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Volume 42, Issue 5
Displaying 1-29 of 29 articles from this issue
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ORIGINAL ARTICLE
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Akihiro Matsunaga, Masao Hosokawa, Yasuhiro Suzuki, Yasunori Nishida, ...Article type: ORIGINAL ARTICLE
2009 Volume 42 Issue 5 Pages 449-454
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSBackground and Purpose: Esophageal carcinoma arising from Barrett's esophagus, Barrett's adenocarcinoma, accounts for roughly half of esophageal cancer occurring in European and American patients. The majority of esophageal cancer histology in Japanese patients is currently squamous cell carcinoma (SCC), but the prevalence of Barrett's adenocarcinoma is expected to increase as the traditional Japanese diet and physical constitution become "Westernized". We clarified clinicopathological features of Barrett's esophageal adenocarcinoma in Japanese patients. Methods: Clinicopathological features of 11 patients and 16 lesion with Barrett's superficial adenocarcinoma who had undergone esophagectomy were compared to those of 517 esophageal cancer patients with superficial squamous cell carcinoma (SCC). Results: Women predominanted in Barrett's superficial adenocarcinoma (27.3%) over those with superficial SCC (9.1%) (p=0.042). The percentage of heavy drinkers was relatively lower in Barrett's superficial adenocarcinoma than in superficial SCC. The incidence of multiple cancer development was higher in Barrett's superficial adenocarcinoma (45.5%) than in superficial SCC (14.3%) (p=0.016). Well-differentiated adenocarcinoma was seen in 14 of 16 lesion (87.5%) of Barrett's superficial adenocarcinoma, and 11 (68.7%) close to the squamocolomunar junction. Histological analysis of Barrett's mucosa around adenocarcinoma showed a specialized columnar type in 12 lesion (75%). Discussion and Conclusions: Our results are roughly consistent with previous reports, but the high incidence of women and multiple cancer development in Barrett's adenocarcinoma has not been well determined. Further study in thus are required to verify these features of Barrett's adenocarcinoma.View full abstractDownload PDF (269K) -
Kae Okoshi, Misa Ishihara, Shigeo Hisamori, Satoshi Nagayama, Hiroshi ...Article type: ORIGINAL ARTICLE
2009 Volume 42 Issue 5 Pages 455-465
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSIntroduction: Recent advance in understanding the biology of gastrointestinal stromal tumor (GIST) etiology involves specifically recognizing the central role of activating KIT mutation and associated KIT protein expression in these lesions. This has led to the development of novel, effective GIST therapy using the receptor tyrosine kinase inhibitor imatinib. We reviewed cases diagnosed pathologically as GIST based on diagnostic criteria. Methods: We reviewed data from patients histologically diagnosed with GIST between 1996 and 2005. Results: We found 31 primary GISTs, 14 recurrent GISTs and 22 small incidental GISTs incidentally during surgery for other diseases. Among primary GISTs, we found 18 cases (58.1%) in the stomach and 17 (54.8%) that were asymptomatic. Most small incidental GISTs were 5-10 mm in size and considered low-risk due to findings of mitosis and MIB-1 index. Although 10 cases involving 14 recurrent GISTs were resected surgically, six recurred, imatinib was administered to 7 patients and was effective in four. One case showed complete response lasting over five years. Conclusions: Asymptomatic GISTs may be often found incidentally in routine health checkup examination in Japan. Therefore, tumor size of GISTs in Japan tends to smaller than that in western countries. Before the development of imatinib, some patients with recurrence underwent tumor resection. Imatinib now has priority in treating recurrent GISTs, and surgery should be considered only for local recurrence or liver metastasis that is completely resectable.View full abstractDownload PDF (427K) -
Shinichi Egawa, Yoh Kitamura, Naoaki Sakata, Shigeru Ottomo, Hisashi A ...Article type: ORIGINAL ARTICLE
2009 Volume 42 Issue 5 Pages 466-472
