Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)
Online ISSN : 1882-5133
Print ISSN : 1345-2843
ISSN-L : 1345-2843
Volume 71, Issue 6
Displaying 1-50 of 56 articles from this issue
Memorial Lecture
Original Article
  • Shin OGUMA, Junko IZAI, Yoshihiro MORIGUCHI, Yukiko TAKATSU, Yoji ANAM ...
    2010 Volume 71 Issue 6 Pages 1413-1422
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    The present study reported the evaluation of modified ultrasound-guided segmental anesthesia, which had been modified from the conventional method, in combination with propofol (modified anesthesia) for kugel inguinal hernia repair. In all, 116 adult patients with inguinal hernia underwent kugel herniorrhaphy under the modified anesthesia. Of the 116 patients, 14 (12.1%) required additional analgesics mainly during the dissection of the peritoneum or the hernial sac. Of the 88 patients who were anesthetized in combination with an occasional scatter of sufficient 0.5% lidocaine into the preperitoneal space, with attention paid to the gentle and careful manipulation in the latest 22 months, 84 (95.5%) could undergo all the procedures only under the modified anesthesia, without requiring any other kind of analgesics such as laughing gas or fentanyl. In conclusion, our modified anesthesia method is safe, simple, and minimally invasive and can be effectively used for kugel herniorrhaphy, especially in the case of day surgery.
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Case Reports
  • Takeshi MIYAMOTO, Masayuki KIMURA, Toru FUKUNAGA, Yuji SUGAMOTO, Mari ...
    2010 Volume 71 Issue 6 Pages 1423-1428
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    A 69-year-old female visited our hospital with blindness in the right eye. She had a tumor in the Turkish saddle. The tumor was resected by a neurosurgeon. Pathological examination confirmed that the tumor had metastasized from breast cancer. She had a history of right breast carcinoma without any metastasis till then. Whole body examination revealed that there was no metastasis other than the Turkish saddle tumor. She received hormonal therapy with aromatase inhibitor but no radiotherapy for the Turkish saddle tumor. The tumor relapsed and caused epilepsy. The patient died from suffocation. Autopsy revealed that the metastasis was solitary.
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  • Kiyoshi SHINGU, Osamu SENGA, Manabu HIRAGURI, Naoto HORIGOME, Gengo KA ...
    2010 Volume 71 Issue 6 Pages 1429-1433
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    A 52-year-old female was found to have a breast mass pointed on mammography screening. A firm mass, 8 cm in diameter, was palpated in her right breast. Fibroadenoma or phyllodes tumor was suspected on imaging ; an inadequate specimen was obtained on fine needle aspiration. Since malignancy could not be ruled out, a tumor resection was performed. Macroscopically, the tumor was elastic/firm, and well-defined. The cut surface was white, homogenous, and solid. On histology, the tumor consisted of collagenous stroma that contained markedly decreased or atrophic ductal and lobular elements. Based on these histologic findings, a fibrous tumor was diagnosed. The postoperative course was uneventful, and her breast had a cosmetically acceptable result. Fibrous tumor is a rare breast disease and is classified into a subtype of fibrous diseases as tumor-like lesions based on the “General rules for clinical and pathological recording of breast cancer”, 16th edition, published by the Japanese breast cancer society. A diagnosis of a fibrous tumor should be considered in patients with a large mass.
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  • Koji SATO, Yasuhiro SUZUKI, Shigeo YAMAZAKI, Takeshi OKAYASU, Masao HO ...
    2010 Volume 71 Issue 6 Pages 1434-1439
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    We present the case of a 34-year-old male who developed a bronchogenic cyst in the right side of the neck due to frequent infection. Drainage or antibiotic treatment failed to prevent recurrent infection. He was referred to our hospital for examination. Preoperative examination revealed fistula to the trachea, and we strongly suspected a cervical bronchogenic cyst. Surgery and histopathological evaluation confirmed the presence of the bronchogenic cyst. There was no evidence of recurrence for 2 years. Cervical bronchogenic cyst with tracheal fistula has been rarely reported.
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  • Yasushi IWASAKI, Katsuhiko NISHIYAMA, Satomi DEGUCHI, Masatoshi KAWATA
    2010 Volume 71 Issue 6 Pages 1440-1444
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    A 79-year-old man developed palpitations on exertion ; severe anemia was found on blood testing. A diagnosis of autoimmune hemolytic anemia was made, and the patient was treated with prednisolone. A chest X-ray and chest CT revealed a solid tumor, 4.9 cm in size, located in the right lung. On histology, the transbronchial lung biopsy specimen showed evidence of pulmonary squamous cell carcinoma. A right lower lobectomy was successfully performed without the need of a blood transfusion since the patient's AIHA was well-controlled with prednisolone treatment. In this case, AIHA was considered to be part of a paraneoplastic syndrome that was related to the lung cancer.
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  • Takashi MURAKAMI, Nobuyuki KAMIMUKAI, Taketo SAITO, Susumu HIRANO, Tad ...
    2010 Volume 71 Issue 6 Pages 1445-1450
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    An 85-year-old man was referred to our hospital because of constipation and abdominal pain. On admission, he showed no abdominal tenderness, but blood tests showed a mild inflammatory reaction, elevated escape enzyme levels, and metabolic acidosis. An abdominal contrast computed tomography (CT) scan showed herniation of the small intestine into the right thoracic cavity from the posterior surface of the right hepatic lobe, which was atrophic. The finding of a reduced contrast effect and thickening of the wall of the herniated small intestine led to the diagnosis of incarcerated hernia of the right diaphragm with strangulation ileus. The patient, therefore, underwent emergent surgery. Surgical findings confirmed the presence of an oval hernial orifice with a diameter of 3 cm in the right posterior surface of the diaphragm. Because the ileum was incarcerated in the hernia orifice, the diagnosis of right-sided Bochdalek hernia was made. The ileum was necrotic over an area of 45 cm in length and was surrounded by a bloody pleural effusion. Therefore, partial resection of the necrotic ileum was performed, followed by right thoracic drainage, and the hernial orifice was closed by suture. Remission was achieved, and the patient was discharged on the 12th day after surgery. Right-sided Bochdalek hernia is rare in adults. Here, we report our experience with a single case of right-sided Bochdalek hernia, which occurred in an elderly patient secondary to strangulation ileus.
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  • Keisuke HARADA, Takayuki NOBUOKA, Daisuke KYUUNO, Fukino SATOMI, Tomoh ...
