All issues
Volume 52 (2019)
- Issue 12 Pages 695-
- Issue 11 Pages 611-
- Issue 10 Pages 551-
- Issue 9 Pages 485-
- Issue 8 Pages 405-
- Issue 7 Pages 345-
- Issue 6 Pages 281-
- Issue 5 Pages 239-
- Issue 4 Pages 191-
- Issue 3 Pages 137-
- Issue 2 Pages 83-
- Issue 1 Pages 1-
- Issue Special_Issue P･･･
- Issue Supplement2 Pag･･･
- Issue Supplement1 Pag･･･
Volume 44, Issue 8
Displaying 1-20 of 20 articles from this issue
- |<
- <
- 1
- >
- >|
ORIGINAL ARTICLE
-
Hayato Nakamura, Takanori Kyokane, Katutaka Watanabe, Noriaki Morofuji ...Article type: ORIGINAL ARTICLE
2011 Volume 44 Issue 8 Pages 929-935
Published: August 01, 2011
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIntroduction : Wound infection after open appendectomy adversely affects quality of life (QOL) and hospital fees. Since April 2008, we have used the Lap-protector (LP) in all cases undergoing open appendectomy for prevention of postoperative wound infection. We conducted a retrospective clinical study to clarify the wound infection preventive effects of LP in open appendectomy. Methods : We reviewed 99 cases of open appendectomy for acute appendicitis between October 2006 and October 2009 and classified cases into the LP (-) group, 49 cases of surgery before April 2008 without the LP, and the LP (+) group, 50 cases of surgery after April 2008 with the LP. Preoperative and intraoperative clinical data were compared between these two groups, and postoperative outcomes were evaluated. Results : A comparison of preoperative and intraoperative data showed serum CRP levels to be significantly higher in the LP (+) group. Other clinical data, such as age, gender, preoperative WBC count, preoperative CT findings (fluid collection and abscess formation), intraoperative macroscopic inflammation degree, and the operating surgeon, were not significantly different. There were 7 cases (14.3%) in the LP (-) group with complications due to postoperative wound infection, compared with no cases in the LP (+) group of postoperative wound infection. These 7 cases of wound infection complications resulted in 4.6 times longer hospital stay after surgery and 2.9 times higher hospital fees than cases of no wound infection, and both differences were statistically significant (p=0.0001, p=0.0001) respectively. Conclusions : The wound infection preventive effects of LP in open appendectomy is evident from this retrospective study. Prevention of wound infection resulted in shorter hospital stay after surgery and lower hospital fees. These favorable outcomes will lead to good QOL of patients and hospital economy.View full abstractDownload PDF (792K) -
Yoshihisa Naito, Yojiro Hashiguchi, Masayoshi Miyoshi, Eiji Shinto, Hi ...Article type: ORIGINAL ARTICLE
2011 Volume 44 Issue 8 Pages 936-943
Published: August 01, 2011
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSPurpose : Accurate preoperative prediction of histological response to preoperative chemoradiation would be useful to determine the optimal surgical approach. We performed endoscopic evaluation of tumor response after short-term preoperative chemoradiation (SCRT) for lower rectal cancer to investigate if histological response could be estimated by endoscopy. Methods : We enrolled 75 patients who underwent endoscopic examination before and 3-4 weeks after the completion of SCRT. SCRT was given for 5 days with a daily dose of 4 Gy (total 20 Gy) along with Tegafur/Uracil (400 mg/day). Radical surgery was performed 4-5 weeks after SCRT. Effect of SCRT was assessed by endoscopy, barium enema (56 cases), and MRI (61 cases). Tumor reduction evaluated by these tests was graded as follows. Endoscopic grades: Partial response (PR), more than two thirds reduction in tumor height; no change (NC), less than two thirds reduction. Barium enema and MRI grades: PR, more than 30% tumor regression; NC, less than 30%. Evaluation was done by two independent surgeons. Histological tumor regression grade was defined as follows: tumor cell necrosis or degeneration is present in less than one third of the tumor area (Grade 1a), between one and two thirds (Grade 1b), more than two thirds but viable cells remain (Grade 2), and complete response (Grade 3). Results : There was a significant correlation between endoscopic grade and histological grade (p=0.0004). Barium enema grade, but not MRI grade, also significantly correlated with histological grade (p=0.0262). The kappa values, which are indicators of inter-observer agreements, indicated moderate agreement. Conclusions : Endoscopy allows better prediction of histological response of rectal cancer to SCRT than barium enema and MRI. Inter-observer agreement seemed to be acceptable.View full abstractDownload PDF (1074K) -
