The number of female doctors in Japan is increasing year by year, and the number of female doctors newly enrolled in the Japan Society of Coloproctology is also increasing. In addition, the Basic Law for Gender Equality and The Act on Promotion of Women's Participation and Advancement in the Workplace have been enacted, and moves to improve the environment in which women can play an active role throughout society are steadily progressing. Under such circumstances, the Gender Equality Committee was established in 2018 at the Japan Society of Coloproctology, and the committee conducted a questionnaire survey of its female members. As a result, pregnancy, childbirth, and childcare were major barriers to career development.
It is important to establish a system of daycare at the Annual Meeting, eliminate the period of pregnancy, childbirth, childcare, etc., and allow reinstatement even after leaving work.
A 46-year-old woman was admitted because of abdominal pain. Some examinations indicated rectal cancer. Before surgery, she had a self-expandable metallic stent placed to relieve a colonic obstruction. Although we tried surgical resection, there was peritoneal dissemination around the primary tumor and the rectal cancer was unresectable due to mobility failure of the rectum. After combination chemotherapy, computed tomography revealed resectable rectal cancer in response to chemotherapy. Intraoperative findings indicated disappearance of peritoneal dissemination and we were able to perform laparoscopic anterior resection. This patient is now in good health.
Sodium polystyrene sulfonate (SPS) is an ion-exchange resin which is commonly used to manage hyperkalemia.
Research has demonstrated that intestinal perforation and necrosis infrequently occurs. We report a case of severe colonic stenosis after surgery for colonic necrosis regarding SPS in a 68-year-old man. The patient presented hyperkalemia due to chronic renal failure, and SPS had been administered orally. Cardiac surgery was carried out due to acute heart failure. Nine days postoperatively he presented with hematochezia with abdominal pain, which was diagnosed as ascending colon necrosis and diffuse peritonitis. We performed right hemicolectomy and double-barrelled colostomy. During restoration of the colon continuity six months later, the remnant colon and rectosigmoid colon were resected due to their stenosis. Severe stenosis and longitudinal ulceration with scarring were noted in the descending colon, and there was ulceration in the sigmoid colon. Microscopic examination revealed basophilic polygonal crystals with foreign body reaction in the colonic wall. If polystyrene sulfonate is absorbed within the colon, excretion is sometimes complicated, and it further damages the tissues as a result of chronic foreign body reaction and inflammation. Polystyrene sulfonate should be administered carefully to ascertain the range of resecting the intestine in necrosis, perforation, and enterocolitis.
A 75-year-old man complaining of hematochezia consulted a local clinic. Colonoscopy revealed a type-3 tumor of the colon. The pathologic analysis of a biopsy specimen was colorectal cancer (well-differentiated adenocarcinoma). He was referred to our hospital for further evaluation and treatment. The pre-operative enhanced CT and 3D-CT angiographic examinations showed that the inferior mesenteric artery arose from the superior mesenteric artery, and thus a diagnosis of rectal cancer (RS, cT3N0M0) was made. A laparoscopic high-anterior resection was performed, preserving the left colic artery and resecting the superior rectal artery and inferior mesenteric vein. The post-operative course was uneventful, and he was discharged on post-operative day 15. The histologic diagnosis was a moderately-differentiated adenocarcinoma of the rectum. The final diagnosis was pT2, pN0, pM0, pStage I. In this case, 3D-CT angiography was useful in diagnosing variation of the inferior mesenteric artery. We report this rare case of rectosigmoid cancer in which the inferior mesenteric artery arose from the superior mesenteric artery.
A 31-year-old man was being treated for Crohn's disease but had self-interruption. The patient complained of abdominal pain and bloody stool, and was diagnosed with a perianal abscess and a left iliopsoas abscess due to penetration of the descending colon. A conservative treatment was performed for the iliopsoas abscess, but since no improvement was observed, laparoscopic partial colectomy was performed. The patient had nausea and abdominal pain on the 12th postoperative day. The patient was diagnosed with an adhesive intestinal obstruction on abdominal CT, and a nasal ileus tube was inserted. Later, it was judged that the internal hernia due to the mesenteric defect was the cause. On the 20th day after the operation, the intestinal obstruction was released and the mesenteric defect was closed by laparoscopic surgery. The patient was discharged without complications after the operation. Internal hernia after laparoscopic colorectal surgery is a relatively rare complication, and mesenteric defects are generally not closed. However, in patients with a high risk of developing internal hernia, preventive procedures such as closing the mesenteric defect should be taken.
A 60-year-old man was admitted to our clinic with a diagnosis of rectal incarceration. A soft ball-sized incarcerated hemorrhoid was palpated with an elastic soft mass. It was considered to be an incarcerated hemorrhoid with a huge hematoma. Computed tomography (CT) showed enhanced contrast, suggesting a transanal prolapse of rectal tumor. As manual reduction was impossible, transanal resection was performed under lumbar anesthesia. Histopathological examination revealed rectal GIST (intermediate risk) with positive staining for c-kit and CD34, and MIB1<1%. Without adjuvant therapy after surgery, the patient was followed up for 1 year without recurrence.
A 76-year-old man presented to our hospital with a positive fecal occult blood test. Colonoscopy revealed a sessile polyp in the cecum, and papillary adenocarcinoma was detected by biopsy. Cancer was suspected to have invaded the deep submucosal layer. Laparoscopic ileocecal resection with D2 lymphadenectomy was performed. Histological examination revealed well-differentiated tubular adenocarcinoma with deep invasion of the submucosal layer (near the proper muscle layer) and venous infiltration, but no lymphatic infiltration and no lymph node metastasis. Pathological stage according to the Japanese Classification of Colorectal Carcinoma was Stage I. No adjuvant chemotherapy was performed. One and a half years after surgery, serum CEA was slightly increased and gradually elevated. FDG-PET/CT and MRI revealed some nodules on the liver surface. A laparotomy was performed, peritoneal dissemination was observed throughout the abdominal cavity and some nodules were observed on the liver surface. Several peritoneal disseminations and several liver nodules were resected. The pathological diagnosis was disseminated adenocarcinoma from cecal cancer. He and his family did not want postoperative treatment including chemotherapy, so best supportive care was provided. He died 1 year and 8 months after surgery for recurrence. We consider this case to be very rare and therefore valuable.
A 43-year-old man visited our hospital complaining of repeated abdominal pain. Abdominal tenderness and peritoneal irritation were not observed, and an elastic soft mass was palpated in the upper abdomen. Abdominal CT showed intussusception invading the transverse colon. Gastrografin enema gradually reduced the intussusception, and showed an elevated lesion in the ascending colon and cecum. Colonoscopy revealed a swollen lesion with mucosal necrosis and erosion on the anal side of Bauhin's valve, and a submucosal tumor was suspected. The possibility of malignancy could not be ruled out, and it was decided that surgery should be performed on an elective basis, and so laparoscopic right hemicolectomy (D3 dissection) was performed. The postoperative course was uneventful, and the patient was discharged on the 6th postoperative day. In the resected specimen, Bauhin's valve was markedly thickened, the size was 140 × 65 mm, and it was diagnosed as ascending colon lymphangioma by immunostaining with a histopathological examination. Adult intussusception accounts for 1 to 5% of total intussusception; colonic intussusception due to lymphangioma is very rare. Here we report a case of adult intussusception due to ascending colon lymphangioma.