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Volume 33, Issue 11
Displaying 1-17 of 17 articles from this issue
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Kazushige Shibahara, Kaeko Oyama, Yoshihiko Arano, Masatoshi Sasaki2000 Volume 33 Issue 11 Pages 1795-1798
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 68 year-old man was admitted to our hospital because of tarry stools. The patient had received a total gastrectomy with Roux-Y reconstruction for early gastric cancer (C, I, 2.0×2.0cm, tub2, sm, ly1, v0, dw (-), pw (-), n (-), Stage IA) 18 years previously. The patient had also under gone a partial transverse colectomy for early colon cancer (T, IIc, 2×2.5cm, well, sm, ly1, v0, ow (-), aw (-), n (-), H0, M0, Stage I). Tarry stools and anemia were first noticed in September 1999. A gastrointestinal X-ray examination revealed an apple core sign in the 3rd portion of the duodenum. The patient was diagnosed with a duodenal tumor, and an operation was performed in November 1999. The tumor was located in the 3rd portion of the duodenum, 2 cm proximal to the Treitz ligamentum. A partial duodenectomy was performed. No signs of liver or lymph node metastases were seen. The resected specimen was a type1 tumor that had invaded to the subserosal layer. The histological diagnosis was a well-differentiated tubular adenocarcinoma (well, ss, ly0, v0, ow (-), aw (-), ew (-), n (-)). The tumor was diagnosed as a primary duodenal carcinoma.
Examination of the afferent loop is necessary, if gastrointestinal bleeding occurs after a total gastrectomy with Roux-Y reconstruction.View full abstractDownload PDF (69K) -
Tsunehiko Morita, Yoshinobu Hata, Tadashi Matsuhisa, Kunihiko Manabe, ...2000 Volume 33 Issue 11 Pages 1799-1801
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 43-year-old women undergoing pylorus-preserving gastrectomy (PPG) for an early gastric cancer was admitted to our institute 20 months later for abdominal pain and vomiting. We operated for an intestinal obstruction encountering a bezoar 4.2×2.5×2.3cm in size, which we removed through an ileotomy. The bezoar consisted of 98% tannin acid, apparently due to persimmons. This is, we believe, the first report of bezoar occoure following PPG.View full abstractDownload PDF (61K) -
Masayuki Okido, Masato Kato, Takashi Matsuura, Hitoshi Ichimiya, Mitsu ...2000 Volume 33 Issue 11 Pages 1802-1805
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSMyxoid changes in the stomach are extremely rare. We report a case of solitary gastric gland heterotopia with myxoid change associated with submucosal tumor. A 54-year-old man admitted to hospital to investigate an elevated gastric lesion undergoing an upper gastrointestinal series and gastroendoscopic examinations was found to have a gently elevated lesion with a shallow depression on the surface of the posterior wall of the upper gastric body. Macroscopic findings of the resected sample showed a well-defined jelly-like mass in the submucosal layer. Microscopic findings showed myxoid tissue, confined to the submucosa, surrounded by cystically dilated heterotopic glands. Pathogenesis is unknown but may be associated with repeated inflammatory change in mucosa. No reports have been made, to our knowledge, on myxoid change in the heterotopic gland, making our case of particular pathological interest. Such unique lesions should thus be considered when diagnosing submucosal gastric tumors.View full abstractDownload PDF (102K) -
Takumi Shimomatsuya, Kazuhiro Maruhashi, Hisashi Sasaki, Yuto Oh, Naok ...2000 Volume 33 Issue 11 Pages 1806-1810
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of early gastric cancer with diffuse bone metastasis, which was diagnosed after resection of bilateral ovarian tumors. A 42-year-old woman underwent bilateral oophorectomy. Histological examination revealed signet-ring cell carcinoma. Endoscopy disclosed a IIc lesion on the upper body of the stomach. Bone scintigram showed diffuse metastasis. Just after systemic chemotherapy (MTX-5FU) was started, gastric hemorrhage was found. Emergent endoscopy detected bleeding similar to Dieulafoy's type ulcer. Although the bleeding was stopped by endoscopic clipping, rebleeding occurred and emergency surgery was performed. Histological findings of the resected stomach revealed early gastric cancer (sm1) without lymph node metastasis. Needle bone biopsy also revealed signet-ring cell carcinoma. Also, the platelet count was decreasing and ALP was increasing gradually. As DIC was diagnosed, systemic chemotherapy was restarted and FOY was administered. Two months later, the patient died of subdural hematoma.View full abstractDownload PDF (118K) -
