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Volume 39, Issue 3
Displaying 1-27 of 27 articles from this issue
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Yoshihiro Moriwaki, Hiroshi Toyoda, Takayuki Kosuge, Mitsugi Sugiyama2006 Volume 39 Issue 3 Pages 277-282
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSMost misingested dental prostheses are easily removed by endoscope or fall naturally into the stomach. Large dental prostheses with sharp metallic clasps, however, may easily injure the pharyngoesophageal mucosa. A 64-year-old man diagnosed with a thoracic esophageal foreign body, esophageal perforation, mediastinitis, pleural perforation, and pneumonia required emergency esophagectomy and preoperative endoscopic examination to evaluate the cervical esophagus for anastomosis and the stomach for reconstruction. No deep ulcer or perforation was seen in the cervical esophagus and no lesion in the stomach. We found purulent pleural effusion, mediastinal abscess, and pleulitis during right thoracotomy and conducted thoracic esophagectomy, drainage, and simultaneous reconstruction by gastric roll with a retrosternal route. We found that the clasp of the misingested dental prosthesis had moved vertically, scratching the esophageal mucosa then had rotated horizontally and had pricked the esophageal wall, which indicated that we should attempt to horizontal rotation on endoscopical removal. After the operation, he was treated with mechanical ventilation for 8 days and transferred to the previous hospital on the 20th postoperative day.View full abstractDownload PDF (496K) -
Keiji Hayata, Makoto Iwahashi, Masaki Nakamura, Mikihito Nakamori, Yos ...2006 Volume 39 Issue 3 Pages 283-288
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 64-year-old man admitted for dysphagia was found in gastrointestinal endoscopy to have circular stenosis due to esophageal carcinoma, with biopsy squamous cell carcinoma with keratin pearl formation, necessitating subtotal esophagectomy and 3-field lymph node dissection. Pathological examination showed welldifferentiated squamous cell carcinoma (SCC) at the primary lesion with lymph node metastasis (#3, #7, #106recR, L, #101R, L, #104R, L). Poorly differentiated SCC and undifferentiated non-small-cell carcinoma were mixed in metastatic lymph nodes of the neck. Tumor cells of this type were confirmed to be derived from epithelial cells because immunohistochemical staining findings were positive for AE1/3 and EMA but negative for chromogranin A, synaptophysin, NSE, and vimentin. Undifferentiated non-small-cell carcinoma may result from dedifferentiation of squamous cell carcinoma.View full abstractDownload PDF (549K) -
Toshiaki Ohara, Makoto Tsumura, Masashi Utsumi, Yasumoto Yamasaki, Yas ...2006 Volume 39 Issue 3 Pages 289-293
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 66-year-old man who had undergone esophagectomy for intrathoracic esophageal cancer developed a peptic epithelial ulcer and edema on the anterior aspect of the reconstructed gastric tube while undergoing regular follow-up examinations. On admission, he received ulcer therapy, but the ulcer didn't heal and the gastric tube was partialy resectioned under local anesthesia. The ulcer recurred twice, and we conducted a thorough investigation. A detailed history revealed that he had been treated of the shoulder with NSAIDS and longterm steroid therapy, and they were thought to be factors contributing to formation of the ulcers. A secretin test was performed to rule out the Zollinger-Ellison syndrome, but it was negative because the patients' plasma gastrin level was continuously high (1, 210-1, 620pg/ml) and there was no paradoxical response. The plasma gastrin level was much higher than in other cases reported in Japan, and we attempted to find the cause. Parietal cell antibody (PCA) was negative. The patient was positive for urophanic and serum antibodies to Helicobacter pylori, but the gastric tube resection specimens were negative, and the cause remained unclear. Because of the generally long-term survival after esophageal cancer surgery, patient education is necessary to prevent the development of gastric tube ulcers.View full abstractDownload PDF (844K) -
Tsunenobu Takase, Akio Harada, Toyohisa Yaguchi, Masaki Kajikawa, Shig ...2006 Volume 39 Issue 3 Pages 294-299
