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Volume 69, Issue 4
Displaying 1-8 of 8 articles from this issue
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Original Article
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Sho Sawazaki, Yasushi Rino, Hirohide Inoue, Norio Yukawa, Munetaka Mas ...2016 Volume 69 Issue 4 Pages 191-196
Published: 2016
Released on J-STAGE: March 25, 2016
JOURNAL FREE ACCESSAim: The aim of this study was to identify the subgroup of patients at the greatest risk by investigating the clinicopathological features associated with postoperative complications in elderly patients with colorectal cancer.
Methods: A total of 82 patients over 75 years old with colorectal cancer who underwent tumor resection between January 2011 and July 2014 at Kamishirane Hospital were enrolled. The clinicopathological data of the patients were retrospectively evaluated.
Results: Postoperative complications over grade 2 in the Clavien-Dindo category occurred in 23 cases (28.0%) in the study group as a whole. A univariate analysis of postoperative complications over grade 2 identified four factors: male, Charlson Comorbidity Index (CCI)≥2, preoperative ileus, and emergency operation. A multivariate analysis of postoperative complications over grade 2 identified two independent factors: male (HR: 6.31, 95% CI: 1.44-27.6; p=0.014) and CCI≥2 (HR: 3.64, 95% CI 1.15-11.5; p=0.028).
Conclusions: Elderly male patients with colorectal cancer who exhibit CCI≥2 are at a high risk for postoperative complications.View full abstractDownload PDF (670K)
Clinical Study
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Daisuke Kitayama, Keigo Matsuo, Takehiro Arai, Shigeru Okada, Kunio To ...2016 Volume 69 Issue 4 Pages 197-204
Published: 2016
Released on J-STAGE: March 25, 2016
JOURNAL FREE ACCESSHigh intersphincteric abscesses sometimes have poor clinical symptoms and may be difficult to diagnose. In addition, a certain percentage of cases can be completely cured without radical surgery for anal fistula by only medical treatment, such as conservative medical treatment and drainage therapy.
As factors for deciding whether or not to perform radical surgery, the duration of illness, presence or absence of diabetes, fever, white blood cells, and type of drainage therapy were studied.
Drainage therapy involves a basic incision from the intersphincteric approach, and if a drainage seton is necessary, drainage therapy is made from outside the external sphincter. After drainage therapy, radical operation for anal fistula was performed in 15% of cases, and there was no case in which radical operation was performed after conservative medical treatment.
The number of cases in which drainage therapy was made from outside the external sphincter was significant (P<0.05), but there was no significant difference for the other factors.
After medical treatment for high intersphincteric abscesses, relatively few cases require radical operation for fistulas. It is important to determine the treatment method based on the presence or absence of a fistula after a sufficient observation period.View full abstractDownload PDF (1349K)
Case Reports
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Miho Shiota, Kotaro Maeda2016 Volume 69 Issue 4 Pages 205-209
Published: 2016
Released on J-STAGE: March 25, 2016
JOURNAL FREE ACCESSA rare case of metastasis to the vagina from rectal cancer is described. An 81-year-old woman was admitted to our hospital because of melena. She underwent a super-low anterior resection (inter sphincter resection) for rectal cancer. Pathological diagnosis revealed well-differentiated adenocarcinoma with T3, N0, M0 (final stage II). A small SMT was found at the anastomotic site by digital examination 2 years after the initial operation. It was removed trans-anally, and local recurrence from rectal cancer was confirmed pathologically. Upon further examination for vaginal bleeding, a tumor 3cm in diameter was confirmed in the left posterior wall of the vagina 26 months after the initial surgery. The tumor was removed trans-vaginally. The pathological diagnosis was metastasis of rectal cancer and cancer cells were found in the vessels around the tumor.View full abstractDownload PDF (786K) -
Tomoki Fukuoka2016 Volume 69 Issue 4 Pages 210-215
Published: 2016
Released on J-STAGE: March 25, 2016
JOURNAL FREE ACCESSAccording to a national survey by the Japan Gastroenterological Endoscopy Society, the rate of accidental complications with colonoscopy is reported to be 0.078%. In the case of perforation by colonoscopy, generally an emergency operation is performed, however, laparoscopic operation or conservative treatment may be performed as a minimally invasive treatment.
