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Volume 46, Issue 8
Displaying 1-10 of 10 articles from this issue
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CASE REPORT
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Masahiro Niihara, Hiroshi Sato, Shuhei Mayanagi, Hironobu Goto, Masano ...Article type: CASE REPORT
2013 Volume 46 Issue 8 Pages 555-563
Published: August 01, 2013
Released on J-STAGE: August 09, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLThe subject was a 71-year-old man with hoarseness and dysphagia. Neck ultrasonography showed an ellipsoidal solid nodule involving the center of the left thyroid lobe. Ultrasound-guided fine needle aspiration (FNA) was performed twice to exclude the possibility of malignancy. The cytologic examination of the second specimen showed a few follicular epithelial cells, saburra, bacteria, necrotic tissue, with no malignancy. Esophagography revealed a barium-filled sac from the left anterolateral wall of the cervical esophagus which led to the diagnosis of a Killian-Jamieson diverticulum. The patient underwent resection of the diverticulum, and his symptoms resolved. Intraoperative endoscopy was effective in identifying the diverticulum which was strongly connected to the thyroid lobe possibly due to previous FNA.View full abstractDownload PDF (2244K) Full view HTML -
Kenichi Iwasaki, Hideo Terashima, Katsuji Hisakura, Naoki Sano, Ryoich ...Article type: CASE REPORT
2013 Volume 46 Issue 8 Pages 564-572
Published: August 01, 2013
Released on J-STAGE: August 09, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLA 63-year-old man admitted for dysphagia and body weight loss was found in preoperative examination to have advanced esophageal cancer in the lower third of the esophagus and early gastric cancer in the gastric cardia. The former was diagnosed as cT3N2M0 Stage III squamous cell carcinoma, and the latter was diagnosed as cT1bN0 Stage IA adenocarcinoma according to the Japanese classification on esophageal and gastric carcinoma. Three-dimensional computed tomography (3D-CT) showed a right aortic arch with an aberrant left subclavian artery and ductus arteriosus originating from a diverticulum at the descending aorta (Edward’s type IIIB). After preoperative chemotherapy, the patient underwent a subtotal esophagectomy via a left thoracotomy and a 3-field lymph node dissection, followed by a high intrathoracic esophagogastrostomy. Through the careful preoperative assessment, we could safely deal with ductus arteriosus and successfully preserve the left recurrent laryngeal nerve. We present very clear intraoperative pictures revealing the anatomical positional relationship of each organ. In addition, we discuss important controversial issues associated with the reconstructive procedure and lymph node dissection along the right recurrent laryngeal nerve, and provided our suggestions.View full abstractDownload PDF (1679K) Full view HTML -
Toshiro Tanioka, Hideki Kawamura, Masahiro TakahashiArticle type: CASE REPORT
2013 Volume 46 Issue 8 Pages 573-578
Published: August 01, 2013
Released on J-STAGE: August 09, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLWe report a case of anastomotic leakage after total gastrectomy treated by endoscopic clipping. The subject was a 63-year-old man with a hiatus hernia. In October 2010, he underwent laparoscopy-assisted total gastrectomy for early gastric cancer. The anastomosis was performed using a circular stapler (OrVilTM). A high fever of 38.5°C occurred on postoperative day 2 and a routine gastrografin meal examination revealed anastomotic leakage of esophagojejunostomy. Gastrografin leaked into the mediastinum. We completely closed the fistula of anastomosis using 3 large-sized clips endoscopically at once. The mediastinal abscess drainage was performed under CT guidance. Meal intake started on postoperative day 20, and the patient was discharged on postoperative day 33. There have been few reports on the treatment for anastomotic leakage by endoscopic clipping, however, we speculate this procedure to be effective for esophagojejunal anastomotic leakage.View full abstractDownload PDF (1579K) Full view HTML -
Naruo Tokuyasu, Kanenori Endo, Miwa Yoshimoto, Jyoji Watanabe, Teruhis ...Article type: CASE REPORT
2013 Volume 46 Issue 8 Pages 579-585
Published: August 01, 2013
Released on J-STAGE: August 09, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLA 69-year-old man with elevated biliary liver enzyme levels, detected by blood tests, was referred to our hospital for medical scrutiny by the primary care physician. Scrutiny and biopsy revealed a tumor that was diagnosed as a neuroendocrine carcinoma. It was 15 mm in diameter and was located in the large hilar bile duct dominating the right hepatic duct. The tumor was judged as being unresectable, because infiltration into the bile duct of the left medial segment branch (B4) was evident. Chemotherapy was given in a total of 3 cycles, commencing every 28 days, CPT-11 was given at a dose of 80 mg/m2 (day 15) and cisplatin was given at a dose of 70 mg/m2 (days 1 and 15). Following treatment the tumor shrank to 9 mm in diameter and invasion of the left hepatic duct was no longer evident. Percutaneous transhepatic portal embolization prior to surgery; radical resection of the expanded right lobe, including excision of the caudate lobe, D2 dissection and choledochojejunostomy was performed. Primary neuroendocrine cell carcinoma in the hilar region is a rare disease, seldom reported in the literature.View full abstractDownload PDF (2076K) Full view HTML -
