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Koichiro Sato, Masaaki Yamaguchi, Toshio Saito, Daizo Fukushima, Takay ...
2014 Volume 39 Issue 6 Pages
1062-1069
Published: 2014
Released on J-STAGE: December 28, 2015
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Herein, we report two thyroid tumors that had been misdiagnosed by fine needle aspiration cytology (FNA); operative rapid pathologic diagnosis confirmed that were actually hyalinizing trabecular tumors.
Case 1: The patient was diagnosed with a malignant tumor in the right lobe of her thyroid by FNA based on the existence of nuclear grooves and intranuclear inclusion bodies before the operation. However, after total thyroidectomy, operative rapid pathologic diagnosis revealed that the tumor was actually a hyalinizing trabecular tumor, and thus she was not required to undergo cervical lymph node dissection. Histological findings also confirmed that the lesion was a hyalinizing trabecular tumor as cell membranes stained positive for MIB-1. Two years have passed without any recurrence.
Case 2: The patient was diagnosed with a malignant tumor in the right lobe of her thyroid by FNA based on the existence of intranuclear inclusion bodies. However, after total thyroidectomy, operative rapid pathologic diagnosis revealed that the tumor was a hyalinizing trabecular tumor, and thus, like Case 1, the patient did not require cervical lymph node dissection. Histological findings also confirmed that the lesion was a hyalinizing trabecular tumor based on cell membrane positivity for MIB-1. Three months have passed without recurrence.
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Yuka Asano, Shinichiro Kashiwagi, Naoyoshi Onoda, Satoru Noda, Sayaka ...
2014 Volume 39 Issue 6 Pages
1070-1075
Published: 2014
Released on J-STAGE: December 28, 2015
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Thyroid metastasis is confirmed at autopsy in approximately 3% of patients with esophageal cancer. Such metastasis is regarded to indicate a terminal status of cancer, as it is often accompanied by multiple organ metastasis at detection and is rarely a target of treatment. We encountered a case of isolated thyroid metastasis of esophageal cancer that was curatively resected. The patient was a 57-year-old male who had undergone thoracoscopic subtotal esophagectomy for thoracic esophageal cancer at 53 years of age and was found to have a thyroid incidentaloma on postoperative follow-up CT. A cytological examination of samples obtained from this site demonstrated squamous cell carcinoma. A diagnosis of thyroid metastasis of esophageal cancer was made based on the patient’s clinical course, and he was curatively treated with right thyroid lobectomy.
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Seiichi Minami, Kazuo Nagashima
2014 Volume 39 Issue 6 Pages
1076-1080
Published: 2014
Released on J-STAGE: December 28, 2015
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An 84-year-old male had a left breast mass for 2 years but left it untreated. He was transferred by ambulance to our hospital due to hematemesis and underwent upper gastrointestinal tract endoscopy for detailed examination of upper gastrointestinal hemorrhage. A Borrmann type Ⅱ tumor approximately 5cm in diameter was detected in the gastric cardia. Biopsy showed a moderately differentiated tubular adenocarcinoma (tub2). Therefore, gastric cancer was diagnosed. Chest computed tomography (CT) after admission showed a 3.5cm mass in the left breast, and breast ultrasound showed a hypoechoic mass. Needle biopsy gave a pathological diagnosis of invasive ductal breast carcinoma. The cancers were judged to not be metastases from other cancers but rather to be synchronous double cancers of the left breast and stomach. Breast cancer surgery was performed first, after that gastric cancer surgery was done, followed by hormone therapy with oral tamoxifen as postoperative adjuvant therapy. The gastric cancer has been observed without adjuvant chemotherapy because the patient has dementia.
Male breast cancer is relatively rare, accounting for only 1% of all breast cancers. This is the 8
th reported case of male breast cancer developing simultaneously with gastric cancer, which is also rare. We report this case with discussion of the relevant literature.
