Nihon Daicho Komonbyo Gakkai Zasshi
Online ISSN : 1882-9619
Print ISSN : 0047-1801
ISSN-L : 0047-1801
Volume 75, Issue 4
Displaying 1-8 of 8 articles from this issue
Clinical Study
  • Sota Suzuki, Akira Tsunoda, Tomoko Takahashi
    2022 Volume 75 Issue 4 Pages 153-161
    Published: 2022
    Released on J-STAGE: March 30, 2022
    JOURNAL FREE ACCESS

    Purpose: Pelvic pressure is a characteristic symptom for patients with enterocele.

    The aim of this study was to assess the efficacy of laparoscopic ventral rectopexy (LVR) for patients with enterocele who had pelvic pressure.

    Methods: Fourteen patients with enterocele and pelvic pressure underwent LVR and postoperative clinical symptoms and defecatory function were evaluated until 36 months. The defecatory function was assessed using the Constipation Scoring System (CSS) and the Fecal Incontinence Severity Index (FISI). Defecography was performed before and 6 months after operation.

    Results: Pelvic pressure and feeling of prolapse improved significantly at each postoperative time until 36 months and 12 months, respectively. Significant improvements in postoperative CSS scores at 3 months, and FISI scores at 3 and 6 months were found. Postoperative defecography showed that enterocele had disappeared in all patients.

    Conclusion: Patients with enterocele who underwent LVR experienced postoperative improvement of pelvic pressure and feeling of prolapse, which are specific symptoms in these patients.

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  • Kenichi Komura, Junko Sugiyama
    2022 Volume 75 Issue 4 Pages 162-169
    Published: 2022
    Released on J-STAGE: March 30, 2022
    JOURNAL FREE ACCESS

    The treatment of halitosis patients who say “anus smells” in an ano-proctology clinic is reported. Nineteen patients presented at my clinic from 2017 to 2019. Three patients were operated on, and all of them improved compared with at the time of their first visit to my clinic. I performed low-frequency electrostimulation in the anal canal for 11 patients. The conditions of four female patients with maximum squeeze pressure below 90 mmHg improved greatly as expected. The four female patients were also instructed in pelvic floor muscle exercises. Unfortunately, 9 of 10 patients who had no anal disease did not improve compared with when they were treated technically.

    Surgery and medicine are highly effective for halitosis patients who have anal disease. Low-frequency electrostimulation in the anal canal and pelvic floor muscle training exercises are considered to be effective for female patients with maximum squeeze pressure below 90 mmHg.

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Case Reports
  • Naoki Kawahara, Yoshiyuki Suzuki, Yu Sakai, Shinji Maeshima, Takehiro ...
    2022 Volume 75 Issue 4 Pages 170-175
    Published: 2022
    Released on J-STAGE: March 30, 2022
    JOURNAL FREE ACCESS

    A 36-year-old woman visited our hospital with a complaint of anal pain. An abdominal CT scan and pelvic MRI showed a presacral cystic tumor extending to the subcutis of the hip through the top of the coccyx. The images suggested that the tumor was a tailgut cyst. Since tailgut cysts can become malignant tumors, radical resection was performed by laparoscopic surgery.

    The operation started with transabdominal mobilization of the rectum with a five-port system. After identification of a presacral cystic tumor in the back of the rectum, the abdominal incision was closed and the body position was changed to prone. Finally, the tumor was resected with the coccyx by the transsacral approach. The postoperative course was uneventful. The tumor was diagnosed as a tailgut cyst with pathological findings. We report our experience of this case of a tailgut cyst treated by laparoscopic transabdominal and transsacral surgery, radical resection of the tumor and preservation of the pelvic nerves with minimal invasion, and review the literature.

