[Show abstract][Hide abstract] ABSTRACT: We report herein a 41-year-old female with a tubo-ovarian abscess (TOA), which microbial cultures showed to contain extended-spectrum beta-lactamase (ESBL)-producing E. coli, a causative agent of community-acquired infection. The patient initially presented with acute abdominal pain and back pain. Pelvic computed tomography and transvaginal ultrasonography revealed multiple cystic lesions in the bilateral ovaries that suggested TOA. An emergency laparotomy was therefore performed due to the potential for life-threatening septic shock from the TOA-associated pelvic inflammatory disease. Microbial cultures of postoperative fluid discharge from the placed intra-abdominal catheter, vaginal secretions, urine, blood, and feces detected ESBL-producing E.coli. In summary, we successfully performed emergency surgery for life-threatening septic TOA caused by ESBL-producing E. coli infection.
[Show abstract][Hide abstract] ABSTRACT: The prevalence of a paracolostomy hernia has been reported to be from 10% to 50%, with serious impairment of the quality of life and sometimes life-threatening morbidity in some cases. Most essential in avoiding the need for further treatment of an end-sigmoid colostomy is prevention of a parastomal hernia.
We examined the effects of the extraperitoneal route for stoma creation to prevent parastomal hernia after laparoscopic abdominoperineal resection for rectal neoplasms.
This is a study of a retrospective cohort.
Data on a total 37 consecutive patients who underwent abdominoperineal resection from March 2005 to December 2010 in Kochi Health Sciences Center were examined retrospectively in this study. Group A included 22 patients whose stoma was created through the extraperitoneal route, and group B included 15 patients whose stoma was created through the transperitoneal route.
The main outcome measures were the rate of parastomal hernia determined through CT and clinical examinations in the 2 groups.
In Group A, 1 case was diagnosed as having a parastomal hernia, whereas, in Group B, 5 cases were diagnosed by CT examination as having a parastomal hernia; the difference in incidence between the 2 groups was significant (p = 0.0305). Furthermore, median duration of the follow-up period between the latest CT examination and the primary operation was 722 days in group A, which was significantly longer than that in group B (442 days) (p = 0.001).
: This study was limited by its nonrandomized retrospective design.
Group B developed parastomal hernia more frequently within a significantly shorter period. A permanent sigmoid colostomy created through the extraperitoneal route can prevent the incidence of parastomal hernia after laparoscopic abdominoperineal resection.
Diseases of the Colon & Rectum 09/2012; 55(9):963-9. DOI:10.1097/DCR.0b013e31825fb5ff · 3.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A83 -year-old man was admitted to our hospital for the treatment of advanced ascending colon cancer with liver metastases. He had initially undergone an ileocecal resection for ascending colon cancer. Subsequently, we started oral administration of UFT/LV(UFT 400mg/day, LV 75 mg/day, and 4 weeks of therapy followed by a week suspension of treatment). After 3 courses, his tumors responded well to treatment, and CT showed marked regression of liver metastases. After 10 courses, liver metastases had almost disappeared. Two years passed without any adverse events since UFT/LV therapy was started. These findings suggest that UFT/LV therapy is very safe and effective for elderly patients with unresectable colorectal cancer.
Gan to kagaku ryoho. Cancer & chemotherapy 03/2012; 39(3):473-5.
[Show abstract][Hide abstract] ABSTRACT: A 70-year-old woman noticed a nodule in the lower anterior aspect of the neck along with horseness of voice. Cervical ultrasonography revealed a homogeneous and hypoechoic tumor of 31 mm in diameter in the lower pole of the left thyroid, in addition to swelling in the perijugular lymph nodes. Cervical computed tomography demonstrated a homogeneous tumor in the lower pole of the left thyroid to the superior mediastinum and small bilateral nodules in the lungs. Although fine-needle aspiration biopsy cytology from the tumor mass is considered to be insufficient specimens, we diagnosed thyroid cancer with lymph nodes metastases based on image diagnosis. Subtotal thyroidectomy, adjacent lymphadenectomy, left recurrent laryngeal nerve resection, and left branchiocephalic vein resection were performed. Immunohistochemistry demonstrated positive staining of tumor cells for CD5 and negative for TTF-1 and thyroglobulin. As a result, we diagnosed as carcinoma showing thymic-like differentiation (CASTLE). Postoperative radiotherapy was subsequently performed, and no recurrence has been noted in a three-year period. Hence, CASTLE should be considered as a differential diagnosis in tumors of the lower pole of the left thyroid to the superior mediastinum.
