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Volume 64, Issue 5
Displaying 1-7 of 7 articles from this issue
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Original Articles
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Naoto Saigusa, Jun-ichi Saigusa, Sumio Saigusa, Hiroyuki Kimata, Syouj ...2011 Volume 64 Issue 5 Pages 313-318
Published: 2011
Released on J-STAGE: April 27, 2011
JOURNAL FREE ACCESSOne of the most important roles of a private clinic is to find critical diseases as soon as possible. A total of 1,600 patients who underwent their first colonoscopy in the Saigusa Clinic from 1994 to 2010 were randomly extracted. We defined "advanced neoplasia (AVN)" as benign polyps with a diameter of 10mm or more and carcinoma. Amongst 115 (7%) patients who had at least one lesion of AVN, 53 (3.3%) patients developed 58 lesions of carcinoma, 36 of which were advanced. One-hundred and thirty lesions of AVN were found in 115 patients. Thirty-five (27%) of AVN arose in the proximal to sigmoid-descending junction. The median length of the interval between the first visit to the clinic and the detection of advanced cancer was 22 days. There were 11 (32%) patients diagnosed as having advanced colorectal carcinomas at their first visit by means of digital examination or on-site sigmoidoscopy. Total colonoscopy is feasible as a routine examination before anorectal surgery because about one quarter of AVN arise in the proximal colon, particularly when the patients are aged 50 years or older. However, sigmoidoscopy without preparation is an examination of choice for early discovery of cancer, especially when the patients show anal bleeding.
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Yoshinori Oikawa, Yukio Saito, Hideaki Yano, Ryuichiro Suda, Yoshimasa ...2011 Volume 64 Issue 5 Pages 319-327
Published: 2011
Released on J-STAGE: April 27, 2011
JOURNAL FREE ACCESSAnastomotic dehiscence following rectal anastomosis continues to pose a serious clinical problem. Between April 1995 and December 2007, 290 patients underwent sphincter-saving operations for rectal cancer in our center. Of those, 39 patients (13%) developed anastomotic leakage. It was noted that leakage occurred in 29% of the patients who had surgery for low rectal (Rb) cancer. Male gender, lower rectal tumor, bowel obstruction prior to surgery, diabetes, longer operating time and greater blood loss were significant risk factors for anastomotic leakage. Two patients developed generalized peritonitis which required emergency re-laparotomy with fashioning of ileostomy while the remaining 37 patients were treated conservatively. Closure of the fistulas was achieved in 30 out of 37 patients who initially had conservative treatment, leaving 7 who eventually required ileostomy or colostomy. Healing of the fistulas tended to take longer in patients of male gender or lower tumor and in patients who developed leakage in earlier postoperative days.
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Clinical Study
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Syu Tanimura, Seiichirou Hoshino, Naoya Aisu, Youichirou Yoshida, Rich ...2011 Volume 64 Issue 5 Pages 328-331
Published: 2011
Released on J-STAGE: April 27, 2011
JOURNAL FREE ACCESSWe studied the operative indications for peritoneal dissemination from metastatic recurrent colorectal cancer with ileus. The symptoms associated with ileus negatively affect the patient's quality of life.
It is difficult to determine the operative indications for the treatment of ileus because surgery results in a shortening of the patient's survival.
A total of 14 patients presenting with recurrent peritoneal dissemination and ileus during the period from 1999 to 2009 were operated on for colorectal cancer at Fukuoka University Hospital.
We classified the patients into two groups: those treated surgically for ileus, and those who were not.
We also classified the 14 patients into two groups: those demonstrating a PNI score of over 40, and those with a PNI score of less than 40.
Our results showed that the patients treated surgically for ileus with a PNI score of over 40 demonstrated a survival of 120 days or more.
