The Japanese Journal of Gastroenterological Surgery
Online ISSN : 1348-9372
Print ISSN : 0386-9768
ISSN-L : 0386-9768
Volume 32, Issue 5
Displaying 1-18 of 18 articles from this issue
  • Shigeyuki Takemura, Kiichi Miya, Hiroshi Takao, Takao Umemoto, Shigeto ...
    1999 Volume 32 Issue 5 Pages 1133-1141
    Published: 1999
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    Influence of Corticosteriod Preoperative Administration for Surgical Stress of the Esophageal Cancer Patients during Peri-and Post-operative Periods Shigeyuki Takemura, Kiichi Miya, Hiroshi Takao, Takao Umemoto and Shigetoyo Saji Second Department of Surgery, Gifu University, School of Medicine In terms of surgical stress during the peri-and postoperative periods, the influence of preoperative ad- ministration of methylpredonisolone (250mg/body) was investigated. Perticipants were esophageal cancer pa-tients divided into two groups: one group treated with steroid (S, n=9), and one group treated without ste-riod (C, n=9). The results showed that heart rate, body temperature, catecholamine dose and C-reactive pro-tein value were significantly lower in the S group than in the C group. Plasma levels of tumor necrosis factor-α, interleukin (IL)-1β, IL-6, IL-8were significantly decreased in the S group than in the C group. Although, the plasma level of IL-10showed significantly high value on day7after operation in the S group, and IL-12showed slightly high values in5cases in the C group on days3to7after operation. Evaluation by T lymphoid cell growth suppression assay showed that the host-immunosuppressive activity decreased slightly6to72hours after operation. Two cases in the S group showed minor signs of shock due to postoperative complications. The above results suggest that preoperative steroid administration can inhibit the hyperproduction of inflam-matory cytokines and reduce surgical stress, however host immuno-competency may decrease also3days af-ter surgery. Therefore, physicians should exercise coution in using this steroid in cases with residual cancer.
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  • Kenji Ohkubo
    1999 Volume 32 Issue 5 Pages 1142-1151
    Published: 1999
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    To elucidate the effect of continuous hyperthermic peritoneal perfusion (CHPP), 47 patients with gastric cancer in stage IVb without liver metastasis were evaluated using therapeutic parament such as adjuvant chemotherapy and clinicopathological paraments such as lymph node metastasis, peritoneal dissemination, p53 expression, vimentin expression and growth index (=%Ki67 index/%apoptosis index). Survival in pa-tients treated by CHPP have a higher tendency than that in patients treated by non-CHPP with adjuvant che-motherapy, without peritoneal dissemination and with p53 expression less than 70%(Cox-Mantel test P<0.05). But there was no significant difference of survival between in CHPP and in non-CHPP without adjuvant chemotherapy, with peritoneal dissemination and with p53 expression more than 70%. According to multi-variate analysis, peritoneal dissmination and p53 expression were determinant prognostic of gastric cancer, but CHPP was not.
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  • Akinori Takagane, Masanori Terashima, Hitoshi Yonezawa, Takashi Irinod ...
    1999 Volume 32 Issue 5 Pages 1152-1159
    Published: 1999
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    In order to identify risk factors of postoperative complications and prognostic factors in aged (75 years and older) resectable gastric cancer patients, the cases of 78 aged patients who underwent gastrectomy from 1986 to 1997 were analyzed by multivariate analyses. Volume of intraoperative bleeding (X1) and preoperative number of red blood cells (X2) were identified as significant risk factors for postoperative complications by logistic regression analysis. The discriminant function was as follows: Z=0.0011X1-0.0027X2+0.3342. Therefore, these findings indicate that it is possible to prevent postoperative complications by controlling intraoperative bleeding. Curability was identified as the most important prognostic factor in aged gastric cancer patients by Cox's proportional hazard model. These results suggest that operations aimed at curability A including D2 lymph node dissections can be done for aged patients who have favorable preoperative general conditions, although effort to minimize intraoperative bleeding is required.
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  • Masayuki Hirokawa, Ichiro Honda, Satoshi Watanabe, Yoshihiro Fujita
    1999 Volume 32 Issue 5 Pages 1160-1165
    Published: 1999
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    We treated 2642 patients with gastric cancer in Chiba Cancer Center. Of these patients, 152 (5.8%) had malignant neoplasma in other organs. There were 44 cases of synchronous cancers, 52 cases of metachronous cancers prior to gastric cancer (Prior group) and 56 cases of metachronous cancers after gastric cancer (Later group). The primary malignant neoplasmas associated with gastric cancers originated in the large bowel (36 cases), oral cavity & pharynx & larynx (21cases), kidney & urinary tract (15 cases) and other organs. Cancer of a digentive system organ was noted in the Synchronous and Prior group. The cumulative 5-year survival rates were 28.1% in the metachronous group, 79.4% in the Prior group and 52.3% in the Later group. The prognosis of early gastric cancer was worse in the Synchronous group and that of advanced gastric cancer was better in the Prior group. In order to investigate multiple primary cancers, it is necessary to classify multiple cancers by the duration beetween gastric cancer and malignant neoplasmas detected at other organs operations.
