Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)
Online ISSN : 1882-5133
Print ISSN : 1345-2843
ISSN-L : 1345-2843
Volume 81 , Issue 8
Showing 1-40 articles out of 40 articles from the selected issue
Original Articles
  • Hiroaki ITAKURA, Terumasa YAMADA, Yasuyuki KOTSUMA, Jin MATSUYAMA, Shu ...
    2020 Volume 81 Issue 8 Pages 1445-1451
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    Objective : The subclavian or axillary vein was punctured and a totally implantable central venous (CV) access port was placed with ultrasonic guidance ; however, a catheter laceration between the pectoralis major and minor muscles occurred, which may be partly due to the catheter going through the pectoralis minor muscle. Therefore, an investigation was conducted to clarify the clinical characteristics of lacerations between the muscles. Method : Of the 269 patients who underwent CV port placement (subclavian or axillary vein puncture) between 2013 and 2017, 199 patients who underwent computed tomography imaging after placement were investigated. Patient baseline characteristics, whether there was access through the pectoralis minor muscle or not, puncture site, and the vascular visualization method, among other factors, were investigated in patients with (n=4) and without (n=195) lacerations between the muscles. Results : Univariate analysis revealed that lacerations between the muscles were observed more frequently in patients with access through the pectoralis minor muscle (p=0.002) and those with thick subcutaneous fat at the puncture site (p=0.002). Discussion : The involvement of the pectoralis minor muscle and subcutaneous fat thickness in catheter lacerations between the pectoralis major and minor muscles was suggested. To avoid access through the pectoralis minor muscle, punctures on the central side of the junction of the cephalic and axillary veins are useful. Conclusion : Anatomical understanding is vital before performing a catheter puncture.

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Clinical Experiences
  • Masashi TSUNEMATSU, Satoshi ISHIYAMA, Sumika TAKAHASHI, Ikuma YOSHIDA, ...
    2020 Volume 81 Issue 8 Pages 1452-1460
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    Background : Since March 2020, coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread rapidly in Japan. Many cases of nosocomial infection have been reported.

    Purpose : To report the purpose of COVID-19 treatment at a community hospital without infectious disease specialists.

    Method : An outpatient clinic for patients with fever was established on April 6. Admission of COVID-19 patients was started on April 12.

    Results : Between April 6 and May 15, there were 136 walk-in outpatients with fever and 178 emergency patients with fever. The detection test for SARS-CoV-2 nucleic acid was performed in 67 patients, with 9 positive results. Twenty-five patients were admitted to a newly established specialty COVID-19 ward. Eighteen of the patients had COVID-19. There were no cases of nosocomial infection at our hospital.

    Conclusion : To prevent nosocomial infection and for the wellbeing of medical workers and their families, it is essential to design a COVID-19 medical care system according to the trends of infections.

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  • Ryo YOSHIOKA, Yutaka OGASAWARA
    2020 Volume 81 Issue 8 Pages 1461-1466
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    The effect of supportive therapy on bone density loss was investigated in 87 postmenopausal breast cancer patients who received an aromatase inhibitor (AI) for five years as postoperative adjuvant therapy. Before administering AI, bone density was measured at two sites : the lumbar spine and femoral neck. An active vitamin D3 preparation (D3) was concurrently administered with AI in patients with a lower T score (≤-1.0) while a bisphosphonate (Bis) or denosumab preparation was concurrently administered in those with a T score ≤-0.25. They were re-evaluated every year to adjust the supportive therapy accordingly. The bone density change rates at five years were -6.11%, -3.11%, and +5.04% in patients without supportive therapy at the beginning of AI administration (n=42), those with concomitant D3 administration (n=34), and those with concomitant Bis administration (n=11), respectively, indicating that the bone density improved even under AI treatment with concurrent Bis administration. Examination of the clinical risk factors for bone density loss demonstrated that bone density significantly reduced in patients who received AI before the age of 60, indicating that more attention should be paid regarding when AI is administered to patients immediately after menopause.

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  • Yuki II, Yuuki SEKINE, Kentaro KAWAMITSU, Shozo MIYANO, Ikuo WATANOBE, ...
    2020 Volume 81 Issue 8 Pages 1467-1470
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    Hartmann's reversal operation consists of delayed colorectal anastomosis and colostomy closure in patients who underwent Hartmann's operation previously. This procedure is still rare in Japan. Six cases of Hartmann's reversal operation by the open approach are reported.

    All six cases underwent Hartmann's operation due to colon perforation as an emergent operation, and the mean time to Hartmann's reversal was 1.4 years. During Hartmann's reversal operation, four of the six cases required hand-sewn colorectal anastomosis because a circular stapler could not be inserted to the anastomotic line due to heavy adhesion and/or kinking of the remnant rectum. The postoperative course was uneventful except for wound infection in two cases, but there were no major complications. This study shows that maintenance of the quality of the remnant rectum during Hartmann's operation is important to obtain good results in Hartmann's reversal.

    In conclusion, this procedure is a valuable option to improve quality of life for patients after Hartmann's operation, and laparoscopic surgery may result in extension of the indication and reduction of the morbidity.

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Case Reports
  • Tomofumi UOTANI, Koshi MATSUI, Yui HOSHINO, Takeshi MIWA, Takuya NAGAT ...
    2020 Volume 81 Issue 8 Pages 1471-1475
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    We report a case of Paget's disease of the breast developed after nipple-sparing mastectomy and breast reconstruction which is extremely rare. The case involved a 62-year-old woman who had undergone nipple-sparing mastectomy, sentinel lymph node biopsy and insertion of a tissue expander for right breast cancer (T2N0M0 Stage IIA) at our hospital 9 years previously. Two years later she underwent implant breast reconstruction where the tissue expander was replaced with an implant. She received hormonal therapy for 6 years after the first surgery, and thereafter she had been followed by periodic examinations. When she was 62 years old, or 9 years after the first surgery, she noticed skin erythema and ulcer around the right nipple and areola. Skin biopsy of the areola confirmed Paget's disease. Right nipple and areola resection and sentinel lymph node biopsy were performed for Paget's disease. She has been followed up in our clinic. Paget's disease of the breast is comparatively rare, but if we perform nipple-sparing mastectomy and implant breast reconstruction, we should bear the possibility of Paget's disease in mind, carefully consider the indications, and follow up the patient for longtime after surgery.

