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Volume 42, Issue 9
Displaying 1-17 of 17 articles from this issue
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ORIGINAL ARTICLE
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Kazunari Mado, Hideki Masuda, Takero Mazaki, Yukimoto Ishii, Nobuhiko ...Article type: ORIGINAL ARTICLE
2009 Volume 42 Issue 9 Pages 1455-1459
Published: September 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSIntroduction: Treatment of patients with colorectal perforation is implemented most effectively when parameters indicating a preoperative severity score can lead to the choice of an appropriate medical institution. Methods: Comparing SOFA (SS), APACHE-II (AS), and POSSUM physiological score (PS), we propose objective preoperative severity evaluation of institutions based on a predicted value the ROC curve. Materials: Subjective were 47 cases, 24 men and 23 women averaging 65.9 years of age-old operated on at our hospital for non-iatrogenic colorectal perforation. Of the 47, 7 died during in hospitalization and 5 within 30 days of surgery, resulting in 85.1% survival. Results: Scores differed significantly with mortality (P<0.001). In ROC analysis, ROC area under the curve of AS and PS was 0.95. AS and PS were evaluated equally and excellently. ROC area under the curve of SS was 0.90. For 50% survival, the predicted value for AS was 21 and for PS was 43 by logit regression analysis. Cases exceeding these values had a poor prognosis. Discussion: AS and PS were appropriate in indicating preoperative severity. Predicted values calculated from AS and PS Logic regression analysis for mortality were appropriate in objectively evaluating institution treatment levels. Setting a cut off is therefore in deciding whether to start treatment of transfer the patient to a more appropriate institution, to ensure better survival.View full abstractDownload PDF (342K)
CASE REPORT
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Akira Umemura, Michihiko Kitamura, Masashi Sawada, Takumi Kato, Akiko ...Article type: CASE REPORT
2009 Volume 42 Issue 9 Pages 1460-1465
Published: September 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSCollision carcinoma at the esophagogastric junction (EGJ) is rare. We report an unusual case of collision cancer between squamous cell carcinoma from the esophagus and adenocarcinoma from the gastric cardia. An 85-year-old man reporting dysphagia was found in endoscopic examination to have a large ulcerated tumor at the EGJ, initially considered esophageal cancer with gastric invasion. Histological examination of the biopsy specimen, however, showed both poor differentiated squamous cell carcinoma and tubular adenocarcinoma. We resected the lower esophagus and conducted total gastrectomy combined with mediastinal and abdominal lymph node dissection. We fashioned an esophagojejunostomy using Roux-en Y reconstruction. Histological examination of the resected specimen showed esophageal squamous cell carcinoma colliding with gastric adenocarcinoma with a distinct intervening border and no morphological transition. One of dissected lymph nodes was contained both. Collision tumors are difficult to detect and diagnose before determination of their histological findings. Clinicians must therefore be aware of the possibility of collision carcinoma when they detect tumors rising from the EGJ.View full abstractDownload PDF (787K) -
Katsumi Makita, Takemasa Midorikawa, Hidefumi Yagi, Yasuro Fujiwara, K ...Article type: CASE REPORT
2009 Volume 42 Issue 9 Pages 1466-1471
Published: September 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSWe present a report on preoperatively diagnosed omental hemorrhage-the first of its kind, insofar as we know. A 61-year-old man seen for widespread abdominal pain and distension in March 2007 was found to have slightly decreased hemoglobin hematological tests, and a small amount of ascites in abdominal ultrasonography (US) and computed tomography (CT). Imaging studies suggested hemoperitoneum. Abdominal CT angiography showed that contrast medium had clearly leaked from peripheral branches of the omental artery, yielding a diagnosis of omental hemorrhage caused by bleeding from the left omental artery. Two hours after, the man's vital signs became unstable and US indicated rapidly increasing ascites, necessitating emergency surgery. The hematoma in the left abdominal cavity and bleeding of the left omental artery were found intraoperatively and treated by partial omentectomy. Seventeen cases of idiopathic omental hemorrhage have been reported in Japan, 5 of which were diagnosed and 2 suspected preoperatively.View full abstractDownload PDF (698K) -
