Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)
Online ISSN : 1882-5133
Print ISSN : 1345-2843
ISSN-L : 1345-2843
Volume 60, Issue 5
Displaying 1-50 of 50 articles from this issue
  • Shinichi YAMASAKI, Masaru TSUYUGUCHI, Shunsuke NIKI, Daisuke WADA, Tsu ...
    1999 Volume 60 Issue 5 Pages 1165-1168
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    A retrospective analysis of 10 patients with thyroid disease who underwent reoperation for postoperative bleeding was performed to know the prevention and strategies for this complication. There were five patients with Graves disease (subtotoal thyroidectomy), three with benign thyroid tumors (extirpation of thyroid tumors), and two with thyroid carcinoma. Eight of 10 patients were reoperated within 6 hours after initial operation. All patients had a complaint of pulsion of the anterior neck. Four patients complained of dyspnea. Removal of hematoma, hemostasis and closed drainage under general anesthesia were done in 9 and under local ansthesia in one patient. The origins of bleeding were twig of artery in anterior neck muscles in four, twig of the superior thyroid artery in two, inferior thyroid vein in one, subcutaneus vein in one and indistinctness in two patients. No complication occurred after reoperation and they were discharged from the hospital 10.7 days on an average after initial operation. Postoperative bleeding often occur from twigs of artery in the surrounding tissues in a short time after operation. A sure hemostasis by ligation of fine vessels and careful observation after operation are important. Prompt surgical treatment brings about favorable outcome if postoperative bleeding has occurred.
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  • Masahiko ISHIKAWA, Norio MORIMOTO, Tadahiro SASAJIMA
    1999 Volume 60 Issue 5 Pages 1169-1172
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    From October 1993 to September 1998, 10 patients (all men) with ischemia of the upper extremity in Buerger's disease underwent a thoracoscopic sympathectomy for hand or finger ischemia. The clinical symptoms of these patients were cold sensation of the hand and/or finger in all patients, and finger ulceration in three patients. Preoperative angiography of the upper extremities was done in all patients for diagnosis of blood flow in the hand and fingers. All patients underwent the procedure under general anesthesia. The patient was placed in a lateral decubitis position, and all three ports were inserted. The scope and other instruments were inserted, and the operator dissected the sympathetic ganglia T2-T4. After the operation, all patients demonstrated a satisfactory clinical response by warm, dry hand and upper extremity. A recurrence was found in one patient (7.7%), for the technical failure of dissection of the ganglia. We conclude that thoracoscopic sympathectomy is effective and safe procedure for the treatment of upper extremity ischemia in Buerger's disease.
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  • Shigeyuki TAMURA, Sumio MIZUNOYA, Kiyonori NISHIOKA, Kentarou KISHI, S ...
    1999 Volume 60 Issue 5 Pages 1173-1179
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    In this study, clinical outcomes of treatments for recurrence of throacic esophageal carcinoma after curative resection were analyzed. Fifty six out of 120 patients, who received curative resection for squamous cell carcinoma of thoracic esophagus between March 1983 and December 1995, experienced a recurrence. These 56 cases were subjected to the study. The sites of recurrence were cervical lymph noden (8 cases), upper mediastinal region (25 cases), a distant organ (16 cases) and others. One-and 2-year recurrence rates were 54% and 86% respectively. The median disease-free survilal period was 11 monhs and median survival period after recurrence was 6 months. The incidence of cervical lymph node recurrence of patients with postoperative irradiation of the T-fields was significantly lower than those without radiation therapy (p<0.05). Patients with cervical lymph node dissection for cervical recurrence and patients with irradiation for upper mediastinal recurrence had relatively good prognosis. Although patients with distant organ metastasis had poor prognosis, active therapies such as transcatheter arterial chemotherapy for liver metastasis or resection of brain metastasis brought some better prognosis. To improve the prognosis of patients with recurred esophageal cancer after curative surgery, not only early diagnosis of recurrence but also vigorous treatment appropriate for the recurred site it would be mandatory.
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  • Hideaki NAGASAKI, Mikio MAKUUCHI, Toyohide NAKAMURA, Shoji SASAYA, Hir ...
    1999 Volume 60 Issue 5 Pages 1180-1189
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    Some problems still lie in the quality of life for the patients undergone proximal gastrectomy for the upper gastric cancer. Because there are some postoperative complications, such as reflux esophagitis. The aim of this study was to examine whether an extended proximal gastrectomy including D2 lymph node dissection reconstructed with a normoperistaltically aligned insertion of an ileocolic segment reduced postoperative complications or improved the quality of life. Subjects were six patients including four men and two women. To know the quality of life, a questionnaire survey asking about postoperative unpleasant symptoms was conducted more than 1 year after the surgery. Endoscopic findings, esophageal manometric study, body weight, amount of feeding and laboratory data were also investigated until postoperative one year.
    Postoperative endoscopy did not show any findings of esophagitis in all the patients. In contrast to patients with total gastrectomy, a lower esophageal high pressure zone newly constructed by ileocecal valve was detected in each patient in the esophageal manometric study. The body weight loss at one year after the surgery was 7.1% as compared with the postoperative body weight. The amount of feeding was restored to 95.0% of that of before surgery. All the laboratory data after the surgery were within normal range. It is consequently concluded that the extended proximal gastrectomy including D2 lymph node dissection reconstructed with an insertion of an ileocolic segment is a prominent method for the patients with early or proper muscle cancers located at the upper half of the stomach.
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  • Hironobu ITO, Hiroaki OMORI, Hiroshi ASAHI, Kazuyoshi SAITO
    1999 Volume 60 Issue 5 Pages 1190-1196
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    In this study, we examined the treatments and medical expenses for cases of perforation of duodenal ulcer. As to therapeutic methods, we selected conservative therapy as a rule, but employed ultrasonographyguided puncture drainage or laparoscopic procedure if a large volume of ascites was noted. Emergency operation was performed for patients who did not respond to conservative therapy, those associated with hematological disease, those with perforation of gastric ulcer, and those misdiagnosed. Elective surgery after sucessful conservative therapy was carried out for cases associated with malignant disease and those of frequently recurred ulcer. Each points for hospital stay, medication, treatment, surgical anesthesia, test, imaging diagnosis, as well as total points became larger in aged patients group. There was a tendency for patients who well responded to conservative therapy to decrease the expenses, but all patients who did not respond to conservative therapy were associated with some postoperative complication to became more expensive. Conservative therapy was liable to be excellent for juvenile patients, but it often ineffective for aged patients who also had complications in the clinical course in a high rate. It is indicated that early decision-making for conservative therapy in aged and severe patients and prevention of complications during clinical course may contribute to the saving of medical expenses.
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  • Isao SHIRAHASE, Toru MORI, Katsuyoshi FURUMOTO, Shinji KOSUGI, Noriaki ...
    1999 Volume 60 Issue 5 Pages 1197-1204
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    A 49-year-old woman who had been pointed out having an adenomatous goiter 27 year before but let it alone was seen at the hospital, when a tumor in the center of the right thyroid lobe was confirmed. Bilateral cervical lymph nodes were palpated. Serum calcitonin and CEA levels were high and 123I-MIBG scintigraphy revealed positive response. With a diagnosis of medullary carcinoma in Stage III (T3a. N1b, M0), a total thyroidectomy and conservative bilateral lymph nodes dissection of the neck were performed. Histopathological study revealed that the tumor was localized in the capsule, gave a positive reaction to calcitonin immunostaining, and was pN0 in Stage II. The tumor marker was normalized after the operation. There have been no signs of recurrence as of 7 months after the operation. On gene examinations, no germinal mutation of RET gene was noted, but mutation of MEN 2A, exon 11, and somatic point mutation of codon 634 were demonstrated. So far, this type of mutation has been though uncommon in sporadic medullary carcinomas in that this is an intriguing case.
