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Volume 48, Issue 9
Displaying 1-12 of 12 articles from this issue
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ORIGINAL ARTICLE
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Daisuke Yamana, Hiroyuki Kasajima, Shigeru Tohyama, Takuji Kagiya, Yus ...Article type: ORIGINAL ARTICLE
2015 Volume 48 Issue 9 Pages 729-738
Published: September 01, 2015
Released on J-STAGE: September 15, 2015
JOURNAL FREE ACCESS FULL-TEXT HTMLPurpose: Emergency surgery for obstructive colorectal cancer is known to have an increased risk of perioperative complications. Conservative therapy primarily involves decompression through the placement of a transnasal or a transanal ileus tube. However, the self-expandable metallic stent (SEMS) became available with insurance coverage in Japan in January 2012. Here, we evaluated the usefulness of SEMS in cases of colon cancer ileus treated at our institution. Methods: Of 1,065 patients who underwent colon cancer surgery in our department from January 2005 to November 2013, 286 had obstructions. SEMS was used in patients with lesions from the transverse colon to the anal side. Patients who did not need decompression and those with lesions from the transverse colon to the oral side were excluded. Of the patients with obstructive colorectal cancer, 32 received SEMS, 27 received a transanal ileus tube, and 39 underwent emergency surgery, and 501 had elective surgery. We examined the patients’ background factors and perioperative courses. Results: The SEMS group had a significantly lower stoma creation rate than the transanal ileus tube and emergency surgery groups. The SEMS group also had significantly higher primary anastomosis, and laparoscopic surgery rates than the other groups. A meta-analysis suggested that the use of SEMS significantly contributed to a lower stoma creation rate. Conclusion: The SEMS can help prevent the need to create a stoma, enables the use of radical and less invasive surgeries, and is useful in cases of colon cancer ileus.View full abstractDownload PDF (1316K) Full view HTML
CASE REPORT
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Hiromi Mukaide, Taku Michiura, Rintaro Yui, Takashi Ozaki, Junichi Fuk ...Article type: CASE REPORT
2015 Volume 48 Issue 9 Pages 739-746
Published: September 01, 2015
Released on J-STAGE: September 15, 2015
JOURNAL FREE ACCESS FULL-TEXT HTMLThe patient was a 60-year-old man who presented with dysphagia and body weight loss and in whom esophageal cancer was diagnosed by endoscopy. Biopsy showed moderately differentiated squamous cell carcinoma. Despite no evidence of infection, laboratory data showed leukocytosis (43,400/μl) and high serum levels of granulocyte-colony stimulating factor (G-CSF) (66 pg/ml). Immunohistochemical study showed positive staining for G-CSF in the tumor cells. The patient had an operation, but the tumor rapidly enlarged and invaded the aortic artery, so we decided against esophagectomy. Chemoradiation therapy (CRT) with 5-fluorouracil and cisplatin was performed and the evaluated response to treatment was a complete response. Furthermore, in this case, adjuvant chemotherapy was added. Recurrence has not been detected for seven-years and four months.View full abstractDownload PDF (1694K) Full view HTML -
Masaki Yamamoto, Tsunehiko Maruyama, Akihiro Sako, Shintaro Sugita, Ka ...Article type: CASE REPORT
2015 Volume 48 Issue 9 Pages 747-753
Published: September 01, 2015
Released on J-STAGE: September 15, 2015
JOURNAL FREE ACCESS FULL-TEXT HTMLGastrointestinal stromal tumors (GIST) rarely affect pediatric and adolescent patients. Herein, we report the case of a 27-year-old woman who was referred to our hospital for a detailed examination of an intra-abdominal tumor and ascites. Upper gastrointestinal endoscopy and contrast-enhanced abdominal CT revealed a ruptured large submucosal tumor in the antrum of the stomach. Thus, distal gastrectomy was performed via a laparotomy. A pathological examination showed a wild-type GIST that did not exhibit any KIT or platelet-derived growth factor receptor gene mutations. After the operation, imatinib was administered (400 mg/day) as adjuvant molecular targeted therapy. However, multiple hepatic metastases were detected at one year postoperatively. Surgical treatment was not indicated because the metastatic tumors were distributed throughout her liver, and complete tumor resection was impossible. So, she was given sunitinib (50 mg/day) according to a 4 weeks on/2 weeks off schedule. At 22 postoperative months, the hepatic tumors had markedly decreased in size. This was an extremely rare case in which a GIST that arose in a young adult was effectively treated with sunitinib.View full abstractDownload PDF (1458K) Full view HTML -
Kouhei Uno, Toshio Iino, Toshirou Kubo, Katsuhiko YanagaArticle type: CASE REPORT
2015 Volume 48 Issue 9 Pages 754-760
Published: September 01, 2015
Released on J-STAGE: September 15, 2015
