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Volume 36, Issue 11
Displaying 1-31 of 31 articles from this issue
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Chikashi Hiranuma, Kenji Omura, Kazuyuki Kawakami, Shouichi Tsukayama, ...2003 Volume 36 Issue 11 Pages 1487-1492
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report an extremely rare case of an esophageal schwannoma. A 64-year-old woman was admitted to hospital after a mediastinal tumor was found on a chest X-ray taken at another hospital. A chest CT, chest MRI and endoscopic ultrasonography showed a solid tumor in the esophagus, the patient was diagnosed as having an esophageal leiomyoma. Thoracoscopic enucleation was performed. The tumor was 3.5×3.0×2.0cm in size and had a grayish white capsule. Histopathologically, the tumor was composed of spindle cell bundles and showed a palisade arrangement of the nucleus. Immunohistochemical examinations were negative for α-smooth muscle actin and positive for S-100 protein. Thus, the tumor was diagnosed as an esophageal schwannoma.View full abstractDownload PDF (98K) -
Osamu Shimooki, Yuko Baba, Toru Yoshida, Tadashi Abe, Noriyuki Uesugi, ...2003 Volume 36 Issue 11 Pages 1493-1497
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe describe a case of squamous cell carcinoma of the esophagus with a solitary metastasis to the small bowel causing small bowel obstruction. A 63-year-old man admitted with dysphagia was diagnosed with lower thoracic esophageal cancer (T3N1M0 Stage III). Esophagectomy was contraindicated due to invasion to the aorta and diaphragm and metastasis to the liver. Enterostomy for nutrition was implemented followed by chemo-radiotherapy. Obstructed bowel symptoms developed on postoperative day (POD) 50. On POD 87, an operation was conducted for ileus. Stricture of the ileum was recognized 50cm orally from the ileal ending, necessitating partial resection of the ileum, including the stricture. The histopathological diagnosis was ileal metastasis from esophageal cancer. Metastasis to the small bowel from esophageal cancer is very rare, with our case only the fifth reported in the international literature.View full abstractDownload PDF (79K) -
Shuichi Tanabe, Ryuzaburou Sineha, Shukichi Miyazaki, Koh Sugawara, Go ...2003 Volume 36 Issue 11 Pages 1498-1503
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case report of splenic metastasis after esophagectomy for esophageal cancer. A 54 year old man underwent esophagectomy for esophageal cancer in 1998. Histologically diagnosed as basaloid carcinoma and poorly differentiated squamous cell carcinoma with pN1 lymph-node metastasis. Seven months after, supraclavicular lymph-node metastasis was detected but put into total remission by radiochemotherapy in 1999. Five months after this, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasoundsonography (US) showed solitary splenic metastasis. Splenectomy was conducted in April 1999, with no other metastasis seen. The man remaning alive and recurrence free in the more than 3 year following splenectomy. Splenic metastasis of esophageal cancer is very rare, and most are not respectable. For patients without other metastasis, radical splenectomy should be considered for esophageal cancer because of the potential longterm survival.View full abstractDownload PDF (139K) -
Tsukasa Takabayashi, Toshio Kanai, Motohito Nakagawa, Michio Sakata, K ...2003 Volume 36 Issue 11 Pages 1504-1509
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSBarium meal and endoscopic examinations were performed in a 64-year-old man with appetite loss and vomiting. An infiltrating ulcerative tumor of the upper and middle portions of the stomach and two elevated submucosal tumors, 30 and 10mm in diameter, in the middle third of the esophagus were found. Biopsy specimens from both the gastric and esophageal tumors showed moderately differentiated adenocarcinomas. Under a diagnosis of gastric cancer with intramural metastasis to the esophagus, a total gastrectomy combined with splenectomy and caudal pancreatectomy was performed. An esophagectomy was omitted because metastasis to multiple lymph nodes, including the nodes around the abdominal aorta, was observed, indicating the systemic spread of the disease. Postoperative chemotherapy using mainly CDDP and 5FU, endoscopic mucosal resection of the esophageal lesions, and irradiation to the supraclavicular and mediastinal regions were effective and resulted in a relatively long survival period. The patient died of multiple organ metastases 34 months after the resection. Although rarely encountered, gastric cancer with intramural metastasis to the esophagus is usually diagnosed at an advanced stage. An operation strategy oriented to the patients' QOL and combined with chemotherapy and radiotherapy should be considered.View full abstractDownload PDF (109K) -