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  • Yoshiichi MAEURA, Mafumi SAITOU, Nobuhisa UEDA, Seiichi MATUNAGA, Sige ...
    1999 Volume 60 Issue 5 Pages 1205-1208
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    A case of primary liposarcoma of the breast is reported with a review of the relevant literature. A 60-year-old woman was seen at the hospital because of an inspection of her breasts. An elastic soft lump (15×10mm) was detected in the right breast (A). The lump revealed irregular in shape and heterogeneous in content by ultrasonography. However, no sign of abnormality was revealed on mammography and aspiration cytology and finally excisional biopsy led to a diagnosis of liposarcoma. Additional wide resection was done because of the positive surgical margin at the first extirpation and another focus of sarcoma was detected with positive margin even at the second resection. So a mastectomy was performed. Histologigal examination showed proliferation of lipoblast with hyperchromatic nuclei. The tumor was diagnosed as well-differentiated liposarcoma. No distant metastasis was noted. No postoperative additional therapy was done. The patient has been doing well without recurrence as of 5 years and 8 months after the last operation. Seventeen cases of liposarcoma of the breast have been reported in the Japanese literature, so far.
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  • Shozo FUJINO, Noriaki TEZUKA, Masutaro ICHINOSE, Satoru SAWAI, Keiichi ...
    1999 Volume 60 Issue 5 Pages 1209-1212
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    A 14-year-old girl was referred to the hospital because of a painless tumor of the left breast. About 4 months before the referral, she began to feel a swelling of the left breast but left it alone; she visited another hospital because the tumor gradually enlarged. On admission, a 12.5×10.5cm elastic soft and well defined tumor was palpated in the left breast and an elastic hard lymph node in her left axillary region. The tumor was diagnosed as phyllodes tumor because of multinodular figure by ultrasonography and enhancement in an early phase by dynamic magnetic resonance imaging and was resected by an enucleation with a little normal gland. Histological examination revealed that the tumor was benign phyllodes tumor 12.5×11.0×6.5cm in size and 400g in weight and no maligant finding were found in the lymph node. No signs of recurrence have been recognized 4 years after the surgery. Although the standard surgical treatment for phyllodes tumors has not been established as yet, wide excision with marginal normal gland is enough for benign phyllodes tumors. Normal gland should be conserved as much as possible and lymph node dissection should be avoided especially in early teens as shown in this present case.
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  • Kazuo AISAKI, Yoshiro CHISHIMA, Yoshinobu SATO, Masami MORO, Osamu KUD ...
    1999 Volume 60 Issue 5 Pages 1213-1217
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    A case of Wilms tumor of adulthood metastasiued to the breast is reported. Wilms tumor is principally a malignant tumor arising in the childhood kidney and it rarely occurs in adults. There have been only 103 adult cases in Japan. And, in general, the most probable neoplasm metastasizing to the breast is malignant lymphoma, follwed by leukemia and gastric cancer, in this order, and no breast metastasis of renal tumor has been reported as yet. A 44-year-old woman was seen at the hospital because of a left breast tumor. A diagnosis of double cancer of the left breast and right kidney was made, and a left mastectomy with associated resection of the pectoral muscle on July 9 and total resections of the right kidney and ureter on August 21, 1996 were performed. Histopathologically, the right renal tumor was Wilms tumor and the left breast tumor was thought to be metastatic foci rather than primary breast tumor because no obvious epithelial components were seen. The definite diagnosis of Wilms tumor of adulthood and breast metastasis was established. Wilms tumors of adulthood can be classified into favorable histology (FH) and unfavorable histology (UH) by histologic types. This patients is classified into UH who may have a poor prognosis and would demand further strict observation of clinical course.
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  • Ryota TANAKA, Fuyo YOSHIMI, Hisayuki ONO, Shoichi MITSUHASHI, Masayuki ...
    1999 Volume 60 Issue 5 Pages 1218-1223
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    A case of left breast cancer associated with von Recklinghausen's disease is reported. A 47-year-old woman was admitted to the hospital because of a left breast tumor with gradually intensifying pain for two months. The tumor was measured 1.7×1.7×1.8cm in diameter on ultrasonography. Multiple neurofibromas and café au lait spots were noticed scattered on the entire skin surface. After an excisional biopsy, breast cancer was diagnosed and a radical standard mastectomy was performed on January 21, 1992. Histologically, the tumor was an invasive ductal carcinoma with metastasis to the axillary lymph node.
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  • Hiroshi NARITA, Tatehiro WAKASUGI, Katsumi KATO, Motoki HATO, Akitoshi ...
    1999 Volume 60 Issue 5 Pages 1224-1228
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    We experienced a case of malignant phyllodes tumor associated with non-invasive ductal carcinoma of the breast.
    A 51-year-old woman was seen at the hospital because of a left breast mass. At the first visit, a 3×3cm elastic hard tumor extending from the C to D areas was palpated. A needle biopsy cytology offered a diagnosis of benign phyllodes tumor and the patient was decided to be followed on an ambulant basis. About 6 months later, the tumor began to enlarge rapidly and then it was extirpated under general anesthesia. Histopathological exploration revealed that the tumor was phyllodes tumor with malignant picture and several ductal structures which should be called intraductal carcinoma adjacent to the phyllodes tumor. The definite diagnosis of non-invasive ductal carcinoma with malignant phyllodes tumor was made.
    It is extremely rare that phyllodes tumor is associated with breast cancer and reported cases have numbered only 20 in Japan so far. Of these 20 cases, 13 cases were of ipsilateral and synchronous like this case, five cases were of contralateral and synchronous, and two cases were of ipsilateral and metachronous.
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  • Teruhisa SAKURAI, Takaomi SUZUMA, Shinji MAEBEYA, Tatsuya YOSHIMASU, J ...
    1999 Volume 60 Issue 5 Pages 1229-1232
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    A rare case of giant intracystic and non-invasive carcinoma of the male breast is reported. A 76-year-old man was seen at the hospital because of a left breast mass. A huge and hard mass, mesuring 10 by 10cm in size, was located in the entire left breast. An aspiration cytologic examination revealed class IV. A ultrasonography revealed a multi-cystic tumor and a mixed pattern. These findings offered a suspicion of breast carcinoma. An intraoperative frozen section diagnosis after tumorectomy indicated ductal carcinoma. Therefore, a modified radical mastectomy was performed. Postoperative pathological examination revealed noninvasive ductal carcinoma. He has been recurrence free for 4 months after the operation without any adjuvant therapy.
