Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine)
Online ISSN : 1882-4781
Print ISSN : 1340-2242
ISSN-L : 1340-2242
Volume 40 , Issue 1
Showing 1-19 articles out of 19 articles from the selected issue
  • Shunsuke Hayakawa, Tetsushi Hayakawa, Shuhei Uehara, Kaori Watanabe, S ...
    2020 Volume 40 Issue 1 Pages 23-27
    Published: January 31, 2020
    Released: September 30, 2020
    JOURNALS FREE ACCESS

    The levels of difficulty of laparoscopic appendectomy (LA) vary significantly depending on the presence or absence of abscess formation and the timing of the surgery. In this study, we conducted a retrospective analysis of the completion rates and surgical results of LA by the clinical type of appendicitis and timing of surgery. The subjects consisted of 507 patients with abscess–forming appendicitis (AA) or non–abscess–forming appendicitis (NAA) who underwent LA. The patients were further subdivided into the following groups by the disease type and timing of surgery: NNA cases who underwent emergency surgery (E–NAA group; n=440), NAA cases who underwent laparoscopic interval appendectomy (LIA) (LIA–NAA group; n=40), AA cases who underwent emergency surgery (E–AA; n=15), and AA cases who underwent LIA (LIA–AA; n=12). A total of 9 patients required conversion of the surgical approach to laparotomy, including 3 from the E–AA group (1 case to ileocolectomy) and 6 from the E–NAA group. The incidence rates of complications were as follows: 4.5% in the E–NAA group, 2.5% in the LIA–NAA group, 26.7% in the E–AA group, and 8.3% in the LIA–AA group. The study suggested that in order to improve the safety of LA, it is important to avoid emergency surgery in patients with AA.

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  • Yukiko Nonaka, Tadahiro Kamiya, Takehito Kato, Kazuhiro Hiramatsu, Yos ...
    2020 Volume 40 Issue 1 Pages 29-34
    Published: January 31, 2020
    Released: September 30, 2020
    JOURNALS FREE ACCESS

    【Aim】The management of abdominal stab wounds has shifted from mandatory laparotomy to selective nonoperative management. This study aimed at evaluating the clinical course of patients with abdominal stab wounds.【Methods】We retrospectively examined data on 33 cases of abdominal stab wounds observed at our institute between January 2006 and December 2017. General surgeons managed the treatment of all patients.【Results】In total, 33 patients were evaluated (median age, 57 years; 23 males and 10 females). Organ evisceration was observed in 12 patients, six of which had omental evisceration. Of 33 patients, 24 underwent urgent laparotomy, among which 12 had organ damage that required repair. Postoperative complications occurred only in four patients undergoing a laparotomy. No cases required delayed laparotomy. The rate of unnecessary laparotomy (UNL) was 50.0%.【Conclusion】The rate of UNL in this study was higher than those previously reported. Omental evisceration does not always necessitate an emergency laparotomy.

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  • Sho Uemura, Koji Fujita, Hiroyuki Kikunaga, Hiroshi Miura, Shojiro Mor ...
    2020 Volume 40 Issue 1 Pages 35-38
    Published: January 31, 2020
    Released: September 30, 2020
    JOURNALS FREE ACCESS

    A 48–year–old man was admitted to our hospital complaining of epigastric and right lower abdominal pain. Laboratory tests showed elevated levels of inflammatory response markers, and contrast–enhanced abdominal CT showed a cystic mass extending from the cecum to the right side of the pelvis and a positive whirl sign of the appendiceal root. The patient was diagnosed as having torsion of an appendiceal mucocele, and emergency operation was performed. At laparotomy, the appendix was found to be swollen with mucus and twisted clockwise by about 720 degrees. After releasing the torsion, appendectomy was performed using an automatic suturing device. We simultaneously performed ileocecal resection with lymph node dissection, as we could not rule out the possibility of mucinous cystadenocarcinoma. The resected specimen showed that the appendix was filled with a gelatin–like substance, and histopathological examination revealed hemorrhagic and congestive changes of the front two–thirds of the appendiceal wall; based on the findings, the condition was diagnosed as a mucous cystadenoma. This case of torsion of an appendiceal mucocele in a patient who presented with the signs of acute abdomen is reported, along with a discussion of the relevant literature.

