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Volume 48, Issue 11
Displaying 1-12 of 12 articles from this issue
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ORIGINAL ARTICLE
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Hirosuke Kuroki, Akira Sugita, Kazutaka Koganei, Kenji Tatsumi, Ryo Fu ...Article type: ORIGINAL ARTICLE
2015 Volume 48 Issue 11 Pages 883-889
Published: November 01, 2015
Released on J-STAGE: November 25, 2015
JOURNAL FREE ACCESS FULL-TEXT HTMLPurpose: Considerations in the first-stage surgery were evaluated based on problems encountered anticipated during residual proctectomy in the second stage of ulcerative colitis. Patients and methods: Twenty-three patients who underwent total/subtotal colectomy and Hartmann’s operation in a two-stage procedure were classified into high- and low-level groups with a rectal stump above and below the peritoneal reflection, respectively. Results: In the second stage, all 17 patients in the high-level group underwent ileal pouch-anal canal anastomosis, while 4, 1, and 1 in the low-level group (n=6) underwent ileal pouch-anal canal anastomosis, ileal pouch-anal anastomosis, and ileal pouch-rectal anastomosis, respectively. The median operative time and blood loss were 212 min and 370 ml and 344 min and 983 ml in the high- and low-level groups, respectively, indicating that blood loss was significantly greater (P=0.04) and the operative time tended to be longer (P=0.26) in the low-level group. The mean number of stools per day 1 year after the second-stage operation was 6.4 and 7.5 in the high- and low-level groups, respectively. Conclusion: Rectal transection below the peritoneal reflection in Hartmann’s operation results in firm adhesions of the rectal stump to the surrounding tissue, such as the seminal vesicle, leading to excessive bleeding due to difficult adhesiolysis, thus prolonging the operative time. These results suggest that the rectum should be transected above the peritoneal reflection when performing Hartmann’s operation as the first stage.View full abstractDownload PDF (1293K) Full view HTML -
Keita Hanada, Hiroaki Hata, Shiori Kikuchi, Hiroki Nakanishi, Masashi ...Article type: ORIGINAL ARTICLE
2015 Volume 48 Issue 11 Pages 890-896
Published: November 01, 2015
Released on J-STAGE: November 25, 2015
JOURNAL FREE ACCESS FULL-TEXT HTMLPurpose: Recently, reports concerning internal hernia after laparoscopic gastrectomy with Roux-en-Y reconstruction are increasing. The aim of this study was to investigate the incidences and factors inducing internal hernia after gastrectomy with Roux-en-Y reconstruction. Method: Between January 2006 and June 2013, 460 patients with gastric cancer underwent gastrectomy with Roux-en-Y reconstruction in our department. We examined incidences of internal hernia and evaluated patient and surgical factors which could influence the occurrence of internal hernia after open and laparoscopic gastrectomy with Roux-en-Y reconstruction based on medical records, retrospectively. Results: Internal hernia occurred in 10 cases (2.2%). The incidence of internal hernia was 0.9% (1/110) after laparoscopic gastrectomy, and 2.6% (9/350) after open gastrectomy. There were no significant patient factors influencing internal hernia onset. Regarding surgical factors, gastrectomy procedures, approach methods, or the root of reconstruction did not affect the incidence of internal hernia. Only mesenteric defect closure had a significant effect on the onset of internal hernia (P=0.041). Conclusion: Internal hernia after gastrectomy with Roux-en-Y reconstruction can be recognized at relatively high frequency. We believe mesenteric defect closure can be useful for the prevention of internal hernia.View full abstractDownload PDF (1255K) Full view HTML
CASE REPORT
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Junichi Yoshizawa, Hitoshi Masuo, Kaori Takasu, Fumitoshi Karasawa, Ko ...Article type: CASE REPORT
2015 Volume 48 Issue 11 Pages 897-903
Published: November 01, 2015
Released on J-STAGE: November 25, 2015
JOURNAL FREE ACCESS FULL-TEXT HTMLA 63-year-old man visited our hospital because of abdominal pain and temporary loss of consciousness. On physical examination, he was in a state of shock, and presented with abdominal pain with tenderness in the upper abdomen. Laboratory data showed anemia and thrombocytopenia. Abdominal enhanced CT showed high-density ascites and a dilated and saccular accumulated contrast medium about 75×45×36 mm in size joined to the right gastroepiploic artery. We diagnosed a ruptured aneurysm of the right gastroepiploic artery, intraabdominal hemorrhage and hemorrhagic shock, and therefore performed an emergency operation. During the operation, we found a massive intraabdominal hemorrhage and a ruptured aneurysm at the right gastroepiploic artery. We resected the aneurysm with the omentum. A ruptured gastroepiploic aneurysm due to shock is rare and prompt diagnosis and treatment is essential.View full abstractDownload PDF (1436K) Full view HTML -
Takehiko Hanaki, Yousuke Arai, Hiroaki Saito, Joji Watanabe, Naruo Tok ...Article type: CASE REPORT
2015 Volume 48 Issue 11 Pages 904-911
Published: November 01, 2015
