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Volume 67, Issue 1
Displaying 1-8 of 8 articles from this issue
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Original Articles
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Osamu Arai2014 Volume 67 Issue 1 Pages 1-7
Published: 2014
Released on J-STAGE: December 27, 2013
JOURNAL FREE ACCESS[Background & Aim] We aimed to clarify the characteristics of colonic cytomegalovirus (CMV) infection without inflammatory bowel disease.
[Method] We selected 15 cases diagnosed as colonic CMV infection based on histological findings and conducted a retrospective study on the characteristics of the patients, endoscopic findings and response to therapy.
[Result] The average age was 64.1 years old and the ratio of males to females was 8:7. Some 47% of the patients had hematological disorder as the underlying disease. Endoscopic findings were mainly divided into redness/erosions/aphtoid lesions, ulcerations, and granular mucosa. Ulcerations were divided into irregular ulcers, punched-out ulcers, longitudinal ulcers, shallow ulcers, annular ulcers and geographical ulcers. It was not frequently found that more than one type of ulcer existed simultaneously. The response rate to anti-viral drugs was 41.7%.
[Conclusion] The degree of mucosal damage of colonic CMV infection without inflammatory bowel disease on endoscopic findings was relatively mild and the site of predilection for ulcerations exhibited a bimodal distribution of the ileocecal region and left-sided colon.View full abstractDownload PDF (381K) -
Fumitake Hata, Takashi Arakawa, Kuniaki Okada, Hidefumi Nishimori, Shi ...2014 Volume 67 Issue 1 Pages 8-15
Published: 2014
Released on J-STAGE: December 27, 2013
JOURNAL FREE ACCESSWe examined sagittal or nearly horizontal histological sections of the pelvic floor tissues from 10 elderly cadavers. These sections included the anal canal/inferior part of the rectum (inferior rectum) as well as the vagina and its associated tissue. The conjoint longitudinal muscle coat, which was rich in elastic fibers, ran inferiorly between the lateral extension of the perineal body (LEPB) and the internal anal sphincter and the end of the external anal sphincter. The longitudinal muscle coat often divided into two bundles and the anterior one ended at the LEPB. Because the rectovaginal septum or fascia was thin and fragmented, the longitudinal muscle coat was a limited, constant plate-like structure interposed between the anal canal and vagina. In the anterior and anterolateral side of the anal canal/inferior rectum, the highest nerve density was seen along the vaginal wall: most of them appeared to run obliquely to the supero-inferior axis. Likewise, the paracolpium contained abundant nerves running almost along the anteroposterior axis. Most of them contained sensory, sympathetic and parasympathetic nerve fibers. To avoid injury to nerves during surgical treatment of rectocele, an approach along the immediately vaginal side of the longitudinal muscle coat seems to be suitable.View full abstractDownload PDF (561K)
Clinical Study
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Katsuhito Suwa, Shintaro Nakajima, Ken Hanyu, Toshiaki Suzuki, Akiko E ...2014 Volume 67 Issue 1 Pages 16-23
Published: 2014
Released on J-STAGE: December 27, 2013
JOURNAL FREE ACCESSPurpose: The aim of this study was to evaluate the characteristics and operative outcomes of parastomal hernia (PSH) repairs performed at our institution.
Patients and methods: Eight primary and 3 recurrent PSH repairs were performed. Types of stoma, the post-stoma placement period before the appearance of hernia, locations of hernia, indications for hernia repair, types of operative procedures, postoperative complications and recurrence were examined.
Results: Mean follow-up periods of primary and recurrent hernias were 16 (2-60) and 25 (10-53) months, respectively. Types of stoma consisted of two end ileostomies, four end colostomies and two loop colostomies, for which the following procedures were performed: two open keyhole repairs (OKH), two laparoscopic Sugarbaker repairs (LSB), one closure of stoma, two relocations and one component separation method (CS). All OKH and CS cases resulted in recurrence, and the mean period before recurrence was 6.7 (5-9) months. For the cases of recurrence, one CS and two LSB were performed. No re-recurrence has yet been observed.