Kazuto Tsuboi, Nobuo Omura, Fumiaki Yano, Hideyuki Kashiwagi2003 Volume 36 Issue 11 Pages 1510-1513
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 59 year-old man with a worsening hiatal hernia and heart burn, was treated using laparoscopic Nissen fundoplication. During the operation, bleeding from the anterior trunk of the vagus nerve was observed, and hemostasis was performed using Laparoscopic Coagulation Shears. Six months after the operation, the patient experienced epigastralgia, and a gastric ulcer was found in the lesser curvature of the upper body during an endoscopy performed eight months after the operation. Laparoscopic Nissen fundoplication is a standard surgical treatment for GERD, and a tight Nissen or a slipped Nissen have been seen as general complications of this method. No reports of a gastric ulcer developing after a Nissen fundoplication procedure have been made in Japan, and only a few reports have been made in Europe and the United States. Thus, the present case is extremely rare and may be of interest to surgeons.View full abstractDownload PDF (52K) -
Yasunori Akutsu, Masato Endo, Toshihiko Hoshino, Mari Kuboshima, Akiko ...2003 Volume 36 Issue 11 Pages 1514-1519
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of G-CSF-producing gastric cancer with multiple liver metastases. A 55-year-old male who complained of general fatigue and of tarry stools was admitted to our hospital. Endoscopy and Xay examination revealed a type-3 gastric cancer. The pre-operative laboratory data indicated leukocytosis (18, 610/mm3) and a high level of G-CSF (76pg/ml). Since we detected multiple liver metastases, so chemotherapy was performed. Because of bleeding from the gastric cancer, however, the patient underwent a total gastrectomy on November 11, 2002. The surgical stage was T3N3P0H3, stage IV. The pathological diagnosis was; tub2, se, pm-, dm-, ly3, v3, n3, stage IV. After the operation, the hepatic metastasis progressed and the serum G-CSF level increased up to 250pg/ml. The patient died of hepatic failure on February 5, 2003. G-CSF-producing gastric cancer is rare and we summarize previous reports.View full abstractDownload PDF (113K) -
Makoto Watanabe, Naokuni Yasuda, Tomokazu Kusano, Hitoshi Kimura, Kazu ...2003 Volume 36 Issue 11 Pages 1520-1524
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a 67-year-old woman found to have primary squamous cell carcinoma of the stomach with liver metastasis. She was admitted for stomach discomfort. Endscopic findings showed a type3 tumor on the posterior wall of the upper gastric body. The tumor was diagnosed as well-differentiated squamous cell carcinoma from a biopsied specimen. Computed tomography showed a tumor 7cm in diameter possibly involving the pancreas. Surgery involved total resection of the stomach, resection of the body and tail of the pancreas, splenectomy, lymph node dissection, and enucleation of the left lateral segment of the liver. Based on TNM classification, the tumor was T4N2M1 (Stage IV). Pathological examination showed normal gastric mucosa between the esophagus and squamous cell carcinoma of the stomach. The patient has remained reccurrence free in the 10 mouths since surgery.View full abstractDownload PDF (110K) -
Keigo Okada, Shigehiro Kikuyama, Yoshihiro Imazu, Rempei Ohyama, Hidek ...2003 Volume 36 Issue 11 Pages 1525-1529
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 56-year-old man admitted for gastric cancer found in mass screening was found in endoscopy to have a 2cm elevated lesion resembling a submucosal tumor with a type IIc-like depression on the posterior wall of the upper and middle stomach. A biopsy specimen showed adenocarcinoma. We preoperatively diagnosed the lesion as type IIa+IIc advanced cancer and conducted distal gastrectomy. The pathological diagnosis was well-differentiated adenocarcinoma extending to the submucosal layer with submucosal heterotopic gastric glands. The pathogenesis of the lesion was mainly explained by acquired aberration. Several reports about the relationship between lesions and cancer have been presented, but the issue remains controversial.View full abstractDownload PDF (113K) -
Motoki Hiroyoshi, Kazunori Ogino, Daisuke Kuroda, Hitoshi Moritomo, Hi ...2003 Volume 36 Issue 11 Pages 1530-1534
