAVM) was suspected. Many arteriovenous anomaly shunt vessels at the pancreatic head were found in the angiography test, thus this patient was diagnosed as having PAVMs. The recurring duodenal ulcer had been caused by the blood steal phenomenon associated with the PAVMs; therefore a subtotal stomach preserved pancreatoduodenectomy was undertaken, with a good postoperative course. As this case is a successful surgical excision of PAVMs, we report on our case with a review of the relevant literature.

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  • Koichiro Fujimasa, Yoshihiro Fukoe, Yugen Ree, Yoshiaki Ozawa, Koji Ot ...
    2019 Volume 39 Issue 6 Pages 1079-1082
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    A 14-year-old male experienced the onset of diarrhea and stomachache from two days previously. He was brought to our hospital as an emergency with a fever and lower right stomachache. Abdominal enhanced CT imaging revealed a target sign in the ileocecum, so an emergency laparascopic operation was performed on the same day under the diagnosis of intussusception. The cecum and appendix were revealed as overlapping the terminal ileum to the ascending colon. We pushed the intussusception in the intestinal tract from the ascending colon on the anal side to the oral side, and obtained reduction by further pulling the oral side. However, we did not detect any organic disease and performed only an appendectomy. The postoperative course was good and the patient left the hospital on postoperative day eight. More than three years have passed since the surgery, but no recurrence of the intussusception has so far been seen. We report this case with some discussion of the relevant literature, because the laparoscopic approach was useful in both diagnosis, repositioning and treatment.

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  • Ryosuke Nomura, Yosuke Ueno, Satoshi Taga, Koichi Yano
    2019 Volume 39 Issue 6 Pages 1083-1085
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    A 60-year-old male felt a pain in his lower abdomen during sit-ups performed using a 5 kg medicine ball placed on his lower abdomen by his trainer. The pain was initially tolerable, but then spread throughout the abdomen, and he therefore made an emergency visit to our hospital. Blood biochemistry tests showed no increase in C-reactive protein (CRP) level or leukocyte count. Abdominal CT images showed discrete free gas in the abdominal cavity, and the patient was diagnosed as having perforation of the digestive tract, although it was difficult to identify the perforation site. In emergency open surgery, a perforation site of 1.5×1.0 cm was found in the small intestine about 250 cm from the Treitz ligament, with intestinal fluid leaking from this site. Cleaning and drainage were performed, and the perforation site was sutured closed. Although there have been many case reports on small-intestinal perforation caused by blunt trauma of the abdominal region, this is the first case of digestive tract perforation caused by a medicine ball, based on our literature search. Healthcare and exercise personnel should understand that a training device can cause physical damage when it is not correctly used.

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  • Atsushi Sugimoto, Tatsunari Fukuoka, Hisashi Nagahara, Masatsune Shibu ...
    2019 Volume 39 Issue 6 Pages 1087-1090
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    A 45-year-old woman from Peru presented with vomiting and abdominal pain. Colonoscopy revealed erosions and ulceration in the cecum. Double balloon endoscopy revealed jejunal stenosis. Although the patient had no evidence of pulmonary tuberculosis, a T-spot TB test was positive. She developed an intestinal obstruction and required emergency surgery. There was a lower jejunal obstruction 220 cm from the ligament of Treitz. A single-port laparoscopic partial jejunectomy was performed. On day 14 after surgery, Mycobacterium tuberculosis was detected in a mucosal culture, indicating a diagnosis of intestinal tuberculosis. Intestinal tuberculosis frequently develops in the ileocecal area but rarely in the jejunum. As the foreign-born population in Japan increases, people with tuberculosis will increasingly be seen. Intestinal tuberculosis should be considered in the differential diagnosis of non-neoplastic intestinal obstruction in individuals from countries with a high incidence of tuberculosis.