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  • Yuji ONODERA, Masami MATSUZAKI, Hiroshi TADA, Ichiro HIRAI, Hiroshi KA ...
    2020 Volume 81 Issue 8 Pages 1476-1481
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    A 50-year-old woman presented with an enlarging left breast mass. We identified a tumor with the maximum diameter of 25 mm in the DC segment of the left breast and diagnosed it as breast cancer T2N0M0 Stage IIA following close exploration. Furthermore, we identified the defect of the pectoralis major and minor muscles on the ipsilateral side. Namely she was associated with congenital defect of the pectoralis muscle. The treatment was preceded by neoadjuvant chemotherapy. The tumor showed a decrease in size on imaging, thereby we performed left mastectomy and sentinel lymph node biopsy. When the left breast was removed, the pectoralis major muscles (in sternocostal area and abdomen) and the pectoralis minor muscles were lacked and the ribs, intercostal muscle and serratus anterior muscle were exposed. However, we safely pursued the operation. Her postoperative course was uneventful and she was discharged from our hospital on the 6th hospital day. There were no histologic cancer remnants. It is believed that one in approximately 20,000 people has congenital defect of the pectoralis muscle. We report a case of breast cancer developed on the affected side of this anomaly which is extremely rare.

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  • Reiko YOSHIE, Ei HAKU, Hisanori KAWAMOTO, Mamoru FUKUDA, Yukinori OKAD ...
    2020 Volume 81 Issue 8 Pages 1482-1488
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    A 50-year-old woman diagnosed with bilateral breast cancer (right : cStage IIIB, luminal HER2- ; left : cStage IIA, luminal HER2+) underwent preoperative antitumor treatment followed by bilateral mastectomy with right axillary lymph node dissection and left sentinel lymph node biopsy. Postoperative therapy consisted of radiotherapy for the right thoracic wall supraclavicular lymph node (50 Gy/25 fractions), followed by trastuzumab plus TS-1. One year postoperatively, recurrence appeared in the skin of the right upper arm and armpit (luminal HER2-), and the regimen was switched to letrozole, but after 1 year of treatment, hepatic metastasis (luminal HER2-) developed, and treatment was switched to fulvestrant plus palbociclib. Three months after the start of this regimen, the hepatic metastasis had progressed, and lung metastasis had also appeared ; treatment was therefore switched to everolimus plus exemestane. A brain metastasis measuring approximately 2 cm appeared in the parietal lobe 2 years and 10 months postoperatively, and weekly paclitaxel (wPTX) with stereotactic radiotherapy (40 Gy/5 fractions) was therefore scheduled. The wPTX dose (second dose) was combined with the second radiotherapy session, and the day after the fourth radiotherapy session, the patient noticed weakness of the left arm and leg. Cranial contrast-enhanced computed tomography showed suspected intratumoral hemorrhage in the brain metastasis. On the same day, a neurosurgeon was consulted, and an emergency craniotomy was performed to remove the tumor and hematoma. There have been few reports of intratumoral hemorrhage during stereotactic radiotherapy, and this case is reported with a short discussion of the literature.

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  • Kentaro YOSHIKAWA, Koichi SHIRONO, Noriyuki KAMIYA, Hajime KITAMURA
    2020 Volume 81 Issue 8 Pages 1489-1496
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    A 49-year-old woman with past histories of appendectomy and intestinal obstruction presented with nausea. From an abdominal CT scan, adhesive small bowel obstruction was suspected. We started non-operative management (NOM). Despite several days of NOM, no symptomatic remission was gained. We checked the CT findings again and found bowel wall thickening with contrast enhancement in two sites of the small bowel and in a site of the transverse colon. From a biopsy with colonoscopy, invasive lobular carcinoma was diagnosed. Breast examination revealed a deformed left breast with a hard mass. The same histology as the transverse colon lesion showed was found by a core needle biopsy, so we diagnosed the case as metastatic breast cancer to the small bowel and the transverse colon. Laparoscopic resection of the small bowel and the transverse colon was performed to resolve the passage disturvance, and the patient was discharged on POD7 without any complications.

    Metastasis of breast cancer to the GI tract is said to be rare, especially the synchronous metastasis to the small bowel and the colon. Here we report the case with a review of the relevant literature.

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  • Takanori KIN, Ayako UENO, Yuri TAKAMATSU, Mitsuya ITO, Kensuke KAWASAK ...
    2020 Volume 81 Issue 8 Pages 1497-1501
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    Though olaparib was approved for use in Japan in 2018, there have been few reported cases due to few eligibility for its use. Here, we report two cases of breast cancer that showed good responses to olaparib. The first case was a 44-year-old woman with right breast cancer (T2N2aM0 stage IIIA, luminal type) who relapsed 2 years after breast surgery with lung metastasis. Hormone and oral anticancer therapies were administered. A BRCA2 mutation was detected, and olaparib was administered as a third-line treatment. A partial response was maintained for 8 months. The second case was a 69-year-old woman with bilateral breast cancer (left is T2N0M0 stage IIA, luminal type ; right details unknown) who relapsed 13 years and 4 months after left breast surgery with abdominal para-aortic lymph nodes (triple-negative on biopsy), right ovary, and peritoneal metastasis. Oral anticancer drugs were administered. A BRCA1 mutation was detected, and olaparib was administered as a second-line treatment. Partial response was maintained for 4 months. In both cases, olaparib was administered as an early line of therapy (as in the OlympiAD trial) and showed good response.

