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Volume 37, Issue 12
Displaying 1-26 of 26 articles from this issue
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A Retrospective Analysis in Recurrent CasesHidetoshi Makita, Masahiko Murakami, Tetsuo Sawatani, Koji Otsuka, Yos ...2004 Volume 37 Issue 12 Pages 1805-1812
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIntroduction: We studied clinical significance based on the courses of tumor markers following surgery for esophageal squamous cell carcinoma. Method: Tumor markers (CEA, SCC and CYFRA21-1) were measured in 55 cases of resected esophageal squamous cell carcinoma before and after surgery. The markers were measured every 3 months postoperatively. Recurrence appeared in 23 cases. Results: The tumor marker showing the highest preoperative positivity was CYFRA21-1 at 30.1%, and it correlated with pathological cancer depth (pT) and prognosis. Positivity in all cases increased significantly with the combination of all 3 markers. Nine cases proving positive for both SCC and CYFRA21-1 suffered postoperative recurrences, which in 8 cases involved lymph node metastasis. Conclusion: Combined CEA, SCC and CYFRA21-1 assay is very useful for diagnosing esophageal squamous cell carcinoma, and is also useful for recurrences. For preoperatively positive CYFRA21-1, it appears that other therapies (chemotherapy and/or radiation therapy) should be conducted postoperatively, even after curative surgery. When both SCC and CYFRA21-1 become positive postoperatively, the possibility of recurrence, especially lymph node metastasis, is very high. Positivity in a combination assay of the 3 tumor markers, even without imaging findings, is suggestive of a recurrence; indicative that tumor markers need to be studied frequently.View full abstractDownload PDF (108K) -
Naoyoshi Terakawa, Sohei Satoi, Hiroaki Yanagimoto, Hidekazu Yamamoto, ...2004 Volume 37 Issue 12 Pages 1813-1818
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIntroduction: The 3% incidence of cholangiocellular carcinoma (CCC) in primary liver cancer in Japan has remained unchanged in the last ten years, but the incidence of underlying type C hepatitis has increased recently. We compared the clinicopathologic features of CCC patients with positive hepatitis C virus (HCV) antibody to CCC patients with negative HCV. Methods: Of 35 patients with CCC admitted to Kansai Medical University between 1992 and 2001, 17 patients with CCC underwent liver resection (HCV group: n=7, non-HCV group: n=10). We studied the annual changes in HCV antibody incidence and compared the clinical background and surgical prognosis in CCC patients with HCV positive and negative antibody. Results: From 1992 to 1996, 9 patients were diagnosed with CCC (HCV positive; n=2, 22%). From 1997 to 2001, 13 of 26 patients with CCC were found to have HCV positive antibody (50%). In resected cases, significant differences existed in AST between groups (59±10 vs. 30±5 U/l, p<0.05). The retention rate of indocyanine green dye at 15 min in the HCV group was higher than in the non-HCV group but not significant. Most patients in the HCV group underwent limited liver resection due to underlying liver damage, meaning curative resection was done less often in the HCV group. No differences were seen in tumor factors (size, number, vascular invasion, lymph node metastasis, or TNM staging) between groups. Overall survival in the HCV group tended to be lower than in the non-HCV group. Conclusion: The incidence of CCC with HCV antibody has been increasing. Patients mostly underwent limited surgery due to underlying liver disease, probably resulting in a poor prognosis.View full abstractDownload PDF (64K) -
Kazuhiro Imai, Satoru Motoyama, Reijiro Saito, Manabu Okuyama, Hiroshi ...2004 Volume 37 Issue 12 Pages 1819-1822
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of primary malignant esophageal lymphoma responding to chemo-radiation therapy. A 42-year-old man admitted for dysphagia was found in esophagography and gastrointestinal fiberscopy to have a 4cm long smooth round stenosis without an irregular mucosal pattern in the middle thoracic esophagus. Computed tomography showed diffuse invasion to the main left bronchus and descending aorta. Diagnosis could not be made from endoscopic biopsy. Video-assisted thoracoscopic biopsy was conducted to confirm histology. The pathological diagnosis was diffuse large cell B lymphoma. Radiotherapy with a total dose of 40 Gy and CHOP chemo-therapy were administered. After treatment, no thoracic tumor was observable in CT. The patient is doing well, with no evidence of recurrence 3 years.View full abstractDownload PDF (71K) -
