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Volume 66, Issue 6
Displaying 1-8 of 8 articles from this issue
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Original Article
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Masatoshi Matsunami, Akira Tsunoda, Nobuyasu Kano2013 Volume 66 Issue 6 Pages 391-396
Published: 2013
Released on J-STAGE: May 31, 2013
JOURNAL FREE ACCESSAim: Although internal rectal prolapse (IRP) is believed to cause functional symptoms such as difficulty of evacuation (fecal incontinence), little has been published on the exact distribution and frequency of symptoms. The aim of this study was to identify the most common symptoms of patients with IRP.
Method: Patients with IRP were diagnosed based on defecography using the Oxford Rectal Prolapse Grade in which an intussusception descending onto the sphincter and into the sphincter was classified into grade 3 and grade 4, respectively. Fecal incontinence was evaluated with the Fecal Incontinence Severity Index (FISI). Regarding defecography, the length of intussusception was measured.
Results: Difficulty of evacuation (72%) was the most common symptom, including feeling of prolapse (70%), fecal incontinence (52%), anal bleeding (38%), anal pain (32%), and tenesmus (32%). The length of intussusception was significantly longer in grade 4 patients than those of grade 3 (P=0.002). Moreover, the length of intussusception significantly correlated with FISI scores. (P=0.019).
Conclusion: A variety of symptoms may be caused by high grade IRP. Among those, difficulty of evacuation, fecal incontinence, and feeling of prolapse were recognized in more than half the cases. It was suggested that the longer the length of intussusception, the worse the severity of fecal incontinence.View full abstractDownload PDF (861K)
Clinical Studies
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Yoshihiro Ohmi, Takuma Ohmi, Kyuma Ohmi2013 Volume 66 Issue 6 Pages 397-405
Published: 2013
Released on J-STAGE: May 31, 2013
JOURNAL FREE ACCESSPurpose: The efficacy of perineal anal canal plastic operation (posterior internal anal sphincter repair) developed by our hospital (1. the anal canal is narrowed by inverting a large part of the posterior wall into the lumen, and 2. the sphincter ani externus and the puborectalis are gathered and sutured), was evaluated in 42 patients with rectal prolapse (incomplete rectal prolapse, 12 patients; complete rectal prolapse, 30 patients).
Results: The postoperative observation period ranged from 6 months to 3 years and 7 months (average, 1 year and 9 months) in the incomplete prolapse group, and from 7 months to 6 years and 2 months (average, 3 years and 3 months) in the complete prolapse group.
No recurrence was found in the 12 cases of incomplete prolapse. Among the 30 cases of complete prolapse, 2 cases (6.7% + 6.7%) developed incomplete and complete prolapse.
Wexner scores were significantly reduced after surgery in both cases of incomplete rectal prolapse and complete rectal prolapse (P < 0.01).
Anal manometry revealed a significant increase of the maximum static pressure after the operation for complete rectal prolapse (P < 0.05).
Conclusions: The present surgical procedure is considered to be useful for both complete and incomplete rectal prolapse.View full abstractDownload PDF (1057K) -
Haruki Sada, Akira Tsunoda, Takuya Sugimoto, Nobuyasu Kano2013 Volume 66 Issue 6 Pages 406-411
Published: 2013
Released on J-STAGE: May 31, 2013
JOURNAL FREE ACCESSThe ligation of the intersphincteric fistula tract (LIFT) procedure for fistula-in-ano described by Rojanasakul revealed a high success rate without any fecal incontinence. Our purpose was to assess the objective anal function in the patients undergoing the modified LIFT for low transsphincteric fistulas. We performed a prospective study. An anal manometric study was performed before and after the procedure. Sixteen patients underwent the modified LIFT procedure. 8 had II Ls and 8 had II Lc. Of the 16 patients, 15 (93.8 %) healed completely. One had persistent symptoms. The median healing time was 9 weeks. None of the patients reported fecal incontinence. There were no significant postoperative changes in either the maximum resting pressure (132.3±32.1cmH2O, 135.3±44.5cmH2O) or the maximum squeeze pressure (407.5±185.2cmH2O, 436.9±219.1cmH2O). Although we need a long-term follow-up, the early outcomes of the modified LIFT for low transsphincteric fistula appear to preserve anal functions.View full abstractDownload PDF (1516K)
Case Reports
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Junichi Fukui, Shigeyoshi Iwamoto, Katsuji Tokuhara, Kazumasa Yoshida, ...2013 Volume 66 Issue 6 Pages 412-415
Published: 2013
Released on J-STAGE: May 31, 2013
JOURNAL FREE ACCESSA case of advanced rectal cancer complicated with complete rectal prolapse was experienced. A 92-year-old female had a history of internal hemorrhoid and rectal prolapse for 60 years. In August 2011, at a nearby clinic, she was diagnosed with a rectal tumor in the lower rectum, but underwent no treatment. In January 2012, she visited our department with a major complaint of irreducible rectal prolapse and anal bleeding, and a circumferential tumor was observed in the prolapsed bowel. A biopsy revealed well-differentiated adenocarcinoma, and abdominoperineal resection was carried out. Pathohistology demonstrated well-differentiated adenocarcinoma with an invasion depth of A. Advanced rectal cancer complicated with complete rectal prolapse is markedly rare, and only seven domestic cases including ours have been reported. The case was intriguing for investigating the possibility of the carcinogenic mechanism over a long duration of rectal prolapse and physical stress to the rectum. Recently, rectal prolapse in elderly females has been increasing and cases complicated with rectal cancer are expected to increase. It was thought important to select treatment with careful consideration of the balance between general condition and curability.View full abstractDownload PDF (1376K) -