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSGastric carcinosarcoma is rare and very few cases differentiating toward specific nonepithelial tissue have been reported. A 74-year-old man admitted for epigastralgia and anorexia was diagnosed with true gastric carcinosarcoma based on endoscopic biopsy showing lesions differentiating toward chondrosarcoma. We conducted total gastrectomy with local resection of the lateral hepatic segment and diaphragm involvement. The primary tumor lesion was composed pathologically of carcinomatous and chondrosarcomatous elements. Carcinomatous elements showed poorly to moderately differentiated adenocarcinoma, along with small-cell carcinoma. Sarcomatous elements showed spindle cells and cartilaginous components. Metastatic lymph nodes contained only carcinomatous elements. The man died of multiple liver metastases 5 months after surgery. The autopsy showed that pathological findings of liver metastases were similar to those of the primary tumor, suggesting the potential of sarcomatous elements for hepatic metastasis. We reported the present case to add to reports on clinical cases of true gastric carcinosarcoma, because fewer than 10 cases have been reported to date.View full abstractDownload PDF (934K) -
Kojiro Taura, Iwao Ikai, Masayuki Shimoda, Shinya Hamasu, Etsuro Hatan ...2006 Volume 39 Issue 3 Pages 300-305
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 53-year-old man with epigastralgia was found in endoscopy to have a tumor at the papilla of Vater, necessitating pylorus-preserving pancreaticoduodenectomy. Histological examination showed round, small cells with scanty cytoplasm proliferating in solid and cribriform patterns with glandular fenestrations. Nuclear atypia was prominent and mitoses were frequent. Tumor cells were positive for chromogranin A and CD56, yielding a diagnosis of neuroendocrine carcinoma (small-cell carcinoma). Liver metastases were observed 2 months post operatively. Hepatic arterial infusion chemotherapy with CDDP/CPT-11 was conducted, based on chemotherapy for small-cell carcinoma of the lung. Although this was initially effective and metastasis almost disappeared, the disease progressed very rapidly after relapse and he died 13 months after surgery. Neuroendocrine carcinoma of the gastrointestinal tract is reported to be very aggressive and have a dismal prognosis. Although effective chemotherapy has not been well documented, a chemotherapy regimen based on small-cell lung cancer provides reasonable alternative therapy for this disease.View full abstractDownload PDF (766K) -
Yasuhiro Tani, Takahito Nakagawa, Toshiya Kamiyama, Kazuaki Nakanishi, ...2006 Volume 39 Issue 3 Pages 306-311
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSHepatocellular carcinoma (HCC) extending into the right atrium is far advanced, and the benefits of surgical resection are controversial. As surgical techniques in liver resection have been improved, some reports have indicated that the surgical resection of HCC with the tumor thrombus at the atrium improved prognosis, and prevented sudden death caused by pulmonary embolism or heart failure. A 68-year-old man who had undergone right pneumonectomy had HCC and a tumor thrombus extending into the right atrium. He underwent hepatectomy with removal of the tumor thrombus using cardiopulmonary bypass. Right hepatectomy was done with an anterior approach and very careful homeostasis, in succession with tumor thrombectomy under cardiopulmonary bypass. Operation time was 7 hr 29 min and blood loss 2, 750ml, with 4 minutes of cardiopulmonary bypass. He remains alive and well in the 11 months since hepatectomy.View full abstractDownload PDF (467K) -
Shintaro Akamoto, Kunihiko Izuishi, Shinichi Yachida, Keiichi Okano, F ...2006 Volume 39 Issue 3 Pages 312-316
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report surgery for paraaortic lymph node recurrence after surgery for hepatocellular carcinoma. The 77-year-old woman had a history of partial hepatic resection (S8) of the liver for hepatocellular carcinoma in 2001. We dissected lymph nodes No.12 and No.13, and metastases was detected in No.12. In 2003, paraaortic lymphadenopathy was found by computed tomography. The paraaortic lymph node was dissected and diagnosed pathologically as solitary recurrence of hepatocellular carcinoma. 22 months after surgery, multiple liver metastasis were detected. She remained alive for 2 years after the second operation. Lymph node metastasis of hepatocellular carcinoma is not uncommon, as demonstrated by its incidence of 28.2% in all autopsy cases in the Japanese literature, but it accounts for only 1.6% of metastases in hepatectomy cases. Solitary lymph node metastasis of hepatocellular carcinoma is usually found at the hepatoduodenal ligament or retropancreatic area.View full abstractDownload PDF (568K) -
Kosei Hoshi, Yukou Saitoh, Ryoichi Anzai, Hiroaki Tanno2006 Volume 39 Issue 3 Pages 317-322