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSBackground and Aims: The Frey procedure involves longitudinal pancreaticojejunostomy with coring of the pancreatic head for chronic pancreatitis. During follow-up, we encountered peripancreatic abscess that required reoperation. We analyzed the long-term outcome in terms of reoperation for patients with chronic pancreatitis undergoing Frey procedure. Patients and Methods: Of 62 patients undergoing the Frey procedure from 1992 to 2008, eight patients required reoperation during follow-up period (Median 45.5 months). Results: Early postoperative morbidity was 15.2% (10 cases) with median postoperative hospital stay of 19.5 days. In long-term follow-up, one patient required choledochoduodenostomy with repititive cholangitis. One required pancreatoduodenectomy for suspicious cancer. Four required distal pancreatectomy and one required cystojejunostomy for the most common type of left-sided relapse. All of them could not stop drinking after the first operation, except for one patient with idiopathic chronic pancreatitis. The mean duration before reoperation was 2 years after the Frey procedure. Resection of the pancreatic tail and recapping using the jejunal loop end effected satisfactory troubleshooting procedure for peripancreatic abscess of the pancreatic tail after the Frey procedure. Conclusion: Abstaining from drinking and sufficient drainage is critically important to preventing the relapse of inflammation. Once relapsed, reoperation should be conducted precisely and positively.View full abstractDownload PDF (665K)
CASE REPORT
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Souya Nunobe, Shigekazu Ohyama, Masanori Tokunaga, Naoki Hiki, Tetsu F ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 473-477
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSWe report a case of advanced gastric cancer in the remnant stomach after proximal gastrectomy, which was not detected over a long period of postoperative follow-up. A 79-year-old male had undergone proximal gastrectomy for early gastric cancer 11 years before. The annual examinations, including upper gastrointestinal endoscopy and abdominal ultrasonography, after the gastrectomy showed no recurrence of gastric cancer, but the remnant stomach had not been examined by endoscopy because of the long length of the interposed jejunum. The patient complained of vomiting two months before the present admission and was diagnosed as having advanced gastric cancer in the remnant stomach, with direct invasion of the transverse colon. Gastrectomy with combined resection of the pulled up jejunum and the transverse colon was undertaken, which turned out to be a non-curative resection with positive lavage cytology. In the present case, gastric cancer in the remnant stomach was not detected in its early stage due to the difficulty in observation of the remnant stomach. It is essential to devise an optimal reconstruction procedure after proximal gastrectomy and to conduct follow up of these patients for a long period of time after the initial surgery.View full abstractDownload PDF (446K) -
Yuki Hayashi, Kanji Miyata, Norihiro Yuasa, Eiji Takeuchi, Yasutomo Go ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 478-482
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSA 63-year-old man had abdominal pain. His doctor pointed out anemia and positive fecal occult blood during follow-up. Upper gastrointestinal endoscopy showed a semipedunculated tumor on the greater curvature of the gastric body, and biopsy indicated well-differentiated adenocarcinoma. Gastrography and computed tomography showed a 6 cm nodular gastric tumor prolapsing into the duodenum. Endoscopic ultrasonography indicated the cancer invading the muscularis propria or deeper. Therefore, distal gastrectomy with D2 lymph node dissection was performed. Results of pathological examination were as follows: moderately differentiated tubular adenocarcinoma, pT2 (SS), ly1, v1, and pN2. We reviewed gastric tumors prolapsing into the duodenum in Japanese literature. Tumors with ball valve syndrome are large (mean diameter: 61 mm), and frequently composed of cancer, myogenic tumor or gastrointestinal stromal tumor. Gastric cancers complicated with this syndrome are predominantly well-differentiated adenocarcinoma or papillary adenocarcinoma. Five of 15 cancers with this syndrome invade the muscularis propria or deeper, therefore, endoscopic resection or limited surgical resection should prudently be indicated even if a semipedunculated tumor.View full abstractDownload PDF (828K) -
Kazuo To, Takashi Nonaka, Yoshihito Shibata, Koji Mochinaga, Yoshikats ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 483-488
