Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons)

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We have encountered five cases of gastritis cystica polyposa (GCP) in the resected specimens for the gastric carcinoma during the past 18 years. All of them were found in the remnant stomachs after distal partial gastrectomy being coexistent with stump carcinomas. The cell kinetics and p53 gene aberrations in the GCP tissues were investigated to assess their precancerous nature, because these tissues have been speculated to have a close relationship with cancerous lesions. At the same time, the normal epithelial and the cancer cells in the same resected stomach were both examined similarly for comparison.
The cell kinetics of these tissues was examined by immunohistochemical staining of Ki-67 to reveal accelerated cell kinetics in both of the cancer and the GCP tissues but not in the normal mucosae. The accumulation of p53 protein in the nuclei was examined also by immunohistochemical staining and was highly noted in the cancer tissues and was moderately noted in the GCP tissues but none in the normal mucosae. The mutations of p53 gene were examined by PCR-SSCP methods and were detected in 25% of the cancer and 50% of the GCP tissues, but none in the normal mucosae. From these results, we think that p53 gene mutations occurred in the GCP tissues may lead the cell cycles to uncontrolled acceleration, which is quite similar to those we see in the cancer tissues.

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We report an exceedingly rare case of peritoneal encapsulation presenting with small bowel obstruction. A 34-year-old man was presented with colicky pain, abdominal fullness, and vomiting. An examination revealed the existence of a right inguinal hernia but no incarceration. He was diagnosed of ileus, and a nasogastric suction was performed for decompression. After 2 days from admission, abdominal pain increased. An examination revealed Blumberg sign and abdominal defense. An emergency laparotomy was decided on with suspicion of strangulated ileus. The ileal loops were encapsulated and strangulated inside a peritoneum like sac, which occurred on the left side of the mesocolon. The sac occurred between the omentum and mesocolon, and encapsulated the small bowel and caused ileus. A division of the neck of the sac and excision of the enveloping membrane was completed, and it then released from strangulation. Histopathology of the sac showed peritoneal tissue. The patient recovered uneventfully.

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We present a relative rare case of extrahepatic biliary cystadenoma communicated with biliary system. A 75-year-old man consulted with low grade fever up and abnormal liver function results were demonstrated by routine blood examination. In abdominal ultrasound and helical triple phase computed tomography scan, a cystic septated lesion, measuring 3 cm in diameter, was found. And endoscopic retrograde cholangiography showed mucinous filling defects in the common bile duct, which was not noted malignant findings by histological examination. Intraoperatively, the cystic lesion was identified toconnect with left hepatic biliary duct. Simple cystectomy was indicated to be enough, since a frozen sectionof the mass stump was negative of mucinous epithelium and malignant area. No evidence of cellular atypiaor tissue invasion to suggest malignancy was found by pathological examination. With immunohistochemicalstudy, positive cells were noted for Ki-67 in the epithelium of cystic wall, while they were negative for p53 and CA19-9.

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Small bowel obstruction caused by food impaction is uncommon and difficult to diagnose accurately, because there are no characteristic symptoms. We report here the case of small bowel obstruction caused by the seed of a Japanese apricot, and leading to acute renal failure. Surgery is the preferred treatment for most cases. We first attempted to treat the food impaction by milking the mass into the cecum. Enterotomy or small bowel resection should be performed when milking is unsuccessful. Investigating the dietary habits of the patient played an important role in diagnosing small bowel obstruction caused by food impaction.

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