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  • Takanobu Akaishi, Yutaka Umehara, Takafumi Yachi, Keinosuke Ishido, Ke ...
    2020 Volume 40 Issue 1 Pages 39-43
    Published: January 31, 2020
    Released: September 30, 2020
    JOURNALS FREE ACCESS

    A 63–year–old woman who had undergone laparoscopic cholecystectomy for cholecystolithiasis 6 months previously visited our hospital complaining of right upper abdominal pain. Abdominal computed tomography and magnetic resonance imaging revealed two intraperitoneal masses, one measuring 35mm in diameter in the right lateral abdominal wall and the other measuring 10mm in diameter under the right diaphragm. These lesions were suspected to be intraperitoneal abscesses and the patient was followed up without treatment. Repeat computed tomography performed 3 months after the first revealed enlargement of both masses; in addition, the mass on the right lateral abdominal wall appeared to have infiltrated the right major psoas muscle. Based on these findings, the lesions were suspected as being malignant tumors, and both lesions were resected 15 months after the original laparoscopic cholecystectomy. Both specimens showed abscess formation and contained a stone each measuring approximately 5mm in diameter. Histopathological examination revealed abscess formation and granulation tissue, and the final diagnosis was intraperitoneal granulomas due to spillage of gallstones during the laparoscopic cholecystectomy performed earlier.

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  • Yuichi Nishihara, Kenichiro Omoto
    2020 Volume 40 Issue 1 Pages 45-47
    Published: January 31, 2020
    Released: September 30, 2020
    JOURNALS FREE ACCESS

    Rectus abdominis diastasis (RAD) is considered to be a high risk factor for recurrence after umbilical hernia repair, and mesh repair is recommended. We report a case of incarcerated umbilical hernia with RAD that was treated by laparoscopic surgery. A 36–year–old woman with a history of two vaginal deliveries visited our hospital complaining of abdominal pain and protrusion of the umbilicus. She had noticed the umbilical protrusion ever since her second baby had been born, and had repeatedly repatriated. Abdominal CT showed an umbilical hernia and RAD, and we performed laparoscopic repair for treatment. Until now, about 3 years since the surgery, no recurrence has been observed. RAD is a little–known condition in Japan. When we plan umbilical hernia repair, it is necessary to confirm the presence of RAD and manage it, to reduce the risk of recurrence.

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  • Yuya Nyumura, Tomoyoshi Okamoto, Katsuhiko Yanaga
    2020 Volume 40 Issue 1 Pages 49-52
    Published: January 31, 2020
    Released: September 30, 2020
    JOURNALS FREE ACCESS

    A 75–year–old diabetic male patient on chemotherapy for inoperable gastric cancer was admitted to our hospital with fever and perineal pain. On admission, the skin of the perineum was partially disintegrated, with extensive rubor. Blood examination revealed evidence of a severe inflammatory reaction, and abdominal–pelvic CT revealed the dirty fat sign from the anus to the rectus abdominis muscle. With the diagnosis of septic shock complicating Fournier’s gangrene, an emergency debridement operation was performed by a multidisciplinary team. Since the necrotic area expanded after the first operation, laparoscopic sigmoid colostomy and percutaneus cystostomy with additional debridement were performed on Day 12. After bilateral orchiectomy and thigh muscle flap reconstruction performed on Day 46, the patient was discharged on Day 85. Fournier’s gangrene is a progressive necrotizing fasciitis that can become complicated by multi–organ dysfunction; therefore, intensive treatment from the early stage with collaboration among multiple departments by a multidisciplinary approach is necessary to save the life of the patient and return him/her earlier to the society.

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  • Hirokazu Matsutomo, Tamotsu Takeuchi
    2020 Volume 40 Issue 1 Pages 53-56
    Published: January 31, 2020
    Released: September 30, 2020
    JOURNALS FREE ACCESS

    A 73–year–old female visited to our hospital complaining of abdominal pain, vomiting and diarrhea. Physical examination revealed abdominal tenderness and muscle guarding. Abdominal CT showed free air in the upper abdomen and multiple diverticula in the rectum, with peripheral inflammatory changes. Emergency operation was performed under the diagnosis of rectal diverticular perforation. Intraoperative exploration revealed a perforation, 3 mm in diameter, in the anterior wall of the rectum, and Hartmann’s operation was performed. Examination of the resected specimen revealed a plastic bread–bag clip firmly fixed at the site of the perforation. We think that this is the first report of a case of gastrointestinal tract perforation caused by a plastic bread–bag clip in Japan.