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a rare case of primary malignant melanoma of the common bile duct. A 55-year-old man reporting general fatigue and icterus was found on MRCP to have a tumor in the middle common bile duct. Since we could not determine malignancy from bile juice cytology, we diagnosed middle common bile duct cancer due to the tumor's large size. Macroscopic findings in resection of the common bile duct and hepaticojejunostomy (Roux-en Y) showed a black tumor about 3cm in diameter. Histopathology and immunohistochemistry showed the tumor to be malignant melanoma. To determine whether the tumor was primary or metastatic, we found FDG-PET to be useful. The tumor had originated in the common bile duct, and FDG-PET detected multiple liver metastasis. Due to the lack of reports on chemotherapy for primary malignant melanoma of the bile duct, we tried dacarbazine, nimustine hydrocholaride, and vincristine sulfate (DAV), but to no avail. The patient died 4 months after surgical resection.View full abstractDownload PDF (855K) -
Ippei Matsumoto, Tetsuo Ajiki, Hidehiro Sawa, Tsunenori Fujita, Takash ...2006 Volume 39 Issue 3 Pages 323-328
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe congenital cysts of the bile duct and anomalous pancreaticobiliary junction often present with acute pancreatitis, but the pancreatitis grade in most cases is mild. We report a type IV-A congenital dilatation of bile duct with severe acute pancreatitis. A 68-year-old woman admitted for severe acute pancreatitis. After treatment for acute pancreatitis, MRCP and ERCP were done, showing a type IV-A congenital dilatation of bile duct. The dilated choledochus was excised and hepaticojejunostomy was conducted 6 weeks after pancreatitis onset. During surgery, we could not dissect the intrapancreatic bile duct due to changes from pancreatitis, so we dissected the bile duct at the upper edge of the pancreas. Congenital dilatation of bile duct of bile duct and anomalous pancreaticobiliary junction must thus be considered as a possible cause of severe acute pancreatitis. Surgical timing should be delayed until pancreatitis changes disappear if the congenital dilatation of bile duct is to be resected once the absence of malignancy has been confirmed.View full abstractDownload PDF (516K) -
Yasuyuki Fukami, Masaki Terasaki, Kenji Sakaguchi, Toru Murata, Masayu ...2006 Volume 39 Issue 3 Pages 329-333
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 79-year-old woman admitted for high fever and right upper quadrant pain was found in abdominal US to have wall thickening and several stones in the gallbladder, suggesting gallstone cholecystitis. Abdominal CT showed dilation of the main pancreatic duct but no lesion. ERP showed stenosis of the main pancreatic duct at the body of the pancreas and dilation at the tail. Cytology of the pancreatic juice was class III. Unable to rule out small pancreatic cancer, we conducted pancreatectomy of the body and tail and splenectomy and cholecystectomy. Pathological findings showed fibrous thickening of the main pancreatic duct at the stenotic portion and atrophy of the acinus around the duct, leading to a definitive diagnosis of main pancreatic stenosis due to localized chronic pancreatitis. We also found pancreatic intraepithelial neoplasia (PanIN) about 5cm toward the tail from the stenosis.View full abstractDownload PDF (468K) -
Kazunari Misawa, Yasuhiro Shimizu, Kenzo Yasui2006 Volume 39 Issue 3 Pages 334-339
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of pancreatic metastasis from lung cancer. A 59-year-old woman underwent left lower lobectomy for lung cancer and chemoradiotherapy for brain metastases in 1998, followed by radiotherapy for bone metastasis in 2002. In June 2003, her serum CEA rose, and in October, abdominal CT showed a solid tumor 3.5 cm in diameter in the head of the pancreas. EUS showed a low echoic tumor with irregular borders, EUSguided fine-needle aspiration biopsy specimens suggested lung cancer metastasis in immunohistochemical staining. Because the primary lesion, brain metastases, and bone metastasis were considered cured, we conducted pancreatoduodenectomy in January 2004. The histological diagnosis of the pancreatic tumor was moderately differentiated adenocarcinoma, compatible with lung cancer metastasis. The patient is alive without recurrence 15 months after surgery. Pancreatic metastasis generally has a poor prognosis, but several cases reported indicate that surgery improved patient prognosis and quality of life. When metastasis is limited to the pancreas with the primary tumor controlled and the patient's general condition good, radical surgery could prove to be the optimal treatment.View full abstractDownload PDF (654K) -
Hidenobu Okino, Motomasa Hiroyoshi, Yoshiki Kitaura, Koji Onitsuka, Ma ...2006 Volume 39 Issue 3 Pages 340-346
