Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons)
Online ISSN : 1882-9112
Print ISSN : 0385-7883
ISSN-L : 0385-7883
Volume 43, Issue 6
Displaying 1-28 of 28 articles from this issue
  • Katsuhisa Shindo, Sadanori Kamikawa
    2018 Volume 43 Issue 6 Pages 989-1000
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    Aim: The ostomates’ QOL questionnaire needed to be revised completely for new ostomates, including urostomates, based on recent advances in surgical and care techniques.

    Methods: The standard ostomates’ questionnaire, established in 1999, was extensively revised to enable appropriate investigation of all ostomates, including urostomates, based recent technical advances. The revised self-administered questionnaire was sent to ostomates by the Japan Ostomy Association and the responses were collected by post/mail. The data were analyzed using the EXCEL statistic series for reliability, consistency and factor analysis.

    Results: Several urology-relevant questions were added to the old questionnaire, which was revised completely, including the 8 items of general health, 28 stoma items and 12 ostomates’ background items. Statistical analysis showed a Cronbach’s coefficient alpha of 0.9344, suggesting reliability and internal consistency of the test items.

    Conclusions: The revised ostomates’ QOL questionnaire can be used for patients who have undergone any ostomy surgery. Statistical results of the questionnaire data might be utilized in clinical situations.

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  • Katsuhisa Shindo, Sadanori Kamikawa
    2018 Volume 43 Issue 6 Pages 1001-1009
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    Aim: A revised questionnaire has been applied for the national survey of ostomates, in order to examine any correlations between the background variables and the QOL. The results should help in surgeons’ improving their surgical techniques and care for ostomates.

    Methods: The data collected from 2200 nationwide ostomates were analyzed for the existence of correlations between each factor and the quality of life and to determine the influence of the stoma on the ostomates’ QOL. The results were analyzed for statistical significance, and collated with clinical experience.

    Results: Statistical analysis showed that the score for each physical, social and life variable was lower in ostomates in general health scoring. The scores for mental factors were slightly lower, and those for vitality and health feelings were higher. Scores for psychological distress and stoma-related problems were lower in JOA and other members, but not in non-members. Housekeeping economy was related to the ostomates’ peristomal skin damage and difficulties during sports, sleep and/or clothing selections.

    Conclusions: Surgeons should show interest in their ostomates’ daily lives and social activities, which will enhance their awareness of the necessity to improve their surgical techniques and care for ostomates.

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  • Daiki Marukawa, Mitsuyoshi Tei, Shingo Noura, Toshinori Sueda, Tae Mat ...
    2018 Volume 43 Issue 6 Pages 1010-1014
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    Appendiceal carcinoma is relatively rare. Between July 2011 and December 2016, we encountered 13 cases of primary appendiceal carcinoma in our hospital. We analyzed the clinical and pathological characteristics, operations, and outcomes of the cases. The median age (range) was 63 years (36-85). The operations were right hemicolectomy (n=1) and ileocecal resection (n=12). Tumor depths were T1 (n=1), T2 (n=1), T3 (n=1) and T4 (n=10). Histological types were moderately differentiated adenocarcinoma (tub2; n=2), poorly differentiated adenocarcinoma, solid type (por1; n=1), and mucinous adenocarcinoma (muc; n=10). Pathological stages were Ⅰ (n=2), Ⅱ (n=6), Ⅲb (n=1), and Ⅳ(n=4). The postoperative median (range) follow-up duration was 37 months (4-60). Regarding outcomes, 10 cases remain alive without a recurrence, but 3 cases died, 2 from a recurrence. Preoperative diagnosis of a primary appendiceal adenocarcinoma is difficult, and the clinical stage is usually advanced when the diagnosis is made. Further cases are necessary to clarify the standard therapy.

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  • Kanako Naito, Kimiyasu Yoneyama, Taketo Sasaki
    2018 Volume 43 Issue 6 Pages 1015-1020
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    Male breast cancer is rare and accounts for only 1% of all breast cancers.

