We report a case of femoral hernia caused by an impacted tumor due to omental actinomycosis.
An 81-year-old woman with one-month history of right inguinal swelling was seen at the hospital because of right inguinal pain, swelling, and redness in May 2002. Abdominal plain CT scan visualized a relatively demarcated tumor 3cm in diameter in the subcutaneous tissue at the right inguinal region. Incarceration of right femoral hernia was diagnosed, and an emergency operation was performed. Surgery identified right femoral hernia in which the greater omentum was incarcerated and the incarcerated portion formed a mass with the size of sparrow's egg. A small quantity of pus was confirmed there. After the operation, omental actinomycosis was histopathologically diagnosed. Since the postoperative 4^th day, redness and swelling at the surgical wound became worse and serous exudates increased so that antibiotics were changed, with a favorable outcome. Thereafter administration of minocycline hydrochloride was maintained for 3 months. There have been no signs of recurrence up to now.

View full abstract

A 58-year-old woman who had underlying disease of neurogenic bladder caused by treatment for uterine cancer with resultant chronic renal failure was seen at the hospital because of a fever of 39°C and abdominal pain. There was muscle guarding in the entire abdomen and diffuse peritonitis was noted. Hematological study revealed serious inflammatory reaction, renal failure and metabolic acidosis. Abdominal CT scan visualized the dilated bladder, bilateral hydroureter, and bilateral hydronephrosis; right side dominant ascites and free air in the abdomen; and air image in the right dilated renal pelvis and bladder. Paracentesis of ascites yielded only contamination without digenstive juice, and hence emphysematous peritonitis secondary to emphysematous urinary infection was diagnosed. We did not employ laparotomy, and successfully managed by conservative therapy with antibiotics.
Although peritonitis, a primary peritonitis without intraperitoneal abnormalities can occur, in which chemotherapy constitutes therapy of first choice and the diagnosis is difficult. This is a rare case in which we were able to diagnose as the disease based on both peritoneal and urinary emphysemas and to treat conservatively.

View full abstract

Primary torsion of the greater omentum is a relatively rare entity disease, and we have great difficulty in diagnosis this disease preoperatively. This paper presents a case of the disease diagnosed preoperatively. A 28-year-old man was admitted to the hospital with a 5-day history of progressive pain in the right lateral abdomen. While he was observed with conservative treatment, abdominal pain and laboratory data were aggravated. Abdominal helical CT scan on the 4th hospital day disclosed characteristic whirled sign by the animated imaging. Emergency operation was performed under a diagnosis of torsion of the greater omentum. On laparotomy, the necrotic omental mass twisted counter-clockwise by single turn and bloody ascites were observed. We resected the necrotic part of the omentum. The patient's postoperative course was uneventful. Of reviewed 87 cases in the Japanese literature including our case, most of the patients were operated on with the diagnosis of appendicitis. Only five patients were correctly diagnosed preoperatively on CT scan of the abdomen. Torsion of the omentum should be considered and meticulous observation of CT scan is needed in a patient with suspected appendicitis.

View full abstract

A 73-year-old woman followed in the gynecological clinic after surgery for carcinoma of the uterine cervix was found to have an elastic hard, poorly movable tumor without tenderness in the entire abdomen. The patient was referred to us for close exploration and treatment. Abdominal CT scan and abdominal angiography showed a solid, segmental, and demarcated tumor about 20×16×8 cm in dimension in the abdominal cavity which were fed by the bilateral gastroepiploic arteries. Tumor makers including CEA, CA19-9, and SCC were in normal ranges. With a suspicion of a tumor, especially sarcoma of the greater omentum, embolization of the bilateral gastroepiploic arteries and an excision of the tumor were performed. The excised material was 16×19×10 cm in dimension, and 1.5 kg in weight. With pathological and immunohistological findings, a possibility of GIST was ruled out and leiomyosarcoma of the greater omentum was diagnosed. There have been no signs of recurrence as of 18 months after the surgery.