    2010 Volume 71 Issue 6 Pages 1451-1456
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    An adult Bochdalek hernia is a rare clinical condition. A 74-year-old woman was admitted to our hospital because of left chest pain and appetite loss. A chest x-ray revealed elevation of the left diaphragm and a gastrointestinal gas image in the left lower thorax. Computed tomography (CT) revealed incarceration of the stomach, greater omentum, and spleen into the left lower thorax. The patient was diagnosed as having a Bochdalek hernia. She was treated by laparoscopic surgery. The hernial contents were reduced into the abdominal cavity, and the adhesions between the hernia hilus and the incarcerated organs were detached. Finally, the diaphragmatic defect was covered with a composite mesh. The patient was discharged on the 19th postoperative day without any complications. At 8 months after the operation, the patient remained asymptomatic. Laparoscopic composite-mesh repair is a safe and less-invasive treatment method for diaphragmatic hernia.
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  • Hideaki TSUBAKIHARA, Hiroyuki TANISHIMA, Takehiro TSUJIMOTO, Koji TAMA ...
    2010 Volume 71 Issue 6 Pages 1457-1461
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    A 43-year-old female was found to have an abnormal shadow on chest X-ray. The chest X-ray showed a shadow protruding upward in a tent-like shape from the right diaphragm ; on abdominal CT and MRI, a tumor was observed between the right diaphragm and the liver surface—fat was present in the tumor. The primary tumor site was thought to be either the diaphragm or the liver, and to be mainly composed of fat. Since the tumor was found to enlarge over two years, and malignancy could not be ruled out, the tumor was resected laparoscopically. Based on the perioperative findings and the histopathological findings of the resected specimen, the tumor was diagnosed as a lipoma originating in the diaphragm. Diaphragmatic lipoma is extremely rare, and only 12 such cases, including the present case, have been reported in Japan. We herein report the findings of this case and review the relevant literature.
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  • Koichi KUBOTA, Tomohiro TANAKA, Shinichiro KOKETSU
    2010 Volume 71 Issue 6 Pages 1462-1466
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    Anaphylactoid purpura (AP) is vasculitis with immune complex deposition, which mainly contains IgA antibody. AP mainly develops in children. It has been rarely reported in adults and is sometimes complicated with severe renal disfunction.
    A 75-year-old woman developed wound infection with methicillin-resistant sraphylococcus aureus (MRSA) after undergoing surgery for the resolution of postoperative ileus in esophageal cancer ; after 2 days she had abdominal pain and fever. Her condition improved after receiving wound treatment, but she simultaneously developed purpura in bilateral legs. She was diagnosed with AP on the basis of clinical information and immunological and serological data. After bed rest and treatment with hemostatic agents, her AP was resolved. However, subsequently, AP recurred and progressed to purpura nephritis complicated with nephrotic syndrome. Her condition became stable after receiving steroid pulse therapy.
    We had some reports of adult AP case as dermadrome, but a few reports of postoperative AP. The cause of AP in our case was wound infection with MRSA, under general condition with the background of malignant disease and operative damage.
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  • Takeshi KOJIMA, Masahumi KATAOKA, Takashi KUISE, Tuyoshi OKADA, Takuro ...
    2010 Volume 71 Issue 6 Pages 1467-1470
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    A 67-year-old man was operated on due to the presence of early esophageal cancer and early gastric cancer in November 2004. On postoperative pathology, a moderately differentiated squamous cell carcinoma of the esophagus with an invasion depth of m3 (mm), and a well-differentiated adenocarcinoma of the stomach with an invasion depth of m was diagnosed. No metastases to the mediastinal or abdominal lymph nodes were noted. In the 30th postoperative month, left axillary lymphadenopathy was found ; a poorly differentiated squamous cell carcinoma was diagnosed on biopsy. No other lesions were found anywhere else ; therefore a left axillary lymph node dissection was performed since a localized carcinoma of the left axillary region was suspected. No radiation therapy or chemotherapy was given. The patient has been followed for about 30 months after the lymph node surgery ; no recurrence has been detected. It is very rare that an early esophageal cancer patient develops an isolated axillary nodal metastasis.
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  • Yoshihiko KAWAGUCHI, Koji KONO, Fumihiko MITSUI, Hideki FUJII
    2010 Volume 71 Issue 6 Pages 1471-1476
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    Case 1 was a 79-year old man, who on CT was found to have a gastric volvulus. Decompression with a gastric tube was successful. However, on endoscopy, ischemic changes were found in the stomach. Thus, a total gastrectomy was emergently performed ; during surgery, a mesenteroaxial gastric volvulus was observed.
    Case 2 was a 79-year old woman, who on CT was found to have a gastric volvulus. Decompression with a gastric tube was successful. No ischemic changes were noted in the stomach on endoscopy ; however, endoscopic repositioning of the gastric volvulus was unsuccessful. Thus, emergent operation was performed, in which the mesenteroaxial gastric volvulus and an incarceration into a hiatal herniation were found ; the stomach was repositioned.
    In general, CT is useful for diagnosing gastric volvulus. With respect to treatment, after decompression with a gastric tube, endoscopy should be performed to identity ischemic changes and to endoscopically reposition the volvulus. If ischemic changes are observed, or endoscopic repositioning is unsuccessful, emergent operation should be performed.
    Gastric volvulus is rare. The treatment algorithm described above is useful for achieving a successful result.
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  • Takeshi FUJISHIRO, Takashi AKAI, Yoshihiro NABEYA, Hiroshi KAWAHIRA, H ...
    2010 Volume 71 Issue 6 Pages 1477-1482
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    A 75-year-old woman consulted a neighboring doctor because of epigastric pain and weight loss of 7kg. Gastroendoscopy showed narrowing of the antrum and pylorus with edematous mucosa, and a mucosal biopsy resulted in Group IV. She was admitted to our hospital for further examination and treatment. Since it was difficult to rule out a possibility of malignancy and severe symptoms had still remained, an operation of distal gastrectomy with Roux-Y reconstruction and lymph nodes dissection (D2) was performed. The postoparative histopathological diagnosis was eosinophilic gastroenteritis of the stomach. Nodules on the anterior surface of the pancreas which was suspected of peritoneal dissemination of gastric cancer during surgery were clarified to be hyperplasia of pancreatic β cells.
    Generally, eosinophilic gastroenteritis is a rare disease of unknown inflammatory etiology characterlized by eosinophilic infiltration of the total gastrointestinal tract. One of the characteristic clinical feature of this disease is peripheral eosinophilia, elevated serum immunoglobulin E, but this case showed no evidence of these findings in preoperative examinations. To the best of our knowledge, this is the 12th case report of eosinopilic gastroenteritis with gastric operation to be documented in Japan from 1983 to 2009.
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  • Toru SAITO, Satoshi NOZAWA, Hiroyuki NAGAI, Toshiaki IWASE, Kensuke SU ...