    Furthermore, among all breast cancers, the frequency of intracystic carcinoma is only 0.07%-3.2%. We encountered a case of non-invasive ductal carcinoma in a male. A 90-year-old man presented to the hospital with a palpable tumor in his left chest. On physical examination, a well-defined tumor measuring 20 mm in diameter was palpable in the left E area. The axillary lymph nodes were not palpable. A mammography examination showed a well-defined circular mass, which was classified as category 3. Ultrasonographic examination showed a 20-mm cystic mass with a 6-mm solid part projecting from the wall of the cyst. A contrast CT examination showed a 17-mm cystic mass with a tumor component of the contrast effect at the wall.

    Mastectomy was performed, as a needle biopsy and cytology examination failed to confirm if the lesion was malignant. We made an incision at the side of the nipple, while preserving the nipple itself. Histological examination revealed a non-invasive ductal carcinoma. Taking the patient’s age into consideration, we did not administer adjuvant therapy, however, the patient has remained recurrence-free since the operation.

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  • Masatoshi Kitakaze, Motohiro Hirao, Takuya Hamakawa, Kazuhiro Nishikaw ...
    2018 Volume 43 Issue 6 Pages 1021-1026
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    Aberrant Right Subclavian Artery (ARSA) is relatively rare, and anatomical abnormalities of the right recurrent laryngeal nerve and thoracic duct often coexist with this condition. Because ARSA is located behind the esopagus, it is difficult to dissect the left upper mediastinal lymph node. In most of cases with ARSA, the right recurrent laryngeal nerve is not recurrent and the thoracic duct runs in the right thoracic cavity, increasing the probability of damage to the right recurrent laryngeal nerve and thoracic duct. Particular care is required during esophagectomy in patients with ARSA.

    The patient was a 55-year-old woman who had undergone endoscopic submucosal dissection (ESD) for thoracic esophageal carcinoma. Surgical esophagectomy was needed in addition, because examination of the ESD specimen revealed vascular invasion. Preoperative CT revealed the ARSA. Thoracoscope-assisted subtotal esophagectomy was performed by cutting the esophagus at the upper side, with reconstruction using a gastric conduit via a retrosternal approach. The patient was discharged without any perioperative complications, and the long-term swallowing difficulty that the patient had suffered from resolved after the operation.

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  • Takao Shimizu, Takeshi Shioya, Osamu Komine, Kotaro Nambu, Yoshimasa W ...
    2018 Volume 43 Issue 6 Pages 1027-1032
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    We report a case of gastric carcinoma causing ball-valve syndrome which was reduced under endoscopic assist before radical surgery. An 89-year-old man presented to his neighborhood doctor with anorexia, and upper gastrointestinal endoscopy revealed a tumor arising from the antrum extending into the duodenal bulb beyond the pyloric ring. The patient was referred to us for further examination and treatment. We diagnosed ball-valve syndrome.

    We decided to perform surgery, because endoscopic reduction was impossible. During the operation, the serosal and muscular layers of the anterior wall of the antrum were found to have invaginated into the duodenal bulb. We reduced the invagination gently by the Hutchinson procedure under endoscopic assist, and performed distal gastrectomy (Billroth-I).

    This report describes a rare case of gastric carcinoma causing ball-valve syndrome that was reduced under endoscopic assist prior to radical surgery.

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  • Tomo Nakagawa, Shunji Endo, Masakazu Ikenaga
    2018 Volume 43 Issue 6 Pages 1033-1041
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    A subset of patients with advanced gastric cancer has the possibility of receiving R0 resection, although the potential of recurrence after surgery is high. Neoadjuvant chemotherapy with S-1 plus cisplatin may improve the prognosis of such patients. However, it is difficult to treat patients with advanced gastric cancer having gastric outlet obstruction as these patients exhibit difficulties with oral intake of S-1 and nutritional compromise. Therefore, radical gastrectomy tends to be chosen rather than neoadjuvant chemotherapy for these patients.

