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Volume 46, Issue 4
Displaying 1-11 of 11 articles from this issue
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ORIGINAL ARTICLE
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Hajime Imamura, Fumihiko Fujita, Yusuke Kawakami, Daisuke Kawahara, Ta ...Article type: ORIGINAL ARTICLE
2013 Volume 46 Issue 4 Pages 237-242
Published: April 01, 2013
Released on J-STAGE: April 09, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLPurpose: Recently, the transumbilical approach has been reported for laparoscopic surgery. We have adopted a longitudinal incision in the umbilicus for the first port incision during laparoscopic colorectal surgery. However, we have encountered some patients who developed fluid collection on their umbilicus scar after the surgery. The aim of our study was to investigate the correlation between the method used for the umbilicus incision and surgical site infections. Methods: We studied 100 consecutive cases of laparoscopic colorectal surgery between December 2007 and February 2012. For the first 50 cases, the incision was made around the umbilicus (Group A), and for the last 50 cases, the incision was made just on the umbilicus (Group B). We investigated the existence of bacteria by a culture examination for 20 cases in Group B pre- and postoperatively. Results: Fluid collection was found postoperatively in 4 cases (8%) in group A, and in 9 cases (18%) in group B. However, bacteria were found in the scar in only 1 case. During the preoperative culture examination, 8 out of 20 cases were found to have bacteria in the scar, although all of the bacteria were normal flora. None of the patients developed a surgical site infection on the umbilical scar postoperatively. Conclusion: The longitudinal incision of the umbilicis is a useful method for improving the cosmesis, and seems to be safe with regard to the risk of surgical site infections.View full abstractDownload PDF (1053K) Full view HTML
CASE REPORT
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Masaki Tokumo, Ryuichiro Ohashi, Masaru Jida, Takafumi Kubo, Tomo Oka, ...Article type: CASE REPORT
2013 Volume 46 Issue 4 Pages 243-252
Published: April 01, 2013
Released on J-STAGE: April 09, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLA 78-year-old woman consulted the Department of Internal Medicine about dysphagia in December 2004. Upper gastrointestinal X-ray examination showed a 3-cm long stricture of the middle thoracic esophagus. Gastrointestinal fiberscopy showed a stricture of the thoracic esophagus at approximately 28 to 30 cm from the incisor, but there was no tumorous appearance on the membrane. For this stricture of the esophagus of unknown origin, balloon dilation was performed at first. Her symptoms slightly improved after dilation, but did not disappear, therefore balloon dilation was repeated 5 times, however, her symptoms did not completely disappear. An esophageal stent insertion was performed in August 2006. Shortly after stent insertion, stent obstruction caused by food waste and continuous precordialgia or epigastralgia occurred. She then consulted the surgery department and in September 2006, underwent an operation under general anesthesia. Pathological examination of the resected specimen showed epithelioid hemangioendothelioma corresponding to the site of stricture. We conclude that this rare tumor was caused by esophageal stenosis.View full abstractDownload PDF (2553K) Full view HTML -
Hisashi Shimizu, Tetsushi Ogawa, Toshiyuki Tanaka, Takamichi Igarashi, ...Article type: CASE REPORT
2013 Volume 46 Issue 4 Pages 253-259
Published: April 01, 2013
Released on J-STAGE: April 09, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLA 64-year-old woman patient underwent distal gastrectomy and D2 lymph node dissection for advanced gastric cancer of histopathologic stage IIIA in September 2008. Uracil/tegafur and polysaccharide were administered for 12 months postoperatively as adjuvant chemotherapy. A follow-up computed tomography (CT) examination in September 2009 detected a small, low-density area in liver segment 8, and the tumor enlarged gradually to 10 mm in diameter, as shown by CT in September 2010. Metastasis of gastric cancer was suspected based on magnetic resonance imaging findings, but fluorodeoxyglucose (FDG) positron emission tomography showed no accumulation of FDG in the same area. A percutaneous needle biopsy revealed a definitive diagnosis of tumor cells with intracytoplasmic vascular luminae and resembling signet ring cells. Immunohistochemically, the tumor cells were positive for CD31 and CD34, but negative for CD20. These histological findings were consistent with an epithelioid hemangioendothelioma. Partial resection of liver segment 8 was performed. The postoperative course was uneventful, and no recurrence or metastasis has been observed for 17 months since the operation.View full abstractDownload PDF (2441K) Full view HTML -
Takahiro Kamiga, Kazuhiro Takami, Tomoya Abe, Takeshi Tominaga, Michia ...Article type: CASE REPORT
2013 Volume 46 Issue 4 Pages 260-267
Published: April 01, 2013
