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Volume 61, Issue 3
Displaying 1-10 of 10 articles from this issue
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Original Article
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H. Ogawa, Y. Funayama, K. Fukushima, K. Miura, A. Oyama, M. Nagao, K. ...2008 Volume 61 Issue 3 Pages 101-106
Published: 2008
Released on J-STAGE: October 02, 2008
JOURNAL FREE ACCESS<Objective> The aim of this study was to determine the long-term outcome after loose-seton drainage for complex anal fistulas in patients with Crohn's disease.
<Methods> Twenty-seven patients with Crohn's disease underwent loose-seton drainage for their complex anal fistula in Tohoku University Hospital. All patients were followed up over 5 years. The ratio of patients who required repeated seton drainage or fecal diversion was determined retrospectively.
<Results> The follow-up period was 8.7±2.1 years. During follow-up, 63% (17patients) underwent repeated surgery and 37% (10 patients) required fecal diversion.
<Conclusion> Approximately two-third patients underwent repeated surgery after primary seton drainage, and over half of them required fecal diversion eventually. Adjuvant therapy with immunosuppressants or anti-TNFα antibody may be considered to improve the outcome after seton drainage for complex anal fistulas in patients with Crohn's disease.
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Case Reports
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K. Ota, M. Fukunaga, H. Takemoto, R. Oshiro, K. Yamamoto, H. Furukawa2008 Volume 61 Issue 3 Pages 107-111
Published: 2008
Released on J-STAGE: October 02, 2008
JOURNAL FREE ACCESSA fifty-six years-old man without a particular colorectal family history was referred to a near-by clinic due to anemia found during a health care examination. At the clinic, multiple colon polyps and a tumor in the transverse colon were found as a result of barium enema examination. He was referred to our hospital and, by means of colonoscopic examination, numerous pedunculated type polyps were identified from the cecum through the rectum. Colonoscopic polypectomy was performed on some of the ascending colon polyps. Since a tumor-like lesion with a diameter of 4cm was also identified by enhanced CT, total colectomy was performed. By histopathological examination, pedunculated polyps densely distributed around the rectum and polyps of ascending colon were diagnosed as juvenile polyps and a tumor in the transverse colon was identified as tubulovillous adenoma (severe atypia).
Compared with adenomatous polyposis, cases of juvenile polyposis have been reported as being poorly related with malignant tumors since it is classified as a teratoma. However, the number of reports in which juvenile polyposis may represent a pre-cancerous state have been increasing. Here we report a case of juvenile polyposis accompanied by tubulovillous adenoma with severe atypia, as well as on a review of related papers.
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Y. Nakazawa, T. Kato, H. Hara, A. Takagi, T. Nogaki2008 Volume 61 Issue 3 Pages 112-118
Published: 2008
Released on J-STAGE: October 02, 2008
JOURNAL FREE ACCESSWe report two cases of MALT lymphoma of the cecum. Both Case 1 and Case 2 were 77-year-old women, and the chief complaint of both cases was fecal occult blood. In both cases colonoscopy showed elevated lesions in the cecum, and biopsy specimens suggested MALT lymphoma. The patients underwent surgery. Macroscopically, the cecal tumor was elevated lesions, measuring 1.4×1.3cm (Case 1) and 3×4cm (Case 2). Histologically, both tumors were diagnosed as MALT lymphoma and there was no lymphnode metastasis. According to the General Rule for Clinical and Pathological Studies on Cancer of the Colon, Rectum and Anus, we diagnosed the lesion of case 1 as SM, N0, M (-) stage I, and case 2 as SS, N0, M (-) stage II. Helicobacter Pylori was negative in the biopsy specimens of both stomachs. Even without chemotherapy, recurrence was not recognized in these cases.
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Y. Hiramatsu, K. Yoshimatsu, H. Yokomizo, T. Hujimoto, A. Umehara, T. ...2008 Volume 61 Issue 3 Pages 119-122
Published: 2008
Released on J-STAGE: October 02, 2008
JOURNAL FREE ACCESSWe herein report a case of mesenteric panniculitis of the large bowel successfully treated by surgery. A 74-year-old man was admitted for further examination of his chief complaint that he wished to defecate many times a day. At his lower left abdomen, an elastic hard tumor of approximately 20cm in size was palpable. Barium enema showed bad extension, stenosis and serrated appearance of the large bowel from the sigmoid colon to the upper rectum. Stenosis without mucosal dysplasia was observed by colonoscope. Computed tomography showed wall thickening at the same part of the large bowel and elevated density of mesenteric fat. Although he was suspected of having mesenteric panniculitis, laparotomy was performed to improve his complaint early. The operative finding was that the walls of the large bowel from the sigmoid to the upper rectum and the mesentery were extremely thickened and so low anterior resection was performed. Pathologically, his diagnosis was of having mesenteric panniculitis based on the findings of necrosis of the subserosal fat and the reactive histiocytosis including foamy cells. Postoperative course was not eventful and his defecation was improved. He was discharged on the 16th POD.
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K. Nakao, M. Hayashi, H. Nagayama, A. Tsunoda, M. Kusano2008 Volume 61 Issue 3 Pages 123-126
Published: 2008
Released on J-STAGE: October 02, 2008
JOURNAL FREE ACCESSA 57-year-old man had been visiting our hospital with the chief complaint of abdominal pain and diarrhea. CT and endoscopic examinations of the lower gastrointestinal tract indicated carcinoma of the rectosigmoidal colon. Histopathological examination by endoscopy revealed moderate and poorly differentiated adenocarcinoma. The patient underwent sigmoidoproctostomy. The resected tumor belonged to whole around type 2 and was 6.5×3.5cm in size. Histopathologically it was adenosquamous carcinoma consisting of a mixture of moderately differentiated adenocarcinoma and poorly differentiated squamous cell adenocarcinoma (pSE, pN1, sH0, sP0, ly2, v1, fStage IIIa).