    In this case, we could successfully administer neoadjuvant chemotherapy with S-1 plus cisplatin after performing a duodenal stent replacement. This may be the first case report describing a patient with gastric cancer who achieved complete pathological response with duodenal stent insertion, followed by neoadjuvant chemotherapy.

    Duodenal stents may help multidisciplinary treatments for patients with advanced gastric cancer having gastric outlet obstruction.

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  • Shunji Endo, Yoshio Oka, Masakazu Ikenaga, Katsuya Ohta, Masami Ueda, ...
    2018 Volume 43 Issue 6 Pages 1042-1047
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    A 61-year-old man was referred to our hospital because of an elevated serum level of carcinoembryonic antigen. Esophagogastroduodenoscopy revealed a type 3 tumor in the prepyloric region, which was confirmed by biopsy as a well-differentiated tubular adenocarcinoma. Enhanced abdominal CT showed multiple metastatic lesions in both lobes of the liver. The gastric cancer was categorized as cT2(SS), cN1, cH1, cP0, cM0, c Stage Ⅳ, according to the Japanese classification of gastric carcinoma (13th edition). Remarkably, after eight courses of chemotherapy with S-1, the primary gastric cancer diminished in size, and the liver metastases disappeared. Thereafter, distal gastrectomy with D2 lymph node dissection and partial resection of two hepatic lesions were performed. Pathologically, the tumor was diagnosed as pT2(SS), pN1, pH0, sM0, f Stage Ⅱ gastric cancer, and the tumor response according to histological evaluation was Grade 1b. Postoperatively, the patient received oral tegafur/uracil and hepatic artery infusion chemotherapy with fluorouracil for a year. At present, 122 months since the surgery, the patient remains in good health and has shown no evidence of relapse. Although simultaneous multiple metastases from gastric cancer are associated with a poor prognosis, this patient was successfully treated by multidisciplinary therapy.

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  • Masashi Nakagawa, Hirokazu Iijima, Nobuji Kono, Yuto Igarashi, Ryuiti ...
    2018 Volume 43 Issue 6 Pages 1048-1052
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    This paper describes a case report of a 10-year-old boy who developed a bruise on his abdomen caused by the handle of his bicycle, and was seen at the emergency clinic in our hospital. When he was first seen he was not sick and his vital signs were stable. After follow-up by an Emergency Room (ER) doctor he was discharged home. However, he came back to the hospital the next day because his pain was worse. An abdominal CT scan and abdominal ultrasound showed collections of retroperitoneal fluid with free air and thickening of the third portion of the duodenal wall. An emergency operation was performed leading to a diagnosis of traumatic duodenal injuries 23 hours after the accident. Intraoperative findings showed a rupture (5×5mm diameter) of the horizontal portion of the duodenum that required simple suturing and closure, a serosal patch, gastrostomy, and a nasogastric tube for decompression. No serious complications occurred after the operation. In this paper we present our experience with a case of traumatic duodenal rupture in childhood, together with a review of relevant literature.

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  • Masaki Horiuchi, Koki Goto, Shigeru Yamagishi, Keita Nakatsutsumi, Hir ...
    2018 Volume 43 Issue 6 Pages 1053-1058
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    A 99-year-old woman visited our hospital with the complaint of lower abdominal pain. Examination revealed tenderness over the entire abdomen with muscular rigidity. Abdominal CT revealed free peritoneal air and ascites, but the exact location of the perforation was not clear. We performed an emergency diagnostic laparoscopy for the purpose detecting the location of the intestinal perforation and found a perforation of the duodenum. We performed simple closure and omental patch repair. She had no postoperative complications and left the hospital on the 12th hospital day, with no decline in the activities of daily living.

