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Yoshiki Hosono
2011 Volume 36 Issue 5 Pages
775-780
Published: 2011
Released on J-STAGE: October 25, 2012
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Breast angiosarcoma is rare and difficult to diagnose. We report a case in which magnetic resonance imaging (MRI) was useful in diagnosis. A 47–year–old woman seen for right breast pain had no palpable tumor or peritumoral skin change. (MMG: Right C region FAD. U: Indistinct tumor margin and mixed hypoechoic and hyperechoic content.) MRI: Irregularly shaped tumor, high signal mass indicating a heterogeneous interior.) The tumor showed a different time intensity curves depending on the area of region–of–interest (ROI). When the b level increased, diffusion–weighted–imaging (DWI) showed a significant decrement. Pathology: High–grade angiosarcoma. Surgery: Simple right mastectomy and sentinel lymph node biopsy. Clinical course: The woman underwent chemotherapy for pulmonary and hepatic metastasis 1.5 years after surgery, dying two years and five months after surgery.
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Harumi Takahashi, Satoru Yamamoto, Kazuhiro Ishihara, Yasuharu Tokuyam ...
2011 Volume 36 Issue 5 Pages
781-786
Published: 2011
Released on J-STAGE: October 25, 2012
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A 63–year–old woman who had had surgery for right lung cancer and subsequent lymph node and brain metastasis was found in September 2009 to have a right breast mass with skin redness and swelling, leading to a diagnosis of breast cancer. When chemotherapy proved ineffective, she was referred to us in September 2010. Right inflammatory breast cancer was suspected and metastatic lung and brain tumors, and right pleural effusion noted. Histologically, both the right breast neoplasm and primary lung cancer were adenocarcinoma. We analyzed gene mutation for epidermal growth factor receptor (EGFR), finding the same mutation in the tyrosine kinase domain in exon 21 in both samples, confirming breast metastasis from lung cancer. EFGR mutation analysis was extremely useful in differentially diagnosing metastastis from primary breast cancer.
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Tohru Miyake, Tomoharu Shimizu, Hiromichi Sonoda, Eiji Mekata, Satoshi ...
2011 Volume 36 Issue 5 Pages
787-791
Published: 2011
Released on J-STAGE: October 25, 2012
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A 60–year–old man with a history of upper left lobe resection for squamous cell lung carcinoma one year earlier was seen for appetite loss and hospitalized due to intestinal obstruction. Small bowel obstruction was resolved after long–tube decompression. An intestinal tube contrast study showed severe terminal ileum stricture. Computed tomography (CT) showed intestinal obstruction with paraaortic lymph node swelling and multiple hepatic tumors. Colonoscopic examination showed mucosal cecal reddening, and a cecal biopsy specimen showed poorly differentiated adenocarcinoma. Based on a diagnosis of intestinal epithelial tumor, we conducted right hemicolectomy for the ileal tumor. Pathological of surgical specimen findings showed squamous cell carcinoma compatible with lung cancer origin. The man was discharged on postoperative day 42. In conclusion, subjects with a small intestinal tumor with high SCC showed be examinal for possible intestinal lung cancer metastasis.
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Hiroaki Tanaka, Naoyoshi Onoda, Keiichiro Hirata, Bunzo Nakata, Kazuya ...
2011 Volume 36 Issue 5 Pages
792-795
Published: 2011
Released on J-STAGE: October 25, 2012
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A 74–year–old man with gastric cancer and undergoing distal gastrectomy, then adjuvant TS–1 and PSK chemotherapy, was seen for general fatigue and appetite loss in adjuvant chemotherapy session 10. Hospitalized for heavy fatigue, palpitations, cough, breathlessness, and cardiac enlargement, he was suspected of acute heart failure. When conservative therapy proved ineffective, we conducted cardiac ultrasonography for pericardial effusion. Results showed high LDH and increased lymphocytes. Adenosine deaminase (ADA) of 80 IU/ml yielded a diagnosis of tuberculous pericarditis. No cancer cells or tuberculous pathogenesis was found. Antiantituberculous chemotherapy improved his general condition, but he died of peritoneal metastasis 1 year later. This case points put the importance of checking for tuberculus pericarditis and possible tuberculous exacerbation associated with adjuvant gastric cancer chemotherapy. Most such pericardial effusion is due to malignant recurrence.
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Isaya Hashimoto, Atsushi Nashimoto, Hiroshi Yabusaki, Satoru Nakagawa, ...