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Koichi Arase, Tetsuya Watanabe, Yasuyuki Moriki, Fumihiro Hamada
2014 Volume 39 Issue 6 Pages
1081-1087
Published: 2014
Released on J-STAGE: December 28, 2015
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We report a case with the episode of suspected pneumocystis pneumonia(PCP) during chemotherapy for gastric cancer. A sixty-year-old man with clinical Stage Ⅳ gastric cancer was treated with chemotherapy by S-1 plus CDDP, PTX and S-1 plus TXT. During washout period, he was admitted for respiratory distress. He was diagnosed PCP from bilateral diffuse ground glass opacities of X-ray and computed tomography (CT), in addition to the elevated serum β-D-glucan. Following treatment of trimethoprim-sulfamethoxazole and corticosteroids with ventilator management, his clinical condition and his chest imaging findings were improved. PCP is known as a potentially fatal opportunistic infection and develops generally in patients undergoing immunosuppressive therapy or Human immunodeficiency virus infection. It requires close attention to PCP during chemotherapy and corticosteroid treatment for gastrointestinal cancer patients.
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Masanori Terashima, Masaki Tanaka, Takashi Sugino, Yuichiro Miki, Rie ...
2014 Volume 39 Issue 6 Pages
1088-1093
Published: 2014
Released on J-STAGE: December 28, 2015
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A 42-year-old woman, who was found to have a submucosal tumor (SMT) of the stomach in medical check up, was transfered to our hospital with a diagnosis of gastrointestinal stromal tumor (GIST) suspected from community hospital. Upper gastrointestinal endoscopy revealed intraluminal growth type SMT with 20mm in size at the greater curvature of the middle body of the stomach. CT scan demonstrated well enhanced intraluminal type SMT at the middle body of the stomach. The enhancement pattern was very similar to that of hemangioma. Subsequently, she received laparoscopic and endoscopic cooperative surgery with a diagnosis of SMT of the stomach highly suspicious of GIST. Pathological examination demonstrated that the tumor was composed of solid sheets of polygonal small cells around well-developed capillary vasculature. Immunohistochemistry revealed strong expression of α-SMA and collagen-Ⅳ and no expression of KIT, CD34, desmin or S100. MIB1 index was very low (1-2%). The tumor was finally diagnosed as benign glomus tumor of the stomach. Postoperative course was uneventful and she discharged hospital 6 days after operation. She is free of recurrence at 1 year after operation.
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Katsuji Sawai, Atsushi Iida, Takanori Goi, Kanji Katayama, Akio Yamagu ...
2014 Volume 39 Issue 6 Pages
1094-1099
Published: 2014
Released on J-STAGE: December 28, 2015
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The contents point: Gasric volvulus is a relatively rare condition comprising an abnormal rotation of the stomach. In some case ,it requires surgery. We report a patient with gastric volvulus who was treated by laparoscopic gastropexy and the postoperative course was uneventful.
A 75-year-old man presented with an onset of abdominal pain and vomiting.
A computed tomography scan and the upper gastrointestinal series revealed gastric volvulus. Endoscopic detorsion of the volvulus was performed, but due to the recurrence of the volvulus laparoscopic gastropexy was performed.
The postoperative course was uneventfuland the patient was discharged 4 days postoperatively.
Laparoscopic gastropexy may be considered one of the minimally invasive and effective therapies for gastric volvulus.
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Naoki Kamitani, Ryo Yoriki, Shuji Osumi, Atsushi Yoshimura, Keiji Shim ...
2014 Volume 39 Issue 6 Pages
1100-1104
Published: 2014
Released on J-STAGE: December 28, 2015
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A 62-year-old man was admitted to our hospital complaining of fever and diarrhea 20 days after hepatectomy due to metastasis of colon cancer. Laboratory data indicated elevated WBC (40,840/μl) and eosinophilia (20.0%), and CT scan showed ascites around liver, spleen, intestine. Colonoscopy showed edema and punctate reddening of mucosa especiaaly in the descending colon. Biopsy of colon wall showed eosinophilic infiltration in colon crypt. Under a diagnosis of eosinophilic gastroenteritis, symptoms improved rapidly by administration of steroid. Eosinophilic gastroenteritis is a relatively rare disease, which characterizes inflammation with eosinophilic infiltration into the gastrointestinal wall. This disease occurs various symptoms for example diarrhea, fever, ascites. We report a case of eosinophilic gastroenteritis caused by operation.