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  • Soichiro Hiramatsu, Kenichi Yanagawa, Nobuo Matsunaga
    2020 Volume 40 Issue 1 Pages 57-59
    Published: January 31, 2020
    Released: September 30, 2020
    JOURNALS FREE ACCESS

    A 50–year–old woman visited the emergency room of our hospital complaining of lower abdominal pain and vomiting. Abdominal CT showed invagination of the small intestine into the pouch of Douglas and displacement of the rectum and uterus. Furthermore, we found a small intestinal loop to the left side of the uterus and vascular convergence in the invaginated mesentery. The patient was diagnosed as having bowel obstruction due to internal herniation through a defect in the broad ligament of the uterus, and emergency surgery was performed on the same day. A 30–cm long segment of the ileum was found to have invaginated through a defect on the left side of the broad ligament of the uterus. After releasing the intestine, the defect was sutured. The postoperative course was uneventful, and the patient was discharged 7 days after the surgery without any complications. We encountered a relatively rare case of internal herniation through a defect in the broad ligament of the uterus which was diagnosed preoperatively based on the characteristic CT findings.

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  • Shota Ebinuma, Keisuke Ohbuchi, Hitoshi Ono
    2020 Volume 40 Issue 1 Pages 61-63
    Published: January 31, 2020
    Released: September 30, 2020
    JOURNALS FREE ACCESS

    A 44–year–old man was treated for thyroid crisis with a beta blocker, antithyroid drugs, a steroid, and an antipyretic agent for 2 weeks at our hospital. However, he visited the emergency department of our hospital soon after discharge, complaining of abdominal pain. Based on the clinical findings, we made the diagnosis of pan–peritonitis due to obstructive colitis and performed emergency surgery. Intraoperative exploration revealed a stenotic site in the transverse colon and dilatation of the bowel segment on the oral side of the stenosis. We resected the dilated bowel segment and the stenotic site. The postoperative course was uneventful. Histopathological examination revealed an ischemic ulcer at the stenotic site. We encountered a rare case of pan–peritonitis and colonic stenosis caused by an ischemic ulcer of the colon in a patient who had just recovered from a thyroid crisis.

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  • Masahiro Sasahara, Hiroyuki Yokoyama, Yusuke Sato, Yoshinari Mochizuki
    2020 Volume 40 Issue 1 Pages 65-68
    Published: January 31, 2020
    Released: September 30, 2020
    JOURNALS FREE ACCESS

    The patient was a 53–year–old woman with chronic renal failure secondary to nephrosclerosis who underwent peritoneal dialysis catheter placement. She developed dialysate outflow problems on the fourth day after the start of dialysis and contrast imaging of the catheter revealed a filling defect suspicious of luminal obstruction. She was diagnosed as having peritoneal dialysis catheter obstruction due to entanglement by as a result of its getting entangled with intraabdominal organs, and urgent exploratory laparoscopy was performed. At surgery, a right ovarian fimbria was found to be wrapped around the catheter, which was released with forceps. Dialysate outflow problems were noted again on the 65th day after the start of dialysis; laparoscopic surgery was repeated, and this time, a left ovarian fimbria was found to be wrapped around the catheter. Catheter obstruction caused by ovarian fimbriae is relatively rare, and recurrence of the obstruction by fimbriae of the contralateral side is even rarer. Laparoscopy is considered to be useful for releasing the obstruction, but currently there are no fixed opinions regarding preventive measures for recurrence.

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  • Shoma Teruta, Takuya Minato
    2020 Volume 40 Issue 1 Pages 69-72
    Published: January 31, 2020
    Released: September 30, 2020
    JOURNALS FREE ACCESS

    A 67–year–old female patient who was involved in a traffic accident was transported immediately to our hospital complaining of right upper abdominal pain. She had bruises and pain in her upper abdomen, and an abdominal contrast–enhanced CT showed high–density ascites and a mass with extravasation of the contrast agent within the mass. We suspected omental hemorrhage and performed angiography, which showed hemorrhage from a small branch of the right gastroepiploic artery. As transcatheter approach to the bleeding point is difficult due to the tortuosity of blood vessels, we performed laparoscopic partial omentectomy for hemostasis. Omental hemorrhage alone is a rare cause of intraabdominal hemorrhage in cases of blunt abdominal injury. Transcatheter arterial embolization for omental hemorrhage is minimally invasive, but it is sometimes difficult to reach the bleeding point due to the tortuosity of blood vessels, or achieve secure hemostasis due to the rich network of omental blood vessels. Operation for omental hemorrhage is relatively easy in terms of the approach to the bleeding point and resection of the greater omentum; laparoscopic surgery is especially useful, because it is less invasive.