Motoo Shinohara, Munetaka Mori, Akihiro Mimuro, Michiaki Yagyu, Nobuak ...2004 Volume 37 Issue 12 Pages 1823-1828
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 60-year-old man medicated for a gastric ulcer and admitted due to an abnormality seen in gastroendoscopic examination was found in endoscopic and radiographic examination of the stomach to have 2 elevated adjacent lesions, on the lesser curvature of the gastric body. The proximal lesion was covered partially with normal epithelium having a linear depression in the center with gradual marginal elevation. The distal lesion had a deep circular depression in the center of the lesion with round marginal elevation resembling a small Borrmann type 2 tumor. The epithelium between the 2 lesions, which seemed separate appeared normal under a diagnosis of early gastric cancer, we conducted proximal gastrectomy. Histopathologically, both tumors were poorly differentiated adenocarcinoma, with severe lymphocytic infiltration and lymphoid follicles. The 2 tumors were connected with intraepithelial spread. Epstein-Barr virus encoded RNA (EBER-1) was detected in both tumor cells by in situ hybridization. This suggests that Epstein-Barr virus infection is related to carcinogenesis.View full abstractDownload PDF (133K) -
Katsunori Saito, Hideaki Hashida, Nozomu Iwashiro, Masanori Ohara, Mas ...2004 Volume 37 Issue 12 Pages 1829-1833
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 77-year-old man had a history of gastric ulcer, for which he used an H2-blocker. In September 2002, early gastric cancer was detected during a periodical endoscopic examination. Distal gastrectomy was performed, and the resected specimen showed a type IIc tumor about 0.8×0.8cm on the posterior wall in the greater curvature side of the antrum. Histological finding disclosed papillary adenocarcinoma and invasion was limited only to the sub mucosa. In the microscopic preparation there was found an eosinophilic granuloma beneath the carcinoma lesion, and a worm body was seen surrounded by necrotic substances. Only 20 cases of compound gastric cancer and Anisakiasis have been reported in Japan, so that any definite relation between both lesions remains obscure. We must be aware of the possibility that the Anisakiasis preferentially infested the cancerous mucosa, and carefully discriminate between cancer and eosinophilic granuloma produced by Anisakiasis.View full abstractDownload PDF (94K) -
Taketsune Kobuchi, Sayuri Konishi, Hirokazu Amaya, Susumu Shiraishi, T ...2004 Volume 37 Issue 12 Pages 1834-1838
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe incidence of once-rare granular echinococcosis of the liver has recently increased and moved away from endemic areas. We report a case of granular echinococcosis of the liver. A 55-year-old Peruvian woman admitted for fever and abdominal pain was admitted with hypotension, tachycardia, hyperthermia, tenderness in the right-upper abdomen, and whole-body redness and itching. Blood studies showed mildly elevated LDH and hypoxia. Abdominal US, CT, and MRI showed an 8 cm cyst in the left lobe of the liver. Suspecting a liver abscess, we conducted US-guided abscess drainage . We detected echinococcus granulosus in the cloudy yellow-brown fluid aspirated from the abscess. We prescribed Albendazole for 2 weeks, then conducted left hepatic lateral segmentectomy. In suspected liver abscess or cyst, we must keep this disease in mind, diagnosing and treating such cases carefully.View full abstractDownload PDF (101K) -
Yuichi Sanada, Akira Kurita, Minoru Tanada, Shigemitsu Takashima2004 Volume 37 Issue 12 Pages 1839-1845
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 63-year old woman admitted for epigastric discomfort was found in gastroscopy. To have a 0'-I lesion on the lesser curvature of the gastric angle. A biopsy showed adenocarcinoma, after which she was admitted to our hospital. Computed tomography showed a large tumor with a low density area in the left hepatic lobe. Con-trast CT showed hyperattenuation of the peripheral portion leading to a diagnosis of synchronous metastatic hepatic tumor with early gastric cancer. Because no other metastatic lesions was found, we conducted distal gastrectomy and left hepatic lobectomy. Histlogically, the gastric cancer was early and without metastasis to the lymph nodes. The liver mass consisted of lymphocytes and plasmocytes. The diagnosis was inflammatory pseudotumor. Inflamatory pseudotumor. This only the eight cases of inflammatory pseudotumor of the liver accompanied by cancer reported in Japan.View full abstractDownload PDF (161K) -