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  • Atsuo GORAI, Tetsukan WOO, Munetaka MASUDA
    2020 Volume 81 Issue 8 Pages 1502-1507
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    The patient was an 83-year-old man who underwent surgery for an anterior mediastinal tumor in our hospital in March 2003 and was diagnosed with squamous cell carcinoma of the thymus. His treatment was terminated when five years had elapsed after the operation without recurrence. A CT scan conducted elsewhere in October 2012 detected a thickened left pleura and he was referred to our hospital. A CT-guided biopsy revealed the diagnosis of pleural dissemination of the thymic cancer and radiation therapy was performed. Close exploration conducted in December 2013 identified metastases to the left axillary lymph node, upper abdominal median lymph node, left upper lobe of the lung, and the cerebellum. We performed radiation therapy for the cerebellar lesion, followed by chemotherapy, leading to a CR. However, in March 2017, he developed left pleural dissemination, left pulmonary lower lobe metastasis, and cerebellar metastasis. We performed radiation therapy for the cerebellar lesion and pleural dissemination and added left partial lower lobectomy of the lung for the lung metastasis. In September 2018, the left axillary lymph node metastasis was extirpated. In July 2019, several pleural disseminations were detected in the left lateral pleura for that he is going on with chemotherapy.

    We report a case of thymic cancer in which multidisciplinary therapy results in a long-term survival.

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  • Atene ITO, Yasuyuki NONAKA, Shohei YOKOYAMA, Tsuyoshi OKADA, Susumu SH ...
    2020 Volume 81 Issue 8 Pages 1508-1512
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    An 83-year-old man was admitted to our hospital complaining of fever and walking difficulties. Partial wall thickening of the ascending colon, intraperitoneal free air, and dilatation of the cecum were detected by contrast-enhanced computed tomography. Acute peritonitis due to the perforation of ascending colon cancer was suspected based on the above, and an emergency operation was performed. Since gram-positive bacilli were detected in the blood before surgery, the patient was concomitantly treated with broad-spectrum antibiotics. Clostridium septicum bacteremia was finally identified, and the patient was treated with antibiotics for two weeks. On postoperative day 20, C-reactive protein levels increased again, and inflammation with free air around the aortic arch was detected by a computed tomography scan. Antibiotic therapy was resumed, but the infected lesion developed into an infectious aortic aneurysm.

    It has been reported in previous reports that the association between clostridium septicum and colon cancer is due to mucosal ulceration or perforation, but the incidence of infected aneurysms caused by bacteremia of clostridium septicum due to colon cancer has rarely been reported.

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  • Koshi NAGANO, Kyukwang CHUNG, Shoji HANADA, Hikaru MIYAMOTO, Yumi MATS ...
    2020 Volume 81 Issue 8 Pages 1513-1518
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    A 75-year-old man was detected to have a nodule at the left lower lobe of the lung during close exploration for an abdominal disorder. A chest CT scan showed a 3.4 × 3.0 cm tumor located in the left lung S9, a 1.8 × 1.4 cm nodule in the left lung S6 and a 1.2 × 0.8 cm nodule in the left lung S1+2. The tumor in the left lung S9 was diagnosed as squamous cell carcinoma by bronchoscopy. Even granted that other nodules were ipsilateral pulmonary lobe metastases, the tumor staging remained in cT4N0M0 Stage IIIA. Accordingly, we determined the patient to be a candidate for surgical resection. The histopathological diagnoses were squamous cell carcinoma, adenocarcinoma, and adenosquamous cell carcinoma for the S9 lesion, S6 lesion, and S1+2 lesion of the lung, respectively.

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  • Sho UEDA, Masato MAEDA, Tomoyasu TAKAYANAGI, Keisuke KAWAMORITA, Toshi ...
    2020 Volume 81 Issue 8 Pages 1519-1522
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    The Adachi classification deals with the bifurcation style of the celiac artery, which is classified into 28 groups with six types. Adachi type III is a type in which the left gastric artery branches from the aorta, and the common hepatic artery and splenic artery form a common trunk with the superior mesenteric artery. A 70-year-old woman was admitted with early gastric cancer due to anemia during follow-up after breast cancer surgery. Preoperative multidetector row computed tomography (MDCT) showed an Adachi type III vascular anomaly. Laparoscopic distal gastrectomy D1 + dissection was performed. Since it was an early gastric cancer, the left gastric artery was dissected at the site exposed at the upper margin of the pancreas, and the tissue from there to the crus of the diaphragm was dissected as No. 9 lymph nodes. There are many vascular anomalies such as Adachi type III, and preoperative diagnosis may determine the extent of dissection and avoid intraoperative complications. 3D-angiography by MDCT was considered useful for diagnosis.

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  • Yuriko ISAGAWA-TAKAYAMA, Kengo KANETAKA, Yasuhiro MARUYA, Akira YONEDA ...
    2020 Volume 81 Issue 8 Pages 1523-1527
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    Kounis syndrome is an acute coronary syndrome precipitated by an allergic reaction to a drug or other substances such as iodinated contrast agents. We describe a 69-year-old man who had gastric cancer, Kounis syndrome, and a history of descending aortic replacement, in whom we had great difficulties in treating anastomotic leakage developed after total gastrectomy due to Kounis syndrome. Anastomotic leakage that occurred 6 days after total gastrectomy necessitated emergency laparotomy, and we confirmed that the anastomosis had been completely separated, and stump closure or re-anastomosis was impossible because of friable tissue due to infection and severe adhesions of the esophagus to the aortic prosthesis. Only drainage was performed. Owing to incomplete drainage of the esophageal stump, cervical esophagostomy was necessary to avoid prosthesis infection. However, following descending aortic replacement and total gastrectomy, the thoracic esophagus received its vascular supply only through intramural blood flow from the cervical esophagus. Therefore, we could not exclude a risk that esophageal dissection in the neck could further impair the blood flow to this esophageal segment with resultant necrosis of the remnant and prosthesis infection. Contrast-enhanced imaging studies to evaluate the blood flow were contraindicated owing to Kounis syndrome. Three days after the re-operation, we eventually resected the thoracic esophagus and performed cervical esophagostomy. The patient's postoperative course was uneventful, and jejunal reconstruction was performed 2 months after the 3rd operation.