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSWe reported a case of dermadrome acommpanied by gastric cancer. A 71-year-old man admitted for epigastralgia was found in Gastrointestinal scopy to have huge type 2 gastric cancer. Abdominal computed tomography showed multiple lymph nodes metastasis, necessitating neoadjuvant chemotherapy with CPT-11 and TS-1. The main tumor and metastatic lymph nodes shrunk dramatically in size, but severe refractory systemic erythema annulare was recognized during fourth course of chemotherapy. We considered dermadrome and conducted distal gastrectomy. Systemic erythema annulare gradually transformed into pigmentation with a crust, almost disappearing after surgery on postoperative day 27th. The man died due to multiple liver metastasis and peritonitis carcinomatosa. Skin lesion recurrence was not seen during the postoperative course.View full abstractDownload PDF (1011K) -
Shojirokazunori Ikenaga, Susumu Oishi, Shinji Tsutsumi, Norihito Kubo, ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 489-494
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSThe association between malignant disease and nephrotic syndrome has been established. Here in we report a case of advanced gastric cancer with nephrotic syndrome. An 82-year old woman admitted for bilateral pedal edema and general fatigue was diagnosed with advanced gastric cancer with nephrotic syndrome, necessitating distal gastrectomy with D1+α lymph node dissection. Histology showed poorly differentiated adenocarcinoma, T3, N1, H0, P0, CY1, Stage IV, Cur C. Her urinary protein decreased and symptoms of nephrotic syndrome improved 5 days after surgery. Twelve months after surgery, she had no nephrotic syndrome symptoms or signs of recurrent gastric cancer. Concurrently with non curative surgery for advanced gastric cancer, her symptoms of nephrotic syndrome improved, indicating a potential advantage of surgery in such a case.View full abstractDownload PDF (777K) -
Tomokazu Kishiki, Kennji Miki, Masanori Teruya, Daisuke Endo, Yoshihar ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 495-498
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSWe report a case of duodenal obstruction due to gastric trichobezoar. An 11-year-old girl admitted for abdominal pain and vomiting, was found to have a firm mass palpated in the left upper abdomen. Blood studies showed elevated white blood cell counts, ALT, γ-GTP, and amylase. Computed tomography (CT) showed a large intraluminal gastric mass containing air and a mass with the same pattern in the duodenum. The girl had developed a habit of eating her hair as a 7-year-old, leading to a diagnosis of duodenal obstruction due to the trichobezoars. We removed the trichobezoars from the stomach and duodenum in emergency laparotomy. Gastric trichobezoar extended the trichobezoar to the duodenum, it was causing duodenal obstruction and elevated ALT, γ-GTP, and amylase. Diagnosis thus requires questions to patients about a history of trichophagia, in addition to suggestive CT findings.View full abstractDownload PDF (549K) -
Amane Kanazawa, Takashi Oshima, Naoto Yamamoto, Tsutomu Sato, Ryo Taka ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 499-504
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSA 52-year-old woman admitted for a pancreas head tumor detected by abdominal computed tomography was further found in gastrointestinal endoscopy to have a submucosal tumor 4 cm in diameter 2.5 cm distal and on the same side of the papilla of vater of the duodenum. Endoscopic ultrasonography showed a submucosal tumor deriving from the duodenal wall muscle layer. Based on a diagnosis of duodenal GIMT and unable to rule out the possibility of malignancy, we conducted segmental duodenectomy, reestablishing gastrointestinal continuity by creating a Roux-en-Y loop of the jejunum through the retrocolic route and side-to-side duodenojejunostomy and jejunojejunostomy. Histological examination indicated leiomyoma. The postoperative course was uneventful, and an upper gastrointestinal imaging series showed smooth passage of contrast medium through the duodenojejunal route. We review reports of duodenal wedge resection for GIMT opposite the papilla of vater. Segmental duodenal resection for GIMT at the same side of the papilla of vater is rare.View full abstractDownload PDF (855K) -
Nobuhiko Okamoto, Kazuo Yamafuji, Junichi Matsui, Atsunori Asami, Kaor ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 505-509
