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Volume 47, Issue 11
Displaying 1-13 of 13 articles from this issue
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ORIGINAL ARTICLE
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Shinichiro Irabu, Jun Yasutomi, Kimihiko Kusashio, Masanari Matsumoto, ...Article type: ORIGINAL ARTICLE
2014 Volume 47 Issue 11 Pages 651-658
Published: November 01, 2014
Released on J-STAGE: November 14, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLPurpose: Although early laparoscopic cholecystectomy is recommended for acute cholecystitis according to the Tokyo Guidelines for the Management of Acute Cholangitis and Acute Cholecystitis, it is not clear whether this procedure is safe in patients receiving antiplatelet therapy. The aim of this study is to evaluate the safety of early cholecystectomy in such patients. Method: A retrospective analysis was performed to evaluate the safety of early laparoscopic cholecystectomy in patients with acute cholecystitis receiving antiplatelet therapy. During the period between April 2010 and May 2013, 130 patients underwent early cholecystectomy for acute cholecystitis in our hospital. Of the 130 patients, 19 patients were receiving antiplatelet therapy (Group A), and 111 patients were not receiving antiplatelet therapy (Group N). Patient background, operative procedure, operation time, intraoperative bleeding, rate of hemoglobin change, postoperative hospitalization, and postoperative complications were evaluated for these two groups. Result: The average age in Group A was significantly higher than that in Group N (72 vs 62; P=0.01). There were no significant differences in operation time, intraoperative bleeding, rate of hemoglobin change, or postoperative complications between the two groups. Conclusion: Early laparoscopic cholecystectomy for acute cholecystitis could be safely performed in patients receiving antiplatelet therapy.View full abstractDownload PDF (1157K) Full view HTML
CASE REPORT
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Jiro Kawakami, Tetsuya Abe, Norihisa Uemura, Ryosuke Kawai, Tomonari A ...Article type: CASE REPORT
2014 Volume 47 Issue 11 Pages 659-667
Published: November 01, 2014
Released on J-STAGE: November 14, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLChylothorax can be a postoperative complication after esophagectomy. Once it occurs, it leads to longer hospital stay and costs. We report a case of selective pleurodesis for refractory postoperative chylothorax. A 69-year-old man was found to have complete response after chemoradiotherapy for thoracic esophageal carcinoma (T3N2M0). Seven months later, salvage esophagectomy with 2-field lymph node dissection through a right thoracotomy was performed for local recurrence. Chylothorax appeared when we started enteral nutrition at 4 hours after surgery. It was unresponsive to conventional therapies, such as fasting, total parental nutrition, and octreotide acetate. Then we detected two leakage points at the right upper mediastinum through lipiodol lymphangiography on POD10. Although conventional pleurodesis was performed, the chylothorax continued. Selective pleurodesis, involving injection of OK-432 10KE and minocycline through the catheter against the leakage sites of right upper mediastinum, underwent on POD 17. The chylothorax immediately decreased without any side effects, and the chest tube was removed on POD 23.View full abstractDownload PDF (1534K) Full view HTML -
Hirohiko Kamiyama, Yurika Makino, Takahiro Hobo, Shigeo Nohara, Yuji S ...Article type: CASE REPORT
2014 Volume 47 Issue 11 Pages 668-674
Published: November 01, 2014
Released on J-STAGE: November 14, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLA 72-year-old woman developed obstructive jaundice, and we diagnosed ampullary carcinoma. She had undergone esophagectomy by right thoracotomy and laparotomy, with cervical, thoracic, and abdominal lymphadenectomy, with reconstruction using gastric tube through posterior intrathoracic route for esophageal cancer at the age of 67. The alignment of the major related vessels was confirmed by 3D-CT-angiography preoperatively. Gastric tube-preserving pylorus-preserving pancreatoduodenectomy (PPPD) was planned for the patient. PPPD-IIA-1 was performed with preservation of right gastroepiploic artery (RGEA), right gastroepiploic vein (RGEV), and right gastric artery (RGA). The post-operative course was good. A gastric tube for reconstruction after esophagectomy may require blood supply mainly by RGEA and RGA. Sacrifice of those vessels might lead to necrosis of the gastric tube. There are 16 domestic case reports, including the present case, of pancreatoduodenectomy (PD) after esophagectomy. RGEA was preserved in all cases except for one. RGEV was preserved in 10 cases. An appropriate procedure of PD after esophagectomy should be chosen in terms of surgical radicality and surgical stress. The authors describe a rare case of gastric tube preserving PD.View full abstractDownload PDF (1434K) Full view HTML -
