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Volume 67, Issue 2
Displaying 1-7 of 7 articles from this issue
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Original Articles
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Fumikazu Koyama, Hisao Fujii, Naoki Inatsugi, Shusaku Yoshikawa, Tadas ...2014 Volume 67 Issue 2 Pages 59-67
Published: 2014
Released on J-STAGE: January 31, 2014
JOURNAL FREE ACCESSTo clarify the incidence and clinical features of perianal lesions in patients with UC, we retrospectively analyzed data from 4,678 patients who underwent surgery for perianal diseases between 2001 and 2010 and data from 773 patients with UC. Perianal lesions occurred in 21 patients (2.7%) with UC including 13 with total colitis, 5 with left-side colitis and 3 with proctitis. On the spectrum of perianal lesions, the percentages of fistula/abscess and hemorrhoid/fissure were 76.2% and 14.3%, respectively, in UC patients, compared with 25.2% and 55.7%, respectively, in common anal disease patients, showing a significant difference (p<0.001). We classified the perianal lesions in UC patients into four categories according to Hughes' classification. Eight of 10 cases with incidental fistula/abscess succeeded with local surgical treatment. There were no lesions similar to the primary lesions of Crohn's disease. Three of 6 cases with secondary fistula/abscess and 2 cases with post-operative anastomotic fistulas failed with local surgical treatment, and required total proctocolectomy or ileostomy. Our conclusions were as follows. The majority of perianal lesions in UC patients were fistula/abscess. The classification of perianal lesions according to Hughes' classification reflected the responsiveness to treatment and the prognosis. It is important to recognize the existence of perianal lesions in the clinical management of patients with ulcerative colitis.View full abstractDownload PDF (1506K) -
Akio Higuchi, Shuji Saito, Hideyuki Ike, Hiroshi Mikayama, Hiroshi Har ...2014 Volume 67 Issue 2 Pages 68-73
Published: 2014
Released on J-STAGE: January 31, 2014
JOURNAL FREE ACCESSAim: The aim of this study was to identify the anatomical variations of mesenteric arteries in patients with colon cancer.
Methods: From March to August 2012, 56 patients underwent 3D-CT angiography. We classified the variations of the right colic artery, middle colic artery and inferior mesenteric artery.
Results: The right colic artery branched from the superior mesenteric artery directly in 25% (Type A), from the middle colic artery in 37.5% (Type B), from the ileocolic artery in 26.8% (Type C), and was absent in 10.7% (Type D). In 80.4% the right and the left branch of the middle colic artery branched from the same point of the abdominal aorta, and branched from different points in 12.5%. The accessory middle colic artery was present in 33.9% in total. Three types of branching of the left colic artery (LCA), sigmoid artery (SA) and superior rectal artery (SRA) were seen. SA branched from SRA in 51.8%, the three arteries branched from the same point in 16.1%, and SA branched from LCA in 32.1%.
Conclusion: 3D-CTA is useful for assessing the anatomy of vascular branching for colorectal surgery.View full abstractDownload PDF (1126K) -
Naoyuki Yoshizawa, Toshiyuki Matsui, Yutaka Yano, Syoichi Nakabayashi, ...2014 Volume 67 Issue 2 Pages 74-79
Published: 2014
Released on J-STAGE: January 31, 2014
JOURNAL FREE ACCESSThe incidence and clinical background characteristics of Clostridium difficile (CD) infection were investigated. The subjects were 103 patients who tested positive for fecal toxin among those who developed fever and diarrhea while on antibiotic therapy during a 2-year, 3-month period. The incidence of CD toxin detection was 72.5 cases per 100,000 patient-days. Their mean age was 83.4 years, there were 13 deaths (12.6%), and recurrence was observed in 16 patients (15.5%). The incidence among patients undergoing continuous infusion of ≥2 antibiotics over a long period was 48.6 cases per 100,000 patient-days, whereas the incidence among patients undergoing other methods of administration was 23.9 cases per 100,000 patient-days; there was a higher incidence with long-term use of multiple antibiotics. In terms of clinical background characteristics, the largest group of patients consisted of 84 (81.6%) patients who were on prolonged bed rest. Of the 103 patients, endoscopic comparisons were performed in 30 cases, and signs were evident in 21 cases (70.0%). Based on these findings, our hospital has a comparatively high incidence of CD, possibly due to prolonged bed rest and long-term use of multiple antibiotics. Endoscopy is useful for definitive diagnosis.View full abstractDownload PDF (795K)