View full abstract

We report a rare case of primary carcinoid tumor of the mesentery. A 73-year-old woman with early stage sigmoid colon carcinoma was seen at the hospital because of close examination before operation. Abdominal CT scan revealed a tumor measured 3.5cm in diameter at the right lower quadrant of abdomen. Magnetic resonance imaging scan revealed a solid mass that moved in the position in comparison with CT finding. On a contrast ileography, there was no tumor or stenosis in the small intestine. A mesenteric tumor was suggested and a laparotomy was performed. The tumor was about 4cm in diameter in the mesentery at the ileocecal region without invasion to circumference and was separated from the gastrointestinal tract. There were no abnormal findings in the ileum and cecum and no lymph node swelling in the mesentery near the mass. Extirpation of the tumor was performed easily. Pathologically, the tumor was diagnosed as carcinoid tumor, and tumor cells were positive on immunohistochemical stainings such as neuron specific enolase and chromogranin. On a thoracic CT scan after the operation, no mass image was revealed in the lungs or mediastinum. Therefore, this tumor was diagnosed as primary carcinoid tumor of the mesentery.

View full abstract

Chordoma is a comparatively rare malignant tumor arising from remnants of the notochord. A 66-year-old man was admitted to the hospital because of a tumor of the sacral region. The tumor was elastic hard. The patient had no tenderness. A abdominal CT and magnetic resonance imaging scans visualized a tumor 12cm in diameter extending from the coccyges to pelvic cavity. It was diagnosed as chordoma by biopsy. An extirpation of the tumor with the fifth sacrum was performed. On pathologic examination, there were no tumor cells on the surgical margin and no sacrum invasion. No neurological disfunction occurred after the operation.

View full abstract

A 24-year-old woman was admitted to the hospital because of abrupt onset of dyspnea, abdominal pain and vomiting. She had been diagnosed as having Cornelia de Lange syndrome in her early childhood. After admission Bochdalek hernia was diagnosed and she was operated on. At first, we approached via laparoscopy, but it was difficult to return the escaped organs, and we changed to laparotomy. After repositioning the escaped organs, the hernia gate was closed with mesh. The postoperative course was uneventful and she was discharged from the hospital 17 days after the operation.
Cornelia de Lange syndrome is a congenital malformation of unknown origin and the patients often die in their childhood. So far no cases of Bochdalek hernia with Cornelia de Lange syndrome in adults have been reported in Japan. We report this first case in Japan with some bibliographical comments.

View full abstract

This report describes a rare case of right axillary vein thrombophlebitis induced by central venous catheter (CVC) in a 24-year-old woman undergone a right hemicolectomy for advanced cecum adenocarcinoma. For adjuvant chemotherapy, CVCs were inserted and replaced via the right subclavian vein once a month for four months. Thereafter IVH reservoir was inserted via the same vein and 5 courses of chemotherapy was started in the outpatient clinic. On the 5th course her right upper limb changed edematous with a feeling of compression. Computed tomography (CT), magnetic resonance imaging (MRI), and venography offered a diagnosis of large thrombus and thrombophlebitis in the right axillary vein. The IVH reservoir was immediately removed and thrombolytic therapies were begun. With these treatments her symptoms disappeared within 10 days. There is a risk of causing thrombosis and thrombophlebitis all the while CVCs are inserted and placed. Prompt and proper treatments are necessary for thrombosis and thrombophlebitis induces by CVCs.

View full abstract

We report a case of aggressive angiomyxoma growing into the pelvic cavity massively. A 36-year-old woman was admitted to the hospital because of abdominal massive tumor. Pelvic CT scan, magnetic resonance imaging and angiography revealed that the tumor occupied the entire pelvic cavity, and resultantly the uterus, bladder and rectum were remarkably oppressed. For suspected myxoid liposarcoma, we performed an operation. Resected specemen was 34×21 cm in diameter with smooth surface and gelatinous appearance. Postoperative pathological examination revealed aggressive angiomyxoma.
Aggressive angiomyxoma is uncommon. In Japan, about 30 cases have been reported in the last 15 years. Most patients presented with a genital or perineal mass. The case wihout symptoms at these regions and growing into the pelvic cavity is rare. We report the case with some bibliographical comments.

View full abstract