Yusuke Okamura, Takeshi NatoriArticle type: CASE REPORT
2013 Volume 46 Issue 8 Pages 586-593
Published: August 01, 2013
Released on J-STAGE: August 09, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLA 59-year-old man underwent radical right nephrectomy for renal cell carcinoma (RCC) in December 2008. Two years later, a follow-up CT showed two lung metastases and gallbladder (GB) tumor, and he was treated with IFN-alpha. While lung metastases kept the disease stable, the GB tumor was progressively growing. He developed acute cholecystitis in November 2011. Abdominal enhanced CT showed a 35 mm GB tumor which was enhanced well at early-phase and washed out at delayed-phase. We suspected the GB tumor of metastasis from RCC. Because of the stable condition of lung metastases and treatment of cholecystitis, we selected a surgical approach for GB tumor. We performed extended cholecystectomy. Macroscopic appearance of the resected GB revealed a 6 cm nodular type soft tumor. Histopathologically, the tumor indicated clear cell carcinoma and was diagnosed as metachronous GB metastasis. Furthermore, blood clotting attached to the surface of the tumor and the GB was filled with hemobilia, so we suspected tumor hemorrhage. RCC is commonly known as metastasizing various organs including GB. So far, there are only 48 cases of GB metastasis from RCC.View full abstractDownload PDF (1691K) Full view HTML -
Yasuro Futagawa, Takeyuki Misawa, Hiroaki Shiba, Hiroaki Kitamura, Yui ...Article type: CASE REPORT
2013 Volume 46 Issue 8 Pages 594-602
Published: August 01, 2013
Released on J-STAGE: August 09, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLCirrhotic patients are at a higher risk for mortality and morbidity at surgery. Therefore, for highly invasive surgery such as pancreaticoduodenectomy, careful attention is required in case selection. Herein, we report two cases of pancreaticoduodenectomy in cirrhotic patients. (case 1) A 74-year-old man with cirrhosis secondary to chronic hepatitis B infection with a Child-Pugh score of 6 (Grade A) underwent pancreaticoduodenectomy for carcinoma of the distal bile duct. Although he did not develop pancreatic fistula or bile leakage, superior mesenteric vein thrombosis was identified on postoperative day 8 for which he was treated by anti-coagulation. Fifteen months after the operation, he has a Child-Pugh score of 7 (Grade B). He also underwent two cycles of TAI for hepatocellular carcinoma. (case 2) A 77-year-old woman with cirrhosis secondary to transfusion-acquired hepatitis C infection with a Child-Pugh score of 5 (Grade A) underwent pancreaticoduodenectomy with splenectomy for carcinoma of the ampulla of Vater. Although she did not develop pancreatic fistula or bile leakage, her clinical course was complicated by anorexia, ascites, hyponatremia and hyperammonemia during the first 2 months. Twelve months after the operation, she has intractable ascites with a Child-Pugh score of 8 (Grade B). Cirrhotic patients are at increased risk of intra-operative bleeding and developing life-threatening post-operative complications such as portal vein thrombosis or decompensated cirrhosis after pancreaticoduodenctomy. Therefore, stringent indications for surgery are of extreme importance. Furthermore, for possible life-threatening post-operative complications, careful monitoring and long-term follow up are essential.View full abstractDownload PDF (2213K) Full view HTML -
Yusuke Watanabe, Shunichi Okushiba, Daisuke Miyasaka, Takeshi Sasaki, ...Article type: CASE REPORT
2013 Volume 46 Issue 8 Pages 603-610
Published: August 01, 2013
Released on J-STAGE: August 09, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLA 54-year-old woman underwent emergency surgery due to superior mesenteric artery occlusion. Her previous health status was unremarkable. In the operating room, widespread ischemic areas with possible overlying necrosis were found in the small intestine, necrotic margins could not be identified. Blood supply to the intestine was observed after thrombectomy and a single necrotic area was found 40 cm proximal to the terminal ileum using intraoperative indocyanine green videoangiography. After the operation, laboratory findings revealed lupus anticoagulant and anti-β2 glycoprotein-I antibody. The patient was given a diagnosis of superior mesenteric artery occlusion with antiphospholipid syndrome (APS), and anticoagulation therapy with aspirin was started. There was no evidence of recurrent thrombosis. In this case, minimization of bowel resection using intraoperative indocyanine green imaging is important. The possibility of APS should be kept in mind for patients with SMA occlusion who have no history of cardiovascular disease or atherosclerosis. Anticoagulation therapy should be continued as a prophylactic therapy for recurrent thrombotic events.View full abstractDownload PDF (1329K) Full view HTML -