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  • Takuya Goto, Takatoshi Nakamura, Takahumi Soeno, Satoru Ishii
    2019 Volume 39 Issue 6 Pages 1091-1093
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    A 61-year-old male developed abdominal pain and vomiting and visited a nearby doctor. He was diagnosed as having a strangulation ileus by careful examination. He was referred to our hospital for surgical treatment and an emergency operation was performed. During the operation, bloody ascites was noted, a Meckel’s diverticulum was found 100 cm from the end of the ileum, and the ileum on the oral side was strangulated by the Meckel’s diverticulum. A continuous cord from the mesentery was found at the tip of the Meckel’s diverticulum. Arterial hemorrhage was observed when the cord was cut. The Meckel’s diverticulum was ligated and detached at the root, and the strangulation was released. The ileum was necrotized and resected including the Meckel’s diverticulum. Arterial hemorrhage was detected in the cord, and the condition was diagnosed as a strangulated ileus due to a mesodiverticular band at the Meckel’s diverticulum. We report herein on a case of strangulated ileus due to a mesodiverticular band at the Meckel’s diverticulum.

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  • Yuki Shin, Ippei Yamana, Jun Ichikawa, Hiroto Sannomiya, Nobuhiko Kore ...
    2019 Volume 39 Issue 6 Pages 1095-1099
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    A 63-year-old woman was admitted with sudden abdominal pain that had developed one day after an upper GI series. Abdominal computed tomography revealed residual barium in the sigmoid colon and free air around the sigmoid colon. An emergency operation was performed for perforation of the sigmoid colon. The perforation measured 3.0 cm. A barium bolus, 8 cm in diameter, was recognized in the abdominal cavity. Colostomy was performed for perforation of the sigmoid colon. Colorectal perforation after barium gastrography is very rare, but such cases can have a fatal outcome if not properly and promptly managed.

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  • Daisuke Iitaka, Tatsuya Matsumoto, Susumu Nakashima, Junshin Fujiyama, ...
    2019 Volume 39 Issue 6 Pages 1101-1104
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    An 83-year-old woman was transported by ambulance to a local hospital due to abdominal pain. Abdominal CT showed free gas in the peritoneal cavity. Since she was not considered to be seriously ill, she was followed-up without treatment. However, on the next day, follow-up CT revealed increased ascites;therefore, she was referred to our hospital for surgery. Blood tests showed no increase in inflammatory markers. An accurate medical history was difficult to obtain due to her dementia. However, because of the presence of abdominal pain, an exploratory laparotomy was performed with a diagnosis of gastrointestinal perforation. Laparotomy showed no contamination by ascitic fluid, and exploration of the stomach, small intestine, and colon failed to reveal any clear perforations of the gastrointestinal tract, leading to a diagnosis of spontaneous pneumoperitoneum. Surgery was completed with the placement of a drain in Douglas’ pouch. The patient’s postoperative course was uneventful, and she was discharged on the 9th postoperative day. We consider that in cases with few abdominal symptoms despite imaging evidence of free gas in the peritoneal cavity, indications for surgical treatment should be carefully determined with this disorder in mind.

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  • Atsushi Tanikawa, Taku Higashihara, Tatsuya Hayashi
    2019 Volume 39 Issue 6 Pages 1105-1108
    Published: September 30, 2019
    Released: August 13, 2020
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    A 44-year-old man experienced sudden anemia and melena while he was hospitalized for the treatment of eosinophilic granulomatosis with polyangiitis. Abdominal contrast enhanced computed tomography showed multiple vascular lesions in the small intestine, and abdominal angiography only revealed multiple aneurysms. The bleeding point could not be identified, and a coil embolization was performed on one of the aneurysms. However, sustained transfusion was required, and our department was consulted regarding an operation. Angiographic examination was carried out again and the bleeding point could finally be identified. After coil embolism of the bleeding point, landmark surgery was performed using the coil as the landmark. The appropriate section of the small intestine was intraoperatively resected under radiographic fluoroscopy using the coil as a guide. Under normal circumstances, in cases where a bleeding source cannot be identified from the serosal side, total resection of the small intestine is often required. In this case, however, we were able to minimize the range of ablation, thanks to the use of the micro-coil as a landmark.