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 01/2012; 73(5):1064-1069. DOI:10.3919/jjsa.73.1064
[Show abstract][Hide abstract] ABSTRACT: A 53-year-old man with anemia was found to have a tumor in the ascending colon by colonoscopy. Endo-scopic biopsy revealed the possibility of either leiomyoma or gastrointestinal stromal tumor (GIST), while CT revealed a tumor of the caudate lobe of the liver. Based on a suspected diagnosis of GIST in the ascending colon and a solitary liver metastasis, we performed ileocecal resection and caudate lobec-tomy. Leiomyosarcoma in the ascending colon and a liver metastasis were confirmed by histopathology, immunohistology, and gene analysis. The definition and treatment of GIST have undergone changes in recent times. Almost all cases formerly diagnosed as leiomyosarcoma of the gastrointestinal tract are now classified as GIST and are treated with molecular targeted agents such as imatinib. As a result, cases of true leiomyosarcoma of the gastrointestinal tract are few and treated solely by surgical resection. In this case, gene analysis was crucial for diagnosis and to determine the treatment course.
[Show abstract][Hide abstract] ABSTRACT: Intersphincteric resection (IRS) is a surgical technique used to preserve sphincter function, mainly cases of low rectal cancer located less than 5 cm from the anal verge [1, 2]. There have been reports of laparoscopic ISR [3, 4], but discussion of the specific techniques used in this laparoscopic surgical procedure have not been sufficient. For better outcomes of this sophisticated procedure, extreme care must taken to prevent perforation of the rectal wall and to preserve the external sphincter muscle. The most difficult steps for ISR are the circular dissection and separation of the internal sphincter muscle from the external sphincter and puborectalis using the perineal approach. The authors' techniques and the advantages of laparoscopic ISR are shown by a video presentation of three rectal tumor cases. Also, the perioperative outcomes for the patients who underwent laparoscopic ISR with this technique are described.
From January 2006 to September 2009, laparoscopic ISR with total mesorectal excision was performed for 15 patients (10 men and 5 women). The median age of the patients was 60.5 years. The T categories of the tumor node metastasis (TNM) classification for the rectal cancers were Tis for two patients, T1 for one patient, T2 for four patients, and T3 for eight patients. The median distance from the anal verge to the tumor in this series was 3.7 cm. The Tis cases had large laterally spreading tumors that could not be removed by endoscopic submucosal dissection. The T1 case presented in the video had a small tumor just above the dentate line that had developed in the presence of chronic ulcerative colitis. Because this case required total proctocolectomy and ileal pouch anal anastomosis, local resection was not used (Table 1). Table 1 Patients' clinical characteristics (2006.1-2009.8) No. of patients: 15 Gender (M/F):10/5 Age: years (range): 60.5 (31-75) pT*: Tis (n=2), T1 (n=1), T2 (n=4), T3 (n=8) Distance from anal verge: cm (range): 3.7 (2-5) * Pathological T categories of the tumor node metastagis (TNM) classification
The 68-year-old man in case 1 had a large, laterally spreading rectal tumor. The 61-year-old man in case 2 had rectal cancer, with a tumor located 4 cm from the anal verge. Laparoscopic surgery was performed after neoadjuvant chemoradiotherapy. The 71-year-old woman in case 3 had T1 rectal cancer, with a tumor located just above the dentate line. After dissection of the intersphincteric space, the prolapsing technique was used.
In the male patients, the rectum with the mesorectum was first dissected to the anal hiatus, initially on the posterior side along the avascular plane. Second, Denonvilliers' fascia was dissected, and the seminal vesicle was exposed. The third step was dissection of the lateral tissues followed by incision of Denonvilliers' fascia with the rectal wall exposure and care taken not to injure the neurovascular bundle (Fig. 1). Along this dissection plane, the puborectalis could be reached and intersphincteric space entered from the lateral side of the rectal wall (Fig. 2). The final step was dissection of the hiatal ligament at the posterior side of the rectum. Nearly circular dissection of the intersphincteric space could be completed. The difficulties associated with the perineal approach were reduced by this abdominal approach, and the tumor could be exteriorized easily. Fig. 1 After incission of the Denonvilliers' fascia at the lateral side of the seminal vesicle puborectalis muscle can be reached at the lateral side of the rectum. Fig. 2 Adhesion line between the puborectalis muscle and rectal wall is enposed. Intersphinecteric space can be entered along this dissection plane at the lateral side of the rectum.
