Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine)
Online ISSN : 1882-4781
Print ISSN : 1340-2242
ISSN-L : 1340-2242
Current issue
Displaying 1-19 of 19 articles from this issue
  • Hirotoshi Tsuru, Daisuke Muroya, Hisaaki Shimokobe, Yuichi Nagao, Yosh ...
    2022 Volume 42 Issue 4 Pages 485-488
    Published: May 31, 2022
    Released on J-STAGE: November 30, 2022
    JOURNAL FREE ACCESS

    Balloon-assisted endoscopic retrograde cholangiopancreatography (BAERCP) has been widely performed in recent years for patients with common bile duct stones after Roux-en-Y reconstruction. However, accidental bowel perforation caused by BAERCP could necessitate emergency surgery. Herein, we describe the case of an 86-year-old Japanese woman who was diagnosed as having jaundice caused by a common bile duct stone 19 years after a total gastrectomy and Roux-en-Y reconstruction for gastric cancer. The patient underwent ERCP by double-balloon enteroscopy. However, we found a deep laceration in the jejunum soon after the procedure. Because she had abdominal pain with signs of peritoneal irritation, we performed emergency operation, closure of the perforation, and cholecystoduodenostomy. The patient was discharged 22 days after the operation. Herein, we report the efficacy of cholecystoduodenostomy combined with suture of the perforation in a patient with obstructive jaundice caused by a common bile duct stone and iatrogenic bowel perforation caused by BAERCP.

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  • Tsutomu Iwata, Fumiya Sato, Ryuzo Yamaguchi, Mizuki Moriyama, Ryo Yama ...
    2022 Volume 42 Issue 4 Pages 489-492
    Published: May 31, 2022
    Released on J-STAGE: November 30, 2022
    JOURNAL FREE ACCESS

    We report a case of ileus caused by a true enterolith. An 85-year-old man visited our hospital with the chief complaints of abdominal pain and vomiting. The patient had no history of abdominal surgery. An abdominal plain CT revealed a structure with a cavity in the small intestine and dilated small bowel on the oral side of this structure. Laparoscopic-assisted surgery was performed on Day 2 of hospitalization based on the diagnosis of ileus caused by a dietary substance or foreign body. We pulled out a stone-like foreign body with good mobility by enterotomy from the small intestine, approximately 120 cm from the ligament of Treitz, and extracted it via a mini-laparotomy through the umbilicus. The ‘foreign body’ was a yellowish enterolith measuring 35×23mm (9.0 g). Chemical analysis revealed that the enterolith partially consisted of deoxycholic acid, and the patient was finally diagnosed as having ileus caused by a bile acid enterolith, one of the true enteroliths.

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  • Daisuke Muroya, Hisaaki Shimokobe, Masaru Matsumura, Yuichi Nagao, Yos ...
    2022 Volume 42 Issue 4 Pages 493-496
    Published: May 31, 2022
    Released on J-STAGE: November 30, 2022
    JOURNAL FREE ACCESS

    A 90-year-old male was brought to our emergency department complaining of vomiting. Abdominal CT revealed pneumatosis intestinalis (PI) and hepatic portal venous gas. However, neither the findings of physical examination, nor laboratory data suggested the presence of bowel necrosis. Therefore, we undertook conservative therapy, including hyperbaric oxygen therapy (HBOT) and antibiotic administration. By the day after the start of the conservative therapy, both the gas in the intestinal wall (PI) and the hepatic portal venous gas were no longer seen. Oral intake was started on hospital day 3, and the patient was discharged on hospital day 8. This case highlights the usefulness of HBOT in effectively managing such patients.