Yasuo Kabeshima, Atsuko Tano, Noriaki Kameyama, Atsushi Toizumi, Yoich ...2004 Volume 37 Issue 12 Pages 1846-1850
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 54-year-old Japanese man with cecal cancer and multiple liver metastases (CEA: 95.0 ng/ml) who under-went ileoceal resection followed by implantation of hepatic arterial infusion was treated postoperatively with 5-fluorouracil, leucovorin, and irinotecan hydrochloride. Since metastatic liver lesions all shrunk markedly after 6 Kur of chemotherapy (CEA: 10.6 ng/ml), and no other metastatic lesion was seen, we resected the liver tumors. He remained alive for 14 months after the first operation. This case is rare in having multiple me-tastasis of colorectal cancer controlled by radical surgery, and chemotherapy with 5-FU, l-LV, and CPT-11.View full abstractDownload PDF (75K) -
Tetsuya Kondo, Yasuhiro Sumi, Katsutoshi Murase, Tsuyoshi Shimamoto, T ...2004 Volume 37 Issue 12 Pages 1851-1856
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 63-year-old man who underwent pylorus-preserving pancreaticoduodenectomy for carcinoma of the duode-nal papilla 4 years 3 months earlier, was admitted for fever and abdominal pain. Computed tomography showed dilation of the intrahepatic bile duct but no tumor. Percutaneous transhepatic cholangiography (PTC) showed obstruction at the common hepatic duct, necessitating PTC drainage. Percutaneous transhepatic cho-langioendoscopy (PTCS) showed no malignant signs around the obstruction. An attempt to pass a wire through the obstruction failed. We made a diagnosis of benign biliary obstruction with resultant hepaticojeju-nal anastomosis. At laparotomy, the hepaticojejunal anastomosis was very narrow. We resected the thickened hepatic duct followed by bilioenteric reanastomosis. Histologically, the resected specimen showed dense fibrous tissue with chronic inflammatory infiltrates compatible with ischemic biliary obstruction. The postop-erative course was uneventful and the patient is doing well.View full abstractDownload PDF (127K) -
Shusuke Haruta, Masaji Hashimoto, Toshiro Iizuka, Masato Matsuzaki, Sh ...2004 Volume 37 Issue 12 Pages 1857-1861
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSHemorrhagic cholecystitis is rare. We report a case of it occurring during anticoagulant therapy. A stone incarcerated in the cystic duct made it difficult to diagnose hemorrhaging into the gallbladder and showed a fluid-fluid level in the gallbladder. The 69-year-old woman with upper abdominal pain, although anemia and liver dysfunction were detected at admission, abdominal ultrasonography showed only small stone in the gall-bladder. MRI and repeated abdominal ultrasonography showed a fluid-fluid level in the gallbladder, leading to the diagnosis of hemorrhagic cholecystitis with an incarcerated stone in the cystic duct necessitating chole-cystectomy. Only 6 cases of hemorrhagic cholecystitis during anticoagulant therapy have been reported in Japan. In our case, hemorrhage was suspected to have been caused by passing of a stone into the common bile duct. The prognosis of hemorrhagic cholecystitis is improving with progress in imaging diagnosis.View full abstractDownload PDF (97K) -
Makoto Yoshida, Takashi Hara, Setsuji Takanashi, Masahiro Ishigooka, M ...2004 Volume 37 Issue 12 Pages 1862-1866
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 78-year-old woman admitted for cholecystitis with gallstones in August 1999 was found in endoscopic retrograde cholangiopancreatography (ERCP) to have a dilated extrahepatic bile duct 18 mm in diameter. She had been admitted elsewhere for cholangitis in December 2000. ERCP showed extensive stricture of extrahe-patic bile duct without bile duct calculus and segmental stricture of intrahepatic bile duct. Given her general condition, no further examination was done. She was seen for abdominal pain and vomiting and was admitted for a thorough examination in May 2002. ERCP showed severe and extensive stricture of extrahepatic bile duct similar to a thread and diverticulum-like outpouchings and segmental stricture of intrahepatic bile duct (B3 and B8). Under a diagnosis of primary sclerosing cholangitis, we conducted laparoscopic cholecystectomy with liver biopsy. We found 2 gallstones and a slight torous epithelial lesion 2.8×1.5 cm on the gallbladder. Histopathological diagnosis was well-differentiated tubular adenocarcinoma of the gallbladder confined to the mucosa. The postoperative course was uneventful, involving oral administration ursodeoxycolic acid at 300 mg per day. Regular checkups have shown no recurrence of carcinoma or jaundice during follow-up, and no change has been seen in the bile duct.View full abstractDownload PDF (86K) -