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  • Tadashi Katsuramaki, Koichi Hirata, Jun Araya, Takashi Matsuno, Minoru ...
    1999 Volume 32 Issue 5 Pages 1166-1172
    Published: 1999
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    The clinical significance of apolipoprotein B (apo B) as an indicator of liver function after hepatectomy was investigated. A total of 32 patients who had undergone hepatectomy in our department during January 1997 and June 1998 were selected for this study. Apo B, total bilirubin (T. bil), albumin, indocyanine green dye retention test at 15 min (ICG), lectin-cholesterol acyl transferase (LCAT), and prealbumin were measured in these patients at pre- and postoperation. The types of hepatic resection performed were partial resection, 6 cases; subsegmentectomy, 8 cases; segmentectomy, 4 cases; and bisegmentectomy, 14 cases. Operations were tolerated in all cases, and severe complications such as liver failure were not observed. No significant differences in changes of apo B between types of operation procedures were found. At postoperative day 7, apo B showed significant correlation with LCAT, prealbumin, and T. bil (r=0.847, r=0.665, r=-0.442), but showed no significant correlation with ICG or albumin. On the basis of these results, apo B was shown to be a good indicator for evaluation of liver function after hepatectomy.
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  • Shuji Suzuki, Tatsuya Yoshikawa, Tatsuo Araida, Tukasa Azuma, Takehito ...
    1999 Volume 32 Issue 5 Pages 1173-1178
    Published: 1999
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    Since 1990, percutaneous transhepatic portal embolization (PTPE) has been performed for patients with biliary tract carcinoma as a safety and extension of surgical indications. In three patients with gallbladder carcinoma and three with biliary carcinoma we studied on following issues. Computed tomography was performed to estimate the remnant liver volume before and after PTPE. As for liver functions, prealbumin, retinol binding protein, transferrin, lipid peroxide, oxygen saturation, ammonia and endotoxin in the bilateral hepatic and portal veins were investigated. The estimated remnant liver volume increased 27.8±5.2%. Rapid turnover proteins showed no changes by to PTPE. A little acceleration of ammonia and deceleration of endotoxin were observed in the unembolized lobe. Especially serum endotoxin levels and the volume change of the remnant liver showed a productmoment correlation. Therefore, the reticuloendothelium system of the liver in the unembolized lobe is assumed to be accelerated after PTPE.
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  • Yuichirou Sakamoto, Akihiro Iyama, Seiji Sato, Kohji Miyazaki
    1999 Volume 32 Issue 5 Pages 1179-1183
    Published: 1999
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    We have experienced 35 surgical cases of strangulated small bowel obstruction and 41 surgical cases of adhesive small bowel obstruction in the past 16 years. Retrospective investigation was conducted in these cases to determine the usefulness of the presence of systemic inflammatory response syndrome (SIRS) as an indication for emergent operation. Twenty-five of the 35 patients with strangulated small bowel obstruction manifested SIRS during admission and before operation. All 35 patients were divided into three groups: with SIRS on admission (group A), shifted to SIRS during admission before operation (group B), without SIRS throughout preoperative admission (group C). We also investigated the presence and length of intestinal necrosis. Finally, we compared this data with that of the patients with adhesive small bowel obstruction. Extensive intestinal necrosis was found at operation in 94.7% of the patients in group A, and the average length was 120cm. Intestinal necrosis was found in 66.7% of the patients in group B, whereas only 30% of the patients in group C was found to have intestinal necrosis at operation, and the average length was 24cm. On the other hand, only 2.3% of the patients with adhesive bowel obstruction manifested SIRS on admission. Thus, the presence of SIRS in patients with bowel obstruction may be a diagnostic clue for determing whether the obstruction is strangulated or adhesive, and the presence of SIRS may well be correlated to the length of intestinal necrosis.
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  • Shiro Nakae, Yoshio Ishikawa, Tetsuya Kuniyasu, Muneharu Konishi, Kuni ...