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Yusuke Takanashi, Jun Isogaki, Akihiro Kawabe
2014 Volume 39 Issue 6 Pages
1105-1109
Published: 2014
Released on J-STAGE: December 28, 2015
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Gastrojejunocolic fistula caused by stomal ulcers after gastrectomy is rare and one of the serious complications of stomal ulcer. A 74-year-old man was carried out distal gastrectomy with Billroth Ⅱ reconstruction for duodenal ulcer in 1967. He visited another hospital for tarry stool in January 2013. Upper gastrointestinal endoscopy revealed active stomal ulcer, and he started using proton pump inhibitor. He was reffered to our hospital with complaints of diarrhea and weight loss in June 2013. Upper gastrointestinal series and colonoscopy showed the gastrojejunocolic fistula. Partial resection of the remnant stomach, small intestine and transverse colon was performed, resulting improvement of diarrhea and poor nutrition. This disease should be considered when the patient presents diarrhea and weight loss after gastrectomy.
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Kazuhiro Suzumura, Yuichi Kondo, Yuji Iimuro, Nobukazu Kuroda, Tadamic ...
2014 Volume 39 Issue 6 Pages
1110-1115
Published: 2014
Released on J-STAGE: December 28, 2015
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A 49-year-old woman was found to have multiple duodenal ulcer scars by upper gastrointestinal endoscopy at another hospital. Her serum gastrin level was elevated and she was admitted to our hospital. In our hospital, upper gastrointestinal endoscopy revealed a submucosal tumor in the descending duodenum. Abdominal CT and selective arterial calcium injection test were performed for locating gastrinoma. In the result of these examinations, the gastrinoma was diagnosed as being located in the descending duodenum. We performed a pylorus-preserving pancreaticoduodenectomy. Postoperative course was uneventful, and her serum gastrin level normalized. She was discharged on the postoperative day 34, and is alive without recurrence 3 years after surgery. We report a surgical case of the duodenal gastrinoma with some bibliographical comments.
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Daisuke Kuraya, Kengo Shibata, Takeshi Kikuchi, Kazuhito Uemura, Hiroa ...
2014 Volume 39 Issue 6 Pages
1116-1121
Published: 2014
Released on J-STAGE: December 28, 2015
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A 77-year-old female was admitted to our hospital complaining abdominal bloating and appetite loss. Abdominal X-ray showed marked distension of the stomach and duodenum. Abdominal ultrasonography demonstrated the aorto-mesenteric angle of 24 degrees. The distance between SMA and aorta, at the location where the duodenum passed from, was 6mm on CT. SMA syndrome was diagnosed. Laparoscopic duodenojejunostomy was performed. A 12mm port was inserted through the umbilicus for videoscope. Next, a left lower quadrant 12mm port and a left upper quadrant 5mm port was placed. Stab wounds were made with cautery on the third part of the duodenum and on the jejunum 30cm distant from the ligament of Treitz to introduce a cutting linear stapler (Endo-GIA
TM Tri-Staple
TM). The stab wounds were stapled shut with a cutting linear stapler. The duration of procedure was 91 minutes. The postoperative course was uneventful. She could have meals on ninth postoperative day and returned previous hospital on 20
th. Laparoscopic duodenojejunostomy would be considered a easier, less invasive, and more effective procedure for treating SMA syndrome.
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Fumihiko Fujita, Hajime Matsushima, Yusuke Inoue, Daisuke Kawahara, Ya ...