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSA 78-year-old woman admitted for upper abdominal pain and showing increased inflammation despite transaminases, alkaline phosphatase, and total bilirubin within normal limits was found in. Ultrasonography to have marked swelling and wall thickening of the gallbladder diagnosed as acute cholecystitis necessitating percutaneous transhepatic gallbladder drainage (PTGBD). Direct cholangiography through the PTGBD tube showed stenosis in the gallbladder neck but computed tomography and endoscopic ultrasonography showed no abnormality. Bile cytology through the PTGBD tube was negative. Laparoscopic cholecystectomy yielded macroscopic findings of stenosis in the gallbladder junction and cystic duct without any mucosal lesion. Pathohistological examination of the excised specimen showed heterotopic Heinrich II type pancreatic tissue.View full abstractDownload PDF (683K) -
Hiroshi Kurahara, Hiroyuki Shinchi, Yuko Mataki, Shinichi Maeda, Shoji ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 510-515
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSMucin-producing bile duct tumors are relative rare and poorly characterized. We report a case of long-term survival in mucin-producing bile duct carcinoma treated with repetitive surgery for recrudescence with biliary tract dilation due to hypersecreted mucin. A 67-year-old man admitted for abnormal hepatic function underwent hepatectomy of the medial segment and left caudate lobe under a preoperative diagnosis of a mucin-producing bile duct tumor. Histologically, the tumor was mucin-producing bile duct adenocarcinoma in mucosa that spread superficially. Half a year later, a tumor at the root of the right caudate lobe branch was treated with YAG laser cauterization. Still half a year later, a tumor at the common bile duct was resected. Two years and four months later, a tumor detected at the right hepatic duct, necessitated extrahepatic bile duct resection, and a tumor at the posterior segment branch was treated two months later with YAG laser cauterization. The man has remained asymptomatic and tumor-free in the 7 years since the last treatment. This suggests that strict follow-up and diligently repeated surgery may enable long-term survival.View full abstractDownload PDF (863K) -
Hiroyasu Nishizawa, Koji Fujimoto, Kazuhiko Yamagami, Takatomo Koshiba ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 516-521
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSWe report a case of pancreatic body cancer associated with autoimmune pancreatitis (AIP) with localized narrowing of the main pancreatic duct. A 61-year-old man admitted to evaluate a pancreatic body tumor was found in abdominal CT and endoscopic US to have an enlarged pancreatic body and a pancreatic body tumor with multiple cysts. ERCP and MRCP showed severe localized narrowing of the main pancreatic duct in the pancreatic body. Serum IgG4 and Dupan-2 were high. Based on these results and a diagnosis of AIP with high suspicion of pancreatic body cancer, we conducted distal pancreatectomy. Pathological examination showed well-differentiated tubular adenocarcinoma within the tumor, together with fibroinflammatory lesions with infiltration of IgG4-positive plasma cells surrounding the tumor and compatible with AIP. In addition to AIP cases with localized narrowing of the main pancreatic duct reported, our case suggests AIP might coexist with pancreatic cancer.View full abstractDownload PDF (1073K) -
Yuuki Takeuchi, Tomoki Fukuoka, Hideki Takami, Hiroki Murakami, Takaya ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 522-527
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSWe report the complication of severe syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in a 58-year-old man with pancreatic head cancer with pancreaticobiliary maljunction. We conducted pylorus-preserving pancreatoduodenectomy (D2, type II rebuilding, t3n2M0 Stage IVa), after which the man recovered, but suffered delayed oral intake due to a delayed gastric emptying. He suffered bacteriologic enteritis and was given a proton pump inhibitor (PPI) to prevent gastric juice loss on postoperative day (POD) 17. On POD 29, he suffered pyrexia and disturbance of consciousness developing into a semicoma state. Detailed examinations showed him to be severely hyponatremic with serum sodium levels of 104 mEq/L yielding a diagnosis of SIADH. Because of sepsis, water restriction was difficult, so we treated his SIADH by forced supplementation of sodium with furosemide and demethylchlortetracycline hydrochloride. He recovered on POD 44, i.e., day 15 after SIADH treatment was started. SIADH is caused, for example, by a tumor or medication, and requires caution in treatment, because it is difficult to diagnose early and it worsens after major surgery. This finding also suggests the possibility of PPI influence in SIADH development.View full abstractDownload PDF (612K) -