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  • Kazuo Mizumoto, Minekazu Yamaguchi
    2018 Volume 43 Issue 6 Pages 1059-1064
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    A 74-year-old woman was rushed to our hospital with the complaints of lower abdominal pain, diarrhea, and vomiting. She was admitted to the hospital, as MDCT revealed intrahepatic portal venous gas. Enhanced MDCT on the following day showed peritoneal fluid and bowel wall edema in the terminal part of the ileum, the ileocecal area and the ascending colon. Enhancement of the superior mesenteric artery from the root to the periphery was noted, and segmental non-enhancing mucosal areas were found in the terminal portion of the ileum (2a), ileocecal area (2b), and ascending colon (2c). We diagnosed the patient as having nonocclusive mesenteric ischemia (NOMI) and treated her by continuous intravenous administration of PGE1 (0.01μg/kg/min) for 5 days. After the treatment, the patient’s complaints resolved, and her white blood cell count, serum CRP, and MDCT findings became normal. She could resume oral intake after 9 days at the hospital and was discharged after 13 days at the hospital.

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  • Keiichiro Kitahama, Takahisa Yoshikawa, Yuki Tajima, Takashi Takenoya, ...
    2018 Volume 43 Issue 6 Pages 1065-1070
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    An 82-year-old woman with lower abdominal pain was referred to our hospital. Her symptoms and CT suggested strangulated ileus. An emergency laparoscopy-assisted operation was performed. The laparoscopy showed bloody ascites in the cavitas pelvis and strangulated ileum obstruction caused by an intrauterine device (IUD). We resected the annular part of the IUD at outside of the abdomen. Although the strangulation was relieved, the color of the strangulated ileum did not improve. Therefore, we resected the necrotic bowel. The patient had an uneventful postoperative recovery and was discharged on the eighth postoperative day. We suppose the IUD uterine perforation in this patient was caused by uterine atrophy and uterine contraction. A strangulated ileus into an IUD is rare. Older female patients who use IUDs have a risk of acute abdominal pain. Therefore, it is important to interview patients regarding the IUD insertion or removal history.

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  • Koji Kuwano, Nobue Futawatari, Yuji Okoshi, Yumiko Sakamoto, Kazuhiko ...
    2018 Volume 43 Issue 6 Pages 1071-1077
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    The patient was an 85-year-old man who visited our hospital with the chief complaint of appetite loss. Examination revealed signs of severe dehydration and renal dysfunction. Abdominal computed tomography revealed the findings of intestinal obstruction caused by a foreign body and the patient was treated by insertion of a long intestinal tube and fluid replacement. A long-intestinal tube contrast study revealed a lucency of about 5 cm in the small intestine, and the patient was diagnosed as having gallstone ileus, based on a history of gallstones and finding of pneumobilia. Another ileus tube contrast study was performed after three days, and surgery was planned for suspected gallstone impaction. Lithotomy via an incision in the small intestine and partial resection of the small intestine were performed with single-port laparoscopic assistance. Intestinal obstruction caused by a gallstone is relatively rare. However, it carries a high mortality and occurs mostly in elderly people. We report a patient who underwent surgery with single-port laparoscopic assistance for gallstone ileus.

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  • Masami Ueda, Masakazu Ikenaga, Katsuya Ohta, Okamoto Akino, Yoshinao C ...
    2018 Volume 43 Issue 6 Pages 1078-1083
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    A male of fifty with abdominal pain and vomiting was admitted to our hospital. Physical examination revealed tenderness in the right lower abdomen. Contrast-enhanced abdominal computed tomography showed increased wall thickness of the appendix, with a high-density area surrounding the appendix. The patient was diagnosed with acute appendicitis and underwent emergency surgery. Histological assessment of the root of the resected appendix revealed a component with signet ring cell carcinoma morphology that was positive for neuroendocrine markers by immunohistochemical staining, which led to the diagnosis of goblet cell carcinoid (GCC) of the appendix. GCC cells were found to infiltrate the surrounding serosa and at the resected margin. An additional laparoscopic ileocecal resection with D3 dissection was performed. The frequency of GCC is 0.05% among all appendectomy cases, and half of the patients with GCC are diagnosed as acute appendicitis preoperatively. We herein report our experience in a patient with acute appendicitis who underwent additional laparoscopic surgery after appendectomy for GCC and present review of the literature.