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  • Eiji MEGURO, Yoshiyuki HOSOI, Hiroshi ASAHI, Kazuyoshi SAITO
    1999 Volume 60 Issue 5 Pages 1233-1237
    Published: May 25, 1999
    Released on J-STAGE: August 24, 2009
    JOURNAL FREE ACCESS
    In recent years, central venous catheterization (CVC) has rapidly advanced and developed. However, along with a wide use of CVC in clinical settings, various complications including infectious diseases have become problems. A 73-year-old woman was admitted to the hospital with a diagnosis of gastric cancer. Preoperative examinations were performed with left subclavian indwelling CVC. Twenty-one days after the catheter was placed in the central vein, the patient developed a temperature of 38.8°C, then the catheter was removed. Although a fever tended to be reduced on the next day, edema was appeared in the left upper extremity. Venography and computed tomography demonstrated an obstruction in the left subclavian region and the presence of thrombi in the left external jugular vein region, with the diagnosis of septic thrombosis induced by CVC, conservative treatment was started. After the patient's condition inproved a distal gastrectomy was performed under general anesthesia. Early removal of the catheter as well as conservative treatment by administering antibiotics, anticoagulants and thrombolytic agents are the primary options for treating septic thrombosis induced by CVC. Moreover, it is considered preferable to perform catheterization with sufficient care.
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  • Jun'ichi OBA, Hidetoshi AOKI, Toshihito YOSHIDA, Tsuyoshi KANAOKA, Kim ...
    1999 Volume 60 Issue 5 Pages 1238-1240
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    A 58-year-old male presented with a diastolic heart murmur was found to have a severe aortic regurgitation on cardiac evaluation. He was transferred to our department, and underwent an aortic valve replacement. During the operation, the aortic valve was recognized quadricuspid, including three equal cusps and one smaller accessory cusp. The finding was consistent with Hurwitz type b quadricuspid aortic valve. It was etiologically thought that the relatively small cusp decreased in size with the aging to produce some space, causing aortic regurgitation. Aortic valve was replaced with Carbomedics 23mm prosthetic valve uneventfully. Thirty-five reported cases are reviewed in terms of clinical features and surgical therapy.
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  • Tadashi IRIYAMA, Shuichiro SUGIMURA, Yoshinobu HATTORI, Koji NEGI, Isa ...
    1999 Volume 60 Issue 5 Pages 1241-1245
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    The use of percutaneous cardiopulmonary support (PCPS) has been facilitated as an adjuvant procedure for severe heart failure or pulmonary insufficiency. In this study, four patients with serious ischemic heart disease who were applied PCPS as a bridge to operation at the department of internal medicine in our hospital were investigated.
    PCPS flow was kept at 0.5 to 1.5L/min preoperatively that contributed to improve their hemodynamics. PCPS was performed uneventfully for 2 hours to 3 days. Three patients were intubated and placed on mechanical ventilation. Intraaortic ballon pumping (IABP) was combined with PCPS in three patients. Two patients who did not require postoperative PCPS survived operation. But the remaining two patients with extensive myocardial damage needed PCPS combined with IABP postoperatively. They could not be weaned from these supports and died on the 6th and 9th postoperative day, respectively. In these two patients, the most determinant factor of their deaths might lie in the severity of the original diseases, but the long-term use of PCPS after thoracotomy might worsen ischemia in the lower extremities, bleeding, DIC, and multiple organ failure.
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  • Kiyoto SHINKAI, Harumi KIDA, Hiroshi HISANO, Shinichi SHIBAZAKI, Hiros ...
    1999 Volume 60 Issue 5 Pages 1246-1249
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    It is said that eosinophilic granuloma, which is classified as one of types of histiocytosis X, arising from the rib rarely occurs and represents 4.1% of all rib tumors. Histopathological features reveal infiltration of eosinophil and proliferation of histiocyte with coffee-bean like nuclei. Recently we experienced a case of eosinophilic granuloma arising from the rib. A 35-year-old woman was admitted to the hospital because of frequent episodes of left chest pain. Chest X-ray films revealed an osteolytic change and a pathological fracture in the left 5th rib. On further examinations, she was given a diagnosis of malignant rib tumor. After resection of the involved ribs, the subsequent defect of chest wall was reconstructedby using Marlex mesh. Resected material was microscopically eosinophilic granuloma arising from the rib. Actually no confirmed lesion of eosinophilic granuloma except rib was found. There have been no signs of recurrence as of 5 years and 9 months after the operation. It is believed that monofocal eosinophilic granuloma arising from the rib like this case has relatively good prognosis compared to multifocal granulomas or juvenile cases.
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  • Masahiro KATADA, Toshihiro MORITA, Shin YAMADA, Shigehisa SAJI
    1999 Volume 60 Issue 5 Pages 1250-1254
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    Perforation of ulcer of the reconstructed gastric tube to vessels after operation for esophageal cancer is so rate that only two cases have been reported in Japan. We have experienced a case of perforated ulcer of reconstructed gastric tube to the left subclavian artery causing massive hematemesis. This paper presents the case with some bibliographical comments.
    A 58-year-old man was admitted to the hospital because of hematemesis. Previous histories disclosed that he underwent a right thoracolaparotomic subtotal esophagectomy and retrosternal esophagogastroanastomosis for a cancer of the middle intrathoracic esophagus in August, 1992; and he had been healthy for 5 years and 11 months after postoperative irradiation until this admission. The patient repeated massive hematemesis and fell in shock state. An emergency operation was performed. When the gastric tube was examined under a median sternotomy, arterial projective bleeding from a small ulcer just beneath the esophagogastoanastomosed site was confirmed. Hemostasis of the bleeding site was attained by simple suture, the reconstructed tube was pulled out, and an esophagostomy and a jejunostomy were performed. Postoperative angiography demonstrated that the perforated organ by ulcer of the reconstructed gastric tube was the left subclavian artery.
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  • Kotaro IWANAMI, Yasuo SUDA, Junya KOBAYASHI, Yojiro HASHIGUCHI, Yoichi ...
    1999 Volume 60 Issue 5 Pages 1255-1260
    Published: May 25, 1999
    Released on J-STAGE: August 24, 2009
    JOURNAL FREE ACCESS
    This paper presents two cases of carcinoma occurred in the distal gastric remnant. Case 1; A 68-year-old woman, who underwent proximal gastrectomy with esophagogastrectomy and pyloroplasty for a gastric leiomyosarcoma 4 years before, was found to have a Borrmann III type carcinoma at the antrum of the remnant stomach on upper GI series and endoscopy. No distant metastases were detected. Then, total gastrectomy and splenectomy with lymphnode dissection were performed. Histological findings of the resected material were pT3 pN3 and poorly differentiated adenocarcinoma.
    Case 2; A 76-year-old man, who underwent the same surgery as Case 1 for an early gastric carcinoma in the cardiac region 13 years before, was found to have a superficial depressed lesion at the posterior wall just under the esophagogastrostomy on recent examination. Biopsied specimen disclosed that it was well differentiated adenocarcinoma of the remnant stomach. Operation is suspended at present, because the patient disagreed with surgical treatment.
    It is though that the frequency of carcinoma in the distal gastric remnant is probably high after proximal gastrectomy. because the remnant portion is a common site for malignancy and it is exposed with regurgitation of duodenal juice. However, previously reported cases including our two cases numbered only 26 in the Japanese literature for 3 decades since 1968. This paper also presents some bibliographical discussion in terms of clinicopathological pictures and possible carcinogenic mechanisms.
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  • Kou IIZUKA, Kosaku MIMURA, Satoshi TAKAHASHI, Masafumi YOSHIDA, Toshih ...
    1999 Volume 60 Issue 5 Pages 1261-1264
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    This paper reports a case of adulthood intussusception of the small intestine which occurred during suction depression therapy using an ileus tube.
    An 89-year-old woman complaining of abdominal pain and vomiting was admitted to the hospital with a diagnosis of adhesive ileus. There was a previvous history of undergoing a cholecystectomy under laparotomy. Symptomatic remission was temporally attained by suction depression therapy using an ileus tube. On the 7th hospital day an abdominal pain occurred and intestinal bleeding was noted on the 9th hospital day.