2011 Volume 36 Issue 5 Pages
796-801
Published: 2011
Released on J-STAGE: October 25, 2012
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A 60–year–old man diagnosed with advanced gastric cancer type 1 and numerous lymph node metastases such as regional, abdominal paraaortic, and Virchow's lymph nodes underwent preoperative chemotherapy with docetaxel, cisplatin, and S–1 (DCS therapy). Distal gastrectomy with D2+ lymphadenectomy was then done after two DCS courses. Pathologically, no viable cancer cells remained in the primary lesion or dissected lymph nodes. The pathological response of preoperative DCS therapy was judged to be grade 3. The postoperative course was uneventful, and the man is now healthy and being seen as an outpatient treated with S–1 for postoperative adjuvant chemotherapy.
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Toru Ishiguro, Keiichiro Ishibashi, Kensuke Kumamoto, Norihiro Haga, H ...
2011 Volume 36 Issue 5 Pages
802-807
Published: 2011
Released on J-STAGE: October 25, 2012
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We report a case of diffuse arteriovenous malformation of the small intestine resected using intraoperative endoscopy for determining optimal surgical margins. A 66–year–old man hospitalized for melena could not have the bleeding source found in endoscopic upper gastrointestinal tract and colon examination. In small–bowel endoscopy, we saw many wine–colored submucosal tumors less than 5 mm from the duodenum to ileum. With the bleeding source not identified, we conducted surgery. Intraoperative endoscopy using a corrugated tube showed numerous submucosal tumors in the small intestine in a 0 to 160 cm segment from Treitz's ligament. Lesions were diffuselyscattered at other small intestine and duodenum segments. We partially resected 0 to 200 cm of the small intestine with and cauterized submucosal tumors at other small intestine sites. The pathological submucosal tumors diagnosis was arteriovenous malformation of the small intestine. Three years after surgery, the man remains well without evidence of recurrence.
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Nobuhisa Matsuhashi, Masahito Tachi, Takuji Sakuratani, Yu Josse Tajim ...
2011 Volume 36 Issue 5 Pages
808-812
Published: 2011
Released on J-STAGE: October 25, 2012
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We report a case in which PET–CT was useful in diagnosing small–intestine cancer preoperatively. A 58–year–old man referred in June 2010 to further evaluate abdominal pain was found in abdominal computed tomography (CT) to have ileus due to a tumor. Abdominal PET–CT showed FDG accumulated at the jejunal wall thickening site. We conducted laparoscopic surgery under a diagnosis of primary small–intestine cancer. Surgery showed no apparent liver metastasis, peritoneal dissemination, or lymph node metastasis, but necessitated partial jejunectomy. Histopathologically, the resected tumor showed well to moderately differentiated adenocarcinoma. The man was discharged 6 days after surgery. We found PET–CT useful in preoperatively diagnosing small–intestine cancer and enabling us to conduct less invasive, more effective resection with laparoscopic assistance.
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Naoko Iida, Tomoyuki Tanaka, Kazuo Matai, Takeyuki Misawa, Kazuhiko Yo ...
2011 Volume 36 Issue 5 Pages
813-817
Published: 2011
Released on J-STAGE: October 25, 2012
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A 78–year–old man with sigmoid colon cancer underwent sigmoidectomy in July, 2008. Seven days after the operation, He reported sudden abdominal upper right quadrant pain, and laboratory data showed severe anemia. Emergency enhanced computed tomography (CT) showed a 16 cm retroperitoneal hematoma in front of the right kidney and an aneurysm 2 cm in diameter on the pancreatic head. The celiac axis was compressed by the median arcuate ligament. Angiography showed aneurysms in both the anterior and posterior pancreaticoduodenal artery necessitating transarterial embolization of both pancreaticoduodenal arteries, the gastoroduodenal artery, and the first jejunal artery for hemostasis. The man was discharged 74 days after initial surgery. Enhanced CT 26 months after initial intervention showed that the hematoma had shrunk to one–seventh of the initial diameter.
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Kiichi Nagayasu, Masaya Kawai, Kazuhiro Takehara, Kouichiro Niwa, Hiro ...
