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Volume 49, Issue 3
Displaying 1-13 of 13 articles from this issue
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CASE REPORT
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Maiko Kikuchi, Masanobu Nakajima, Masakazu Takahashi, Hitoshi Satomura ...Article type: CASE REPORT
2016 Volume 49 Issue 3 Pages 169-176
Published: March 01, 2016
Released on J-STAGE: March 18, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLA 63-year-old man who had been experiencing heartburn and was found to have Barrett’s esophageal adenocarcinoma throughout an 18-cm region of long segment Barrett’s esophagus (LSBE). Upper gastrointestinal endoscopy revealed LSBE, the proximal end being 24 cm from the teeth, and a type 3 tumor at 29–33 cm. Moderately differentiated adenocarcinoma Tub2 was diagnosed by histopathological examination of a biopsy specimen. CT and PET scans showed no distant or lymph node metastases, thus, the esophageal adenocarcinoma was classified as stage II (T3N0M0). The patient underwent transthoracic esophagectomy by the McKeown technique and gastric tube reconstruction. The postoperative histopathological diagnosis was muscularis propria invasion, and was staged as T2. The intramucosal carcinoma spread over the entire field of the 18-cm LSBE. There have been relatively few reports of Barrett’s esophageal adenocarcinoma in LSBE in Japan. However, because the incidence of LSBE and Barrett’s esophageal adenocarcinoma will likely increase with the westernization of Japanese lifestyle and diet, Japanese physicians should include Barrett’s esophagus in their differential diagnoses when evaluating patients with esophageal symptoms. To the best of our knowledge, this is the first report of cancer permeating throughout an area of LSBE.View full abstractDownload PDF (2366K) Full view HTML -
Si-Yuan Yao, Sakae Mikami, Ryuichi Mikami, Yoichiro Tada, Souichi Shio ...Article type: CASE REPORT
2016 Volume 49 Issue 3 Pages 177-184
Published: March 01, 2016
Released on J-STAGE: March 18, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLSuperior mesenteric artery (SMA) syndrome is a mechanical obstruction of the third portion of the duodenum by a narrow aorto-mesenteric angle. The traditional approach to SMA syndrome was open bypass surgery. Nowadays, that conventional approach has been replaced by laparoscopic surgery. However single incision laparoscopic approach for SMA syndrome is extremely rare. A 20-year-old woman with a diagnosis of SMA syndrome was prepared for surgery after failed conservative management. To achieve surgery with a minimal scar, single incision laparoscopic duodenojejunostomy was performed and the postoperative course was uneventful. Herein, we report a patient with SMA syndrome who was treated by single incision laparoscopic duodenojejunostomy. This can be an effective surgical method for treating SMA syndrome especially in young female patients, for cosmetic reason.View full abstractDownload PDF (1868K) Full view HTML -
Tomofumi Ohashi, Yoshito Tomimaru, Shigeru Marubashi, Akira Tomokuni, ...Article type: CASE REPORT
2016 Volume 49 Issue 3 Pages 185-191
Published: March 01, 2016
Released on J-STAGE: March 18, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLThe patient was a 44-year-old woman who was diagnosed with Budd-Chiari syndrome at the age of 24. As the liver cirrhosis progressed, she was registered for deceased donor liver transplantation at the age of 34. Since the liver function became worse 11 years after the registration, she was re-registered at a higher rank on the waiting list. Fortunately, she could undergo deceased donor liver transplantation one month after the re-registration. She is now alive in good condition one year after the transplantation. Compared with western countries, the waiting period for transplantation is very long in Japan. The shortage of brain-dead donor is the root cause for it and a serious problem for organ transplantation in our country.View full abstractDownload PDF (1525K) Full view HTML -
Ryuichiro Sato, Chikashi Shibata, Hajime Iwasashi, Kazuaki Mukouda, Ka ...Article type: CASE REPORT
2016 Volume 49 Issue 3 Pages 192-198
Published: March 01, 2016
