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Volume 70, Issue 6
Displaying 1-10 of 10 articles from this issue
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Original Article
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Yoriyuki Tsuji, Hiroo Ieda2017 Volume 70 Issue 6 Pages 391-399
Published: 2017
Released on J-STAGE: May 25, 2017
JOURNAL FREE ACCESSA retrospective study was conducted to compare the efficacy of two different surgical procedures for the treatment of chronic anal fissure with stenosis. The first procedure involved sliding skin graft (SSG) on a total of 133 cases at Ieda Hospital from October 2010 to August 2011 and at Takano Hospital from April 2012 to March 2014. The second procedure involved VY-plasty on 40 cases at Ieda Hospital from October 2009 to September 2010. The findings revealed that the average anal diameter in cases without stenosis was 29±2 mm; the distance of the skin flap when it was mobilized up to the dentate line was significantly shorter in SSG (13 mm) than in VY-plasty (22 mm); the rate of the severest stenosis, based on three categorical degrees, was not more than 5% in both cases; the rate of postoperative complications was significantly lower in SSG than in VY-plasty; the postoperative healing period was significantly shorter in SSG (37 days) than in VY-plasty (47 days) but there was no significant difference in the healing rate between both procedures, and the anal manometry for both procedures had a significantly reduced postoperative maximum resting pressure.View full abstractDownload PDF (1035K)
Case Reports
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Satoshi Narihiro, Katsuhito Suwa, Takuro Ushigome, Shigemasa Sasaki, T ...2017 Volume 70 Issue 6 Pages 400-403
Published: 2017
Released on J-STAGE: May 25, 2017
JOURNAL FREE ACCESSA 65-year-old man, who had been followed up with a diagnosis of submucosal tumor of the descending colon for ten years, presented at our institution complaining of massive hematochezia. Laboratory and endoscopic examinations revealed significant anemia (Hb 7.1 g/dl) and deep ulcer on top of the tumor. The patient underwent laparoscopic partial resection of the colon, and his postoperative course was uneventful. Pathological examination revealed the tumor to be schwannoma without malignant potential. Schwannomas arising in the gastrointestinal tract are rare, and those arising in the large intestine are even rarer. Schwannomas do not usually metastasize or undergo malignant transformation. Therefore, asymptomatic cases can usually be observed. We herein present a rare case of colonic schwannoma with hemorrhage causing severe anemia.View full abstractDownload PDF (804K) -
Yuhi Suzuki, Toshio Nakamura, Takahiro Shimamura, Kazuya Okamoto, Kenn ...2017 Volume 70 Issue 6 Pages 404-410
Published: 2017
Released on J-STAGE: May 25, 2017
JOURNAL FREE ACCESSThe patient was a male aged over 80 years. In August 2014, bloody stools were noted. In September, he consulted the Department of Gastroenterology of our hospital, was diagnosed with rectal cancer complicated by liver abscess, and was admitted for detailed examination and treatment. To treat liver abscess, an antibiotic was administered, leading to a reduction. In October, low-position anterior resection and D3 dissection were performed. After surgery, left hemiplegia was observed and a detailed examination was conducted, leading to a diagnosis of brain abscess. Conservative treatment with an antibiotic reduced the symptoms, and he was discharged. Patients with rectal cancer complicated by liver abscess and brain abscess are rare. We report this patient, and review the literature.View full abstractDownload PDF (950K) -
Kazunori Sasaki, Tomohide Takahashi, Shuji Saito2017 Volume 70 Issue 6 Pages 411-416
Published: 2017
Released on J-STAGE: May 25, 2017
JOURNAL FREE ACCESSA 48-year-old female underwent high anterior resection and partial hepatectomy of segment 6 for rectal cancer with liver metastasis, followed by adjuvant chemotherapy at the age of 45. Twenty-five months later, left ovarian tumor and a small amount of ascites were detected by follow-up CT. The ascites disappeared in response to additional chemotherapy. However, she had stable disease (SD) of the ovarian tumor and underwent hysterectomy and bilateral oophorectomy with postoperative chemotherapy. The final diagnosis was pathological metastasis from the rectal cancer. The patient is still alive at present without any evidence of recurrence 60 months after the second operation. Metachronous ovarian metastasis from colorectal cancer is generally reported to have a poor prognosis. However, we here present a case of long-term survival with a surgical and chemotherapeutic approach in this kind of situation.View full abstractDownload PDF (899K) -
Keiichi Onji, Hiroyuki Sawada, Masahiko Fujimori, Kouichi Okugawa, Hir ...2017 Volume 70 Issue 6 Pages 417-423
Published: 2017
Released on J-STAGE: May 25, 2017
JOURNAL FREE ACCESSWe report a case of T1 signet-ring cell carcinoma of the colon. A 69-year-old woman was admitted to our hospital with the complaint of constipation and was found to be immunologically-positive on a fecal occult blood test. Colonoscopic examination revealed an elevated submucosal tumor-like lesion, 10 mm in diameter, in the sigmoid colon, type 0-Is+IIc, and endoscopic mucosal resection was performed. The resected material suggested diffuse infiltration of signet-ring cell carcinoma into the deeper part of the submucosal layer with positive resection margin and venous invasion. No metastasis was detected in either the lymph nodes or distant organs upon further examination. Thus, additional surgical resection was performed. Pathological examination identified signet-ring cell carcinoma, pT1b, int, INFc, ly1, v1, pN2(21/32) and H0, P0, M0, Stage IIIb. Despite postoperative adjuvant chemotherapy, the patient developed multiple bone metastases and died 1.75 years later. Signet-ring cell carcinoma is a rare histological type of colon cancer that has a poor prognosis. This is a very rare case of T1 signet-ring cell carcinoma of the colon.View full abstractDownload PDF (1191K) -
Shinichi Yoshioka, Mutsumi Fukunaga, Masaki Tsujie, Shigeyuki Ueshima, ...2017 Volume 70 Issue 6 Pages 424-427
Published: 2017
Released on J-STAGE: May 25, 2017
JOURNAL FREE ACCESSWe report a case of rectovaginal fistula following surgery for rectal carcinoma successfully treated with a preservative method with estriol and chloramphenicol.