Released on J-STAGE: April 09, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLWe report a case of biliary peritonitis due to bile leakage from the gallbladder without perforation, complicated by early-stage gallbladder cancer. A 76-year-old man was admitted to our hospital because of severe abdominal pain. Abdominal CT and MRI showed swelling of the gallbladder and the presence of ascites around the liver and the spleen. A laparoscopic operation was performed under a diagnosis of acute cholecystitis. Biliary ascites was found throughout abdominal cavity. No perforation of both the gallbladder and the biliary tract was detectable. Cholecystectomy and peritoneal drainage were performed. Intraoperative cholangiography indicated possibility of pancreaticobiliary maljunction. Histopathological examination revealed severe dysplasia/carcinoma in situ in the body and fundus of the gallbadder. Severe dysplasia extended to subserous layer through Rokitansky-Aschoff sinus (RAS). The thinning of the gallbladder, caused by infiltration of severe dysplasia and carcinoma in situ to RAS and tissue damage by regurgitated pancreatic juice in the presence of occult pancreatobiliary reflux, was followed by bile leakage.View full abstractDownload PDF (1689K) Full view HTML -
Naoyuki Tokunaga, Masaru Inagaki, Yuji Kimura, Koji Kitada, Hiromi Iwa ...Article type: CASE REPORT
2013 Volume 46 Issue 4 Pages 268-274
Published: April 01, 2013
Released on J-STAGE: April 09, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLA 75-year-old man complaining of right upper quadrant abdominal pain visited another hospital, and the acute cholecystitis was suspected based on ultrasonogram (US) and computer tomography (CT) scans. He was introduced our hospital for further examination and surgical treatment. Enhanced CT scan showed a circumferential wall thickness in the middle third of the gallbladder, and revealed the abcess formation outside the gallbladder wall, too. The clinical diagnosis of suppurative cholecystitis was made, and an urgent cholecystectomy was performed. Histopathological examination incidentally showed a moderately or poorly differentiated adenocarcinoma mixed with multinucleated syncytial trophoblasts. Immunohistochemistry revealed positive staining for HCG in the trophoblastic-cell component. According to the pathological diagnosis, we performed second operation immediately for the necessity of additional hepatectomy and lymph node dissection, but radical excision was immposible because of diffuse peritoneal dissemination and multiple liver metastasis. The patient survived only about four months following the first surgery. Primary gallbladder choriocarcinoma is exceedingly rare, and the prognosis is poorer than typical gallbladder adenocarcinoma in the literature. We report a case of gallbladder choriocarcinoma which demonstrated a rapidly aggressive course after cholecystectomy.View full abstractDownload PDF (1573K) Full view HTML -
Noriyuki Egawa, Takao Ide, Keita Kai, Atsushi Miyoshi, Kenji Kitahara, ...Article type: CASE REPORT
2013 Volume 46 Issue 4 Pages 275-281
Published: April 01, 2013
Released on J-STAGE: April 09, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLA 77-year-old man who was given a diagnosis of gallbladder cancer and preoperative imaging showed an invasive mass lesion in the fundus of the gallbladder. We conducted S4a+5 hepatectomy, cholecystectomy, partial gastrectomy and D2 lymph node dissection. The mucosa of the gallbladder did not have a neoplasm, and the liver and stomach were invaded by a submucosal tumor-like lesion macroscopically. Histopathologically, the tumor consisted mainly of pseudo-sarcomatous proliferative and components which were positive for cytokeratin 7 and vimentin, yielding a diagnosis of sarcomatoid carcinoma of the gallbladder (WHO classification; undifferentiated carcinoma, spindle and giant cell type). Moreover, a fundal type gallbladder adenomyomatosis was observed in the resected specimen, suggesting the possibility that the tumor had arisen from Rokitansky-Achoff sinus (RAS). Adjuvant chemotherapy using gemcitabine was administered, and he is alive without recurrence for 20 months after surgical treatment. To the best of our knowledge, this case is the first reported case of sarcomatoid carcinoma of the gallbladder arising from a fundal type of adenomyomatosis.View full abstractDownload PDF (1528K) Full view HTML -
Norio Okumura, Tsutomu Fujii, Tadao Ishikawa, Suguru Yamada, Masaya Su ...Article type: CASE REPORT
2013 Volume 46 Issue 4 Pages 282-288
Published: April 01, 2013
Released on J-STAGE: April 09, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLWe report a case of a 66-year-old man who was given a diagnosis of pancreatic head cancer with involvement of the superior mesenteric vein and nerve plexus around the superior mesenteric artery. We started combined chemotherapy of S-1 (tegafur, gimeracil, oteracil potassium) and gemcitabine as neoadjuvant chemotherapy. The patient was seen at the hospital because of severe anemia after one course, and upper gastrointestinal endoscopy showed duodenal bleeding. Chemotherapy was stopped, and curative resection was performed. Histopathological examination revealed the penetration of the necrotic tumor at the bleeding site, possibly resulting from chemotherapy. To the best of our knowledge, this is the first report of a resected case of pancreatic cancer with perforation or penetration to the gastrointestinal tract during neoadjuvant chemotherapy or chemoradiotherapy. An oncologic emergency should be taken into consideration when neoadjuvant treatment is applied to the patient with pancreatic cancer.View full abstractDownload PDF (1423K) Full view HTML -