Released on J-STAGE: November 25, 2015
JOURNAL FREE ACCESS FULL-TEXT HTMLWe report a case of pneumopericardium caused by gastric ulcer perforation. The patient was an 89-year-old man who was admitted to our hospital due to loss of consciousness and shock. Emergency CT revealed cardiac tamponade and pneumopericardium caused by gastric ulcer perforation into the pericardium cavity, and CT-guided insertion of a pigtail catheter for the pericardial cavity was performed. With drainage of the cavity and intermittent suction of the nasogastric tube, his vitals soon stabilized and his general condition gradually improved; however, he suddenly died on the 14th hospital day. Acute heart failure due to arrhythmia or pericarditis was considered to be the possible cause. Pneumopericardium is very rare and that caused by gastrointestinal perforation is a severe condition, which may follow a fatal clinical course. However, it is difficult to decide when to perform the surgery for the fistula and a more thorough discussion is required to understand the necessity for surgical intervention in the fistula. Here, we review and discuss 17 cases of pneumopericardium caused by gastrointestinal perforation reported in Japan.View full abstractDownload PDF (1390K) Full view HTML -
Yusuke Sato, Yoshihisa Kawase, Takuji Takahashi, Osamu Okochi, Kenji T ...Article type: CASE REPORT
2015 Volume 48 Issue 11 Pages 912-920
Published: November 01, 2015
Released on J-STAGE: November 25, 2015
JOURNAL FREE ACCESS FULL-TEXT HTMLWe report a case of distal gastrectomy with reconstruction of artery graft for gastric cancer after coronary artery bypass grafting (CABG) using the right gastroepiploic artery (RGEA). A 64-year-old man with history of CABG using RGEA at the age of 55 was diagnosed with advanced gastric cancer in the antrum with No. 6 lymph node metastases. Coronary arteriography showed a complete occlusion of the right coronary artery #2 and the RGEA graft remained distinctly patent. Therefore, we considered that artery graft reconstruction was indicated for RGEA resection to dissect No. 6 lymph nodes completely and performed artery reconstruction concomitantly with gastrectomy. First, catheters were inserted into the femoral artery and the RGEA graft for perfusion from the femoral artery. We performed distal gastrectomy with D2 lymph node dissection and the RGEA graft was anastomosed to the common hepatic artery-saphenous vein graft. This procedure may be one of the options for gastric cancer with No. 6 lymph nodes metastases in patients who have undergone CABG using the RGEA.View full abstractDownload PDF (1749K) Full view HTML -
Yui Ishiguro, Tsuyoshi Shimamura, Shigenori Homma, Hideki Kawamura, No ...Article type: CASE REPORT
2015 Volume 48 Issue 11 Pages 921-928
Published: November 01, 2015
Released on J-STAGE: November 25, 2015
JOURNAL FREE ACCESS FULL-TEXT HTMLA 57-year-old woman underwent a living-donor liver transplantation (LT) for cirrhosis from autoimmune hepatitis. She had been receiving immunosuppressive therapy with tacrolimus and mycophenolate mofetil. Eight years later, gastroscopy revealed a 5-cm submucosal tumor at the posterior wall of the gastric angle. The tumor was characterized by the features of a gastrointestinal stromal tumor (GIST) and partial gastrectomy was performed. The immunohistochemical findings of the resected specimen demonstrated positivity for c-kit and CD34, and negativity for S-100 and SMA, which is consistent with GIST. According to the Fletcher classification, the tumor was categorized as low-grade malignant potential: 4.2 cm in size with low mitotic activity (<5/50 HPF). The patient is surviving without recurrence 42 months after gastrectomy despite receiving no adjuvant therapy and use of the same immunosuppressants as before. Due to recent advances in perioperative management in LT, the number of long-term survivors is increasing. Because the occurrence frequency of de novo neoplasms in transplanted patients is higher than in the general population, they should be followed carefully, considering the possibility of various de novo malignancies.View full abstractDownload PDF (2002K) Full view HTML -
Takayuki Yamamoto, Shunji Narumi, Manabu Okada, Makoto Tsujita, Takahi ...Article type: CASE REPORT
2015 Volume 48 Issue 11 Pages 929-935
Published: November 01, 2015
Released on J-STAGE: November 25, 2015
JOURNAL FREE ACCESS FULL-TEXT HTMLWe report a case of delayed graft duodenal perforation 5 months after simultaneous cadaveric pancreas-kidney transplantation (SPK). A 45-year-old woman with insulin-dependent diabetes during over 20 years underwent SPK in August 2013. She was discharged on postoperative day 27 with normal pancreas and kidney function. Five months later, she was admitted to our hospital because of severe lower abdominal pain due to acute peritonitis and septic shock in January 2014. On emergency operation, perforation of the anastomosed site between graft duodenum and ileum was detected. Perforation was closed with primary suture and omentopexy. Intestinal fistula tube was placed for decompression of the graft duodenum. She was discharged on postoperative day 27 with normal pancreas and kidney function. At 11 months after this surgery, her pancreas and kidney function were stable (HbA1c: 5.4%, Serum creatinine: 0.74 mg/dl). Delayed graft duodenal perforation after SPK is rare.View full abstractDownload PDF (1610K) Full view HTML -