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 45-year-old woman who underwent distal pancreatectomy and splenectomy for a solid-pseudopapillary tumor of the pancreas (PSPT) 2 years and 5 months earlier was found to have multiple liver metastases in follow-up CT, necessitating curative anterior segmentectomy and radiofrequency ablation. PSPT is a rare neoplasm with distinctive pathological features and low-grade malignant potential that preferentially affects young women, although cases developing into metastatic disease mostly involving the liver and peritoneum are increasingly reported. Based on maximal data, we analyzed and summarized clinical features of 50 cases with liver metastasis reported. in Japan as follows: average age was approximately 15 years older than that of the cases without hepatic metastasis; location of the primary tumor in the pancreas head is rare; tumors are about 15mm bigger than those of the cases without hepatic metastasis; metastasis took an average of 6.8 years to develop; 56% of cases showed multiple hepatic metastases; the prognosis for patients undergoing surgical treatment was good; and chemotherapy was not effective. These results indicated the need for longterm postoperative follow-up and aggressive surgical treatment in liver metastasis. Molecular biology recently revealed that pancreatic ductal carcinoma and PSPT progress genetically through two pathways, distinctly reflecting both prognosis and gender preference, but PSPT remains a surgical enigma.View full abstractDownload PDF (776K) -
Kazuteru Watanabe, Toru Kubota, Kaori Kubota, Michio Ueda, Yasuhiko Mi ...2006 Volume 39 Issue 3 Pages 347-351
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 41-year-old man with epigastralgia found by CT to have a pancreatic cystic mass was diagnosed by CT and MRCP as having a solid pseudo-papillary tumor (SPT) and underwent distal pancreatectomy. The resected specimen showed a 47×30×43mm solid, cystic mass with calcification in the dense capsule. Solid parts were formed by bleeding and necrotic tissues. Histological examination showed a diffuse sheetlike arrangement of tumor cells having nuclear atypia. Pseudo-papillary clusters and lymphatic invasions had occured in the tumor. These findings suggest aggressive malignant potential. SPTs are reported to be rare and with low malignant potential, and occur mainly in young women. They can, however, occur in men and in all age groups. Complete resection is associated with long-term survival and close follow-up is advisable, particularly when histological examination suggests an aggressive tumor.View full abstractDownload PDF (594K) -
Yukiyasu Okamura, Kiyoshi Ishigure, Tadao Ishikawa, Yoshikuni Inokawa, ...2006 Volume 39 Issue 3 Pages 352-357
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSAcinar cell carcinoma of the pancreas is a rare tumor accounting for about 1% of pancreatic exocrine neoplasms. Acinar cell carcinoma with subcutaneous fat necrosis is even rarer, with only 2 such cases having been reported in Japan. A 75-year-old man admitted for appetite loss was found on physical examination to have elastic and hard mass extending 10cm in the left upper quadrant of the abdomen. There were multiple subcutaneous nodules distributed in both legs. Laboratory tests showed a marked increase serum lipase and elastase 1. Serum CEA and CA19-9 were normal. Computed tomography scan of the abdomen showed a large mass consisting of solid and cystic lesions in the left upper quadrant. We conducted distal pancreatectomy on the diagnosis of the tumor from the pancreatic tail. The histopathological diagnosis was acinar cell carcinoma. Following surgery, serum lipase and elastase 1 decreased to normal, and skin lesions disappeared. The man remains alive without signs of recurrence 4 years after surgery.View full abstractDownload PDF (731K) -
Naoto Suzuki, Kentaro Nakao, Kazuhiro Narita, Katsuo Yamazaki, Hirotak ...2006 Volume 39 Issue 3 Pages 358-362
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 61-year-old woman complained of the sudden onset of abdominal pain. An Abdominal CT scan showed a hematoma extendly from the duodenum to the bifurcation of the common iliac artery in the retroperitoneal space. Laparotomy revealed a hematoma in right retroperitoneal cavity. Since the patient's vital signs were stable and the hematoma was non-expanding, we did not enter the retroperitoneal space. The bleeding source was not identified not intraoperatively or by postoperative 3D-CT angiography. Stricture of the duodenum was diagnosed on postoperative day 10, and effectively treated conservatively. There have been no hemorrhagic episodes since the patient was discharged. If there retropritoneal disease of unknown cause is seen in a patient, the presence of retroperitoneal hematoma should be considered as a possible cause, although it is rare.View full abstractDownload PDF (610K) -
