Nihon Daicho Komonbyo Gakkai Zasshi
Online ISSN : 1882-9619
Print ISSN : 0047-1801
ISSN-L : 0047-1801
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Volume 71, Issue 2
Displaying 1-10 of 10 articles from this issue
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Original Articles
  • Clostridium Difficile Infection: A Possible Cause of Anastomotic Leakage after Colorectal Surgery
    Tetsu Yamamoto, Ryoji Hyakudomi, Yoshitsugu Tajima
    2018 Volume 71 Issue 2 Pages 63-69
    Published: 2018
    Released on J-STAGE: January 29, 2018
    DOIhttps://doi.org/10.3862/jcoloproctology.71.63
    JOURNAL FREE ACCESS
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    To evaluate the relationship between Clostridium difficile (CD) infection (CDI) and postoperative complications after colorectal surgery, 185 patients who underwent surgery for colorectal cancer in our hospital between 2014 and 2016 were reviewed. The mean age was 70.7 years. As possible risk factors for postoperative CDI, advanced age (≥ 65) and a history of antibiotics treatment, chemotherapy, abdominal surgery, and hospitalization prior to surgery was recognized in 131, 3, 10, 18, and 52 patients, respectively. Forty-seven patients (25.4%) had multiple risk factors for CDI. CD toxin and CD antigen were positive in 17 and 29 patients, respectively, and CD carriers were more frequently found in patients with multiple risk factors for CDI (p = 0.031). Severe diarrhea and CD-associated diarrhea (CDAD) were recognized in 26 and 8 patients, respectively. Anastomotic leakage occurred in 7 patients (3.8%), and its incidence was 15.4% in patients with severe diarrhea and 25.0% in patients with CDAD (p = 0.001). Postoperative CDAD and severe diarrhea were identified as risk factors for anastomotic leakage. Because CD carriers had multiple risk factors for CDI, preoperative assessment and preparation focusing on such patients with multiple risk factors may help to reduce postoperative complications, including anastomotic leakage.
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  • Transanal Irrigation for Refractory Disordered Defecation: A Prospective Multicenter Clinical Study in Japan
    Toshiki Mimura, Akira Tsunoda, Atsushi Sengoku, Hidetoshi Katsuno, Yos ...
    2018 Volume 71 Issue 2 Pages 70-85
    Published: 2018
    Released on J-STAGE: January 29, 2018
    DOIhttps://doi.org/10.3862/jcoloproctology.71.70
    JOURNAL FREE ACCESS
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    Purpose: To evaluate the efficacy and safety of transanal irrigation (TAI) for the management of refractory disordered defecation.
    Method: This was a prospective multicenter clinical study. Patients with fecal incontinence and/or constipation who had not responded to standard conservative therapies were treated with TAI for 10 weeks. Its efficacy was evaluated with Visual Analogue Scale (VAS, 0: unsatisfied - 10: satisfied) regarding their satisfaction about current bowel management as well as with the proportion of patients who wished to continue TAI after the study (success rate).
    Results: TAI was performed in 32 patients (median age: 55.5 yo; male: 19). Out of the 25 patients (78%) who completed the 10-week TAI therapy, 23 patients (success rate: 72%) wished to continue TAI after the study. The VAS of the satisfaction in the 23 success patients significantly improved from a median of 2.2 before TAI to 7.5 at the 10th week after its commencement (P<0.0001). Colonic perforation occurred in 3 patients (9.4%).
    Conclusion: TAI is effective in a majority of patients with refractory disordered defecation, although colonic perforation could occur. Sufficient education and supervision should be provided so that patients can properly and safely perform TAI.
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Case Reports
  • Eight Cases of Transanal Rectal Foreign Body Extraction Based on an Analysis of 96 Japanese Literature Reports
    Tomoya Takami, Tomoyuki Yamaguchi, Kotaro Hatano, Masafumi Tomita
    2018 Volume 71 Issue 2 Pages 86-90
    Published: 2018
    Released on J-STAGE: January 29, 2018
    DOIhttps://doi.org/10.3862/jcoloproctology.71.86
    JOURNAL FREE ACCESS
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    Transanal rectal foreign body insertion is mainly the result of sexual preference. We report 8 cases who were treated between 2008 and 2017. They were all men, ranging in age from 12 to 64 years. The foreign objects included penlight (1 case), sexual toys (2 cases), plastic cylinder (3 cases), spray can (1 case), and swab (1 case). Although 5 foreign bodies were removed transanally, 2 were removed transanally by endoscope and 1 by observation. Extraction involved spinal anesthesia in 2 cases, general anesthesia in 1 case and no anesthesia in 4 cases. There were two cases of mucosal laceration after the procedure. We reviewed the histories of these 8 patients who were treated at our institute and the case reports of 96 patients who were treated between 1987 and 2016.
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  • Acute Infectious Purpura Fulminans Caused by Citrobacter Freundii Sepsis in a Patient with Crohn's Disease
    Shoji Kasai, Hidenori Karasaki, Atsuo Maemoto, Shigeru Furukawa, Takah ...
    2018 Volume 71 Issue 2 Pages 91-96
    Published: 2018
    Released on J-STAGE: January 29, 2018
    DOIhttps://doi.org/10.3862/jcoloproctology.71.91
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    Acute infectious purpura fulminans (AIPF) is a life-threatening disease, characterized by a rapid progression of symmetric peripheral gangrene associated with severe infection and often requires urgent amputation or reconstructive surgery even for survivors. To the best of our knowledge, this is the first reported case of AIPF in a Crohn's disease (CD) patient. A 40-year-old female suffering from CD for more than 20 years was hospitalized due to obstruction of the ileum. Anti-tumor necrosis factor therapy was withdrawn 15 days before the surgical intervention. During the peri-operation period, paralytic ileus followed by severe sepsis occurred and she then presented the symptoms of AIPF in the hands and legs, which was caused by Citrobacter freundii infection. Given the immunocompromised and hypercoagulability condition of CD patients, daily medicine can result in such fatal complications and thus careful attention to the patient's immune factors is critical. A multidisciplinary team approach is also crucial to rescue the patient from AIFP.