    2010 Volume 71 Issue 6 Pages 1483-1486
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    We report a rare case of primary gastric lymphoma with spontaneous perforation. A 67-year-old woman was admitted to our hospital with a complaint of abdominal pain. Abdominal computed tomography revealed free air and ascites around the stomach. We conducted an emergency surgery and found a 10 mm perforation in the lesser curvature of the lower portion of the stomach. In addition, a hard mass was attached to the perforated area. We thought this was a gastric tumor and performed distal subtotal gastrectomy. The resected tumor measured 8.5 × 6.0 mm in size. Pathohistological diagnosis was malignant lymphoma of diffuse large B-cell type. The patient was administered adjuvant chemotherapy (CHOP) after the operation. The patient showed good recovery with no signs of recurrence.
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  • Kimihiro IGARI, Masato NISHIZAWA, Arihiro AIHARA, Takanori OCHIAI, You ...
    2010 Volume 71 Issue 6 Pages 1487-1491
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    A 54-year-old man was admitted to our hospital for epigastric discomfort. Upper gastrointestinal endoscopy revealed giant folds and ulcers in the upper and middle third of the stomach. Histologic analysis revealed T-cell type malignant lymphoma. Computed tomography and gallium scintigraphy showed no lymph node swelling or metastasis to other organs, except to the lymph nodes around the stomach. We performed total gastrectomy and splenectomy with D2 lymph node dissection, and the patient was completely cured. The patient was diagnosed with primary gastric T-cell lymphoma. T-cell type malignant lymphoma of the stomach is very rare and no treatment strategy has been established thus far. Further accumulation of cases might help in establishing a treatment for this condition.
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  • Hiroki MURAKAMI, Chie TANAKA, Yasuhiro KODERA, Akimasa NAKAO
    2010 Volume 71 Issue 6 Pages 1492-1495
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    The patient was a 72-year-old man who had a total gastrectomy and splenectomy for gastric cancer 1 year earlier (T3, N2, H0, P0, CY1. M0, and stageIV). He received chemotherapy after surgery. He complained of left chest pain of one week's duration. The skin covering his left chest was edematous. Chest CT revealed thickening of the subcutaneous tissue of the left chest wall. A soft tissue infection of the left chest wall was suspected, and antibiotics were administered, but the infected area expanded rapidly ; bacterial cultures grew Streptococcus pyogenes.
    Necrotizing fasciitis was suspected and antibiotics effective against Streptococcus pyogenes were given. Subsequently, the patient required emergent debridement and intensive care. After these treatments were given, he recovered and was discharged on the 68th hospital day.
    Necrotizing fasciitis is a rapidly progressing infection with a high mortality. There are only a few case reports of necrotizing fasciitis in patients receiving chemotherapy. Nevertheless, necrotizing fasciitis should be considered as a possible complication of chemotherapy.
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  • Jinichi MORI, Yoshiaki IWASAKI, Manabu OHASHI, Soya NUNOBE, Tomohiro I ...
    2010 Volume 71 Issue 6 Pages 1496-1500
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    A 79-year-old woman underwent a total gastrectomy with a D1+β lymph node dissection, cholecystectomy, and Roux-en-Y reconstruction for stage II gastric cancer T2 (MP) N1P0H0CYXM0 ; the postoperative diagnosis was T3 (SE) N0H0P0CY1M0 stage IV. Minor leakage was observed on the seventh postoperative day, but it was successfully treated by drainage. The patient was discharged on the 28th postoperative day. On the 60th postoperative day, blood testing showed thrombocytopenia. She was diagnosed as having thrombotic thrombocytopenic purpura (TTP) ; she subsequently developed a hemolytic anemia with schistocytes, impaired renal function, and intermediately decreased ADAMTS13 activity. Infusion of fresh frozen plasma (FFP) rapidly corrected the thrombocytopenia and hemolytic anemia. Thus, this treatment was continued intermittently for two months. No relapse has occurred since FFP infusion therapy was stopped. The most common cause of postoperative TTP is reported to be cardiovascular surgery. Most cases of postoperative TTP progress rapidly ; the patient's prognosis is generally poor. We report a rare case of TTP that occurred following surgery for gastric cancer that progressed slowly.
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  • Masanori TAKAHASHI, Keisuke KOEDA, Hisataka FUJIWARA, Takehiro CHIBA, ...
    2010 Volume 71 Issue 6 Pages 1501-1506
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    An extremely rare case of a patient who underwent radical resection for gastric cancer complicated by an upside down stomach, with prolapse of the entire stomach and stomach volvulus associated with an esophageal hiatal hernia, is reported. The patient was a 73-year-old woman who was referred and admitted to our department with a diagnosis of advanced gastric cancer after visiting another physician complaining of pressure in the upper abdomen. Upper gastrointestinal series revealed an upside down stomach, with the entire stomach prolapsed into the diaphragm. Upper gastrointestinal endoscopy showed type 3 gastric cancer in the pyloric antrum. Based on these findings, the patient was diagnosed with an esophageal hiatal hernia and advanced gastric cancer. Open total gastrectomy, D2 dissection, and esophageal hiatal hernia repair were performed. The final diagnosis was type 5, T2(MP), N1, H0, P0, M0, stage II, with a curability of A. No postoperative complications were observed, and the patient was discharged on day 12. She currently has no complaints or evidence of relapse, and she is being followed on an outpatient basis. The relevant literature is also reviewed.
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  • Hidefumi KUBO, Daiki KIJIMA, Kousuke TADA, Makoto MIYAHARA, Hiroyasu H ...
    2010 Volume 71 Issue 6 Pages 1507-1512
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    Acute afferent loop syndrome is a comparatively rare complication following gastrectomy. We report a case of recurrence of gastric cancer with acute afferent loop syndrome 4 years and 5 months after total gastrectomy, together with a review of the literature.
    An 85-year-old man with a history of undergoing total gastrectomy for advanced gastric cancer was admitted to our hospital because of abdominal pain and vomiting. Abdominal ultrasonography and CT scan showed a dilated afferent loop, dilated bile duct and common pancreatic duct, and an extremely swollen gallblaldder. He was diagnosed as having acute afferent loop syndrome. Endoscopic decompression of the afferent loop was unsuccessful, so emagency laparotomy was done. At laparotomy, we saw that he had undergone total gastrectomy with Roux en-Y reconstruction. The afferent loop proximal to the Treitz ligament was entremely dilated, but the loop distal to the ligament and the anastomosis of jejuno-jejunostomy were almost intact. No causes of obstruction of the afferent loop could not be identified. Because of haemodynamic instability, a new Roux en-Y reconstruction was perfomed through the retro-colic route. The patient was discharged from our hospital on the postoperative day 23.
    Afferent loop syndrome carries very poor prognosis and hence it demands early diagnosis and prompt treatment as possible as we can.
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  • Akiko OKADA, Toshiyuki ARAI, Satomi SAEKI, Yoshito OKADA, Keiji AIZU, ...