    Abdominal ultrasonography on the 11th day offered a diagnosis of intussusception and an emergency laparotomy was performed. During operation, anterograde jejuno-jejunal intussusception was found at about 70cm from the Treitz' ligament. A partial excision of the invaginated intestine with end-to-end anastomosis was performed.
    When we encounter intensifying abdominal pain and vomiting during insertion of an ileus tube, abdominal ultrasonography and CT scan must be performed considering a possible onset of intussusception.
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  • Tetsuya INOUE, Mikiko KONDO, Yoshiaki KOMURA, Shigeru TAKEKAWA, Masato ...
    1999 Volume 60 Issue 5 Pages 1265-1268
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    We experienced a case of ischemic stricture of the small intestine. A 44-year-old man with no previous history of any diseases was admitted to the hospital because of abdominal pain with nausea and vomiting after meals. On admission ileus like condition of subileus unknown origin was suspected. His symptoms disappeared by the conservative treatment but recurred after oral intake. Small intestinal radiograms showed a segmental stenosis in the jejunum. Computed tomography showed segmental whole circumferential wall thicking of the intestine. Laparotomy was performed. A portion of the small intestine about 15 cm in length distal from the Treitz' ligament thickened, narrowed, and was covered with the omentum. Involved jejunal segment was resected. By histological examination, the lesion was diagnosed as ischemic stricture of the small intestine because of facts that a 10 cm long stenotic area was composed of whole circumferential UL-II_??_III nonspecific ulcers and that sclerotic changes were seen in the mesenteric arteries around the stenotic area.
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  • Shoji ISHIDA, Akira INABA, Yuji KOBA, Kaoruko SEKI, Hisaya OYAMA, Take ...
    1999 Volume 60 Issue 5 Pages 1269-1272
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    Benigh tumor of the small bowel is rare among all tumors of the digestive tract, especially perforation of the tumor. The authors report a case of perforation of a jejunal leiomyoma causing peutoritis. A 73-year-old man was admitted to the hospital because of lower abdominal pain. There was tenderness in the entire abdomen. Abdominal CT scan revealed a hypervascular mass lesion in the upper abdomen. Significant abdominal findings were uncertain initially, however, after 10-hour observation, peritonitis became obvious and CT scan identified ascites in the Douglas cavity. An emergency operation was performed and a 5×5×4cm sized tumor with a fistula was found at the jejunum 10cm from the Treitz's ligament. With a diagnosis of peritonitis due to the perforated small bowel tumor of extramural growth, an excision of the jejunum by 15cm including the tumor was carried out. Histopathological picture of the tumor was compatible with that of leiomyoma. Postoperative course was uneventful and the patient was discharged from the hospital on 35th hospital day.
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  • Yoshiro MATSUMOTO, Hideyuki ISHIDA, Nobuo MURATA, Masashi FUJIOKA, Yas ...
    1999 Volume 60 Issue 5 Pages 1273-1276
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    Leiomyomas of the small intestine are relatively rare. This paper reports a case of leiomyoma of the jejunum presented with abcess formation. A 37-year-old man was admitted to the hospital because of fever and a mass in the lower abdomen.
    Ultrasonography and computed tomography demonstrated a mass measuring approximately 8cm in diameter in which air and fluid were found. Magnetic resonnance imaging demonstrated that the intensity of the wall of the mass was as similar as that of the musculature. Leakage of th contrast medium from the lumen of the upper jejunum into the cavity of the mass was found by a radiography of the small intestine. Superior mesenteric arteriography revealed a hypervascular mass.
    Laparotomy revealed a jejunal tumor growing extramurally, adherent to the mesentery of the sigmoid colon. Partial resection of the affected jejunum and sigmoid colon was performed. Histologically, it was leiomyoma of the jejunum with abcess formation.
    Among 184 case reports of leiomyoma of the jejunum or ileum between 1989 and 1997 in the Japanese literature, there are only two cases other than this case which presented with abcess formation.
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  • Hiroaki SHIBAHARA, Yoshichika OKAMOTO, Saburo MITA, Hideo HAYAKAWA, Mi ...
    1999 Volume 60 Issue 5 Pages 1277-1282
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    Two cases of primary cancer of the jejunum preoperatively diagnosed by endoscopic biopsy are reported. Patient 1 was a 42-year-old woman presented with anemia. Diagnosis of primary cancer of the jejunum was made preoperatively. At operation a palliative gastrojejunostomy was performed because the tumor invaded the superior mesenteric artery and vein. The patient died of the cancer 3 months after the operation. Patient 2 was a 62-year-old man presented with ileus. Preoperative diagnosis was primary cancer of the jejunum. Partial resection of the jejunum with lymph node dissection was performed. The postoperative course was uneventful and the patient has been doing well one year after the operation. In these cases, X-ray examination of the small intestine and enhanced computed tomography (CT) of the abdomen were useful for detecting the existence of the tumor. And endoscopy and angiography enabled us to characterize the tumor. Defenitive diagnosis was obtained preoperatively with biopsy through an endoscope. Primary tumor of the small intestine lacks in specific clinical manifestations, and presents difficulty in early diagnosis. It this disease in suspected, small bowel X-ray examination and enhanced CT are needed to diagnose the existence of the tumor. Furthermore, small bowel cancers near the Treitz ligament and Bauhin should be evaluated by endoscopy.
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  • Motohiro ITO, Akio OHNISHI, Mutsuhiko YOSHITOMO, Masashi YAMAMOTO, Tsu ...
    1999 Volume 60 Issue 5 Pages 1283-1287
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    A rare case of adult reversed rotation presented with ileus on day 3 keeping supine position for a pelvic fracture is reported. A 68-year-old man was admitted to the hospital because of a traffic accident on October 26, 1997. The right iliac frature and retroperitoneal hematoma were observed and he took the supine position for the pelvic fracture. On day 3 after admission, he was performed the nasal intubation of an ileus tube due to sudden biliary vomiting. An abdominal CT revealed dilataion of second portion of the duodenum and dislocation of the small intestine toward the right side. On day 6, abdominal distention, muscle quarding in the right upper quadrant and hypotention were confirmed, and an emergency laparotomy was performed. Reversed rotation with malrotation was found existing the transverse colon behind the duodenum. And the third portion of the duodenum was fixed by a ligamentum like material from lower margin of the pancreas, and a transition of the jejunum showing flexion and obstruction was found. Release of the fixation and flexion, and an appendectomy were performed.
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  • Yoshitetsu KAWA, Shinobu KASUYA, Syoujirou MIYAZAKI, Tohru FUJITA, Yos ...
    1999 Volume 60 Issue 5 Pages 1288-1292
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    We present the case of calculus in a Meckel's deverticulum. A 67-year-old woman with a history of repeated attacks of lower back pain and vomiting several times a year was seen at the hospital because of lower back pain and vomiting. The patient was diagnosed with having intestinal obstruction by abdominal X-ray examination, and was admitted on the same day. After admission symptoms ameliorated following conservative treatment. Radiological enteroclysis and CT performed after symptomatic remission showed an abnormal shadow accompanied by polygonal calcification 2.5cm in diameter in the bowel, which was likely to be the ileum. Abdominal section performed to diagnose the intestinal abnormality revealed a projected diverticulum in a sac at a site 40cm towards the mouth from the terminal ileum. A foreign body was palpable within the lumen. There were no other abnormal findings such as stenosis or tumor of the small intestine. A section of the ileum about 5cm in range including the diverticulum was excised. The foreign body within the diverticulum was polygonal blackish brown stone with the size of 2.5×2.0cm and the thickness of 0.5cm, considered to be an intestinal stone. Histologically, the membrane of the diverticulum was ileal mucosa membrane. No findings of ectopic gastric mucosa nor malignancy was seen. Meckel's diverticulum containing an intestinal stone was diagnosed. We rarely encounter reports of Meckel's divertidulum containing an intestinal stone. This paper reports such a rare case together with some bibliographical comments.
