The Japanese Journal of Gastroenterological Surgery
Online ISSN : 1348-9372
Print ISSN : 0386-9768
ISSN-L : 0386-9768
Volume 39, Issue 6
Displaying 1-16 of 16 articles from this issue
  • Motoaki Nagano, Toshio Shimayama, Nobuyasu Takahashi, Naoya Imamura, K ...
    2006 Volume 39 Issue 6 Pages 643-648
    Published: 2006
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    Introduction: The purpose of this study was to evaluate the indications and usefulness of conservative treatment of perforated duodenal ulcer (PDU).Patients and Methods: A total of 80 patients with PDU between April 1997 and March 2004 were classified to a conservative treatment group and an operative therapy group, and the two groups were compared. The following criteria are generally recommended for conservative treatment: 1) generally stable condition; 2) no or only slight localized fluid collection observed by ultrasonographyor computed tomography; and 3) after 1999 less than 2cm gastrografin leakage during upper gastroduodenography (UGI) was added.Results: Among the 80 patients, 46 were initially treated conservatively, five of whom developed an abscess and 6 were converted to surgery, yielding a completion rate of 87%(40/46). The conservative treatment group was significantly younger and had shorter hospital stays than the operative therapy group. The addition of UGI was followed by there a further increase in the completion rate of the conservative treatment, and no abdominal abscesses developed.Conclusions: Our new criteria, including the UGI findings, seem useful for the indications for conservative treatment of the patients with PDU.
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  • Yoshihiro Yasuda, Makoto Takagi, Takashi Ogata, Seisyoku Ri, Yoshiaki ...
    2006 Volume 39 Issue 6 Pages 649-652
    Published: 2006
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    We report an omental hematoma caused by a dissecting rupture of the right gastroepiploic artery. An 85-year-old man visited our hospital complaning of vomiting and abdominal pain. Abdominal CT revealed massive ascites without free air. Because the patient demonstrated muscular defense, an emergency laparotomy was performed. During the laparotomy, a hematoma was found in the right gastroepiploic arterial field of the omentum, a partial resection of the omentum was performed. Histological examination revealed the rupture of a dissecting aneurysm in the right gastroepiploic artery.
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  • Yoshitaka Uji, Toshiomi Kusano, Hiroya Iida, Hiroyuki Yuzawa, Takashi ...
    2006 Volume 39 Issue 6 Pages 653-659
    Published: 2006
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    A 67-year-old female complaining of epigastralgia was admitted to our hospital. Upper gastrointestinal endoscopy revealed the presence of a type-2 gastric cancer. Preoperative laboratory data indicated anemia, leukocytosis (27, 700/μL) and a high level of granulocyte-colony stimulating factor (G-CSF). The patient underwent both a total gastrectomy and a pancreaticosplenectomy. The surgical stage grouping was T4, N0, H0, P0, CY0, M0, and Stage IIIA. Regarding the pathological diagnosis, most of the tumor was a poorly differentiated adenocarcinoma, while part of the tumor was a squamous cell carcinoma. After the operation, the patient. s leukocyte count and serum G-CSF level both improved. Multiple liver metastases were detected three months after surgery. Hepatic arterial infusion was performed, but the hepatic metastases progressed nevertheless. The patient died on postoperative day 170. At the time of autopsy, metastases were detected in the lung, small intestine and general lymph nodes. An immunohistochemical examination using anti-G-CSF antibody revealed a negative reaction in both the primary and metastatic tumor cells. However, this case was diagonosed as a G-CSF producing gastric cancer based on the laboratory findings and clinical course.
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  • Takehiro Sakai, Koichi Sato, Yoshie Hasegawa, Yuka Kimura, Masashi Koy ...