    2010 Volume 71 Issue 6 Pages 1513-1517
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    A 73-year-old man visited our hospital with the complaint of black stools that had started 1 month ago. Upper gastrointestinal endoscopy revealed 2 type 1 tumors in the upper part of the lesser curvature and in the posterior wall of the gastric body and 1 type 0-IIc lesion in the antrum. Examination of the biopsy specimens of all 3 tumors revealed adenocarcinoma. Total gastrectomy and splenectomy with D2 lymph node dissection and Roux-en-Y esophagojejunostomy were performed. Histopathological examination revealed that the tumor in the posterior wall of the body consisted of 2 different parts : poorly differentiated and papillary adenocarcinomas. Because the 2 components had a clear border without transition, this tumor was thought to be a collision cancer. Moreover, because the poorly differentiated adenocarcinoma showed extensive lymphocyte infiltration, we performed Epstein-Barr virus (EBV) encoded small RNA (EBER-1) in situ hybridization. We found that the poorly differentiated adenocarcinoma was EBV-positive and the papillary adenocarcinoma was EBV-negative. The final diagnosis of this cancer was a collision tumor of papillary adenocarcinoma and EBV-related gastric carcinoma.
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  • Takeshi KURODA, Mitsutoshi FUKUYAMA, Masahiro IUCHI, Yo FUKUDA, Yoshin ...
    2010 Volume 71 Issue 6 Pages 1518-1523
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    A 70-year-old man ate a boiled sea bream one week before being admitted to hospital with a two-day history of upper abdominal pain. Tenderness was localized in the left upper region. Abdominal CT scan revealed a linear, high density lesion measuring about 10 mm in length and free air in the adipose tissue near the horizontal portion of the duodenum. Gastrointestinal endoscopy was performed to extract the foreign body but it could not be seen in the intestinal lumen. A laparotomy was done after the patient's of abdominal pain improved on conservative therapy. The small intestine and adipose tissue where the foreign body was thought to have penetrated were swollen for about 4 cm around the Treitz ligament. When the adipose tissue near the Treitz ligament was dissected a fish bone about 10 mm in length was detected in the mesentery of the jejunum. A Partial resection from the horizontal portion of the duodenum to the jejunum and an end-to-end anastomosis were performed. In the Japanese literature 26 cases of perforation and penetration of the duodenum and 8 cases of penetration of the horizontal portion of the duodenum by a fish bone have been reported.
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  • Kiyoto TAKEHARA, Kunitoshi SHIGEYASU, Takashi ARATA, Kohji TANAKAYA, H ...
    2010 Volume 71 Issue 6 Pages 1524-1528
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    A 75-year-old male presented with epigastric discomfort and melena 2 days after undergoing intracoronary stenting. Upper gastrointestinal endoscopy revealed a soft submucosal tumor with ulceration in the second portion of the duodenum. Computed tomography (CT) scan showed a dense fat mass in the second portion of the duodenum which led to the preoperative diagnosis of lipoma. Endoscopic resection posed a high risk of bleeding because the patient was on anticoagulation therapy ; therefore, we performed tumor resection under laparotomy. The tumor was 40×16×12 mm in size, and its histopathological diagnosis was lipoma.
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  • Shuichiro TAKANASHI, Kazuya SUZUKI, Koji MOROHARA, Naokuni YASUDA, Koj ...
    2010 Volume 71 Issue 6 Pages 1529-1533
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    We report a resected case of carcinoid tumor located in the accessory papilla of the duodenum. A 42-year-old man was found to have a tumor in his duodenum ; a diagnosis of carcinoid was made based on a biopsy specimen. Pylorus-preserving pancreaticoduodenectomy was performed. The resected specimen contained a tumor that was 18mm in size, which was located in the accessory papilla of the duodenum ; on histopatholoy, lymph node metastases were found.
    This is the fourteenth reported case of carcinoid tumor in the accessory papilla of the duodenum. Eleven of these cases had positive lymph nodes, although the tumors themselves were small. This suggests that radical surgery with regional lymph node resection is useful for treating patients with this disease.
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  • Yoshiyuki INOUE, Hisanaga HORIE, Masahiro SATOU, Yoshikazu YASUDA
    2010 Volume 71 Issue 6 Pages 1534-1538
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    A 77-year-old man with abdominal pain was referred to our hospital. He was diagnosed with colonic diverticulitis by abdominal computed tomography (CT) examination. However, he suffered a relapse of inflammatory reaction after treatment. Abdominal CT findings revealed abscess formation around the ileocecal region. During surgery, it was observed that peritoneal abscess cavity was surrounded by sigmoid colon, ileum, and ileocecal mesentery. The cavity communicated with the intra-mesenteric abscess cavity in the ileocecum. The abscess was drained and ileocecal resection was performed. Pathological examination revealed ileal diverticulitis with penetration to mesentery and peritoneal abscess formation. We should consider ileal diverticulitis in the differential diagnosis of acute abdomen with nonspecific abdominal pain.
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  • Yasuro KATO, Yoshihito KAKIMOTO, Takeru HYAKUTAKE, Osamu MURAKAMI
    2010 Volume 71 Issue 6 Pages 1539-1543
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    An 82-year-old woman was admitted because of severe abdominal pain. She had a fever and severe tenderness in her right abdomen. Blood tests revealed a high inflammation level. Abdominal CT showed a large amount of free air and a small amount of ascites ; the small intestine with a thick wall crossed the anterior side of the ascending colon. A small intestinal tumor and perforation were diagnosed. We operated emergently on the same day. The jejunum was found to have a thick wall ; there were three perforations. A partial resection of the jejunum was done. An infiltration of small to medium-sized atypical lymphocytes was seen in the jejunum wall ; there were many CD3-positive T cell lymphoma cells. The patient's status deteriorated gradually, and she died of aspiration pneumonia 80 days after the operation. In patients with a tumor and perforation of the small intestine, the possibility of malignant lymphoma should be considered.
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  • Ryo SEISHIMA, Takeshi NAGASE, Motohito NAKAGAWA, Yusuke KUMAMOTO, Shun ...
    2010 Volume 71 Issue 6 Pages 1544-1549
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    Undifferentiated cancer of the small intestine has rarely been reported. We report herein a case of undifferentiated cancer of the small intestine with multiple metastases to the intestinal wall and lymph nodes around the pancreas head and a review of the literature.
    A 53-year-old man was seen at our hospital because of body weight loss, thirsty and abdominal pain. On laboratory data, a marked inflammatory response (WBC 19,400/μl, CRP 14.8 ng/ml) and anemia (Hb 8.4 g/dl) were noted. Serum IL-2 receptor concentration increased to 2,400 IU/l, though tumor marker levels of CEA and CA19-9 were within normal limits. An abdominal CT scan showed the presence of multiple tumors with the size of less than 4 cm within the abdominal cavity. From these findings, malignant lymphoma in the abdominal cavity was initially diagnosed. This patient was surgically operated on in March 2008 due to the development of abdominal symptoms. Operative findings showed that tumors with the maximum diameter of 8 cm were scattered in the small intestinal wall, mesentery and pancreas head. Only the small intestine was resected, because his general condition was so unstable that the resection of the pancreas head might entail a high risk. The pathological diagnosis of undifferentiated cancer of the small intestine was made because only epithelial markers were positive. After the operation, however, his condition took a sudden turn for the worse, and he died on the 27th postoperative day.