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report the case of a 64-year-old man with gastric cancer accompanied by pyrolic stenosis, which we treated with chemotherapy using TS-1. An endocopy revealed a type-2 gastric cancer that was diagnosed as a poorly differentiated adenocarcinoma on the basis of biopsy findings. A gastrectomy was impossible because of pancreas invasion, and a gastrojejunal bypass operation was performed. The patient was treated with a daily oral administration of 120 mg of TS-1 for 4 weeks followed by 2-week rest. After one cycle of this regimen, a computed tomography (CT) examination showed the regression of the primary tumor and lymph node metastasis. After three cycles, a CT examination confirmed that the primary tumor and lymph node metastasis had disappeared. The effectiveness of the drug continued until the end of the eighth course, and surgery was performed once again. A distal gastrectomy was subsequently performed without obtaining any residual tumor findings. Chemotherapy with TS-1 is expected to be an effective method for treating advanced gastric cancer.View full abstractDownload PDF (72K) -
Yasuharu Tokuyama, Tomohiko Furuta, Takashi Suhara, Atushi Matuo, Yosh ...2003 Volume 36 Issue 11 Pages 1535-1540
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 81-year-old man underwent total gastrectomy for type 4 gastric cancer from the gastric body to the antrum. A postoperative pancreatic fistula was confirmed by fistulography to be connected to the esophagojejunostomy stump on post operative day (POD) 28 and also to the common bile duct at the next day's examination. We implemented conservative therapy using somatostatin analog and blood coagulating XIII factor, but found no effect for closing the fistula. On POD 58, fistulography showed the fistula connected to the duodenal stump, and fibrin glue injection into the fistula, closing it. He was discharged on POD 82. In our experience, fibrin glue injection has moved very useful in closing persistent postoperative pancreatic fistulas.View full abstractDownload PDF (102K) -
Masato Matsuzaki, Harushi Udagawa, Masaki Ueno, Shinji Mine, Takashi F ...2003 Volume 36 Issue 11 Pages 1541-1544
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIn 1985 a 64-year-old man underwent total gastrectomy, lower esophagectomy, distal pancreatectomy, and splenectomy with jejunal interposition approached by a left thoracoabdominal incision for gastric cancer at the cardia. Although his clinical course was uneventful, dysphagia and postprandial vomiting began in March 2001 and gradually worsened. Gastrofiberscopy showed marked tortuosity but no stenosis in the interposed jejunum. He was admitted for further examination and found in an upper gastro intestinal series to have stenosis and saccular extension of the interposed jejunum. He underwent surgery based on a diagnosis of diverticulum of the interposed jejunum and intrathoracic herniation. Operative findings showed that the interposed jejunum had prolapsed in to the right thoracic cavity through a right mediastinal pleural defect. The pleural defect was closed by flat Marlex mesh and the interposed jejunum fixed to the diaphragm. After surgery his symptoms disappeared and oral intake increased. Only one case of postoperative pleural herniation of the intestine has, to our knowledge, been reported in the literature. It is thus important to add to the differential diagnosis, if dysphagia appears after gastric or esophagial surgery with intramediastinal reconstruction.View full abstractDownload PDF (52K) -
Ikuya Fujiwara, Hiroshi Konosu, Yasunori Sawabe, Tomoya Inoue, Shuji S ...2003 Volume 36 Issue 11 Pages 1545-1548
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of duodenal obstruction caused by a large extraluminal duodenal diverticulum. A 76-year-old woman was admitted for epigastric pain, appetite loss and vomiting. Abdominal computed tomography (CT) showed marked dilatation of the duodenum and a large diverticulum filled with undigested food at the third portion of the duodenum. It also demonstrated cholangitis with fluid collection surrounding the gall bladder. It was considered that elevation of the intraluminal pressure of the duodenum had caused cholangitis, and an ileus tube was inserted into the duodenum to reduce the intraluminal pressure. The cholangitis improved immediately, however obstruction of the duodenum persisted, so we performed surgery. A laparotomy showed that the diverticulum, 7 cm in diameter, was filled with undigested vegetable matter and had caused extraluminal compression of the duodenum leading to duodenal obstruction. We resected the diverticulum. The patient's postoperative course was uneventful.View full abstractDownload PDF (76K) -
Manabu Yamamoto, Takeshi Okamura, Yasuharu Ikeda, Kazuya Endo, Yasushi ...2003 Volume 36 Issue 11 Pages 1549-1553