Released on J-STAGE: March 18, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLDuodenal ulcer penetration is a rare cause of acute cholecystitis, and we managed such a case successfully with a laparoscopic approach. An 81-year-old man with a history of diabetes, chronic obstructive pulmonary disease, and hypertension developed upper abdominal pain and severe hypotension. Emergency endoscopy demonstrated a giant bleeding ulcer in the duodenal bulb, and hemostasis was achieved endoscopically. The CT showed a duodenal ulcer penetrating to the gallbladder wall, but there was no extraluminal air. The patient was treated conservatively with food restriction and antibiotics, but he became febrile 13 days after treatment. The CT showed a thickened gallbladder wall with intramural emphysema and significant contrast enhancement on the serosal side. Intraoperative findings were consistent with acute cholecystitis. The adhesion between the gallbladder and duodenal wall was easily lysed with blunt dissection. Inflammation around the penetrated duodenal wall was minimal, and there was a serosal defect in the gallbladder wall, which was consistent with duodenal ulcer penetration. Laparoscopic cholecystectomy was performed and the perforated duodenal ulcer was repaired with an omental patch. Pathologic examination revealed gangrenous acute cholecystitis with fungal outgrowth in the gallbladder wall. The postoperative course was uneventful.View full abstractDownload PDF (1887K) Full view HTML -
Takeya Sakamoto, Yoshiaki Tsuchiya, Tatsuya Nomura, Atsushi Matsuki, S ...Article type: CASE REPORT
2016 Volume 49 Issue 3 Pages 199-206
Published: March 01, 2016
Released on J-STAGE: March 18, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLA 63-year-old man had undergone distal gastrectomy for early gastric cancer. Approximately 14 years after gastrectomy, serum carcinoembryonic antigen level elevated, and abdominal CT scan showed a 6-cm papillary tumor extending into the gallbladder. During the previous 12 years of follow-up after gastric cancer surgery, a tumor had been identified on CT series, and seemed to originate from the cystic duct. Extended cholecystectomy, extrahepatic bile duct resection, dissection of the regional lymph nodes, and choledochojejunostomy were performed. In the resected specimen, the tumor was localized in the cystic duct, and showed intraluminal papillary growth. Histological examination revealed tubular adenocarcinoma of the cystic duct with invasion to the fibromuscular layer. We report the rare natural history of a primary carcinoma of the cystic duct from occurrence of the neoplasm to invasive tubular adenocarcinoma, as observed from CT and histological findings.View full abstractDownload PDF (1609K) Full view HTML -
Nobuyuki Kamimukai, Tomoaki Takahashi, Takahiro Nakajima, Atsuo Kobaya ...Article type: CASE REPORT
2016 Volume 49 Issue 3 Pages 207-215
Published: March 01, 2016
Released on J-STAGE: March 18, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLThe patient was a 64-year-old man who presented with jaundice. Laboratory tests showed elevation of serum levels of total bilirubin and alkaline phosphatase and γ-glutamyl transferase. Serum IgG4 concentration also elevated to 254 mg/dl (normal, 4.8–105). CT findings suggested autoimmune pancreatitis (AIP) and IgG4-related sclerosing cholangitis (IgG4-SC). To exclude the possibility of cancer at the thickened segment of the bile duct, biliary cytology was required. Cytology revealed atypical cells, and adenocarcinoma of the bile duct was highly suspected. Cholangiogram showed strictures at the hilar part of the bile duct and distal common bile duct (CBD), but did not discriminate between the stricture of carcinoma and the stricture of IgG4-SC. Steroid treatment was started for IgG4-SC. Fourteen days later, endoscopic retrograde cholangiography showed improvement of the stricture at the hilar part of the bile duct, with remnants of the distal CBD strictures. Brush cytology of the stricture at the distal CBD showed adenocarcinoma. Pancreaticoduodenectomy was performed. Microscopic examination of the resected specimen revealed diffuse and dense infiltration of lymphoplasma cells, and adenocarcinoma infiltrating subserosa at the distal CBD. The patient was given a diagnosis of cholangiocarcinoma with a suspected background of IgG4-SC. The location of the carcinoma was clarified correctly before surgical operation following steroid treatment. We present a case of cholangiocarcinoma with IgG4-SC, with a review of the literature.View full abstractDownload PDF (2473K) Full view HTML -
