Nihon Daicho Komonbyo Gakkai Zasshi
Online ISSN : 1882-9619
Print ISSN : 0047-1801
ISSN-L : 0047-1801
Volume 69, Issue 2
Displaying 1-14 of 14 articles from this issue
Original Article
  • Kunio Toge, Keigo Matsuo, Takehiro Arai, Daisuke Kitayama, Sigeru Okad ...
    2016 Volume 69 Issue 2 Pages 59-65
    Published: 2016
    Released on J-STAGE: January 22, 2016
    JOURNAL FREE ACCESS
    To clarify the progressive time course of the prolapse of hemorrhoids and risk factors affecting their development and progress, we conducted a questionnaire survey of 200 patients who underwent surgery. The severity of prolapse of II was subdivided into IIa (stage in which a patient felt prolapse for the first time) and IIb (stage in which a patient felt prolapse at almost every bowel movement) according to the Goligher classification, and the intervals of disease stages were measured using the Visual Analog Scale (VAS) with an interval of 1 year = 1 cm. The median intervals of II to III, III to IV, IIa to IIb, and IIb to III were 5, 1, 3, and 0.2 years, respectively, and over 70% of patients showed intervals of less than 10 years over the entire period. We examined the intervals of the disease stages of prolapse by patient factor (sex, stool hardness, functional constipation, constipation score, amount of dietary fiber intake, occupation, gross appearance of hemorrhoids) and found that the factor accelerating the progression was a constipation score of 7 or higher and that the intervals of disease stages of II to III and IIa to IIb were significantly shorter (P=0.04). It was suggested that high constipation scores might accelerate the progression of hemorrhoids.
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Clinical Studies
  • Wataru Fujii, Akira Tsunoda, Tomoko Takahashi
    2016 Volume 69 Issue 2 Pages 66-74
    Published: 2016
    Released on J-STAGE: January 22, 2016
    JOURNAL FREE ACCESS
    Introduction: The aim of this study was to assess the efficacy of the transanal anterior Delorme (TAD) procedure for patients with rectoceles.
    Methods: Patients with symptoms of obstructed defecation were examined by defecography and those having rectoceles underwent the TAD procedure. The patients were evaluated by clinical symptoms, manometric and volumetric tests. Constipation and fecal incontinence was evaluated with the Constipation Scoring System (CSS) and Fecal Incontinence Severity Index (FISI). Defecography was performed before and 6 months after operation.
    Results: A total of 11 patients were female. The size of the rectocele significantly decreased and clinical symptoms were improved postoperatively. CSS and FISI improved significantly after operation, although the latter deteriorated transiently. Manometric and volumetric tests showed no significant change after operation.
    Conclusion: The TAD procedure may be an effective perineal approach for rectoceles.
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  • Yasuaki Miura, Atsushi Shirahata, Tadashi Matsumoto, Yasuo Ishida
    2016 Volume 69 Issue 2 Pages 75-80
    Published: 2016
    Released on J-STAGE: January 22, 2016
    JOURNAL FREE ACCESS
    Conventional treatments such as the Hartmann procedure or stoma creation have been performed to treat obstructive colorectal cancer. Due to the recent introduction of the trans-anal drainage tube and colonic stent placement, emergency surgery can now be avoided. We have experienced eight cases of colonic stent treatment for palliative care of non-curative colorectal cancer. Colonic stent placements were successful in all cases, but there were three complications after treatments: two cases of obstruction and one case of perforation, and one case of not effective. There were no cases of stent obstruction in the other patients receiving palliative care who eventually died. However, there are negative data for colonic stent replacement as a safe bridge to surgery (BTS). Thus, colonic stent placement as a palliative treatment may a useful option for providing a markedly improved quality of life to patients with advanced colonic cancer.
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  • Ryuzaburo Kagawa, Yoshiro Araki, Masahiro Tomoi
    2016 Volume 69 Issue 2 Pages 81-89
    Published: 2016
    Released on J-STAGE: January 22, 2016
    JOURNAL FREE ACCESS
    Thirty-nine cases of pelvirectal fistula and abscess were classified by jack-knife position MRI into two types of disease in terms of the routes for the fistulas to reach the pelvirectal fossa: levator ani penetrating type in 10 cases and intersphincteric space ascending type in 29 cases.