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  • Hajime ORITA, Takeo MAEKAWA, Kiyotaka YABUKI, Koich SATO, Yoshihisa TA ...
    1999 Volume 60 Issue 5 Pages 1293-1297
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    A 35-year-old man was admitted to the hospital because of anal bleeding, abdominal pain, and frequent diarrhea. On admission, there were peritoneal sign. hyperleukocytosis, and ascites on an abdominal CT scan. An emergency operation was performed with a diagnosis of generalized peritonitis. During surgery, about 300ml of light yellowish and slightly muddy ascites and congestion and mild edema on serosa of the ileum covering about 45cm about 60cm oral side from the ileocecal region were noted. A partial excision of the ileum was performed. The excised material revealed five relatively shallow concave lesions, 5_??_7mm in diameter and small circule in shape. Histopathologic and immunohistochemical studies disclosed that the concave lesion were MALT lymphoma.
    MALT lymphomas of the small intestine are relatively rare, and the case of MALT lymphoma of the small intestine with ascites is presented together with some bibliographical comments.
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  • Masahide KAJI, Atsushi TSUNEDA, Katsuhiro YOSHIMOTO, Hisashi FUJII
    1999 Volume 60 Issue 5 Pages 1298-1301
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    In patients without previous history of undergoing abdominal surgery, primary volvulus with necrosis of the small intestine is rarely encountered disorder. Recently, we experienced such a case. A 31-year-old woman, teacher of the piano, was admitted to the hospital because of sudden onset of abdominal pain after having a midnight snack. There was tenderness in the entire abdomen. WBC was 9, 200/mm3 and CRP was 0.3mg/dl. Plain X-ray film of the abdomen revealed small intestinal gas and CT scan revealed a small amount of ascites and the thickness of the small intestinal wall. Symptomatic remission was attained by administration of analgesics. On the next day, she was operated on because a mass 10cm in diameter was felt at the right abdomen. At laparotomy, a bloody ascites was present and the gangrenous small bowel was found to be twisted by 540° with clockwise rotation around the mesenterium. A resection of the necrotic bowel and an end-to-end anastomosis were performed. Volvulus of the small intestine must be considered as a probable diagnosis when the patient presents with acute abdomen without any histories of undergoing laparotomy.
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  • Hideyuki ISHIDA, Masayuki TATSUTA, Kazuhiko HASHIMOTO, Seizo MASUTANI, ...
    1999 Volume 60 Issue 5 Pages 1302-1307
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    We experienced three cases of adult intussusception due to tumors of the small intestine. Case 1: A 52-year-old woman was seen at the hospital because of a lower abdominal pain. The patient was diagnosed as having an intussusception due to a tumor of the small intestine and was operated on. Histopathological examination of the tumor revealed myxoma. Case 2: A 58-year-old woman was seen at the hospital because of an upper abdominal pain. The patient was diagnosed as having an ileo-colic intussusception and was operated on. Histopathological examination of the tumor revealed gastrointestinal stromal tumor (GIST). Case 3: A 28-year-old woman was sees at the hospital because of a lower abdominal pain. The patient was diagnosed as having an intussusception and was operated on. Histopathological examination of the tumor revealed leiomyoma. In a recent one decade there have been no reports in Japan that myxoma or GIST caused an intussusception. These three cases are presented with a review of the literature.
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  • Hiroyuki YUASA, Hisao TAMAKI, Takayuki SANDA, Katsuhiro KAWAMURA, Naok ...
    1999 Volume 60 Issue 5 Pages 1308-1312
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    In this paper, we report a case of intestinal intussusception caused by a lipoma of the ileum in an adult, whose diagnosis was made preoperatively by ultrasonography (us) and computed tomography CT. A 67-year-old man was admitted to the hospital because of abdominal pain and anal bleeding. Physical examination revealed a hardmass in the right lower abdomen. The mass was movable, and with tenderness. Abdominal us showed a 1.6cm mass surrounded by hyperechoic and hypoechoic layers (multiple concentric ring sign). Abdominal CT showed a stratifotrm low density tumor surrounded by various concentric layers in the ascending colon. Barium enema showed a coiled spring sign in the ascending colon. Based on these results the diagnosis of intestinal intussusception of the small intestine caused by a lipoma was made. Upon laparotomy the diagnosis of intussusception of the smal intestine caused by a limpoma was made. Upon laparotomy the diagnosis of ileum-colon type antegrade intussusception was confirmed, and an ileal tumor of 1.5×1.5cm, located 60cm from the Bauhin valve was disclosed. A partial resection of the ileum was performed. The resected material showed a polypoid tumor 1.5×1.5cm in size. Histopathologic ally, it revealed typical features compatible with the diagnosis of benign lipoma.
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  • Naoyuki MIYAGUCHI, Kazuma FUKUDA, Hideyuki NISHI, Masayuki MANO, Shoki ...
    1999 Volume 60 Issue 5 Pages 1313-1316
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    A 17-year-old man was admitted to the hospital because of right lower abdominal pain. Since the patient did not respond to administration of antibiotics, an appendectomy was performed with a diagnosis of appendicitis. Histological findings of the appendix were compatible with Crohn's disease. However, further examination of the gastrointestinal organs showed no findings of Crohn's disease.
    Five months later, this patient was admitted again because of abdominal pain and bloody diarrhea. Colonoscopy revealed erythema, edematus and hemorrhagic mucosa in the orifice of appendix.
    We considered to be highly suggestive of recurrence of Crohn's disease and an liocecal-resection was performed. Histologically, this case was considered that Crohn's disease confined to the appendix might extend to the cecum. The patient has been recurrence-free as of 2 years after the operation.
    Crohn's disease confined to the appendix in relatively uncommon and presents difficulty in diagnosis. The rare case is presented, together with a reveiw of the literature.
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  • Kaori SHIGEMITSU, Tsuyoshi MATSUNO, Noriyuki KAMO, Tomoki YAMATSUJI, Y ...
    1999 Volume 60 Issue 5 Pages 1317-1321
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    A rare case of appendiceal mucocele causing an intussusception is reported. An 89-year-old woman was admitted to the hospital because of abdominal pain and vomiting. She was suspected to have an intussusception on abdominal ultrasonography (US) and computed tomography (CT), and a gastrographin enema revealed a typical ‘crab-finger’ finding in the hepatic flexure. Thereafter, the intussusception was spontaneously released. We could not identify any cause of the intussusception and followed the patient on an ambulant basis. Half a year later, she visited the hospital again because of right flank abdominal pain and was diagnosed as having intussusception caused by a cystic mass by abdominal CT and US. She had rebound tenderness and so we performed an emergency operation. Because the release of the intussusception was unsuccessful during surgery, a right hemicolectomy was performed. Even in the resected material, the intussusception could not be released manually. Histological diagnosis was mucinous cystadenoma.
    Abdominal ultrasonography and computed tomography are useful for the preoperative diagnosis of this desease and in a case of poor risk or when the patient shows the sign of peritonitis or intestinal necrosis, the opportunity of the operation should not be missed.
