Nihon Daicho Komonbyo Gakkai Zasshi
Online ISSN : 1882-9619
Print ISSN : 0047-1801
ISSN-L : 0047-1801
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Volume 63, Issue 2
Displaying 1-9 of 9 articles from this issue
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Original Article
  • Clinicopathological Characteristics and Surgical Outcomes of Mucinous Colorectal Carcinoma with Curative Resection
    Amane Kanazawa, Manabu Shiozawa, Shuzo Tamura, Daisuke Inagaki, Naoto ...
    2010 Volume 63 Issue 2 Pages 43-50
    Published: 2010
    Released on J-STAGE: February 02, 2010
    DOIhttps://doi.org/10.3862/jcoloproctology.63.43
    JOURNAL FREE ACCESS
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    The clinicopathological characteristics of mucinous colorectal carcinoma with curative resection were compared with those of well-moderately differentiated adenocarcinoma as a control. Mucinous colorectal carcinoma was classified into two groups according to the histological characteristics, and the prognostic factors and clinicopathological factors were examined. Mucinous colorectal carcinoma accounts for 5.1% of all primary colorectal cancer. Compared with well-moderately differentiated adenocarcinoma, mucinous carcinoma was found more often in the right side of the colon, with a large tumor size and advanced stage. The 5-year overall survival rates for mucinous carcinoma and well-moderately adenocarcinoma were 68.8% and 80.8%, respectively. Univariate and multivariate analyses identified three factors as independent prognostic features significantly affecting the 5-year overall survival rates in mucinous carcinoma: lymphatic invasion, lymph node metastasis and pathological type (poorly-differentiated type). Patients with more risk factors had a markedly worse 5-year overall survival. Mucinous colorectal carcinoma was classified into two groups according to the histological characteristics. The 5-year overall survival rates for the poorly-differentiated type and the well-differentiated type were 40.0% and 71.8%, respectively. In mucinous colorectal carcinoma, the presence of multiple adverse prognostic factors identifies a high-risk subgroup. Other therapeutic and follow-up plans should be considered between mucinous carcinoma and well-moderately adenocarcinoma.
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Clinical Study
  • Is Fecal Incontinence a Rare Disease?: Clinical Outcome of Management of Patients with Fecal Incontinence in Our Institute
    Kazuhiko Yoshioka, Shigeyoshi Iwamoto, Katsuji Tokuhara, Yoshitaka Hat ...
    2010 Volume 63 Issue 2 Pages 51-55
    Published: 2010
    Released on J-STAGE: February 02, 2010
    DOIhttps://doi.org/10.3862/jcoloproctology.63.51
    JOURNAL FREE ACCESS
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    Fecal incontinence is a psychological and social burden for patients. We retrospectively reviewed patients with fecal incontinence to clarify the clinical outcome in our institute. Between April 1998 and March 2008, 134 patients with fecal incontinence visited our institute. Forty-two were male and 92 were female, the mean age was 57.5 years. One hundred two patients (76.1%) were referred to or visited our institute after obtaining information through the Internet or newspapers and 32 patients (23.9%) were those who had not obtained any information about fecal incontinence before consultation. The most common presumptive etiology of incontinence was unknown (idiopathic fecal incontinence) and was found in 68 patients. The mean value of Wexner score was 10.3. In 114 patient who received treatment conservative treatment was solely administered in 92 patients (80.7%) while 22 patients(19.3%) received surgical treatment. Forty-three patients (67.2%) out of 64 patients who received conservative management with polycarbophil calcium and pelvic muscle training symptomatically improved. Functional results were good in 13 patients (59.1%) out of 22 patients who received surgical treatment.
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Case Reports
  • Two Cases of Emergency Operations in Patients Undergoing Bevacizumab Treatment
    Kozo Yoshikawa, Mitsuo Shimada, Nobuhiro Kurita, Masanori Nishioka, Sh ...
    2010 Volume 63 Issue 2 Pages 56-60
    Published: 2010
    Released on J-STAGE: February 02, 2010
    DOIhttps://doi.org/10.3862/jcoloproctology.63.56
    JOURNAL FREE ACCESS
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    Bevacizumab has become a widely used intervention in patients with advanced colon cancer. In view that a negative effect of wound healing has been reported, surgery should be performed 4-6 weeks after the last treatment. This study examined the approaches to the management of emergency operations in patients undergoing bevacizumab treatment. In this report, four operations were performed for two patients undergoing bevacizumab treatment. Surgical complications and the postoperative course were examined. Case1: The patient was a male in his 50s with descending colon cancer, multiple liver metastasis and lung metastasis. This patient was suffering from ileus due to descending colon cancer. A transverse colostomy was performed. In addition, a descending colectomy and drainage were conducted for the retroperitoneal abscess formation. Case2: The patient was a male in his 70s with mucinous cystadenocarcinoma of the appendix and carcinomatous peritonitis. This patient was suffering from abdominal pain. As a CT showed free air, an emergency operation was performed. Drainage was also performed. The extent of the surgical procedures should be limited, and construction of a stomy should be preferred to primary anastomosis.
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  • A Case of Metastatic Carcinoma of Anal Fistula Caused by Implantation from Rectal Cancer
    Koichi Sato, Hiroshi Azuma, Yasuyuki Miyakura, Hisanaga Horie, Toru Ha ...