2014 Volume 39 Issue 6 Pages
1122-1126
Published: 2014
Released on J-STAGE: December 28, 2015
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A 76-year-old male visited to the clinic because of his black stools and anemia. As the administration of chalybeate was not effective for him, he was referred to our hospital. A double-balloon enteroscopy showed a tumor with ulcer of the ileum, and a biopsy specimen suggested adenocarcinoma. Laparoscopic partial resection of the ileum with intracorporeal anastomosis was performed successfully. The resected specimen revealed a type Ⅱ tumor, measuring 20×22mm. The histopathological examination revealed tubular adenocarcinoma with muscularis propria invasion, but there was no lymphovascular invasion. The incidence of primary small intestinal cancer is relatively rare. This patientʼs postoperative course went well, and there were no complications. The complete laparoscopic resection with intracorporeal anastomosis was a less invasive method and is useful for the small neoplasms of the small intestine.
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Tomohiro Kunishige, Naoya Ikeda, Masatou Ueno, Tetsuhiro Kanamura, Koj ...
2014 Volume 39 Issue 6 Pages
1127-1131
Published: 2014
Released on J-STAGE: December 28, 2015
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We report a case of rice cake-induced small bowel obstruction treated by laparoscopic surgery. A 68-year-old man with abdominal pain was admitted to our hospital. Computed tomography revealed a dilatation of the small intestine caused by a foreign-body. Due to the clinical deterioration, the patient underwent a laparoscopic-assisted emergency surgery on the following day of admission and was diagnosed as the rice cake-induced small bowel obstruction. The laparoscopic-assisted removal could be used as the first-choice surgical procedure for rice cake-induced small bowel obstruction when surgical treatment is needed to remove.
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Masakazu Ikenaga, Toshiki Hitora, Takahiko Nishigaki, Ho Min Kim, Masa ...
2014 Volume 39 Issue 6 Pages
1132-1137
Published: 2014
Released on J-STAGE: December 28, 2015
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We report a case of ileus caused by an appendix epiploica of the transverse colon. A 39-year-old man presented to our hospital with diarrhea, vomiting, and abdominal pain. He was initially diagnosed with infectious gastroenteritis and, ileus. Following insertion of a long tube, abdominal symptoms improved, although small bowel obstruction persisted. Therefore, the patient underwent laparoscopic surgery under general anesthesia. This examination indicated the presence of an appendix epiploica of the transeverse colon that adhered to the mesentery of the small bowel, which appeared reddish and erosive. The adhesion of the appendix epiploica was resected by using laparoscopic coaguration shears. As the strangulated small bowel did not exhibit an ischemic change, bowel resection was not required. The appendix epiploica was then resected from the body and removed. The patient was discharged 10 days after surgery without any complications.
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Mitsuru Ishizuka, Hitoshi Nagata, Kazutoshi Takagi, Yoshimi Iwasaki, G ...
2014 Volume 39 Issue 6 Pages
1138-1145
Published: 2014
Released on J-STAGE: December 28, 2015
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A 35-year-old female patient receiving gynecological treatment for endometriosis was diagnosed as having small bowel obstruction due to an ileal tumor. Laparoscopic ileo-cecal resection with D3 lymph node dissection was performed, because preoperative diagnosis was not confirmed. The intraoperative observation showed that there were a lot of blue-berry spots in the pelvic space and all such spots were cauterized using power device. Although pathological diagnosis showed a heterotopic endometriosis of the terminal ileum along with a dissected lymph node, there were no malignant findings in the resected specimen including dissected lymph nodes. Laparoscopic surgery would be adequate for such disease, because both curative surgery for small bowel obstruction due to an ileal endometriosis and cauterization for all blue-berry spots could be performed at the same time.