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  • Hiroki SHINKAWA, Takahisa FUJITA, Shuji NAKA, Toru NOJIRI, Takashi INO ...
    1999 Volume 60 Issue 5 Pages 1322-1326
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    A 12-year-old girl was admitted to the hospital with an 8-day history of abdominal pain, nausea and fever. High fever (40°C), marked leukocytosis (12, 700/mm3), and positive CRP (38.1mg/dl) were noted. On physical examination, the abdomen was distended with diffuse tenderness, rebound tenderness and muscle guarding. The maximal tenderness was elicitted in the right lower quadrant. An upright chest X-ray film revealed free air under bilateral diaphragms. Distended small bowel loops were seen on the abdominal X-ray films. There were no leakages of gastrografin on upper GI study. A diagnosis of perforated appendicitis with generalized peritonitis was made. An emergency operation was scheduled. Through a right lower paramedian incision the peritoneum was opened, revealing a considerable amount of purulent exudate which grew out E. coli on culture. Exploration revealed gangrenous appendix with perforation and abscess in the iliocecal area. Appendectomy and drainage of the peritoneal cavity was performed. The postoperative course was uneventful except for the wound abscess. The patient was discharged on the 32th post operative day.
    It is extremely rare that perforative appendicitis is associated with peritoneal free air, and only 39 cases (35 cases in the world and four cases in Japan) have been reported since 1960. Some bibliographical comments are also presented.
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  • Hidenori SUMIDA, Masahiko YAMAZAKI, Takehiro KATO, Koichiro NAKANO, Sh ...
    1999 Volume 60 Issue 5 Pages 1327-1331
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    A 32-year-old man was admitted to the hospital because of lower abdominal pain, fever, and watery diarrhea. Colonoscopic fiber revealed solitary small ulcer in the sigmoid colon. High level of CRP persisted. CT was performed with a suspicion of inflammatory lesion around the large intestine, when abscess like low density area (LDA) was demonstrated in the Douglas' pouch. Barium enema study visualized a leakage of constrast medium from the wall of the sigmoid colon into abdomen. The patient was diagnosed as having peritonitis due to perforation of diverticulitis and was operated on. During surgery, the large intestine, small intestine, and omentum formed a mass, and small nodules existed on entier the serosa of abdominal cavity that looked like peritonitis carcinomatosis. Further, a retention of serous ascites was present in the Douglas' pouch that was coincident with the LDA on CT. Perforation of the sigmoid colon was confirmed, and a partial excision of the sigmoid colon and a biopsy of the omentum were performed. Histological study revealed that serosal side inflammation was severe at the perforated site but almost no inflammation in mucosa side. In the biopsied omentum and perforated site, foreign body granulation associated wit fat necrosis was noted. Cytologic diagnosis, anaerobic culture, and tuberculous smear test of the ascites were negative. The high CRP level still persisted after the operation. On 59 th postoperative day, we were reported that a culture and identification test for tubercle baccillus resulted in positive and tuberculostatic therapy was started. The patient was discharged from the hospital 113 days after the operation.
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  • Takaho OKADA, Hiroyoshi MORITA, Akira KAGAMI, Toshihiko KURODA
    1999 Volume 60 Issue 5 Pages 1332-1335
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    We report a case of incomplete-type Gardner's syndrome in a 31-year-old man, who had a desmoid tumor on his back in association with adenomatous polyposis coli. There was a previous history of undergoing an excision for a desmoid tumor at the age of 20. This time, he complained of epigastralgia and was diagnosed as having polyposis coli by fiber colonoscopy. Some of the polyps were more than 3cm in diameter and histologically showed severe dysplasia. Genetic analysis indicated that the polyps were a C→A point mutation in codon 935 of APC gene-exon 15. Since cancer change can occur for the disease in a high rate when the patients become over 20 years old, this patients was thought to be a candidate for operation.
    He underwent a total colectomy, ileoanal anastomosis with J-pouch of the terminal ileum and diverting ileostomy (two-step operation). Since ileostomy closure, he has been doing well.
    Though he has no residual mucosa in the middle cuff of the rectum, further careful examination of the desmoid tumor will be needed.
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  • Tsutomu NAMIKAWA, Seiya NAKAMURA, Yuji KONDO, Kuniyasu YAMASHITA, Keij ...
    1999 Volume 60 Issue 5 Pages 1336-1340
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    A case of idiopathic perforation of the transverse colon is reported. A 79-year-old woman was referred to the hospital because of abdominal pain after taking a purgative medicine for constipation. On admission, there were severe tenderness in the upper abdominal region and signs of peritoneal irritation. Intraperitoneal free air was detected by abdominal X-ray film and computed tomography. Emergency operation was carried out under a diagnosis of perforating pertitonitis. Laparotomy findings revealed a punched out perforation 2 cm in size in the anterior wall of the transverse colon, and fecal materials in the omental bursa. After irrigation of peritoneal cavity with massive isotonic solution, a partial resection of the transverse colon including perforated portion was performed. Histologically no regenerative mucosa was seen around the perforated area, but sharp break off muscle layer, and neutrophil cell infiltration in the subserosal tissue were demonstrated. After the operation she was managed under artificial respirator assisted ventiration until 16 th postoperative day (POD) because of septic shock state, and discharged 84 th POD. On the occasion of an aged person's sudden abdominal pain, early diagnosis and early therapy should be performed bearing a possibility of idiopathic perforation of the colon in mind.
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  • Masahisa MATSUMOTO, Morito MARUTA, Koutarou MAEDA, Toshiaki UTSUMI, Ku ...
    1999 Volume 60 Issue 5 Pages 1341-1344
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    A clinicopathological features of suture line recurrence were studied in 337 patients who underwent curative resection for primary colonic cancer at the department between 1974 and 1996. Two patients had a suture line recurrence (0.6%) 3 and 16 months after the initial operation respectively. They were both female and 42 and 53 years old at the initial operation. Both primary tumors were located in the sigmoid colon. Surgical margin was 6 to 10cm in both cases. The primary cancer invaded beyond the colonic wall with positive nodes, slight to moderate lymphatic invation and no vessel invasion in each case. These cases were curatively resected at the initial operation. The local recurrence was considered to be originated from implantation metastasis of exfoliated cancer cells.
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  • Kazuya YAMAGUCHI, Masato URANO, Kazuhiro ISHIHARA, Satoru YAMAMOTO, Ch ...
    1999 Volume 60 Issue 5 Pages 1345-1349
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    A case of colonic cancer developed in a blind loop of sigmoidectomy which was performed 13 years before is reported with some discussion about six cases seen in the Japanese literature. An 84-year-old man, who had undergone a side-to-end colo-sigmoidostomy as a reconstruction for a cancer of the sigmoid colon in 1980. was seen at the hospital because of diarrhea in March, 1993. As a result of close examination, a colonic cancer developed in a blind loop was observed. Colectomy with the blind loop was performed. The patient has been doing well for five years after the operation without any recurrence signs.
