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Volume 49, Issue 4
Displaying 1-14 of 14 articles from this issue
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ORIGINAL ARTICLE
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Masaharu Ishida, Naoaki Sakata, Munetoshi Katagiri, Gunpei Yoshimatsu, ...Article type: ORIGINAL ARTICLE
2016 Volume 49 Issue 4 Pages 261-266
Published: April 01, 2016
Released on J-STAGE: April 19, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLPurpose: In surgery for left colon cancer, there is no consistent idea about management of the inferior mesenteric vein (IMV). The IMV and its surrounding tissue is not considered as a subject of general dissection since the existence of the lymph nodes surrounding the IMV has not been clarified. The authors have previously encountered a case of descending colon cancer with metastasis to the lymph node surrounding the IMV. Based on this experience, the search for regional lymph nodes around the IMV was performed in 10 cadavers. Method: The tissue along the IMV was carefully examined in the cadavers. After gross observations, the IMV including the surrounding tissue was excised for microscopic search of the regional lymph nodes. Result: In 8 cadavers, lymph nodes surrounding the IMV were identified, and in 4 cadavers, the lymph nodes were located in the middle portion between the left colon artery and the splenic vein. Therefore, lymph nodes around the IMV were considered to exist at a relatively high frequency. Conclusion: Although lymph nodes around the IMV have been described in textbooks since the 1900s, they are not regarded as a significant issue in colon cancer surgery today. However, there is a possibility of metastasis of colon cancer to the lymph nodes along the IMV, if the left colonic lymphatic flow is obstructed in such tumor metastasis and the cancer cells travel through the accessory lymphatic path along the IMV. To clarify the clinical significance of the lymph nodes surrounding the IMV, the accumulation of future clinical data is necessary.View full abstractDownload PDF (2080K) Full view HTML
CASE REPORT
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Takeshi Fujita, Toshikazu Kanai, Manpei Yamashita, Atsushi Yamamoto, M ...Article type: CASE REPORT
2016 Volume 49 Issue 4 Pages 267-275
Published: April 01, 2016
Released on J-STAGE: April 19, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLA 71-year-old woman was found to have a large duodenal tumor on screening by abdominal PET-CT. Esophagogastro-duodenoscopy revealed a large semipedunculated tumor in the duodenal bulb and biopsy specimens were histologically diagnosed as Brunner’s gland adenoma. In diagnostic imaging, the tumor was at least 5 cm in diameter and the precise location of the tumor stalk extending to duodenum could not be determined. Suspecting benign tumor based on endoscopic biopsy, we decided to remove the tumor to avoid duodenal obstruction due to tumor growth and the potential of malignancy. Because of endoscopic findings, we considered endoscopic polypectomy to be risky and performed laparoscopic distal gastrectomy with partial duodenectomy using intraoperative laparoscopic ultrasonography (LUS) under the water soakage method to accomplish total laparoscopic resection. Histopathological examination showed that this tumor was 50 mm in diameter and diagnosed as Brunner gland adenoma with adenocarcinoma. To the best of our knowledge, this is the first report of a case of duodenal carcinoma of a huge Brunner gland tumor resected laparoscopically determining the distal margin of duodenum by intraoperative LUS using the water soakage method.View full abstractDownload PDF (2450K) Full view HTML -
Satoshi Takada, Tatsuo Nakano, Eisuke Ojima, Yoshio MichiwaArticle type: CASE REPORT
2016 Volume 49 Issue 4 Pages 276-284
Published: April 01, 2016
Released on J-STAGE: April 19, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLA 59-year-old man was admitted because of acute pancreatitis. Esophagogastroduodenoscopy revealed an ampullary tumor which was diagnosed as tubular adenoma by biopsy. Because it was very difficult to detect carcinoma in adenoma and measure invasion depth, pylorus-preserving pancreaticoduodenectomy was performed after improvement in pancreatitis symptoms. Pathological findings revealed a growth in carcinoma tissue within the common channel and main pancreatic duct, which might be the cause of pancreatitis. The accessory duct of Santorini could not be detected with MRCP or pathological findings. Carcinoma tissue is limited at the mucosa (Tis, stage I). Although ampullary tumor is usually diagnosed by the presence of jaundice, acute pancreatitis is a rare feature. We review previous case reports on ampullary tumor presenting with acute pancreatitis.View full abstractDownload PDF (2838K) Full view HTML -