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Ken Sujishi, Takanobu Yamada, Yuji Yamamoto
2014 Volume 39 Issue 6 Pages
1146-1149
Published: 2014
Released on J-STAGE: December 28, 2015
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A 45-year-old woman with a history of constipation from the beginning of menopause in December 2012 presented to the Department of Internal Medicine of our hospital with vomiting and abdominal pain. Severe stenosis of the sigmoid colon was confirmed by abdominal computed tomography, and transanal ileus tube insertion was attempted. However, the procedure was too difficult and an emergency laparotomy was eventually performed. The ileum and the entire colon were significantly distended. A tumor forming a rigid adhesion with the rectum and uterus was observed in the sigmoid colon. Therefore, we performed sigmoidectomy and D2 lymphadenectomy. Postoperatively, this case was diagnosed as intestinal endometriosis by histopathological examination. Intestinal endometriosis accounts for approximately 10% of all cases of endometriosis, and frequently involves the sigmoid colon and rectum. However, the occurrence of obstruction of these regions is relatively rare. Here we report a rare case of intestinal endometriosis causing bowel obstruction at the level of the sigmoid colon.
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Jun Kawachi, Hidemitsu Ogino, Rai Shimoyama, Naoko Isogai, Kazunao Wat ...
2014 Volume 39 Issue 6 Pages
1150-1154
Published: 2014
Released on J-STAGE: December 28, 2015
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A 33-year-old man was diagnosed with sigmoid diverticulitis at a local clinic and underwent in-patient treatment. His abdominal pain failed to improve, and four days after discharge he was examined at our hospital. He was prescribed oral antibiotics as an outpatient and kept under observation, but as his abdominal pain persisted and pain on urination also appeared, he was referred to the Department of Surgery and admitted as an emergency patient. Pneumaturia and pyuria were evident, and abdominal CT revealed air retention in the bladder, while plain pelvic MRI revealed a fistula and vesico-sigmoid fistula was diagnosed. Cystoscopy revealed severe inflammatory lesions near the trigone of the bladder, but the fistula and ureteral orifice were unclear. Surgery was therefore postponed while a transverse colostomy was created, and sigmoid colectomy and bladder repair were performed six months later as combined cystocopic and laparoscopic surgery. The colostomy was closed after another month. The patientʼs subsequent course has been uneventful, with no recurrence.
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Hiroki Hamamoto, Junji Okuda, Keitaro Tanaka, Masashi Yamamoto, Maiko ...
2014 Volume 39 Issue 6 Pages
1155-1160
Published: 2014
Released on J-STAGE: December 28, 2015
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A 58-year-old woman complaining of hematochezia was diagnosed with rectal cancer (RS, 2, cSS, N1, H0, P0). A laparo-scopic-assisted anterior resection was performed. The hard adhesion between the rectal wall and the uterus indicated that the rectal tumor directly invaded the uterus. After proximal lymph node dissection, open surgery was performed. By intraoperative enteroscopy, we recognized that the main tumor was located distal from the adhesion. Intraoperative histological examination revealed no malignancy, and the ad-hesion was diagnosed as endometriosis. We therefore report a case of rectal endometriosis for which intraoperative histo-logical examination and enteroscopy allowed for the preser-vation of the uterus. We also include a literature review.
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Masahiro Ikeda, Tetsuya Kaneko, Takamasa Tokoro
2014 Volume 39 Issue 6 Pages
1161-1168
Published: 2014
Released on J-STAGE: December 28, 2015
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We experienced a case in which right hepatectomy was performed on a hepatocellular carcinoma arising from non-alcoholic steatohepatitis with postoperative complication by Wernickeʼs encephalopathy. The patient was a 62-year-old man. Serum tests for hepatitis B and C were negative. He had been treated for sleep apnea syndrome and diabetes mellitus. His body mass index was 28kg/m
2. Tracheotomy was performed due to postoperative respiratory failure. Potassium-free, low calorie fluid was transfused due to hyperkalemia and hyperglycemia after operation. Oral intake was started on postoperative day 33, but disorientation and ataxia were complicated on postoperative day 43. Brain MRI of T2-weighted sequences showed hyperintensity areas symmetrically at medial thalamic lesions along the aqueduct and the third ventricle. Wernickeʼs encephalopathy was diagnosed according to these MRI findings. Vitamin B
1 was transfused immediately and symptoms of Wernickeʼs encephalopathy were promptly improved. In this didactic case, the causes of Wernickeʼs encephalopathy were considered to be insufficient replacement of vitamin B
1, decrease of coenzyme activity of vitamin B
1 due to diabetes mellitus and liver damage, and acceleration of glucose metabolism due to insulin load for diabetes mellitus and hyperglycemia.