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  • Atsushi KAMACHI, Nobuyoshi IINUMA, Noriyuki KITAGAWA, Shingo AKITA, Sh ...
    2020 Volume 81 Issue 8 Pages 1528-1532
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    A 71-year-old female was emergently transported to our hospital due to sudden abdominal pain. Abdominal contrast-enhanced computed tomography (CT) examination revealed a saccular structure on the dorsal side of the right mesocolon and within the structure, the ileum was accompanied by a blood flow disturbance, mainly congestion. Emergency surgery was performed with the diagnosis of a strangulated intestinal obstruction. When the strangulation was released, a 3-cm hernial orifice was found on the right inferior margin of the mesocolon in the left ileocecal region, where the jejunum begins. Examination of the inside of the hernia sac revealed that the ventral side of the hernia sac was on the right side of the mesocolon and the dorsal side was on the parietal peritoneum. The duodenum in the hernia sac did not form a horizontal portion and inside the hernia sac, the descending portion lead to the caudal side and then to the jejunum. The patient was diagnosed as strangulated intestinal obstruction due to right paraduodenal hernia with intestinal malrotation presenting with incomplete rotation of the duodenojejunal limb. The hernia orifice was opened widely to prevent recurrence of an intestinal obstruction. In cases of internal hernias with a sac-like structure, a selection of operative procedure according to the type of a disease is recommended, with the possibility of intestinal malrotation in mind.

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  • Shimpei TAKAGI, Ryoji MAKIZUMI, Asako FUKUOKA, Takayuki ASANO, Kazuhir ...
    2020 Volume 81 Issue 8 Pages 1533-1537
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    An 81-year-old man presented with left lateral abdominal pain lasting for 3 days and was referred to our hospital with a suspicion of gastrointestinal perforation. He also had left lateral abdominal pain 3 years previously and was treated conservatively at another clinic. On physical examination in our hospital, no peritoneal irritation was observed, but there was tenderness in the left lateral region of abdomen. Abdominal contrast-enhanced CT scan showed an enhanced region of low-absorption with a cord-like high-absorption structure in its inside in the left lateral abdomen. Another CT scan taken 3 years before showed the similar findings, suggesting that abscess formation due to perforation of a fish bone ingested 3 years before might recur. First, she was treated conservatively and was scheduled for surgery after improvement of inflammation. Fifteen days later, surgical findings showed a causative abscess cavity to be near the small intestine, and when we opened it, rosacea-like contents and a fish bone of about 2 cm in length were found. We resected about 20 cm of the small intestine around the abscess cavity and performed a functional end-to-end anastomosis. The patient's postoperative course was good, and he was discharged on the hospital day 9. Generally, gastrointestinal foreign bodies are often excreted spontaneously, and complications are reported to affect about 1% of all cases. We experienced a relatively rare case of digestive tract perforation caused by a fish bone that had retained and formed an abdominal abscess in 3 years.

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  • Nobuyoshi ASO, Tomokazu KISHIKI, Koichiro KOJIMA, Tadahiko MASAKI, Nob ...
    2020 Volume 81 Issue 8 Pages 1538-1543
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    A 73-year-old man who had undergone right hemicolectomy for cecal cancer experienced abdominal pain and diarrhea after eating grilled meat 2 months previously and was treated with medication due to suspected Campylobacter enteritis. Although his diarrhea improved, the abdominal pain persisted, and his skin became reddened in the navel area. A CT scan showed abdominal wall abscess formation because of a gastrointestinal foreign body. Laparotomy revealed abscess formation involving the anastomosis, which was firmly adhered to the abdominal wall, and a toothpick that had penetrated the intestinal wall at about 5 cm proximal to the anastomosis was found in the abscess. After removal of the toothpick, partial small bowel resection was performed. The patient's postoperative course was uneventful, and he was discharged on postoperative day 8. Toothpicks can cause bowel perforation and peritonitis. It is rarely reported that abdominal wall abscess is formed due to a gastrointestinal foreign body which has penetrated the intestine and reached the abdominal wall.

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  • Anri MAEDA, Hiroki TAKAHASHI, Tatsuya TANAKA, Yoichi MATSUO, Shuji TAK ...
    2020 Volume 81 Issue 8 Pages 1544-1549
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    Myeloid sarcoma (MS) is an extramedullary disease associated with acute myeloid leukemia (AML). A very rare case of MS found in the appendix is reported because it was a valuable case that was difficult to diagnose and treat. A 64-year-old man developed a fever during chemotherapy for myelodysplastic syndrome (MDS). He had developed MDS two years after his first chemotherapy for AML.

    He had a several-day history of fever, and abdominal CT showed terminal dilation of the appendix and stranding of the adjacent fat. He was diagnosed as having acute appendicitis. He was thought to have a high risk in the perioperative period because he was being treated with a course of antibiotics and steroids for pancytopenia and interstitial pneumonia. However, there was concern about the possible failure of medical treatment, since his disease occurred during an extensive course of antibiotics. Therefore, laparoscopic appendectomy was performed. On macroscopic examination, the resected specimen showed terminal enlargement of the appendix, and large blast-like cells were aggregated in the area on pathological examination. The final diagnosis was MS. Early surgical resection should be considered for diagnosis and treatment if a patient with AML has abdominal pain or fever with an enlarged appendix.

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  • Takeshi SUNAMI, Kisyu KITAYAMA, Kazunori NAKAZAWA, Katsuya SAKASHITA, ...
    2020 Volume 81 Issue 8 Pages 1550-1555
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    An 80-year-old man was seen at a clinic complaining of abdominal pain around his navel, and he was referred to our hospital for the purpose of close exploration. Two type 2 tumors were found in the cecum and ascending colon by a colonoscopy, and a biopsy indicated adenocarcinoma. Laparoscopic right hemicolectomy with D3 dissection was performed with the diagnosis of cecum and ascending colon cancer. Pathological diagnoses were cecum cancer tub2, pT3, Ly0, V1, pN0 (0/17), and ascending colon cancer tub2>por2, pT3, Ly3, V0, pN0 (0/17), which was partly composed of micropapillary carcinoma (MPC) at the invasive edge of the tumor. Lymph node metastasis was not recognized (Stage IIa), so that adjuvant chemotherapy was not performed. He developed multiple liver metastases at 19 postoperative months, followed by multiple bone metastases. The patient died 2 years after the surgery. MPC is associated with lymph node metastasis in a high incidence, and the prognosis is poor. MRC has been reported in the mammary gland, urinary bladder, and lung. However, MPC has rarely been reported in the colon, so we present here a case of ascending colon cancer with MPC, with some discussion of the literature.