Hiroki Odawara, Susumu Ohwada, Susumu Kawate, Noboru Oriuchi, Kenji Ka ...2004 Volume 37 Issue 12 Pages 1867-1871
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case in which FDG-PET was useful in diagnosing of early-stage extrahepatic bile duct cancer. A 60-year-old woman reporting right upper quadrant pain was found in abdominal ultrasonography to have a tumor in the common bile duct. Tumor markers in serum were slightly elevated (AFP: 11.2ng/ml, CA19-9: 41U/ml). Abdominal CT and ERCP showed a tumor in the middle bile duct, but we could not determine ma-lignancy. FDG-PET revealed a high accumulation of FDG with a standardized uptake value (SUV) of 3.6 and a SUV ratio of 2.8, which led to the diagnosis of cancer of the middle bile duct, necessitating pylorus-preserving pancreatoduodenectomy with standard lymph node resection. A papillary tumor 2 cm in diameter was found in the middle bile duct of the resected specimen. Microscopically, the tumor was a papillary adeno-carcinoma limited to the fibrous muscular layer and showing no lymph node metastasis. It is often difficult to diagnose malignancy of bile duct cancer in earlier stages, and FDG-PET may provide useful information in making a definitive diagnosis.View full abstractDownload PDF (109K) -
Takahiro Tsuchikawa, Tatsunosuke Ichimura, Shigeki Abeshima, Naoto Has ...2004 Volume 37 Issue 12 Pages 1872-1876
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 63-year-old woman reporting left upper quadrant abdominal pain and admitted under diagnosis of cholangitis was found in abdominal computed tomography (CT) to have an atrophied right hepatic lobe and a dilated intrahepatic bile duct. Percutaneous transhepatic cholangio drainage (PTCD) removed a large amount of mucin-like material. CT and cholangiography findings suggested a mucin-producing lesion in the right hepatic duct with a congenital choledochal cyst involving both intra-and extrahepatic ducts. Right hepatectomy with resection of the common bile duct and left hepatico jejunostomy (Roux-en-Y) was done. Macroscopic findings showed a 5.5×4 cm IIa tumor from the bifurcation to the right hepatic duct. Histopathologically, the tumor was well differentiated adenocarcinoma in the mucosa without lymph node metastasis or invasion of the surrounding tissues. The patient remains alive and well in the 27 months postoperatively without sign of reccurrence.View full abstractDownload PDF (92K) -
Taishi Hata, Masataka Ikeda, Hirofumi Yamamoto, Masakazu Ikenaga, Masa ...2004 Volume 37 Issue 12 Pages 1877-1882
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a 68-year-old man preoperatively diagnosed with a pulmonary embolism (PE) and deep venous thrombosis (DVT) who underwent successful pancreatic cancer surgery. He underwent pulmonary perfusion scintigraphy and computed tomography (CT) preoperatively. Lung scintigraphy showed multiple defects in both lung lobes, and CT showed DVT of the left peroneal vein. Anticoagulant therapy was initiated immediately after the diagnosis and stopped during surgery. Pancreaticoduodenectomy was done with a physical modality alone to prevent DVT, and anticoagulant therapy was restarted the next day. The patient recovered uneventfully and pulmonary scintigraphy taken on postoperative day 8 showed improved bilobular defects. This case demonstrates the possibility that patients with preexisting asymptomatic PE may be diagnosed postoperatively with PE after the manifestation of clinical symptoms.View full abstractDownload PDF (101K) -
Hideaki Nezuka, Kazuhisa Yabushita, Shouzou Houjou, Masashi Inokuchi, ...2004 Volume 37 Issue 12 Pages 1883-1887