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe successfully treated a case of duodenal bleeding with bleeding shock by jejunal patching in a patient with osteosarcoma after both radiation and chemotherapy. A 35-year-old woman was admitted to our hospital because of a tumor of her back. On admission, the tumor was biopsied, with a diagnosis of osteosarcoma. The patient had undergone chemotherapy. Her previous history showed she had undergone radiation therapy (70 Gy) and surgical treatment twice in the upper abdomen due to malignant lymphoma. She was critically ill, presenting symptoms of hematemesis and beeding shock. Under the diagnosis of duodenal bleeding, an emergency laparotomy was carried out. On laparotomy, massive sclerotic and edematous organs, stomach, duodenum and intestine, were recognized due to the previous radiation and chemotherapy. The duodenal ulcer had penetrated into the liver. Therefore, during the approach to the bleeding point, the duodenum was opened. Arterial bleeding was stopped by a 3.0 proline ligation. Jejunal patching (Roux-Y) for the anterior wall defect of the duodenum was then performed, and a gastrojejunostomy (Davine type) was added for the inhibition of re-bleeding. As for surgical technique, the jejunal patching was effective for duodenal defect repair. After discharge, the patient is doing well.View full abstractDownload PDF (90K) -
Satoshi Katagiri, Masakazu Yamamoto, Takehito Otsubo, Hideo Katsuragaw ...2003 Volume 36 Issue 11 Pages 1554-1559
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe patient was a 60-year-old woman with chronic hepatitis C after interferon therapy with complete response. On October 16, 1995, resection of segments 4 and 8 of the liver was performed for a 3cm hepatic tumor identified in segments 4 and 8. Histopathologically, the hepatic lesion showed moderately differentiated hepatocellular carcinoma (HCC) fc (+) fc-inf (+) vp0 vv0 b0 tw (-) im0 and concomitant chronic hepatitis. Abdominal ultrasonography performed 5 months postoperatively disclosed a low echoic mass posterior to the near of the pancreas head. Abdominal computed tomography revealed a low density tumor at the level of the pancreas head. Angiography revealed a slightly hypervascular lesion at the gastroduodenal artery. We diagnosed lymph node metastasis of HCC and performed lymph node resection. Histopathologically, the lymph node showed a poorly differentiated HCC with solid growth. Six years later, no intrahepatic recurrence or lymph node metastasis has been observed over the entire course. This case represents an extremely rare presentation of metastatic HCC.View full abstractDownload PDF (150K) -
Yoshifumi Katagiri, Atsuyoshi Onitsuka, Yoshihiko Kato, Shigeru Kiyama ...2003 Volume 36 Issue 11 Pages 1560-1564
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of leiomyosarcoma of the gallbladder associated with acute cholecystitis caused by intraluminal hemorrhage. A 66 year-old-man referred for right hypochondralgia with fever was found in ultrasonography to have a low echoic mass in the gallbladder with thickening of the wall. Computed tomography on admission showed raised attenuation of bile with negative attenuation of the mass in the gallbladder. Twenty days later, bile attenuation became hypodense, corresponding to hemorrhage in the gallbladder. He underwent extended cholecystectomy with lymph node dissection. In postoperative histological examination using immunohisthogical staining, the tumor was found to have spindle-shaped pleomorphic cells arranged in inner lacing bundles with positive response to desmin and smooth muscle actin, leading to a definitive diagnosis of leiomyosarcoma of the gallbladder. Although leiomyosacoma of the gallbladder seldom is radically resected, early diagnosis was enabled due to acute cholecystitis caused by bleeding from the tumor, necessitating radical resection.View full abstractDownload PDF (106K) -
Yoshihiro Moriwaki, Kenichi Yoshida, Shigeru Yamagishi, Satoshi Hasega ...2003 Volume 36 Issue 11 Pages 1565-1570
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe experienced a case of severe acute pancreatitis (SAP) with abdominal compartment syndrome (ACS) who underwent a decompression laparotomy resulting in multiple surgeries, open wound drainage (OWD), and daily peritoneal lavage. A 51-year-old man was diagnosed as having SAP and was placed on continuous hemodialysis filtration and continuous regional arterial infusion. However, the patient reqired a decompression laparotomy because of ACS, and with a necrotizing infection of the retroperitoneium and multiple intestinal necrosis. The intestinal wall was edematous and thickened; as a result, the wall could not be sutured. We controlled the peritonitis from the continuous leakage of intestinal contents by frequent operation, drainage, necrosectomy, tube jejunostomy, and daily peritoneal lavage. The lost abdominal wall was repaired with a free musclar flap and skin graft. The patient was transferred to another hospital on the 302nd hospital day. ACS is thought to be a surgical indication for acute pancreatitis, and OWD is useful for the management of ACS with peritonitis.View full abstractDownload PDF (136K) -