Conclusions: The recurrence rate of our PSH repair was 38%, and the mean period before recurrence was 6.7 months. Operative outcomes of LSB repairs were satisfactory.View full abstractDownload PDF (379K)
Case Reports
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Hidenori Tsukui, Takeshi Suto, Norihiro Ishi, Ichiro Kawamura, Eichi I ...2014 Volume 67 Issue 1 Pages 24-28
Published: 2014
Released on J-STAGE: December 27, 2013
JOURNAL FREE ACCESSWe report a case of endometrioid adenocarcinoma arising from rectal endometriosis. A female in her fifties was admitted for the chief complaint of lower abdominal pain and anal pain in January 2009. Colonoscopy revealed an edematous change in the rectosigmoid. CT examination of the abdomen revealed an enhanced tumor in the rectum. Because of occlusive ileus, low anterior resection was performed in March 2009. The tumor was located in the serosa side. Histologically, we diagnosed endometrial adenocarcinoma arising in the endometriosis of the rectum; endometriosis was noted around the tumor located in the rectal wall. After the operation, DJ therapy was carried out. Forty-three months postoperatively the patient's condition remains good and there are no signs of tumor recurrence. We report this case of endometrial adenocarcinoma arising from endometriosis of the rectum.View full abstractDownload PDF (446K) -
Daisuke Ito, Shintaro Nakajima, Ken Hanyu, Katsuhito Suwa, Tomoyoshi O ...2014 Volume 67 Issue 1 Pages 29-34
Published: 2014
Released on J-STAGE: December 27, 2013
JOURNAL FREE ACCESSA 64-year-old man underwent laparoscopic anterior resection with D2 lymph node dissection for rectal cancer. His postoperative course was uneventful, and he was discharged on day 11 after surgery. He developed intestinal obstruction twice within 5 months after surgery, which were treated successfully with conservative therapy. He was admitted seven months after the operation because of induration with tenderness and redness in the midline abdominal wound. Abdominal computed tomography showed an accumulation of fluid containing gas just beneath the midline wound. Small intestinal adhesion was suspected around the rectal anastomosis. He underwent emergency surgery, in which an abscess was found to originate from the anastomotic region in the pelvis, and the anastomosis site and small intestinal adhesions had formed a mass. He underwent vemoval of the adhesions, partial resection of the intestine and drainage, but peritonitis developed two days later. The cause of peritonitis was judged to be a leakage from the anastomosis created at the time of the first operation, which was treated by colostomy. His postoperative course after colostomy was uneventful. Retrospectively, delayed anastomotic leakage (DAL) seemed to be responsible for intraabdominal and subcutaneous abscesses.View full abstractDownload PDF (420K) -
Naoto Nishigori, Fumikazu Koyama, Tadashi Nakagawa, Kazuaki Uchimoto, ...2014 Volume 67 Issue 1 Pages 35-44
Published: 2014
Released on J-STAGE: December 27, 2013
JOURNAL FREE ACCESSPrimary small intestinal cancer is rare and there is no established standard diagnosis and therapy. We report five cases of primary small intestinal cancer. Case 1: A 66-year-old man was found to have jejunal cancer coincidentally by upper gastrointestinal radiograph during a medical check and prolonged survival was obtained. Case 2: A 72-year-old man with jejunal cancer, with direct invasion to the descending colon. Case 3: A 60-year-old woman, in whom diagnosed jejunal cancer associated with hereditary non-polyposis colon cancer by past and family histories. Case 4: A 64-year-old woman. We could not diagnose advanced jejunal cancer because of the center of the small intestine. Case 5: A 70-year-old man. Advanced jejunal cancer with multiple liver metastasis was intractable to treatment. We discuss the clinicopathological factors of these five cases and 178 domestic reported cases.View full abstractDownload PDF (545K) -
Tsuneyuki Uchida, Hideaki Kato, Chikashi Hiranuma, Toru Watanabe2014 Volume 67 Issue 1 Pages 45-50
Published: 2014
Released on J-STAGE: December 27, 2013
JOURNAL FREE ACCESSA 47-year-old woman was admitted to our hospital suffering from continuous pain in the lower abdominal region for a week. She complained of muscular defense in the same region. Blood examination showed that the values of inflammation were increasing. Abdominal ultrasonography and enhanced computed tomography showed a target-like appearance and a pseudokidney sign in the ileocecal area. We therefore performed an emergency laparotomy, suspecting ileocecal intussusception. During the operation, a tumor-like lump was found in the ileocecal area. It was also found that the appendix had been drawn up into the cecum. Accordingly, we diagnosed the case as appendiceal intussusception. As it was suspected that the lump was a malignant neoplasm of the appendix, right hemicolectomy was carried out. In addition, a submucosal tumor was palpated in the ileum and a partial resection of the ileum was also made. The specimen of the resected part showed that there had been a complete intussusception of the appendix. Histological examination revealed that there had been endometrial tissue in the muscle layers of the appendix and ileum. The patient has shown no recurrence for one and a half years since the operation.View full abstractDownload PDF (395K) -
Shintaro Nakajima, Yoshiko Uno, Masahisa Ohkuma, Tadashi Anan, Makoto ...2014 Volume 67 Issue 1 Pages 51-57
Published: 2014
Released on J-STAGE: December 27, 2013
JOURNAL FREE ACCESSRecently, the outcome of colorectal cancer has improved greatly thanks to progress in chemotherapy. Even if recurrence or metastasis is limited to the local site, prolongation of survival is now possible by performing radical excision. Herein we report a case of resection of a metastatic nodule in the anterior abdominal wall which was reconstructed using a ParietexTM Composite Mesh, and review the literature. A 74-year-old man underwent low anterior resection for rectal cancer in 2007, and was given UFT as an adjuvant therapy. He developed anastomotic recurrence in 2008 for which abdominoperineal resection was performed, followed by radiation (total 50 Gy) and TS-1 therapy for one year. However, isolated metastases were found in the abdominal wall just beneath the midline wound. After 12 courses of panitumumab + mFOLFOX6, we performed laparectomy in 2012 because there was no other recurrence or metastasis. The defect of the abdominal wall after resection was 11×10 cm in diameter, for which abdominal wall reconstruction was performed using a ParietexTM Composite Mesh, paying attention to his permanent colostomy. As of twelve months after the operation, there are no recurrence or stoma problems.View full abstractDownload PDF (480K)
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