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  • Hiroyuki Kanazawa, Tatsuhiko Takahama, Yuichiro Kametani, Fukuei Kanai ...
    2022 Volume 42 Issue 4 Pages 497-500
    Published: May 31, 2022
    Released on J-STAGE: November 30, 2022
    JOURNAL FREE ACCESS

    The patient was a 59-year-old man complaining of upper abdominal pain, who was brought to our emergency department in a state of shock. Contrast-enhanced CT showed intra-abdominal bleeding and hematoma formation in the right retroperitoneum. After initial treatment to stabilize the circulation, abdominal angiography was performed. The origin of the celiac artery was occluded due to median arcuate ligament syndrome, with compensatory dilatation and tortuousness of the pancreatic artery arcade. Selective angiography from the right colic artery showed an aneurysm and bead-like stenosis in the anastomotic branch connecting the marginal artery of the middle colic artery to the right gastroepiploic artery. Based on the results of angiography, the patient was diagnosed as a case of acute abdomen and severe hemorrhagic shock caused by segmental arterial mediolysis (SAM). Treatment options include conservative treatment, embolization, and laparotomy.

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  • Keita Minowa, Tatsuya Nodagashira, Tomohisa Tokura, Kohei Kudo
    2022 Volume 42 Issue 4 Pages 501-504
    Published: May 31, 2022
    Released on J-STAGE: November 30, 2022
    JOURNAL FREE ACCESS

    An 83-year-old woman with a day’s history of abdominal pain was found in a dazed state at home by her son and brought by ambulance to our hospital. The patient was in an unstable hemodynamic state and arterial blood gas at arrival revealed marked acidemia. Suspecting ischemic bowel necrosis from the findings of abdominal CT, we performed total colectomy and ileostomy. Postoperatively, the patient’s condition improved, but the hyperlactatemia was persistent, accompanied in time by elevated serum creatinine kinase levels. On day 3, CT showed findings suggestive of non-occlusive mesenteric ischemia. We undertook open abdominal management after partial small bowel resection, and performed jejunostomy on day 5. Although there were difficulties in managing postoperative complications such as intra-abdominal abscess caused by anastomotic leakage of the rectal end and the short bowel syndrome, the patient recovered with conservative treatment and was transferred for rehabilitation on day 140. If gangrenous ischemic colitis is suspected, surgery should be performed bearing in mind the possibility of NOMI, including a second-look operation.

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  • Hitoshi Ono
    2022 Volume 42 Issue 4 Pages 505-507
    Published: May 31, 2022
    Released on J-STAGE: November 30, 2022
    JOURNAL FREE ACCESS

    An 84-year-old woman who was undergoing outpatient endocrine treatment at our department for right breast cancer presented to us with the chief complaint of left lower abdominal pain. Abdominal radiography showed small bowel gas with niveau formation, and the patient was diagnosed as having ileus. Computed tomography (CT) revealed volvulus in the region of the mobile cecum. As the contrast effect of the intestinal tract was preserved, we selected conservative management. The patient resumed oral intake after her symptoms improved and was subsequently discharged. However, she returned complaining of vomiting and left lower abdominal pain 2 months after discharge. Physical examination showed tenderness, but no guarding in the left lower abdomen. CT revealed a closed dilated loop in the ileocecal region and poor intestinal wall blood flow on angiography. She was diagnosed as having strangulated bowel obstruction caused by volvulus and underwent emergency surgery on the same day. The dilated ileocecal area was identified to the left in her lower abdomen. The intestinal tract regained its usual color following release of the strangulation; however, the ascending colon and retroperitoneum of the cecum were poorly fixed, which necessitated ileocecal resection. We report a relatively rare case of volvulus in an elderly patient, together with a brief review of the literature.