JOURNAL FREE ACCESS FULL-TEXT HTMLWe present a rare case of Bouveret’s syndrome. A 78-year-old woman was admitted to our hospital because of vomiting. Abdominal CT demonstrated intrahepatic pneumobilia and a 45-mm gallstone impacted in the duodenum. We diagnosed Bouveret’s syndrome due to calculus displacement from the gallbladder or common bile duct to the duodenal bulb through a fistula. Since the patient’s general condition was poor, we performed a palliative gastrojejunostomy. On postoperative day 84, she was readmitted to the hospital because of recurrence of vomiting. Abdominal CT demonstrated that the gallstone had become displaced and impacted into the jejunum. Therefore, a second operation was performed to extract the gallstone from the jejunum. She was then discharged without any complications. Most patients with Bouveret’s syndrome are elderly with multiple comorbidities. Therefore, selection of treatment methods should be based on the general condition of the patient.View full abstractDownload PDF (1421K) Full view HTML -
Shinji Okazaki, Keisuke Onishi, Hiroyuki Kumata, Yuji Konno, Makoto Ho ...Article type: CASE REPORT
2015 Volume 48 Issue 9 Pages 761-768
Published: September 01, 2015
Released on J-STAGE: September 15, 2015
JOURNAL FREE ACCESS FULL-TEXT HTMLA 70-year-old woman who complained of nausea and vomiting lasting for two weeks was admitted to our hospital due to small bowel obstruction. Abdominal CT visualized calcification in the small bowel and gas in the gallbladder. The findings were also suggestive of adhesion in the gallbladder and duodenum. Therefore, gallstone ileus with a cholecystoduodenal fistula was diagnosed. Since the bowel obstruction did not resolve with conservative therapy, a two-stage laparoscopic surgery was performed. Initially, a single-incision laparoscopic surgery was carried out, and laparoscopy showed the site of small bowel obstruction and severe adhesion around the gallbladder. Therefore, enterolithotomy was performed using only the port incision site. On postoperative day 33, laparoscopic surgery consisting of cholecystectomy and closure of the cholecystoduodenal fistula was performed and the fistula on the duodenal side was treated with omental patch repair. Laparoscopic surgery has recently been recognized to be feasible for the treatment of gallstone ileus. Here, we describe the use of two-stage laparoscopic surgery for gallstone ileus with a cholecystoduodenal fistula, with a review of the literature.View full abstractDownload PDF (1585K) Full view HTML -
Yukihiro Watanabe, Kojun Okamoto, Yohei Morita, Shingo Ishida, Katsuya ...Article type: CASE REPORT
2015 Volume 48 Issue 9 Pages 769-775
Published: September 01, 2015
Released on J-STAGE: September 15, 2015
JOURNAL FREE ACCESS FULL-TEXT HTMLThe patient was a 76-year-old man who was found to have a 2-cm sized cyst at the pancreas head which was diagnosed as an intraductal papillary mucinous neoplasm (IPMN) of mixed type in 2007. Thereafter he had been followed in the clinic, and the IPMN had not shown any apparent change for five years. In 2012, although an abdominal CT/MRI did not show apparent enlargement of the cyst and increase of the main pancreatic duct diameter, upper gastrointestinal endoscopy revealed the significantly opened orifice of the papilla of Vater. ERCP revealed a fistula from a multilocular cyst at the pancreas head to the duodenum, and a filling defect in the cyst. Intraductal US showed a solid nodule in the cyst. We performed pancreaticoduodenectomy under a diagnosis of mixed-type IPMN penetrating to the duodenum, suggesting that it was malignant change. The lesion was pathologically diagnosed as the non-invasive type of intraductal papillary mucinous carcinoma, based on the highest degree of epithelial atypia. However, the epithelium around the fistula was low-grade adenoma without a malignant component. This paper presents a case of malignant progression of mixed type IPMN which formed a duodenum fistula with little change of the main duct and cyst during long-term observation.View full abstractDownload PDF (2041K) Full view HTML -
Haruka Motonari, Shinichiro Kameyama, Tetsuhiro Hara, Haruki Taniguchi ...Article type: CASE REPORT
2015 Volume 48 Issue 9 Pages 776-781
Published: September 01, 2015
Released on J-STAGE: September 15, 2015
JOURNAL FREE ACCESS FULL-TEXT HTMLWe report a rare case of ileal duplication with diverticulitis. A 46-year-old woman presented with right lower abdominal pain, and was referred to our hospital because of suspected colonic diverticulitis. Abdominal CT scan showed a bowel wall thickening suggestive of diverticulitis and an increase in the concentration of fat tissue surrounding the intestine. Continuity between the lesion and the surrounding intestinal tract could not be confirmed. Furthermore, the blood supply to the lesion was from the superior mesenteric artery branches, which led to the suspicion of ileal duplication. We performed a single-incision laparoscopic partial ileal resection. The duplicated tract was 12×5 cm with wall thickening, and was located 45 cm from the terminal ileum on the mesenteric side. Histopathological examination revealed that the duplicated tract showed the ileal mucosa and muscle layer to be without atypia, and a diverticulum with partial acute inflammation, confirming the diagnosis of diverticulitis of the duplicated ileum. To the best of our knowledge, there have been no reports of ileal duplication with diverticulitis so far, and we believe this is a rare case.View full abstractDownload PDF (1385K) Full view HTML -