Kei Yonezawa, Jun Nakagawa, Toshihiko Gotoh, Motoko Harigai, Toshiki K ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 528-532
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSWe report a case of splenic infarction and abscess associated with pancreatic tail cancer. A 53-year-old man whose month-long dull pain from the left hypogastric lesion to the left flank had become intolerable and who had developed abdominal muscular defense was found in abdominal computed tomography (CT) to have abscess-like lesions by the pancreatic tail and an infarction and abscess of the spleen, necessitating emergency laparotomy. The abdominal cavity had purulent ascites and the pancreatic tail had indurated and infiltrated into the spleen and the transverse colon, indicating carcinoma. The spleen contained infarction and an abscess that appeared to be the source of the purulent ascites. En bloc resection was avoided due to its diffuse retroperitoneal invasion. We conducted distal pancreatosplenectomy and resected the distal transverse colon and constructed a transverse colostomy. Pathologically, cancer of the pancreas was diagnosed as poorly differentiated adenocarcinoma. Its vascular invasion into the spleen resulted in splenic infarction. Pancreatic cancer also perforated the transverse colon, possibly causing secondary infection in addition to the splenic infarction. Such a case as ours is very rare and the underlying etiology is quite unique.View full abstractDownload PDF (840K) -
Shin Saida, Akiharu Yagawa, Daisuke Yamaguchi, Tomotaka Yasumura, Tosh ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 533-539
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSWe report a case of intestinal malrotation concomitant with strangulated intestinal obstruction due to a paraduodenal hernia. A 25-year-old man admitted for sudden severe right lateroabdominal pain onset and vomiting was found in CT to have aggregation of the mesenterium and small intestine enhanced poorly in the cul-de-sac at the right abdomen. The duodenum and jejunum took down the right side of the superior mesenteric artery, so emergency laparotomy was conducated for a strangulated intestinal obstruction due to a paraduodenal hernia. Intraoperative findings found no fixation of the retroperitoneum and mesenterium at the right side of the abdomen, and we visualized a hernia orifice about 3 cm in diameter and the jejunum attached about 40 cm from the edge of the hernia. Following herniotomy, the strangulated intestine didn't require resection because no sign of intestinal necrosis was seen. Adult malrotation rarely causes a strangulated internal obstruction.View full abstractDownload PDF (640K) -
Keiichi Hayashi, Chikashi Shibata, Yuji Funayama, Kouhei Fukushima, Ko ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 540-545
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSA 21-year-old man undergoing appendectomy for acute appendicitis in 2002 was found to have inflammation of the terminal ileum and mesentery. Further fluoroscopy of the small intestine showed a nodular lesion at the terminal ileum, but no other abnormalities were seen. He was followed up without definitive diagnosis as an outpatient and admitted for acute abdomen presenting lower abdominal pain and high fever in 2005. Nil per os and antibiotics administration relieved symptoms, but a mesentery tumor was not ruled out in imaging modalities necessitating surgery. Cystic lesions at the terminal ileum and mesentery necessitated partial ileal resection. Pathologically, lymph ducts were dilated, yielding a definitive diagnosis of intestinal lymphangiectasia.View full abstractDownload PDF (907K) -
Koji Maeda, Shuzo Kono, Kazuo Kitagawa, Tomoyoshi Okamoto, Katsuhiko Y ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 546-550