2011 Volume 36 Issue 5 Pages
818-822
Published: 2011
Released on J-STAGE: October 25, 2012
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A 53–year–old man seen for lower right abdominal pain was diagnosed with acute appendicitis and underwent an appendectomy. The vermiform appendix was gangrenous but showed no obvious tumor. Histopathological examination indicated goblet cell carcinoid (GCC), with the surgical margin positive for the tumor. The residual tumor was treated with laparoscopic ileocecal resection, confirming goblet cell carcinoid of the appendix. Morphological features resembled poorly differentiated adenocaricinoma, making the tumor potentially highly malignant, and necessitating adjuvant chemotherapy. No sign of recurrence has arisen in the two years since surgery. GCC is considered more malignant than typical carcinoid tumors, and its biological behavior resembles that of adenocarcinoma.
Laparoscopic surgery for goblet cell carcinoid of the appendix and adjuvant chemotherapy is rarel and requires intensive observation.
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Motohiro Ito, Hiroo Oshita, Tsuneaki Hato, Makoto Yamada, Takahito Ada ...
2011 Volume 36 Issue 5 Pages
823-828
Published: 2011
Released on J-STAGE: October 25, 2012
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An 83–year–old man undergoing low anterior resection for rectal cancer 28 years earlier and seen for sudden–onset lower abdominal pain and vomiting showed tenderness, muscular guarding, and rebound tenderness in the lower left abdomen. Blood tests showed increased amylase, mild metabolic acidosis, and elevated CEA (18.2 ng/ml). Abdominal computed tomography (CT) showed portal venous gas patterns and a poorly enhanced left colon wall, necessitating emergency surgery for gangrenous ischemic colitis with portal venous gas. Left colectomy and transverse colostomy were con–ducted after left colon necrosis and 400 ml of malodorous brownish–red ascites were found. Endotoxin was absorbed immediately after surgery, the man's general condition stabilized, and he was discharged on postoperative day 36. Pathological findings showed mucosa and submucosa necrosis. Decreased blood flow when the inferior mesenteric artery was ligated in rectal cancer surgery helped concomitantly increase internal intestinal tract pressure due to constipation and enema, causing necrosis and portal venous gas. Serum CEA may have risen when CEA–rich mucosa became necrotic and burst, releasing CEA into the blood.
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Takashi Ikebe, Katsuyuki Mayumi, Takayoshi Nishioka, Genya Hamano, Mas ...
2011 Volume 36 Issue 5 Pages
829-834
Published: 2011
Released on J-STAGE: October 25, 2012
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We report a case of rectal endocrine cell carcinoma resulting in local recurrence and hepatic metastases early postoperatively following polypectomy.
A 56–year–old man was diagnosed with endocrine cell carcinoma based on polypectomy findings in treating a rectal polyp. The resection margin was judged positive for tumor cells, so a full transanal lesion excision was added to the procedure. Histopathological findings were sm, INFβ, ly2, and v0, and both vertical and horizontal margins were negative. Eight months later, however, local recurrence and multiple hepatic metastases were found. The local recurrence was treated by low anterior laparoscopic resection and hepatic metastases with m–FOLFOX6 + bevacizmab chemotherapy. Unfortunately, hepatic metastases gradually worsened and the man died of cancer 348 days after the initial surgery, or 98 days after reoperation. Rectal endocrine cell carcinoma invariably involves a dismal prognosis, although its incidence is low and no established opinion on therapeutic principle exists.
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Chie Takasu, Mitsuo Shimada, Nobuhiro Kurita, Takashi Iwata, Hirohiko ...
2011 Volume 36 Issue 5 Pages
835-839
Published: 2011
Released on J-STAGE: October 25, 2012
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A woman in her 30s diagnosed with endometriosis in her 20s had been treated with oral medication but had abdominal pain and melena during her menstrual period in 2006. An endometriosis lesion was found in the rectum 20 cm from the anal verge. Computed tomography (CT) showed rectal stenosis, but not complete bowel obstruction. She continued hormonal therapy but symptoms worsened. We conducted laparoscopic rectal low anterior resection in 2005. The postoperative course was uncomplicated. One year postoperatively, her condition remains good and she is symptom–free.
Reports of rectal endometriosis with laparoscopic rectal low anterior resection are still rare, given that laparoscopic surgery is less invasive and useful but requires high skill.
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Katsuji Sawai, Takanori Goi, Masako Nakazawa, Atsushi Iida, Kanji Kata ...
2011 Volume 36 Issue 5 Pages
840-845
Published: 2011
Released on J-STAGE: October 25, 2012
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Advances in cancer diagnosis and surgery have made it possible to find multiple primary cancers, although reports of quintuple cancer remain rare.