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  • Yuki Yamasaki, Masaaki Urade
    2019 Volume 39 Issue 6 Pages 1109-1112
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    A 43-year-old man visited our emergency outpatient unit complaining of pain from the scrotum to the right lower quadrant. His scrotum had enlarged to the size of an infant’s head. A CT scan revealed a huge right inguinal hernia containing the omentum and transverse colon. Since the hernia could not be reduced by manipulation, an emergency operation was performed. At first, we attempted to reduce the hernia contents laparoscopically, but we could not. Even after switching to laparotomy surgery we were still unable to reduce the hernia contents, and it was finally possible to return the omentum and transverse colon to their correct position by adding a right inguinal skin incision and expanding the hernia gates. Bowel resection was avoided because the transverse colon showed no evidence of necrosis and perforation. On the other hand, an ischemic change was observed in a part of the omentum so we resected it. The hernia hilum was repaired using a Polysoft® mesh via an anterior approach. We seldom encounter cases of inguinal hernia containing the transverse colon, although inguinal hernias are a common condition. Recently, the usefulness of laparoscopic hernia repair has been reported, but in this case it was impossible to reduce the hernia contents with only a laparoscopic approach. We report on our case together with a review of the relevant literature.

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  • Itaru Osaka, Atsushi Tanikawa, Taku Higashihara, Tatsuya Hayashi
    2019 Volume 39 Issue 6 Pages 1113-1115
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    We report herein on a case of ruptured vagina and strangulated bowel obstruction occurring during conservative therapy with a pessary for a vaginal stump prolapse. An 80-year old female patient had undergone a total hysterectomy for uterine fibroids approximately 40 years previously. One month prior to presenting, she was treated with a pessary for a vaginal stump prolapse but visited our hospital due to lack of improvement. Vaginal wall erosion and a 1-cm perforation were found. Although the decision to perform surgery was made shortly thereafter, on the same evening a small bowel prolapse from the vagina was observed, and the patient underwent an emergency laparotomy. Small bowel incompetence and a strangulated bowel obstruction due to the vaginal rupture were diagnosed, the small intestine was resected, and a colpocleisis was performed. Vaginal excision is performed more frequently in the elderly, and conservative treatment is often chosen, but in cases such as the present one, radical surgical intervention should be considered.

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  • Ema Mitsui, Masafumi Kataoka, Mototaka Inaba
    2019 Volume 39 Issue 6 Pages 1117-1119
    Published: September 30, 2019
    Released: August 13, 2020
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    A 72-year-old man who had undergone an esophagectomy for esophageal cancer 3 years previously presented with right neck, shoulder and chest pain. Abdominal contrast-enhanced CT revealed intraperitoneal bleeding from multiple bilobed liver tumors. Hepatic arterial embolization was performed. After that chemotherapy was instigated under the diagnosis of hepatic metastases from esophageal cancer and it was effective. However, the patient died of liver failure due to rapidly growing liver tumors about 5 months after the chemotherapy was started. Hemoperitoneum secondary to hepatic metastases is rare. Emergency hepatic arterial embolization is a less-invasive and effective treatment for patients with hemoperitoneum due to hepatic metastasis.

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  • Kento Kawasaki, Naohisa Waki, Hiroshi Sonobe
    2019 Volume 39 Issue 6 Pages 1121-1125
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    A 60-year-old man presented with abdominal pain for 10 days. Physical examination on arrival showed a tumor and muscular defense on palpation in the right lower quadrant. Computer tomography demonstrated ileocecal intussusception up to the ascending colon and enlargement of a regional lymph node along the ileocecal artery and aorta. The patient underwent lower gastrointestinal endoscopy, resulting in a reduction of the intussusception, and revealed the tumor located in the ileocecal valve. A laparoscopic ileocecal resection (D3) was performed. Histopathological examination revealed a malignant lymphoma (mantle cell lymphoma) in the terminal ileum. Following a good postoperative course, the patient was discharged 12 days after surgery. Most adults with intussusception have an underlying lesion. We report herein on a case of intussusception caused by a malignant lymphoma, treated with laparoscopic surgery.

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  • Takumi Shimomatsuya, Goshi Matsuki, Yuta Niimi, Shinta Nagano, Junsuke ...
    2019 Volume 39 Issue 6 Pages 1127-1130
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    【Background】Intussusception in adults is rare and most of cases are associated with tumors such as colon cancer. 【Methods】We retrospectively reviewed 9 patients (2 males and 7 females) with intussusception caused by colon cancer over the past ten years in our hospital. 【Results】The patient mean age was 76.1 years (range, 60-91 yr). The symptoms were abdominal pain in 6 patients, bloody stools in 2 patients, and vomiting in 1 patient. Based on the computed tomographic findings, all patients were diagnosed as having intussusceptions due to an intestinal tumor. All patients except one did not have intestinal obstruction. Emergency surgery was performed in 3 patients and elective surgery was performed in 6 patients. Open surgery was performed in 5 patients and laparoscopic surgery was performed in 4 patients. The tumors were located in the cecum in 5 patients, in the ascending colon in 3 patients, and in the rectum in 1 patient. The depth of tumor invasion was M in 1 patient, SM in 1 patient, MP in 1 patient, and SS in 6 patients. Postoperative courses were uneventful. The mean length of postoperative hospital stay was 11.7 days. 【Conclusion】It is important to select the treatment depending on urgency, safety, and curability for intussusception caused by colon cancer.