Hiromitsu Domen, Joe Matsumoto, Tetsufumi Kojima, Etsuo Hiraguchi, Kaz ...2006 Volume 39 Issue 3 Pages 363-366
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTransepiploic hernia is rare and asymptomatic, making it difficult to diagnose preoperatively. We report a case of transepiploic hernia successfully diagnosed and treated laparoscopically. A 16-year-old woman seen for abdominal pain had no history of laparotomy or abdominal injury. Abdominal X-ray and CT showed the presense of a small amount of intestinal gas. She was admitted with a diagnosis of acute abdomen. Four hours later, she suddenly vomited with great abdominal pain. We suspected strangulated ileus due to an internal hernia and conducted emergency surgery by laparoscope. The small intestine had herniated through an abnormal hiatus of the greater omentum. A single loop was strangulated, but not necrotic. Strangulation was released laparoscopically and the greater omentum opened. Three days after surgery, she was discharged. No other cases than this have, to our knowledge, been diagnosed and treated laparoscopically. We therefore suggest that laparoscopy is useful in diagnosis or repositioning when an internal hernia is suspected.View full abstractDownload PDF (511K) -
Kazuhiko Shimamura, Toshiyuki Yamazaki, Shiro Kuwabara, Norio Katayana ...2006 Volume 39 Issue 3 Pages 367-372
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 44-year-old man with upper abdominal pain and a retroperitoneal tumor detected by abdominal CT was found to have a large tumor palpable in the upper right abdomen, but no abdominal tenderness or peritoneal irritation. Abdominal CT showed a large tumor adjacent to the lower hepatic surface. Portography showed a tumor-compressed portal vein without invasion of the portal vein. Inferior vena cavography showed invasion of the inferior vena cava above the orifice of the right renal vein. The preoperative diagnosis was a retroperitoneal tumor. Laparotomy showed that the tumor stretched from the upper right renal vein and right adrenal gland to the lower hepatic surface with invasion to 10cm into the inferior vena cava. The tumor was extirpated in wedge resection of the inferior vena cava. The defect of the inferior vena cava was repaired by a continuous suture. The resected tumor was 19×14×12cm and histologically diagnosed as leiomyosarcoma. Only surgical removal effectively treats leiomyosarcoma. Especially in retroperitoneal leiomyosarcoma, tumor invasion to major vessels is proved by diagnostic imaging. Tumor recurrence should be diagnosed and treated early by diagnostic imaging.View full abstractDownload PDF (529K) -
Yasumitsu Hirano, Hiroshi Nozawa, Makoto Hirano, Takuo Hara, Koichi Na ...2006 Volume 39 Issue 3 Pages 373-376
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 66-year old man was admitted our hospital for right lower abdominal pain. Blood examination showed leukocytosis (WBC count 16, 500/mm3), and the C reactive protein (CRP) level was elevated (18.9mg/dl), Abdominal ultrasonography showed a swollen appendix. Appendectomy was performed for a preoperative diagnosis of acute appendicitis, and pathological examination of the resected appendix showed signet ring carcinoma. Laparoscopic ileocecal resection with lymph node dissection was performed 53 days later. No residual tumor or lymph nodes metastasis were detected. The patient received postoperative chemotherapy and has remained in good health without clinical evidence of recurrent disease. It is very important to closely examine the resected appendix, including histologically, to avoid missing appendiceal tumors.View full abstractDownload PDF (626K) -
Hideo Miyamoto, Kouichi Okita, Ritsu Kusama, Yoshirou Fujimori, Kiyofu ...2006 Volume 39 Issue 3 Pages 377-383
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSPseudomyxoma peritonei is a clinical entity resulting from low-grade-malignancy tumor-cell implantation. Distant metastasis in these cases is very rare. We report a case of pseudomyxoma peritonei with splenic metastasis from mucinous cystadenocarcinoma of the appendix. A 65-year-old man undergoing surgery for an inguinal hernia was found interperioperatively to have a nodular region on the peritoneum of the hernial sac. Histopathology results suggested psedomyxoma peritonei. Abdominal CT scan and MRI showed a multilocular 13×11×16cm cystic mass involving the spleen necessitating surgery in February 2004. Laparotomy revealed jelly-like mucinous materials filling the abdominal cavity and countless mucinous nodules scattered through the intestinal tract, the mesentery, and the omentum. The appendix was slightly swollen. We conducted splenectomy, partial omentectomy, and appendectomy, removing as much of the mucinous materials as possible. We irrigated abdominal cavity with warm saline and distilled water. The histopathological diagnosis was mucinous cystadenocarcinoma of the appendix and splenic metastasis from the appendix. When we encounter a case of cystic mass of the spleen, we should examine the appendix considering a possibility of this disease.View full abstractDownload PDF (486K) -