Shin-ichi Nakanuma, Shinichi Kinami, Katsunobu Oyama, Hiroshi Funaki, ...Article type: CASE REPORT
2009 Volume 42 Issue 9 Pages 1472-1477
Published: September 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSA 58-year-old woman admitted for multiple myeloma and treated with chemotherapy was found in Abdominal computed tomography (CT) to have showed wall thickening in the upper gastric body, together with multiple cystic lesions at the same site. Barium enema studies showed wall hardening with unclear margins in the upper gastric body and fundus. Endoscopy showed a low protruding nodular lesion with unclear margins on the posterior wall of the upper gastric body. Endoscopic biopsy indicated well-differentiated adenocarcinoma, yielding A diagnosis of Borrmann type 4 advanced gastric cancer with diffuse heterotopic multiple cysts. The tumor was found to have spread from the upper gastric body to the fundus, with serosal penetration and peritoneal dissemination. The Pathological diagnosis was well-differentiated adenocarcinoma invading all layers diffusely forming large glandular cavities and scirrhous changes. Immunohistochemical staining showed tumor cells to be positive for MUC5AC and slightly positive for MUC6 but negative for MUC2. Based on these findings, the definitive diagnosis was gastric phenotype. Borrmann type 4 advanced gastric cancer consisting of well-differentiated adenocarcinoma alone is rare. Our case suggested two characteristic features: large carcinomatous glandular cavities such as gastric cysts related to well-differentiated adenocarcinoma of Borrmann type 4 advanced gastric cancer, and an endoscopic picture of a low protruding nodular lesion with unclear margins related to differentiated carcinoma with a gastric phenotype.View full abstractDownload PDF (1002K) -
Hiroyuki Kanazawa, Iwao Ikai, Fumitaka Oike, Seisuke Sakamoto, Etsuro ...Article type: CASE REPORT
2009 Volume 42 Issue 9 Pages 1478-1483
Published: September 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSWe report a case of hepatocellular carcinoma (HCC) with bile duct tumor thrombosis (BDTT) followed by two times recurrences of solitary tumors in the extrahepatic bile duct after hepatectomy. A 72-year-old man who underwent right hepatectomy and bile duct thrombectomy for HCC with BDTT suffered jaundice. Jaundice was appeared at eight months after surgery. ERCP showed a filling defect in the common hepatic duct. The solitary recurrent lesion was resected together with a part of the bile duct wall. At seven months after second laparotomy, a solitary tumor recurred in a lower bile duct distant from the first recurrent site. He underwent resection of the extrahepatic bile duct including recurrent tumor and hepaticojejunostomy. Pathologically, the recurrent tumor invaded the bile duct epithelium. We assumed that tumor cells floating in the bile juice were implanted on extrahepatic bile duct epithelium. The patient was well without recurrence at sixteen months after the last surgery.View full abstractDownload PDF (877K) -
Yoshinori Yamada, Akemi Iwamoto, Kanenori Endo, Yasuaki Hirooka, Masah ...Article type: CASE REPORT
2009 Volume 42 Issue 9 Pages 1484-1489
Published: September 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSWe report a rare case of hepatocellular carcinoma (HCC) with solitary recurrence in the diaphragm. A 60-year-old man undergoing lateral hepatic segmentectomy for HCC seven years earlier, and referred for elevated serum PIVKA-II concentration showed no clear evidence of HCC recurrence in computed tomography (CT), magnetic resonance imaging (MRI), or gallium scintigraphy. 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG PET/CT), however, showed FDG uptake in the diaphragm near the spleen, necessitating partial diaphragm resection and splenectomy. Histopathological findings confirmed moderately differentiated HCC of the diaphragm. Following an uneventful postoperative clinical course, the man remains in good health 3 years after surgery. We found FDG PET/CT useful for detecting extrahepatic HCC recurrence and deciding on appropriate surgical strategy. Although extrahepatic HCC recurrence is associated with a dismal prognosis, it is noteworthy that extensive surgery improved the prognosis.View full abstractDownload PDF (666K) -