The present case was a 71-year-old woman. When she underwent colonoscopy in another facility, perforation of the sigmoid colon occurred and so she was introduced to our institution. Upon CT scan, a large quantity of retroperitoneum emphysemas around the inferior vena cava, aorta, and the right kidney, and a mediastinum emphysema near the esophagus were found.
Because the abdominal pain was slight and abnormality of the inflammatory reaction by blood test was not recognized, we chose conservative treatment. The condition and the emphysema gradually improved, and she was discharged after one month. There have been few reports on conservative treatment for iatrogenic colonic perforation, and recovery following conservative treatment with widespread air leaks is rare. It is suggested that operation can be avoided in more cases through close observation.View full abstractDownload PDF (2622K) -
Masahiro Hada, Masanori Kotake, Chikashi Hiranuma, Takuo Hara2016 Volume 69 Issue 4 Pages 216-220
Published: 2016
Released on J-STAGE: March 25, 2016
JOURNAL FREE ACCESSWe report the use of a self-expandable metallic stent (SEMS) for a colostomy stricture caused by peritoneal metastasis of rectal cancer. An 87-year-old woman underwent laparoscopic low anterior resection for rectal cancer in 2012, and Hartmann's procedure for local recurrence in 2014. The first histological findings of the tumor showed moderately differentiated adenocarcinoma (T3, N1b, ly1, v1, P0, H0, M(-), pStageIIIA (TMN)). She complained of abdominal pain, constipation, and abdominal distension in 2015. A colostomy stricture due to peritoneal metastasis of rectal cancer was diagnosed. We performed SEMS insertion therapy from the colostomy. Immediately following insertion, a lot of stool was passed via the stent. SEMS therapy was a useful palliative option and was minimally invasive.View full abstractDownload PDF (2239K) -
Yasuhiro Takeda, Tetsuya Kajimoto, Kazuhisa Yoshimoto, Hideyuki Kashiw ...2016 Volume 69 Issue 4 Pages 221-226
Published: 2016
Released on J-STAGE: March 25, 2016
JOURNAL FREE ACCESSWe describe a case of a huge lower rectal gastrointestinal stromal tumor (GIST) successfully treated with neoadjuvant imatinib mesylate (IM) followed by anus-preserving laparoscopic surgery. A 76-year-old male was referred to our hospital with a huge tumor in the pelvic cavity. On digital examination, an elastic hard tumor with a smooth surface was palpated in the posterior wall of the rectum. MRI showed the solid mass to measure 81 mm in diameter which compressed the rectum and sacrum. Endoscopic ultrasonography (EUS) revealed the lesion to originate from the fourth layer, and the internal echo was nonuniformly hypoechoic. The tumor was diagnosed as a rectal GIST by EUS-FNAB. Neoadjuvant IM (400mg/day) was administered for 4 months to decrease the risk of morbidity and prevent extensive surgery, the tumor volume reduced to 70%. We successfully performed laparoscopic super-low anterior resection without rupturing the tumor capsule. For a large lower rectal GIST, neoadjuvant IM could be anus-preserving and allow low invasive surgical treatment.View full abstractDownload PDF (823K) -
Yoshiro Araki, Ryuzaburo Kagawa, Hiroshi Yasui, Masahiro Tomoi2016 Volume 69 Issue 4 Pages 227-230
Published: 2016
Released on J-STAGE: March 25, 2016
JOURNAL FREE ACCESSA 40-year-old woman, gravida ii, para ii, was referred to our hospital due to a perianal mass in the episiotomy scar with cyclic pain coinciding with her menses, and an anal fistula was suspected. We depicted the lesion in the superficial external anal sphincter by ultrasonography and MRI taken in the jackknife position. The mass was excised completely, but sphincteroplasty was not performed. Her postoperative course was uneventful and without incontinence. The pathological examination revealed that the lesion was endometriosis having endometrial glands and stroma. The possible etiology was a mechanical transplantation of endometrial tissue into the episiotomy wound during vaginal delivery. Ultrasonography and MRI are useful for differential diagnosis and assessment for anal sphincter involvement.View full abstractDownload PDF (2618K)
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[in Japanese]2016 Volume 69 Issue 4 Pages Mics04_1
Published: 2016
Released on J-STAGE: March 25, 2016
JOURNAL FREE ACCESSDownload PDF (540K)
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