    1999 Volume 32 Issue 5 Pages 1184-1191
    Published: 1999
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    Among patients with colorectal cancer who underwent resection during the last 15 years, 101 cases were detected by positive fecal occult blood tests (occult blood group) and 578 cases were detected by symptoms (symptomatic group). The number of cases in the occult blood broup has increased, but that of the symptomatic group has remained at the same level for the last six years. In the symptomatic group, the incidence of early or mp cancer tended to be lower in right-sided colon (right-sided colon 8.5%, left-sided colon 17.1%, rectum 35.9%). However, in the occult blood group, the incidence of early or mp cancer was more than 50% for all tumor locations. In the early and mp cancer, the ratio of occult blood group tended to be higher in the rightsided colon than in the left-sided colon or in the rectum. These results suggest that the fecal occult blood test can be useful in screening for early detection of right-sided colon cancer.
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  • Nozomi Shinozuka, Isamu Koyama, Yoshitaka Suzuki, Tsunenori Arai, Yosh ...
    1999 Volume 32 Issue 5 Pages 1192-1197
    Published: 1999
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    To evaluate the efficacy of recombinant human erythropoietin (r-HuEPO) for gastrointestinal cancer surgery, we performed preoperative blood donation in 31 patients (3 with esophageal cancer, 5 with gastric cancer, 9 with liver cancer, 4 with pancreatic cancer, 3 with biliary tract cancer, 2 with colon cancer, 5 with rectal cancer), who were to undergo elective surgery. These patients were divided into two groups by r-HuEPO administration methods. Fifteen patients with hemoglobin concentrations under 13.0g/dl received r-HuEPO administration subcutaneously before autologous blood donation and on the same day of autologous blood donation (pre EPO (+) group). Sixteen patients with hemoglobin concentrations more than 13.0g/dl received r-HuEPO administration once a week without pre r-HuEPO (pre EPO (-) group). In the pre EPO (+) group, initial hemoglobin concentrations were 11.9±1.0g/dl and increased to 12.6±1.3g/dl, indicating a significant increase. The amount of donated autologous blood in the pre EPO (+) group and the pre EPO (-) group were 914±195ml, 1, 040±219ml. This study indicates the safety of autologous blood donation and the effectiveness of rh-EPO administration before autologous blood donation in anemic patients with gastrointestinal cancer.
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  • Akira Igarashi, Koichi Okuda, Makoto Nishiwaki, Kazuyuki Tsujitsuka, T ...
    1999 Volume 32 Issue 5 Pages 1198-1202
    Published: 1999
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    A 69-yaer-old woman visited a practitioner with a complaint of upper abdominal discomfort and was referred to our hospital. Upper gastrointestinal roentgenographic and endoscopic examinations revealed an elevated tumor at the esophagocardiac junction. Total gastrectomy and splenectomy were performed and resection of the pancreas tail was added. Histopathological diagnosis of the resected tumor (7.0×7.5cm) was small cell carcinoma of the stomach. Although, no metastasis was found, sarcoid reactions comprised of epithelioid cells and giant cells observed in the regional lymph nodes. Sarcoid reaction is often found in the regional lymph nodes of various malignant tumors, but reports of sarcoid reaction in the spleen are few. The prognosis of small cell carcinoma of stomach is poor. On the other hand, sarcoid reaction is usually considered to indicate good prognosis. We report a case of small cell carcinoma of the stomach, which coexists with sarcoid reaction in the spleen.
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  • Hiroyuki Nishi, Masaaki Nakahara, Nobuo Ogino, Kazuyasu Nakao, Chon-Ma ...
