Language：Japanese   Publisher：The Japanese Society of Gastroenterological Surgery  

<p>A 80-year-old woman visited our hospital with a complaint of abdominal pain and vomiting. Her abdomen showed muscular guarding with tenderness in the right lower quadrant. Abdominal CT showed an area of poor contrast of the small intestine in the right lower abdomen with surrounding ascites. We diagnosed strangulation ileus in the small intestine and performed emergency surgery. In surgery, the cord was found to be continuous from the posterior wall at the umbilicus into the abdominal cavity, and the small intestine was strangulated. The strangulation was released when the cord was resected. The cord was continuous to the anterior of the ileal mesentery about 20 cm proximal from the ileocecal valve. No Meckel’s diverticulum was found. Histopathological examination revealed that the cord contained an artery and vein, and was diagnosed as vitelline vascular remnants. Vitelline vascular remnants without Meckel’s diverticulum are often found in the presence of ileus, making diagnostic imaging and preoperative diagnosis difficult. Prophylactic resection of vitelline vascular remnants may be desirable if a diagnosis can be made or if they are discovered by chance during surgery.</p>

DOI： 10.5833/jjgs.2019.0138

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Language：Japanese   Publisher：Japan Surgical Association  

<p>We performed distal pancreatectomy with preservation of the pancreatic body for carcinoma of the remnant pancreas which was diagnosed 4 years and 8 months after pancreatoduodenectomy for bile duct carcinoma. The patient was a 75-year-old man undergone pancreatoduodenectomy for carcinoma of the inferior bile duct which was pathologically diagnosed as well-differentiated tubular adenocarcinoma Stage II. Four years and 8 months later, an increase in the CA19-9 level was noted. An abdominal CT scan showed a 2-cm poorly enhanced irregular-shaped tumor at the remnant pancreatic tail. The main pancreatic duct had dilated, and a granular shadow which seemed to be a pancreatic stone was confirmed in the main pancreatic duct in the vicinity of the pancreatojejunostomy. Pancreatic carcinoma in the remnant pancreas and chronic pancreatitis due to the pancreatic stone were diagnosed, and we performed distal pancreatectomy with preservation of the pancreatic body, splenectomy and lymph node dissection. At surgery, the jejunum was dissected and lifted at the distal aspect of the gastrojejunostomy, and jejunal anastomosis was made at the distal pancreatic stump as a drainage of the pancreatic duct for recurrent pancreatitis. The histopathological diagnosis was tubular adenocarcinoma Stage IB. After the operation, his blood-sugar level has been kept stable without using insulin. As metachronous remnant pancreatic carcinoma after resection of bile duct carcinoma is extremely rare, we present this case with some bibliographical comments.</p>

DOI： 10.3919/jjsa.81.349

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Language：Japanese   Publisher：Japanese Society of Female Felvic Floor Medicine  

DOI： 10.32310/jfpfm.16.1_3

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Publisher：金原出版  

DOI： 10.18888/op.0000000937

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Language：Japanese   Publisher：Japan Surgical Association  

The patient was a 77-year-old man who underwent wedge resection of a gastrointestinal stromal tumor of the third portion of the duodenum in 2005. There was no recurrence, and follow-up observation was completed in 2011. He was found to have anemia and was referred to our hospital in 2014. Examination showed a tumor in the third portion of the duodenum. Partial duodenectomy was performed due to suspected local recurrence. Because histopathological examination showed a tissue image similar to that at the initial surgery, and it occurred near the previously resected area, local recurrence of the duodenal GIST was diagnosed. A review of the Japanese reports on duodenal GIST that caused late recurrence showed that, in cases with a low mitotic index and a large tumor size, there is a possibility of late recurrence, and long-term follow-up may be necessary. In principle, the treatment of recurrent GIST is imatinib, but there are cases in which the prognosis is expected to improve with resection, as in the present case. It is necessary to clarify the clinical picture of such cases to be able to select appropriate therapy in the future.

DOI： 10.3919/jjsa.79.1864

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Language：Japanese   Publisher：The Japanese Society of Gastroenterological Surgery  

<p>A 74-year-old man presented with a complaint of abdominal pain. His abdomen showed muscular guarding with tenderness in the right lower quadrant and laboratory data showed a remarkable elevation of an inflammatory response. Abdominal CT showed thickness in the small intestinal wall and an abscess formation with an elevation of surrounding fat density in the right lower abdomen. We diagnosed peritonitis caused by perforation of a diverticulum of the small intestine and performed emergency laparoscopic surgery. A diverticulum was detected on the mesenteric side 30 cm proximal from the ileum end and the tip was perforated. The diverticulum resection was performed with partial ileal resection. Histopathological examination revealed the muscular layer and the mucosal lining of the diverticulum were continuous with those of the ileum. These findings yielded a diagnosis of ileal duplication. We report a rare case of a perforated ileal duplication.</p>

DOI： 10.5833/jjgs.2017.0034

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Language：Japanese   Publisher：The Japanese Society of Gastroenterological Surgery  