Yuuki Takeuchi, Masahiro Suenaga, Jyunichi Tobinaga, Toyohiko Uchida, ...2000 Volume 33 Issue 11 Pages 1811-1815
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe encountered two cases of liver cirrhosis requiring distal gastrectomy for gastric cancers after terminal esophagoproximal gastrectomy (TEPG) with extensive devascuralization and splenectomy for esophageal varices. One patient was a 61-year-old woman who had undergone TEPG for esophageal varices 17 years before and was detected to have early gastric cancer in the lower third of the stomach by gastrointestinal endoscopic examination (0-IIa+IIc, T1N0M0 Stage IA). The other patient was a 71-year-woman who had undergone TEPG for esophageal varices two years before and was detected to have gastric cancer in the middle third of the stomach (3, T2N0M0 Stage IB). In both cases, we successfully performed distal gastrectomy and lymph node dissection without operative complications probably because of the preservation of sufficient blood supply to the remaining stomach as indicated by preoperative angiography. Both cases are alive five years and more after their operation without any evidence of recurrence of the gastric cancer. This surgical procedure may be recommended for liver cirrhosis patients with gastric cancer developing after TEPG in order to decrease the operative mortality and morbidity.View full abstractDownload PDF (110K) -
Dai Shida, Fuyo Yoshimi, Yukiyo Ogata, Yuji Asato, Jirou Shimazaki, Ma ...2000 Volume 33 Issue 11 Pages 1816-1820
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWhile inguinal hernia is one of the most common diseases, and neoplasms of any organs are seen with great frequency, combinations of the two, i.e., hernial tumors are rare. A case of cholangiocarcinoma with metastasis to an inguinal hernial sac is reported. A 72-year-old Japanese man was admitted with a left inguinal hernia of 3 years' duration. His health was otherwise generally good. Herniorrhaphy was performed, and the redundant hernial sac was excised. The gross hernial sac specimen contained two tiny, white nodule-like thickened areas, and histological examination revealed an unexpected adenocarcinoma. After further examination, a diagnosis of cholangiocarcinoma with peritonitis carcinomatosa was made. Tumors of saccular type herniae are rare, and according to the results of a search of the English and Japanese literature, this is the first report of a case of cholangiocarcinoma that metastasized to an inguinal hernial sac.View full abstractDownload PDF (73K) -
Osamu Teshigahara, Masahiro Suenaga, Yuuki Takeuchi, Hiroteru Hayakawa ...2000 Volume 33 Issue 11 Pages 1821-1825
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of an intrapancreatic accessory spleen indistinguishable preoperatively from nonfunctional islet cell tumor. A 53-year-old woman, treated for chronic hepatitis, was found to have a mass lesion in the tail of the pancreas in the early phase of the enhanced computed tomography. Abdominal ultrasonography showed a low-echoic mass 2 cm in diameter. Splenic arteriography showed a hypervascular stain fed by a branch of the great pancreatic artery. Endoscopic retrograde pancreatography showed a normal pancreatic duct. Duodenoscopy showed normal Vater papilla. Resection of the pancreatic tail and spleen showed accessory spleens in the tail of the pancreas.View full abstractDownload PDF (122K) -
Takashi Tsuchiya, Syun Sato, Fumie Ikezawa, Fumito Saijo, Hideaki Koda ...2000 Volume 33 Issue 11 Pages 1826-1830
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 52-year-old female who presented with abdominal pain had undergone laparotomy at another hospital and been diagnosed as having a tumor of the IVC. She underwent reoperation at our hospital. The tumor arose from the IVC wall and extended into the right renal vein. The IVC patency was maintained. First, the right renal vein was anastomosed to the IVC using an autologous graft (saphenous vein), and then the tumor was completely resected along with a segment of the IVC wall. The IVC was reconstructed using an EPTFE graft. During the IVC resection and reconstruction, the IVC was clamped for 43 min. without any bypass. No remarkable changes in blood pressure or congestion were observed. The postoperative course was uneventful and the patient was discharged on the 18th postoperative day.