We report the case of a 49–year–old man with quintuple cancer who had undergone right hemicolectomy for ascending colon cancer elsewhere. When he was 66, we operated on him for stomach cancer. He was later diagnosed with and surgically treated for bladder cancer at age 70, rectal cancer at age of 71, and gallbladder cancer at age of 72.
Case reports of quintuple cancers diagnosed and treated over a single lifetime are rare, with only 13 reported in Japan.
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Minoru Fujisawa, Toshiaki Kitabatake, Kuniaki Kojima
2011 Volume 36 Issue 5 Pages
846-849
Published: 2011
Released on J-STAGE: October 25, 2012
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We encountered a patient with intrapelvic actinomycosis accompanied by sigmoid colon stenosis for which oral antibiotic treatment was effective. The patient was a 66–year–old female who visited a physician for a chief compliant of right lower abdominal pain. On abdominal CT, an irregular mass accompanied by right hydronephrosis was noted in the right pelvic cavity, and the patient was referred to our department. On the contrast enema of the sigmoid colon, serrated stenosis was noted in the sigmoid colon over the rectum, and a colonoscope could not be passed through. Thus, surgery was performed. Since dissection was difficult because of the sigmoid colon, rectum and swallowing origin was involved to the broad granulomatous mass, resection was gived up and colostomy was applied to the descending colon.
Actinomycetes was detected in the excised sample, and intrapelvic actinomycosis was diagnosed, for which oral amoxicillin was continuously administered for 6 months. Then, the granulomatous mass disappeared, and right hydronephrosis improved on CT scan, colostomy was closed because sigmoid colon stenosis had improved on contrast enema.
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Yuki Sato, Yoshihiro Takasaka
2011 Volume 36 Issue 5 Pages
850-855
Published: 2011
Released on J-STAGE: October 25, 2012
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A 52–year–old woman seen for epigastralgia and diagnosed with a gastric ulcer was found in abdominal ultrasonography and computed tomography (CT) to have a hepatic mass. Laboratory data showed eosinophilia. Contrast CT showed a 26×24×20 mm tumor recognized in hepatic segment 5. The woman declined the hepatic biopsy needed to make a definite diagnosis, because
18F–fluorodeoxyglucose–positron emission tomography. CT showed that high FDG had accumulated in the hepatic mass with a standardized early–phase uptake of 3.17 and in late–phase 3.34.
Suspecting tumor malignancy, we conducted hepatic lobectomy after receiving informed consent. Fascioliasis was confirmed immunoselorogically.
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Hiroyuki Negishi, Shinjiro Kobayashi, Kohei Segami, Takahiro Sasaki, J ...
2011 Volume 36 Issue 5 Pages
856-860
Published: 2011
Released on J-STAGE: October 25, 2012
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We report a case of Gross B floating gallbladder discovered without torsion abnormality. A woman in her 60s seen for back pain was found in abdominal ultrasound and computed tomography (CT) to have the gallbladder in the left upper abdominal quadrant. Calculus was seen in the interior. Specifically, the gallbladder was in the left hepatic lobe at MRCP, and a torsional gallbladder abnormality was suspected. A close elective examination showed no abnormal abdominal findings and no inflammatory findings in biochemical testing. In later ERC, the gallbladder was located in its usual site to the right of the common bile duct. The woman was finally diagnosed with floating gallbladder and gallstones, necessitating laparoscopic cholecystectomy. The gallbladder ligament was present only in the cervical gallbladder, mostly free of the liver, so the woman was diagnosed with Gross B floating gallbladder. Such cases are not infrequent, but rarely are discovered unless a torsion abnormality causes acute abdomen, for example.
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Yusuke Takahashi, Kunitoshi Nakagawa, Yukimasa Suzuki, Kojin Endo, Ter ...
2011 Volume 36 Issue 5 Pages
861-864
Published: 2011
Released on J-STAGE: October 25, 2012
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A 38–year–old woman admitted for a cystic pancreatic tail lesion detected in a physical examination was found in abdominal enhanced computed tomography (CT) to have a 2.5 cm cystic lesion of the pancreatic tail with a partially irregular margin. The cyst showed low signal intensity in T1–weighted magnetic resonance imaging (MRI) and high signal intensity in T2–weighted imaging. Since possible malignancy could not be ruled out, distal pancreatectomy and splenectomy were done. The resected specimen showed a unilocular cystic pancreatic tail lesion. The pathological diagnosis was an epidermoid cyst originating in an intrapancreatic accessory spleen. Cysts rarely form in such a spleen–hence our report.