    The levator ani penetrating type is defined as a disease producing abscesses at the pelvirectal fossa penetrating through the levator ani after rupturing the anal sphincters and presenting with the form of ischiorectal fistula. The levator ani penetrating type includes many postoperative recurrent cases, and almost all of them clearly have a primary abscess in the deep part of the external anal sphincter, located posteriorly. The intersphincteric space ascending type is defined as a disease producing abscesses at the pelvirectal fossa, the small fistulous tract ascending from the primary orifice in the intersphincteric place, located posteriorly. In the intersphincteric space ascending type, there are many cases without a clear primary abscess in the deep part of the external anal sphincter and lesion in the ischiorectal fossa. The intersphincteric space ascending type is considered the essential form of pelvirectal fistula. These forms should be considered as two discrete diseases with completely different pathological conditions.
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  • Masaaki Uchida, Yoshio Yamamoto, Takashi Sato
    2016 Volume 69 Issue 2 Pages 90-95
    Published: 2016
    Released on J-STAGE: January 22, 2016
    JOURNAL FREE ACCESS
    Background: Little is known about the efficacy of second ALTA therapy for recurrent hemorrhoids.
    Patients and Methods: A total of 50 patients who had undergone second ALTA therapy for recurrent hemorrhoids were enrolled. The morbidity and recurrence rate of second ALTA therapy were compared with those of first ALTA.
    The group with improved hemorrhoids followed by first ALTA and those without, and the periods until recurrence following the first ALTA, were differentially analyzed.
    Results: The morbidity was similar between first and second ALTA. There was no difference of recurrence rate between first and second ALTA (p=0.87). The recurrence of the patients with improved hemorrhoids did not differ from those without. In a subgroup analysis, the early recurrence group followed by first ALTA also relapsed earlier with some carry-over effect, whereas the late recurrence group presented a similar pattern of recurrence as the first result without carry-over effect.
    Conclusions: Second ALTA therapy had limited effect on curability, although it had some effect on morbidity. Second ALTA therapy may be a strategy for recurrent hemorrhoids, however, further information about recurrence is needed.
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Case Reports
  • Ryosuke Yoshida, Naohisa Waki, Kazuki Yamashita
    2016 Volume 69 Issue 2 Pages 96-100
    Published: 2016
    Released on J-STAGE: January 22, 2016
    JOURNAL FREE ACCESS
    A 69-year-old man who had undergone right upper lobectomy for pleomorphic lung carcinoma (T1bN0M0; stage IA) 7 months earlier was admitted to our hospital complaining of repeated right lower abdominal pain for about a month. Enhanced CT scan showed a mass close to the appendix, and abscess formation caused by acute appendicitis or tumorous lesion was suspected. Emergency ileocecal resection with D2 lymphadenectomy was successfully performed without rupture of the abscess. Histopathological examination indicated appendiceal metastasis from pleomorphic lung carcinoma. Although appendiceal metastasis from lung carcinoma is rare, the possibility of this state should be considered in order to improve the prognosis in patients with a past history of poorly differentiated lung carcinoma.
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  • Kazuki Ueda, Junichiro Kawamura, Fumiaki Sugiura, Koji Daito, Tadao To ...
    2016 Volume 69 Issue 2 Pages 101-107
    Published: 2016
    Released on J-STAGE: January 22, 2016
    JOURNAL FREE ACCESS
    A 66-year-old female underwent laparoscopic high anterior resection for recto-sigmoid colon cancer. During routine follow-up with no adjuvant chemotherapy, she had a complaint of bloody stool 9 months postoperatively.
    Digital examination and colonoscopy showed a 2 cm tumor on the anastomotic site with the same pathological findings as a primary tumor (tub2). Radiologic examination showed lateral lymph nodes (LLNs) swelling. Under detailed informed consent, we planned preop-chemotherapy (mFOLFOX6) without radiotherapy for local control. After the completion of 6 cycles of mFOLFOX6, radiologic examination revealed remarkable reduction of the recurrent tumor and LLNs. She underwent salvage surgery including LLNs dissection with temporary ileostomy 16 months after the primary surgery.
    The pathology report showed no malignancy with postop-scar, which meant pCR. After the surgery, she received 6 cycles of adjuvant mFOLFOX6, and then the temporary ileostomy was closed. She remains well 3 years after the salvage surgery.