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  • Yusuke Taki, Ko Ohata, Satoshi Kato, Masakazu Takagi
    2018 Volume 43 Issue 6 Pages 1084-1088
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    A 28-year-old woman resident of a nursing home with mental retardation and a history of recurrent abdominal pain was transported to our hospital one morning with acute-onset of abdominal pain. Abdominal computed tomography showed type 2 cecal volvulus (loop type) and the patient was diagnosed as having Chilaiditi syndrome. Emergent laparoscopic surgery was performed. The wedged cecum between the liver and right diaphragm was released. The twisted ascending colon was rotated 180 degrees counterclockwise and the torsion was released. The intestine showed no signs of necrosis. We fixed the ascending colon to the right lateral abdominal wall with seven stitches. The postoperative course was uneventful. Until over 2 years after the surgery, the patient showed no recurrence of the condition. Provided the condition of the intestine is assessed carefully, laparoscopic cecopexy may be considered as a useful procedure for cecal volvulus without intestinal necrosis.

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  • Hiroki Nakamoto, Takahisa Ishikawa, Ryouji Yokoyama, Makoto Nishikawa, ...
    2018 Volume 43 Issue 6 Pages 1089-1095
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    A 79-year-old woman who had undergone laparoscopic right hemicolectomy for ascending colon cancer 2 years earlier was admitted to our hospital. Histopathology revealed a T4b(SI, retroperitoneal)N0M0 stageⅡtumor, with vascular invasion (v2). She was administered 8 courses of Xeloda after the surgery. A follow-up CT performed 2 years after the surgery showed an irregular mass in the uterine body showing ring enhancement, and a mass in the pelvic floor. FDG-PET showed increased uptake by both the mass in the uterine body and that in the pelvic floor. We suspected the lesions as being metastases from ascending colon cancer, or as a primary tumor of the uterus with seeding. Extensive total hysterectomy and excision of the mass in the pelvic floor were performed. The mass was in the retroperitoneal region beyond the peritoneum reversing section . Pathological examination revealed that both the masses in the uterine body and retroperitoneal were metastases from ascending colon cancer. At present, 20 days since the surgery, the patient has shown a favorable course. We report this case, as metachronous metastases from the ascending colon cancer to the uterine body and retroperitoneum are rare.

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  • Hiroki Nakamoto, Takahisa Ishikawa, Ryouzi Yokoyama, Makoto Nishikawa, ...
    2018 Volume 43 Issue 6 Pages 1096-1101
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    A 79-year-old man underwent laparoscopic sigmoidectomy for sigmoid colon cancer 4 years ago. Pathological findings were moderately differentiated tubular adenocarcinoma, T4 (SI, abdominal wall), N0, M0, Stage Ⅱ, and ly1, v2. He received internal administration of 8 courses of capecitabine after surgery. CEA levels gradually increased from 1 year and 3 months after surgery, so CT and FDG-PET were conducted 1.5 years after surgery, but no visible lesions were observed. 4 months later, CT showed multiple splenic tumors and a nodule in the area near the lower spleen; they were suspected of being multiple splenic metastases and peritoneal dissemination or accessory splenic metastases. Splenectomy and nodectomy were conducted. Pathological findings showed that the splenic tumors and nodules were sigmoid colon cancer metastases. Splenic tumors invaded the splenic capsule, so the nodule near the lower spleen was suspected as a disseminated lesion from the splenic tumors. Systemic chemotherapy was administered after surgery, but a new nodule was observed in the peritoneum in the area near the spleen 1 year after surgery. He was diagnosed with peritoneal recurrence. Chemotherapy was continued, and the disease condition was maintained under control.