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSHemosuccus pancreaticus-blood entering the gastrointestinal tract through the pancreatic duct is rare, and most commonly caused by a pseudoaneurysm of the splenic artery due to acute or chronic pancreatic inflammation. We report hemosuccus pancreaticus caused by a microrupture of the splenic artery with arteriosclerosis into the main pancreatic duct without aneurysms or pancreatic cystic lesions. A 79-year-old man suffering from recurrent hematemesis and melena from July 1996 consulted several hospitals but the cause of gastrointestinal bleeding was not found. In November 2001, endoscopy showed fresh bleeding from the Vaters papillae, and he was diagnosed as hemosuccus pancreaticus. Since we did not detect the hemorrhage locally in angiography near the splenic artery, he did not improve in conservative treatment, so we conducted total pancreatectomy. Histopathologically, the cause of bleeding was a microrupture of the splenic artery with arteriosclerosis into the main pancreatic duct. Hemosuccus pancreaticus is rare, but it is important to treat gastrointestinal bleeding whose origin is not immediately known.View full abstractDownload PDF (115K) -
Hiroyuki Kasajima, Satoko Morohashi, Takaaki Yoshizaki, Susumu Ohishi, ...2004 Volume 37 Issue 12 Pages 1888-1893
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 70-year-old man underwent total gastrectomy with lymph node dissection (D1+α) under a diagnosis of multiple gastric cancers in September 2000. Abdominal computed tomography showed a solitary splenic tumor about 10 cm in diameter in October 2002, necessitating TS-1 therapy. Closer examination showed no metastatic lesion in other organs, so we conducted surgery under a diagnosis of solitary metastasis to the spleen from gastric cancer in February 2003; i. e. splenectomy with resection of the diaphragm. Histopathological examination showed moderately differentiated adenocarcinoma of the spleen, histologically compatible with metastasis from gastric cancer. He remains recurrence-free a year later. Cancer rarely metastasizes to the spleen except in terminal status. Radical surgery is thus recommended for gastric carcinoma patients who have metachronous splenic metastasis.View full abstractDownload PDF (115K) -
Jun Ohishi, Shingo Yoshioka, Takanobu Maki, Akira Tomita2004 Volume 37 Issue 12 Pages 1894-1899
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe treated 2 cases of paracecal hernia surgically based on preoperatively diagnosis. Case 1: An 89-year-old woman hospitalized for congestive heart failure experienced abdominal pain and vomiting, with spontaneous pain and tenderness in the right lower abdomen. She was diagnosed with ileus based on abdominal X-ray. Abdominal CT showed radical distribution in the paracecal region. Ileus due to paracecal hernia was suspected, necessitating emergency surgery. Case 2: A 59-year-old man transferred to our hospital on suspiction of ileus due to small bowel volvulus had spontaneous pain and tenderness in the right lower abdomen Abdominal CT showed incarcerated intestines on the right side of the retroperitoneum and ascites and US showed involvement of the small intestine into the retrocecum. Based on a preoperative diagnosis of retrocecal hernia, we conducted emergency surgery. Paracecal hernia is rare, with unpredictable symptoms that make it difficult to diagnose preoperatinely. In most cases, there were some abnormal findings in the right lower abdomen, such as spontaneous pain, tenderness, or palpitation of a mass lesion. Reports of preoperative diagnosis of this disease by abdominal CT have increased. Physical findings of the right lower abdomen and findings in abdominal CT and US must thus be kept in mind for early treatment.View full abstractDownload PDF (94K) -
Chihiro Tono, Shuji Kawamura2004 Volume 37 Issue 12 Pages 1900-1904
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of enterostenosis after reposition of an incarcerated inguinal hernia. A 72-year-old man experienced enterostasis caused by incarceration of a right inguinal hernia on October 1, 2003, repaired by taxis after admission. Seven days later the patient underwent radical surgery for the hernia and was discharged. On November 4, 27 days after surgery, he suffered from another intestinal obstruction involving stenosis of the small intestine. The stenosis was not improved by conservative therapy and required surgery on November 18. Two parts of the middle small intestine were stenotic, necessitating removal of 13 cm. Histological findings showed ischemic enteritis with stenotic change. Such patients should be carefully followed up after repair of an incarcerated inguinal hernia to help avoid delayed small bowel stenosis following ischemic enteritis.View full abstractDownload PDF (99K) -
Takayuki Tajima, Masaya Mukai, Tomoya Hinoki, Yasuo Ohtani, Shinkichi ...2004 Volume 37 Issue 12 Pages 1905-1909