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  • Atsuko Tsubomoto, Junichi Koike, Aya Suzuki, Hiroshi Nakayama, Taisuke ...
    2022 Volume 75 Issue 4 Pages 176-181
    Published: 2022
    Released on J-STAGE: March 30, 2022
    JOURNAL FREE ACCESS

    An 80-year-old woman visited our hospital because of anal pain and anal prolapse. Colonoscopy examination revealed a white-toned mass extending from the anal canal to the anterior wall of the rectum. Since the pathology of the biopsy tissue suggested squamous cell carcinoma showing sarcomatoid proliferation, additional immunohistological staining was required. Abdominal perineal rectal amputation and D3 dissection were performed. The postoperative pathological diagnosis was sarcomatoid amelanotic malignant melanoma, pStage IIIb. A literature search on sarcomatoid amelanotic malignant melanoma revealed that it is an extremely rare disease, with few reports of anal canal primary. In this case, multiple liver metastases and lung metastases occurred 3 months after the operation, and ilium metastases occurred 15 months later. Currently, follow-up is underway according to BSC policy.

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  • Kazuo Kitagawa, Naoto Takahashi, Mutsumi Kaji, Sayumi Kurita, Satoshi ...
    2022 Volume 75 Issue 4 Pages 182-187
    Published: 2022
    Released on J-STAGE: March 30, 2022
    JOURNAL FREE ACCESS

    We report the case of a 77-year-old woman with ascending colon cancer with multiple liver and lung metastases. She underwent a right hemicolectomy. The result of postoperative pathological examination was Stage IVb with RAS wild type and BRAF mutation in pT3 pN2b cM1b (HEP, PUL). She received Bevacizumab plus FOLFOXIRI therapy; however, it was discontinued due to the development of diarrhea. Additional mutational analysis found that the tumor had high microsatellite instability; therefore, she was started on Pembrolizumab therapy, which was remarkably effective and the lung metastases disappeared. Two partial hepatectomies were performed with R0 resection. Pathological complete response was confirmed in the resected liver. Recurrence-free survival was 27 months after hepatectomy.

    From the results of BEACON CRC study, Encorafenib, Binimetib and Cetuximab combination therapy using BRAF inhibitors can be used after secondary treatment. However, they have a slightly better prognosis than colorectal tumors without MSI and do not have the same response to chemotherapeutics. The discovery of MSI in colorectal tumors highlights the diversity of colorectal cancer and its impact on the professional management of patients.

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  • Yosuke Kamada, Tatsuya Matsumoto, Noriaki Koizumi, Chouhei Sakakura
    2022 Volume 75 Issue 4 Pages 188-192
    Published: 2022
    Released on J-STAGE: March 30, 2022
    JOURNAL FREE ACCESS

    The patient was a 71-year-old woman. She had been taking a number of medications, including sodium valproate, for psychiatric disorders. She presented to our hospital with fever and abdominal distension, and had a high inflammatory response, megacolon, and a large amount of content accumulation in the rectum. She was admitted to our hospital for treatment. Lower gastrointestinal endoscopy showed a large amount of undigested medication in the rectum, thought to be ghost pills of sodium valproate, and multiple ulcers from the sigmoid colon to the rectum. It was thought that the multiple rectal ulcers were caused by a large amount of ghost pills left in the rectum for a long time because of chronic constipation and megacolon. She underwent a sigmoid colon colostomy and intraoperative bowel cleansing using an endoscope. A large amount of ghost pills equivalent to about 1 cup of kidney dish was found in the rectum. The postoperative course was good. We report this case of refractory rectal ulcer due to a large amount of ghost pills.

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  • Tsukasa Taguchi, Hiroshi Takeyama, Shingo Noura, Yozo Suzuki, Junzo Sh ...
    2022 Volume 75 Issue 4 Pages 193-197
    Published: 2022
    Released on J-STAGE: March 30, 2022
    JOURNAL FREE ACCESS

    The patient was a 74-year-old man who had undergone radical cystectomy and construction of an ileal orthotopic neobladder for bladder cancer 9 years ago. Follow- up CT revealed ascending colon cancer and he was referred to our department for colectomy. We laparoscopically performed indocyanine green (ICG) fluorography for ileal neobladder blood flow evaluation during operation. ICG fluorography findings revealed a contrast-enhanced effect of the ileal neobladder and so laparoscopic ileocecal resection with intracorporeal reconstruction was performed. The ileal neobladder was safely preserved.

    Four days after the surgery, the patient developed a urinary tract infection but improved rapidly with antibiotic therapy. The patient was discharged from the hospital 18 days after the surgery. This is the first report of laparoscopic surgery with indocyanine green fluorography and intracorporeal reconstruction for ascending colon cancer after ileal neobladder construction.

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