    2006 Volume 39 Issue 6 Pages 660-665
    Published: 2006
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    A 52-year-old woman was diagnosed as having descending colon cancer during further examination for anemia. The patient underwent a left colectomy with D3 node dissection with end-to-end anastomosis reconstruction. The accessory middle colic artery was secured as a feeding artery, and the middle colic artery was preserved. Diet was started on postoperative day 5, and nausea and vomiting appeared on postoperative day 9. An upper gastrointestinal series revealed linear cut-off in the third portion of the duodenum and dilation of the proximal duodenum. Ultrasonography and three-dimensional imaging using computed tomography revealed narrowing of the aorto-mesenteric angle. The patient was diagnosed as having aorto-mesenteric occlusion of the duodenum, and was treated with conservative therapy by continuous nasogastric decompression, total parenteral nutrition, and position change, and the symptoms gradually improved. The nasogastric tube was removed on postoperative day 23, and diet was started on postoperative day 28. The aorto-mesenteric angle after symptom improvement did not change compared with that at the onset. The postoperative course was uneventful after starting diet, and the patient was discharged on postoperative day 49. We should consider aorto-mesenteric occlusion of the duodenum in patient with a colectomy, when nausea and vomiting appears frequently and no findings suspected as ileus could be detected in the abdominal radiography during the early period after surgery.
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  • Daiji Iwami, Izumi Mochizuki, Tatsuya Nakano, Takuji Hirano, Hiroshi K ...
    2006 Volume 39 Issue 6 Pages 666-671
    Published: 2006
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    We report a case of inflammatory pseudotumor of the liver with septic shock and disseminated intravascular coagulation. A 51-year-old woman admitted for fever and right hypochondralgia and referred due to a hepatic mass lesion detected by abdominal computed tomography (CT) was found on admission to have blood pressure of 77/51mmHg and laboratory data showing disseminated intravascular coagulation with decreased platelet counts and increased FDP. Imaging diagnosis following ultrasonography (US), CT, and magnetic resonance imaging showed a space-occupying lesion 8cm in diameter in the right hepatic lobe. Selective hepatic angiography showed tumor staining and occlusion of the anterior branch of the right portal vein. Fine needle aspiration biopsy under US to determine a definitive diagnosis showed that the lesion consisted of numerous lymphocytes and neutrophils without malignant pathological features. Cultures from the lesion grew Streptococcus species, leading to suspicion of an inflammatory pseudotumor. Conservative therapy using antibiotics had no effect on the inflammatory reaction, necessitating exploratory surgery and right hepatectomy and cholecystectomy. The cut surface of the lesion showed a yellowish white solid tumor with scattered microabscesses. Pathological examination yielded a definitive diagnosis of inflammatory pseudotumor. The patient recovered without complications and remains well without symptom recurrence in the 3 years since her operation.
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  • Hiroaki Ozasa, Ryoichi Shimizu, Hiroaki Toshimitsu, Katsuhiro Matoba
    2006 Volume 39 Issue 6 Pages 672-676
    Published: 2006
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    In September, 2003 a 41-year-old woman was admitted for epigastric pain, vomiting, and fever. She had undergonep revious surgery in June, 2000 for an anomalous pancreaticobiliary duct junction and congenital biliary dilatation. On admission in 2003 computed tomography showed intrahepatic biliary dilatation involving the lateralpart of the left lobe that was unassociated with tumor. Percutaneous transhepatic choledochoduodenography showed bile duct stricture at the site where a retrograde transhepatic biliary drainage (RTBD) tube has been inserted in 2000. The intraoperative pathologic diagnosis of a frozen section specimen was benign biliary stricture with inflammatory cell infiltration and fibrosis, and lateral segmentectomy was performed instead of left lobectomy. Punctures of intrahepatic bile ducts with an RTBD tube should be performed with a sufficiently fine tube as peripherally as possible to avoid postoperative complications, such as inflammatory biliary stricture. When a wider biliary drainage tube is needed, it should be inserted via the alimentary tract rather than via the liver.
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  • Naoki Sakurai, Junichiro Yamauchi, Hisashi Shibuma, Eiichi Ikeda, Shun ...