Histological diagnosis was leiomyosarcoma of the IVC. Six months later, the patency of the IVC graft was still maintained. In Japan, ours is the 53th case report, and the 12th with resection and reconstruction of the IVC.View full abstractDownload PDF (83K) -
Takenori Hada, Shuzo Kohno, Yutaka Oda, Isao Kobayashi, Masahiro Ikega ...2000 Volume 33 Issue 11 Pages 1831-1834
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 52-year-old man presented with epigastralgia in April 1998. Barium examination of the small intestine and colonoscopy revealed short and long segmental stenosis in the ileum. Surgery was performed, as conservative therapy was not effective. The surgical procedure employed was stricturoplasty for the short stenosis and resection for the long one. Macroscopic examination of the resected intestine revealed a tubular and concentric stenosis, annular and segmental ulcers and thickness of the wall. Microscopic examination revealed Ul-II ulcers with inflammatory cell infiltration, and fibrosis, mainly in the submucosal layer. The diagnosis of ischemic enteritis was made. Ischemic enteritis is a rare condition. Forty cases have been reported in the Japanese literature. Resection is the procedure of choice for ischemic enteritis. However, the successful treatment in this case suggests that stricturoplasty is an acceptable procedure for short segmental stenosis caused by ischemic enteritis.View full abstractDownload PDF (86K) -
Hiroshi Yajima, Yoshiyuki Hoya, Kazuo Matai, Syuzo Kohno, Yutaka Oda, ...2000 Volume 33 Issue 11 Pages 1835-1838
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of jejunal mesenteric pseudocyst. The patient was a 31-year-old woman who was found to have microhematuria during a routine check-up. She visited the Department of Medicine at our hospital. An abdominal mass was found during an ultrasonography examination, and the patient was referred to our department for further examination and possible surgery. Computed tomography showed an intra-abdominal cyst. The preoperative diagnosis was dermoid cyst, and a cystectomy by laparotomy was performed. The cyst had originated from the mesentery of the jejunum. The surface of the 4-cm-diameter cyst was white, smooth, and hard. The unilocular cyst contained a cloudy yellow fluid. Microscopically, the wall of the cyst was composed of a thick, fibrous tissue, lymph follicles, and hyalinization. The cyst lacked an epithelial lining. These findings suggest that the cyst was a pseudocyst arising from fat necrosis of the jejunal mesentery. Pseudocysts of the mesentery are rare, and only 13 cases, including the present case, have been reported in Japan.View full abstractDownload PDF (81K) -
Masanobu Hyodo, Chuuji Sekiguti, Munetoshi Tsukahara, Hideo Nagai2000 Volume 33 Issue 11 Pages 1839-1843
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of colonic penetration caused by a transanal decompression tube in a transverse colon cancer patient. A 70-year-old male presented with colonic obstruction due to advanced transverse colon cancer at the site of the splenic flexure. Following failure to alleviate the intestinal obstruction with a long nasointestinal tube, we introduced a transanal decompression tube via a colonoscope. Despite the insertion of the tube through the colonic stenosis being uneventful, the patient developed fever and abdominal pain 4 days after the insertion of the tube. A plain abdominal X-ray and CT suggested penetration of the transanal decompression tube into the mesentery proximal to the stenosis caused by the tumor. The penetration-related local inflammation subsided with conservative therapy with antibiotics and cessation of continuous suction. A radical operation was performed 19 days after the insertion of the transanal decompression tube. The cause of the perforation was thought to be the rapid decompression and continuous suction. It is true that a transanal decompression tube is very useful in the management of colonic obstruction due to advanced colon cancer, but we should bear in mind the possible injury associated with the insertion of the tube, not only at the time of insertion but also several days after the insertion.View full abstractDownload PDF (82K) -
Seiji Ito, Takashi Hirai, Tomoyuki Kato2000 Volume 33 Issue 11 Pages 1844-1848
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTwo cases of mucinous carcinoma are reported which developed below the mucosal layer after local resections of a rectal adenoma and in situ adenocarcinoma. Case 1: A patient with a rectal polyp underwent endoscopic resection of the polyp. The polyp recurred, and it was then resected by a trans-sacral procedure. Pathological examination of the tumor on both occasions revealed a tubulovillous adenoma. Two years and 3 months later, a submucosal tumor which developed at the same site was locally resected. Pathological examination this time revealed a mucinous carcinoma in the submucosa, hence a low anterior resection was performed in addition. Case 2: The patient had undergone transsacral resection of in situ adenocarcinoma of the rectum. Three months later, the rectal polyp recurred and was resected by a trans-anal procedure. The pathological diagnosis was villous adenoma. Subsequently, the polyps recurred three times and were resected endoscopically, but the pathological diagnosis each time was adenoma with either mild or moderate atypia. The rectal polyp recurred yet again, but this time a submucosal tumor was suspected from digital examination and endoscopic ultrasonography (EUS). Since incisional biopsy of the tumor revealed an adenoma in the mucosal layer and mucinous carcinoma in the submucosal layer, an abdominoperineal resection was performed. Thus, while following up patients after trans-sacral resection of rectal neoplasms, it is important to be on the lookout for such a submucosal recurrence.View full abstractDownload PDF (95K) -