Kota Wakiyama, Jun Nakamura, Masako Urata, Yasuo Koga, Osamu Ikeda, Hi ...Article type: CASE REPORT
2013 Volume 46 Issue 4 Pages 289-294
Published: April 01, 2013
Released on J-STAGE: April 09, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLA 66-year-old man presented with sudden onset of upper abdominal pain. Laparoscopic total gastrectomy with D2 lymph node dissection, splenectomy and Roux-en Y (overlap) reconstruction had been performed for advanced gastric cancer 1 and half year before. Abdominal CT scan showed a dilated small intestine prolapsed into the mediastinum through the esophageal hiatus not involving the anterior heart. Ischemia of the prolapsed small intestine was suspected, because of poorly enhanced images of the bowel wall. Strangulation ileus caused by esophageal hiatal hernia was diagnosed, and an emergency operation was performed under laparoscopy. After successfully reducing the prolapsed small intestine back to the abdominal cavity, the necrotic part of the intestine was resected. This case was considered to be rare, but specific to the laparoscopic surgery for gastric cancer.View full abstractDownload PDF (1162K) Full view HTML -
Daisuke Takeuchi, Naohiko Koide, Motohiro Okumura, Akira Suzuki, Shini ...Article type: CASE REPORT
2013 Volume 46 Issue 4 Pages 295-301
Published: April 01, 2013
Released on J-STAGE: April 09, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLA 25-year-old woman presented at 22 weeks of gestation complained of acute right hypochondrial pain. Abdominal computed tomography showed the ileocecal area displaced cranially, swelling of the appendix with inflammatory change of the periappendiceal fat. Emergency appendectomy was performed. Gross examination of the resected appendix revealed a tumor (7 mm in diameter) at the tip of the appendix. Histopathological examination revealed the tumor was composed of proliferation of atypical cells with round nuclei. Using immunohistochemical staining yielded a diagnosis of neuroendcrine tumor of the appendix. The tumor cells infiltrated the proper muscular layer of the appendix, but without evidence of vascular involvement. Uterine contractions started at 36 weeks of gestation, and the patient underwent cesarean section. During the operation, lymph nodes surrounding the ileocecal artery were dissected and peritoneal washing cytology was performed, but all results were negative for atypical tumor cells. This was a rare case of appendiceal neuroendocrine tumor with appendicitis during pregnancy.View full abstractDownload PDF (2227K) Full view HTML -
Naoki Hashimoto, Junya Kobayashi, Michio Hara, Yuji Honda, Hitoshi Ish ...Article type: CASE REPORT
2013 Volume 46 Issue 4 Pages 302-309
Published: April 01, 2013
Released on J-STAGE: April 09, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLAmong colorectal carcinomas, squamous cell carcinomas are rare, especially those arising in the colon. Squamous cell carcinoma of the colon has a poorer prognosis than adenocarcinoma of the colon, with minimal response to treatment. We encountered a case of primary squamous cell carcinoma of the sigmoid colon. An 80-year-old woman complaining of anal bleeding was given a diagnosis of a squamous cell carcinoma of the sigmoid colon after a colonoscopy with a biopsy. General exploration revealed no evidence of another malignancy, and she had no previous history of malignancy. The preoperative diagnosis was primary squamous cell carcinoma of the sigmoid colon. We performed a sigmoidectomy with partial intestine resection due to direct invasion of the small intestine, and we constructed an artificial anus. The center of the tumor was necrotic, forming a cavity. The histopathological findings showed squamous cell carcinoma with slight keratinization. No adenocarcinoma component was detected. The patient died of local recurrence 15 months postoperatively.View full abstractDownload PDF (1576K) Full view HTML
CLINICAL EXPERIENCE
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Roko Sakai, Yoshirou Fujii, Kazuhiro Kondo, Kazuhiro Otani, Kazuo Chij ...Article type: CLINICAL EXPERIENCE
2013 Volume 46 Issue 4 Pages 310-316
Published: April 01, 2013
Released on J-STAGE: April 09, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLIndocyanine green retention rate at 15 minutes (ICGR15) has been widely used for preoperative evaluation of the liver function in hepatocellular carcinoma (HCC) patients. In HCC patients with suspected constitutional ICG excretory defect (CIED), that is defined to represent disproportionately high ICGR15, preoperative evaluation of hepatic functional reserve may be difficult. We report for 4 HCC patients with an extremely abnormal ICGR15 (more than 60%) despite Child-Pugh grade A, who underwent uneventful hepatectomy. The ICGR15 values were 60.6, 72.0, 78.8, and 96.6% respectively, and surgical procedures performed were left hepatectomy, S3 partial resection, right anterior sectionectomy, and left hepatectomy, respectively. No patients experienced postoperative liver failure. In one patient, 99mTc-galactosyl-human serum albumin scintigraphy was useful for preoperative evaluation of liver function. We herein report these 4 cases and review the literature.View full abstractDownload PDF (1581K) Full view HTML
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