    As in this case, splenic metastatic lesions, which invade the splenic capsule and result in peritoneal dissemination, can appear and develop rapidly after colon cancer surgery, so we must pay attention to this.

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  • Ryuta Taniguchi, Noritaka Minagawa, Koji Onitsuka, Yoshitaka Sakamoto
    2018 Volume 43 Issue 6 Pages 1102-1105
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    A 37-year-old woman presented to our hospital with jaundice. Clinical results were as follow: serum total bilirubin concentration, 16 mg/dL; serum direct bilirubin, 13 mg/dL; serum alkaline phosphatase, 1,781 IU/L; and γ-glutamyltranspeptidase, 399 IU/L. Abdominal computed tomography (CT) revealed expansion from the common bile duct to the intrahepatic bile ducts of both hepatic lobes and a solid tumor in a multilocular cyst of the left hepatic lobe with neighboring lymphadenopathy. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography revealed choledocholithiasis in the lower bile duct. The biliary cytology was class I. The multilocular cyst was reduced in size after biliary drainage, but CT revealed a residual solid tumor with a contrasting effect. These findings indicated a intraductal papillary neoplasm of the bile duct (IPNB) or cholangiocarcinoma. Left lobectomy with lymph nodes dissection was performed. Pathological findings indicated no neoplastic lesion in the expanded bile duct; however xanthogranulomatous inflammation throughout the neighboring fat tissue was observed. These results indicated, xanthogranulomatous cholangitis (XGC), which is rare. Reports suggest that differentiation between cholangiocarcinoma and bile duct stenosis is needed because of xanthogranulomatous cholecystitis. In our case, XGC occurred in the intrahepatic bile duct and required differentiation from IPNB.

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  • Daisuke Yagi, Yasuaki Hattori, Motoki Sugano, Yoshikazu Takinami
    2018 Volume 43 Issue 6 Pages 1106-1110
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    Bleeding from a pseudoaneurysm after pancreaticoduodenectomy (PD) is one of the fatal complications of this procedure. Bleeding frequently occurs from the stump of the resected gastroduodenal artery, and first line treatment is transcatheter embolization of the hepatic artery, but with the interruption of blood flow through the hepatic artery, there is a risk of liver failure and liver abscess. In recent years, covered stents, which allow for hemostasis while maintaining hepatic blood flow, have come into use.

    In this case, upon identifying sentinel bleeding from a pancreatic fistula after PD, we placed a covered stent in the common hepatic artery, which we believe prevented massive hemorrhage. We think that anticipation of arterial rupture upon detecting the pancreatic fistula, frequent evaluation of the patient and monitoring of the drain, and close communication with the interventionalist performing catheterization were crucial to favorable outcome in this case.

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  • Mikihiro Nakayama, Motoji Fukasawa, Tomoyuki Ohta
    2018 Volume 43 Issue 6 Pages 1111-1115
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    We report a case of biliary tract visualization using near-infrared imaging with indocyanine green (ICG) injected into a percutaneous transhepatic gallbladder drainage (PTGBD) catheter during laparoscopic cholecystectomy (LapC). An 86-year-old male was diagnosed with Tokyo Guideline 2013 Grade 2 acute cholecystitis. We inserted a PTGBD catheter in the patient during the first hospital day because a lack of personnel made emergency surgery impossible. After hospital day 14, we performed a LapC. We injected ICG directly into the PTGBD catheter before the dissection. The cystic duct and common bile duct were clearly visualized using near-infrared imaging, and we were able to avoid biliary tract injury. Near-infrared imaging with ICG injected into the PTGBD catheter improved the safety of LapC, and these image examinations can be performed more efficiently even in hospitals with few personnel, owing to the simplicity of the procedure.