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  • Mitsuhisa MUTO, Michinaga TAKAHASHI, Masaru ONUMA, Tatsuya UENO, Hiroo ...
    2010 Volume 71 Issue 6 Pages 1550-1554
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    We report a case of acute appendicitis with duodenal stenosis accompanied by intestinal malrotation.
    A 78-year-old man complaining of abdominal pain and fever was referred to our hospital after unsuccessful conservative therapy. An abdominal CT scan revealed a perityphlic abscess with acute appendicitis and intestinal malrotation where the ileocecal region was located at the ventral aspect of the descending portion of the duodenum. Since duodenal obstruction developed and inflammation became severe despite conservative treatment for three days, he underwent operation. At laparotomy, we found that the descending portion of the duodenum had been involved by the perityphlic abscess. We performed appendectomy and drainage, followed by side-to-side duodeno-jejunostomy because of fibrous duodenal stenosis resulting from long-term inflammation. Although he suffered from temporary anastomotic passage impairment, he was discharged from the hospital on the 29th day after the operation.
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  • Yusuke TSUNETOSHI, Hironobu KIKUCHI, Katsushi KURANUKI, Mitsuo YASUHAR ...
    2010 Volume 71 Issue 6 Pages 1555-1559
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    A 65-year-old man who had undergone ileocecotomy for ascending colon cancer in August 2006 developed anastomotic leakage on the 4th postoperative day. He underwent reoperation, including resection of the anastomotic site and re-ileocolotomy. On the 16th postoperative day, an abdominal CT scan revealed an intraabdominal abscess around the anastomotic site, which required 3rd operation consisted of washing and drainage. Soon after the beginning of meal, succus entericus had leaked from the wound and drain. Despite long-term fasting and washing through a drain for 4 weeks, intractable enterocutaneous fistula was formed. We tried administration of human plasma coagulation factor XIII for five days and injection of fibrin glue three times every seven days, but the fistula still opened. Accordingly we tried endoscopic injection of histoacryl, and eventually succeeded to close the fistula. Because this method is simple, visible and easy, it might be one of the useful therapies to treat intractable enterocutaneous fistulae.
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  • Kei UKON
    2010 Volume 71 Issue 6 Pages 1560-1565
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    Colorectal perforation is a rare complication of barium gastrography. Most of these patients have some underlying colorectal disease such as diverticulum or cancer which contributes to the perforation. Few cases of the disease arisen from only barium retention have been reported. We present three cases of this disease with a review of the literature.
    Case 1 involved a 71-year-old male. Two days after gastrography, stomachache occurred following the first barium evacuation. Hartmann's operation was performed for rectal (Ra anterior wall) perforation. Case 2 involved a 70-year-old female. Intermittent stomachache occurred on the next day after gastrography, followed by intensified pain two days later. Expansion of the sigmoid colon with barium was visualized, and a medium amount of evacuation was seen. On the next day, severer pain occurred and Hartmann's operation was performed for sigmoid colon perforation (mesentery side). Case 3 involved a 73-year-old female. Barium evacuation was only a little after gastrography. Stomachache occurred three days after gastrography, and Hartmann's operation was performed for sigmoidal colon perforation (anterior wall).
    Although colorectal perforation after barium gastrography is rare, it is iatrogenic and sometimes results in unfortunate outcome. Much attention to this disease and confirmation of the amount of barium evacuation are essential.
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  • Tsuyoshi FUKUSHIMA, Hidekazu SANO, Kazutomo KIKUCHI, Masataka WADA, Yu ...
    2010 Volume 71 Issue 6 Pages 1566-1570
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    We report the case of a 65-year-old woman who had been on dialysis because of renal failure resulting from light-chain associated (AL) amyloidosis and was treated with brachytherapy (Bt) for carcinoma of the left breast in 2007. The patient complained of abdominal pain on the 11th day after the administration of the first dose of Paclitaxel, which was administered as adjuvant chemotherapy. Computed tomography (CT) scans showed free air, which led to the diagnosis of perforation peritonitis, and the patient underwent emergent surgery. Laparotomy revealed a perforation on the left side of the transverse colon. Therefore, the left half of the colon was resected, the anal stump was closed, the transverse colon was elevated, and a stoma was constructed. Histopathological examination showed no inflammatory or tumoral lesions but revealed eosinophilic deposits in the vascular walls of blood vessels ranging from submucosal arterioles and venules to medium-sized subserous arteries and veins. Congo red staining showed positive findings. These results showed that the perforation might have been caused by amyloid deposition, or by vascular rupture, hemorrhage, or circulatory failure due to Paclitaxel. After the operation, purulent discharge was found from the drain placed in the abdominal cavity, and contrast imaging for the visualization of the small intestine suggested recurrence of the digestive tract perforation. However, spontaneous closure of the perforation was achieved by conservative treatment, and the patient was discharged on the 36th day after surgery.
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  • Kenta TOMORI, Hidejiro KAWAHARA, Kazuhiro WATANABE, Takuro USHIGOME, S ...
    2010 Volume 71 Issue 6 Pages 1571-1574
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    A 64-year-old male with abdominal discomfort was referred to our department since a 6-cm tumor was found in the transverse colon on barium enema. As his diabetes mellitus was poorly controlled, he was admitted two weeks before surgery. As part of the preoperative preparation, he was given Niflec 2,000 ml orally from noon the day before surgery. Though tumor invagination was identified in the transverse colon on the computed tomography done four days before surgery, no tumor was detected during the surgery. Intraoperative colonoscopy identified an ulcerative lesion at the site where the tumor had been detected preoperatively. He underwent a partial resection of the colon which included the ulcerative lesion along with a D2 dissection. Pedunculated giant colon polyps can spontaneously detach. The preoperative bowel preparation could be responsible for the dislodgement.
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  • Chika MAEDA, Gengo KANEKO, Naoto HORIGOME, Manabu HIRAGURI, Noriyuki A ...
    2010 Volume 71 Issue 6 Pages 1575-1578
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    A rare case of superficial angiomyxoma (SAM) arising in the anal canal is reported. A 69-year-old man with gastric cancer who was being followed postoperatively developed a left inguinal hernia and an anal polyp. Endoscopy showed a peduncular, walnut-sized, elastic-soft mass in the anal canal. Since the mass prolapsed frequently, a transanal resection was performed. On histopathology, the resected specimen was diagnosed as a superficial angiomyxoma. SAM arising in the anal canal is very rare.