Maki Takai, Kenkichi Hashimoto, Shota Hasuda, Kiyoshi Kajiyama, Masahi ...2006 Volume 39 Issue 3 Pages 384-389
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSVermiform appendix carcinoma is rare and difficult to diagnose preoperatively. We report two cases. Laboratory data in case 1 was WBC of 35, 800/mm3 and CRP of 7.1mg/dl while that in case 2 was WBC of 10, 900/mm3 and CRP of 21.2mg/dl. Imaging studies suggested abscess due to the perforated appendicitis, but neither showed strong tenderness at the cecum. Colonoscopy showed malignant change at the orifice of the vermiform appendix, leading to a diagnose is carcinoma of the vermiform appendix. We emphasize that among patients with cecal lesion, a discrepancy between laboratory data and physical findings suggests colonoscopy to obtain a definitive preoperative diagnosis of carcinoma of the vermiform appendix.View full abstractDownload PDF (531K) -
Masahito Nawa, Juji Tsuchiya, Masayoshi Asano, Susumu Tachibana, Hajim ...2006 Volume 39 Issue 3 Pages 390-394
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 63-year-old woman undergoing continuous ambulatory peritoneal dialysis (CAPD) chronic renal failure since 4 years earlier was admitted for abdominal pain with bloody stool. Although CT showed free air and retention of ascites, this did not necessarily imply intestinal perforation, because they were frequently seen for CAPD. She was treated for CAPD peritonitis on day 1.Food residue in the dialysate on day 2, however necessitated emergency laparatomy under a diagnosis of perforative peritonitis. Under an intralaparatomy diagnosis of transverse colonic perforative panperitonitis, we conducted transverse colostomy and peritoneal drainage. Despite severe postoperative MODS due to sepsis, we could relieved the woman. s symptoms using CHDF, PE, PMX, and other therpy.View full abstractDownload PDF (861K) -
Takeshi Gohongi, Takesaburo Ogata, Hiroyuki Iida, Naoto Gunji, Reiko N ...2006 Volume 39 Issue 3 Pages 395-400
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 78-year-old woman with ischemic heart disease was admitted with the chief complaint of lower abdominal pain and diarrhea. X-ray and endoscopy revealed multiple colon ulcers. Seven months later, subtotal colectomy was performed under her peritonitis condition. Ten round ulcers of various sizes from Ul-II to Ul-IV in grade were irregularly distributed from the ascending colon to the sigmoid colon. These ulcers sharply bordered normal mucosa and showed flat surface without epithelial regeneration. Histological study on serial sections revealed some organized microemboli in the subserosal small arteries lying under ulcer lesions. She suffered from postoperative candidiasis. Despite intensive life support, she died of cardiac and renal failure on the postoperative 275th day. Multiple ischemic ulceration of the colon is very rare. Such a case may increase in number in the aging society coming in Japan.View full abstractDownload PDF (572K) -
Keiko Nishiguchi, Hirohiko Onoyama2006 Volume 39 Issue 3 Pages 401-405
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report on a 31-year-old man with X-linked hypogammagloblinemia who developed multiple colorectal cancer. An immunodeficiency had been diagnosed in the patient since four years of age. On family history, his three uncle had died in infancy due to infection, and one brother was also diagnosed as hypogammagloblinemia. He had visited a fanily doctor due to abdominal pain and anal bleeding. Three cancers of the rectosigmoid region were detected by barium enema and low anterior resection was performed, and resected specimen revealed tumors lesions, including 3 cancers and 3 adenomas. Immnogurobulin was supplied intra venously after operation. However, β-D glucan was elevated to 114.2pg/ml, post operative course was uneventful. Considering family history and Methyl pyronne staining of the specimen, the hypogammagloblinemia of the patient was considered as X-linked disease. We reported a rare case of colorectal cancer combined with hypogammagloblinemia.View full abstractDownload PDF (569K) -
Satoshi Yodonawa, Isao Ogawa, Yukinobu Goto, Hiromichi Ito, Miyuki Kit ...2006 Volume 39 Issue 3 Pages 406-411