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Kanji Ishihara, Yoshitaka Fujii, Shogo Tanaka, Ryoya Hashiba, Yusuke N ...
2011 Volume 36 Issue 5 Pages
865-869
Published: 2011
Released on J-STAGE: October 25, 2012
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A 23–year–old man undergoing appendectomy 7 years earlier and seen for fever and right upper abdominal pain was hospitalized after computed tomography (CT) and ultrasonography (US) suggested possible abdominal wall or intraperitoneal abscess. Antibiotics relieved symptoms, after which we operated based on an abdominal wall abscess diagnosis. The abscess was resected, and gramulated tissue showed no foreign body. The pathological diagnosis was abdominal wall abscess within tissue granulation. No malignancy was seen and the man was discharged on postoperative day 7. Since 1990 in Japan, delayed abdominal wall abscess related to appendectomy was reported in only 8 cases, including ours. No sign of abdominal wall abscess recurrence has been seen in the 4 years since.
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Shogo Tanaka, Kohichi Ohno, Yusuke Nakamura, Kanji Ishihara, Sayaka Ta ...
2011 Volume 36 Issue 5 Pages
870-876
Published: 2011
Released on J-STAGE: October 25, 2012
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A 75–year–old woman seen for increasing lower left abdominal pain 10 hours after onset had slight left lower abdomen tenderness, but no peritonitis. Contrast–enhanced computed tomography (CT) showed ileal wall thickening without enhancement and the superior mesenteric artery well–enhanced from the trunk to the peripheral region. Based on these findings and a preoperative diagnosis of nonocclusive mesenteric ischemia, we conducted emergency laparotomy 21 hours after onset. Ischemic changes were found in a 20–cm long region of the ileum starting 70 cm from the proximal end. Peripheral mesenteric congestion was present for 70 cm around the ischemic portion. Arteries within the mesentery were well palpable. We resection the ileum over the region of mesenteric congestion. Macroscopically, mucosa had segmentalized ischemia. Histologically, the ileum was hemorrhagically necrotic but mesentery vessels had no thrombosis. The postoperative course was uneventful and the woman was discharged on postoperative days 13.
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Toshiaki Mishima, Yoshimasa Otani, Tetsuya Tomonaga, Izumi Sakamoto, M ...
2011 Volume 36 Issue 5 Pages
877-883
Published: 2011
Released on J-STAGE: October 25, 2012
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A 60–year–old woman seen for right back pain was found to have an extensive tumor was in the retroperitoneal space that had invaded the inferior vena cava, together with a 1.0 cm hepatic tumor. Combined resection of the retroperitoneal tumor and the inferior vena cava and liver tumor biopsy were done. Histopathologically, the woman was diagnosed with liver metastasis from retroperitoneal leiomyosarcoma developing in the inferior vena cava. RFA was conducted for liver metastases. The woman developed new lesions, including liver metastasis, lung metastases, and peritoneal metastasis, requiring that RFA be repeated. Multiple metastasis recurrence necessitated systemic chemotherapy of CYVADIC and docetaxel/gemcitabine (DG). The woman died 48 months (4 years) after surgery. Although she was not completely cured, multimodal treatment enabled relatively long–term tumor growth inhibition.
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Kumiko Jojima, Yosuke Koike, Masanori Niimi
2011 Volume 36 Issue 5 Pages
884-890
Published: 2011
Released on J-STAGE: October 25, 2012
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A 44–year–old woman seen for an ulcer of the right leg, coldness in the right foot, and intermittent claudication in the right lower limb was diagnosed with angiodysplasia and referred for evaluation. Her three symptoms were capillary hemangioma, congenital varicose veins, and leg size discrepancy–all typical of Klippel–Trenaunay syndrome. Angiography showed arteriovenous fistula, making the diagnosis Klippel–Weber syndrome (KWS). Enhanced computed tomography showed the inferior vena cava (IVC) to be absent below the renal hilus. The ulcer was washed, covered with wrapfilm, compressed, with an elastic bandage. Leg elevation recommended, after which the ulcer decreased in size. Based on these findings, the ulcer was believed to be due to venous stasis. Foot coldness and intermittent claudication were considered due to ischemia caused by the arteriovenous fistula. We believe that both KWS and congenital IVC absence caused the venous stasis ulcer. It is thus important to look for abdominal and pedal angiodysplasia when seeking the cause of leg ulcers.
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