Kiichi Sugimoto, Shun Ishiyama, Masaki Hata, Makoto Takahashi, Yutaka ...Article type: ORIGINAL ARTICLE
2011 Volume 44 Issue 8 Pages 944-954
Published: August 01, 2011
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIntroduction : At present, there is no consensus concerning the validity of primary tumor resection in patients with unresectable distant metastasis. Particularly in colorectal cancer patients with extensive metastatic lesion within the liver, the selection of a therapeutic strategy for the primary tumor is difficult because liver dysfunction, jaundice and ascites are occasionally seen preoperatively. This study was undertaken to retrospectively analyze the short-term outcome of primary tumor resection and its predictive factor in patients with colorectal cancer accompanied by synchronous liver metastasis and to identify patients requiring care in evaluating the indication for primary tumor resection. Subjects and Methods : Of the patients with colorectal cancer with synchronous liver metastasis encountered during the past decade, we studied 81 patients who underwent primary tumor resection alone without resection of liver metastasis. Clinicopathological factors during the perioperative period were examined regarding hospital mortality and postoperative complications as the short-term outcome. Results : Six patients (7.4%) died during hospital stay. In multivariate analysis, only abnormality in T-Bil was identified as an independent predictive factor of hospital mortality (P=0.04, odds ratio=24.13). Postoperative complications were noted in 34 patients (42.0%). Patients with postoperative complications, compared to those without postoperative complications, had significantly more abnormalities in T-Bil found on univariate analysis (P=0.01). No other clinicopathological factor was identified as a predictive factor. Discussion : When selecting a therapeutic strategy including determination of indications for primary tumor resection for colorectal cancer with synchronous liver metastasis, we need to take the preoperative T-Bil level fully into account.View full abstractDownload PDF (872K)
CASE REPORT
-
Tetsuro Tominaga, Shigekazu Hidaka, Kenji Tanaka, Tsunenori Taguchi, A ...Article type: CASE REPORT
2011 Volume 44 Issue 8 Pages 955-962
Published: August 01, 2011
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 48-year-old man was referred to us because of a tumor in the esophagus. Abdominal CT and Chest CT revealed multiple abnormalities, intestinal malrotation, interrupted inferior vena cava, dilated azygous vein, and polysplenia. We performed esophagectomy with lymph nodes dissection, splenectomy and, retrosternal reconstruction with a gastric tube. He was discharged on postoperative day 32. It has been reported that patients with intestinal malformation occasionally have some other abnormality, Therefore esophagectomy in such cases could be more difficult. Preoperatively, we defined the abnormalities, and carefully planned the optimal operative procedure and approach. Esophagectomy was successfully performed in this patient with intestinal malrotation.View full abstractDownload PDF (1628K) -
Koji Fukase, Masahiro Iseki, Takanori Morikawa, Syun Sato, Tsuyoshi To ...Article type: CASE REPORT
2011 Volume 44 Issue 8 Pages 963-969
Published: August 01, 2011