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  • Atsushi Urakami, Kazuki Matsushita, Akihisa Akagi, Naomasa Ishida, Mun ...
    2022 Volume 42 Issue 4 Pages 509-512
    Published: May 31, 2022
    Released on J-STAGE: November 30, 2022
    JOURNAL FREE ACCESS

    Endoscopic biliary drainage (EBD) is a well-established method of managing biliary diseases. Perforation of the gut by a migrated EBS has been reported in less than 1% of cases. The authors present the first case of formation of a subcutaneous abscess due to transverse colon penetration of a migrated EBS. A 92-year-old woman who had undergone EBS placement for cholangitis with choledocholithiasis 3 years earlier presented to us with a subcutaneous abscess in the left abdomen. CT showed the EBS penetrating the transverse colon and abdominal wall. In view of the patient’s bedridden condition, dementia, senility, and absence of evidence of peritonitis, we only performed drainage of the subcutaneous abscess; the EBS was left as it was, because of the high surgical risk. The patient showed an uncomplicated recovery following the abscess drainage, and was discharged to a nursing facility.

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  • Keiichi Ikemoto, Yukiko Niwa, Moe Iwata, Fuminori Horibe, Toshihiko Mo ...
    2022 Volume 42 Issue 4 Pages 513-516
    Published: May 31, 2022
    Released on J-STAGE: November 30, 2022
    JOURNAL FREE ACCESS

    A 71-year-old man presented to the emergency department with abdominal pain and vomiting. Abdominal contrast-enhanced computed tomography showed heterogeneous enhancement of the small bowel and pneumatosis intestinalis. Non-occlusive mesenteric ischemia (NOMI) was suspected, and emergency surgery was performed. There was discontinuous dark-red discoloration of the small intestine over a 70-cm long segment. Indocyanine green (ICG) fluorography conducted to evaluate the intestinal blood flow showed complete absence of blood flow to an approximately 100-cm segment of the intestine, including the 70-cm discolored segment, with additional 20- and 10-cm segments on its proximal and distal sides. One-stage resection with anastomosis was performed. The patient was discharged on the 30th postoperative day without any complications. ICG observation is useful for deciding the appropriate length of bowel to resect, as it also reveals ongoing mucosal ischemic changes that cannot be detected under white light.

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  • Tomoko Doki, Daisuke Satomi, Satoshi Fukutomi, Koumei Ishige, Koichiro ...
    2022 Volume 42 Issue 4 Pages 517-520
    Published: May 31, 2022
    Released on J-STAGE: November 30, 2022
    JOURNAL FREE ACCESS

    A 41-year-old woman visited our hospital with a history of epigastralgia, nausea, vomiting, and diarrhea. The symptoms were not severe, but she developed melena on the day after her first visit. Abdominal computed tomography showed colonic invagination into the descending colon, and emergency laparotomy was performed. It was easy to restore the invaginated bowel segment, which showed no ischemic change, back to the original state. And the cecum and ascending colon were not fixed to the right abdominal wall. Ileocecal resection was performed because of a mass felt at the appendicular root, which turned out to be appendiceal intussusception. The association of intussusceptions and malrotation is named Waugh’s syndrome, which is commonly encountered in infants and children, but is a rarity in adults. We report an adult case of Waugh’s syndrome with appendiceal intussusception, with a review of the literature.

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  • Yasuhiro Iijima, Tsuyoshi Notake, Akira Shimizu, Yuji Soejima
    2022 Volume 42 Issue 4 Pages 521-525
    Published: May 31, 2022
    Released on J-STAGE: November 30, 2022
    JOURNAL FREE ACCESS

    Accidentally ingested foreign bodies are often discovered in the upper gastrointestinal tract and usually removed endoscopically or excreted through the gastrointestinal tract. However, depending on the type of foreign body, abdominal surgery may be required in some cases. A 90-year-old woman accidentally swallowed her denture while eating. She consulted a family doctor two days later, who identified the denture on a plain x-ray of the abdomen and referred the patient to our hospital. Esophagogastroduodenoscopy confirmed the presence of a denture in the third part of the duodenum, but the denture was not mobile and it was judged that endoscopic removal would entail a high risk of bowel damage. Therefore, we decided to perform laparotomy. We palpated the denture in the third part of the duodenum, made an incision in the bowel wall on the side opposite to the pancreas, and removed the denture. It is said that although rare, foreign bodies could also get stuck in the duodenum in some cases. We report this case of a foreign body in the duodenum, with a review of the literature.