Tatsuto Terada, Norihiko Furusawa, Akira Kobayashi, Takahide Yokoyama, ...Article type: CASE REPORT
2016 Volume 49 Issue 3 Pages 216-224
Published: March 01, 2016
Released on J-STAGE: March 18, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLA 72-year-old woman lost 10 kg during a 6-month treatment period for diabetes. She was given a diagnosis of pancreatic tumor by abdominal CT and referred to our hospital. A necrolytic migratory erythema (NME) was observed around the perineum and the knee. The laboratory investigations revealed normocytic anemia and hypoproteinemia. The glucagon level was elevated to 1,730 pg/ml. Enhanced abdominal CT showed a 3-cm diameter, mildly enhanced mass in the body of the pancreas. Endoscopic retrograde pancreatography showed interruption of the main pancreatic duct (MPD) in the head of the pancreas. Following the diagnosis of a pancreatic glucagonoma with an intraductal growth into the MPD, we performed distal pancreatectomy. A pathologic examination revealed a pancreatic neuroendocrine tumor, which was positive for immunohistochemical staining of chromogranin A, synaptophysin and glucagon. With a Ki-67 index of 1.7%, the tumor was identified as a neuroendocrine tumor, grade 1. We herein report a rare case of the intraductal growth of a pancreatic glucagonoma.View full abstractDownload PDF (2142K) Full view HTML -
Koji Kitada, Masaru Inagaki, Hiroki Kajioka, Naoyuki Tokunaga, Hiromi ...Article type: CASE REPORT
2016 Volume 49 Issue 3 Pages 225-233
Published: March 01, 2016
Released on J-STAGE: March 18, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLA 73-year-old woman with epigastric pain and vomiting was admitted to our hospital in September 2012. Serum chemistry testing showed elevated pancreatic enzymes. Abdominal CT revealed that the pancreatic tail was enlarged and edematous and that a solid tumor (diameter, 14 mm) was present in the body of the pancreas. A diagnosis of paraneoplastic acute pancreatitis was made. Poorly differentiated adenocarcinoma was noted on specimens from brushing cytology, and distal pancreatectomy was elected. Macroscopically, the tumor was solid with hemorrhage. Microscopic examination revealed that the tumor cells had reactive multinucleated giant cells with components of ductal carcinoma. The final diagnosis was anaplastic carcinoma with osteoclast-like giant cells. A space-occupying lesion was noted in the remnant pancreas at 20 months after surgery, but it was not clear whether this represented recurrence. At 26 months after surgery, the patient complained of abdominal pain, and elevated pancreatic enzymes were noted. The tumor of the remnant pancreas was enlarged, and brushing cytology specimens showed multinucleated giant cells with adenocarcinoma cells. Therefore, a diagnosis of recurrent anaplastic carcinoma was made, and total pancreatectomy was performed. Microscopically, it was confirmed as anaplastic carcinoma with osteoclast-like giant cells.View full abstractDownload PDF (1895K) Full view HTML -
Kazunori Sasaki, Tomohide Takahashi, Satoru Kouno, Masakazu Wakabayash ...Article type: CASE REPORT
2016 Volume 49 Issue 3 Pages 234-241
Published: March 01, 2016
Released on J-STAGE: March 18, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLA 73-year-old woman with a chief complaint of abdominal discomfort was given a diagnosis of pancreas head cancer concomitant with celiac artery stenosis. Abdominal CT demonstrated stenosis with calcification at the root of the celiac artery, but 3-dimensional-CT angiogram images did not show a typical “hooked appearance” that is a characteristic of median arcuate ligament syndrome. Conventional angiogram revealed a focal narrowing of the celiac axis, hepatopetal blood flow from the superior mesenteric artery to the proper hepatic artery via the pancreatic arcade and the gastroduodenal artery, and hepatofugal blood flow to the common hepatic artery and the splenic artery. Pancreaticoduodenectomy with arterial reconstruction was performed out of consideration of stenosis caused by atherosclerosis or extrinsic compression. The surrounding tissue of the celiac axis was dissected and skeletonized, but the hepatic arterial flow did not improve. After reconstruction of the digestive tract, an arterial bypass using the greater saphenous vein was performed between the right common iliac artery and the common hepatic artery. The postoperative course was uneventful without complications. Intrahepatic arterial flow measurement using Doppler ultrasound was useful regarding convenience and stability. It is important to diagnose this disease preoperatively and plan arterial reconstruction during the pancreaticoduodenectomy procedure.View full abstractDownload PDF (2115K) Full view HTML -