Hirofumi Ueda, Koji Komeda, Yoshihiro Inoue, Mitsuhiro Asakuma, Fumito ...Article type: CASE REPORT
2016 Volume 49 Issue 4 Pages 285-292
Published: April 01, 2016
Released on J-STAGE: April 19, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLInflammatory pseudotumor (IPT) is a rare disease that is often difficult to differentiate from liver metastasis. A case of liver tumor discovered during follow-up after three hepatectomies for colorectal liver metastases that was initially diagnosed as metastatic recurrence and resected is reported. Pathological examination showed it to be an IPT. The patient was a 62-year-old woman who had undergone sigmoid colectomy for sigmoid colon cancer (tub2, SS, N1, H0, Stage IIIa) in October 2009. In January 2010, multiple liver metastases were found, and mFOLFOX6/bevacizumab therapy was initiated. CT conducted in April 2011 revealed only partial response, and hepatectomy was performed. The patient experienced repeated metastatic recurrences, and a further two hepatectomies were performed. Bile duct stenosis resulted from the third surgery, and a stent was placed. During follow-up, a mass was observed in segment 2 of the liver. Liver metastatic recurrence was diagnosed and the mass appeared to be gradually enlarging, therefore the patient underwent laparoscopic segment 2 partial hepatectomy in October 2012. Pathological examination revealed signs of inflammatory cell infiltration and fibrosis, including plasma cells, lymphocytes, and histiocytes, with fibrous connective tissue proliferation, and IPT was ultimately diagnosed.View full abstractDownload PDF (2639K) Full view HTML -
Shinjiro Kobayashi, Kazumi Tenjin, Kouhei Segami, Hiroyuki Hoshino, Ma ...Article type: CASE REPORT
2016 Volume 49 Issue 4 Pages 293-300
Published: April 01, 2016
Released on J-STAGE: April 19, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLAn 84-year-old man had been found to have a massive cystic lesion in the pancreatic body 25 years prior to the current presentation and underwent spleen-preserving distal pancreatectomy. The lesion was pathologically diagnosed as a solid-pseudopapillary neoplasm (SPN). The patient experienced multiple recurrences at 7, 10, 11 and 20 years after the first surgery and underwent tumor resection each time. He complained of postprandial abdominal distention 2 years after the 4th surgery (22 years after the first surgery). Detailed examination revealed a cystic mass approximately 10 cm in size with a lobulated multilocular structure at the pancreatic surgical margin. Recurrence of SPN was diagnosed, for which resection of the pancreatic body, tumor and spleen was performed. Pathologically, the specimen showed morphologically homogeneous epithelial tumor cells arranged in a pseudopapillary pattern. Immunostaining was positive for β-catenin and CD10, and consistent with SPN. We report a rare SPN case that recurred locally five times, with successful removal on each recurrence. The relevant literature is also discussed.View full abstractDownload PDF (2792K) Full view HTML -
Akihiko Takagi, Teiichi Sugiura, Yukiyasu Okamura, Takaaki Ito, Yusuke ...Article type: CASE REPORT
2016 Volume 49 Issue 4 Pages 301-308
Published: April 01, 2016
Released on J-STAGE: April 19, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLSerous cystadenoma of the pancreas is a slow-growing benign tumor. Although it may become symptomatic following tumor growth, jaundice due to biliary obstruction is rare even in cases with tumors of the head of the pancreas. A 31-year-old woman who had pancreatic tumor was referred to our hospital. She was given a diagnosis of serous cystadenoma, 30 mm in diameter, by imaging studies and followed-up because she was asymptomatic. During 8 years of follow-up, the tumor had gradually increased from 30 to 43 mm in size, and the patient had obstructive jaundice. She underwent pancreaticoduodenectomy. Pathological examination of the resected specimen showed serous cystadenoma of the pancreas, of which a part compressed the bile duct. The growth rate of the present case was 1.3 mm/year and the doubling time was 23.1 years, which presented a relatively slow growing rate even among patients with serous cystadenoma of the pancreas with obstructive jaundice.View full abstractDownload PDF (1600K) Full view HTML -
Kenichi Inaoka, Shin Takeda, Ken Kondo, Kota Inagaki, Mitsuru Kinoshit ...Article type: CASE REPORT
2016 Volume 49 Issue 4 Pages 309-316