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  • Yu Onodera, Hiroyuki Oshikiri, Kenji Shimizu, Iku Higashimoto, Jin Tes ...
    2022 Volume 42 Issue 4 Pages 527-531
    Published: May 31, 2022
    Released on J-STAGE: November 30, 2022
    JOURNAL FREE ACCESS

    Acute cholecystitis that occurs after cardiovascular surgery is a severe complication that is associated with a high mortality rate. A 25-year-old woman with Turner syndrome underwent aortic arch and valve replacement for chronic Stanford type A dissection and aortic valve stenosis at the department of cardiovascular surgery. After the surgery, laboratory examination revealed slight elevation of the total leukocyte count and serum C-reactive protein level. However, no clinical symptoms were observed, and the source of infection was unclear. The findings of abdominal computed tomography performed on postoperative day 14 suggested ischemia and abscess formation in the gallbladder wall, and the patient was diagnosed as having gangrenous cholecystitis. Although the patient had scarce clinical symptoms, we performed urgent laparoscopic cholecystectomy considering the risk of infection of the artificial vascular graft and artificial valve. In this case, laparoscopic surgery might have contributed to minimally invasive surgery and prevented secondary infectious spread.

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  • Takashi Sakuma, Masaichi Ohira
    2022 Volume 42 Issue 4 Pages 533-536
    Published: May 31, 2022
    Released on J-STAGE: November 30, 2022
    JOURNAL FREE ACCESS

    A 58-year-old male was admitted to our hospital with the chief complaints of epigastric pain and vomiting. Abdominal contrast-enhanced CT suggested strangulated bowel obstruction and emergency operation was performed. During the procedure, a 4-cm long tubular structure was found 80 cm proximal to the terminal ileum. The apex of the structure was adherent to the mesentery of the terminal ileum, forming a loop. A 60-cm segment of the small intestine was incarcerated within the loop, resulting in strangulated bowel obstruction. We performed adhesiolysis and resection of the tubular structure. Histopathological examination revealed Meckel’s diverticulum with ectopic gastric mucosa. The postoperative course was uneventful and the patient was discharged 18 days after the emergency surgery. Bowel obstruction is the most common complication of Meckel’s diverticulum, although strangulated bowel obstruction resulting from inflammatory adhesions of Meckel’s diverticulum is rare. It has been suggested that the longer the length of Meckel’s diverticulum, the larger the size of hernia, and the higher the risk of strangulated bowel obstruction. In addition, the presence of ectopic tissues might affect the risk of formation of inflammatory adhesions.

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  • Fumitoshi Mizutani, Hideyuki Dei, Hiroshi Hasegawa
    2022 Volume 42 Issue 4 Pages 537-540
    Published: May 31, 2022
    Released on J-STAGE: November 30, 2022
    JOURNAL FREE ACCESS

    A 76-year-old woman with a history of caesarean section was admitted to our hospital complaining of severe lower abdominal pain of sudden onset. She had developed a ventral incisional hernia 8 years earlier and was diagnosed at the current admission as having a strangulated ventral incisional hernia; emergency surgery was performed using the endoscopic mini/less open sublay (EMILOS) technique. EMILOS is a hybrid operational procedure for the treatment of ventral hernias in which both the open and endoscopic approaches are used; the bowel condition can be checked thoroughly and a mesh can also be placed in the retrorectal space without the need for a large skin incision. The patient was discharged on postoperative day 4, and has shown no hernia recurrence until now, 2 years since the surgery. We believe that EMILOS is an effective technique that not only allows avoidance of pain caused by fixation devices, but also of adhesions and postoperative ileus, which are well-known complications of intraperitoneal onlay mesh repair.