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  • Naoya Fukuda, Yasuaki Iimura, Kazuyuki Hirose, Dai Miyazaki, Nagato Sa ...
    2020 Volume 40 Issue 1 Pages 73-77
    Published: January 31, 2020
    Released: September 30, 2020
    JOURNALS FREE ACCESS

    An 82–year–old man presented with bruising all over the body after a fall. Computed tomography (CT) revealed left diaphragmatic rupture and prolapse of the stomach and transverse colon into the thoracic cavity. We made the diagnosis of traumatic diaphragmatic hernia, and immediately performed thoraco– and laparoscopic repair of the hernia. The operation was performed with the patient in the semi–right lateral decubitus position, and the hernia of the intra–abdominal organs was reduced laparoscopically. Thoracoscopy revealed no injury of the lung or mediastinum. A horizontal rupture of the diaphragm measuring 8cm in length was noted in the left central tendon; the defect was sutured laparoscopically. The operative diagnosis was traumatic diaphragmatic hernia, typeⅢb, according to the criteria of the Japanese Association for the Surgery of Trauma. A repeat CT performed on postoperative day 11 revealed increased pericardial fluid accumulation and recurrence of the diaphragmatic hernia. Reoperation (thoracoscopic repair using a mesh) was performed on postoperative day 75. Until now, 12 months after the reoperation, there has been no further evidence of recurrence. The thoracoscopic approach might be the preferred approach for surgical repair of traumatic diaphragmatic hernias occurring adjacent to the pericardium.

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  • Tomosuke Kitagawa, Ryuichi Nishimura, Sho Fujiwara, Nozomi Koyamada
    2020 Volume 40 Issue 1 Pages 79-83
    Published: January 31, 2020
    Released: September 30, 2020
    JOURNALS FREE ACCESS

    Disseminated intravascular coagulation (DIC) is a frequent complication of bone marrow carcinomatosis, and carries a very poor prognosis. Herein, we present the case of a 61–year–old woman who had undergone total gastrectomy for advanced gastric cancer 29 months earlier. She received S–1 for 1 year as postoperative adjuvant chemotherapy. At 29 months after the gastrectomy, she was admitted to our hospital with gingival hemorrhage. Based on the findings of physical and laboratory examination, she was diagnosed as having DIC complicating disseminated bone marrow carcinomatosis secondary to gastric cancer. The patient received chemotherapy with the combination of S–1 plus cisplatin, which resulted in resolution of the DIC and pain control. The patient survived for approximately 10 months after the onset of DIC. Although there are no standard therapies for DIC complicating disseminated bone marrow carcinomatosis, the current case illustrates that chemotherapy may be useful for the control of DIC complicating bone marrow metastasis from gastric cancer. Therefore, early diagnosis of DIC in these patients can facilitate the introduction of prompt and appropriate chemotherapy.

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  • Toshinori Hirano, Takumi Harada, Yuki Kaiki, Tatsuya Tazaki
    2020 Volume 40 Issue 1 Pages 85-88
    Published: January 31, 2020
    Released: September 30, 2020
    JOURNALS FREE ACCESS

    An 81–year–old male was admitted to our hospital with right–sided inguinal swelling. Abdominal CT showed a hernia sac in the right femoral region, which was diagnosed as an incarcerated femoral hernia. We performed emergency surgery via the anterior approach. Intraoperatively, a segment of the small intestine was found to be incarcerated in the femoral canal. Partial resection of the small intestine and tissue repair were performed. On the first postoperative day, the patient developed dyspnea. Chest CT showed evidence of pulmonary embolism and abdominal CT showed constriction of the right femoral vein. A continuous intravenous heparin drip was initiated and the patient recovered by a week.