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 34-year-old man referred for melena and abdominal mass was found, on admission, by abdominal CT and MRI to have a huge left upper abdominal mass. Closer examination showed a suspected mesenchymal tumor arising from the transverse mesocolon, involving the transverse colon and pancreas, necessitating en bloc resection of the tumor by left hemicolectomy, distal pancreatectomy, and splenectomy. The resected 17×11×8 cm, 1, 500g tumor consisted microscopically of atypical polygonal cells proliferating in a solid nest with abundant eosinophilic cytoplasm. Immunohistochemically, tumor cells were positive for synaptophysin, chromogranin A, and neuronal-specific enolase (NSE) and the tumor was diagnosed as endocrine cell carcinoma. The patient underwent adjuvant chemotherapy with CDDP and CPT-11, but died due to local recurrence, liver metastasis, and peritonitis carcinomatosa 7 months after surgery. The prognosis of colorectal endocrine cell carcinoma is dismal, requiring effective intensive treatment, including neoadjuvant chemotherapy and radiation.View full abstractDownload PDF (496K) -
Yoshiko Bamba, Tatsuya Nakano, Hiroaki Tomimatsu, Shingo Kameoka2006 Volume 39 Issue 3 Pages 412-416
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of retrograde intussusception caused by a pedunculated adenoma of the sigmoid colon. A 72-year-old man admitted with left lower abdominal pain was found to have a hard elastic mass about 7cm palpable in the left lower abdomen. Abdominal X-ray showed gas throughout most of the intestine and the colon to the splenic flexure. The target sign was detected in the descending colon on CT scan. The oral side was continuous with the distended intestine, and on the anal side the mesentery was inserted into the lumen of the colon. Enema detected beak-like stenosis, necessitating surgery under a diagnosis of retrograde intussusception. The sigmoid colon was inserted in the oral side and the apex was palpated in the descending colon. Sigmoidectomy revealed a tumor 35×21×16mm pedunculated found in pathological examination to be an adenoma.View full abstractDownload PDF (405K) -
Kinya Matsumoto, Kazuya Odawara, Tsuyoshi Toyota, Hideo Watanabe, Fumi ...2006 Volume 39 Issue 3 Pages 417-421
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 57-year-old woman admitted for difficult evacuation and a sense of residual urine was found in CT and MRI to have a submucosal tumor 4 cm in diameter in the anterior wall of the lower rectum arising in the rectovaginal septum, suggesting GIST and necessitating transanal excision. The tumor was 4.5×4.0×3.6 cm. HE staining showed fascicular proliferated spindle-shaped tumor cells. Immunohistochemical studies showed a GIST of the rectum (borderline to low-grade malignancy) with positive staining for c-kit and CD34, and negative staining for desmin and S-100 protein. The woman was discharged uneventfully on postoperative day 10. No evidence of recurrence has been found in the 1 year and 4 months since. Abdominoperineal resection is often conducted for rectal GIST, but if local excision should be feasible in cases such as ours when the tumor is small.View full abstractDownload PDF (534K) -
Katsufumi Miyamoto, Chyousei Kusumoto, Yasunari Kawabata2006 Volume 39 Issue 3 Pages 422-427
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSPurpose: We evaluated the effectiveness of peritoneovenous shunt for refractory ascites and evaluated the usefulness of the prognostic index after peritoneovenous shunting developed by Jordi G et al Materials and methods: Subjects were 15 patients with refractory ascites undergoing peritoneovenous shunting from November 1999 to November 2003. Abdominal girth, body weight, performance status, volume of oral intake, renal function, and coagulability were evaluated pre- and postoperatively. Mean survival was calculated. The prognostic index was calculated in 9 patients based on the following equation: PI= [0.2866×Pugh score]-[0.0440×ascitic fluid protein concentration (g/l)] + [0.6926×previous spontaneous bacterial peritonitis]-[0.5656×alcoholic etiology] Results: Abdominal girth and body weight decreased significantly after shunting. Renal function significantly improved. Coagulability changed significantly after shunting. The volume of oral intake improved significantly after shunting. Performance status was not worsen by surgery. Mean survival was 165 days. Prognostic index and survival term were correlated significantly. Conclusion: Peritoneovenous shunting was useful for improving quality of life in patients with refractory ascites, and the prognostic index was useful in patient selection for peritoneovenous shunting.View full abstractDownload PDF (723K)
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