    2010 Volume 63 Issue 2 Pages 61-67
    Published: 2010
    Released on J-STAGE: February 02, 2010
    DOIhttps://doi.org/10.3862/jcoloproctology.63.61
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    A 53-year-old male visited our clinic complaining of anal bleeding and perianal pain. A fistula was palpable at the posterior side of the anus. Because a rectal tumor was suspected at the same time, a colonoscopy was performed, which confirmed the presence of a circular ulcerated mass at the rectum 5cm from the anal margin. A biopsy of the secondary opening and rectal mass showed a well-differentiated adenocarcinoma. The patient underwent abdominoperineal resection. The anal fistula tumor showed the same histological appearance as the rectal cancer, so we considered that cancer cells from the rectal cancer had become implanted in the anal fistula. Anal fistula is a common disease found by medical examination and is effectively treated, but in a biopsy that is particularly positive for the induration in the fistula, metastatic carcinoma of anal fistula should be taken into consideration in the case of complications with colorectal cancer, and a careful examination is necessary. On the contrary, for cases diagnosed as anal fistula cancer, confirmation by colonoscopy should always be performed.
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  • Long-term Use of Tamoxifen and Sulindac for the Treatment of Mesenteric Desmoid Tumors and Polyposis in Gardners' Syndrome
    Tomohide Mukogawa, Hisao Fujii, Fumikazu Koyama, Tadashi Nakagawa, Kaz ...
    2010 Volume 63 Issue 2 Pages 68-74
    Published: 2010
    Released on J-STAGE: February 02, 2010
    DOIhttps://doi.org/10.3862/jcoloproctology.63.68
    JOURNAL FREE ACCESS
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    A 56-year-old female was operated on for advanced sigmoid colon cancer and a metastatic liver tumor at another hospital in October 1995. Intra operative colonoscopy revealed the colorectal polyposis for the first time. After the operation, an endoscopic resection was performed for the remnant polyps. She had the intra-abdominal tumors since early 1997 and was introduced to our hospital. She was diagnosed as having mesenteric desmoid tumors with Gardner's syndrome and was operated on in June 1997. Because the operative findings revealed that the mesenteric desmoid tumors had invaded the superior mesenteric artery and extensive surgical resection was expected to cause a low quality of life, we judged them as unresectable. Therefore, the tumors were treated with Tamoxifen and Sulindac, after which the largest tumor gradually decreased in size from 7cm to 1.5cm on computed tomography. We have maintained partial response in treating the desmoid tumors using this combination therapy for more than 10 years. There have been no other reports of long-term regression of a desmoid tumor such as in this case.
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  • Perineal Hernia After Abdominoperineal Proctectomy: Report of Two Cases
    Shintaro Nakajima, Katsuhito Suwa, Tetsuya Yamagata, Kazuo Kitagawa, T ...
    2010 Volume 63 Issue 2 Pages 75-81
    Published: 2010
    Released on J-STAGE: February 02, 2010
    DOIhttps://doi.org/10.3862/jcoloproctology.63.75
    JOURNAL FREE ACCESS
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    Perineal hernias are rare secondary disorders that occur after pelvic surgery or following trauma. Here, we report two such cases of a hernia that developed after abdominoperineal resection for rectal cancer. In both cases, conditions pertinent to this complication, such as postoperative wound infection or disturbed wound healing, were absent.
    Both patients noticed tumors in the perineal region within three postoperative months. For each patient, the diagnosis of a perineal hernia was made based on the symptoms, a CT and MR findings. Composix EX Mesh was used to repair the hernia via the abdominal approach. Such a technique was thought to be an effective tension-free procedure, provided that the operative field is not contaminated.
    We herein report two patients with a perineal hernia that developed after abdominoperineal resection for rectal cancer, and review the literature with reference to prevent such a complication.
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  • A Case of Fulminant Amoebic Colitis Complicated with Ulcerative Colitis That Was Difficult to Diagnose
    Shin Saida, Toshifusa Ozawa
    2010 Volume 63 Issue 2 Pages 82-87
    Published: 2010
    Released on J-STAGE: February 02, 2010
    DOIhttps://doi.org/10.3862/jcoloproctology.63.82
    JOURNAL FREE ACCESS
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    A 55-year-old male was admitted to our hospital complaining of diarrhea and hematochezia. A colonoscopy revealed a soiled multiple ulcer irregularity at the ascending and sigmoid colon, but a biopsy was not performed. He had been treated for ulcerative colitis for several years, so steroid treatment was started for the diagnosis of severe ulcerative colitis. About a month later, his condition did not improve, so a colonoscopic examination and Computed Tomography (CT) examination were performed again. The biopsies of the colonoscopy identified Entamoeba histolytica, so metronidazole treatment was started based on a diagnosis of amoebic colitis after 42 days from his admission. Suddenly, however, after 4four days of metronidazole, he experienced severe abdominal pain and bloody stools. An emergency operation was performed based on the diagnosis of a toxic mega colon with perforation, which was detected under CT examination. Intraoperative findings revealed that the ascending and transverse colon were necrotic and multiple penetrations were detected in the ascending colon. After a subtotal colon resection, his clinical course improved and left the hospital on foot 127 days after admission. When we encounter a patient complaining of hematocezia and diarrhea, we should consider this disease.
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