    SAM is a benign tumor. However, local recurrence is frequent after incomplete resection. Complete resection and careful observation are required.
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  • Hiroshi IINO, Yoshiyuki MORI, Makoto SUDOU, Tadashi HYUGA, Toshiki KOB ...
    2010 Volume 71 Issue 6 Pages 1579-1583
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    A 32-year-old pregnant woman was referred to our hospital due to a right ovarian tumor at the 22nd week of gestation. Right oophorectomy was performed by obstetricians after histopathological findings revealed a suspected metastatic adenocarcinoma from gastrointestinal malignancy. Colonoscopy indicated an advanced sigmoid colon cancer. Sigmoidectomy with colostomy was performed at the 29th week of gestation without disturbing pregnancy. At the 32nd week of gestation, cesarean delivery was performed followed by total abdominal hysterectomy, complete regional lymph node dissection of the sigmoid colon, and closure of the colostomy. Postoperative course of the patient and the infant were uneventful. Although colorectal cancer is uncommon during pregnancy, its prognosis is reported to be very poor for both the patient and fetus. We found that adequate cooperation between surgeons and obstetricians for reaching a concensus on the surgical treatment without delay is necessary for a successful outcome.
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  • Hideo OKUMURA, Kazuki YAMASHITA, Yasuo OKA, Hideo MATSUMOTO, Atsushi U ...
    2010 Volume 71 Issue 6 Pages 1584-1588
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    We report a case of rectal cancer in a patient with situs inversus totalis who was treated by laparoscopic-assisted low anterior resection. A 53-year-old man was admitted to our hospital for treatment of rectal cancer. During childhood, he was diagnosed with situs inversus totalis. Pathological examination performed after endoscopic submucosal dissection of the rectal cancer revealed submucosal invasion and lymphatic vessel invasion ; we performed laparoscopic-assisted low anterior resection. Before the operation, we simulated a mirror image by watching a movie of a patient with a normal anatomy undergoing a similar operation played in inverse enantiomorph. During the operation, the operator and the endoscopist stood in opposite locations compared to those for standard operations in orthotopic patients. The trocars were also placed in mirror-image positions. The operation was successful, demonstrating that laparoscopic surgery can be performed safely in patients with situs inversus totalis provided the surgery is preceded by sound preoperative preparation.
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  • Shin EMOTO, Hirofumi KAMACHI, Munenori TAHARA, Toshiya KAMIYAMA, Michi ...
    2010 Volume 71 Issue 6 Pages 1589-1595
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    It is difficult to diagnose polypoid lesions of the gallbladder. We experienced a case of gallbladder carcinoma with adenomyomatosis (ADM) in which contrast-enhanced ultrasonography (CE-US) was useful for the differential diagnosis of a polypoid lesion.
    A 58-year-old man was pointed out having a polypoid lesion in the gallbladder by screening US in February 2009, and he was referred to our facility for further examinations. In the laboratory data, CEA was elevated to 8.3ng/ml. Abdominal CT and MRI showed the polypoid lesion but failed to determine whether it was malignant or not. Base line US showed a hypoechoic area in the gallbladder bed suggestive of invasion of the tumor. Since US examination indicated the invasion of the tumor to the gallbladder bed, CE-US was performed. CE-US showed strongly diffused enhancement pattern in the localized papillary lesion adjacent to ADM. This finding strongly suggested the possibility of malignancy and we performed extended cholecystectomy with liver parenchymal resection. Papillary adenocarcinoma of the gallbladder with segmental ADM was identified macroscopically. The pathological diagnosis was tub1>pap s(-), ss, pHinf0, pBilf0, pPV0, pA0, pN0, pBM0, pHM0, pEM0, int INFβ, pn0, ly0, v0, pT2, pN0, and fStageII. We conclude that CE-US is available for making the differential diagnosis of polypoid lesions of the gallbladder. It is important to make a decision of treatment after taking every finding of examinations into consideration.
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  • Tomonari ISHIMINE, Sinitirou KAMEYAMA, Tutomu ISA, Fumiko KOHAKURA, Hi ...
    2010 Volume 71 Issue 6 Pages 1596-1602
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    We report a case of anaplastic ductal carcinoma of the pancreatic head. A 64-year-old woman was admitted to our hospital complaining of epigastralgia ; she had obstructive jaundice and liver dysfunction. On upper gastrointestinal endoscopy, a tumor at the opposite side of Vater's pappilla located in the second portion of the duodenum was found. On laboratory testing, increased serum CEA and CA19-9 levels were noted. Ultrasonography and CT showed a solid mass measuring 32×23 mm in diameter located in the head of the pancreas. Contrast-enhanced CT and MRI revealed nonhomogenous mass. Based on these clinical findings, a resection was performed under a diagnosis of cancer of the duodenal papilla. The resected tumor appeared to be focally expanding ; lymphnode metastases were present. On histology, an anaplastic ductal carcinoma of the giant cell type that was characterized by a non-cohesive, sarcoma-like growth pattern, and the presence of bizarre mono-and multi-nucleated giant cells was found. The patient died of renal failure 29 months after the operation.
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  • Mai TSUTSUI, Takuji NORO, Munefumi ARITA, Hironori OHDAIRA, Naruo KAWA ...
    2010 Volume 71 Issue 6 Pages 1603-1609
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    A 49-year-old male diagnosed with pancreatic head cancer underwent pancreatoduodenectomy and portal vein resection. The operation was successful ; however, after starting oral ingestion from postoperative day 6, he developed a tympanitic abdomen. From the postoperative day 10, over 3500 ml/day of chylous ascites was discharged through the drain. Low and non-fat diet was not effective; from day 30, we started percutaneous administration of octreotide acetate (300μg/day). Octreotide acetate was very effective for the treatment of ascites. The patient was discharged on day 45. Few studies have reported chylous ascites after pancreatoduodenectomy (PD). Chylous ascites is mainly caused by trauma to the cisterna chyli during operation. Although chylous ascites is generally treated by conservative treatment, octreotide acetate may be effective for treating intractable cases.
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  • Masaya KAINUMA, Takatsugu YAMAMOTO, Chie WATANABE, Shogo TANAKA, Kanji ...
    2010 Volume 71 Issue 6 Pages 1610-1614
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    A 35-year-old woman with no medical history was diagnosed as having an aneurysm of the splenic artery by ultrasonography at a medical check-up. Abdominal angiography showed the aneurysm 2cm in diameter adjacent to the celiac artery and the serpiginous splenic artery. Cardiologists and radiologists consulted us about the case because interventional radiological treatment (IVR) to prevent rupture of the aneurism was difficult. We recommended laparotomic ligation of the proximal splenic artery and intraoperative Doppler echography via a small abdominal incision. After we obtained the informed-consent from the patient, the surgical treatment was performed. When we interrupted the arterial inflow/outflow of the aneurysm, Doppler echography demonstrated arterial blood flow to the pancreas and spleen via the left gastro-epiploic, inferior pancreatic, and dorsal pancreatic arteries. We performed ligation of the splenic artery adjacent to the aneurysm. The patient's postoperative course was uneventful.