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 74-year-old woman was referred to our hospital for acute upper abdominal fullness and pain. Computed tomography showed a part of the stomach had migrated into the left thoracic cavity and significant dilatation of the stomach in the left thoracic cavity and abdominal cavity. We attempted to insert a nasogastric tube but failed. Under a diagnosis of esophageal hiatus hernia in which the stomach was incarcerated, an emergency operation was performed because she went into shock. On laparotomy, we found herniation of the upper stomach through an esophageal hiatus. An organoaxial gastric volvulus of the stomach and massive necrosis of the gastric wall were confirmed, so we decided to perform total gastrectomy. Postoperatively she had minor dehiscence of the esophagojejunostomy, but she recovered by conservative therapy. Gastric volvulus is relatively rare in adults and frequently presents in chronic or recurrent form. Although in the case of acute gastric volvulus with diaphragmatic hernia, urgent surgery is often performed, reduction is usually easy. However, necrosis in most of the stomach is very unusual. We report an unusual case of an acute gastric volvulus, resulting massive gastric wall necrosis, which was treated with total gastrectomy.View full abstractDownload PDF (1261K) -
A Case of Duodenal and Jejunal Varicose Veins with Unidentified Extrahepatic Portal Vein ObstructionHirotaka Fujita, Hisamitu Shinohara, Seiji Ohata, Hiroshi Tabuchi, Aii ...Article type: CASE REPORT
2011 Volume 44 Issue 8 Pages 970-977
Published: August 01, 2011
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe patient was a 69-year-old man with a chief complaint of tarry stool. Upper gastrointestinal endoscopy revealed no abnormalities. His melena subsided after fasting. However, once oral ingestion was resumed, the melena recurred and anemia was persistent. Thus, CT was performed, raising the suspicion of small bowel varices. Angiography revealed duodenojejunal varices, as well as obstruction of the superior mesenteric, portal, and splenic veins. The duodenojejunal varices were confirmed by small bowel endoscopy, and the patient was referred to our department. Endoscopic treatment was not possible due to multiple varices affecting the jejunum as well. In addition, because unexplained extrahepatic portal obstruction was noted, partial duodeno-jejunectomy with vascular excision was highly likely to result in postoperative hepatic failure. For this reason, open surgery was performed for variceal embolization via the ileal vein. At more than 5 years after embolization, no sign of relapse (e.g., melena) has been noted. However, in view of reports on recanalization of embolized collaterals, this patient should continue to be followed closely.View full abstractDownload PDF (1431K) -
Kazuhiro Suzumura, Tadamichi Hirano, Yuji Iimuro, Takaaki Sugimoto, Na ...Article type: CASE REPORT
2011 Volume 44 Issue 8 Pages 978-984
Published: August 01, 2011
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 63-year-old woman had been observed for a hepatic cyst for about 8 months. In June, 2009, her CA19-9 level was found to be elevated and she was admitted to our hospital. Abdominal ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) showed a multilocular cystic tumor in the left lobe of the liver, and they showed a partial wall thickening in the cystic tumor. Fluorodeoxyglucose positron emission tomography (FDG-PET) showed uptake in the cystic tumor. Biliary cystadenocarcinoma was diagnosed and left lobectomy of the liver was performed. Macroscopic findings showed the cystic tumor to be composed of blood and mucin, and wall thickening. Histopathologically, the tumor was cystadenocarcinoma with ovarian-like stroma. The postoperative course was uneventful and she is alive without recurrence for 12 months after surgery. Since biliary cystadenocarcinoma with ovarian-like stroma are rare, we report this case with a review of the literature.View full abstractDownload PDF (1600K) -
Jun Muto, Ken Shirabe, Yohei Mano, Takashi Motomura, Kazuki Takeishi, ...Article type: CASE REPORT
2011 Volume 44 Issue 8 Pages 985-990
Published: August 01, 2011