Kunio Takeuchi, Tetsu Ando, Masao Sekihara, Takashi Hara, Minako Yoshi ...2000 Volume 33 Issue 11 Pages 1849-1853
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 60-year-old male was admitted with melena. Colonoscopy revealed a I sp lesion in the posterior wall of the lower rectum and an SMT-like lesion immediately proximal to it. The serum CEA level was 128.5 ng/ml. Miles operation was performed. The I sp tumor was 25×20 mm in size and the SMT-like lesion was 60×40×30 mm in size. Histological examination of the resected specimen showed that the I sp lesion was a welldifferentiated adenocarcinoma in the mucosal layer, but showed the features of mucinous carcinoma in the submucosal layer. The lymph node metastasis in node number 251 measuring 60×40×30 mm in diameter was a mucinous carcinoma. The findings in this carcinoma with a high propensity for case suggest that mucinous carcinoma is a highly invasive metastasis.View full abstractDownload PDF (129K) -
Takeshi Shioya, Yojiro Hashiguchi, Yasuo Okura, Takeshi Sekine2000 Volume 33 Issue 11 Pages 1854-1858
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSPatients who have received pelvic irradiation are reported to be at increased risk of subsequently developing malignancies of the large bowel. We report five cases of rectal carcinoma, one early cancer and four advanced cancers, that developed following pelvic irradiation for the uterine cervical and corpus cancer. The mean age of the patients was 70 years (range, 64 to 77 years), and the mean interval between irradiation and surgery for rectal cancer was 12.9 years (range, 5 to 25 years). Radiation-induced changes in the remaining bowel were recognized in all five patients, and four of them had symptoms of radiation proctitis. One of the five tumors was histologically diagnosed as well differentiated adenocarcinoma and the other four as moderately differentiated adenocarcinoma. Histopathological examination revealed that all four advanced carcinomas included a deep ulcer covered with necrotic tissue that contained many blood cells on its surface. Three of the four patients with advanced rectal cancer died within 2 years after surgery, indicating a poor prognosis for radiation-induced rectal carcinoma. Long-term follow-up with careful surveillance for colorectal cancer is required in patients who have undergone pelvic irradiation.View full abstractDownload PDF (105K) -
Yoshiyuki Kuwabara, Masami Mitani, Noriyuki Sinoda, Atsushi Sato, Akir ...2000 Volume 33 Issue 11 Pages 1859-1863
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe present a case of esophageal cancer involving the trachea. The patient received an anterior mediastinal tracheostomy with pedicled omental flap following a total laryngo-esophagectomy and reconstruction using the stomach. Patient: A 54-year-old man. Operation: In the left lateral position, the entire intrathoracic esophagus and its associated mediastinal lymph nodes were mobilozed through the right fifth intercostalspace. In the supine position, a large U-shaped incision was made on the neck, and a vertical midline incision was made from bottom of the U-shaped incision to the level of the third rib. After the anterior chest wall was amply resected, the tumor was removed along with the larynx, pharynx, proximal trachea, and esophagus. After an upper abdominal incision was made, we mobilized the entire omentum and the stomach and moved them towards the neck through the posterior mediastinum. A pharyngo-gastric anastomosis was then performed. The omentum was placed around the trachea, the main arteries, and the site of anastomosis. The wound in the neck and anterior chest was closed using one layer, and the end of the trachea was sutured to the skin overlying the resected sterum. Conclusions: We suggest the use of the omentum as a simple and reliable technique in constructing a mediastinal tracheostomy following a total laryngo-esophagectomy for cervicothoracic esophageal cancer.View full abstractDownload PDF (106K) -
Kenichiro Uemura, Yoshiaki Murakami, Takashi Yokoyama, Yoshio Takesue, ...2000 Volume 33 Issue 11 Pages 1864-1868
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 40-year-old man had undergone splenectomy 8 years previously for idiopathic thrombocytopenic purpura (ITP), with a good initial clinical response. He had been under treatment with prednisolone and cyclophosphamide for thrombocytopenia for the last 3 month. Abdominal ultrasonography, computed tomography and scintigraphy showed a mass that looked like an accessory spleen in the splenic fossa near the tail of the pancreas. After laparoscopic accessory splenectomy, the medication could be discontinued, as his platelet count had increased to 37.0×104/μl. This case confirms that accessory splenectomy after open splenectomy can safely be performed laparoscopically, thereby avoiding a major open procedure. The procedure should be considered as a therapeutic option for recurrent ITP, if accessory splenic tissue is seen on ultrasonography, computed tomography or scintigraphy.View full abstractDownload PDF (59K) -
Yoshihiro Kinoshita, Harushi Udagawa, Kenji Tsutsumi, Masanori Ueno, T ...2000 Volume 33 Issue 11 Pages 1869
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSDownload PDF (19K)
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