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSA 74-year-old man suffereing from bronchial asthma for six years reporting diarrhea, constipation, and abdominal pain underwent steroid pulse treatment with methylprednisolone at 1,000 mg/day administered for three days, followed by internal use of prednisolone at 50 mg/day based on a diagnosis of allergic granulomatous angiitis (AGA). Abdominal pain was present on day 10 after hospitalization, and computed tomography showed intraperitoneal free air, necessitating emergency surgery for intestinal perforation. Emergency laparotomy showed panperitonitis due to a perforated ulcer in the ileum 280 cm distal to the Treitz ligament. The skip lesions of mucosal disorder was noted 110 cm distal to the Treitz ligament and impending rupture of an ulcer was identified 140 cm from the Treitz ligament, necessitating ileostomy and intraperitoneal drainage. On the postoperative day (POD) 7, oral intake was started and the patient was discharged on POD 38. AGA in digestive organs complicated by perforation tends to be associated with a poor prognosis, making careful selection of operative procedure important.View full abstractDownload PDF (644K) -
Manabu Sato, Chikashi Shibata, Terutada Kobayashi, Tatsuya Ueno, Makot ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 551-556
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSWe report a case of chronic intestinal pseudo-obstruction (CIP) due to primary amyloidosis. A 56-year-old man with abdominal distention and diagnosed with idiopathic CIP underwent emergency surgery after the duodenum was thought to have been perforated during re-insertion of a long intestinal tube. Although no perforation was detected in the duodenum or small intestine, the jejuoileal intestinal wall was extremely fragile, and gut-handling caused multiple perforations, necessitating resection of the small intestine for 300 cm and end jejunostomy. Pathological examination showed CIP secondary to primary amyloidosis, which caused the men's death six months later. The prognosis for CIP secondary to primary amyloidosis is dismal, with surgical intervention a last-ditch effort because destruction of the intestinal wall is go rapid.View full abstractDownload PDF (679K) -
Tadaaki Noguchi, Muneo Kawamura, Takeshi Kawamura, Hisao Matsuda, Taka ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 557-560
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSA 72-year-old woman with no surgical history suffering from abdominal pain and referred after conservative 2-day treatment elsewhere was hospitalized for subileus but symptoms became worse. We operated the day after admission under a diagnosis of strangulated ileus. We found the ileum strangulated due to a knot in a long Meckel's diverticulum. We resected the Meckel's diverticulum and necrotic intestine and conducted end-to-end anastomosis. The clinical course was good. Strangulated ileus due to a knot in a Meckel's diverticulum is very rare, with our case only the eigth reported in Japan.View full abstractDownload PDF (697K) -
Shingo Oya, Kanji Miyata, Norihiro Yuasa, Eiji Takeuchi, Yasutomo Goto ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 561-565
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSA 16-year-old man with lower abdominal pain and fever, lower abdominal tenderness, and muscular guarding was found in blood tests to have an elevated inflammatory response and in abdominal computed tomography (CT) to have a mass-like dilated intestine containing air, fluid, calcification, and ascites at rectovesical pouch, necessitating emergency surgery in November 2006. Laparotomy showed turbid ascites and the Meckel's diverticulum located 90 cm oral from the terminal ileum. The diverticulum was 4.5 cm in size and had neck stenosis together with perforation necessitating diverticulectomy. The diverticulum contained two enteroliths composed of bile acid. Pathological examination showed that ectopic gastric mucosa were present in the diverticulum and the perforation was located in ileal mucosa near gastric mucosa. We judged the perforation to be due to acid secretion from ectopic gastric mucosa, stagnation and retention of intestinal content in the diverticulum by the neck stenosis, and direct mechanical stimulation by enteroliths.View full abstractDownload PDF (731K) -
Kazuma Yamakawa, Masahiro Fujikawa, Riichiro Nezu, Jun-ichi Hasegawa, ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 566-570