    1999 Volume 32 Issue 5 Pages 1203-1207
    Published: 1999
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    We report a case of chylothorax following resection of esophageal carcinoma which was successfully treated with pleurodesis. A 62-year-old man was admitted to our hospital because of middle intrathoracic esophageal carcinoma. He underwent right thoracolaparotomy, esophagectomy, lymph node dissection, pylo-roplasty and intrathoracic anastomosis. On and after the 1st postoperative day, more than 1, 400-2, 000 ml.day of drainage continued through a chest tube. On the 10th day, the effusion became milky after oralinges-tion of ice-cream. Lymphangiography showed an interruption of the medium flow at the level of Th10. So, we made a diagnosis of chylothorax. Conservative treatment with total parenteral nutrition and supplement of al-bumin did not decrease the volume of drainage. Therefore, pleurodesis with intrapleural infusion of OK-432 10KE and minocyclin 200mg was carried ous for 3 days beginning on the 13th postoperative day. The treat-ment resulsed in a marked decrease in the drainage, and the chest tube was removed on the 18th day. The pleural effusion was almost resolved by the 55th day, and no symptoms such as dyspnea and chest pain were observed. We reviewed four cases of pleurodesis for chylothorax after resection of esophageal carcinoma. All the cases were treated successfully
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  • Masanori Matsuda, Hideki Fujii, Masatoshi Mogaki, Yoshiro Matsumoto
    1999 Volume 32 Issue 5 Pages 1208-1212
    Published: 1999
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    A 44-year-old man was admitted to our hospital because of hepatic tumor detected by ultrasonography during follow-up for chronic hepatitis B. In January 1995, he underwent right lobectomy of the liver for a tu-mor 6.0cm in diameter and with a diagnosis of hepatocellular carcinoma (HCC). The resected specimen showed moderately differentiated HCC with capsular infiltration and satellite nodules around the main tumor. He received hepatic arterial infusion chemotherapy. In March 1996, 2 recurrent HCC nodules were detected in the medial and lateral segments of the liver. Microwave coagulation therapy under laparotomy was per-formed. Computed tomography (CT) in August 1996 revealed multiple recurrent tumors in the left lobe of the liver and a tumor embolus in the middle hepatic vein which extended to the inferior vena cava. After October10, he developed grade I to II hepatic coma. CT showed the tumor embolus in the middle hepatic vein now ex-tended to the right atrium. Low density in the lateral segment suggested congestion. His hepatic failure pro-gressed very rapidly after that and he died on October 29. Autopsy revealed congestive hepatic necrosis in the lateral segment of the liver caused by an out flow obstruction of the left hepatic vein orifice by the tumor embolus extending from middle hepatic vein. We speculated that the rapidly progressing hepatic failure was due to this secondary Budd-Chiari syndrome.
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  • Ei Sekoguchi, Kenji Tsuchie, Hiroshi Kuriki, Kenji Sakaguchi, Eiji Hay ...
    1999 Volume 32 Issue 5 Pages 1213-1216
    Published: 1999
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    A 48-year-old woman, who had occasional right hypochondralgia for one year, consulted a local medical doctor. Abdominal ultrasonography was performed and showed dilatation of the common bile bile duct. There after, she was referred to our hospital, where endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography were performed. A diagnosis of congenital dilatation of bile duct was made, but pancreaticobiliary maljunction was uncertain. Resection of the dilated bile duct was carried out. To determine the cut end of the distal bile duct, intraoperative cholangiography was performed, and showed no sign of pancreaticobiliary maljunction. The level of amylase value in bile juice of the bile duct was normal as 32IU/l.This case is an interesting example of the relationship between congenital dilatation of bile duct and pancreaticobiliary maljunction.
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  • Yoshito Kuroki, Syunyou Otagiri, Takashi Sakamoto, Kazuhiro Tsukada
    1999 Volume 32 Issue 5 Pages 1217-1221
    Published: 1999
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    A diagnosis of bile duct carcinoma is difficult to make in the early stage before the onset of jaundice. We report here, a patient with carcinoma in the mucosal layer of the bile duct, who was without jaundice, and who was diagnosed in the early stage. The patient was a 72-year-old woman who was admitted to our hospital because of a burn that occurred in her home. She exhibited liver dysfunction (elevation of GOT, GPT, ALP andγ-GTP) but without jaundice. Ultrasonography and computed tomography showed dilatation of the bile duct and a mass in the lower third portion of the extrahepatic bile duct. Endoscopic retrograde cholangiography revealed a 4.5 cm filling defect in the bile duct, and magnetic resonance cholangiography showed similar findings. Subsequently, pylorus-preserving pancreato-duodenectomy was performed. Pathological analysis revealed 2 papillary tumors (12×12 mm, and 18×9 mm in size) in the bile duct, which were characterized as papillary adenocarcinoma located in the mucosal layer with no lymph node metastasis (Bi, pap, m, hinf0, ginf0, panc0, du0, pv0, a0, n (-), stage I). The patient has been well for 17 months after surgery without recurrence.
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  • Masahiro Hirose, Tomomi Yokota, Atsurou Sugita, Shinichi Murao, Kanji ...