    Neoadjuvant chemotherapy without radiation followed by radical surgery is the other modality for anastomotic recurrence after rectal cancer surgery.
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  • Yusuke Kitagawa, Yujiro Murata, Noriyasu Tamura, Yoshinori Oikawa, Nao ...
    2016 Volume 69 Issue 2 Pages 108-114
    Published: 2016
    Released on J-STAGE: January 22, 2016
    JOURNAL FREE ACCESS
    A 67-year-old man was admitted with bloody stool lasting for six months. He was diagnosed as severe ulcerative pancolitis. Despite mesalazine, prednisolone treatment and leucocytapheresis, the clinical condition showed no improvement. Therefore, laparoscopy-assisted subtotal proctocolectomy was carried out. In the specimen, ulcerating lesions with neutrophil mucosal infiltration were spread over the entire colon and rectum, which extended to the terminal ileum beyond the ileocecal valve. On the second day after surgery, massive hemorrhage appeared from the ileal stoma.
    Endoscopic examination from the ileal stoma revealed mucosal erosions and ulcers with oozing within 25cm of the ileum in a continuous fashion from the edge of the stoma. We had to resect the ileum between the site of 30cm proximal from the stoma and the stoma, and create a new ileostomy stoma. In general, though the inflammatory area of ulcerative colitis is limited to the colon, the ileum occasionally is involved by superficial inflammation (backwash ileitis), which extends proximally beyond the ileocecal valve. In emergency cases, it is hard to determine the extent of the disease preoperatively. We report a case of ulcerative colitis needing ileectomy due to massive hemorrhage associated with backwash ileitis after subtotal proctocolectomy.
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  • Tomoki Fukuoka
    2016 Volume 69 Issue 2 Pages 115-120
    Published: 2016
    Released on J-STAGE: January 22, 2016
    JOURNAL FREE ACCESS
    Colic diverticulitis is a commonly encountered disease, but there have been few reports of cases with a fistula formed in a neighboring organ. Furthermore, there have been no reports in Japan of multiple fistulae occurring after constructing a stoma in the mouth side of the lesion. The present case was a 64-year-old woman. We constructed a stoma of the transverse colon for obstruction of the sigmoid colon, and tried to resect the stenosis department for the second, but were forced to abandon the procedure due to strong adhesion to the neighboring region. We confirmed a sigmoid colic-ileal fistula by enema examination approximately one year later, but followedup the case because there were no subjective symptoms. Approximately two years and six months later, she complained of a slight fever and a left inguinal ache, and we confirmed an abscess from the left iliopsoas to the hip joint in abdominal CT. A thorough investigation after percutaneous drainage showed that the abscess penetrated to the retro-peritoneum and formed abscess other than sigmoid colic-ileal fistula. We diagnosed multiple fistulae due to chronic inflammatory disease of the colon and performed a sigmoid colon resection and ileal segmental resection. Perforation due to chronic inflammation of the sigmoid colon diverticulum was diagnosed by histopathological examination.
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  • Takafumi Oshiro, Yuzo Hirata, Yuzo Okamoto, Shinkichiro Yoshioka, Hiro ...
    2016 Volume 69 Issue 2 Pages 121-126
    Published: 2016
    Released on J-STAGE: January 22, 2016
    JOURNAL FREE ACCESS
    We report a case of rectal metastasis from ovarian cancer. A 56-year-old woman had undergone total hysterectomy, bilateral salpingo-oophorectomy, extensive dissection of the pelvic and para-aortic lymph nodes, and resection of the greater omentum for an ovarian carcinoma two years and two months earlier. After postoperative chemotherapy, no recurrence or metastasis had been found until she suffered from irregular defecation and melena. An abdominal CT scan showed wall thickening and narrowing of the lower rectum and a space-occupying lesion with ring enhancement in S7 of the liver.
    Colonoscopy revealed a type-2 tumor accompanied by ulceration on the surface of the lesion. The biopsy specimen revealed adenocarcinoma. With a preoperative diagnosis of primary rectal cancer, surgical resection of the rectal tumor was performed. The final histological diagnosis was metastasis from the ovarian cancer to the lower rectum.
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