Masahide Awazu, Tomoyuki Wakahara, Shinobu Tsuchida, Sachiyo Shirakawa ...Article type: CASE REPORT
2015 Volume 48 Issue 11 Pages 936-943
Published: November 01, 2015
Released on J-STAGE: November 25, 2015
JOURNAL FREE ACCESS FULL-TEXT HTMLWe treated a 49-year-old man who had undergone choledochectomy and hepaticojejunostomy for congenital bile duct dilatation at the age of 20 years and had been suffering from repeated cholangitis due to hepatolithiasis since he was aged 37 years. Preoperative diagnostic imaging showed multiple bilobar hepatolithiasis, with the largest stone being 35 mm in diameter, and atrophy of the left lobe of the liver. The patient underwent left hepatectomy and jejunostomy to allow endoscopic lithotomy of residual stones in the right lobe, which succeeded in clearing all the intrahepatic bile ducts. Cholangitis caused by hepatolithiasis recurred 19 months after treatment. However, the jejunostomy enabled endoscopic lithotomy to be performed again promptly. This surgical procedure is a useful strategy for recurrence of multiple hepatolithiasis after choledochojejunostomy, which has been reported to be frequent, as it allows repeated and minimally invasive performance of endoscopic lithotomy.View full abstractDownload PDF (2326K) Full view HTML -
Yuta Minami, Makoto Kawamoto, Koki Goto, Yuki Honma, Ryo Takagawa, Jun ...Article type: CASE REPORT
2015 Volume 48 Issue 11 Pages 944-951
Published: November 01, 2015
Released on J-STAGE: November 25, 2015
JOURNAL FREE ACCESS FULL-TEXT HTMLMetastasis in the spermatic cord from pancreatic cancer is very rare. A 73-year-old man had undergone due to gastric ulcer 50 years previously. In January 2012, he had distal pancreatectomy, total gastrectomy, partial colectomy and cholecystectomy for stage IVa pancreatic tail cancer. He also received adjuvant chemotherapy of gemcitabine. Eight months later, CT showed a left inguinal mass and FDG-PET suggested spermatic cord metastasis. No other distant metastasis was detected. In October 2012, left inguinal orchiectomy was performed under a diagnosis of spermatic cord metastasis of pancreatic tail cancer. Histological examination of the resected tumor revealed a poorly-differentiated adenocarcinoma compatible with a metastasis from the pancreatic cancer. The patient’s postoperative course was uneventful, and he did not wish to receive adjuvant chemotherapy. During postoperative follow-up, he has shown a possible recurrent disease of peritoneal dissemination. He survived for 21 months after orchiectomy.View full abstractDownload PDF (2522K) Full view HTML
CLINICAL EXPERIENCE
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Takeaki Aoki, Yoshikazu Morimoto, Hitoshi Mizuno, Yuusuke Akamaru, Kei ...Article type: CLINICAL EXPERIENCE
2015 Volume 48 Issue 11 Pages 952-960
Published: November 01, 2015
Released on J-STAGE: November 25, 2015
JOURNAL FREE ACCESS FULL-TEXT HTMLTwelve patients with aberrant right hepatic artery (ARHA) underwent pancreaticoduodenectomy for periampullary cancers. The diseases included 8 cases of pancreatic cancer, 3 cases of bile duct cancer, and 1 case of papillary cancer. We classified ARHA into the following 4 types: Type A, ARHA arising from the superior mesenteric artery (SMA); Type B, common hepatic artery arising from SMA; Type C, each right and left hepatic artery arising from celiac artery separately; Type D, ARHA arising from the gastroduodenal artery (GDA). The number of patients was 6, 1, 3 and 2, respectively. ARHA was preserved in 10 patients. However, 2 patients needed ARHA resection for curative operation. Of these 2 patients, 1 underwent arterial reconstruction and was uneventful after operation, but the other without reconstruction suffered from recurrent cholangitis. According to histopathological examinations, an R0 operation was carried out in 7 patients and a non-R0 in 5 patients. The reasons for non-R0 were dissected peripancreatic tissue margin positive (4 cases) and liver metastasis (1 case), and all non-R0 patients died of the primary disease. The preoperative imaging studies should be precisely carried out to undergo pancreaticoduodenectomy for patients with ARHA, and the detailed evaluation for ARHA types is also necessary to perform R0 operations.View full abstractDownload PDF (1568K) Full view HTML
SPECIAL CONTRIBUTION
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Takako Kojima, J. Patrick BarronArticle type: SPECIAL CONTRIBUTION
2015 Volume 48 Issue 11 Pages 961-962
Published: November 01, 2015
Released on J-STAGE: November 25, 2015
JOURNAL FREE ACCESS FULL-TEXT HTMLDownload PDF (602K) Full view HTML
EDITOR'S NOTE
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Takehito OtsuboArticle type: EDITOR'S NOTE
2015 Volume 48 Issue 11 Pages en11-
Published: November 01, 2015
Released on J-STAGE: November 25, 2015
JOURNAL FREE ACCESS FULL-TEXT HTMLDownload PDF (660K) Full view HTML
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