Published: April 01, 2016
Released on J-STAGE: April 19, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLA 68-year-old woman presented with upper abdominal fullness. An abdominal CT scan showed a 13 cm multilobular cystic lesion with a solid component in the pancreatic body and tail. A CT scan one year previously showed a 2-cm cystic tumor in the tail of the pancreas, suggesting it had grown rapidly. Distal pancreatectomy and splenectomy combined with lymph node resection and total gastrectomy were performed. The tumor measured 16×11×5 cm and consisted of a cystic lesion and a solid component containing necrotic tissue inside. Histologically, the solid component represented anaplastic carcinoma (giant cell type) in continuity with a cystic lesion lined by mucinous epithelia. The cyst wall had focal hypercellular stromal cells showing calretinin positivity, indicating the presence of an ovarian-like stroma. These findings suggested anaplastic carcinoma associated with mucinous cystic neoplasm (MCN) of the pancreas, which is rarely reported.View full abstractDownload PDF (2423K) Full view HTML -
Shinji Tsutsumi, Yoshikazu Toyoki, Takuji Kagiya, Toshiro Kimura, Nori ...Article type: CASE REPORT
2016 Volume 49 Issue 4 Pages 317-325
Published: April 01, 2016
Released on J-STAGE: April 19, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLA 54-year-old man was admitted to a hospital because of jaundice and high fever due to a tumor of the pancreatic head. He was then transferred to our institution after percutaneous transhepatic biliary drainage. Abdominal CT revealed wall thickening and stenosis of the distal bile duct. The superior mesenteric artery (SMA) was located on the right side of the superior mesenteric vein (SMV). Pancreaticoduodenectomy (PD) was performed under the diagnosis of distal bile duct cancer and intestinal malrotation. During the operation, the third portion of the duodenum was located on the ventral side of the SMA, with the absence of the ligament of Treitz. The transverse colon was located on the dorsal side of the SMA, and the cecum on the right side of the artery. These findings revealed a reversed intestinal malrotation. The final pathological diagnosis was pancreatic ductal carcinoma with invasion to the bile duct and portal vein, and no distal bile duct cancer. We report herein an extremely rare case of pancreatic cancer with adult reversed rotation treated by PD.View full abstractDownload PDF (1860K) Full view HTML -
Toru Watanabe, Koshi Matsui, Tetsuji Yamaguchi, Isaya Hashimoto, Kazut ...Article type: CASE REPORT
2016 Volume 49 Issue 4 Pages 326-333
Published: April 01, 2016
Released on J-STAGE: April 19, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLA 56-year-old woman presented with exertional shortness of breath. CT showed a remarkably swollen spleen and peripheral blood revealed atypical lymphocytes. Bone marrow smear and flow cytometry suggested hairy cell leukemia Japanese variant (HCLjv). Three weeks after admission, splenomegaly increased from 2,125 cm3 to 3,207 cm3. Because pancytopenia and abdominal retention had progressed, splenectomy was performed to improve symptoms and obtain a definitive diagnosis. To prevent bleeding and reduce splenic volume, embolization of the splenic artery with balloon catheter was performed preoperatively. Thus splenectomy was performed safely. The operation took 146 minutes and blood loss was 30 ml. Reduced splenic volume with embolization was 2,657 g. Splenectomy was effective in diagnosing this splenomegaly with HCLjv, and it led to the improvement of abdominal retention.View full abstractDownload PDF (1865K) Full view HTML -
Yusuke Yoshikawa, Masashi Tsuruta, Hirotoshi Hasegawa, Koji Okabayashi ...Article type: CASE REPORT
2016 Volume 49 Issue 4 Pages 334-341
Published: April 01, 2016
Released on J-STAGE: April 19, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLSelf-expanding metallic stents (SEMS) are considered feasible for colorectal cancer with bowel obstruction, however, careful observation must be performed following the procedure because of critical morbidity caused by situations such as perforation or migration. The patient was a 61-year-old man who complained of abdominal distension and pain for a few days. A CT revealed advanced transverse colon cancer with bowel obstruction. WallFlexTM Colonic Stent (6 cm) was first placed incompletely, thus, another longer stent (12 cm) was added and bowel obstruction was successfully relieved. On the following day, an abdominal X-ray showed migration of the first stent to the proximal site of the colon. Following total dissipation of small bowel distention, he underwent laparoscopic left hemi-colectomy. Like extracting the colon through a small incision, the migrated stent could be retrieved by the forceps under an endoscope inserted from the proximal resected lumen before anastomosis. Although it is hard to retrieve a migrated colorectal stent, we considered our report could provide a promising option with safety and reliability during laparoscopic colorectal surgery.View full abstractDownload PDF (1709K) Full view HTML -