Atene Ito, Kazuyuki Kawamoto, Kentaro Yasuchika, Taebun Park, Tadashi ...Article type: CASE REPORT
2014 Volume 47 Issue 11 Pages 675-682
Published: November 01, 2014
Released on J-STAGE: November 14, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLA 79-year-old woman was referred to our hospital with carcinoma of the ampulla of Vater．CT showed a hepatic artery branching from the superior mesenteric artery and passing through the pancreatic head. Aplasia of the pancreas was also revealed. Gastrointestinal fiberscopy revealed a tumor spreading from the ampulla of Vater towards the anus. Adenocarcinoma was confirmed by biopsy and total pancreatomy was undertaken. Intraoperatively, the hepatic artery in the pancreatic parenchyma and the spleen were preserved. Histologically, the tumor was a moderately differentiated tubular adenocarcinoma, pT1, N0, M0, fStage I, R0. Aberrant hepatic arteries are often encountered and must be carefully handled in surgery of the pancreas head area, to preserve hepatic blood flow and achieve surgical objectives.View full abstractDownload PDF (1973K) Full view HTML -
Kanji Minamoto, Ichiro Yuasa, Toshio IkedaArticle type: CASE REPORT
2014 Volume 47 Issue 11 Pages 683-689
Published: November 01, 2014
Released on J-STAGE: November 14, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLCongenital agenesis of the left hepatic lobe is a rare anomaly, only 32 of which have been reported in Japan. We present here a case of left hepatic lobe agenesis accompanied with classical hepatocellular carcinoma (HCC). A 65-year-old man was referred to our hospital for further examination after mild dysfunction of liver was deteted in an annual medical checkup. He had neither hepatitis nor cirrhosis, and there were surgical histories of cholecystectomy 28 years previously and choledocholithotomy 10 years previously without hepatic resection. Abdominal CT revealed absence of the left hepatic lobe with caudate hypertrophy and a solitary hypervascular HCC occupying whole of the posterior segment of the right lobe. Transcatheteral arterial chemo-lipiodolization followed by posterior segmentectomy one month later were carried out successfully. This is apparently the first case of HCC with congenital agenesis of the left hepatic lobe undergoing curative resection.View full abstractDownload PDF (1771K) Full view HTML -
Michinobu Umakoshi, Masaya Satake, Yoshio Kobayashi, Yoshiaki Shindo, ...Article type: CASE REPORT
2014 Volume 47 Issue 11 Pages 690-696
Published: November 01, 2014
Released on J-STAGE: November 14, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLA 62-year-old woman showed an abnormal shadow in upper left lung field in chest X-ray. Her sialyl LewisX (SLX) was 150 U/ml and lung cancer was suspected. Bronchoscopic biopsy was performed and the diagnosis of moderate to well-differentiated adenocarcinoma was obtained. Abdominal CT examination also showed a cystic lesion with a nodule approximately 7 cm in diameter in the lateral segment of the liver. We proceeded treatment of the lung cancer first, and the left upper lobectomy was performed. Curative resection was performed. However, after surgery, SLX elevated to more than 2,000 U/ml. FDG-PET CT examination was ordered, though only physiological accumulation was seen. With the diagnosis of cystic liver tumor, left lateral segmentectomy was performed 3 months after pulmonary resection. The resected specimen showed multilocular cystic lesions with nodules in part, and cystic fluid was mucinous. The SLX of cyst fluid was more than 2,000 U/ml. Histopathologically, the resected cystic lesions were diagnosed as intraductal papillary neoplasm of the bile duct (IPNB). SLX showed decreased 40 U/ml in about one month after the surgery. We report this rare case of IPNB which showed high serum SLX level.View full abstractDownload PDF (2177K) Full view HTML -
Hiroki Aoyama, Yasuhiro Kurumiya, Ei Sekoguchi, Satoshi Kobayashi, Yas ...Article type: CASE REPORT
2014 Volume 47 Issue 11 Pages 697-703
Published: November 01, 2014