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  • Kenji SHIRAKAWA, Hironori KOBAYASHI, Satoshi HIRAHARA, Yuta KUHARA, Ha ...
    2020 Volume 81 Issue 8 Pages 1556-1562
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    A 69-year-old woman came to our hospital complaining of pain in the right lower abdominal quadrant. An abdominal computed tomography (CT) scan by a local doctor detected a tumorous lesion in the ascending colon. A colonoscopic examination revealed advanced cancer in the ascending colon, and it was difficult to pass the lesion. There were six polyps in the transverse colon, for which we performed endoscopic mucosal resection. Histopathological examinations found that the two lesions were suggestive of mucosal carcinoma with a serrated adenoma component, and four lesions suggestive of serrated adenoma. We performed a laparoscopic right hemicolectomy with D3 dissection and found eight lesions on the excised specimen. All of the lesions were colorectal cancers. In this case, four serrated adenomas and ten synchronous multiple primary colorectal cancers were observed. Six out of the ten colorectal cancers had serrated adenoma. We believe that the underlying oncogenic mechanism for the development of these cancerous lesions was the “serrated pathway” of carcinogenesis, and consecutively diagnosed the patient with serrated polyposis syndrome. This syndrome is associated with a highly increased risk of colorectal cancer. We need to carefully observe the patient for progression of colorectal cancer in the future.

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  • Koya YASUKAWA, Shinji NAKATA, Syusei SANO, Kei KUSAMA, Akihito NISHIO, ...
    2020 Volume 81 Issue 8 Pages 1563-1569
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    A 76-year-old woman was referred to our department after an abnormality was identified on a computed tomography (CT) scan performed during investigation for anemia. Blood tests showed an elevated human chorionic gonadotropin level of 194,000 mIU/ml, and abdominal contrast-enhanced CT showed a large mass in the ascending colon with invasion of the duodenum, as well as irregularly shaped masses in the liver. Examination of a biopsy specimen from the lesion in the ascending colon identified it as choriocarcinoma, and since there were no abnormalities of the gynecological organs, primary colorectal choriocarcinoma was diagnosed. The tumor could not be removed because the superior mesenteric artery was involved, and only gastrojejunostomy and ileo-transverse colostomy were performed, because gastrointestinal stenosis was evident. Postoperatively, the patient was treated with chemotherapy for chorionic carcinoma, methotrexate, etoposide, and actinomycin D, but the cancer progressed, and her general condition deteriorated rapidly to the point that it was decided to switch to palliative care approximately 6 months after surgery. Primary colorectal choriocarcinoma is extremely rare, with only 22 cases reported worldwide to date. There is no established method of treatment, and most patients already have distant metastasis at presentation, making its prognosis extremely poor.

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  • Hajime FUJIWARA, Mizuo HASHIMOTO, Tetsushi MIZUTANI, Hiroaki USUI, Mot ...
    2020 Volume 81 Issue 8 Pages 1570-1574
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    A 68-year-old man on no medication and with no past medical history visited the hospital because of a 1-week history of abdominal pain and vomiting. Abdominal contrast-enhanced CT suggested ileus of descending colon cancer, and left hemicolectomy was performed on the same day. On postoperative day 4, fever and a decrease in blood pressure were observed. Suture failure was diagnosed, and conservative treatment was given. On postoperative day 21, the suture failure was resolved, but the fever and hypotension did not improve. Adrenal insufficiency was suspected because blood tests showed hyponatremia and elevated eosinophils. Cortisol was normal, but ACTH was low (6.8 pg/ml). Pituitary dysfunction was suspected, and a four-load test was performed ; it only showed ACTH reaction failure, and the patient was diagnosed with isolated ACTH deficiency. Steroid administration was started. The patient's blood pressure recovered promptly, the fever resolved, and blood tests showed improvement in sodium and eosinophils. The steroids are currently being gradually decreased on an outpatient basis. Isolated ACTH deficiency is often idiopathic, but rarely diagnosed postoperatively. This case is reported along with a review of the literature.

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  • Motonobu NISHIMURA, Mizuo HASHIMOTO, Tetsushi MIZUTANI, Hiroaki USUI, ...
    2020 Volume 81 Issue 8 Pages 1575-1582
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    Distal intramural spread (DIS) of rectal cancer is scattered, but it is rare in colon cancer. Hepatocellular carcinoma and renal cell carcinoma often form intravenous tumor embolism in the portal vein and inferior vena cava, but it is rare in colon cancer. A case of colon cancer in which concurrent DIS and intravenous tumor embolism occurred is presented. The patient was a 74-year-old man who had been visiting a clinic for diabetes and hypertension. He was referred to our hospital because of exacerbation of diabetes and underwent whole-body CT. Thickening of the splenic flexure of the colon, neoplastic lesions from the inferior mesenteric vein (IMV) to the splenic vein (SpV), and a space-occupying lesion of liver S5 were found. Colonoscopy showed one transverse colon cancer and two descending colon cancers that were close to each other. The diagnosis was three lesions of colon cancer, intravenous tumor embolism from the IMV to the SpV, and liver metastasis, and preoperative chemotherapy was performed. On CT re-examination, the patient was judged to have partial response (PR). Left colectomy, pancreatectomy, splenectomy, and partial liver S5 resection were performed. Pathological examination showed that the descending colon cancer was the primary, and the other two lesions were DIS. Tumors also invaded from the IMV to the SpV.

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  • Atsushi TOYOFUKU, Katsushi FUJIMOTO, Yugo IHA, Hiroaki KURODA, Aiichir ...
    2020 Volume 81 Issue 8 Pages 1583-1591
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    We report two cases of port site recurrence after laparoscopic colectomy for colorectal cancer.

    Case 1 : A 73-year-old man was diagnosed with sigmoid colon cancer and received laparoscopic-assisted colectomy. CT scan showed port site recurrence in addition to lung and liver metastases 10 months after laparoscopic colectomy. The patient received en bloc excision of the abdominal wall tumor because of intolerant local pain, though he received 1st. line chemotherapy. We resumed chemotherapy, but he passed away 20 months after resection of the port site recurrence.