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  • Taro Mashiko, Naoki Yazawa, Yoshihito Masuoka, Toshio Nakagohri
    2019 Volume 39 Issue 6 Pages 1131-1135
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    A 73-year-old woman was scheduled to receive preoperative treatment for locally advanced pancreatic head cancer. She suddenly developed hematemesis and a bloody bowel discharge. Marked anemia and severe shock were observed at the time of admission. Contrast-enhanced abdominal computed tomography revealed leakage of the contrast agent from the gastroduodenal artery, and emergency embolization was performed. During hospitalization, the patient developed ventricular tachycardia, which improved following cardiopulmonary resuscitation. Abdominal radiography performed the following day revealed free air inferior to the right dome of the diaphragm. Contrast-enhanced abdominal CT confirmed a large quantity of free air in her abdominal cavity. Thus, she was diagnosed as having a gastric perforation, and an emergency laparotomy was performed on the same day. During laparotomy, a laceration measuring approximately 7cm was found along the lesser curvature of the upper body of the stomach. The patient was diagnosed as having a gastric rupture that occurred during the cardiopulmonary resuscitation. The ruptured area was sutured following drainage of the abdominal cavity. She was discharged on the 13th postoperative day. Since gastric ruptures are a rare complication of cardiopulmonary resuscitation, we report herein on this case with a review of the relevant literature.

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  • Ippei Uezu, Daijiro Kagawa, Tomofumi Chibana, Yoshiki Chinen, Masayosh ...
    2019 Volume 39 Issue 6 Pages 1137-1140
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    A 69-year-old man was hospitalized elsewhere because of Parkinson’s disease. He was brought to our emergency room complaining of stridor and decreased oxygen saturation. A physical examination showed stridor, and laryngeal endoscopy revealed edema in the bilateral arytenoids with vocal cord paralysis. We performed tracheal intubation, and he was admitted to our hospital as an emergency. On the third day of hospitalization, we performed extubation but his respiratory condition became worse. We therefore performed reintubation with jet ventilation. His consciousness level subsequently decreased, and hypotension and abdominal distension appeared during reintubation. Computed tomography showed a perforation of the esophagogastric junction and a large amount of intraperitoneal free air. We diagnosed a tension pneumoperitoneum, and an abdominal puncture was carried out promptly. His abdomen was swiftly decompressed and systemic perfusion showed improvement. His course thereafter was good. We report herein on a rare case of tension pneumoperitoneum which was successfully treated with an abdominal puncture together with a review of the relevant literature.

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  • Suguru Yamauchi, Kenki Tsuda, Tadanori Nagayasu, Shuji Nagao, Tetsu Fu ...
    2019 Volume 39 Issue 6 Pages 1141-1143
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    A 44-year-old woman with lower abdominal pain was admitted to our hospital. Abdominal contrast-enhanced computed tomography revealed a strangulated obstruction, and laparoscopic emergency surgery was performed. The small intestine was incarcerated and strangulated. The color of the small intestine recovered following removal of the strangulation. However, an area of inadequate blood flow in the strangulated intestine was observed. Judgment on whether intestinal resection or preservation was difficult. Thus, we laparoscopically performed indocyanine green fluorography (ICGF) for intestinal blood flow evaluation. ICGF findings revealed a contrast-enhanced effect from the vasa recta to the intestinal wall demonstrating an area inadequate blood flow within approximately 10 seconds, and the entire circumference of the intestinal wall revealed a contrast-enhanced effect, and the patient had an uncomplicated postoperative course. Our data suggest that it is possible to make a judgement on the quality of the intestinal blood flow using ICGF without performing intestinal resection.