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  • Yohei Kawatani
    2020 Volume 40 Issue 1 Pages 89-93
    Published: January 31, 2020
    Released: September 30, 2020
    JOURNALS FREE ACCESS

    Although hepatic artery aneurysms are rare, rupture of a hepatic artery aneurysm frequently has serious consequences; therefore, these aneurysms should ideally be treated before rupture. Herein, we report a case in which we successfully performed coil embolization in a patient with impending rupture of a common hepatic artery aneurysm. A 70–year–old woman presented with a 1–day history of progressive upper abdominal and back pain. Enhanced computed tomography of the abdomen revealed a 16–mm saccular aneurysm in the common hepatic artery and features consistent with impending rupture of the aneurysm. We immediately performed endovascular coil embolization. During the procedure, we preserved the gastroduodenal and celiac arteries to preserve collateral blood flow to areas distal to the embolized artery. The patient’s symptoms disappeared one day after the procedure, and she was discharged on the day. She was still doing well at the 6–month follow–up.

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  • Kenichi Ishizu
    2020 Volume 40 Issue 1 Pages 95-97
    Published: January 31, 2020
    Released: September 30, 2020
    JOURNALS FREE ACCESS

    A 78–year–old man was admitted to our hospital with a week’s history of persistent right lower abdominal pain. Physical examination showed tenderness and a subcutaneous swelling over a previous appendectomy scar. Abdominal CT revealed a low–density area, with an internal slender high–density area, measuring about 3 cm in diameter, extending from the subcutaneous tissue to the rectus abdominis muscle. We diagnosed the swelling as an abscess formed around a foreign body in the abdominal wall. Incision and drainage was performed under local anesthesia. Four months later, the abscess and foreign body were removed under general anesthesia. The abscess was present outside the peritoneum, and the foreign body was a fishbone.

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  • Naotake Funamizu, Takahiro Ozaki, Ryo Nakanishi, Tomomi Okamoto, Miki ...
    2020 Volume 40 Issue 1 Pages 99-101
    Published: January 31, 2020
    Released: September 30, 2020
    JOURNALS FREE ACCESS

    A 74–year–old man was admitted to Ageo Central General Hospital complaining of lower abdominal pain. Based on the clinical findings, including hematologic examination and abdominal computed tomography (CT), the patient was suspected as having an intra–abdominal abscess caused by a foreign body. Emergency operation was performed. Laparoscopy revealed perforation of Meckel’s diverticulum by a fish bone. The patient was treated by laparoscopic partial resection of the small intestine and discharged on day 10 after the surgery. Based on our experience, we suggest that laparoscopy is useful for making an accurate diagnosis and performing the requisite surgery for Meckel’s diverticulum perforation by a fish bone.

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  • Shoichiro Arai, Daisuke Muroya, Masayuki Okabe, Yukiya Kishimoto
    2020 Volume 40 Issue 1 Pages 103-106
    Published: January 31, 2020
    Released: September 30, 2020
    JOURNALS FREE ACCESS

    A 78–year–old female presented to the emergency department with abdominal pain. A CT scan revealed a pelvic abscess concomitant with perforated appendicitis. Subsequently transgluteal catheter drainage was performed under ultrasound (US) guidance. After five months of conservative therapy, a laparoscopic interval appendectomy was performed. The patient was discharged six days after the operation without any postoperative morbidity.

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  • Manabu Kujiraoka, Koji Asai, Manabu Watanabe, Hodaka Moriyama, Ryutaro ...
    2020 Volume 40 Issue 1 Pages 107-109
    Published: January 31, 2020
    Released: September 30, 2020
    JOURNALS FREE ACCESS

    A 70–year–old woman with a medical history of malignant pleural mesothelioma was being treated at another hospital. She was referred to our hospital for abdominal pain and a lump in the right inguinal region that was diagnosed as a small bowel perforation and intestinal obstruction associated with an incarcerated Richter’s inguinal hernia. Although eligible for emergency surgery, consent was not obtained due to the terminal stage of the malignant pleural mesothelioma. Conservative treatment was performed after obtaining informed patient consent. A long tube was inserted for the intestinal obstruction and incisional drainage was performed under local anesthesia in the right inguinal region. The tip of the long tube escaped into the hernia sac through the perforation on day 8 of hospitalization; therefore, an intestinal fistula tube was inserted from the inguinal region, and a drainage route for digestive fluid was secured through the perforation. The long tube was removed on day 17, and oral feeding was started. The obstruction did not relapse; the patient was discharged on day 63 with the intestinal fistula tube left in place. Conservative treatment via intestinal fistula construction could be considered in case of surgery refusal.

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