Eiji Minato, Ippei Fujino, Nobuhito Sugihira, Kazuo Matsumoto, Kouichi ...2003 Volume 36 Issue 11 Pages 1571-1574
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 72-year-old man was admitted to our hospital presenting with hypotension and abdominal distension. Laboratory findings on admission revealed an abnormally increased number of leucocytes, composed of atypical lymphocytes and an elevated serum level of anti HTLV-1 antibody, suggestive of adult T cell leukemia (ATL). Abdominal CT scan showed a massive fluid collection and a laceration of the spleen. Emergency laparotomy revealed a massive hemoperitoneum due to rupture of the spleen, and the spleen was excised. Histologically, the spleen was infiltrated with ATL cells. Spontaneous splenic rupture due to leukemia is relatively rare. We report on this case together with some bibliographic comments.View full abstractDownload PDF (67K) -
Kazuhito Inoguchi, Takashi Yoshioka, Shinya Gomi, Hajime Nakai, Yojiro ...2003 Volume 36 Issue 11 Pages 1575-1580
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of unique enterolith associated with perforation of jejunal diverticula in the afferent loop. A 75-year-old man, with a history of gastrectomy and oral administration with ursodeoxycholic acid in treating type C chronic hepatitis was admitted to our hospital for abdominal pain on March 12, 2002. The next day, he was referred to surgery for paritonitis and underwent an emergency operation. Gastrointesital reconstruction by Billroth II anastomosis was done at the previous operation. A mesenteric abscess caused by perforation of the jejunum in the afferent loop and an enterolith in the abscess was found at laparotomy. We partially resected the jejunum and reconstructed a gastrojejunostomy by Roux en Y anastomosis. Pathological findings indicated a perforation of jejunal diverticula caused by diverticulitis. The enterolith consisted from a core and to an outer layer. Analysis indicated the core consisted of deoxycholic acid and the outer layer of ursodeoxycholic acid. The enterolith was suggested to be a combination enterolith constructed from a bile acid enterolith as the core and medicine as the outer layer. In the present case, a jejunal diverticula and gastrointestinal reconstruction by Billroth II anastomosis was considered to have caused stagnation of the intestinal contents and bacterial overgrowth, which led to formation of the enterolith.View full abstractDownload PDF (110K) -
Hideyuki Ubukata, Teruhiko Kasuga, Gyou Motohashi, Motonobu Katano, Yo ...2003 Volume 36 Issue 11 Pages 1581-1586
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe case of an afferent loop obstruction is reported. A 65-year-old male received a total gastrectomy with Roux-Y reconstruction (retrocolic) because of gastric remnant cancer. He had been previously operated on for a gastric ulcer 40 years earlier with a wide resection and BillrothII reconstruction (retrocolic). On the third post-operative day (POD) after the gastrectomy, liver dysfunction was observed; on the fourth POD, the patient's upper abdominal pain began to worsen. On the ninth POD, a CT scan revealed a markedly dilated duodenum, and jaundice on his skin became noticeable on the twelfth POD. On thirteenth POD, a percutaneous bowel drainage (PBD) procedure was performed under US guidance, and an afferent loop obstruction was diagnosed. A UGI series showed a narrow segment about 10 cm distal to the gastrojejunal anastomosis. The patient's abdominal pain improved remarkably compared to the previous day, and the PBD catheter was removed and oral intake was resumed on the twenty-seventh POD. The patient's condition continued to improve, and he was discharged from hospital on the thirty-eight POD. Afferent loop obstruction is a very severe disease, and prompt recognition and immediate treatment are necessary. Most cases are treated using surgery, but the mortality rate is quite high (11%-28%). Percutaneous bowel drainage might be a very effective and easy procedure for the treatment of afferent loop obstruction like the present case.View full abstractDownload PDF (124K) -
Takashi Hisamatsu, Atsushi Nanashima, Kouichi Izumikawa, Hideaki Haga, ...2003 Volume 36 Issue 11 Pages 1587-1592