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  • Nobuharu YANABU, Tomonobu SATO
    1999 Volume 60 Issue 5 Pages 1350-1354
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    A surgically treated case of villous tumor of the rectum is reported. A 58-year old woman was admitted to the hospital because of palpitation and general fatigue. Laboratory examination revealed hypokalemia and severe anemia. Barium enema and colon fiberscopy showed a large soft and cauliflower-shaped tumor occupying the pelvic space. A biopsy of the rectal tumor proved adenocarcinoma. We diagnosed the case as rectal villous tumor followed by cancer change and electrolyte deplesion syndrome (EDS). Although the cancer change of villous tumor occurs in a high rate, the size of tumors do not always reflect the depth of invasion to the rectal wall. So transanal endoscopic microsurgical excision (TEME) or surgical treatment such as local excision or bowl resection is precedentory employed for rectal tumors, except those being clearly suspicious of malignancy. It has been reported, however, that the recurrence rate after TEME or local excision is 17.5-50%, indicating the importance of surgical margin and periodic endoscopic observation of clinical course. In our case, abdominoperineal resection was performed because of its size and location. The postoperative course has been uneventful and EDS has been improved. Postoperative histological findings revealed well differentiated adenocarcinoma in all parts of the villous tumor.
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  • Yoshiro MATSUBA, Tohoru MURATA, Ken NIIMI
    1999 Volume 60 Issue 5 Pages 1355-1360
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    Tumor at the intestinal stoma site has been reported as one of the late complications of stomas. There have been very few reports about malignant tumors except adenocarcinomas originating from the colostomy site after abdominal-perineal resection for rectal cancer, and the ileostomy site after total colectomy for familial polyposis coli (FAP) or ulcertive colitis (UC).
    We present here an interesting case of squamous cell carcinoma at the colostomy site. The patient was a 58-year-old woman on hemodialysis chronically. She had been colostomised for atresia ani on the 21 st day after birth and colostomy had been reconstructioned because of ileus when she was 26 years old.
    Recently, granulation tissues were growing around her stoma site and she had been treated with electrocoagulation. After she was transferred to the hospital, a peristomal polypoid tumor appeared and grew to golfball size in about 10 months. Though we could not prove it malignant by a biopsy, the polypoid tumor easily bled and disturbed to use colostomy pouching systems. So it was resected under epidural anesthesia. Pathological diagnosis of the excised material was well differentiated squamous cell carcinoma. We speculated that the high carcinogenesis in the hemodialyzed patients and chronic irritation to the skin around the colostomy might participate in development of the tumor.
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  • Hiroshi AKIMOTO, Akira FUJIWARA, Masanao KOBAYASHI, Haruto NISHIMURA
    1999 Volume 60 Issue 5 Pages 1361-1365
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    Type IIIb liver injury by classification of Japanese association for the surgery of trauma is a most severe type of blunt liver injury and its prognosis is very poor compared with other types of injuries. We experienced a case of type IIIb liver injury which was successfully treated with a right hepatectomy and gauze packing, so-called staged laparotomy. A 28 year-old woman was injured by a traffic accident and a CT scanning showed a widespread liver injury in the right lobe with massive intraperitoneal hemorrhage. Hemodynamic state on admission was stable, but soon became unstable in the emergency room. Right hepatectomy was performed because of massive injured volume and no sign of coagulopathy. But after the hepatectomy, coagulopathy was revealed and gauze packing was immediately performed. In ICU, coagulopathy was improved but intraperitoneal bleeding continued, and 2nd laparotomy was decided for intra-abdominal hypertension. In the 2nd laparotomy, the hemorrhage from the stump of the liver was almost controlled that demonstrated the effectiveness of Gauze packing. Staged laparotomy with gauze packing is recommended for the treatment of severe blunt liver injury from the standpoint of damage control surgery. Staged laparotomy was very effective for our case but early gauze packing before coagulopathy might be more effective.
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  • Takafumi HAYASHI, Takashi SAWATA, Tetsu SHIMIZU, Yoshihiro KAWAMURA, K ...
    1999 Volume 60 Issue 5 Pages 1366-1369
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    A 60-year-old man, who suffered from non-treated diabetus mellitus, admitted to the hospital because of fever and nausea. Abdominal CTscan and ultrasonography (US) revealed gas-containing liver abscess localized in the lateral segment of the liver. Systemic administration of antibiotics did not improve the condition of sepsis and DIC, and US guided percutaneous transhepatic abscess-drainage (PTAD) was unsuccessful because of multiple septa formation in the abscess cavity. Emergency lateral segmentectomy of the liver including the abscess cavity 10×9×5cm in size and a cholecystectomy were performed. After operation, the patient responded fairly well to therapies; sepsis and DIC gradually improved and blood sugar level became controllable by insulin. Emergency hepatectomy for gas-containing pyogenic liver abscess is a good indication in the case of which liver abscess difficult to be drained with PTAD due to multiple septa formation.
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  • Toshio UEMATSU, Hiroshi KITAMURA, Masanori IWASE, Shingo KUZE, Futoshi ...
    1999 Volume 60 Issue 5 Pages 1370-1374
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    A 75-year-old woman was seen at the hospital because of sudden onset of abdominal pain. Tenderness and rebound tenderness were noticed on the abdomen, but muscular rigidity was lacked. Computed tomography showed massive hepatic portal venous gas in the left lobe of the liver. On emergency laparotomy, there was no necrotic bowel. A small segment of the ileum that was edematous and slightly hyperemic was found. A postoperative follow-through study of the small intestine showed thumbprinting in the ileum. We diagnosed this case as suffering from transient ileal lesion without definitive diagnosis.
    Hepatic portal venous gas is a complication that is commonly observed in cases with bowel necrosis and is deemed a stigma of poor prognosis. Emergency operation is usually thought to be performed. However, hepatic portal venous gas has been also reported in cases lacking bowel necrosis like this case. Patients with hepatic portal venous gas are not always candidates for operation. In the case of hepatic portal venous gas with bowel necrosis, emergent laparotomy should be performed. If a possibility of bowel necrosis can not be ruled out, operation preceded by laparotomy should be performed. The introduction of laparoscopy may be useful not only for making the early diagnosis of the bowel necrosis but also for eliminating negative laparotomy.
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  • Hiroshi KOMODA, Yasuhiro TANAKA, Masaharu HONDA, Masanori HOUKI, Tetsu ...
    1999 Volume 60 Issue 5 Pages 1375-1379
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    We report a case of rhabdomyolysis associated with a continuous infusion of vasopressin (VP) used in the treatment of acute gastrointestinal bleeding.
    A 68-year-old man with alcoholic liver cirrhosis was admitted to the hospital because of massive anal bleeding. Endoscopy showed no active bleeding site in the esophagus, stomach, duodeum and colon. Bleeding from the small intestine was suspected and an open laparotomy was performed. During surgery, no bleeding point was found and portal vein pressure was 30mmHg. After the operation, gastrointestinal bleeding continued, and a continuous intravenous VP infusion was started at a rate of 0.2U/min. Ten hours after administration of VP, skin mottling in the lower extremitis were noted. The serum myoglobin level was 17, 100ng/ml. Rhabdomyolysis due to VP was diagnosed, and the VP infusion was suspended. But because of exacerbation of the gastrointestinal bleeding, VP infusion was resumed at a rate of 0.1U/min. Transjugular intrahepatic portosystemic shunt (TIPS) was performed and portal vein pressure was markedly reduced after TIPS. But the skin mottling extended to the truncus. The patient died of multiple organ failure and sepsis.
    As far as we could review, only seven cases of rhabdomyolysis associated with a continuous infusion of vasopressin have been reported.
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  • Akihiko TACHIBANA, Naoto FUKUDA, Tatsuo YAMAKAWA, Kunihiko KIRA, Takem ...