We observed the clinical course at the outpatient clinic and closed the stoma in July 2007.
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T. Oshiro, Y. Fukuda, K. Mizunuma, M. Matsuda2008 Volume 61 Issue 3 Pages 127-131
Published: 2008
Released on J-STAGE: October 02, 2008
JOURNAL FREE ACCESSWe report a case of rectal perforation and perirectal abscess after glycerin enema in a hemodialysis patient. A man in his fifties visited a hospital with the complaint of perianal pain after a glycerin enema, which had been used for treatment of constipation. At first, there were no typical findings on pictures, and his course was observed without active medical treatment. Eighteen days after his glycerin enema, he visited the hospital because of severe perianal pain and high fever. He was diagnosed as having a perirectal abscess and was transferred to our hospital for surgical treatment. He was successfully treated by percutaneous aspiration drainage without laparotomy.
Glycerin enema is a common procedure, but there is a risk of severe complications, possibly causing rectal perforation, and this procedure must therefore be done carefully.
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T. Hirasawa, S. Matsuo, K. Akagi, Y. Takaishi, Y. Nakajima, O. Tsutsum ...2008 Volume 61 Issue 3 Pages 132-136
Published: 2008
Released on J-STAGE: October 02, 2008
JOURNAL FREE ACCESSToxic shock syndrome (TSS) is characterized by symptoms such as sudden high fever, systemic erythema, and decreased blood pressure; these are due to toxins produced by Staphylococcus aureus. In serious cases, there is rapid multiple organ failure leading to death. We report our experience of a 39-year-old male patient who developed TSS after undergoing ligation hemorrhoidectomy. He experienced fever, systemic diffuse erythema, sore throat, and congestion of the palpebral conjunctiva. There were no signs of postsurgical wound infection, so serious drug eruption was suspected. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in subsequent wound and stool cultures, leading to the diagnosis of TSS. Following treatment with continuous hemodiafiltration and vancomycin, the symptoms went into remission. TSS progresses rapidly and becomes life-threatening if treatment is delayed. Therefore, when TSS is suspected in postsurgical patients who experience fever of 39°C or higher, dermal erythema, shock, and other symptoms of toxicity, treatment should be started promptly.
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K. Toyota, J. Nambu, T. Takahashi, M. Ikeda, N. Tokumoto2008 Volume 61 Issue 3 Pages 137-140
Published: 2008
Released on J-STAGE: October 02, 2008
JOURNAL FREE ACCESSA gastrointestinal stoma has often been created at the lower abdomen according to the principle of the Cleveland Clinic which proposes that the umbilicus should be avoided. We experienced a case of colostomy at the umbilicus, to which good care was given. A 74-year-old female, with a past history of chronic renal failure, anemia, sick sinus syndrome, chronic heart failure, and cerebral infarction, was admitted to the hospital for colonic obstruction due to transverse colon cancer. Since resection under general anesthesia was judged to carry a high risk, she underwent transverse loop colostomy under local anesthesia. Considering her small and slim build, the possibility of securing a flat surface area for attachment of a pouch, and her bedridden condition, a stoma was created at the umbilicus. Her postoperative clinical course was uneventful, and after it was confirmed that her family members were able to provide stoma care, she was discharged from the hospital. Although cases requiring colostomy have decreased recently, the umbilicus may be a good candidate site for colostomy.
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H. Kato, K. Kunieda, K. Yawata, M. Ito2008 Volume 61 Issue 3 Pages 141-146
Published: 2008
Released on J-STAGE: October 02, 2008
JOURNAL FREE ACCESSA 59-year-old man underwent right hemicolectomy under the diagnosis of ascending colon cancer. Postoperative immunohistochemical examination led to a diagnosis of leiomyosarcoma of the colon. Approximately 14 months later, abdominal US, CT, and MRI revealed a 25×20-mm SOL in liver S5, which was diagnosed as a heterochronous hepatic metastasis from leiomyosarcoma. Since there were no signs of local recurrence, simple hepatic metastasis was diagnosed, and hepatectomy was performed. After surgery, the resected tumor was histopathologically diagnosed as hepatic metastasis of the previous colon leiomyosarcoma. Three months after hepatectomy, abdominal CT showed a 23×15-mm SOL in the S4-S5 border, which was diagnosed as residual liver recurrence. Re-hepatectomy was performed, and the resected tumor was immunohistochemically diagnosed as hepatic metastasis of leiomyosarcoma. The patient has been free of recurrence for 12 months after re-hepatectomy. Leiomyosarcoma of the gastrointestinal tract is a very rare disease, frequently metastasizes to the liver, and can only be treated by surgical resection. We report a case of successful hepatectomy for two heterochronous hepatic metastases of cecal leiomyosarcoma, a very rare digestive leiomyosarcoma.
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How I do it
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Y. Takagi, T. Shoji2008 Volume 61 Issue 3 Pages 147-150
Published: 2008
Released on J-STAGE: October 02, 2008
JOURNAL FREE ACCESSDownload PDF (808K)
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