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  • Tomone Ueki, Hideyuki Wada, Hiroki Niwa, Kenichi Mizunuma, Ryo Takahas ...
    2022 Volume 42 Issue 4 Pages 541-544
    Published: May 31, 2022
    Released on J-STAGE: November 30, 2022
    JOURNAL FREE ACCESS

    Herein, we report a case of transmesocolic hernia. A 74-year-old man complaining of right upper abdominal pain was referred to our hospital as a suspected case of strangulated intestinal obstruction. Abdominal contrast-enhanced computed tomography (CT) revealed dilatation of a segment of the small intestine with a closed-loop. A preoperative diagnosis of strangulated intestinal obstruction due to internal hernia was made and emergency laparoscopic surgery was performed. The hernial orifice in the transverse mesocolon was identified, with an incarcerated jejunal hernia; based on the intraoperative findings, we made the diagnosis of transmesocolic hernia. Because the incarcerated small intestinal segment was not necrotic, the hernia orifice was repaired by hand-sewn sutures, without any bowel resection. The patient showed a good postoperative course and was discharged on postoperative day 20. Although transmesocolic hernia is an infrequent disease and its preoperative diagnosis in this case was difficult, in retrospect, we consider that identification of the vessels of both the transverse mesocolon and small bowel mesentery in multiplanar reconstructed CT images might have enabled the diagnosis. We believe that MPR of CT images would be useful for preoperative diagnosis of transmesocolic hernia.

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  • Ryuta Midorikawa, Daiki Miyazaki, Satoki Kojima, Hiroto Ishikawa, Yuki ...
    2022 Volume 42 Issue 4 Pages 545-548
    Published: May 31, 2022
    Released on J-STAGE: November 30, 2022
    JOURNAL FREE ACCESS

    A 38-year-old woman was admitted to our hospital with left-sided abdominal pain. Laboratory examination revealed elevated levels of inflammatory markers. Abdominal computed tomography (CT) revealed the whirl sign, suggesting omental torsion; the twisted omentum was found to have. We made the diagnosis of omental torsion caused by left inguinal hernia. The laparoscopic findings revealed omental torsion with necrosis and adhesion of the peripheral omentum to the left inguinal ring. Laparoscopic omentectomy with inguinal hernia repair via a transabdominal preperitoneal approach (TAPP) was performed as a one-stage procedure. The postoperative course was uneventful and the patient was discharged without any complications. In conclusion, laparoscopic omentectomy with TAPP as a one-stage procedure was an effective treatment for omental torsion with inguinal hernia.

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  • Yukino Yoshimura, Nobumi Tagaya, Koji Matsushita, Junichi Suzuki, Junp ...
    2022 Volume 42 Issue 4 Pages 549-552
    Published: May 31, 2022
    Released on J-STAGE: November 30, 2022
    JOURNAL FREE ACCESS

    Prolapse of the small intestine due to vaginal cuff dehiscence after total hysterectomy is a rare postoperative complication, although its frequency has increased in recent years. Case 1: A 70-year-old female patient underwent total cystectomy, total hysterectomy, and ileal conduit diversion under robot-assisted laparoscopic surgery for bladder cancer 14 months ago. She received insertion of a pessary three days ago under the diagnosis of vaginal prolapse, but removed it by herself. She visited the hospital complaining of discomfort and was diagnosed as having transvaginal prolapse with incarceration of the small intestine. Case 2: A 43-year-old female patient underwent total hysterectomy and bilateral oophorectomy through an open laparotomy for an ovarian tumor 5 months ago. After sexual intercourse 2 days ago, she visited the hospital complaining of abdominal pain and was diagnosed as having transvaginal prolapse with incarceration of the small intestine. In both cases, laparoscopic observation revealed that the vaginal cuff could be repaired without any intestinal resection. Initial transvaginal pneumoperitoneum and subsequent observation of the intraperitoneal cavity enable a surgeon to judge the condition of the intestinal tract after release of the incarceration and confirm safe closure by suture from inside and outside the abdominal cavity during repair of the vaginal cuff. This simultaneous combined approach seems to be useful.