Released on J-STAGE: November 14, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLA 63-year-old woman was found to have a 20 mm cystic lesion at the pancreatic head, 22 years previously. The lesion gradually increased from 30 mm two years previously to 37 mm in one year, with no evidence of malignancy, including an internal nodule, and we followed it up as a benign lesion. She had no past history of pancreatic injury or alcohol intake. She was admitted due to darkening of urine and an itching sensation. Blood analysis showed a slightly elevated total bilirubin level and liver function abnormality. Abdominal CT scan and MRI showed a 50-mm cystic lesion at the pancreatic head and dilatation of the intrahepatic bile duct, but no mass lesion was recognized in the cyst. ERCP showed compressive stenosis of the middle and lower bile duct and main pancreatic duct with dilatation of the intrahepatic bile duct and distal pancreatic duct. The cyst had no connection to the main pancreatic duct. We diagnosed obstructive jaundice induced by the cyst and performed subtotal stomach preserving pancreatoduodenectomy. Serous fluid was seen in the cyst. Histologically, the cyst was lined by a cuboidal epithelium and was finally diagnosed as a true cyst of the pancreas.View full abstractDownload PDF (1749K) Full view HTML -
Junichiro Kamiya, Kensuke Sugiura, Akihiko Tonouchi, Yoshihisa Fujita, ...Article type: CASE REPORT
2014 Volume 47 Issue 11 Pages 704-710
Published: November 01, 2014
Released on J-STAGE: November 14, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLThe prognosis of metastatic or locally advanced pancreatic cancer is extremely poor. Results of neoadjuvant chemotherapy approaches for achieving improved resectability are currently unsatisfactory. We report a rare case of initially unresectable pancreas cancer treated by adjuvant surgery after chemotherapy for three years and nine months from initial treatment. A 73-year-old woman was admitted to our hospital for pancreatic tumor. Abdominal CT scan revealed a 2.5-cm mass in the pancreas head, which involved the common hepatic artery and celiac axis. Ultrasound-guided fine needle aspiration cytology was performed. Pathology revealed a well-differentiated pancreatic adenocarcinoma. We started chemotherapy using gemcitabine plus S-1, treating it as an unresectable locally advanced pancreatic cancer. After chemotherapy, follow-up images demonstrated loss of tumor clarity, allowing for R0 tumor resection. The patient underwent pancreaticoduodenectomy, with a negative margin status, 3 years and 9 months from initial treatment. Histologically, few atypical cells were detected in the resected specimens, and most of the tumor showed a fibrous change. She has been well without recurrence for 1 year and 4 months, and survives for more than 5 years from the initial treatment. Surgical intervention should be considered for unresectable locally advanced pancreatic cancer after a long-term favorable response to chemotherapy.View full abstractDownload PDF (1371K) Full view HTML -
Katsushi Takebayashi, Hiromichi Sonoda, Soichiro Tani, Hiroyuki Ohta, ...Article type: CASE REPORT
2014 Volume 47 Issue 11 Pages 711-718
Published: November 01, 2014
Released on J-STAGE: November 14, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLA 29-year-old man was admitted for abdominal pain and vomiting. Abdominal CT and MRI revealed a discrete mass, involving the right ureter, causing right hydronephrosis. Laparotomy was performed under a preoperative diagnosis of malignant retroperitoneal tumor. Operative findings showed that the tumor invaded the right ureter and the iliocecum. Therefore we performed combined resection of the tumor and right ureter and iliocecum, followed by intestinal and urinary reconstruction. The histopathological diagnosis was low-grade fibromyxoid sarcoma originated in the retroperitoneum. Microscopically, characteristic alternating fibrous and myxoid areas with a whorled pattern were detected. The tumor was well-circumscribed, and was characterized by poor cellularity, composed of uniform spindle cells. Immunohistochemically, the tumor cells were focally positive for vimentin. Twenty-four months later, he is healthy without recurrence. The majority of low-grade fibromyxoid sarcomas arise in the limbs. We report a rare case of low-grade fibromyxoid sarcoma that arose from the retroperitoneum.View full abstractDownload PDF (2473K) Full view HTML -
Hironori Kobayashi, Katsunari Miyamoto, Shiro Nakai, Mikio Fujimoto, Y ...Article type: CASE REPORT
2014 Volume 47 Issue 11 Pages 719-725
Published: November 01, 2014
