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Volume 69, Issue 8
Displaying 1-7 of 7 articles from this issue
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Clinical Studies
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Masaya Yokoyama, Kazuma Yamazaki2016 Volume 69 Issue 8 Pages 411-417
Published: 2016
Released on J-STAGE: July 25, 2016
JOURNAL FREE ACCESSWe report on 36 cases where colonic stents were placed and retrospectively analyze the efficacy. Colonic stents were placed in 27 patients to perform single-stage elective surgery (Bridge to Surgery [BTS] Group), and in 9 patients to alleviate malignant colorectal obstructions (palliative treatment group). Of the 36 patients, 35 had a stent placed successfully.
In the BTS group, there were no major complications associated with the placement of the stent. Patients who had elective surgery could have fluids on post-operative day 1 (median), solid food on post-operative day 3 (median), and could leave the hospital on post-operative day 13 (median).
For the palliative treatment group, eight out of nine could receive a stent. One patient had complications from restenosis but was able to have food.
We found that endoscopic placement of SEMS to relieve colonic obstruction can correct dehydration, electrolyte imbalance, and friable colonic mucosa due to large bowel distention. By avoiding emergency surgery, it is suggested that patients can start having food early on in the post-operative period, and can recover quickly after operation.
Successful placement of SEMS not only achieved colonic decompression but also improved quality of life.View full abstractDownload PDF (2351K) -
Ryuichi Mibu, Hiromitu Matsuda, Yohei Tominaga2016 Volume 69 Issue 8 Pages 418-423
Published: 2016
Released on J-STAGE: July 25, 2016
JOURNAL FREE ACCESSWe evaluated the clinical outcome of surgical repair in 15 patients with obstetric injury. The patients had injuries at a mean age of 24.9 years old, and underwent surgery at mean 47.3 years old. Two patients suffered from fecal incontinence (FI) alone, 4 from rectovaginal fistula (RF) alone, 5 from FI and RF, and 4 from cloaca-like deformity. The surgical procedures consisted of perineoplasty with “-” or “X”-shaped incision, anterior levatoplasty and plication of injured external anal sphincter. Nine of 11 FI patients did not complain of symptoms after surgery. Two patients had surgical site infection, and 2 other patients had wound dehiscence. Manometric data revealed that maximum anal resting pressure increased (preoperative: 25.9±10.0 mmHg, postoperative” 34.9±15.7 mmHg: p=0.021), but squeeze pressure and rectal sensation did not change. In defecography, RF and rectocele disappeared after surgery. Our surgical procedure may be appropriate for severe obstetric injury.View full abstractDownload PDF (2415K) -
Naoto Saigusa, Jun-ichi Saigusa, Tadashi Yokoyama, Takaaki Oosawa, Sei ...2016 Volume 69 Issue 8 Pages 424-429
Published: 2016
Released on J-STAGE: July 25, 2016
JOURNAL FREE ACCESSTwenty-one Crohn's disease (CD) patients who initially presented with anorectal fistula and received biological agents within 1 year after diagnosis were retrospectively investigated. The mean interval between fistula onset and CD diagnosis was 1.3 years and the mean interval between CD diagnosis and introduction of biologics was 0.4 years. The mean follow-up duration was 2.5 years. Anorectal fistula was diagnosed based on examination under anesthesia, and bowel lesions were evaluated by direct inspection using ileocolonoscopy or video capsule enteroscopy performed within 1 month before/after the time of evaluation of anorectal fistula. The biologics used were infliximab for 14 patients and adalimumab for 7. Remission of anorectal fistula was achieved in 20 (95.2%) patients, and 11 of them continued seton drainage. Nine (42.9%) patients achieved bowel mucosal healing (ulcer-free status). Typical bowel lesions (longitudinal ulcers or cobblestone appearance) were identified in only 8 (38.1%) patients, whereas the remaining 13 (61.9%) showed early bowel lesions such as aphthae, erosions, and tiny ulcers. The higher rate of patients with early bowel lesions may support the higher success rate of biologics. “Top down therapy” combined with surgical management represents a promising avenue for patients with Crohn's disease who initially present with anorectal fistula.View full abstractDownload PDF (651K)
Case Reports
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Yasufumi Yamada, Hajime Yokomizo, Mao Nakayama, Yuuki Yano, Sachiyo Ok ...2016 Volume 69 Issue 8 Pages 430-435
Published: 2016
Released on J-STAGE: July 25, 2016
JOURNAL FREE ACCESSThe case subject was a 71-year-old man. Comorbidities were atrial fibrillation and high blood pressure. Low anterior resection was performed for rectal cancer, and though postoperative anastomotic leakage was confirmed, it resolved with conservative treatment and the patient was discharged. However, on postoperative day 45, the patient was hospitalized again for nausea, abdominal pain, and diarrhea. Although symptoms improved temporarily with conservative treatment, the patient experienced fever and bloody stool on postoperative day 64. The examination led to a diagnosis of colon necrosis, and an emergency operation was performed. As much necrotic intestinal tract was removed as possible, and a colostomy was constructed. The patient progressed well postoperatively and was discharged on postoperative day 38.