    Splenic artery aneurysm is a disease that we often encounter. When splenic artery aneurysm is diagnosed, some treatment for it should be done to avoid rupturing. IVR using coils and stent are employed in most cases. In instances in which the difficulty of IVR is strongly expected due to morphorogy, size, and location of the aneurysm like in this case, classical surgical treatments should be considered as arterial ligation.
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  • Kazunori TSUKUDA, Hiroaki ASANO, Minoru NAITO, Takayuki MURAOKA, Hideo ...
    2010 Volume 71 Issue 6 Pages 1615-1618
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    Splenic metastasis secondary to a malignancy is rare ; case reports of splenic metastases from colorectal cancer or gastric cancer which were surgically resected are occasionally reported. However, case reports of splenic metastases from ovarian or uterine cancers are quite rare. We report a case of splecic metastasis from an endometrial cancer. The patient was a 57-year-old female who underwent hysterectomy for endometrial cancer a year prior. The PET-CT scan showed a solitary splenic tumor that was considered to be related to sarcoidosis ; it was thus followed. However, the splenic tumor enlarged and a CT-guided biopsy was performed. The splenic tumor was found to be a metastasis from the endometrial cancer. A splenectomy was performed since no other metastases were found. However, it was found that tumor had metastasized to the lymph nodes and had invaded the gastric wall.
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  • Daisuke TAKAYANAGI, Takerou MAZAKI, Kazunari MADOU, Hirohisa OGAME, Yu ...
    2010 Volume 71 Issue 6 Pages 1619-1623
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    A 62-year-old woman was admitted in July 2008 because of sudden onset of abdominal pain, nausea, and vomiting. An abdominal X-ray examination and CT scan showed niveaus of the small bowel. A long tube was inserted, and conservative treatment was instituted on the second day after admission. However, a symptomatic remission was not achieved. Intestinal contrast study through a long tube showed obstruction of the small intestine. An operation was carried out on the thirteenth day after admission. The small intestine was incarcerated into a mesenteric defect of the right peritoneal surface of the sigmoid mesentery located 100 cm distal to the Treitz fascia. An internal hernia was diagnosed. The intussuscepted small intestine was released manually without performing intestinal resection, since no ischemia was present. The mesenteric defect of the right peritoneal surface was sutured. The postoperative course was uneventful, and the patient was discharged on the eighteenth day after surgery.
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  • Akiho OKADA, Ken-ichi YOKOTA, Yuuko ITAKURA, Hiroshi OHTOMO, Sigekuni ...
    2010 Volume 71 Issue 6 Pages 1624-1627
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    A 51-year-old man was admitted due to lower abdominal pain. Plain abdominal radiography revealed intestinal obstruction. Gastrografin enema revealed no obvious abnormality. However, subsequent abdominal computed tomography (CT) scan clearly showed the small intestine located posterior to the sigmoid colon. Internal hernia related to mesosigmoid was strongly suspected, and the patient was operated on the 7th day after the onset of the disease. Laparotomy revealed that the ileum about 110 cm proximal to the terminal ileum was incarcerated into the fossa between the mesosigmoid and retroperitoneum. Intersigmoid hernia was diagnosed. We reduced the incarceration, closed the fossa, and resected the perforating portion of the ileum. Herein, report a rare case of intersigmoid hernia, and discuss the cases previously reported in Japan.
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  • Akira UMEMURA, Yuji GOUKON, Yoshihiro ENDO, Yu SUZUKI, Akiko UMEMURA, ...
    2010 Volume 71 Issue 6 Pages 1628-1633
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    A 76-year-old man who had been treated for hepatocellular carcinoma and chronic pulmonary emphysema in our clinic was seen at our hospital because of abdominal pain and vomiting. There were abdominal distention and muscular defense in the left upper quadrant of abdomen. Abdominal enhanced CT scan showed thickening and edema of the left colonic wall. Emergency surgery was performed with a diagnosis of diffuse peritonitis. The necrotized left colon was excised followed by colostomy. Although postoperative mechanical ventilation was required, the patient was discharged from the hospital on the postoperative day 39. Histopathological examinations showed Congo-red positive amyloid protein deposits in small vessels of the submucosal layer.
    Emergency surgery has occasionally been reported for intestinal amyloidosis associated with chronic rheumatism and long-term hemodialysis. However, few reports have been made of emergency surgery for secondary intestinal amyloidosis in patients without these factors. In this case, AA amyloid protein was determined based on immunostaining, and secondary amyloidosis was diagnosed. However, we could not confirm whether this condition was caused by the malignancy or chronic obstructive pulmonary disease.
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  • Masako KANEMATSU, Katsuyuki KUNIEDA, Masahiko KAWAI, Narutoshi NAGAO, ...
    2010 Volume 71 Issue 6 Pages 1634-1638
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    An 89-year-old woman visited a hospital because of abdominal pain and was pointed out free air on an abdominal CT scan. Since she had been pointed out bloody stools and an elevated CEA level at that hospital, she was referred to the emergency center in our hospital with a suspicion of gastrointestinal perforation due to malignant neoplasm of the lower gastrointestinal tract. When she was first seen, an abdominal CT scan showed intraabdominal free air and ascites and perforative peritonitis was diagnosed. She was in a shock state so that laparotomy under general anesthesia was considered impossible. She was admitted to our hospital for the purpose of conservative therapy. With intensive care, her general condition gradually became stable. An abdominal CT scan on the 18th hospital day disclosed a pyometra, and transvaginal drainage was performed. Lower gastrointestinal endoscopy on the 42nd hospital day revealed sigmoid colon cancer. Hartmann operation was performed on the 64th hospital day, when no perforated sites were seen around the sigmoid colon cancer but perforation was present in the fundus of uterus. Hysterectomy was thus performed as well.
    Perforation of a pyometra is often misdiagnosed as gastrointestinal perforation, and it must be kept in mind as a probable differential diagnosis of causative disorders for perforative peritonitis in aged women.
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  • Akira SOGAWA, Yu KIMURA, Susumu NAKASIMA, Ken-ichiro FUKUDA, Zyunshin ...
    2010 Volume 71 Issue 6 Pages 1639-1642
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    Perforation of the digestive tract such as a fish bone caused by a foreign body is rare since the foreign body usually passes on its own. ; when it occurs, it can have very serious consequences. Most of the reported cases recovered with conservative therapy ; some cases required an enterectomy. We report a case of a retroperitoneal abscess caused by a fish bone that was found when the abscess was drained. An 83-year-old man was admitted to our hospital due to left lower abdominal pain. A retroperitoneal abscess caused by a fish bone was found. At surgery, the retroperitoneal space was accessed via a pararectus incision. The abscess was treated via drainage, without a need for bowel resection. A proper preoperative assessment allows a proper surgjcal approach to be chosen.