    2006 Volume 39 Issue 6 Pages 677-682
    Published: 2006
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    We report a rare case of so-called carcinosarcoma of the gallbladder. A 54-year-old woman, reporting postprandial right upper abdominal pain and referred for treatment of an intra abdominal tumor of unknown origin was suspected preoperatively of having advanced transverse colon cancer invading the gallbladder and duodenum. Because the gallbladder and duodenum were obviously involved in the giant tumor, we conducted right hemicolectomy, extended cholecystectomy (common bile duct preservation), and partial resection of the duodenum. Histological examination showed that the tumor consisted of two different cell types; poorly differentiated adenocarcinoma and spindle-cell sarcoma with differentiation to cartilage and partly bone. Both types of tumor cells transferred each other. Spindle-shaped tumor cells around cartilage were positive for keratin. This histological evidence, led to a definitive diagnosis of so-called carcinosarcoma of the gallbladder.
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  • Toshihiro Muto, Takamasa Tokoro, Eisaku Sato, Tetuya Kaneko, Akira Ori ...
    2006 Volume 39 Issue 6 Pages 683-688
    Published: 2006
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    69-year-old man underwent extended left hepatectomy for hilar cholangiocarcinoma in November 1999, and curability B resection was achieved. In May 2003, he was admitted for cholangitis that was improved by conservative therapy, but recurrence in the remnant bile duct of the pancreas was revealed, and he underwent a pancreatoduodenectomy curatively in July 2003 but he died of multiple liver metastases at the 20th postoperative month. We concluded that fragments originating from the fragile hilar cholangiocarcinoma growing papillary in the bile duct were seeded in the residual bile duct, although metachronous carcinogenesis in the biliary tract may also explain the pathogenesis. It has been reported that there is little opportunity for salvage surgical resection in recurrent cases after curative operation for hilar cholangiocarcinoma, and an atypical and aggressive procedure is often required, resulting in a poor prognosis. In 17 reported cases including our case in Japan since 1990, three patients (17%) died in hospital, 12 patients (70%) suffered recurrence after reoperation. Seven patients (41%) have survived for one year or more however, therefore surgical treatment for recurrence is an important current arm in the absence of other effective alternatives.
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  • Yoshitsugu Nakanishi, Masafumi Sato, Masaya Kawada, Hiroshi Gyoubu, Hi ...
    2006 Volume 39 Issue 6 Pages 689-695
    Published: 2006
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    A 69-year-old man referred for upper abdominal pain and back pain was found in ultrasonography (US) to have a low echoic mass 1.6cm in diameter with hyperechoic spots inside the pancreatic body. Enhanced US showed a hypervascular tumor. Abdominal computer tomography (CT) showed a mass enhanced on the pancreatic body. Biopsy from the tumor revealed adenocarcinoma diagnosed as carcinoma of the pancreas necessitating distal pancreatectomy with splenectomy. Histological studies showed a tumor 1.5cm in diameter consisting of tubular adenocarcinoma and spindle cells. The definitive diagnosis was anaplastic spindle-cell carcinoma of the pancreas. Five months after the operation, recurrence was found in the left abdominal field and 1 month after that, a tumor was found at the ampulla of Vater. Biopsy from the tumor at the ampulla of Vater showed sarcomatous components. Liver metastasis also occurred, and the man died 8 months after the operation.
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  • Shojiro Kikuchi, Yoshitaka Nakamura, Tokunari Okayama, Hiroo Konishi, ...