Ryota Tanaka, Eiji Ako, Naoki Kametani, Yukihiro Kato, Masahiro Komoto ...Article type: CASE REPORT
2016 Volume 49 Issue 3 Pages 242-249
Published: March 01, 2016
Released on J-STAGE: March 18, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLA 64-year-old man with melena consulted our hospital, and was subsequently hospitalized. Colonoscopic examination showed a type 1 tumor in the sigmoid colon, and a biopsy indicated well-differentiated adenocarcinoma. Abdominal contrast-enhanced CT images did not show the tumor in the sigmoid colon, and showed no swelling in the lymph nodes, or metastasis. Laparoscopic sigmoidectomy with D2 dissection was performed. Pathological examination indicated pMP, pN1, M0: fStage IIIa, which was mainly composed of invasive micropapillary carcinoma (95%), as well as well-differentiated adenocarcinoma (5%). Postoperative adjuvant chemotherapy was performed. The patient is alive at 7 postoperative months with no recurrence. Invasive micropapillary carcinoma has a high incidence of invasive lymph node and lymphoid metastasis, and the prognosis is poor. Reports of invasive micropapillary carcinoma are very rare. This case requires careful follow-up.View full abstractDownload PDF (2462K) Full view HTML -
Hiroyuki Maruyama, Masaru Koizumi, Daijiro Takahashi, Kenichi Oshiro, ...Article type: CASE REPORT
2016 Volume 49 Issue 3 Pages 250-257
Published: March 01, 2016
Released on J-STAGE: March 18, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLA 76-year-old man presented with sudden lower abdominal pain and nausea. Abdominal CT scan revealed a dilated small intestine with poor enhancement of the intestinal wall in the right lower abdomen and a right scrotal hydrocele. Preoperative diagnosis was a strangulated bowel obstruction and a right scrotal hydrocele. Emergency operation was performed. Intraoperative diagnosis showed the reduction en masse of an inguinal hernia, since a hernia sac was seen between the abdominal wall and the preperitoneal space. The small intestine became strangulated in the right internal inguinal ring. Partial resection of the small intestine and plication of the hernia orifice were performed. The second patient was a 60-year-old man who presented with 8 hours of abdominal pain and vomiting and was transported by ambulance with persistent symptoms despite reduction of a right inguinal protrusion. Abdominal CT scan revealed a prominent small intestinal loop near the right inguinal region. Reduction en masse of a right inguinal hernia was diagnosed and emergency operation was performed. A definitive diagnosis of reduction en masse of inguinal hernia was made based on strangulated small intestine in the right internal inguinal ring and a hernia sac in the preperitoneal space. The small intestine was reduced without resection and the hernia was repaired using mesh in the preperitoneal space. We report two cases of reduction en masse of an inguinal hernia with a review of previous cases of reduction en masse in Japan and a brief review of the literature.View full abstractDownload PDF (1659K) Full view HTML
SPECIAL CONTRIBUTION
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Takako Kojima, J. Patrick BarronArticle type: SPECIAL CONTRIBUTION
2016 Volume 49 Issue 3 Pages 258-259
Published: March 01, 2016
Released on J-STAGE: March 18, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLDownload PDF (575K) Full view HTML
EDITOR'S NOTE
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Yojiro HashiguchiArticle type: EDITOR'S NOTE
2016 Volume 49 Issue 3 Pages en3-
Published: March 01, 2016
Released on J-STAGE: March 18, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLDownload PDF (665K) Full view HTML
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