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Volume 61, Issue 8
Displaying 1-10 of 10 articles from this issue
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Original Articles
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Hiroyuki Kurihara, Tadao Kanai, Toru Ishikawa, Shinichiro Kanai, Keiic ...2008 Volume 61 Issue 8 Pages 467-475
Published: 2008
Released on J-STAGE: August 21, 2008
JOURNAL FREE ACCESSPURPOSE: The purpose of this study is to present a new standard classification of fistulas to clarify the low intersphincteric fistula and posterior complex fistula.
PERINEOPELVIC SPACES: The perineopelvic spaces are classified as follows: subcutaneous and submucous spaces (IL and IH, the boundary is the dentate line), low and high intersphincteric spaces (IIL and IIH, the boundary is the dentate line), perianal space (IIL), ischiorectal fossa (III) and the supralevator space (IV). Because we identified a septum of connective tissue, including vessels and nerves in the ischiorectal fossa (we named the septum as the septum of ischiorectal fossa). The fossa is separated into two spaces: lower and higher (IIIL and IIIH). Furthermore, we identified two important spaces in the mid posterior anal region: the posterior deep space (IIIP) and the space of Courtney (IIICourtney). The anterior border of the posterior deep space is the internal sphincter, the superior border is the inferior surface of the puborectalis, while the inferior and lateral borders are the anterior surfaces of the external sphincter. The anterior border of the space of Courtney is the posterior surface of the deep external sphincter, while the superior and inferior borders are the superficial external sphincter.
CLASSIFICATION: Anal fistulas are classified based on the extension form of the fistula tract. The types of fistulas are as follows: subcutaneous fistula, submucous fistula, low and high intersphincteric fistulas, posterior deep fistula, low and high ischiorectal fistulas, and supralevator fistula.
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Hisataka Katoh, Shigehisa Fumino, Shigeru Ono, Ryoichi Fukata, Osamu K ...2008 Volume 61 Issue 8 Pages 476-480
Published: 2008
Released on J-STAGE: August 21, 2008
JOURNAL FREE ACCESSPediatric colorectal polyps often show various symptoms, depending on their location. In this study, we reviewed the clinical characteristics of colorectal polyps retrospectively.
From 1987 to 2007, 26 children with colorectal polyps were consecutively treated at our institute. There were 20 boys and 6 girls, and their mean age was 4.0 yr (range, 1-13). The most common initial presentation was rectal bleeding in 17 of the children. Prolapse of the polyp from the anus was noted in 6 cases with rectal polyps. Among them, 2 cases were at first misdiagnosed with rectal prolapse. All polyps were solitary lesions and juvenile polyps except 3 polyps, and 20 polyps were observed in the rectosigmoid colon. Transanal excision was performed in 6 cases, and endoscopic polypectomy in 18 cases. Self-amputation was noted in 1 case. One case with a giant polyp in the transverse colon, who presented massive anal bleeding, required open polypectomy.
Routine total colonoscopy is mandatory for children with colorectal polyps because of the possibility of multiple lesions. Additionally, children with rectal prolapse should be investigated to detect colorectal polyps.
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Takayoshi Utsunomiya, Okihiko Shibata, Motoko Yamabe, Shin-ichi Kikuta ...2008 Volume 61 Issue 8 Pages 481-488
Published: 2008
Released on J-STAGE: August 21, 2008
JOURNAL FREE ACCESSThe wound-healing process of 30 patients (13 males and 17 females) after hemorrhoidectomy was investigated by measuring the wound tissue blood flow in association with 3 growth factors and plasminogen activators. The wound-healing process was clearly divided into four phases: On days 1 to 5 after hemorroidectomy, the tissue blood flow was a low value and did not fluctuate, which was defined as the inflammatory phase. On days 6 to 12, it increased linearly, which was defined as the proliferative phase. On days 13 to 24, the tissue blood flow was a high value, which was defined as the remodeling phase. From the 25th postoperative day, the blood flow began to decline, which was defined as the maturity phase. In the inflammatory and proliferative phases, plasma fibrinogen and vascular endothelial growth factor increased in correlation with each other. During this period, both tissue and urokinase type plasminogen activators were elevated. From the early proliferative phase to the middle of the remodeling phase, the platelet derived growth factor increased. At the late stage of the remodeling phase, the activity of the transforming growth factor (TGF) reached the peak. Then, with the decline of TGF activity, the wound healing reached the maturity phase. It is concluded that the process of wound healing after hemorrhoidectomy involves complex interactions between various mediators and extracellular matrix in a timely fashion. Postoperative wound edema and bleeding occasionally occur in the normal process of wound healing after hemorrhoidectomy.