Hideki Suzuki, Wataru Wada, Kenichiro Araki, Tsutomu Kobayashi, Akihik ...Article type: CASE REPORT
2009 Volume 42 Issue 9 Pages 1490-1495
Published: September 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSWe report the case of a patient with biliary hamartomas, also called von Meyenburg's complex mimicking cholangiocarcinoma. A 58-year's old man reporting a abdominal fullness was found in computed tomography (CT) to have intrahepatic biliary dilation of the left hepatic duct. Drip-infusion cholangiography with computed tomography (DIC-CT) and endoscopic retrograde cholangiopancreatography (ERCP) showed cystic or beaded dilatation-like lesions of the left intrahepatic bile duct and left bile duct stenosis, but no definitive tumor-like lesion. Portogram showed a left poratal vein branch stricture. Based on a diagnosis of hepatic duct cancer possibly invading the liver or portal vein, we conducted left hepatic lobectomy of the liver. Intraoperative frozen sections of the stump of the left bile duct showed no malignancy, so we did not excise any extra bile duct. Histopathologically no malignant cells were seen in the bile duct epithelium, although small cystic lesions were found along the left hepatic duct. The definitive diagnosis was biliary hamartoma (von Meyenburg complex).View full abstractDownload PDF (860K) -
Yoshiyuki Inoue, Masaru Koizumi, Yasunaru Sakuma, Naohiro Sata, Yoshik ...Article type: CASE REPORT
2009 Volume 42 Issue 9 Pages 1496-1500
Published: September 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSA 67-year-old man with abdominal distension and pain after routine colonoscopy and suspected of pyothorax due to right pleural effusion. The findings was found in abdominal computed tomography to have abnormal air density and massive ascites indicating emphysematous cholecystitis. Emergency surgery showed no colonic perforation but the gallbladder wall evidenced necrotic change. We confirmed the existence of emphysematous "colonoscopy cholecystitis", one of the differential diagnoses for patients with abdominal pain after colonoscopy.View full abstractDownload PDF (535K) -
Hiroyuki Shinchi, Yukou Mataki, Hiroshi Kurahara, Shinichi Maeda, Fumi ...Article type: CASE REPORT
2009 Volume 42 Issue 9 Pages 1501-1505
Published: September 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSWe report a case of hepatic metastasis from bile duct cancer treated by hepatectomy followed by arterial chemotherapy. A 41-year-old man undergoing pylorus-preserving pancreaticoduodenectomy in April 1995 had been diagnosed histopathologically with moderately differentiated adenocarcinoma with regional lymph node metastasis. Hepatic metastasis 1.6 cm in diameter in Couinaud's segment VI was detected in follow-up computed tomography (CT) in December 1995, with partial hepatectomy in April 1996. We conducted both arterial and systemic chemotherapy postoperatively, and the man remains alive without recurrence 12 years after hepatectomy. When a patient has a solitary metastasis of the liver with no other evidence of recurrence, hepatic resection appears to be an effective option.View full abstractDownload PDF (674K) -
Ken-ichi Okada, Toshihide Imaizumi, Masahiro Matsuyama, Shoichi Dowaki ...Article type: CASE REPORT
2009 Volume 42 Issue 9 Pages 1506-1511
Published: September 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSAn asymptomatic 55-year-old man seen for further evaluation of a pancreas head mass was found in ultrasonography (US) to have a low echoic 46×38×28 mm mass. Dynamic computed tomography (CT) and magnetic resonance imaging (MRI) showed an enhanced mass. Diffusion MRI demonstrated a high signal tumor presumably rich in cells. Angiography showed no evidence of vascular invasion except for compression to portal veins. Differential diagnosis included tumor-forming pancreatitis, nonfunctioning islet cell tumor, pancreatic lymphoma, invasive ductal carcinoma, and solid and pseudopapillary tumor. Laparotomy for tissue biopsy showed atypical lymphoid cell infiltration suggesting possible malignant lymphoma. The definitive diagnosis, based on histopathological examination of permanent sections, including immunohistochemical staining, was pancreatic mucosa-associated lymphoid tissue (MALT) lymphoma. Eight sessions of chemotherapy reduced the mass totally, suggesting a complete response. Primary pancreatic lymphoma is a rare, basically systemic disease, making chemotherapy the first choice. Pancreatic MALT lymphoma is a low-grade B cell lymphoma, for which excessive surgery should be avoided if possible, by careful evaluation of biopsy. Biopsy should be conducted in all procedures in case preoperative graphical findings are not consistent with typical findings for invasive ductal pancreatic carcinoma.View full abstractDownload PDF (765K) -