    Case 2 : A 42-year-old woman was diagnosed with descending colon cancer and received laparoscopic-assisted colectomy. CT and PET-CT scans showed port site recurrence and anastomotic recurrence 36 months after laparoscopic colectomy. The patient simultaneously received colectomy including the anastomosis where the recurrent tumor was located and en bloc excision of the abdominal wall. Though she is now visiting our hospital, no recurrence is confirmed as of three months after resection of the port site recurrence.

    Port site recurrence occurs through a rare manner of recurrence after laparoscopic-assisted colectomy for colorectal cancer. Despite hypotheses advocated for the mechanism of the recurrence, we have not gained clear-cut evidence. In this paper, we report two cases of port site recurrence in our institution.

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  • Katsuya SAKASHITA, Ryugo SAWADA, Kotaro MIURA, Ryo TAKAHASHI, Yuichi F ...
    2020 Volume 81 Issue 8 Pages 1592-1596
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    Recently, indocyanine green fluorescent cholangiography has been reported to effectively delineate the biliary tree during surgery. A case of a spontaneously ruptured giant hepatic cyst with biliary communication successfully treated with laparoscopic deroofing using intraoperative indocyanine green fluorescent cholangiography is presented.

    An 89-year-old woman was admitted to our hospital due to right hypochondralgia of sudden onset with no history of abdominal trauma. Abdominal CT showed a giant hepatic cyst with a diameter of 15 cm located in the right hepatic lobe and fluid collection. Drip infusion CT cholangiography showed contrast medium pooling in the hepatic cyst. Therefore, biliary peritonitis caused by a spontaneously ruptured hepatic cyst communicating with a bile duct was diagnosed, and laparoscopic deroofing was emergently performed under the guidance of intraoperative indocyanine green fluorescent cholangiography. The bile leakage was detected at the bottom of the hepatic cyst using intraoperative indocyanine green fluorescent cholangiography, and it was closed with laparoscopic suturing technique. There was no postoperative bile leakage, the patient's postoperative course was uneventful, and she was discharged from the hospital.

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  • Yuhi YOSHIZAKI, Naoki TAKABAYASHI, Ryosuke KIKUCHI, Takanobu ONODA, Yu ...
    2020 Volume 81 Issue 8 Pages 1597-1603
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    A 39-year-old woman in the 28th week of pregnancy visited our hospital for right hypochondriac pain and nausea. Because of gallstone pancreatitis, she was admitted to gastroenterology. Her condition improved with conservative therapy, but there was concern about the risk of recurrent gallstone pancreatitis. Laparoscopic cholecystectomy was performed at 28 weeks of gestation. Initial port entry was a subxiphoid, open technique under direct vision. Intra-abdominal CO2 insufflation pressures were maintained at 8 mmHg. The surgery was successful, with no postoperative complications. The patient was discharged on the 14th postoperative day. She delivered a healthy baby at 35 weeks of gestation. In Japan, most cases of laparoscopic cholecystectomy are performed in the 1st or 2nd trimester. In this case, laparoscopic cholecystectomy was performed safely in the 3rd trimester.

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  • Hiroaki MITSUGASHIRA, Ryuichi NISHIMURA, Shigehito MIYAGI, Fuyuhiko MO ...
    2020 Volume 81 Issue 8 Pages 1604-1610
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    A 69-year-old man who received thoracoscopic esophagectomy with gastric tube reconstruction for esophageal cancer at the age of 64 had an uneventful postoperative course. A cystic lesion in the pancreatic head which had been pointed out before the surgery became larger. Following detailed examination, it was diagnosed as mixed type intraductal papillary mucinous neoplasm. He underwent pylorus preserving pancreaticoduodenectomy (PPPD), sparing the gastric tube, the right gastroepiploic artery and vein, and the right gastric artery and vein. The gastric tube blood flow was evaluated by using the indocyanine green (ICG) fluorescence method during the surgery. To assess the gastric tube blood supply, image evaluation during PPPD is rarely performed but useful for patients who have previously received esophagectomy.

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  • Masayuki AKIYA, Ryota MATSUKI, Masaharu KOGURE, Yutaka SUZUKI, Toshiyu ...
    2020 Volume 81 Issue 8 Pages 1611-1615
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    We performed pancreaticoduodenectomy with splenic artery resection (PD-SAR) for invasive pancreatic body cancer. The blood flow of the spleen and the residual pancreas was evaluated using indocyanine green (ICG) fluorescence imaging. The luminescence of the spleen was sufficient, however, that of the residual pancreas was poor within 1cm from the cut margin. We closed the stump of the remnant pancreas with sutures to avoid severe pancreatic leakage associated with pancreatico-jejunostomy. No postoperative splenic infarction nor pancreatic fistula occurred, and the glucose tolerance was preserved. It would be useful to introduce intraoperative ICG fluorescence imaging to evaluate the blood flow of the residual pancreas and the spleen during PD-SAR.

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  • Shin SASAKI, Yuko TAKAMI, Yoshiyuki WADA, Tomoki RYU, Hiroki URESHINO, ...
    2020 Volume 81 Issue 8 Pages 1616-1623
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    A 44-year-old woman who had been healthy all her life and had never previously visited a hospital was brought to our hospital by ambulance complaining of dyspnea, with a 2-month history of abdominal distension and loss of appetite. Blood biochemistry tests showed severe anemia (Hb 1.9 g/dl). Contrast-enhanced computed tomography showed a 13-cm multilocular cystic tumor in the pancreatic tail that was displacing the stomach. Upper gastrointestinal endoscopy suggested gastric wall invasion by the pancreatic tail lesion, but a biopsy of the gastric lesion showed no evidence of malignancy. Ultrasound endoscopy showed no intracystic mural nodules. Upper gastrointestinal hemorrhage due to penetration of the gastric wall by a mucinous cystic neoplasm was diagnosed, and after the anemia had improved, elective surgery was performed. The tumor showed widespread, strong adhesions to the gastric wall, and resection of the pancreatic body and tail with aplenectomy and total gastrectomy was performed. Histopathological testing identified severely atypical regions in part of the sample, and noninvasive mucinous cystic adenocarcinoma was diagnosed. There was no invasion of the adjacent gastric wall by the noninvasive mucinous cystic adenocarcinoma. Anemia caused by penetration of the gastric wall by noninvasive mucinous cystic adenocarcinoma is very rare, and this case is reported with a discussion of the literature.