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSDilatation of the intrahepatic bile duct of the left lateral segment of the liver at a medical checkup was pointed out in a woman in her 30s, but no solid lesion was observed. On her next annual medical checkup, the bile duct dilatation extended to the entire left lobe and the extrahepatic bile duct was also dilated. A 5-cm tumor was observed in the left lateral segment of the liver. After evaluation, we diagnosed intraductal papillary neoplasm of bile duct (IPN-B) and performed surgery. We performed extended left lobectomy, Spiegel lobectomy and biliary tract reconstruction. The tumor was a 5.5-cm multilocular cystic tumor and was definitively diagnosed as a mucin-producing intraductal papillary adenocarcinoma pathologically. She has no evidence of recurrence 11 months after surgery. IPN-B is known as a high risk tumor but its prognosis after surgery is good. The progression of the IPN-B is still unknown. In this IPN-B case, the tumor grew rapidly in one year but curative resection was possible.View full abstractDownload PDF (820K) -
Munefumi Tomomatsu, Chiaki Yasui, Shinichi Ikuta, Tsukasa Aihara, Hiro ...Article type: CASE REPORT
2011 Volume 44 Issue 8 Pages 991-996
Published: August 01, 2011
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 39-year-old man with abdominal pain and vomiting was referred to our hospital. He had consumed alcohol (about 75 g per day) for 18 years. Upper gastrointestinal series revealed a circumferential stricture of the second portion of the duodenum. Abdominal CT and MRI showed a cystic mass (20 x 15 mm) at the groove area between the duodenum and choledochus, and portal venous obstruction accompanied with the growth of collateral vessels. We suspected groove pancreatitis rather than pancreatic cancer. His symptoms subsided with conservative treatment, but he was readmitted for vomiting. The size of the cystic mass increased. We adopted a distal gastrectomy with Roux-en-Y jejunal reconstruction. The postoperative course was uneventful. The cystic mass disappeared with no recurrences for 2 years after surgery.View full abstractDownload PDF (1082K) -
Yuki Numaga, Toshihiro Ohya, Norifumi Takahashi, Hisashi Shimizu, Keni ...Article type: CASE REPORT
2011 Volume 44 Issue 8 Pages 997-1004
Published: August 01, 2011
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 71-year-old man visited a medical clinic complaining of vomiting, and was referred to our hospital for examination. Blood examination showed leukocytosis (white blood cell count 17,480 /μl) and his serum CA19-9, DUPAN-2, and Span-1 levels were elevated (2,804, 841, and 134 U/ml, respectively). Abdominal computed tomography revealed a heterogeneously enhanced tumor with a diameter of about 6 cm in the third portion of the duodenum. Upper gastrointestinal endoscopy revealed a submucosal tumor at the same location. The endoscopic biopsies showed duodenitis (group 1). From these findings, a diagnosis of duodenal tumor was made and partial resection of the duodenum and jejunum was performed. On macroscopic observation, the duodenal tumor had ulcerated, forming an extramural mass 6 cm in diameter. Histologically, there were areas of adenocarcinoma forming tumor glands and areas of squamous cell carcinoma with keratinization. The histological examination confirmed the diagnosis of adenosquamous carcinoma of the small intestine. The patient underwent postoperative chemotherapy. However, he died 10 months postoperatively, after local recurrence was found in the 8th postoperative month and liver metastases were found in the 9th postoperative month. Adenosquamous carcinoma of the small intestine is rare; including this case, there have been only 26 cases reported in the Japanese literature.View full abstractDownload PDF (1147K) -
Jun Hamaguchi, Yoshiaki Maeda, Toshiki Shinohara, Noriaki Futakawa, No ...Article type: CASE REPORT
2011 Volume 44 Issue 8 Pages 1005-1010
Published: August 01, 2011
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 55-year-old woman underwent a curative operation after diagnosis of a soft tissue sarcoma in the right upper thigh. Based on a definitive diagnosis of malignant fibrous hisciocytoma (MFH) by pathology, postoperative chemotherapy was performed. After 23 months, bilateral pulmonary metastasis was detected by CT. Resection of bilateral lung masses was scheduled, but melena appeared, and then anemia. A tumor found at the ileocecal junction by colonoscopy. The tumor was biopsied, and elective surgery was scheduled after close evaluation. However, obstructive intestinal symptoms such as vomiting etc. appeared, immediately. She was introduced to our division, and an urgent laparotomy was