Toshikazu Shioiri, Masami Fujishiro, Itaru Ishibashi, Takashi Kodama, ...Article type: CASE REPORT
2015 Volume 48 Issue 9 Pages 782-788
Published: September 01, 2015
Released on J-STAGE: September 15, 2015
JOURNAL FREE ACCESS FULL-TEXT HTMLWe report a case of adult intussusception caused by cecal abscess that was treated by single-port laparoscopic ileocecal resection following reduction by preoperative water-soluble contrast enema. A 41-year-old woman was admitted to our hospital due to abdominal pain. An abdominal CT scan with intervenous contrast medium revealed an ileocolic intussusception. We reduced it with a water-soluble contrast enema study. A colonoscopy showed a mass lesion mimicking the submucosal tumor in the cecum. We performed a single-port laparoscopic ileocecal resection. Histological examination revealed a submucosal abscess about 30 mm in diameter in the cecum. Intussusception in adults is rare compared with in children, and an emergency operation is performed in many cases. Here, we report a rare case of adult intussusception caused by cecal abscess, which could be effectively treated by preoperative reduction followed by single-port laparoscopic surgery.View full abstractDownload PDF (2261K) Full view HTML -
Eriko Manabe, Seiichi Shinji, Michihiro Koizumi, Hayato Kan, Takeshi Y ...Article type: CASE REPORT
2015 Volume 48 Issue 9 Pages 789-797
Published: September 01, 2015
Released on J-STAGE: September 15, 2015
JOURNAL FREE ACCESS FULL-TEXT HTMLA 67-year-old man was seen for lower abdominal pain and hospitalized. Pressure pain and a palpable mass were present in the lower left abdomen, and hematology tests showed severe inflammatory signs, with a leukocyte count of 20,600 cells/μl, and C-reactive protein at 14 mg/dl. Abdominal CT showed multiple sigmoid colon diverticula, wall thickening, and increased concentration of adipose tissue in the surrounding area, so a diagnosis of diverticulitis was made, and the patient was admitted to the hospital as an emergency case. Endoscopic examination of the large intestine showed partial circumferential stenosis and edematous changes and reddening on the mucosal surface in the sigmoid colon, and the endoscope could not pass through this region. Biopsy showed no signs of malignancy. Conservative treatment was carried out, but abdominal pain and inflammatory signs recurred, so sigmoidectomy was performed. Histological tests showed type-4 sigmoid colon carcinoma (tub1, SS, and N2). In particular, well-differentiated adenocarcinoma extended and caused colonic stenosis with marked inflammatory cell infiltration and fibrosis without cancer lymphopathy, so it was thought to be the inflammatory type. A further colectomy was carried out to perform lymph node dissection, and 12 courses of mFOLFOX6 were administered as postoperative adjuvant chemotherapy, followed by monitoring with no signs of recurrence for 18 months. Recurrent diverticulitis should be considered in the differential diagnosis of type-4 colorectal carcinoma.View full abstractDownload PDF (1607K) Full view HTML -
Kenta Ishii, Kazuhiro Hiramatsu, Takehito Kato, Seiji Natsume, Matsuyo ...Article type: CASE REPORT
2015 Volume 48 Issue 9 Pages 798-807
Published: September 01, 2015
Released on J-STAGE: September 15, 2015
JOURNAL FREE ACCESS FULL-TEXT HTMLWe encountered two cases of primary squamous cell carcinoma that developed in the ascending colon. Case 1: A 73-year-old man could not move and was brought to our hospital by ambulance. He was anemic and a tumor of the ascending colon was diagnosed. We performed a right hemicolectomy with partial liver resection due to direct invasion of the liver. In the histopathological examination of the total segmentation of surgical specimens, adenocarcinomatous components were not detected, but slight keratinization was observed, from which squamous cell carcinoma was diagnosed. The patient is alive now at 34 months postoperatively with no evidence of recurrence. Case 2: A 50-year-old man complaining of right lower quadrant pain was given a diagnosis of an ascending colon cancer with retroperitoneal abscess and multiple liver metastases. We performed an ileocecal resection, but the radial margin was positive. The histopathological findings showed primary squamous carcinoma of the ascending colon. The patient died of liver metastasis in spite of intensive chemotherapy on postoperative day 53. Among colorectal carcinomas, pure squamous cell carcinomas are extremely rare, especially those arising in the colon. We present these cases with a review of the literature.View full abstractDownload PDF (1725K) Full view HTML
SPECIAL CONTRIBUTION
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Takako Kojima, J. Patrick BarronArticle type: SPECIAL CONTRIBUTION
2015 Volume 48 Issue 9 Pages 808-810
Published: September 01, 2015
Released on J-STAGE: September 15, 2015
JOURNAL FREE ACCESS FULL-TEXT HTMLDownload PDF (551K) Full view HTML
EDITOR'S NOTE
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Tetsuo OhtaArticle type: EDITOR'S NOTE
2015 Volume 48 Issue 9 Pages en9-
Published: September 01, 2015
Released on J-STAGE: September 15, 2015
JOURNAL FREE ACCESS FULL-TEXT HTMLDownload PDF (690K) Full view HTML
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