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Kotaro Ozawa2008 Volume 61 Issue 8 Pages 489-497
Published: 2008
Released on J-STAGE: August 21, 2008
JOURNAL FREE ACCESS[Study 1] We investigated the characteristics of 2,242 intersphincteric fistulas concerning sex, age, property, number, position of primary opening, course from primary opening to secondary opening and operation.
[Result 1] Among patients with intersphincteric fistula, males outnumbered females and most patients were between 10 and 60 years of age. Internal openings were usually located in the 2, 6, and 12 o'clock positions. In multiple fistula cases, 12 and 2 o'clock internal openings combined with the 6 o'clock internal opening. Laying-open fistulectomy was performed in posterior quadrant, coring out fistulectomy was performed in the anterior and lateral quadrant.
[Examination 2] We investigated microscopically the distinction between normal anal gland and its resected intersphincteric fistulas.
[Result 2] Anal glands in intersphincteric fistulas were detected in 69.5% (119/171 cases). Many characters such as a form stellar type of expanded gland, hyperplasia of the epithelium and squamous metaplasia were recognized.
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Clinical Studies
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Motoi Uchino, Hiroki Ikeuchi, Keita Tanaka, Hiroki Matsuoka, Takashi K ...2008 Volume 61 Issue 8 Pages 498-503
Published: 2008
Released on J-STAGE: August 21, 2008
JOURNAL FREE ACCESSCrohn's disease (CD) patients are frequently complicated with anal lesions, which show multiple incidence and intractable characteristics, thus preservation of anal function and comorbidity are important considerations for treatment. We studied 108 CD patients who underwent surgery for anal lesions. To preserve the anal sphincter and prevent recurrence, seton drainage was employed as a basic operative procedure in some of the cases. Patients in remission after 5 years accounted for 85.2%, while those who needed another surgery comprised 39.8%. The cumulative rate of reoperation was 32.4% after 5 years, with the rate of reoperation at 31.3% for patients with seton drainage and 68.0% for those without, which was significantly different. In contrast, 16.9% of the patients with seton drainage also had an ostomy diversion, while 16.0% without seton drainage underwent an ostomy diversion, which was not significantly different. Eleven patients had recto-vaginal fistulas that were not curable, which resulted in an ostomy diversion in 5 and proctectomy in 2. Our results showed that a combined seton procedure was effective for relapse prevention, while it was rather ineffective for radical cure. Thus, it is considered that seton drainage should be selected for CD patients undergoing surgery for anal lesions.
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Tomonori Hamada, Haruhiko Naito, Toshiki Shinohara, Yoshiaki Maeda2008 Volume 61 Issue 8 Pages 504-508
Published: 2008
Released on J-STAGE: August 21, 2008
JOURNAL FREE ACCESSPurpose: The aim of this study was to assess all morbidity and mortality associated with temporary loop ileostomy (LI) in colorectal cancer operations.
Methods: An analysis was performed of 39 patients who underwent LI construction and closure between 1995 and 2007.
Results: Twenty patients required temporary fecal diversion for protection against low colorectal anastomosis, while nineteen patients required LI after anastomotic leakage. The round shaped LI formed a spout without a rod. The average stoma size was 30mm×30mm×26mm (height). Complications arising from LI construction included three peristomal skin disorders, two stomal ulcers, and two small bowel obstructions. There was no retraction, prolapse, hernia, high stoma output, or mortality. The closure was stapled (functional side-to-side) in 24 patients while a hand-sewn anastomosis (end-to-end) was done in 15 patients. In the hand-sewn group, five patients had anastomotic small-bowel obstruction, and one patient had a anastomotic leak required reoperation.
Conclusion: LI is a safe procedure for fecal diversion with acceptable and generally minor complications. Stapled closure is safe with low risk of bowel obstruction.
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Suketo Sou, Toshihiro Sakurai, Toshiyuki Matsui, Masaki Miyaoka, Sizuk ...2008 Volume 61 Issue 8 Pages 509-515
Published: 2008
Released on J-STAGE: August 21, 2008
JOURNAL FREE ACCESS(Objective) The objective of this study was to elucidate the efficacy of short-term therapy with a polymeric formula (Racol®) in patients with active Crohn's disease (CD).