<p>A 61-year-old man had undergone curative distal gastrectomy and D2 lymph node dissection for advanced gastric cancer. We administered postoperative chemotherapy with S-1. Twelve months after the operation, an abdominal CT scan showed a marked swelling of the para-aortic lymph node. Seven cycles of S-1+PAC and 6 cycles of S-1+DOC were carried out, but was changed to CPT-11+CDDP because of increased CEA values 9 months after the start of treatment. The CEA value was reduced after the change, the abdominal CT scan revealed that the para-aortic lymph node was smaller. Because PET revealed only a swelling of the para-aortic lymph node, we performed a para-aortic lymph node dissection, and the left renal vein combined resection 2 years from the initial surgery. We used postoperative chemotherapy with 3 cycles of CPT-11+CDDP, and observed. The patient is presently alive with no signs of recurrence after 5 years from the dissection. In para-aortic lymph node metastases of gastric cancer after surgery, because some cases have extended prognosis or are curative by dissection, it is necessary to accumulate and examine further cases related to adaptation and treatment strategy.</p>

DOI： 10.5833/jjgs.2016.0081

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Language：Japanese   Publisher：THE JAPANESE ASSOCIATION OF RURAL MEDICINE  

We report the first case in the Japanese literature of toxic shock syndrome following incisional hernia repair. We performed incisional hernia repair in a 54-year-old man with a BMI of 32.6 kg/m2 who underwent sigmoidectomy for cancer of the sigmoid colon one and half years earlier. Postoperative course was complicated by subcutaneous hemorrhage, which resolved with conservative management, and he was discharged on the 9th postoperative day. However, 3 days after discharge, he was readmitted with shock, high fever, diarrhea, vomiting, somnolence, and acute renal failure. He was diagnosed with toxic shock syndrome (TSS) due to TSS toxin-1 produced by MRSA infection of the subcutaneous hematoma. Drainage was performed and vancomycin, clindamycin, and gamma-globulin therapy were administered, with intensive supportive care. Treatment was successful and he was discharged 24 days after admission.

DOI： 10.2185/jjrm.66.65

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Language：Japanese   Publisher：THE JAPANESE ASSOCIATION OF RURAL MEDICINE  

We report a case of accessory breast cancer in the right axillary region. A 67-year-old woman visited our department complaining of a lump in the right underarm. We suspected cancer of an accessory breast from the findings of mammography and ultrasonography; a histological diagnosis of breast cancer was obtained by needle biopsy. With a preoperative diagnosis of accessory
breast cancer accompanied by ipsilateral axillary nodal involvement, the patient underwent wide local resection of the right axillary region with lymph-node dissection (level II). Histopathological findings of the resected specimen revealed that the tumor was composed of solid tubular carcinoma with intraductal component, with normal breast tissue in the region adjacent to the tumor. A diagnosis of right axillary accessory breast cancer (pT2, N1, pStage IIb) was confirmed. Postoperative chemotherapy and radiotherapy were administered. At present, 18 months after surgery, no sign of recurrence has been observed.

DOI： 10.2185/jjrm.66.72

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Language：Japanese   Publisher：Japan Surgical Association  

A 60-year-old man who developed a bruise in the upper abdomen after he fell against an iron fence was admitted to our hospital. Abdominal CT scan showed injury of the head of the pancreas. Endoscopic retrograde pancreatography (ERP) showed no contrast medium leakage from the main pancreatic duct. We selected conservative treatment with an endoscopic nasopancreatic drainage (ENPD) tube placed in the main pancreatic duct. ENPD contrast examination on the second day showed contrast medium leakage from the main pancreatic duct at the pancreatic head. We diagnosed type IIIb pancreatic trauma, however, continued conservative treatment as the general condition of the patient was improving. The ENPD was exchanged for an endoscopic retrograde pancreatic drainage (ERPD) tube on the 25th day. The patient was discharged on the 36th day with the ERPD tube in place. The ERPD tube was removed after three months from the injury. A medical follow-up at 13 months revealed disappearance and absence of recurrence of the bruise.<BR>Surgical treatment may be avoided in some case with type IIIb pancreatic trauma by instituting pancreatic drainage. It is necessary to accumulate further evidence to establish a standard therapeutic strategy for type IIIb pancreatic trauma.

DOI： 10.3919/jjsa.77.1223

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Publisher：南江堂  

DOI： 10.15106/j00393.2016142691

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Language：Japanese   Publisher：Japan Surgical Association  

A 44-year-old man was admitted to our hospital with abdominal pain and vomiting. He had increased numbers of eosinophils in his peripheral blood. Lower gastrointestinal tract biopsy revealed inflammatory cell infiltration (mainly eosinophils). We initiated oral steroid therapy under a diagnosis of eosinophilic gastroenteritis. The patient's symptoms subsided and he experienced weight loss. He was then readmitted to our hospital with relapse. He complained of a severe abdominal pain on the 20<SUP>th</SUP> day from diagnosis. Computed tomography detected ascites and intraperitoneal free air in the abdomen, so we performed emergency surgery under a diagnosis of small bowel perforation. Abdominal cavity exploration confirmed perforation of the ileum at a site 30 cm from the distal ileum. Histopathological examination of the ileum revealed inflammatory cell infiltration (mainly eosinophils) around the perforation site, and we made a diagnosis of small bowel perforation due to eosinophilic gastroenteritis. One year after surgery, the patient has experienced no relapse.<BR>Eosinophilic gastroenteritis can frequently relapse, sometimes causing gastrointestinal perforation. Therefore, appropriate maintenance treatment is important.

DOI： 10.3919/jjsa.76.2984

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