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  • Yu NORIMATSU, Kyoji ITO, Nobuyuki TAKEMURA, Fuminori MIHARA, Hideki MI ...
    2020 Volume 81 Issue 8 Pages 1624-1630
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    Primary splenic lymphoma (PSL) is a rare disease. A case of PSL in which splenectomy was effective for diagnosis of lymphoma subtypes and treatment of hemophagocytic syndrome and disseminated intravascular coagulation (DIC) is presented. A 72-year-old man was admitted with symptoms of fever, general malaise, and weight loss. Imaging findings showed splenomegaly with increased FDG uptake. Although laboratory findings indicated hemophagocytic syndrome and DIC, and hematologic malignancy such as leukemia or lymphoma was suspected, core biopsies of bone marrow and skin did not confirm an obvious diagnosis. His general condition deteriorated gradually, and, therefore, splenectomy was performed for diagnosis and treatment of hemophagocytic syndrome. After surgery, his general condition and laboratory data improved promptly, and the pathological findings showed peripheral T cell lymphoma of the spleen. Splenectomy is effective for PSL in terms of not only diagnosis, but also treatment of hemophagocytic syndrome with PSL.

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  • Tomoya HIRAI, Yuki HOMMA, Yasuhiro SHIMIZU, Takahumi KUMAMOTO, Ryusei ...
    2020 Volume 81 Issue 8 Pages 1631-1636
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    A 53-year-old woman was referred to our department when a splenic tumor was detected by a CT scan performed for diabetes insipidus. The abdominal CT had revealed uneven contrast-enhanced effects in the spleen indicating the presence of a mass with a maximum diameter of 7.7 cm. A PET-CT also detected abnormal accumulation in the same region. Although an MRI was performed, a definite diagnosis could not be made based on the imaging findings, and malignancy could not be ruled out. Therefore, we decided to perform laparoscopic splenectomy for diagnostic treatment. Histopathological examination revealed advanced inflammatory cell infiltration and spindle-shaped cell proliferation, while immunostaining revealed CD21, CD35, CD23, and EBER positivity. Based on the above results, the patient was diagnosed as EBV-related inflammatory pseudotumor-like follicular dendritic cell tumor of the spleen. This is a rare tumor characterized by inflammatory pseudotumor, follicular dendric cell sarcoma and EBV infection. Although uncommon, EBV-related inflammatory pseudotumor-like follicular dendritic cell tumors should be considered in cases of indeterminate splenic tumors. Laparoscopic splenectomy may be an appropriate treatment option.

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  • Toshio ONISHI, Akihiro YONEI, Takeshi KIKUCHI, Yuichi TUCHIDA, Kunihik ...
    2020 Volume 81 Issue 8 Pages 1637-1642
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    Case 1. A 46-year-old woman presented to a neighboring hospital because of a vulvar mass detected by herself and was referred to our hospital with a suspicion of intramural myoma of the uterus and angiomyofibroblastoma by imaging studies ; they appeared to require surgical resection. She underwent surgical resection for the intramural myoma of the uterus by gynecologists in our hospital and that for the vulvar mass by our team. The histopathological diagnosis of the vulvar mass was angiomyofibroblastoma (AMFB). Her postoperative course was uneventful and she was discharged without complications. She has been free from recurrence as of 2 years after the operation. Case 2. A 52-year-old woman presented to the Department of Gynecology because of swelling of the right external genitalia. Angiomyofibroblastoma was suspected on imaging. She was referred to our department because surgical resection would be necessary. The surgical resection of the primary lesion led to the histopathological diagnosis of AMFB. Her postoperative course was uneventful and she was discharged from our hospital. She has been free from recurrence as of 3 months after the operation.

    We report two cases of AMFB, together with a literature review.

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  • Kozo HAYASHI, Naoki MOROBOSHI, Yoichiro KAWAHARA, Shinichi MATSUGE, Yo ...
    2020 Volume 81 Issue 8 Pages 1643-1647
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    The case involved a 66-year-old woman who had been on the treatment for autoimmune hepatitis elsewhere as an outpatient. There was a previous history of undergoing left oophorectomy and right partial oophorectomy for an ovarian tumor at the age of 23. Furthermore, she underwent colectomy for a metastatic sigmoid colon tumor arisen from the ovarian cancer when 40 years had elapsed after the ovarian surgery. Thereafter, a follow-up chest CT scan disclosed a new nodular lesion at the anterior mediastinum, and then she was referred to our hospital. Since efficient methods for preoperative diagnosis were absent, we performed tumor excision with associated resection of the anterior chest wall to treat as well as to diagnose it. The histopathological diagnosis was the same ovarian cancer (serous carcinoma) as the previous sigmoid colon tumor. The patient received adjuvant chemotherapy and has been alive without having recurrence as of 10 years after the second operation.

    This paper deals with a rare case of ovarian cancer which recurred to the sigmoid colon and the anterior mediastinum metachronously, solitarily and distantly after a lapse of more than 40 years following the initial operation, together with a literature review.

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  • Misato SAWAI, Masahiro KIMURA, Saburo SUGITA, Yuki EGUCHI, Toru IMAGAM ...
    2020 Volume 81 Issue 8 Pages 1648-1653
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    A 37-year-old woman had genital bleeds 4 days before her visit. She had lower abdominal pain since the previous day and was transported to our hospital by ambulance. There was lower abdominal tenderness and muscular defense. Blood tests showed a low white blood cell count of 1,040/μL and a high C-reactive protein of 35.5 mg /dL. A computed tomography scan revealed moderate ascites and the small intestine wall was edematous. There were no findings suggesting perforation or intestinal ischemia. Transvaginal ultrasound revealed severe ascites in the Douglas fossa. Based on the results of the rapid ascitic bacterial tests, the patient was diagnosed with primary peritonitis due to group A Streptococcus. A large amount of purulent ascetic fluid was removed during surgery, but no obvious perforation was found. Intra-peritoneal antibiotic therapy with meropenem was started. On day 4 of hospitalization, Streptococcus pyogenes (Group A) were detected in ascitic and vaginal cultures. This is a case of a rare disease that is often difficult to diagnose because there are no characteristic imaging findings. In this case, a preoperative gynecological examination was performed, and the patient was identified and treated.