    2006 Volume 39 Issue 6 Pages 696-701
    Published: 2006
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    Peritoneal adenocarcinoma in peritoneum is rare, originating in the paramesonephric duct. An 80-year-old woman seen for diarrhea and abdominal pain was found in computed tomography (CT) to have a large intraabdominal mass. Preoperative diagnosis by CT, magnetic resonance imaging (MRI), and fluorodeoxyglucose-positron emission tomography (FDG-PET) indicated appendiceal cancer with peritoneal dissemination. The pathological diagnosis of the resected specimen was papillary adenocarcinoma of the ascending colon with mucinous cystadenocarcinoma and clear cell carcinoma. The woman underwent combined chemotherapy with CDDP/TS-1 for local recurrence. The prognosis of adenocarcinoma with clear cell carcinoma is generally dismal due to the poor response to chemotherapy. In this case, surgical resection and chemotherapy brought the recurrent tumor under control, thus indicating a new way of potentially managing such tumors.
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  • Naoaki Sakata, Yasushi Wada, Takanori Morikawa, Kyohei Ariake, Tsuyosh ...
    2006 Volume 39 Issue 6 Pages 702-707
    Published: 2006
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    We report a rare case of small bowel perforation in secondary amyloidosis in a 72-year-old Japanese woman under going treatment for rheumatoid arthritis. The patient developed severe abdominal pain during hospitalization for appetite loss. C-reactive protein was elevated. Abdominal computed tomography (CT) showed free air over the liver and ascites and intestinal dilation, necessitating emergency surgery for diffuse peritonitis secondary to 2 jejunal perforations. We conducted partial resection and reconstructive end-to-end jejunojejunostomy. Despite post-operative intensive care, her general condition failed to improve and she died of multiple organ failure on postoperative day 6. Postmortem diagnosis was gastrointestinal amyloidosis secondary to rheumatoid arthritis based on histological findings such as amyloid deposits within the muscularis mucosae layer and vascular smooth muscle and perforation in small bowel diverticula, and a marked increase in serum amyloid A (SAA) protein. Although gastrointestinal diverticula and perforation due to amyloidosis is very rare -this is, to our knowledge, the first such report in Japan- we assume the incidence will increase together with recent increases in rheumatoid arthritis. The prognosis of gastrointestinal perforation due to amyloidosis is dismal. Gastrointestinal amyloidosis should be considered a probable diagnosis in patients with acute abdomen and a history of rheumatoid arthritis.
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  • Norihito Ise, Kimiyuki Shirayama
    2006 Volume 39 Issue 6 Pages 708-712
    Published: 2006
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    A 79-year-old female, whose past history was unremarkable, complained of constipation and anorexia. A diagnosis of intestinal obstruction was made on the basis of a plain abdominal X-ray film and she was admitted to our hospital after insertion of an ileus tube. Laboratory data on admission revealed mild elevation of WBC count, CRP, Hb, Ht, and BUN levels, but there were no other abnormal findings. A subsequent abdominal Xray showed that the volume of intestinal gas had decreased, but the tenderness in the right lower abdomen was not improved. Three days after admission, she was diagnosed as having intussusception of the terminal ileum with abdominal ultrasound and CT, which showed the “target sign”. An emergency operation was thus performed. Operative findings disclosed 13cm intussusception of the terminal ileum distal to Bauhin.s valve accompanied by small bowel volvulus; the small bowel was twisted 270° counterclockwise. A slight ischemic change of extensive small bowel was seen, but no gangrenous small bowel was detected, so the volvulus was able to be rotated back to the correct position. An ileocecal resection was performed because a portion of the intussuscepted intestine had already exhibited severe ischemic change. The patient had favorable progress after the operation and was discharged on the 15th postoperative day. In this case, small bowel volvulus could be induced by an indwelling ileus tube.
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  • Shigeaki Sawada, Naotaka Okamura, Shigenori Nagakura, Takashi Tada, Na ...