Nobuyoshi Yamazaki, Akihiro Kobayashi, Yusuke Nishizawa, Masaaki Ito, ...2013 Volume 66 Issue 6 Pages 416-421
Published: 2013
Released on J-STAGE: May 31, 2013
JOURNAL FREE ACCESSA 79-year-old woman was seen by a clinic because of melena, and then consulted our department after the diagnosis of rectal cancer. A pelvic MRI showed the tumor had invaded the vagina so very low anterior resection, and uterus and vagina resection, as well as a transverse colon colostomy were performed. After the operation, the patient complained of anal pain, and anastomotic leakage was diagnosed. The abscess was located in the ventral side of the anastomosis; the abscess was improved by opening the vaginal stump. The patient complained of perineal pain and increased vaginal discharge 10 weeks after the operation. CT and MRI showed a 3 cm tumor in the ventral side of the anastomosis. The cytology of the vaginal discharge was Class V; thus, locally recurrent rectal cancer (LRRC) was diagnosed. The patient did not wish to have surgical resection and chemotherapy; so, radiation therapy was performed. Following 50Gy of radiotherapy, clinical complete response (clinical CR) was confirmed. The patient survived for more than 11 years without recurrence. The surgical resection for LRRC was a very invasive treatment, and the chemotherapy for elderly patients was not safe; so, radiation therapy of more than 50Gy aimed at clinical CR will be an option for LRRC treatment.View full abstractDownload PDF (1109K) -
Keiji Hirata, Hiromitsu Matsuda, Takayuki Toyonaga, Yukio Sonoda, Hide ...2013 Volume 66 Issue 6 Pages 422-427
Published: 2013
Released on J-STAGE: May 31, 2013
JOURNAL FREE ACCESSA 46-year-old woman was presented to us with general fatigue and constipation. A Computed Tomography scan and sigmoidscopy showed bulky sigmoid colon cancer with stenosis and multiple huge metastases of the liver. She received Intravenous Hyperalimentation and then mFOLFOX6 / Panitumumab was started. After 4 courses of chemotherapy, liver metastases markedly decreased. However, she suffered from thrombocytopenia and leukocytopenia with splenomegaly, which caused discontinuation of the chemotherapy. After confirmation of the normocellular state of her bone marrow, she underwent laparoscopic splenectomy and sigmoidectomy followed by an uneventful recovery. The splenectomy improved thrombocytopenia and leukocytopenia, and enabled her to resume chemotherapy with the same regimen. Oxaliplatin-based chemotherapy occasionally induces hepatic sinusoidal dilatation and causes portal hypertension associated with splenomegaly. Surgical splenectomy seemed to be useful for treating prolonged thrombocytopenia and leukocytopenia with splenomegaly after discontinuation of oxaliplatin, and allowed the continuation of chemotherapy.View full abstractDownload PDF (1465K) -
Toshiya Tanaka2013 Volume 66 Issue 6 Pages 428-433
Published: 2013
Released on J-STAGE: May 31, 2013
JOURNAL FREE ACCESSThe report of cancer in the diverticulum of the large intestine is rare. We have reported this case after a review of associated literature. A 66-year-old woman was hospitalized with fecal occult blood positive. In the lower digestive tract an imaging inspection with an endoscope was undertaken and the tumor was observed as a flat elevated early colon cancer of 0-Is, 2.0×1.5cm in size, located in the sigmoid colon. The view of the diverticulum was not able to be checked before the operation. Endoscopic ultrasonography revealed that the tumor had invaded the proper muscle layer. We tried a laparoscpe-assisted sigmoidectomy. The intraabdominal adhesion was severe, therefore we moved to a sigmoidectomy with laparotomy.
With a macro-scopic view of the excision specimen, the tumor was observed in the orifice of the diverticulum. The size of the orifice was 2 mm and the tumor was running through the diverticulum.
Microscopically, the sac-like structure was a true diverticulum with a muscle layer. A mucinous lake is frequentlly seen in the invasive area. The final diagnosis was advanced cancer of S, 0-Is, 20×20mm, pSS, pN0, sH0, cP0, cM0, f Stage II.View full abstractDownload PDF (1760K) -
Ken-ichi Takahashi, Yuji Funayama, Fumie Ikezawa, Fumito Saijo, Masaru ...2013 Volume 66 Issue 6 Pages 434-438
Published: 2013
Released on J-STAGE: May 31, 2013
JOURNAL FREE ACCESS[Case] 50-year-old male who had undergone left nephrectomy for renal cell carcinoma 5 years before was receiving oral administration of sunitinib because of lung metastasis and bone metastasis. He was introduced to our hospital because of perianal discharge for 2 months and severe perianal pain for 2 week. Pus with a bad odor was discharged from a secondary opening of the anal fistula. Swelling, tenderness and crepitus was widely observed around the perianal region, scrotum and left inguinal region. Abdominal CT showed extensive pus collection and emphysema around this region. So he underwent a fistulotomy and wide skin incision and debridement of necrotic tissue with the diagnosis of Fournier's gangrene. The postoperative course was uneventful. [Discussion] Although diabetes mellitus was the most well known risk factor of Fournier's gangrene, patients with malignancies are also reported to be at great risk. As for sunitinib, there has been no report of a case with Fournier's gangrene during sunitinib therapy. However, the possibility that myelosuppression and/or the anti-angiogenic effect of sunitinib promoted the development of Fournier's gangrene cannot be denied in our case. It is important to take the possibility of Fournier's gangrene into consideration when the patients receiving sunitinib therapy complain of anal pain.View full abstractDownload PDF (1346K)
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