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  • Yoshinobu FUSE, Toshinori OINUMA, Masashi KUROBE
    2020 Volume 81 Issue 8 Pages 1654-1659
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    A 7-year-old girl presented with hematuria recognized by a health examination at school. Abdominal ultrasound demonstrated a large retroperitoneal heterogeneous mass almost occupying the left lateral region of abdomen and the left kidney was seen separately and excluded by the mass. Abdominal CT and MRI scans revealed a large, well-encapsulated lipomatous mass measuring 14 cm in the maximum diameter with calcification partly. The mass was suspected to be a benign lipoma, while teratoma was considered as a differential diagnosis. The mass had not directly invaded the other organs. En-bloc resection of the mass was thus performed. Histopathology confirmed it as mature lipoma and the calcification site was fat necrosis.

    Follow-up study at 4 years after the operation revealed no evidence of recurrence.

    Retroperitoneal lipomas are extremely rare in pediatric population. To the best of our knowledge, there are no pediatric reports of retroperitoneal lipoma presented with hematuria or associated with some calcification in the literature.

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  • Shigeaki KURIHARA, Akihiro MURATA, Sadatoshi SHIMIZU, Shintaro KOUDAI, ...
    2020 Volume 81 Issue 8 Pages 1660-1664
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    A 54-year-old man was brought to our emergency department because of sudden abdominal pain accompanied by cold sweat. An abdominal computed tomography scan revealed the presence of a large retroperitoneal tumor with intratumoral hemorrhage, 11 cm in diameter, at the caudal side of the ascending portion of the duodenum and the left side of the aorta. Although we considered emergency surgery due to severe abdominal pain, after close inspection, we decided to proceed with elective surgery since a paraganglioma was suspected. The abdominal pain was relieved by narcotic analgesics. The tumor was diagnosed as a paraganglioma based on the high level of urinary catecholamine and MIBG uptake by the mass though 123I-MIBG scintigraphy. After preoperative blood pressure control using α-adrenergic blockers, surgical resection was performed. During the operation, circulation dynamics were stable. The postoperative course was uneventful, and the patient was discharged on postoperative day 9. Only few reports of paraganglioma with acute abdomen are available. It is important to diagnose paragangliomas preoperatively because emergency surgery without a previous diagnosis of paraganglioma is associated with high mortality.

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  • Kazunori TOKIZAWA, Kaoru TAKESHIMA, Hideo BABA, Jun MIYAUCHI, Kazuo YA ...
    2020 Volume 81 Issue 8 Pages 1665-1671
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    We report a rare case of double cancer involving a retroperitoneal undifferentiated pleomorphic sarcoma (UPS) and an ascending colon carcinoma. A 75-year-old male was admitted to our hospital because of a high fever and painful abdominal mass in the right lower quadrant. An enhanced CT scan and colonoscopy revealed an ascending colon carcinoma with perforation and an abscess. In addition, a 4.7-cm retroperitoneal tumor was found adjacent to the third portion of the duodenum and a duodenal submucosal tumor was suspected. A right hemicolectomy and retroperitoneal tumor resection were performed simultaneously. Practically, the retroperitoneal tumor was discontinuous to the duodenum and located just ventral to the abdominal aorta at the level of the left renal vein. The drainage veins of the tumor ran directly into the inferior vena cava. The major axis of the retroperitoneal tumor was 5.3 cm. Histologically, the retroperitoneal tumor was diagnosed as a UPS. Adjuvant radiotherapy was performed on the tumor bed of the retroperitoneal UPS. The patient is alive with no signs of recurrence 18 months after the surgery.

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  • Koji MIYAGAWA, Yudai NAKABAYASHI, Junki YAMAJYO, Momoko TODO, Nobuaki ...
    2020 Volume 81 Issue 8 Pages 1672-1677
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    A 61-year-old woman had been consulting a gynecologist since she noticed swelling in her left inguinal region a few years ago. Because the mass had grown in the previous 10 days, she was referred to surgery for suspicion of hydrocele of the canal of Nuck. A close review of imaging exams obtained over time revealed that the mass had moved inside the inguinal canal toward the outer inguinal ring. We diagnosed the patient with hydrocele of the canal of Nuck with infection and performed surgery. The tumor was half protruding from the external inguinal ring. When the inguinal canal was opened and the tumor was detached from the surrounding tissue, a 4-cm spherical mass with fibrous cord adhered to the blue line outside the inner inguinal ring. The tumor was in contact with the uterine ligament but was not continuous, and communication with the genitofemoral nerve was unknown. Histopathological examination revealed schwannoma. Although it is difficult to identify the nerves that cause schwannomas, the genital branch of the genitofemoral nerve is considered to be involved because of its change over time. In this study, we report a rare case of schwannoma in the inguinal region and provide a brief literature review.

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  • Toshimichi KOBAYASHI, Satoshi TABUCHI, Naokazu CHIBA, Sou KATAYANAGI, ...
    2020 Volume 81 Issue 8 Pages 1678-1681
    Published: 2020
    Released: February 26, 2021
    JOURNALS FREE ACCESS

    A 30-year-old man was referred to us because of suspected acute appendicitis, having complained of right lower abdominal pain lasting for 3 days. Palpation showed tenderness and rebound tenderness located in the right lower abdomen, and biochemical findings showed a remarkable increase in inflammatory reaction. An abdominal computed tomography (CT) examination showed increased fat density located on the ventral side of the ascending colon and directly inferior to the abdominal wall. Since the patient had no history of abdominal surgery, abdominal trauma, or omental torsion, we made the diagnosis of idiopathic omental infarction. After admission, conservative treatment with fasting and antibiotics was initiated. The symptoms gradually improved, and she was discharged on the 12th day after admission. In this study, we report a case of idiopathic omental infarction that improved following conservative treatment.

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