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 64-year-old man been admitted, for ileus 2 months previously and discharged without diagnosis because of spontaneous resolution presented again with vomiting. Abdominal examination showed epigastric tenderness, but no peritoneal irritation. Plain abdominal X-ray showed no ileus. Abdominal CT showed intussusception in the right hypogastric region, but blood tests showed no findings to suggest inflammation. The man's symptoms again resolved spontaneously with passage of a large amount of flatus and defecation. An ileus tube was inserted to about 175cm and contrast studies showed a tumor 4 cm diameter in the ileum. Laparotomy showed intussusception of the small bowel at a diameter of 6 cm about 35 cm from the ileocecal valve. Intussusception was reduced manually and part of the small intestine excised. Histopathological examination fielded a diagnosis of liposarcoma. Based on these findings, diagnosed this as a rare liposarcoma causing intussusception of the small bowel.View full abstractDownload PDF (89K) -
Kei Kanoh, Minoru Sukigara, Shohjiroh Takayama2004 Volume 37 Issue 12 Pages 1910-1913
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a rare case of intestinal endometriosis causing intussusception. A 43-year-old woman reporting abdominal pain and intermittent diarrhea on July 22, 2002 was found in ultrasonography and computed tomography to have intestinal intussusception. Because of the mildness of symptoms, she wished to avoid surgery but increasing pain and loss of appetite led her to consent eventually to surgical intervention 9 days after the first consultation. A submucosal tumor in the cecum had advanced into the ascending colon, causing the intussusception, which was released bimanually, followed by ileocecal resection to remove the tumor. The histological diagnosis was ectopic endometriosis.View full abstractDownload PDF (112K) -
Yoshihiro Moriwaki, Koji Kanaya, Takayuki Kosuge, Toshiro Yamamoto, Mi ...2004 Volume 37 Issue 12 Pages 1914-1919
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of necrotizing ischemic colitis of the rectum with colon cast due to traumatic hypoperfusion of the pelvis. A 66-year-old man, who run was over by a truck and admitted, showed no sign of rectal or intestinal injury immediately after the accident, but we found spontaneous passage of a 160cm colon cast on hospital day 25. Colonofiberscopy showed necrosis and perforation of the rectosigmoid colon, necessitating emergency operation on hospital day 30. Pelvic abscess was completely demarcated. The patient underwent transverse loop colostomy. Patients with severe pelvic fracture are usually treated at the department of orthopedics or intensive care. If such patients showed ischemic complications of the left side colon, the gastroenterologist, gastroenterological endoscopist, and gastroenterological surgeon must be specifically knowledgeable about gastrointestinal complications under unusual conditions, such as pelvic traumatic injury. As gastroenterology specialists we must recognize such special pathophysiology as a matter of course.View full abstractDownload PDF (104K) -
Suguru Sawada, Yutaka Ozeki2004 Volume 37 Issue 12 Pages 1920-1923
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 68-year-old man diagnosed with peritonitis due to perforated acute appendicitis underwent and appendectomy and drainage. The postoperative pathological diagnosis was primary moderately differentiated adenocarcinoma of the appendix. Abdominal CT showed 4 metastatic liver tumors in the right lobe. We followed the man up 3 month after appendectomy. Right hemicolectomy and right hepatic lobectomy were done. The pathological diagnosis was moderately differentiated metastatic adenocarcinoma of the liver and lymph nodes. The man was discharged on post 28 operative day, but died of the recurrence 20 months after the first operation. Primary adenocarcinoma of the appendix is rare, In addition to, as is hepatectomy for liver metastasis. Although the prognosis of primary appendiceal adenocarcinoma with liver metastasis is dismal, aggressive hepatectomy is indicated unless distant metastasis and peritoneal dissemination existed. Hepatectomy after the first operation should be done as soon as the patient's general condition allows.View full abstractDownload PDF (104K) -
Akiko Amamoto, Atsushi Mitamura, Naoko Takatsu, Taichi Fukuzawa, Masaa ...2004 Volume 37 Issue 12 Pages 1924-1929