    1999 Volume 60 Issue 5 Pages 1380-1383
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    An asymptomatic 68-year-old man who had been pointed out cholecystolithiasis at the age of 65 was admitted to the hospital for close examination of the gallbladder. Abdominal ultrasonography (US) revealed multiple stones of the gallbladder and a left adrenal tumor lesion, measuring 27mm in diameter. This tumor had no enhanced effect at CT scan. MRI revealed a high signal tumor at both T1 and T2 weight imagings. With the diagnosis of cholelithiasis and the left adrenal tumor, a cholecystectomy and a left adrenalectomy were carried out. The section of the excised tumor was mainly dark reddish in color with a yellowish part within it. Histologically, the tumor was composed of bone marrow elements and mature fat cells other than adrenal components. Pathological diagnosis of the tumor was adrenal myelolipoma. A review of the literature on the adrenal myelolipoma, a rare non-functioning benign tumor, is also presented.
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  • Yoshinori SUZUKI, Mitsuru DOHKE, Fumitaka NAKAMURA, Kyosuke MIYAZAKI, ...
    1999 Volume 60 Issue 5 Pages 1384-1388
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    It is relatively uncommon that rectal cancer metastasizes to the ovary. This time we experienced a case of rectal cancer with bilateral ovarian cancer which were resected on an one-step approach.
    A 42-year-old woman was seen at the hospital because of abdominal tumor and constipation. Abdominal echography revealed a large cystic tumor in the right ovary. As to tumor markers, CEA and CA 125 were as high as 1, 000ng/ml and 79U/ml respectively and a malignant tumor of the digestive system was suspected. Barium enema study revealed apple core sign in the rectum. Abdominal CT scan and MRI revealed a large cystic tumor in the right ovary. With a suspicion of metastatic ovarian tumor from rectal cancer or primary ovarian tumor, low anterior resection for the rectal cancer, bilateral oophorectomy and uterectomy were performed simultaneously. Postoperative course was uneventful. Histological grading of the rectal cancer was se, ly1, v1, n1, P2, H0, and stage IV. Histological diagnosis of the resected specimen material of the rectum was well differentiated adenocarcinoma and not only the right ovary but also the left ovary had metastatic foci from the rectal cancer.
    It is considered that bilateral oophorectomy should be performed when metastatic ovarian tumor of rectal cancer is diagnosed, because bilateral ovarian metastases can occur in a high rate.
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  • Takehiro OKABAYASHI, Shinichi HAMADA, Takeki SUGIMOTO, Michiya KOBAYAS ...
    1999 Volume 60 Issue 5 Pages 1389-1392
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    We recently experienced a case of abdominal leiomyosarcoma which was preoperatively diagnosed as mesosigmoid origin. A 66-year-old woman was admitted to the department because of a lower abdominal mass. A computed tomography revealed a large solid mass and angiographically it's localization was detected as mesosigmoid. We performed an extirpation of the mass with segmental sigmoidectomy. The tumor was diagnosed as leiomyosarcoma with the pathological and immunohistochemical evaluation.
    Leiomyosarcoms originated in the mesenterium are rare, and so far 54 cases have been reported in the Japanese literature including ours.
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  • Masaho OTA, Tomomitu KIKUCHI, Kyosuke SHIGEMATSU, Hideo KATSURAGAWA, K ...
    1999 Volume 60 Issue 5 Pages 1393-1397
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    A 70-year-old woman was hospitalized with signs admitted to the hospital because of abdominal pain and vomiting. Abdominal radiograph demonstrated giant gas lesion in her pelvic cavity. Barium enema study showed a stenosis of the sigmoid colon, cavity of which consistent with the giant gas lesion in the radiograph in oral side of the stenosis, and a leakage into the abdominal cavity as well. Three hours after admission, an exploratory laparotomy was performed because of peritoneal stimulant sign and shock. Ascites with stool smell was found in the abdominal cavity. An infant head size mass was found in the sigmoid mesentery, and a cancer of the sigmoid colon was pointed out in this anal side. Hartmann's operation was pesformed. Histological findings showed pT3 well differentiated adenocarcinoma in the mesenteric side, and penetration of intramesenteric abscess 5.5cm in diameter from oral side of the tumor at a distance of 2cm. There was nonspecific acute inflammation between the tumor and the hole continuously. About 1, 000ml of pus was found in the intramesenteric abscess. It is rare that intramesenteric abscess occurred by penetration of the colon. We think it is necessary to distinguish this disease from others in case of abdominal pain without peritonitis, and pyrexia with abnomal findings of liver and billary tract.
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  • Taizen URAHASHI, Katumi YOSHII
    1999 Volume 60 Issue 5 Pages 1398-1401
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    Spigelian hernia is considered an uncommon spontaneous hernia of the abdominal wall. We report a case of Spigelian hernia with incarcerated small bowel and greater omentum. A 63-year-old woman was admitted to the hospital because of a right lower quadrant mass and pain. The abdominal findings showed a 15×10cm sized tender mass. CT scan of the abdomen showed the mass lateral to the linea semilunaris and contained loops of small bowel. The palient was diagnosed as having a Spigelian hernia with incarcerated small bowel and underwent an emergency surgical repair. We found herniated small bowel and greater omentum under the linea semilunaris. The hernia orifice was 2×2cm in size and was closed with interrupted suture. The patient was discharged foon the hospital 10 days later. There has been no recurrence as of 13 months after the operation. Spigelian hernia presents difficulty in presperative diagnosis because of its rarity, nonspecific symptoms and only a limited knowledge of this disease. We should consider this disease as a probable differential diagnosis for patients with an abdominal mass and pain. Liberal the most use of abdominal sonography and CT scan may allow to make the preoperative diagnosis.
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  • Terutoshi YAMAOKA, Shinsuke MII, Akira MORI, Hisanobu SAKATA
    1999 Volume 60 Issue 5 Pages 1402-1405
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    A 46-year-old man was admitted to the hospital because of coldness of the foot and toe. There was previous histories of undergoing a femoro-infrapopliteal bypass grafting with a reversed autogenous saphenous vein for Beuger disease of the right lower limb 8 years before, and of being diagnosed as having an asymptomatic graft aneurysm one year before admission which was followed without surgical treatment. This time, his symptom were caused by emboli from an intraluminal floating thrombus formed in the graft aneurysm. Finally patient underwent an alteration of femoro-popliteal bypass with a new reversed saphenous vein. Chronic outforce at the knee junction might cause the graft aneurysm in this rare case.
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  • Toshihiko ICHIHARA
    1999 Volume 60 Issue 5 Pages 1406-1408
    Published: May 25, 1999
    Released on J-STAGE: January 22, 2009
    JOURNAL FREE ACCESS
    Blunt injury of the artery due to compressed trauma is uncommon, especially localized dissection of the artery in the lower limb without open fracture and remarkable skin change. Recently we experienced a case of locally dissected obstruction of the left popliteal artery due to a compressed trauma.
    A 65-year-old man hit by the shovel car in the left of the knee. His left knee was compressed between the ground and the shovel. When he was seen at the hospital, arteries under the left popliteal artery were pulseless and he complained of cold sensation. He had fissured fractures of the peroneotibial bones, but there were no open wounds and the skin was clean.
    Angiography revealed locally dissected obstruction of the left popliteal artery. An orthopedic treatment was only fixation. Therefore an emergency popliteal artery reconstruction was perforned which was bypass operation with autologous saphenous vein graft. The postoperative course was uneventful successful patency of the graft. This emergency bypass operation for dissected obstruction of the popliteal artery which was thought uncommon is reported here.
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