done. There were two lesions in the intestine: one was in the jejunum and the other in the ileum. In addition, the jejunum lesion had caused intussusception. Excision of the small intestine was performed for these two lesions. We finally established a diagnosis of relapse of MFH by the pathological immunostaining findings and comparison with the pathological findings of the initial lesion. There are few operationed cases of metastasis to the intestinal tract from outside the stomach, and the cases presenting intussusception are particularly rare. We described this case and reviewed the pertinent literature.View full abstractDownload PDF (1604K) -
Kohei Ishioka, Kazuaki Uchimoto, Kenichi Ohtsuki, Fumikazu Koyama, Tad ...Article type: CASE REPORT
2011 Volume 44 Issue 8 Pages 1011-1017
Published: August 01, 2011
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe present a case of a 67-year-old woman with diabetes mellitus who was being treated for poor glycemic control with miglitol, an α-glucosidase inhibitor (αGI) drug. Approximately 8 months after starting the medication, she was admitted to our hospital with acute abdominal pain and fever. Laboratory data showed increased C-reactive protein (CRP) levels. Imaging findings showed massive intraperitoneal free air, foamy gas collections throughout the small bowel wall and the mesentery, and thinning of a segment of the small bowel wall. A presumptive diagnosis of pneumatosis cystoides intestinalis (PCI) with perforation of the small bowel was made, and an exploratory laparotomy was performed. However, intraoperative findings revealed no perforation in the gastrointestinal tract and foamy gas collections were located only in the ileum, throughout the ileal wall and the adjacent mesentery. Miglitol medication was stopped postoperatively and no further evidence of PCI has been noted on follow-up exam 1 year after surgery. This is the first report of PCI arising as a complication of miglitol therapy. Many PCI lesions due to miglitol appear in the large bowel. However, in this case, PCI lesions were present only in the ileum. Since miglitol suppresses absorption of glucose in the proximal small bowel unlike other αGI drugs, we suggest that the etiology of PCI in this scenario is due to increased ileal intraluminal pressure resulting from the maximal glucose absorption and fermentation taking place in the distal small bowel with minimal involvement of the large bowel.View full abstractDownload PDF (894K) -
Mamiko Takii, Hiroshi Ohtani, Tetuo Nakamura, Yuichi Arimoto, Kousei H ...Article type: CASE REPORT
2011 Volume 44 Issue 8 Pages 1018-1023
Published: August 01, 2011
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSDiagnosis of acute appendicitis during pregnancy is often difficult, because it is necessary to distinguish it from other gynecological diseases. This woman, who was 18 weeks pregnant, had a complaint of acute upper abdominal pain. We suspected acute appendicitis by clinical findings and diagnostic imaging, but a definitive diagnosis was not made. Acute appendicitis was diagnosed finally by laparoscopic techniques and laparoscopic appendectomy was performed safely. The clinical course after surgery was good. The progress of the pregnancy was excellent and she delivered a healthy infant. Laparoscopic surgery is useful because it has a safe period during pregnancy and treatment immediately following diagnosis is possible.View full abstractDownload PDF (1141K) -
Takeshi Miyamoto, Toru Fukunaga, Masayuki Kimura, Yuji Sugamoto, Mari ...Article type: CASE REPORT
2011 Volume 44 Issue 8 Pages 1024-1030
Published: August 01, 2011
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA woman in her 70s required laparoscopic ileocecal resection for cystadenocarcinoma of her vermiform appendix. Later, disseminated recurrence was resected. As an adjuvant local treatment, three cycles of intraperitoneal chemotherapy with cisplatin, 5-FU and mitomycin C were given. Subsequently, ileus developed and she was admitted. US and water-soluble contrast study suggested that this ileus might have been induced not by dissemination but by something like a cocoon. We found no evidence of recurrent dissemination but operation revealed an encapsulating peritoneal sclerosis, probably caused by intra-peritoneal. The capsule was peeled off allowing sufficient nutritional intake after the operation.View full abstractDownload PDF (1194K) -