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Case Reports
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Satoru Umegae, Koichi Matsumoto, Tatsushi Kitagawa, Midori Noji, Takay ...2011 Volume 64 Issue 5 Pages 332-336
Published: 2011
Released on J-STAGE: April 27, 2011
JOURNAL FREE ACCESSAnorectal malignant lymphoma is rare, with an incidence reported to be 0.2% of malignant diseases of the colon and rectum. The most common site of intestinal malignant lymphoma is the ileocecal region (70%). Anorectal malignant lymphoma is often misdiagnosed as carcinoma or inflammatory disease before surgery, and its correct diagnosis is often obtained based on histological examination of a resected specimen after surgery. The treatment of anorectal malignant lymphoma has not yet been established, and the prognosis is reported to be extremely poor. We herein report one case of anal malignant lymphoma diagnosed following surgery for hemorrhoids and anal fissures. When an anal induration is encountered in clinical practice, a histological investigation should be conducted. Postoperative adjuvant therapy should include radiation and R-CHOP chemotherapy wherever possible.
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Keizo Yamaguchi, Yutaka Ogata, Takafumi Ohchi, Masaaki Takeuchi, Teruo ...2011 Volume 64 Issue 5 Pages 337-342
Published: 2011
Released on J-STAGE: April 27, 2011
JOURNAL FREE ACCESSAn 82-year-old woman with sigmoid colon cancer underwent sigmoidectomy and D3 lymph node dissection in March 1996. The tumor was diagnosed pathologically as well-differentiated adenocarcinoma, se, ly3, v1, n2, stage IIIb. After postoperative oral administration of UFT for 1 year, fecal occult blood test turned positive in November 2000. Although increases in CEA and anemia were observed, no abnormalities were found by upper and lower endoscopy. Contrast examination of the small intestine revealed stenosis and dilatation of the oral side, leading to diagnosis of small intestinal tumor. Partial resection of the small intestine was performed in June 2001. The tumor was located in the anal side of the jejunum 90cm from Treitz's ligament. Since the main lesion was in the submucosal layer and histological findings were similar to those of sigmoid colon cancer, metastasis was suspected. Immunohistological staining was positive for CD10 and MUC2 and negative for human gastric mucin, demonstrating intestinal mucin phenotype. The tumor was suspected to be metastasis of colon cancer to the small intestine. She died of multiple bone metastases 3 years and 2 months after the resection of the small intestinal tumor. These findings suggest the usefulness of mucin phenotype in the differential diagnosis of epithelial small intestinal tumors.
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Masanori Fukushima, Masaki Yamakawa, Kouki Ikeda, Norihiro Kohara, Ken ...2011 Volume 64 Issue 5 Pages 343-348
Published: 2011
Released on J-STAGE: April 27, 2011
JOURNAL FREE ACCESSA 59-year-old man was admitted to our hospital for right lower abdominal pain. On abdominal CT image, we found a 5-cm line of high density in the ascending colon. We suspected intestinal penetration by a fish bone, but on colonoscopic examination we found a wooden toothpick in the ascending colon and removed it successfully. Thereafter his clinical course was satisfactory and he was discharged from the hospital.
Perforation or penetration of the colon by an accidentally swallowed toothpick is rare, and its preoperative diagnosis is difficult, because patients rarely relate a history of swallowing a toothpick and most toothpicks are not radiopaque. But if we can diagnose this condition preoperatively, there is a possibility that colonoscopic treatment can replace or significantly lessen the need for traditional open surgical procedures to remove foreign bodies from the colon.
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Naoto Nishigori, Fumikazu Koyama, Tadashi Nakagawa, Kazuaki Uchimoto, ...2011 Volume 64 Issue 5 Pages 349-354
Published: 2011
Released on J-STAGE: April 27, 2011
JOURNAL FREE ACCESSParastomol hernia is a relatively high-frequency complication, yet surgical treatments remain to be established and there are issues of high recurrence rates and invasiveness. Recently, surgical repair using mesh with the aim of reducing recurrence rates has been reported, but the operative procedure remains to be unified and there are more complications of infection and fistula formation with bowels. We have achieved a minimally invasive approach with good outcome by inserting a Marlex Mesh® using the onlay method after closing the hernia orifice, and also making an incision in the aponeurosis of the external abdominal oblique muscle because of relaxation incision. We discuss and report on three cases who underwent the same method in our hospital and 36 domestic cases of parastomal hernia repair.
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