Clinical Study
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Makoto Ohara2014 Volume 67 Issue 2 Pages 80-85
Published: 2014
Released on J-STAGE: January 31, 2014
JOURNAL FREE ACCESSWe retrospectively evaluated the outcomes in 4,126 patients who underwent ALTA therapy for internal hemorrhoids in our clinic between December 2005 and August 2012 (ALTA therapy alone: 2,814, ALTA therapy with excision for accompanying external hemorrhoids: 1,312). Our follow-up data showed that the overall recurrence rate was 4.0% and the recurrence rate rose by about 1.1% a year with constant probability. It is suggested that the rate for ten years after ALTA therapy would be around 11%. Although the recurrence rate in 2,814 patients with ALTA therapy alone was 5.3%, the rate in 453 patients who underwent ALTA therapy with excision up to the dentate line for accompanying external hemorrhoids was only 0.66%. These data suggest that ALTA therapy with appropriate excision can significantly control recurrence.View full abstractDownload PDF (1327K)
Case Reports
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Masahito Uji, Masahiko Suzuki, Yutaro Asaba, Takashi Miyake, Tomohito ...2014 Volume 67 Issue 2 Pages 86-90
Published: 2014
Released on J-STAGE: January 31, 2014
JOURNAL FREE ACCESSAn 82-year-old woman underwent medical examination after complaining of lower abdominal pain. Computed tomography revealed a foreign body perforating the sigmoid colon and abdominal free air. She was admitted to our hospital and the foreign body, which was subsequently shown to be a fish bone, was removed endoscopically. She was treated by conservative medication without complications. In the literature, perforation of the colon by foreign bodies has been treated surgically in many cases. However, there are also cases that can be treated endoscopically and conservatively.View full abstractDownload PDF (1357K) -
Kenji Takeshita, Shintaro Nakajima, Ysohiko Uno, Masahisa Ohkuma, Tada ...2014 Volume 67 Issue 2 Pages 91-96
Published: 2014
Released on J-STAGE: January 31, 2014
JOURNAL FREE ACCESSAn 82-year-old woman was transferred to our hospital with sudden severe abdominal pain, frequent vomiting and hematemesis in January 2012. She had undergone sigmoid colostomy for a recto-vaginal fistula caused by radiation therapy for uterine cervical cancer approximately 20 years earlier. A parastomal hernia was detected in 2010, but was followed conservatively. A plain abdominal X-ray revealed remarked distension of the stomach with a large amount of liquid content. Abdominal CT showed subcutaneous protrusion of the gastric body from the caudal side of the stoma. A diagnosis of parastomal hernia incarcerated by the stomach was made, for which a nasal gastric tube was inserted, hemorrhagic gastric content of approximately 2,000 ml was drained, and incarceration was reduced. Emergency gastrointestinal fiberscopy revealed lacerations at the gastroesophageal junction, for which Mallory-Weiss syndrome was diagnosed. She was followed conservatively because she refused surgical treatment. To our knowledge parastomal hernia incarcerated by the stomach is very rare, and only three cases have been reported in the literature. We herein report this case that led to Mallory-Weiss syndrome and review the literature.View full abstractDownload PDF (1092K) -
Koji Munakata, Ichiro Takemasa, Mamoru Uemura, Naotsugu Haraguchi, Jun ...2014 Volume 67 Issue 2 Pages 97-102
Published: 2014
Released on J-STAGE: January 31, 2014
JOURNAL FREE ACCESSAcute compartment syndrome (ACS) associated with surgery is a rare complication, and an early diagnosis and prompt treatment are considered to be very important. We report a case with ACS of the lower limbs after laparoscopic surgery. A 40-year-old male underwent laparoscopic intersphincteric resection (ISR) and bilateral lateral pelvic lymph node dissection after neoadjuvant chemotherapy for advanced lower rectal cancer. The operation was successfully completed in the lithotomy or trendelenburg position, with operative time of 331 minutes and estimated blood loss of 80 ml. Severe pain in the left-lower leg was observed 19 hours after surgery. Computed tomography and compartment pressures of leg examinations revealed ACS, and an emergency fasciotomy was performed 7 hours after onset. The patient recovered without any other intensive treatment and the fasciotomy wound was healed by primary suture. He was discharged on the 13th post-operative day. No recurrence or other sequela of ACS was observed for 14 months after the treatment.View full abstractDownload PDF (1502K)
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