    1999 Volume 32 Issue 5 Pages 1222-1226
    Published: 1999
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    We report a case of intestinal Behcet's disease treated only by simple closure of perforated lesions in the cecum and the ascending colon. A 26-year-old man had suffered from fever and sore throat since February 20, 1995. Four days later he was admitted to our hospital with an oral aphtoid ulcer and skin eruptions at his chest. On the fifth day after admission he suddenly complained of right lower abdominal pain. The next day an emergency operation was carried out under a diagnosis of bowel perforation. There were two perforated lesions in the cecum and the ascending colon. We resected the lesions and closed them by simple suturing. Histologically nonspecific inflammatory infiltrations were noted in the neighborhood of the perforated ulcers, so called “punched out”. This was diagnosed as intestinal Behcet's disease because of the presence of abovedetailed clinical findings, iritis and positive HLAB-51. His postoperative recovery was uneventful without hyperalimentation therapy, and he was discharged on the 49th postoperative day. Surgical procedures are absolutely indicated in cases of the intestinal Behcet's disease with perforated lesions. Right hemicolectomy (resection of the ileum more than 1 meter from Bauhin's valve) and a hyperalimentation therapy are usual methods of treatment. However, in our case, only simple closure of the perforated lesions was performed and the patient's recovery was much better than the reported cases with conventional treatments
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  • Tetsunobu Udaka, Kenzo Hori, Takashi Andou, Kazuhiro Tsuji, Hidenobu M ...
    1999 Volume 32 Issue 5 Pages 1227-1230
    Published: 1999
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    Hepatic portal venous gas occurs in a variety of digestive diseases, and demonstrates a poor prognosis. A successfully treated case of pneumatosis coli with hepatic portal venous gas is reported. A 75-year-old woman was admitted to our hospital complaining of a sudden onset of abdominal pain. Abdominal CT showed dilated peripheral distribution of air in the hepatic portal vein and emphysema in the wall of the caecum, ascending colon and transverse colon. We made a diagnosis of pneumatosis coli with hepatic portal venous gas. Due to an increase in abdominal pain, an emergent laparotomy was performed 12 hours after onset. Pneumotosis was detected in the wall of the caecum, ascending colon and transverse colon. Right hemicolectomy with ileostomy and transverse colostomy were performed. After an uneventful recovery from surgery, closure of the ileostomy and transverse colostomy was performed with side-to-side, ileo-transverse colostomy. The postoperative course was uneventful and the patient was discharged on the 79th day after initial surgery.
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  • Tomoki Ebata, Kanji Miyata, Tatsuo Hattori, Youichiro Kobayashi, Makot ...
    1999 Volume 32 Issue 5 Pages 1231-1234
    Published: 1999
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    We report three cases with diagnoses of hepatic falciform arteries (HFA). Based on 156 celiac angi-ograms, the incidence of the HFA was 1.9%. If possible, the HFA should be occuluded before intraarterial in-fusion therapy. Case 1. Angiogram performed because of hepatic metastasis from breast cancer demonstrated the HFA arising from the left hepatic artery. CT arteriography further revealed that the HFA ran just under the rectus abdominis muscle toward the umbilicus after originating from the ramus of the medial and the lateroanterior branches. Case 2. Angiogram performed because of hepatic metastasis from small intestinal leiomyosarcoma showed the HFA following a caudal course from the middle hepatic artery. Selective angi-ogram visualized a communication to the deep epigastric artery. The HFA was occuluded before intraarterial chemotherapy infusion. Case 3. Angiogram performed because of gallbladder cancer revealed the HFA aris-ing from the middle hepatic artery. The falciform ligament and round ligament were removed. Histopathologi-cal examination revealed an artery, 1mm in diameter, with thick adventitia.
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  • Takaaki Yamamoto, Shigeyuki Kawachi, Hideyuki Kawahara, Masahiro Hamay ...
    1999 Volume 32 Issue 5 Pages 1235-1239
    Published: 1999
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    A 65-year-old woman was admitted to our hospital because of repeated tarry stools. Upper and lower in-testinal examination, including panendoscopy, upper gastrointestinal series, small intestinal x-ray, barium en-ema and colonoscopy, revealed no source of bleeding. A superior mesenteric arteriogram demonstrated a di-lated draining vein from early arterial phase to late vonous phase, leading to the diagnosis of arteriovenous malformation (AVM). A microcoil was placed within the artery near the AVM lesion as a marker by the se-lective angiography technique in order to identify the lesion during surgery. The operation was started under laparoscopy. Since the laparoscopy did not enable us to find the lesion, an intraoperative fluoroscope was in-troduced. With the assistance of the laparoscopy, the lesion bearing jejunum, 33cm in length, was pulled out of the abdomen through the minilaparotomy and resected. Gross observation of the resected specimen re-vealed a circular brownish discolored area measuring 5 cm in length. Histological examination demonstratedthe dilated vessels mainly in the submucosal layer. The postoperative course was uneventful and she was dis-charged from the hospital on the 11th postoperative day. We concluded that the laparoscopic surgery com-bined with the angiographic technique of placing a microcoil is one of the effective strategies for the treat-ment of intestinal AVM.
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