    2006 Volume 39 Issue 6 Pages 713-717
    Published: 2006
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    A 47-year-old man suffering from abdominal pain and vomiting had been admitted a third time for the same symptoms, but previously treated conservatively. Based on abdominal computed tomography and hypotonic duodenography, we diagnosed obstruction of the jejunum due to an internal hernia in the Treitz ligament and conducted a laparotomy. We found that the jejunum, 6cm distal to the Treitz ligament adhered to the retroperitonium, forming a diverticulum. We conducted wedge resection and the postoperative course was uneventful. Histopathological examination of the diverticulum showed a true diverticulum of the jejunum with an inflammatory change at the serosa but not at the mucosa site. The definitive diagnosis was traction jejunal diverticulosis, making this case one of interest due to its rarity.
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  • A Case Report and Review of Thirteen Cases of Primary Carcinoma of the Appendix from Our Hospital Facilites
    Kunihiro Yamasawa, Yukio Saito, Hideaki Yano, Fumie Sato, Norisuke Yok ...
    2006 Volume 39 Issue 6 Pages 718-723
    Published: 2006
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    We report a case of primary adenocarcinoma of the appendix difficult to distinguish from acute appendicitis. A 56-year-old woman with lower right quadrant abdominal pain was diagnosed preoperatively with acute appendicitis with abdominal abscess by ultrasound and computed tomography. Following appendectomy, pathological examination showed adenocarcinoma of the appendix. Ileocecal resection with regional lymph node dissection and removal of the abscess wall was conducted two weeks after the first operation. In addition to the case presented, we review the Japanese literature, i.e. 255 cases with adenocarcinoma of the appendix from 1995 to 2004, including 13 cases of our own.
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  • Hiroyuki Kitagawa, Michiya Kobayashi, Takehiro Okabayashi, Ken Okamoto ...
    2006 Volume 39 Issue 6 Pages 724-728
    Published: 2006
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    A 36-year-old woman underwent sigmoidectomy with D3 lymphadenectomy and partial hepatectomy of the lateral and S4 segment on June 1999 under a diagnosis of sigmoid colon cancer with liver metastasis in the lateral and S4 segment. Histological diagnosis of the resected specimen was well-differentiated adenocarcinoma. She underwent postoperative adjuvant chemotherapy with arterial infusion of 5-FU using transarterial reserver and oral administration of 5'-DFUR. After the first treatment, she underwent 3 partial liver resections and radio-frequency-ablation (RFA) due to hepatic cancer recurrence over the next 18 months. Chest x-ray showed a lung tumor with cavitation in the middle left lung field 42 months after initial treatment. We suspected metastasis to the lung or pulmonary aspergilloma. Transbronchial lung biopsy failed to yield a definitive diagnosis, so we partially resected the lung. Pathological findings for the frozen section showed metastatic lung tumor from sigmoid colon cancer. Metastatic lung tumor rarely forms a cavity.
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  • Tadao Ishikawa, Naohito Kanazumi, Shuji Nomoto, Soichiro Inoue, Shin T ...
    2006 Volume 39 Issue 6 Pages 729-735
    Published: 2006
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    A 56-year-old man hospitalized elsewhere for epigastralgia since May 2004 was diagnosed with descending colon cancer with solid tumors in the liver and pancreas. After undergoing left hemicolectomy, he was admitted to our hospital for further evaluation and treatment of the hepatic and pancreatic tumors. The absence of dilation of the main pancreatic duct led to a diagnosis of metastatic liver tumor that further metastasized to the local lymph node and invaded the pancreatic parenchyma, although the possibility of primary pancreatic head cancer with liver metastasis could not be denied due to elevated serum DUPAN-2. Because surgery could be curative if tumors had been of colorectal origin, the patient was eventually treated with pancreaticoduodenectomy and right hepatectomy in July 2005. Histopathologic studies showed that both hepatic and pancreatic tumors were compatible with metastasis from colon cancer having both well-and moderately differentiated components. Immunohistology showed that both colon and pancreatic tumors were positive for CEA/CK20 and negative for CK7, hence the final diagnosis of colon cancer with synchronous hepatic and pancreatic metastases. The patient died for liver and bone metastases 12 months after the surgical therapy.
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