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  • Masahiro KAWABATA, Tsukasa IHARA, Masanori AKASHI, Shinichi TOMISAKI, ...
    2010 Volume 71 Issue 6 Pages 1643-1648
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    Surgery was performed on a 43-year-old man who was referred to our department by a local physician for further examination and treatment after being diagnosed with a right adrenal tumor on abdominal ultrasound during a medical checkup. A tumor of retroperitoneal origin was diagnosed intraoperatively and resected. On histopathological examination, Homer-Wright rosettes were observed, and because the tumor was MIC2-positive on immunostaining, it was diagnosed as a peripheral primitive neuroectodermal tumor (PNET). Despite adjuvant chemotherapy, the patient died of the tumor approximately two years and seven months postoperatively. PNET is a small round cell tumor that develops outside the central nervous system and differentiates into neuroepithelium histologically, immunologically, and ultrastructurally. It often develops in the limbs and chest wall, and it rarely occurs in the abdomen. A case of PNET thought to be of retroperitoneal origin is reported and the relevant literature reviewed.
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  • Masayuki SATOH, Kenichi SHIIBA, Tsuneaki FUJIYA, Hideaki YAMANAMI, Rin ...
    2010 Volume 71 Issue 6 Pages 1649-1653
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    A 76-year-old man was admitted to our hospital because of pollakisuria, sense of lower abdominal fullness, and edema of bilateral lower limbs. A large soft elastic mass was palpable in the linea terminalis pelvis. Colonoscope examination revealed that the rectum was compressed by a tumor. Computed tomography (CT) and magnetic resonance imaging (MRI) findings revealed a mass of mixed solitary and cystic parts in the pelvic cavity. The levels of serum glucose as well as those of insulin and insulin-like growth factor (IGF)-I were low, whereas IGF-II level was elevated. We suspected that the tumor was a nonislet-cell tumor causing hypoglycemia. The tumor was resected with the bladder and prostate because it had infiltrated into these organs in histological examination, patternless arrangements of spindle cells were observed and no invasion to bladder and prostate was noted. Further, immunochemical analysis revealed that tumor cells were positive for CD34, and the final diagnosis of the tumor was a solitary fibrous tumor. After operation, the serum glucose and IGF-II levels returned to normal and the bilateral edema of lower limbs was not detected because of improvement in venous return and lymphostasis.
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  • Atsushi KAMBARA, Hiroshi KAMBARA, Koji HINO, Syoken KANEDA, Yoshiaki H ...
    2010 Volume 71 Issue 6 Pages 1654-1658
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    The patient was a 55-year-old male who had a one-year history of slowly-progressing lumbago, numbness and hypoesthesia at a lower half of the body and claudication. Plain X-ray, CT, MRI and angiographies revealed an irregular dumbbell-shaped mass at the L-1 lumbar nerve root irregularly involving the vertebura, and evolving into the retroperitoneum to form a continuing large mass with large cystic change. The mass was 22cm in diameter. A part of the mass in the retroperitoneum strongly compressed the abdominal organs and displaced the liver, kidney and inferior vena cava toward cranial, foot, and left direction, respectively.
    The mass was resected with two stage operations. Firstly, a part of the mass at the lumbar root was resected through the back approach leaving a retroperitonal part. Secondly, under lapalotomy, the residual large part of the mass in the retroperitoneum and in the back masses was extirpated. Histologically, the tumor was composed of spindle-shaped neoplastic cells. The tissue revealed vimentin (+), actin (+), α1-ACT (+), S100 (+), C-kit (-), and MIB-1 was 7%. Benign schwannoma was thus diagnosed.
    The symptoms disappeared immediately after the removal of the mass. No apparent loss of motor function was observed after the therapy.
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  • Norio OKUMURA, Mitsuru SAKAI, Shigeru YOSHIDA, Kazuhiko NAKADA, Youji ...
    2010 Volume 71 Issue 6 Pages 1659-1662
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    A 79-year-old woman visited our hospital with the complains of lower abdominal pain and bilateral femoral pain. Computed tomography (CT) scan revealed incarcerated bilateral obturator hernia for which was performed an emergency operation. Laparotomy revealed rupture of the small intestine and its incarceration into left obturator foramen. The incarcerated intestine was resected, and the hernial hilum was closed by direct suturing after thorough washing. Nine days after the operation, she complained of left femoral pain. CT scan showed an abscess in the left obturator foramen. Ultrasonography-guided percutaneus drainage of the abscess was performed. Although postoperative complication of the patients was subsided eventually, we should select the best procedure for the hernia hilum among various and controversial procedures to prevent postoperative abscess formation.
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  • Masashi YANADA, Junichi SHIMADA, Hiroshi KOHNOSU, Yasunori SAWABE, Har ...
    2010 Volume 71 Issue 6 Pages 1663-1666
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    The patient was a 79-year-old man who had an extended thymectomy for thymic carcinoid 2 years prior. FDG-PET was performed to rule out recurrent discase. The FDG-PET images showed an abnormal accumulation in the right inguinal region. In order to obtain a definite diagnosis, an inguinal tumor resection was done under local anesthesia. The resected tumor was confirmed to be a leiomyosarcoma on histopathology. Thus, the residual tumor was subseguently fully resected along with the great saphenous vein. A primary leiomyosarcoma involving of the venous system is rare ; involvement of the great saphenous vein is even rarer. In this paper, we report a case of primary great saphenous vein leiomyosarcoma which showed high-uptake on FDG-PET.
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  • Bun SANO, Takashi SHIROKO, Hiroki KATO, Nozomi AMAOKA, Keisuke YOSHINO ...
    2010 Volume 71 Issue 6 Pages 1667-1672
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL FREE ACCESS
    When the patient was 63 year old she presented after she had swallowed eight sewing needles and developed abdominal pain. Abdominal computed tomography (CT) scan and an X-ray examination showed a needle located outside of the 2nd portion of the duodenal wall. Urgent abdominal surgery was performed on the same day. The needle had penetrated the duodenal wall, and it was buried in the iliopsoas muscle. When the patient was 64 years old she swallowed two needles and was admitted to the hospital complaining of abdominal pain. Abdominal CT scan and an X-ray examination showed a needle in the subcutaneous tissue of the left abdominal wall ; the needle was removed under local anesthesia.
    When the patient was 69 year old abdominal CT scan and an X-ray examination showed two needles in the pelvic cavity.
    On laparotomy needles were removed without requiring a bowel resection. This patient requires careful follow-up as she may swallow a needle again.
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