(Subjects) There were 11 patients with active CD who were administered enteral nutrition therapy and who consented to receive the therapy with polymeric formula (Racol®). Out of the 11 patients, 3 patients dropped out and 8 patients were included to be analyzed.
(Method) After continual administration of Racol® for 6 weeks, the remission rate by Crohn's Disease Activity Index (CDAI) was determined. C-reactive protein (CRP), erythrocyte sedimentation rate and blood albumin were also measured. X-ray findings were graded using a score system and the scores of post-therapy were compared with those of pre-therapy. In addition, fractionated blood fatty acids were measured and the ratio of n-3 fatty acid to n-6 fatty acid (n-3/n-6 ratio) was compared.
(Results) The remission rate by CDAI was 87.5% (7/8 subjects). CRP, erythrocyte sedimentation rate, blood albumin and X-ray finding scores were also significantly improved between pre-EN therapy and post-EN therapy. There was no difference in n-3/n-6 ratio between pre-EN therapy and post-EN therapy.
(Conclusion) The results of this study suggest that the short-term therapy with polymeric formula diet (Racol®) could be effective in patients with active CD.
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Hiroki Ikeuchi, Hiroki Nakano, Motoi Uchino, Mitsuhiro Nakamura, Hirok ...2008 Volume 61 Issue 8 Pages 516-520
Published: 2008
Released on J-STAGE: August 21, 2008
JOURNAL FREE ACCESSPurpose: In order to clarify candidates for mucosectomy, we examined the clinical characteristics of patients with ulcerative colitis (UC) who underwent an ileoanal pouch-anal anastomosis (IPAA) and were complicated with cancer at the site of mucosectomy area.
Subjects and Methods: Sections from the anal transitional zone of 319 patients who underwent an IPAA from January 2003 to December 2006 were examined pathologically.
Results: Cancer was observed in 4 (1.3%) of the 319 specimens. As for surgical indications, 1 case was classified as a well-differentiated adenocarcinoma and the other 3 as high grade dysplasia (HGD). Pathological examinations of the resected specimens revealed multiple cancerous lesions in all 4 cases. Histologically, 2 cases were classified as a well-differentiated adenocarcinoma and 2 as squamous cell carcinoma. Regarding invasion depth, sm infiltration was observed in 1 case, while the other 3 were carcinoma in situ.
Conclusion: UC patients with HGD in the colon often have multiple lesions. Since cancerous complications are considered likely to occur in the mucosectomy area, an IPAA with mucosectomy is indicated for such patients.
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Yasuo Nakajima, Yasunobu Tsujinaka2008 Volume 61 Issue 8 Pages 521-526
Published: 2008
Released on J-STAGE: August 21, 2008
JOURNAL FREE ACCESSDiagnosis of anal pyoderma and anal fistula by palpation is a common but extremely difficult method. We studied the effectiveness of ultrasonic examination as a supplementary diagnostic modality by examining 50 cases of pyoderma and 100 cases of low intermuscular anal fistula to determine which of the two diagnostic methods-palpation alone or ultrasound combining radial and transcutaneous linear echo-is more consistent with the surgical findings. The diagnostic accuracy of palpation alone was 60% for pyoderma and 86% for anal fistula, which increased to 94% and 99%, respectively, with ultrasonic diagnosis. Additionally, the transcutaneous linear probe can qualitatively diagnose soft tissue tumors such as atheromas and lipomas. Preoperative ultrasound is thus an extremely effective supplemental diagnostic modality.
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Case Report
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Koichi Nakamura, Toshio Nakamura, Kiyotaka Kurachi, Tadataka Hayashi, ...2008 Volume 61 Issue 8 Pages 527-533
Published: 2008
Released on J-STAGE: August 21, 2008
JOURNAL FREE ACCESSA 33-year old woman had been undergoing annual checkups by colonoscopic examination for Crohn's disease for 15 years. During a regular checkups she was diagnosed with transverse colon cancer and so was referred to our hospital. Colonoscopy revealed severe inflammation, with irregular and granular changes in the transverse colon. Because the biopsy tissue from this lesion had small epithelioid cell granuloma, we diagnosed the condition as a transverse colon cancer associated with Crohn's disease. As a result, we performed laparoscopic assisted subtotal colectomy. Pathological examination of the resected specimen revealed a mucinous adeocarcinoma with adjacent dysplasia, ss, ly1, v1, n0. We experienced a case of transverse colon cancer involving circumjacent dysplasia associated with Crohn's disease. We present this case with some references to the literature.
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