On postoperative day 49, the patient experienced bloody stool from the colostomy along with abdominal pain and vomiting. Based on test results, the patient was diagnosed with recurrence of colon necrosis and underwent a second emergency operation. The necrotic intestinal tract was removed up to the ascending colon, and a colostomy was rebuilt with the ascending colon in the right lower abdomen. Repeated late onset colon necrosis following a rectal cancer operation is extremely rare.View full abstractDownload PDF (1564K) -
Fumitaka Asahara, Jun Miyauchi, Kazuhiko Hashimoto2016 Volume 69 Issue 8 Pages 436-440
Published: 2016
Released on J-STAGE: July 25, 2016
JOURNAL FREE ACCESSThe patient was a 72-year-old woman in whom fecal occult blood was found. Colonoscopic examination as a second screening showed a transverse colonic tumor, and poorly differentiated adenocarcinoma was diagnosed from a biopsy specimen preoperatively. We performed laparoscopic resection of the transverse colon. Histopathologically, neuroendocrine carcinoma (NEC) and poorly differentiated tubular adenocarcinoma components were found in the tumor; they extended from the mucosal layer to the proper muscular layer. Each carcinoma accounted for more than 30% of the tumor; a diagnosis of mixed adenoneuroendocrine carcinoma (MANEC) was made. Though MANEC is very rare and its prognosis is quite poor, this case shows no recurrence and metastasis one year after the radical resection.View full abstractDownload PDF (971K) -
Daiji Ikuta, Hiromichi Sonoda, Hiroyuki Ohta, Tomoyuki Ueki, Toru Miya ...2016 Volume 69 Issue 8 Pages 441-447
Published: 2016
Released on J-STAGE: July 25, 2016
JOURNAL FREE ACCESSWe present two cases of anal canal cancer with Pagetoid spread that were preoperatively diagnosed and a suitable resection area was detected by preoperative mapping biopsy. Case one was a 72-year-old male who presented with anal pain since two years ago. He applied steroid ointments to treat anal pruritus, but with no improvement noted. Case two was a 72-year-old male with bloody stools since three years ago. For both cases we observed erosion at the perianal skin. We performed biopsy and diagnosed both cases as anal canal cancer with Pagetoid spread by immunohistochemistry. We then performed a laparoscopic abdominoperineal resection. After doing a mapping biopsy of 1 cm and 2 cm separate concentric areas around the anal erosion, we performed preoperative rapid pathological biopsies to diagnose negative margins for cancer cells, and then determined the resection area of the anal skin. The surgical margin was negative for cancer cells. We report these two cases of anal canal cancer with Pagetoid spread and review the literature.View full abstractDownload PDF (1241K)
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[in Japanese]2016 Volume 69 Issue 8 Pages Mics08_1
Published: 2016
Released on J-STAGE: July 25, 2016
JOURNAL FREE ACCESSDownload PDF (542K)
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