Koichi Shinoto, Ikuya Oshima, Seiji Yoshimura, Takamitsu Ariga, Masahi ...Article type: CASE REPORT
2011 Volume 44 Issue 8 Pages 1031-1038
Published: August 01, 2011
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 62-year-old woman was admitted to our hospital because of abdominal pain. Computed tomography (CT) revealed fluid collection in the abdominal cavity and an aneurysm in the middle colic artery. Hypovolemic shock developed and this was assumed to be due to bleeding from the aneurysm. Emergency surgery was performed and bleeding from the aneurysm in the right branch of the middle colic artery was confirmed. The affected vessel was ligated proximally and distally, and removed. Pathologic examination revealed an idiopathic aneurysm due to medical necrosis. The postoperative course was uneventful, and the patient was discharged on the 20th postoperative day. Ruptured aneurysm of the middle colic artery is generally rare. Interventional radiology (IVR) is the first choice of treatment because diagnosis and therapy can be done simultaneously, however, laparotomy may be preferable depending on the condition.View full abstractDownload PDF (1402K) -
Tomohiro Hosono, Takeshi Kawamura, Keishiro Murakami, Rikiya Sato, Tad ...Article type: CASE REPORT
2011 Volume 44 Issue 8 Pages 1039-1046
Published: August 01, 2011
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe patient was a 53-year-old man who was referred to our hospital with complaint of bloody feces. Colonoscopic study revealed an easy-bleeding subpedunculated protruding tumor of about 15 mm in size in the descending colon, and endoscopic mucosal resection (EMR) was performed. The pathohistological diagnosis was pyogenic granuloma. Bloody feces appeared again when he was being followed as an outpatient and colonoscopy was performed. Relapse in the form of a. protruding tumor of about 20 mm in size was recognized in the part that had been treated by EMR. Due to fear of recurrence, segmental resection of the descending colon was performed. The postoperative pathological diagnosis was again, pyogenic granuloma. Pyogenic granuloma which arises in areas of the intestinal tract other than the oral mucosa is extremely rare. Because of easy bleeding, it is necessary to suspect this as the cause for gastrointestinal bleeding. In addition, careful consideration in selecting the method of treatment is important because it often relapses and the speed of development is comparatively rapid.View full abstractDownload PDF (1923K) -
Kenta Kitamura, Shuji Saito, Akio Shiomi, Yusuke Kinugasa, Shigeki Yam ...Article type: CASE REPORT
2011 Volume 44 Issue 8 Pages 1047-1054
Published: August 01, 2011
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 61-year-old man was found to have a type 2 tumor of the sigmoid colon by colonoscopy and moderately differentiated adenocarcinoma was diagnosed by biopsy. Preoperative CT showed paraaortic lymph node metastasis. Radical surgery was difficult due to cirrhosis, so he underwent a Hartmann operation with D2 lymph node dissection. The operation was not curative due to paraaortic lymph node metastasis. The pathological diagnosis was adenocarcinoma with about 20% neuroendocrine differentiation in the primary tumor and about 30% neuroendocrine differentiation in the metastatic lymph nodes. Postoperative chemotherapy included CPT-11 and CDDP based on the chemotherapy regimen for small cell lung carcinoma. After 2 cycles, paraaortic lymph nodes significantly decreased in size, and 4 additional cycles were given. On follow-up 61 months postoperatively and 54 months after chemotherapy the patients was disease-free.View full abstractDownload PDF (1781K) -
Masaki Sano, Takamori Nakayama, Tsunehiro Shintani, Koh Shiraishi, Syu ...Article type: CASE REPORT
2011 Volume 44 Issue 8 Pages 1055-1061
Published: August 01, 2011
