岡山医学会雑誌

A 78-year-old woman visited our hospital after developing severe abdominal pain and upper abdominal swelling. An emergency operation was performed following a diagnosis of linea alba hernia with impaction of the falciform ligament of the liver as observed on CT findings. A defect of about 30 mm in diameter was observed in the linea alba, and preperitoneal adipose tissue and the falciform ligament of the liver prolapsed from the location of the defect and were impacted. We resolved the impaction of the falciform ligament of the liver by dissecting it, and we resected the preperitoneal adipose tissue. Simple closure was performed to correct the hernia orifice because the surrounding tissue was relatively rigid and the tension was mild. The patient's condition improved, and she was discharged on the 5th postoperative day.

抄録全体を表示

A 58-year-old man was diagnosed as having descending colon cancer and underwent a left colectomy with D3 node dissection and end-to-end anastomosis reconstruction. The accessory middle colic artery was secured as a feeding artery, and the middle colic artery was preserved. Diet was started on postoperative day 5 (POD5), and nausea and vomiting appeared on POD10. An upper gastrointestinal series revealed to-and-fro peristalsis in the third portion of the duodenum and dilatation of the proximal duodenum. Abdominal CT showed that the second portion of the duodenum was markedly dilated and the third portion was compressed by the superior mesenteric artery (SMA). As a result, he was diagnosed with post-operative superior mesenteric artery syndrome (SMAS) and treated with conservative therapy. The symptoms improved with a nasogastric tube, and he started to eat after POD26, followed by a successful outcome.

抄録全体を表示

抄録を表示する抄録を非表示にする

We experienced 20 patients with distal bile duct carcinoma from May, 1997 to December, 2007. The male/female ratio was 11/9 and the average age was 69.6 years. The operative procedures were as follows : pancreaticoduodenectomy (PD), 9 ; pyrolus preserving pancreaticoduodenectomy (PPPD), 8 ; subtotal stomach preserving pancreaticoduodenectomy (SSPPD), 2 and hepatico-jejunostomy without resection, 1. We performed a clinicopathological study on 16 patients with distal bile duct carcinoma, excluding 3 operation-related deaths and 1 unresectable case. The cumulative survival rate was 70% at 3 years and 11% at 5 years. The 3-year survival rates at fStageII, fStageIVa and fStageIVb were 100%, 80% and 0%, respectively. Log-rank analysis revealed that pathological pancreatic and duodenal invasion and curative resectability may be prognostic factors, while lymph node metastasis and perineural and stump invasion did not affect prognosis. Six recurrences in the 11 curative resection cases (54.5%) were observed ; therefore, postoperative systemic chemotherapy is warranted to curtail recurrence in advanced distal bile duct carcinoma.

抄録全体を表示

PDF形式でダウンロード (553K)

J-STAGEへの登録はこちら（無料）