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  • Kazuki Mashiko, Hiroshi Yasumatsu, Taichiro Ueda, Mariko Yamamoto, Yut ...
    2022 Volume 42 Issue 4 Pages 553-556
    Published: May 31, 2022
    Released on J-STAGE: November 30, 2022
    JOURNAL FREE ACCESS

    A 74-year-old female patient was transferred to the department of gastroenterology because of acute gastrointestinal bleeding after total hip arthroplasty. Her systolic blood pressure dropped to 40 mmHg and emergency upper gastrointestinal endoscopy showed arterial bleeding from the duodenal bulb. The acute care surgery team decided to perform resuscitative thoracotomy, aortic clamping, and emergency laparotomy for damage control. Through a midline laparotomy, we made an incision on the anterior wall from the pylorus to the duodenal bulb, and sutured the bleeding vessel (gastroduodenal artery [GDA]) directly. Subsequently, we closed the incised anterior wall temporarily and performed transcatheter coil embolization of the GDA. Twenty-four hours after the initial surgery, as her status was improving, we safely performed planned re-operation. During the second operation, we resected the pylorus and duodenal bulb as part of duodenal diverticulization. After the operation, the patient recovered uneventfully, with moderate residual brain dysfunction, and was transferred to another hospital for further rehabilitation. The approach involving anterior duodenotomy and vessel ligation for potentially fatal duodenal ulcer bleeding is rapid and simple, and seems to be suitable as “surgical rescue.”

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  • Hideharu Tanaka, Shuji Komori, Yoshinori Iwata, Chihiro Tanaka, Naruto ...
    2022 Volume 42 Issue 4 Pages 557-560
    Published: May 31, 2022
    Released on J-STAGE: November 30, 2022
    JOURNAL FREE ACCESS

    An 87-year-old woman with a hemorrhagic duodenal ulcer was transferred to our hospital because of persistent hemorrhage and difficulty in hemostasis. Upper gastrointestinal endoscopy revealed a huge ulcerative lesion with arterial hemorrhage on the posterior wall of the duodenal bulb. Endoscopic hemostasis was attempted, but the massive bleeding led to hemorrhagic shock, and emergency laparotomy was performed. Intraoperative observation revealed that the duodenal ulcer had penetrated the head of the pancreas and was firmly adherent to it. Pancreaticoduodenectomy was also considered as a surgical procedure, but considering the advanced age of the patient and his general condition in the presence of hemorrhagic shock and coagulopathy, we performed distal gastrectomy with the ulcer floor left on the pancreatic side. The postoperative course was uneventful, with no development of a postoperative pancreatic fistula, and the patient was transferred to the previous doctor on the 24th postoperative day. Hemorrhagic duodenal ulcer penetrating into the pancreas requires prompt attention and careful treatment selection.

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  • Yukari Sakae, Yusuke Nakamura
    2022 Volume 42 Issue 4 Pages 561-564
    Published: May 31, 2022
    Released on J-STAGE: November 30, 2022
    JOURNAL FREE ACCESS

    An 8-year-old boy was brought to us with a 2-day history of abdominal pain. On the basis of the presence of signs of peritoneal irritation on physical examination, imaging findings of four foreign objects in the abdomen, and a review of the history, we determined that the patient had swallowed several neodymium magnets. Computed tomography showed the four magnets in the small bowel. Emergency surgery was performed, which revealed that two of the magnets had adhered to each other with the small bowel wall sandwiched between them; this portion of the small bowel showed necrotic changes, and partial resection of the affected bowel segment was performed. The remaining two magnets were located in the descending duodenum and were removed endoscopically. Ingestion of multiple magnets is more dangerous than ingestion of a single magnet, as it can lead to perforation, penetration, and fistulation via pressure necrosis of the intestinal wall or peritoneum, or to intestinal obstruction via loop formation. In many cases, the parents are not witness to the swallowing, highlighting the importance of detailed history-taking and imaging examinations for an accurate diagnosis.

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