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 76-year old man with a history of chronic viral hepatitis and obstinate constipation was admitted to our hospital with severe abdominal distension. The patient had no remarkable abdominal pain or signs of any inflammatory disorders. An abdominal X-ray film showed massive intra-abdominal free-air, but no signs of ulceration or perforation were found in an upper GI series. However, a 3cm multi-cystic lesion was found in the lower intestines, protruding into the abdominal cavity next to the site of the massive free-air, ascites observed on CT images. Pneumatosis cystoides intestinalis (PCI) was thought to be the most probable diagnosis, and an emergency laparoscopy was performed to rule out the possibility of intestinal perforation and relieve the patient's symptoms. A laparoscopy examination revealed multiple cystic lesions in the terminal ileum, ascites, and a liver with the appearance of chronic hepatitis; no evidence of intestinal perforation was seen even in the area of the multiple cystic lesions. Other PCI in the colon was observed by postoperative colonoscopy. The patient recovered without any complications. Although conservative therapy has been described as a common initial treatment for patients with PCI, our experience suggests that performing a laparoscopy examination may be useful not only for confirming the diagnosis, but for reducing the massive pneumoperitoneum resulting from severe constipation in patients with PCI.View full abstractDownload PDF (85K) -
Shinichi Kadoya, Masato Tokuraku, Takeshi Harada, Yukio Furukawa, Sato ...2003 Volume 36 Issue 11 Pages 1593-1597
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 71-year-old woman was admitted to our hospital for a lower abdominal tumor. Magnetic resonance imaging showed a large cystic tumor extending from the right lower abdomen to the pelvis. Under the diagnosis of a right ovarian tumor, a gynecologist performed a laparotomy. However, the tumor originated in the ileocecal area. Angiography of the superior mesenteric artery showed tumor vessels branching from the ileocolic artery. We performed an ileocecal resection. The histopathological diagnosis was malignant fibrous histiocytoma of the mesentery of the terminal-ileum. The patient has remained disease-free 6 months after the resection.View full abstractDownload PDF (111K) -
Kazuyuki Mizunuma, Naoki Haruta, Ryo Shinhara, Manabu Kurayoshi, Yuich ...2003 Volume 36 Issue 11 Pages 1598-1602
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 33-year-old man admitted to our hospital for fever elevation and abdominal pain, was found in CT scans to have an enhanced lesion in thickened mesentery. Although the patient was suspected of having mesenteric panniculitis, laparotomy was performed to diagnose exactly. During surgery, the condition was confirmed as mesenteric panniculitis. Biopsies in swollen mesentery and lymph nodes and abdominal drainage were performed. Pathological study also showed mesenteric panniculitis. Since inflammatory reaction was not improved by administered antibiotics after operation, prednisolone (10mg/day) was administered from the 7th postoperative day, and rapidly improved inflammatory findings. Mesenteric panniculitis is an unspecific inflammatory disease of unknown cause, rarely induced in the mesentery. We show a case report that low-dose steroid medication is effective for mesenteric panniculitis.View full abstractDownload PDF (80K) -
Koji Nishijima, Masato Kiriyama, Hiroshi Itoh, Toru Ii, Yoshiyuki Kuro ...2003 Volume 36 Issue 11 Pages 1603-1608
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 20-year-old male with a 6-year history of Crohn's disease presented with right femoral pain and swelling. A diagnosis of right femoral abscess extending from a psoas abscess was made based on the findings of an MRI examination and a gastrograffin enema. He had been received percutaneous drainage for a right femoral abscess at the age of 19 years. A laparotomy was performed, revealing swelling and stiffening of the terminal ileum and cecum; the right femoral abscess had expanded from a psoas abscess and a retroperitoneal abscess. Surgical drainage of the abscess cavity and ileocecal resection was performed. The resected specimen showed signs of Crohn's ileocolitis, with an external fistula in the appendix that was considered to have caused the abscess. The patient had an uneventful recovery and has remained well without any recurrence of symptoms for 6 years since his operation. Although the expansion of a psoas abscess to the femoral area is rare complication in Japan, the increasing prevalence of Crohn's disease has made this condition an important complication requiring surgical intervention.View full abstractDownload PDF (104K) -
Hidetaka Yamanaka, Kaname Ono, Tatsuroh Satoh, Hiroshi Seko2003 Volume 36 Issue 11 Pages 1609-1614