Masao Nakajima, Tetsuji Uchiyama, Atsushi Adachi, Hiroyuki Uchisako, S ...Article type: CASE REPORT
2013 Volume 46 Issue 8 Pages 611-617
Published: August 01, 2013
Released on J-STAGE: August 09, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLWe report an uncommon case of a rectovesical fistula due to rectal diverticulitis treated in two-stage operation. The patient was a 62-year-old man who was admitted for abdominal distention and pneumaturia. Abdominal computed tomography showed bowel obstruction and a rectovesical fistula due to a rectal tumor. We performed a colostomy on the basis of the diagnosis of ileus due to a rectal tumor. Postoperative examinations led to a diagnosis of rectovesical fistula due to rectal diverticulitis. Conservative observation (oral administration of levofloxacin hydrate: 500 mg/day+meloxicam: 10 mg/day) was chosen because malignancy was not suspected. During the observational period, the inflammation and pneumaturia resolved. We performed two-stage operation (partial resection of the rectum) 5 months after the first operation. During the operation, we found that the degree of adhesion between the rectum and bladder was not as severe as expected and that the rectovesical fistula had disappeared. The findings for the resected specimen suggested that the rectovesical fistula had been caused by rectal diverticulitis. Because a rectovesical fistula due to rectal diverticulitis is a benign disease, the use of invasive procedures should be kept to a minimum in such cases. The two-stage operation was very effective for the treatment of the rectovesical fistula. Therefore, we present this rare case of rectovesical fistula due to rectal diverticulitis with a review of the literature.View full abstractDownload PDF (1819K) Full view HTML -
Yasushi Sekino, Naohiko Koide, Satoshi Ishizone, Shigeo Tokumaru, Shin ...Article type: CASE REPORT
2013 Volume 46 Issue 8 Pages 618-625
Published: August 01, 2013
Released on J-STAGE: August 09, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLHirschsprung’s disease (HD) is a congenital disease caused by absence of ganglion cells of the neural plexuses in the wall of the intestinal tract, and is characterized as stubborn constipation. Colorectal cancer after a radical operation for HD has been rarely addressed. Here, we report two cases of colorectal cancer after surgery for HD. <Case 1> A 52-year-old woman was admitted because of vaginal bleeding. She had a medical history an operation for HD at the age of 18. Based on the diagnosis of adenocarcinoma of the anastomosis infiltrating into the vagina, posterior pelvic exenteration was performed. The pathological examination showed that the adenocarcinoma developed at the anastomosis site and invaded deeply along the impacted mucosa. She had local recurrence in the pelvis, and has received chemotherapy. <Case 2> A 56-year-old man was admitted because of lumber pain. He had a medical history of an operation for HD at the age of 4. MRI showed a tumor in the presacral space, and the biopsy specimens through colonoscopy histologically revealed mucinous carcinoma. The tumor was unresectable due to extensive contact with the sacrum, and the patient has received chemoradiotherapy. Both patients had a medical history of modified Duhamel’s operation and adenocarcinoma of the anastomosis of the previous operation for HD. These tumors showed extramural progression, which is an atypical growth pattern of colorectal cancer.View full abstractDownload PDF (2545K) Full view HTML -
Shun-ichi Ishigami, Kazuhiko Kitaguchi, Koichi Hanamoto, Katsuaki Ura, ...Article type: CASE REPORT
2013 Volume 46 Issue 8 Pages 626-633
Published: August 01, 2013
Released on J-STAGE: August 09, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLA 56-year-old man was seen at a hospital because of lower abdominal pain in spring 2010. Abdominal CT revealed two hypovascular cystic tumors 6 cm in diameter with hypervascular components in the pelvis, and laparotomy was performed. Hypervascularized multicystic tumors of various sizes were observed in the omentum, with ileal invasion. Omentectomy and partial resection of the ileum were performed. Immunohistochemically, these tumors were diagnosed as benign multicystic peritoneal mesothelioma (BMPM) with adenomatoid tumor (AT) of the omentum. The composite case of BMPM with AT is rare. To the best of our knowledge, only 4 studies, other than our case, have been published to date. Malignant transformation or lymph node metastasis of BMPM has been reported of which half have been complicated by postoperative local recurrence. Our patient was also reoperated for recurrence. With the induction of adjuvant chemotherapy, he has been free of recurrence 24 months after the second surgery.View full abstractDownload PDF (1541K) Full view HTML
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