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  • Masahiro Mizuno, Yoshinao Tanahashi, Koji Masumori, Yoshiharu Sato, Yu ...
    2019 Volume 39 Issue 6 Pages 1145-1148
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    An acute superior mesenteric artery (SMA) embolism is often correlated with a poor prognosis, or can cause deterioration in the patient’s quality of life in cases of short bowel syndrome. To avoid a wide resection of the bowel, it is essential to confirm the range of bowel ischemia with intraoperative angiography. In the present study, two patients with embolic occlusion of the SMA were treated with an intraoperative embolectomy via the middle colic artery using a Fogarty catheter. After confirming the patency of the SMA, intra-arterial thrombolysis was postoperatively conducted with urokinase. We report herein on the efficacy of intensive perioperative treatment in patients who have been successfully rehabilitated into society.

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  • Wataru Goto, Toru Inoue, Katsunobu Sakurai, Takahumi Nishii, Akiko Tac ...
    2019 Volume 39 Issue 6 Pages 1149-1151
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    A 60-year-old man underwent a left nephrectomy to treat a ruptured renal angiosarcoma. Six months later, he was diagnosed as having peritoneal dissemination from the renal angiosarcoma. Under the diagnosis of hemoperitoneum due to the rupture of a peritoneal disseminated tumor, he underwent emergency surgery. A ruptured giant tumor invading the small intestine was recognized, and was resected along with a part of the small intestine. Multiple liver metastases and peritoneal dissemination were also observed. After the surgery, the liver tumors increased in size and ruptured repeatedly, leading to severe anemia. We performed a total of three transcatheter arterial embolization procedures to control the hemorrhage. However, the tumor growth continued to increase rapidly, and the patient died 42 days after the surgery. Renal angiosarcomas are very rare and are characterized by an extremely poor prognosis because of the high rates of metastasis and recurrence. Therefore, even in the case of an oncologic emergency, a minimally invasive approach should be selected to obtain maximum relief for the patient.

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  • Kenichiro Omoto, Takashi Ohishi, Syu Tanizawa, Yuichi Nishihara, Takeh ...
    2019 Volume 39 Issue 6 Pages 1153-1157
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    We report herein on a case of septic shock due to bacterial translocation after placement of a metallic stent in the colon. A 62-year-old man was seen by our hospital because of abdominal distension. A CT scan showed colon dilatation, and he was diagnosed as having a colorectal obstruction due to rectosigmoid cancer. A colonic stent was inserted immediately and it was successful. Approximately 11 hours after the procedure, the patient went into septic shock. A CT scan demonstrated air collections within the cecal and ascending colonic walls. The blood culture tested positive for Escherichia coli. An operation was performed on the 50th day after improvement of the patient’s general condition, however, the tumor was unresectable. A colostomy was performed on the sigmoid colon. The patient was discharged home on the 61st day after admission. Sepsis following colonic stent insertion is rare, however, the possibility of complications should be kept in mind because they are potentially fatal.

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  • Masato Hayashi, Takahiro Manabe, Yurika Iida, Tomokazu Tokoro, Shohei ...
    2019 Volume 39 Issue 6 Pages 1159-1162
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    A 52-year-old woman was referred to our hospital because of subsequent left back pain following vomiting after alcohol consumption. Conservative treatment was selected under the diagnosis of pleurisy, but her general condition got worse because of pyothorax. The patient was diagnosed as having a spontaneous esophageal rupture based on the results of upper endoscopic and gastrographic examinations, and thoracoscopic surgery was performed for her ten days after onset. Thoracoscopic findings revealed a perforation site at the lower esophagus, and irrigation of pleural cavity and placement of drainage tubes were carried out during this operation. Postoperative administration of antibiotics and enteral nutrition therapy were effective for her, and oral intake was subsequently resumed on the 33rd postoperative day. She was eventually discharged from our hospital on the 44th postoperative day. This case suggests that a thoracoscopic approach could be useful to achieve adequate drainage in a patient with a poor general condition.