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe predominant symptoms of eosinophilic gastroenteritis often vary, but conservative therapy is usually the treatment of choice. Occaisionally, however, surgical therapy cannot be avoided. We report the case of a 47-year-old man admitted for increased abdominal pain who was treated using a partial ileectomy with investigation of reported cases in Japan. The patient had no relevant past medical history or allergies. On admission, abdominal distension, hardenning, lower abdominal tenderness, rebound tenderness and muscular defense were recognized. Laboratory data showed neutrophile-predominant leukocytosis but a normal range of eosinophils. The patient's LDH and CRP levels were also elevated. An emergent operation was performed after abdominal X-ray and CT examinations suggested a diagnosis of strangulated ileus. A partial ileectomy of 14cm length was performed since the ischemic ileitis was located 160cm on the oral side of the ileocecal valve. Microscopic examination of the resected specimen showed eosinophilic ileitis of a predominantly transmural type.View full abstractDownload PDF (103K) -
Masatoshi Kadoya, Yasuhiro Suzuki, Kazuaki Hazama, Yoshitsugu Nakanish ...2003 Volume 36 Issue 11 Pages 1615-1620
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 57-year-old man admitted to hospital for malaise was shown by laboratory data to have anemia. A CT scan and MRI examination showed a small intestinal tumor with a thickened wall, and an intestinal fluoroscopy showed an aneurysmal-type tumor with a rough area on the intestinal wall. A selective angiography revealed a light, stained tumor with the ileal artery supplying nutrients. A malignant lymphoma of the intestine was thus suspected. An emergency operation was performed because of peritonitis. The rupture of the intestinal tumor, accompanied by multiple small tumors on the oral side, to the intra-abdomen caused peritonitis at a point located 90 cm on the anal side of the Treitz'ligament. The small intestine was resected extensively. Histologically, the tumor was identified as an anaplastic carcinoma with multiple intramural metastases; further immunohistochemical examination revealed the lesion to be positive for CAM 5.2 and Vimentin. The patient recovered and began to ingest solid food, but he died 55 days after the operation when his condition rapidly deteriorated. An autopsy revealed an intra-abdominal recurrence and distant metastases to the left lung, liver, and other locations. Anaplastic carcinoma of the small intestine is a rare disease; we describe the findings of the present case and review the relevant medical literature.View full abstractDownload PDF (104K) -
Hiroyuki Kawasaki, Kazuaki Sasaki, Hajime Takasaka, Keisuke Ohno, Tsuy ...2003 Volume 36 Issue 11 Pages 1621-1625
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIncarcerated internal hernia is a relatively rare disease that occasionally presents as ileus, but usually does not have characteristic findings. Pre-operative diagnosis is very difficult. We experienced a rare case of an incarcerated internal hernia in a paracolic gutter of the descending colon. This is only the second such cases to be encountered in Japan. A 72-year-old woman who had visited to another hospital because of shizophrenia suddenly complained of abdominal pain and vomiting. An abdominal roentgenogram showed intestinal dilatations, and the patient was admitted for surgery. A contrast radiography showed a tapering and obstruction of the intestine on the left side of the abdominal cavity, and an internal hernia or pathognomonic adhesion was suspected. A definitive diagnosis could not obtained, however, and a laparotomy was performed under a diagnosis of ileus. The operative findings revealed that a part of the small intestine had protruded through a 1.5×1.5 cm defect of the paracolic gutter on the left side of the descending colon. The intestine was reduced to the abdominal cavity, and the hilus of the hernia was completely excluded. The patient has been well for the last 2 years.View full abstractDownload PDF (90K) -
Yoshifumi Sakata, Hideo Mishima, Kazuya Yamaguchi, Naoki Hirabayashi2003 Volume 36 Issue 11 Pages 1626-1629
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 71-year-old woman seen for anemia and positive fecal occult blood, was found in Barium enema examination and colonoscopy to have colon cancer at the hepatic flexure. Preoperative screening showed anemia, prolonged prothrombin time (PT)(22.8 s23.5%), and activated partial thromboplastin time (APTT)(58.1s). The level of the factor V was 9%. Her parents had a consanguineous marriage. We found the patient had congenital factor V deficiency (parahemophilia), so we transfused 6 units of fresh frozen plasma (FFP) preoperatively to improve PT and APTT. Under transfusion of FFP, we conducted right hemicolectomy. We transfused 20 units of FFP postoperatively. No serious hemorrhaging was detected during or after surgery.View full abstractDownload PDF (43K) -