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report an extremely rare, severe case of ileus due to colon cancer associated with portal venous gas, extensive intestinal necrosis, and perforating peritonitis. A 57-year-old man reporting severe abdominal pain and nausea during examination for ileus had abdominal distension, tenderness, and tachycardia on physical examination. Laboratory studies showed inflammation response and metabolic acidosis. Abdominal computed tomography showed ascites, free air, and portal venous gas. Emergency surgery found reddish-brown ascites with foul-smelling extensive intestinal necrosis from the ileum to the sigmoid colon. A tumor with circular stenosis was located at the sigmoid colon, and perforation was observed at the tumor. Due to severe circula-tion problems, he initially underwent a resection of the necrotic intestine, followed 37 hours later by second-look operation. Polymyxin B immobilized fiber column and other intensive cares for respiratory failure and disseminated intravascular coagulation were conducted postoperatively. The patient improved and was discharged 59 days after the first operation.View full abstractDownload PDF (113K) -
Yoshito Okada, Shoichi Suzuki, Takashi Nakayama, Osamu Watanabe2004 Volume 37 Issue 12 Pages 1930-1933
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 53-year-old woman admitted for lower abdominal pain was found to have a large tumor in the lower abdominal wall. The top of tumor had necrosed, leading to fecal discharge. Fecal discharge was also found in urine. Pelvic computed tomography showed a massive lesion in the pelvic space and abscess cavity in the abdominal wall. Colonography showed the leakage of contrast medium from the sigmoid colon. Cystoscopy showed fecal fluid in the bladder. The patient had used an intrauterine contraceptive device for 20 years. Histopathologic examination of the endometrial cavity of uterus showed sulfur granules of actinomycosis. From these findings, the patient was diagnosed as having actinomycosis of the uterus due to the intrauterine contraceptive device. The abdominal abscess was thought to have originated from a sigmoid colon and blad-der fistulas. Because conservative therapy was ineffective, we surgically drained and resected the fistula. The postoperative course was uneventful. The abscess cavity in the abdominal wall disappeared and no recurrent mass has been found in the months since.View full abstractDownload PDF (60K) -
Norihiro Okamoto, Morito Maruta, Koutarou Maeda, Yoichi Sakurai, Masah ...2004 Volume 37 Issue 12 Pages 1934-1938
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSMetachoronous multiple carcinoma in the stoma is condition after abdominoperineal resection, and only 26 cases have been reported in Japan. We report a 67-year-old man with a second tumor in the stoma 15 years after abdominoperineal resection for rectal cancer. The patient reported constipation and increasing tumor size in the stoma 20 years after surgery. A biopsy revealed adenocarcinoma at the stomal site. The patient was diagnosed as having adenocarcinoma at the colostomy site with concomitant gastric cancer, necessitating en block resection of the sigmoid colon and colostomy site with reconstruction of a colostomy in the trans-verse colon and distal gastrectomy. Histopathological examination showed adenocarcinoma in the stoma invading to the adjacent skin and the muscle with adenocarcinoma of the stomach.View full abstractDownload PDF (75K) -
Hideaki Motohashi, Mitsuru Obata, Shingo Morimoto, Shunsuke Kato, Taka ...2004 Volume 37 Issue 12 Pages 1939-1943
Published: 2004
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of surgical resection for diverticulitis of the sigmoid colon associated with obstruction. An 86-year-old woman reporting sudden abdominal pain was admitted with ileus diagnosed by abdominal X-P. Gastrographin examination showed stenosis of the sigmoid colon, and abdominal computed tomography a thickened wall with edema and diverticulitis. Based on these findings, she was diagnosed with ileus resulting from diverticulitis. There were no abdominal findings in colonoscopy 25cm from the anal verge. She under-went subtotal colectomy due to dilation of the oral side of the colon. The resected specimen revealed stenosis for 6cm in the sigmoid colon due to thickening of the wall. Pathological examination revealed normal mucosa, thickening of the muscular layer, and the infiltration of inflammatory cells. Based on these findings, we diag-nosed the cause of stenosis as wall thickening due to diverticulitis and edematous changes. No malignancy was seen. Despite the many complications of diverticulitis, stenosis requiring surgery is rare. We report this case together with a discussion of the diverticulitis literature.View full abstractDownload PDF (74K)
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