Junichi Saito, Naoyuki Kobayashi, Hirohito Seki, Yoshito Ueyama, Toshi ...Article type: CASE REPORT
2009 Volume 42 Issue 9 Pages 1512-1516
Published: September 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSAn 86-year-old woman seen for abdominal pain and taking aspirin daily for atrial fibrillation was found on physical examination to have muscular guarding, and erect abdominal X-ray showed a large amount of gas in the small intestine. Three hours after onset, computed tomography (CT) showed hepatic portal venous gas (PVG) with branching and a small amount of air in the small intestinal wall. Her general condition worsened, necessitating emergency surgery under a diagnosis of panperitonitis due to intestinal necrosis. Moderate amounts of bloody ascites and marked edema and necrosis of the small intestine and an ischemic gray portion were seen. Pathological findings showed hemorrhagic necrosis throughout the entire small intestine and necrosis with blood coagulation in the mucosal layer consistent with superior mesenteric artery (SMA) occlusion. The postoperative course was fair. This is, to our knowledge, the second report of SMA occlusion associated with PVG detected less than three hours after onset. Surgical treatment should thus be considered in SMA occlusion with PVG at an early stage once intestinal necrosis is suspected.View full abstractDownload PDF (734K) -
Toshihiro Otsuka, Hideki Kawasaki, Kazuhito Takamura, Kanehiro Yoshida ...Article type: CASE REPORT
2009 Volume 42 Issue 9 Pages 1517-1522
Published: September 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSA 72-year-old woman admitted for a pelvic tumor cavity in November 2007 was found in abdominal computed tomography (CT) to have a 5.0×8.0 cm tumor drainaged by the superior mesenteric vein yielding a prepoperative diagnosis of gastrointestinal stromal tumor of the ileum. The tumor and ileum were resected. The tumor 9.0×7.0×6.0 cm attached to the ileal serosa, was white and yellowish white with necrosis and hemorrhaging. Histologic of findings indicated that the tumor arose from the ileal serosa. It showed a patternless proliferation of spindle cells with irregularly arranged hyalinized collagen bundles in a myxoid stroma and prominent vessels such as those in hemangiopericytoma. Tumor cells showed immunohistochemical reactivity for vimentin, CD34, CD99, and bcl-2 but were negative for c-kit. Histology indicated a solitary fibrous tumor of the ileum. The postoperative course was uneventful and the woman remains disease-free 6 months after surgery. A solitary fibrous tumor of the ileum is very rare.View full abstractDownload PDF (806K) -
Takashi Nonaka, Hidetoshi Fukuoka, Hiroaki Takeshita, Terumitsu Sawai, ...Article type: CASE REPORT
2009 Volume 42 Issue 9 Pages 1523-1527
Published: September 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSWe report a very rare case of hamartomatous polyp of the appendix. A 60-year-old man admitted for an appendiceal tumor found in endoscopy was also found to have a tumor with a stalk in the cecum. Barium enema studied showed polypoid lesions at the cecum, with enhanced computed tomography (CT) indicating a tumor. Based on these findings, we conducted laparoscopy-assisted ileocecal resection . Histologically, the tumor was not malignant and the polypoid showed excessive hyperplasia and a prominent core consisting of branching bands of smooth muscle derived from the muscularis mucosae. The polyp was diagnosed as a hamartomatous polyp.View full abstractDownload PDF (841K) -
Takaya Kobatake, Yoshiro Kubo, Tomohiro Nishina, Hiroyuki Takahata, Ko ...Article type: CASE REPORT
2009 Volume 42 Issue 9 Pages 1528-1533