Takekazu Iuchi, Takashi Hirai, Yukihide Kanemitsu, Tomoyuki Kato, Yosh ...2003 Volume 36 Issue 11 Pages 1630-1635
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 55-year-old man underwent sigmoidectomy and D3 lymph node dissection for sigmoid colon cancer in 1995. Histological diagnosis was moderately differentiated adenocarcinoma, ss, n0, ly1 and v1. Elevation of the serum CEA level was noticed in April 1996. In December 1996, a hard mass was detected by palpation of the anterior wall of the rectum. Pelvic CT revealed a small mass behind the seminal vesicle and we diagnosed this as recurrence of the sigmoid colon cancer. We performed a low anterior resection combined with seminal vesicle resection in March 1997. The tumor was 3cm large and existed under the peritoneum between the rectum and the seminal vesicle with wrinkle at peritoneal reflection. Histological diagnosis was moderately differentiated adenocarcinoma. The patient remains alive at the time of writing without any sign of recurrence in a 5-year follow-up.View full abstractDownload PDF (111K) -
Takayuki Iwamoto, Kazuya Miyoshi, Shinya Ohtsuka, Tatsuhiko Sakata, To ...2003 Volume 36 Issue 11 Pages 1636-1640
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of successfully resected rectal inflammatory myofibloblastic tumor (IMT) associated with intraabdominal hemorrhage. A 26-year-old man reporting acute abdominal pain and showing a large fluid collection in abdominal ultrasonography had 1, 400 g of coagulation removed and the upper rectum with 2 bleeding nodular lesions resected, followed by an uneventfull postoperative course. The lesions, located in the submucosa to subserosa of the rectum, consisted of spindle cells having eosinophilic tapered cytoplasm and plump nuclei and nucleoli infiltrated by inflammatory cells. Frequent mitotic figures and hemorrhage were also noted. A review of the literature indicates that patients with intraabdominal IMTs usually evidence a mass, fever, and weight loss, whereas intraabdominal hemorrhage is extremely rare.View full abstractDownload PDF (79K) -
Yutaka Shiino, Shunzo Ozaki2003 Volume 36 Issue 11 Pages 1641-1645
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSFournier's gangrene is a rare, rapidly progressive and potentially fatal gangrenous infection of the perineum and genitalia. A 62-year-old man, who had previously undergone three operations for the anal fistula, was hospitalized complaining of a high-grade fever and anal pain. An initial incision was made to drain the abscess in the perianal area. Four days later, extended incisions, lavage, debridement and drainage all the way down to the left calf were performed in conjunction with the creation of a sigmoid colostomy for fecal diversion. Rectal examination revealed a fixed and obstructing induration. Abscess cultures yielded Escherichia coli and four other anaerobic organisms. Hyperbaric oxygen therapy was delivered for ten days. Following a histopathologic diagnosis of anal canal cancer, a curative abdominal perineal resection was performed. Histopathology revealed a stage IIIB (T2N2M0), moderately differentiated adenocarcinoma. We experienced a rare case of an advanced adenocarcinoma of the anal canal manifesting as a perianal abscess progressing to extended Fournier's gangrene.View full abstractDownload PDF (105K) -
Shinya Nomura, Kiyoshi Maeda, Naoyoshi Onoda, Shinichiro Kashiwagi, Ma ...2003 Volume 36 Issue 11 Pages 1646-1650
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 58-year-old man who had been suffering from an anal fistula with purulent discharge for about 40 years was admitted to our hospital for severe anal pain. Biopsy specimens from the fistular wall showed adenosquamous carcinoma. Further examination revealed that extensive invasion of the sacrum, therefore, after radiation therapy combined with anticancer chemotherapy, an abdominoperineal excision was performed. Histological examination of the resected specimens showed necrosis in the majority of the tumor cells. The patient was discharged 52 days after surgery without any major complication. Preoperative radiation therapy combined with chemotherapy was considered to be effective for advanced anal fistula cancer in which preservation of a safe surgical margin might be difficult intraoperatively.View full abstractDownload PDF (101K)
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