A woman in her 70s underwent low anterior resection for rectal carcinoma. 12 days after the operation, a flow of coating to the vagina was found. Colonoscopy revealed a rectovaginal fistula. For treatment, estriol and chloramphenicol were put into the vagina and dietary restriction using intravenous hyperalimentation was applied. 14 days after treatment, the flow of coating to the vagina stopped and the discomfort around the rectovaginal space disappeared. 26 days after treatment, the rectovaginal fistula was completely cured.
This method may be a recommended treatment for rectovaginal fistula.View full abstractDownload PDF (735K) -
Yukiko Takatsu, Yoshihiro Moriguchi, Tateki Ito2017 Volume 70 Issue 6 Pages 428-434
Published: 2017
Released on J-STAGE: May 25, 2017
JOURNAL FREE ACCESSPrimary peritoneal carcinoma is a relatively rare malignancy characterized by disseminated lesions. It is similar to papillary serous ovarian carcinoma with respect to its histological appearance, and most patients develop carcinomatous peritonitis.
A 78-year-old woman visited a local hospital for a medical examination. Ultrasound examination revealed a pelvic mass, and so she was referred to our hospital. A computed tomography scan showed a solitary cystic lesion in the pouch of Douglas and a hepatic mass. During exploratory laparotomy, a tumor was identified in the pouch of Douglas and was found to be invading the rectum and uterus. No carcinomatous peritonitis was present. Hartmann's operation was thus performed. Histopathological examination showed characteristics of a serous adenocarcinoma in the peritoneum-based mass, and 12 lymph node metastases were found in the mesorectum. The patient received postoperative adjuvant chemotherapy for a primary peritoneal carcinoma. At the time of this writing (3 years after diagnosis), she is still in complete remission and the hepatic mass has spontaneously disappeared. This case illustrates that a primary peritoneal carcinoma may present as a pelvic mass. We suggest that surgeons consider mesorectal lymph node dissection in patients with primary peritoneal carcinoma that has invaded the rectum.View full abstractDownload PDF (916K) -
Ryo Otsuka, Shuji Saito, Ryouichi Hirayama, Yasuaki Miura, Hitomi Taka ...2017 Volume 70 Issue 6 Pages 435-439
Published: 2017
Released on J-STAGE: May 25, 2017
JOURNAL FREE ACCESSColonic stenting as a bridge to surgery (BTS) for lower rectal cancer requires investigation. We present a report of safe laparoscopic low anterior resection with the anal end of the stent inside the tumor.
A 63-year-old woman presented with thin stools and abdominal pain. Rectal examination revealed a circumferential tumor with the lower margin located 6 cm from the anal verge. Computed tomography showed a mass extending from the rectosigmoid to the lower rectum, with its center located in the upper rectum, and a large amount of stool on the oral side.
A colonic stent (Niti-S; diameter, 22 mm; length, 8 cm) was inserted to avoid the need for a covering stoma. To obtain a good distal margin, the stent was placed to ensure that its anal end did not protrude from the tumor. The patient was readmitted for laparoscopic low anterior resection and bilateral lymph node dissection. After 23 days, she was discharged in remission. BTS stenting for lower rectal cancer is not recommended because the distal margin becomes excessively long during surgery. By placing the anal end of the stent inside the tumor, we obtained an adequate margin during surgery, avoided stoma creation, and performed laparoscopy safely.View full abstractDownload PDF (778K) -
Naoko Iida, Takenori Hada, Ryuzo Murai, Masahiro Ikegami2017 Volume 70 Issue 6 Pages 440-444
Published: 2017
Released on J-STAGE: May 25, 2017
JOURNAL FREE ACCESSA 51-year-old woman presented with a 3-month repeated history of anal bleeding after defecation. Although colonoscopy demonstrated numerous hemispherical protrusions with acute inflammation spreading over the lower rectum which suggested Chlamydia trachomatis proctitis, she almost recovered without treatment. Six months later, she had a relapse of anal bleeding and tenesmus. The second colonoscopic examination still showed edematous hemispherical protrusions over the lower rectum and rough-surfaced mucosa with mucopus and partial friability at the oral side of protrusions.
Biopsy specimens of the rectum showed hyperplasia of lymphoid follicles and diffuse infiltration of inflammatory cells.
Although Chlamydia trachomatis proctitis was supposed to be closest to these conditions, treatment with azithromycin hydrate was not successful. Although bacteriological analysis including Chlamydia trachomatis was negative, colonoscopic and pathological findings could not deny UC, so we comprehensively considered that the clinical course and results implied atypical ulcerative colitis with hyperplasia of lymphoid follicles. Administration of mesalazine was effective with a remarkable improvement on colonoscopic findings.View full abstractDownload PDF (1006K)
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2017 Volume 70 Issue 6 Pages Mics06_1
Published: 2017
Released on J-STAGE: May 25, 2017
JOURNAL FREE ACCESSDownload PDF (562K)
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