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  • A Case of Colonic Metastasis from Breast Cancer Operated Twice with Laparoscopic Assisted Colectomy
    Takeshi Hori, Masashige Tendou, Go Masuda, Kazuhiro Teramura, Tetsuro ...
    2018 Volume 71 Issue 2 Pages 97-103
    Published: 2018
    Released on J-STAGE: January 29, 2018
    DOIhttps://doi.org/10.3862/jcoloproctology.71.97
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    Colorectal metastasis from breast cancer is rare. We report a case of colonic metastasis from breast cancer operated twice with laparoscopic assisted colectomy. A case was a 66-year-old woman with a complaint of abdominal pain. Nine years before, she had undergone partial mastectomy for invasive ductal carcinoma. Endoscopic examination revealed a stenosis in the transverse colon. A laparoscopic-assisted left hemicolectomy was performed with a suspicion of primary colon cancer. Histopathologic pictures of the resected material offered a diagnosis of colonic metastasis of breast cancer.
    Endoscopic examination 16 months after the operation revealed a stenosis again in the rectum. A laparoscopic assisted colectomy and ileostomy were performed with a suspicion of metastatic colon cancer.
    The possibility of intestinal metastasis needs to be considered in patients with a history of breast cancer.
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  • A Case of Sigmoid Colon Perforation by Ingested Fish Bone Treated Conservatively with an Endoscopic Procedure
    Taichi Mafune, Yukihito Kokuba, Yuta Ogura, Ryuichi Kishi, Ryuichi Osh ...
    2018 Volume 71 Issue 2 Pages 104-109
    Published: 2018
    Released on J-STAGE: January 29, 2018
    DOIhttps://doi.org/10.3862/jcoloproctology.71.104
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    Gastrointestinal perforation by fish bone is most frequently seen in Japan, and surgical intervention is often required in cases of lower gastrointestinal perforation. Here we report a case of sigmoidal colon perforation by a fish bone in which the fish bone was endoscopically removed. The case was an 85-year-old female. She had myasthenia gravis and was receiving long-term steroid therapy. CT examination revealed colon perforation by a foreign body with high density signal and free air. We diagnosed sigmoidal colon perforation by a fish bone. Because the signs of peritoneal irritation were localized and the patient was considered at relatively high risk for surgical intervention, conservative medical treatment was selected. Although the physical condition and inflammation improved, CT showed that the fish bone remained at the same site. The fish bone was removed endoscopically on hospitalization day 32, and her clinical course was favorable and she was discharged on day 39. Endoscopic fish bone removal and medical treatment can be selected when the impact of the perforation is localized. In the present case, the perforated intestinal tract was adhered to surrounding tissue resulting in successful endoscopic removal of the fish bone, therefore the factor of time should be considered when this treatment option is selected.
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  • A Case of Rectal Cancer that Developed Late Anastomotic Dehiscence During Bevacizumab Therapy
    Shigeo Kawai, Hideaki Ito
    2018 Volume 71 Issue 2 Pages 110-114
    Published: 2018
    Released on J-STAGE: January 29, 2018
    DOIhttps://doi.org/10.3862/jcoloproctology.71.110
    JOURNAL FREE ACCESS
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    A 72-year-old man complained of frequent mucus or viscous bloody stool from the anus, during a regular visit in March 2017. He had been diagnosed with lower rectal cancer in May 2014, and in July 2014 had received neoadjuvant chemoradiotherapy (Tegafur, Gimeracil, Oteracil Potassium and 4500cGy) and undergone a low anterior resection with primary hand-sewn anastomosis through the anus and diverting transverse colostomy. After postoperative adjuvant chemotherapy, the stoma was reversed in March 2015, and he clinically did well for 8 months. The rectal cancer recurred in the liver in January 2016 and chemotherapy treatment including bevacizumab was started in February 2016.
    At the visit, the colon anastomosed to the mouth side of the anal canal could not be palpated by digital examination from the anus. Computed omography and proctoscopy revealed that dehiscence of anastomosis had occurred, 2 years and 8 months after the surgery. An abdominal surgery with the creation of stoma was performed. Late anastomotic dehiscence may occur during bevacizumab therapy. Clinicians who use anti-angiogenic agents such as bevacizumab should be aware of this rare complication.
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  • Laparoscopy-Assisted Colectomy for a Patient with Situs Inversus Totalis and Sigmoid Colon Cancer
    Fumitaka Asahara
    2018 Volume 71 Issue 2 Pages 115-120
    Published: 2018
    Released on J-STAGE: January 29, 2018
    DOIhttps://doi.org/10.3862/jcoloproctology.71.115
    JOURNAL FREE ACCESS
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    An 82-year-old man had been diagnosed in infancy with situs inversus totalis. In a medical check-up, he was diagnosed with sigmoid colon cancer by colonography. Chest radiography and computed tomography (CT) revealed situs inversus totalis. We performed a laparoscopic-assisted resection of the sigmoid colon with no serious complication. Preoperative three-dimensional CT findings provided useful information such as tumor location and its relationship with the feeding arteries, and image training by left-right inversion of the surgical video enabled us to perform laparoscopic surgery safely in this patient with situs inversus totalis.
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