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Norio Yukawa, Yasushi Rino, Hiroshi Tamagawa, Naoto Yamamoto, Shinichi ...
2014 Volume 39 Issue 6 Pages
1169-1174
Published: 2014
Released on J-STAGE: December 28, 2015
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We report a case of hepatocellular carcinoma that was safely resected by hand-assisted laparoscopic partial hepatectomy with microwave coagulation therapy. The patient was an 81-year-old man who had undergone coronary artery stenting for angina pectoris in 2008. In addition, a pacemaker had been implanted because of atrioventricular block. The patient had a history of hypertension, cerebral infarction, and sigmoid colon carcinoma. The American Society of Anesthesiologists physical status (ASA-PS) was classified as Grade 3. Because a liver tumor was detected on computed tomography, he visited our hospital in August 2012. He was given a diagnosis of hepatocellular carcinoma in segment 8 with liver cirrhosis. The preoperative indocyanine green retention rate at 15 minutes (ICGR15) was 47% (16% on asialoscintigraphy). To minimize surgical invasion, we performed a laparoscopic partial hepatectomy with the use of an ultrasonic energy system for dissection, cutting, and coagulation (Harmonic
® Scalpel), applying microwave coagulation therapy. The postoperative course was uneventful, and the patient was discharged on day 12 after the operation.
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Kohei Murakami, Yoshikazu Morimoto, Takeyoshi Yumiba, Makoto Fujii, Yu ...
2014 Volume 39 Issue 6 Pages
1175-1180
Published: 2014
Released on J-STAGE: December 28, 2015
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A 57-year-old woman was admitted due to diagnosis GBC. Enhanced computed tomography showed a wall thickening of the gallbladder and an unclear borderline between gallbladder and adjacent liver and colon. Positron Emission Tomography (PET) showed an abnormal accumulation of FDG in the region. Surgical operation was performed under a diagnosis of GBC with invasion to hepatic bed and colon. No malignant sign was found by intraoperative frozen examination, then extended cholecystectomy and partial resection of the colon was undertaken. Extra hepatic bile duct and lymph node resection were never undertaken. The result of pathologic diagnosis from permanent preparation was a xanthogranulomatous cholecystitis (XGC). XGC is one type of subacute cholecystitis showing similar examination findings to gallbladder cancer (GBC). Accumulating of FDG was often seen in XGC. It is often difficult to differentiate XGC from GBC preoperatively, so that too much invasive operation was performed. When we diagnosed GBC preoperatively, we consider that it is important to set a high value on intraoperative findings and a frozen examination to avoid unnecessary surgical stress.
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Yasuhiro Shimizu, Nobuhiro Sugano, Hirochika Makino, Takashi Oshima, C ...
2014 Volume 39 Issue 6 Pages
1181-1186
Published: 2014
Released on J-STAGE: December 28, 2015
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An 85-year-old man was seen at the hospital because of sudden abdominal pain in right upper quatant(RUQ) and vomitting. Tenderness and rebound were present around RUQ and Murphy sign was positive. Blood chemistry was normal except for WBC of 10,260/
μl and CRP of 2.1mg/dl. Abdominal Ultrasonography showed swelling of the gallbladder with thickened wall and the cystic duct was not visualized. CT showed twisted pedicle of the cystic duct and the gallbladder shifted caudally. The gallbladder torsion was diagnosed and emergency open cholecystectomy was performed. During surgery, the Gross type-Ⅱ floating gallbladder was twisted counter-clockwise by 720 degrees and the adhension band to the gallbladder caused its torsion. The patient was discharged without any troubles.
We experienced this rare case of the gallbladder torsion and report it with the consideration based on present case reports.
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Eiji Tsujita, Yasuharu Ikeda, Nao Kinjo, Kazuhito Minami, Manabu Yamam ...