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSA73-year-old woman admitted for abdominal distention and a huge mass was found in abdominal computed tomography (CT) and magnetic resonance imaging (MRI) to have a heterogeneously enhanced tumor 9.0 cm in diameter at the back of the superior mesenteric vessels. Small bowel radiography showed a small type 2 lesion in the proximal jejunum. The preoperative diagnosis was gastrointestinal stromal tumor (GIST) of the jejunum. At surgery, we found a tumor 10 cm in diameter at the jejunal mesentery just distal from the Treitz ligament, necessitating segmental resection of the jejunum together with the mesenteric tumor. The resected specimen showed a type 2 tumor 19×19 mm in diameter of the proximal jejunum. The jejunal tumor was diagnosed histologically as a carcinoid tumor, depth sm, and the jejunal mesentery tumor was diagnosed as lymph node metastasis. The woman remains alive without recurrence in the over 22 months following resection. Jejunal carcinoid tumor is rare in Japan. The mesenteric lymph node metastasis in our case was huge, although the primary carcinoid tumor was small with depth sm, leading to detection of the primary lesion in the jejunum.View full abstractDownload PDF (755K) -
Ken Hagiwara, Minoru Matsuda, Motoo Yamagata, Masahito Igarashi, Shige ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 571-576
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSWe report laparoscopic appendectomy in an athlete with an ultrathick abdominal wall. A 19-year-old male athlete hospitalized for abdominal pain, excessive bodyweight, and a body mass index of 52.1 despite being 164 cm tall and weighing 140 kg was suspected from physical examination and computed tomography to have gangrenous appendicitis with local peritonitis. We chose laparoscopic appendectomy to minimize the surgical incision size and effects on his athletic career. Operative findings showed a swollen perforated appendix with a large amount of pus throughout the abdominal cavity. We conducted lavage and drainage and finished surgery with only 4 trocar port sites. He has continued his career. We concluded that laparoscopic appendectomy is effective in athletes with ultrathick abdominal walls because of the minimal adverse effect on the abdominal wall and the athlete's career potential.View full abstractDownload PDF (858K) -
Shunji Kinuta, Naoki Koshiishi, Hiroyuki Wakana, Tomoaki Tuchiya, Hide ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 577-582
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSWe report a case of IMT coexisting with colon cancer the first case of its kind, to our knowledge, reported in Japan. An 89-year-old woman with fever, anemia, and an inflammatory hematological test response was diagnosed with carcinoma by colonoscopy, necessitating right colon resection. The histopathological diagnosis was both moderately differentiated tubular adenocarcinoma and inflammatory myofibroblastic tumor (IMT). The fever and inflammatory response both improved after operation, so we concluded that IMT was related to these symptoms.View full abstractDownload PDF (759K) -
Yuji Takakura, Noriaki Tokumoto, Masazumi Okajima, Satoshi Ikeda, Taka ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 583-588
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSWe report two cases of early SM colon cancer with synchronous liver metastasis. Case 1: A 70-year-old man with a protruding (Isp) 25 mm primary cancerous lesion of the transverse colon was found histologically to have well-differentiated adenocarcinoma, SM, ly0, v0. Computed tomography showed a huge 14-cm-diameter tumor in the right hepatic lobe, necessitating right hepatic lobectomy for intrahepatic cholangiocarcinoma. A definite histological diagnosis of colonic adenocarcinoma metastasis was obtained. Case 2: A 78-year-old woman was found to have a 20 mm IIa+IIc cancerous lesion in the cecum, together with a 2 cm liver tumor. Needle biopsy indicated colonic adenocarcinoma metastasis, necessitating ileocecal resection and partial hepatectomy. Histological findings for the primary lesion were well-differentiated adenocarcinoma, SM, ly0, v3, together with a definitive histological diagnosis of hepatic metastasis of colon cancer. Immunohistochemicaly hepatic specimens stained positive for CK20 and β-catenin and negative for CK7 in both cases. This was very helpful to make a diagnosis.View full abstractDownload PDF (1004K) -
Ippei Fukada, Kazuyuki Kawamoto, Masato Oyama, Mitsuhiro Kunisue, Mich ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 589-593
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSWe report a very rare case of rectal perforation with sigmoid colon evisceration through the anus. A 27-years'-old mentally retarded man brought to emergency ward due to mass bloody bowel discharge and intestinal escape on defecation was found to have the sigmoid colon escaping from the anus, necessitating emergency surgery due to rectal perforation. The torn region was rectosigmoid which located in 10 cm from the oral side from peritoneal reflection. The sigmoid colon had invaginated in the rectal anal stump. We conducted Hartmann's operation, the postoperative course was good and the man was discharged on postoperative day 40.View full abstractDownload PDF (747K) -