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  • Hiroyuki Tsukayama, Yoshihiko Kadowaki, Ayako Watanabe, Kenji Hattori, ...
    2018 Volume 43 Issue 6 Pages 1116-1120
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    A man in his teens was admitted to our hospital after a Motor Vehicle Accident. Although initial abdominal CT showed slightly poor contrast enhancement in the head of pancreas, non operative management was performed because of no abdominal tenderness. Twelve hours after the accident, abdominal pain worsened, and fluid extravasation into the peritoneal and the retroperitoneal space around the pancreas head was obvious on repeat CT scan. We diagnosed a type Ⅲb pancreas injury by endoscopic retrograde pancreatography (ERP). Laparotomy was performed after we failed to place a stent in the main pancreatic duct. Saponification around the pancreas head, and a complete resection of the main pancreatic duct with injury of the pancreatic parenchyma at the level of the of the superior mesenteric vein (SMV) were found. After debridement around the injury, the proximal edge was simply closed and the distal side of the pancreas was anastomosed to the posterior wall of the stomach. Post-operative course was uneventful and the patient was discharged on POD 17. Our experience is that it is difficult to standardize surgical care for pancreatic trauma. Nevertheless, pancreasticogastrostomy is a simple and safe procedure for preserving the pancreas and the spleen.

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  • Kazuomi Suzuki, Wataru Izumo, Toru Teduka, Hideo Katsuragawa
    2018 Volume 43 Issue 6 Pages 1121-1128
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    The patient is a 50-year-old woman with pancreatic neuroendocrine tumor (pNET). She was scheduled to perform surgery for uterine cancer. The pancreatic tumor was detected on the preoperative examination. She had type2 diabetes mellitus, HbA1c 6.8%. CT showed an enhanced tumor, 35mm in diameter, in the pancreatic head and the absence of body and tail of the pancreas was detected. MRI showed a tumor, low intensity in T1 and high intensity in T2. Diffusion-weighted image revealed a high intensity tumor. EUS-FNA yielded a diagnosis of pNET G2. Based on the diagnosis of pNET G2 with agenesis of the pancreatic body and tail, we performed pylorus preserving total pancreatectomy with D2 lymphadenectomy. Resected specimen showed a solid tumor, 50mm in diameter, in the pancreatic head. Pathological findings showed chromogranineA (+), synaptophisin (+), and Ki-67 index 10%. She was given a diagnosis of the pNET G2, T2N0M0 Stage Ⅰb (AJCC/UICC TNM), non-functional. Two years after the surgery, there are no findings of recurrence and she is on a favorable course of nutrition and control of blood glucose.

    We experienced the surgical case of pNET with agenesis of the pancreatic body and tail. We report this case with some knowledge.

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  • Norimitsu Okui, Kikuo Aizawa, Fumitake Suzuki, Taro Sakamoto, Katsuhik ...
    2018 Volume 43 Issue 6 Pages 1129-1135
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    Primary splenic neoplasms are rare. We report a case of colonic obstruction due to invasion of the transverse colon by a splenic lymphoma. A 75-year-old man complaining of abdominal distension was admitted to our hospital. Computed tomography revealed colonic obstruction. Colonic stent placement was performed, but no findings suggestive of colon cancer were noted on colonoscopy. Further examinations revealed a primary splenic tumor invading the pancreatic tail, diaphragm and transverse colon. Splenectomy was performed in combination with partial colonic resection. Histologically, the splenic tumor was diagnosed as a diffuse large B-cell lymphoma. One month after the operation, the patient was diagnosed as having gastric and liver metastasis and was administered chemotherapy (R-CHOP). As of 6 months after the operation, the patient has been receiving chemotherapy.