2014 Volume 39 Issue 6 Pages
1187-1191
Published: 2014
Released on J-STAGE: December 28, 2015
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We report a case of a pancreatic tumor metastasizing from uterine cancer. A 68-year-old woman pointed out pancreatic tumor 9 years after hysterectomy for uterine cancer. Preoperative imagings showed large tumor in the pancreatic tail. No other metastatic lesion was found, so conducted a distal pancreatectomy. Adjuvant chemotherapy was performed after pancreatectomy. She survived 2 years after pancreatectomy.
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Hiroki Murakami, Shinichi Fujitake
2014 Volume 39 Issue 6 Pages
1192-1196
Published: 2014
Released on J-STAGE: December 28, 2015
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An 80-year-old man was transferred to our emergency clinic because of discomfort with cold sweat while waiting at the pharmacy. He hardly showed any subjective symptoms such as spontaneous abdominal pain or tenderness at the time of emergency conveyance, though he felt nauseated when the ambulance service had arrived at the pharmacy. Hematological tests did not reveal elevated inflammatory reaction or other abnormal findings. However, abdominal computed tomography showed presence of free air around the spleen and the bowel in the abdominal cavity; therefore, he was referred to the surgery department under the suspicion of gastrointestinal perforation. He was admitted and was administered conservative treatment for idiopathic pneumoperitoneum. The patient refused colonoscopy; therefore, upper gastrointestinal endoscopy was performed, but no perforation was detected. On the sixth day, his abdominal symptoms had resolved and hematological data was normal; further, abdominal computed tomography revealed no free air after oral intake was resumed. He was discharged from our hospital after 14 days.
Care should be taken when considering surgical intervention in cases in which idiopathic pneumoperitoneum is suspected, especially when symptoms and laboratory data hardly suggest severe peritonitis in spite of imaging studies showing presence of free air in the abdominal cavity.
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Yuichiro Ohigashi, Hiroya Yabuuchi, Muneaki Matsumoto, Daisuke Hokuto, ...
2014 Volume 39 Issue 6 Pages
1197-1201
Published: 2014
Released on J-STAGE: December 28, 2015
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An 87-year woman with pain in left coxa and left leg had a medical examination to another hospital. She was diagnosed by abdominal CT scan as the left obturator hernia, and presented to our hospital.
The abdominal CT scan suggested the left obturator hernia, but the small bowel obstruction was not presented. We diagnosed her illness as the left obturator hernia with the Howship-Romberg sign, and without the small bowel obstruction. So, we performed an elective laparoscopic surgery on the patient. It was possible to observe the intraperitoneal space, and repaired the hernia orifice with the mesh sheet in a good view. The post operative course was uneventful.
The obturator hernia without the small bowel obstruction is very rare. I give a presentation such a case be a standard treatment procedure for operating of the laparoscopic surgery.
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Tomohiro Murata, Minoru Fukuchi, Satoshi Hatano, Kunihiko Amano, Takea ...
2014 Volume 39 Issue 6 Pages
1202-1207
Published: 2014
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We herein report a rare case of a pelvic mesothelial cyst with high level of serum CA19-9. A 19-year-old man was admitted to our hospital with a 2-months history of lower abdominal pain. Computed tomography showed a low density mass of 2.5cm in diameter with fluid collection. The results of blood biochemical examinations were normal. However, serum tumor marker studies revealed elevated CA19-9 (1,844U/ml). We performed a resection for the pelvic multicystic mass. The pathological examinations revealed a mesothelial cyst lined by mesothelium with partially squamous metaplasia. Immunohistochemical staining revealed both mesothelium and squamous metaplasia positive for CA19-9. The postoperative serum CA19-9 levels normalized postoperatively. To the best of our knowledge, this is the first report of a pelvic mesothelial cyst with elevated serum CA19-9. Furthermore, mesothelial cyst is uncommon, but occasionally observed in the pelvis. We therefore should consider this disease in the differential diagnosis of the pelvic cystic mass.
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