Released on J-STAGE: November 14, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLA 37-year-old man was admitted to the hospital with complaints of abdominal pain and vomiting. Abdominal CT revealed an intestinal obstruction. Ileus was cured by conservative medical treatment. He had no history of abdominal operation. We performed single-incision laparoscopic surgery through an umbilical incision for diagnostic purposes. At surgery, we found a band extending from the ileum, 40 cm proximal to the end of the Bauhin’s valve, and adhering to the right medial umbilical fold. Pathologically, it was found to contain an artery and vein, and was diagnosed as vitelline vascular remnants. In Japan, the number of reported cases of vitelline vascular remnants without Meckel’s diverticulum is extremely low. To the best of our knowledge, this is the only case of vitelline vascular remnants without Meckel’s diverticulum treated by single-incision laparoscopic-assisted surgery in Japan.View full abstractDownload PDF (1273K) Full view HTML -
Hiroo Konishi, Hiroko Okamura, Kanzi Kawai, Yukihiko SagaraArticle type: CASE REPORT
2014 Volume 47 Issue 11 Pages 726-733
Published: November 01, 2014
Released on J-STAGE: November 14, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLThe patient was a 74-year-old woman who developed thoracolumbar vertebral metastases after surgery for bilateral breast cancer and underwent palliative therapy by oral administration of oxycodone. She urgently came to our hospital due to increased back pain and malaise. Abdominal CT showed the presence of free air in the abdominal cavity and an emphysematous lesion. Peritoneal irritation signs were not apparently detected by the initial physical examination. However, the lack of symptoms was thought to be caused by oxycodone. As the possibility of gastrointestinal perforation could not be denied, exploratory laparotomy was performed. Surgery revealed an emphysematous lesion about 10 cm in length at the ileum site of the mesentery but no perforation. Assuming the possibility of metastasis of breast cancer to the small intestine, partial ileal resection was performed. Postoperative histopathology indicated pneumatosis cystoides intestinalis. Recently, pneumatosis cystoides intestinalis has been increasingly reported and there is a certain level of consensus on the diagnosis and treatment. Herein, we report the present case, demonstrating the difficulty in the diagnosis and treatment of pneumatosis cystoides intestinalis associated with free air in the abdomen during palliative therapy, with a review of the literature.View full abstractDownload PDF (1479K) Full view HTML -
Akiko Matsumoto, Tsunenori Fujita, Takahiro Ozaki, Izuru Ohtubo, Tohru ...Article type: CASE REPORT
2014 Volume 47 Issue 11 Pages 734-739
Published: November 01, 2014
Released on J-STAGE: November 14, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLA 64-year-old woman with rectal cancer underwent laparoscopic low anterior resection. Postoperative diagnosis was fStage IV (moderately differentiated adenocarcinoma (tub2), pT2 (MP), pN2 (6/15), cH1, cP0, cM0, EGFR (+), K-RAS mutation). Chemotherapy with XELOX+Bevacizumab (Bev) was started on post operative days 32, but capecitabin intake was stopped on the 11th day due to grade 2 diarrhea and vomiting from the 9th day of initiating chemotherapy. She then suffered grade 4 leukocytopenia, grade 4 thrombocytopenia, grade 2 fever, grade 3 diarrhea and vomiting. Hematotoxicity was improved by the administration of G-CSF and platelet transfusion in addition to antibiotics and antimycotics, while diarrhea and vomiting continued and the drug-induced enteritis with cytomegalovirus enteritis was diagnosed. After the general state improvement, partial hepatectomy was performed and chemotherapy with CPT-11+Bev was conducted, but she died with progression of disease fifteen months after the first operation. The dihydropyrimidine dehydrogenase (DPD) activity in pheral mononuclear blood cells showed remarkably low, so this case was diagnosed as DPD deficiency. DPD deficiency is very rare, and no diagnosis nor screening system has been established for its detection. In DPD deficiency, 5-fluorouracil can lead to severe and sometimes life-threatening adverse events, therefore prompt and adequate treatment must be considered for this condition.View full abstractDownload PDF (1128K) Full view HTML
SPECIAL CONTRIBUTION
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Takako Kojima, J. Patrick BarronArticle type: SPECIAL CONTRIBUTION
2014 Volume 47 Issue 11 Pages 740-741
Published: November 01, 2014
Released on J-STAGE: November 14, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLDownload PDF (547K) Full view HTML
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