Published: September 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSWe report a case of bevacizumab-associated perforation of the mesocolon. A 51-year-old man who had undergone palliative colon resection for descending colon cancer with paraaortic lymph node metastasis two years earlier, was treated with FOLFOX plus bevacizumab therapy as second-line chemotherapy for 13 months after FOLFIRI chemotherapy for 9 months. During cycle 17 of bevacizumab therapy, he was admitted for pain in the right lower abdomen and fever. Physical examination showed tenderness and peritoneal irritation in the right abdomen. Abdominal CT showed thickening of the ascending colon wall and bubbles in the ascending mesocolon. He was diagnosed with perforation of the colon necessitating emergency right colectomy with primary anastomosis. Histologic diagnosis showed perforation at a diverticulum. He was discharged without complications. Bevacizumab-associated perforation is rare but serious, requiring early diagnosis and management. The creation of a defunctional stoma is thought to be better upon early diagnosis, good general condition, and very localized peritonitis as in this case. Primary anastomosis may also be possible.View full abstractDownload PDF (796K) -
Junichi Takamizawa, Shingo Kuze, Takanori Kyokane, Hiroaki Shibahara, ...Article type: CASE REPORT
2009 Volume 42 Issue 9 Pages 1534-1538
Published: September 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSWe report a case of metastatic colon cancer in an inguinal hernia sac diagnosed by FDG-PET and treated surgically. A 74-year-old man undergoing sigmoidectomy for perforated sigmoid colon cancer in January 2006 was found in October 2007 to have serum CA19-9 elevated to 100.9 U/ml. Although neither abdominal US nor CT suggested recurrence, FDG-PET showed high FDG accumulation in the right inguinal area and the right ventral bladder. Reexamination of CT showed enhanced nodules at corresponding sites. Under a diagnosis of metastatic colon cancer in an inguinal hernia sac, we conducted laparotomy, finding hard tumors at the inguinal hernia orifice and in the inguinal hernia sac. Combined with an inguinal approach, we completely resected the inguinal saccular tumors. Resected specimens showed two tumors at the tip and the orifice of the inguinal hernia sac, one 25 mm and the other 20 mm in diameter. Histological examination comfirmed metastatic saccular carcinoma of sigmoid colon cancer previously resected. The postoperative course was good, and the man is doing well without recurrence eight months after surgery.View full abstractDownload PDF (567K) -
Hiroyuki Sugimoto, Suguru Yamada, Hideki Kasuya, Naohito Kanazumi, Shu ...Article type: CASE REPORT
2009 Volume 42 Issue 9 Pages 1539-1544
Published: September 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSA 65-year-old man presenting with diabetes and abnormal blood examination results was found in CT to have a large liver tumor with intrahepatic bile duct dilation. He had undergone colectomy for colon cancer 11 years earlier, so we conducted endoscopic examination that indicated gastric cancer. Based on diagnosis of intrahepatic biliary cancer with synchronous gastric cancer, we conducted right hepatectomy and dital gastrectomy, but found pathological evidence of cancer metastasis from colon cancer with synchronous gastric cancer. This unusual case featured characteristics of liver metastasis with a biliary tumor thrombus derived from colon cancer and a markedly long interval between colectomy and metachronous liver metastasis.View full abstractDownload PDF (905K) -
Yutaka Kimura, Hiromitsu Hoshino, Hiroshi Yano, Takashi Iwazawa, Katsu ...Article type: CASE REPORT
2009 Volume 42 Issue 9 Pages 1545-1549
Published: September 01, 2009
Released on J-STAGE: December 23, 2011
JOURNAL FREE ACCESSA 63-year-old man found in gastrointestinal endoscopy screening to have type 0 IIc early gastric cancer of the lower third of the stomach was also found to have a celiac artery aneurysm in abdominal CT staging. Abdominal angiography showed that the common hepatic artery, splenic artery, and left gastric artery branched from a celiac artery aneurysm 2 cm in diameter. We simultaneously conducted distal gastrectomy with Roux-Y reconstruction and aneurysmectomy with arterioarterial anastomosis of the common hepatic and splenic arteries. The celiac artery aneurysm was saccular with internal elastic lamina disruption, pathologically diagnosed as well-differentiated tubular adenocarcinoma, Type 0 IIc, T1 (M), N0, H0, P0, M0, Stage IA. Celiac artery aneurysms are quite rare and this is, to our knowledge, the first case of a celiac artery aneurysm simultaneously treated with aneurysmectomy and distal gastrectomy for gastric cancer in Japan.View full abstractDownload PDF (824K)
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