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  • Tomoko Fukushima, Mari Nakagawa, Mizuki Takeuchi, Daichi Noda, Yukio T ...
    2018 Volume 43 Issue 6 Pages 1136-1142
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    A 68-year-old woman visited our hospital with left upper abdominal pain. Abdominal computed tomography showed a low-density mass in the spleen. Over a period of six months, the mass grew to 26 mm in diameter and another small lesion emerged next to the mass. FDP-PET also showed high FDG accumulation in the same area. We suspected that the tumors might be malignant and performed laparoscopic splenectomy. The histopathological diagnosis was inflammatory pseudotumor. Laparoscopic splenectomy has great benefits from both the cosmetic and therapeutic aspects. However, close attention should be paid to the handling of splenic tumors during operation, since we sometimes face difficulty in distinguishing between benign splenic tumors and malignant ones.

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  • Kenji Matsumoto, Yasuyuki Inoue, Mio Sakaguchi, Katsusuke Mori, Koji K ...
    2018 Volume 43 Issue 6 Pages 1143-1148
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    A 48-year-old woman was admitted to our hospital with hematochezia. Abdominal enhanced CT showed a right ovarian cystic teratoma penetrating the rectum. Colonoscopy revealed penetration of the rectum by the ovarian teratoma, and elective operation was performed. Bilateral salpingo-oophorectomy, total abdominal hysterectomy and low anterior resection were performed en bloc. Intraoperative frozen section examination showed a mature cystic teratoma. Mature cystic teratoma penetrating the rectum is rare. Intraoperative frozen-section diagnosis is necessary, because the extent of surgery depends on whether the lesion is benign or malignant.

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  • Yasushi Domeki, Junich Sugita, Haruyuki Tsuchiya, Shuhei Kawasaki, Yo ...
    2018 Volume 43 Issue 6 Pages 1149-1153
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    We report a case of lumbar hernia who underwent laparoscopic surgery with VENTRALIGHT ST and showed a good postoperative course. An 81-year-old obese woman who became aware of a tumor on the right side of her back that gradually extended to her abdominal wall after 5 surgeries, including a femoral replacement surgery, following a traffic accident in 2008 was admitted to our hospital. She was diagnosed as having superior lumbar hernia based on the findings of ultrasound and computed tomography. Her height was 151 cm, weight, 70 kg, and body mass index, 30.7 kg/m2. The operation was started with three ports and the approximately 6×5 cm hernia orifice was exposed. The patient’s position was changed to the left lateral decubitus position and an additional 5-mm port was made in the right lower quadrant. The hernia orifice was then covered with VENTRALIGHT ST, which was then fixed to the abdominal wall with Bard Sorbafix by the double crown method. After an uneventful postoperative course, the patient was discharged on the 8th day. Until 1 year post surgery, no recurrence was observed.

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  • Hiroaki Itakura, Katsuya Ohta, Masami Ueda, Yujiro Tsuda, Shinsuke Nak ...
    2018 Volume 43 Issue 6 Pages 1154-1160
    Published: 2018
    Released on J-STAGE: December 27, 2019
    JOURNAL FREE ACCESS

    The incidence of symptomatic Meckelʼs diverticulum is rare, particularly that of diverticular torsion is as low as 3.2%. Here we report a case of torsion of Meckelʼs diverticulum of the intestinal neck after an internal hernia because of a mesodiverticular band. A 19-year-old female was admitted with abdominal pain. Enhanced abdominal CT revealed a tumor with poor contrast effect in the right lower quadrant. Accordingly, we suspected an internal hernia or ileum obstruction. Follow-up CT after 8 h revealed an increase in ascites and attenuation of contrast effect. We performed an urgent laparoscopy because a strangulated ileum obstruction was observed. We found blood flow disturbance in the small intestine because of which we had to perform laparotomy. The tumor was an ileum diverticulum, with a cord between the mesenterium and diverticulum. The diverticulum had become necrotic because of 360° torsion with the neck. Finally, we diagnosed the ileum obstruction as a 360° torsion of Meckelʼs diverticulum, twisted by a mesodiverticular band. Axial torsion of Meckelʼs diverticulum by MDB is rare. In our case, it seemed that the preoperative diagnosis was feasible because preoperative CT findings exhibited Meckel diverticulum and MDB.

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