Takeshi Takei, Naoto Nishigori, Fumikazu Koyama, Shinji Nakamura, Hide ...Article type: CASE REPORT
2016 Volume 49 Issue 4 Pages 342-349
Published: April 01, 2016
Released on J-STAGE: April 19, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLMuir-Torre syndrome (MTS) is an autosomal dominantly inherited disease caused by a pathological germ-line mutation in one of the mismatch repair genes and is considered a phenotypic variant of Lynch syndrome. Our patient was a 61-year-old man. He had had colorectal cancer at the ages of 36, 38, 46 and 56, respectively, and gastric cancer at the age of 50. Two people among his second-degree relatives had colorectal cancer. He met Amsterdam Criteria II, and we suspected the case to be Lynch syndrome and followed it up. He had a 10 mm nodule on his back at age 61. It was a sebaceous carcinoma. He previously had internal malignancies, therefore, we diagnosed the case as MTS. Gene analysis revealed germ-line mutation in the MLH1 gene, and we diagnosed the case as Lynch syndrome. Gastroenterological surgeons should be concerned about MTS when a patient with Lynch syndrome has a sebaceous tumor.View full abstractDownload PDF (1641K) Full view HTML -
Masafumi Ohira, Shigenori Homma, Susumu Shibasaki, Tadashi Yoshida, No ...Article type: CASE REPORT
2016 Volume 49 Issue 4 Pages 350-359
Published: April 01, 2016
Released on J-STAGE: April 19, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLWe report three cases of adult intussusception due to advanced colorectal cancer that could be treated with elective laparoscopic resection without emergency treatment. Case 1: An 81-year-old man was given a diagnosis of transverse colon cancer. CT image revealed an intussusception at the site of the tumor, but no signs of bowel ischemia. In addition, since the patient was asymptomatic, we performed an elective laparoscopic right hemicolectomy. Case 2: A 76-year-old man was found to have rectal cancer. Although CT image led to a diagnosis of an intussusception at the site of the tumor, no signs of bowel ischemia were found and he had no symptoms. Thus, we performed an elective laparoscopic high anterior resection. Case 3: In a 49-year-old man with sigmoid colon cancer the CT image revealed an intussusception at the site of the tumor. No signs of bowel ischemia were found and he had only mild symptoms. As a result, we performed an elective laparoscopic Hartmann’s operation. All three patients were discharged without any complications. Conclusion: If the symptoms are only mild in patients with adult intussusception due to colorectal cancer, elective laparoscopic resection without preoperative emergency management can be performed safely.View full abstractDownload PDF (2112K) Full view HTML -
Takuya Matsui, Hidehiko Kitagami, Yasuhiro Kondo, Keisuke Nonoyama, Ka ...Article type: CASE REPORT
2016 Volume 49 Issue 4 Pages 360-366
Published: April 01, 2016
Released on J-STAGE: April 19, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLA 51-year-old man visited a primary care doctor because of lower abdominal pain. On a diagnosis of small bowel obstruction he was referred to our hospital. CT on admission revealed stenosis of the small intestine in the left lower abdomen. We determined strangulated ileus due to internal hernia and performed an emergency laparoscopic surgery that revealed that the small intestine had herniated into the intersigmoid fossa. We extracted the incarcerated small intestine. Because there was no necrosis, we did not perform bowel resection, and only performed simple closure of the hernia orifice. The patient recovered uneventfully and was discharged on postoperative day 4. We report a case of successful laparoscopic diagnosis and treatment for intersigmoid hernia, along with a review of the literature.View full abstractDownload PDF (1453K) Full view HTML
EDITOR'S NOTE
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Hiroki IkeuchiArticle type: EDITOR'S NOTE
2016 Volume 49 Issue 4 Pages en4-
Published: April 01, 2016
Released on J-STAGE: April 19, 2016
JOURNAL FREE ACCESS FULL-TEXT HTMLDownload PDF (664K) Full view HTML
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