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 79-year-old woman who had had right inguinal bulging for 2 years was brought to our hospital due to an increase in the inguinal bulging. The protrusion was 4 x 4 cm in size and was diagnosed as incarcerated femoral hernia. Manual reduction of the incarceration was not successful. A CT scan revealed incarcerated solid mass with bowel gas in the hernia sac and no sign of bowel obstruction. Since her abdominal findings were normal, we suspected that the content of the hernia was Richter type incarceration the ileum of Richter type. Operation was performed immediately. A swollen appendix was disclosed when we opened the hernia sac. Normograde appendectomy was carried out, and the posterior wall of the inguinal canal was repaired by the Proline Hernia Repair System. Pathologically the appendicitis was diagnosed as catarrhal inflammation and congestion on top of the appendix and no abscess was found. The surgical site was not infected postoperatively.View full abstractDownload PDF (1280K) -
Kenji Omori, Kanji Miyata, Norihiro Yuasa, Eiji Takeuchi, Yasutomo Got ...Article type: CASE REPORT
2011 Volume 44 Issue 8 Pages 1062-1069
Published: August 01, 2011
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 67-year-old woman suffered postprandial chest and back pain. Because gastrography revealed a saccular gastric protrusion above the diaphragm, her gastroenterologist made a diagnosis of paraesophageal hiatal hernia. After admission to the surgical department, she underwent esophageal manometry and 24-hr pH and bilirubin monitoring for evaluation of gastroesophageal reflux disease (GERD); however, these examinations did not indicate GERD. Close evaluation of the computed tomography findings disclosed a left diaphragmatic crus between the abdominal esophagus and the herniated stomach; therefore, we made a diagnosis of parahiatal hernia. The operation was performed laparoscopically, the hernia content (gastric fundus) was reduced into the abdominal cavity, and the orifice was sutured. Because parahiatal hernia mimics paraesophageal hiatal hernia in clinical findings and diagnostic images, it is usually not correctly diagnosed preoperatively, only by the intraoperative findings. Paraesophageal hiatal hernia results from defects of the tissue around the gastroesophageal junction, but on the other hand, parahiatal hernia originates from embryological weakness of the diaphragm. Paraesophageal hiatal hernia frequently needs fundoplication but parahiatal hernia does not; therefore, these two hernias should be distinguished before operation.View full abstractDownload PDF (1461K) -
Hiroya Enomoto, Masahisa Ohkuma, Tetsuya Kobayashi, Shintaro Nakajima, ...Article type: CASE REPORT
2011 Volume 44 Issue 8 Pages 1070-1078
Published: August 01, 2011
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 54-year-old man visited another clinic with a right inguinal mass in March 2009, where an incarcerated right inguinal hernia was diagnosed and he was referred to our hospital. On emergency admission, a right inguinal bulging mass with rubor and tenderness was identified, and an incarcerated right inguinal hernia was diagnosed. Abdominal plain computed tomography (CT) demonstrated a tubular structure with intestinal gas suggestive of intestine protruding from the abdominal cavity through the right inguinal canal, which ended in a sac-like structure. The tubular structure was connected with the cecum, suggesting that the structure was the vermiform appendix. Intraoperatively, we approached the lesion by an inguinal incision, and the hernia sac was identified to have protruded through the inner inguinal ring. The hernia content was reduced and returned into the abdominal cavity, and therefore laparotomy by lower abdominal midline incision was performed. Upon exploration of the peritoneal cavity, no extension of inflammation or non-bacterial contamination was identified. The vermiform appendix was dark red and exhibited apparent static change due to incarceration. Appendectomy and hernioplasty with iliopubic tract repair were performed. His postoperative course was uneventful and he was discharged on postoperative day 6. Inguinal hernia containing the vermiform appendix is rare and is called "Amyand's hernia". We report this extremely rare case diagnosed preoperatively by abdominal CT, and review the literature.View full abstractDownload PDF (1454K)
- |<
- <
- 1
- >
- >|