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  • Masato Tanikake, Kazuhiro Kami
    2019 Volume 39 Issue 6 Pages 1163-1166
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    We experienced a case of intra-abdominal hemorrhage stemming from liver injury caused by the detachment of a hepatic-intestinal adhesion in a woman in her fifties who had undergone gastrointestinal reconstruction for pancreatic cancer. Three years after the operation, she was diagnosed as having an intrahepatic bile duct stone and underwent therapeutic endoscopic retrograde cholangiopancreatography (ERCP) with a double-balloon endoscope. After completion of the operation, she experienced sudden cardiac arrest. Contrast-enhanced computed tomography (CT) was performed after resuscitation which revealed intra-abdominal hemorrhage and extravascular leakage on the surface of the left lobe of the liver. Argent angiography was immediately performed revealing hemorrhage from branch A3 of the left hepatic artery. Based on CT and angiographic findings, the hemorrhage was revealed to have been the result of liver injury. Reexamination of preoperative images showed that the afferent loop was attached over its length to the liver surface from which the hemorrhaging occurred, indicating a hepatic-intestinal adhesion. It was thus likely that the endoscopic procedure caused detachment of the adhesion and damage to the liver capsule, resulting in hemorrhaging. It is important to note that while therapeutic ERCP is a very useful therapeutic modality, it is associated with complications, including rare, procedure-specific, adhesion-related complications, especially in patients who have previously undergone gastrointestinal reconstruction.

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  • Tetsunobu Udaka, Jun Kouzai, Hiroaki Asano, Masatoshi Kubo, Hironori K ...
    2019 Volume 39 Issue 6 Pages 1167-1170
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    Gallbladder perforation can refer to a gallbladder perforated by acute cholecystitis, an injury, or a tumor. From 2008 to 2018, we encountered 9 patients (5 males and 4 females) with gallbladder perforation. Patients ages ranged from 62 to 92 years (average: 82.3 years). We could diagnose gallbladder perforation in 8 of the 9 cases preoperatively. An open cholecystectomy was carried out in all cases. The histopathological findings showed 7 cases of perforation by gangrenous cholecystitis and 2 cases of perforation by gallbladder cancer. The postoperative course was good in all cases. It is especially important to perform an emergency surgical operation for GradeⅢ severe cholecystitis with gallbladder perforation.

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  • Hideki Osawa, Hikaru Watanabe, Shuichiro Hara, Kenji Sakai, Hiroshi No ...
    2019 Volume 39 Issue 6 Pages 1171-1174
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    A 67-year-old woman was transported to our emergency outpatient department for continuous vomiting and abdominal pain while taking medicine prescribed by her previous doctor. She had undergone pituitary tumor resection 6 years prior and was receiving hormone replacement therapy. She presented with sudden-onset hypotension during the examination. Although sufficient fluid resuscitation and vasopressors were administered, she continued to exhibit hypotension and her serum lactate level was high. The physical examination suggested intestinal necrosis, which needed to be confirmed. As she had contrast agent allergy, we performed a laparoscopic examination instead of contrast CT to investigate the condition of the intestines. We changed to laparotomy because of a poor visual field due to distention of the intestines but found no necrotic change. She recovered after the administration of antibiotics and hormone replacement therapy after surgery. On the 4th day, Salmonella species O8 was cultured from blood and fecal samples; therefore, we suspected adrenal insufficiency caused by Salmonella enteritidis.

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  • Takashi Shirobe, Hidemitsu Ogino, Hiroyuki Murayama, Youki Sasaki
    2019 Volume 39 Issue 6 Pages 1175-1177
    Published: September 30, 2019
    Released: August 13, 2020
    JOURNALS FREE ACCESS

    A wandering spleen is a rare clinical condition caused by absence or underdevelopment of the suspensory ligaments, allowing the spleen to be mobile in the abdomen. The wandering spleen is disposed to splenic torsion along the vascular pedicle, leading to splenomegaly and splenic infarction. When an infarction is suspected, due to volvulus of the wandering spleen, an emergency operation is necessary. In such cases, splenectomy is the most common procedure, compared to splenic salvage methods. Considering the life-threatening risk of overwhelming post-splenectomy infection, however, the splenic salvage operation is still preferable. We present herein the case of a 13-years-old boy with a volvulus associated with a wandering spleen, who underwent an urgent laparoscopic splenopexy. The patient made very good prognosis and he was discharged on the 4th post-operative day. This technique can be performed by any surgeon who has mastered the basic skill of laparoscopic surgery. This approach may therefore be useful to decrease the number of unnecessary splenectomies for wandering spleens and to avoid the possibility of overwhelming post-splenectomy infection.

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