Reiji Nozaki, Masahiro Kamiga, Masaya Okazaki, Fumito Imamura, Kentaro ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 594-599
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSWe report a case of metastatic gastric cancer developing from rectal cancer. A 75-yesr-old man undergoing abdominoperineal resection for rectal cancer in July 2005 underwent subsequent adjuvant chemotherapy. Histropathological examination showed signet-ring cell carcinoma, A, ly3, v3, N2, RM1, stage IV. He reported melena in May 2006 and underwent gastrofiberscopy, which showed a submucosal tumor with an ulcer ated top in the middle portion of the stomach. Histologically, the gastric lesion was signet-ring cell carcinoma, the same as the rectal cancer. The tumor was therefore definitively diagnosed as gastric metastasis from rectal cancer.View full abstractDownload PDF (984K) -
Tomoyuki Monma, Takeshi Sakuma, Mutsuo Yamada, Naoto Katagata, Fumiaki ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 600-605
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSWe report a rare case of multiple malignant pleural mesothelioma metastases to the gastrointestinal tract. A 53-year-old man with anemia had undergone surgical resection of the left chest wall for osteosarcoma 18 months earlier. Gastrointestinal endoscopy showed multiple submucosal tumors and biopsy specimens showed metastatic malignant tumors. We conducted laparotomy for hemostasis, and found multiple tumors in the small intestine. Immunohistochemical examination showed that tumor cells of specimens from the small intestine stained positive for mesothelial markers, calretinin, and WT1, so we conducted immunohistochemical examination for biopsy specimens of the chest wall and stomach and found positive staining for mesothelial markers. The definitive diagnosis was multiple gastrointestinal metastases of malignant pleural mesothelioma.View full abstractDownload PDF (1084K) -
Kentaro Matsumoto, Toshihito Uehara, Keiji Hirata, Naoki Nagata, Koji ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 606-610
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSA 34-year-old female woman with lower abdominal pain since early November 2002 was found in abdominal CT to have a well-circumscribed pelvic tumor measuring 10 cm in diameter. Under a diagnosis of intrapelvic tumor, we undertook surgical resection, finding a huge tumor of the sigmoid colon serosa, and the huge tumor was resected. Multiple disseminated small nodules were noted on the surface of the uterus, ovary, and Douglas cavity, yielding a diagnosis of malignant mesothelioma (diffuse mixed type) based on postoperative pathological examination. Intravenous Paclitaxel was given weekly for 3 consecutive weeks followed by a 1-week rest (one course). After 5 courses, complete remission was observed. The patient remains without recurrence 5 years and 2 months after surgery.View full abstractDownload PDF (687K) -
Terutada Kobayashi, Koh Miura, Makoto Kinouchi, Toshinori Ando, Atsush ...Article type: CASE REPORT
2009 Volume 42 Issue 5 Pages 611-616
Published: May 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSWe report a patient with a desmoid tumor arising from the mesentery and treated using high-dose tamoxifen and sulindac for about two years. A 72-year old man followed up after abdominoperineal resection for advanced rectal cancer followed by partial resection of the right lung for metachronous lung metastasis was found in CT to have an intraabdominal mass suggesting a metastatic tumor. Intraoperatively, we found that the tumor arose from the mesentery of the small intestines. Because resecting the tumor would have led to short bowel syndrome, we conducted only an excisional biopsy. Pathological diagnosis showed the tumor to be spindle-cell-like, but not metastatic carcinoma. Immunohistochemical analysis showed KIT (+), CD34 (-), and AE1/AE3 (-), leading us to start treatment for GIST using imatinib mesylate, but the tumor continued to progress. Additional immunohistochemical analysis showed β-catenin positive in the nucleus, so we have continued treatment with sulindac and high-dose tamoxifen under the diagnosis of a desmoid tumor, and the tumor has decreased significantly in size in the last two years.View full abstractDownload PDF (833K)
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