The mean duration of surgery was 386 min, and the mean blood loss was 108 ml. The mean postoperative hospital stay was 18 days. The diverting ileostomy was closed at a mean of 7.3 postoperative months. No remarkable perioperative complication was encountered (Table 2). Table 2 Perioperative outcomes (n=15) Duration of surgery: min (range) 386 (319-510) Blood loss: ml (range) 108 (0-180) Postoperative hospital stay: days (range) 18 (11-31) Complications: n (range) Anastomotic leakage 1 Stricture of the anastomosis 1 Pelvic abscess 1 Postoperative period until the stoma closure (months) 7.3 (3-16)
Laparoscopic ISR enabled reduction of the difficulties associated with the perineal approach. An advantage of laparoscopic ISR is the ability clearly to visualize anatomic structures in the deep pelvic cavity.
[Show abstract][Hide abstract] ABSTRACT: About 50% of patients who have a permanent stoma experience some degree of parastomal hernia formation. To prevent this complication, the extraperitoneal route is considered to be more effective than the transperitoneal route in the case of open colorectal surgery. This technique also has superiority in avoiding postoperative intestinal obstruction. Although laparoscopic surgery for rectal cancer has not been proved to be as safe as open surgery by a randomized-controlled trial, some studies have shown the equality of long-term results with laparoscopic low anterior resection and laparoscopic abdominoperineal resection. It is anticipated that cases of laparoscopic abdominoperineal resection will increase in the near future. However, a laparoscopic technique for creation of a permanent stoma has hardly been discussed. Most operative procedures for laparoscopic stoma creation have been performed with transperitoneal route, which may cause parastomal hernia and/or intestinal obstruction. This report describes a laparoscopic technique for permanent sigmoid stoma creation through the extraperitoneal approach.
[Show abstract][Hide abstract] ABSTRACT: A 60-year-old-man underwent initial resection of a rectal tumor, with a transanal approach, on December 6, 2000. The tumor was diagnosed as a gastrointestinal stromal tumor(GIST) by KIT and CD34 immunohistochemistry. In June 2003, a third recurrence in the rectum was discovered, at the same location as the initial tumor, and he was referred to our hospital. Magnetic resonance imaging (MRI) revealed a tumor 3.0 cm in diameter, compressing the prostate anteriorly. After the oral administration of imatinib mesylate (Gleevec, Glivec) at a dose of 400 mg per day for 3 months, the size of the tumor had decreased to 1.2 cm in diameter. On December 12, 2003, a fourth operation was performed successfully, with a perineal approach, preserving sphincter function. More than 40 months after the fourth operation, neither local recurrence nor distant metastasis was detected. Our strategy of treatment with imatinib allows not only complete excision of the tumor but it also reduces postoperative impediments in patients with recurrent rectal GIST.
International Journal of Clinical Oncology 09/2008; 13(4):355-60. DOI:10.1007/s10147-007-0735-1 · 2.13 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: ABSTRACT: A 60-year-old-man underwent initial resection of a rectal tumor, with a transanal approach, on December 6, 2000. The tumor was diagnosed as a gastrointestinal stromal tumor(GIST) by KIT and CD34 immunohistochemistry. In June 2003, a third recurrence in the rectum was discovered, at the same location... [more]
/ Japan Society of Clinical Oncology. 09/2008; 13(4):355-60
International Journal of Clinical Oncology 09/2008; 13(4):355-60. · 2.13 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Xanthogranulomatous changes in the pancreas are extremely rare. A 66-year-old man presented with a 2-year history of epigastralgia. Computed tomography scan revealed a 4-cm low-density area around the body of the pancreas. Magnetic resonance imaging demonstrated that the mass appeared hyperintense on a T2-weighted image and isointense on a T1-weighted image. Based on a diagnosis of invasive ductal carcinoma of the pancreas, distal pancreatectomy and splenectomy were performed. Sections examined from the mass showed an aggregation of many foamy histiocytes, lymphocytes, and plasma cells. The surrounding pancreatic tissue showed fibrosis and chronic inflammation. These findings suggested a xanthogranulomatous inflammation, and resulted in a diagnosis of xanthogranulomatous pancreatitis.
Journal of Hepato-Biliary-Pancreatic Surgery 02/2008; 15(2):240-2. DOI:10.1007/s00534-007-1251-4 · 1.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Laparoscopic surgery for colon cancer has been shown by several randomized, controlled trials to be an acceptable alternative to open surgery; however, laparoscopic rectal surgery has not been evaluated in a randomized trial. One of the most serious problems associated with laparoscopic rectal surgery are bowel clamping, irrigation, and transection of the rectum, and laparoscopic rectal surgery has not been as reliable as open rectal surgery.
We present our new technique, the laparoscopic double-stapling technique, which eliminates these problems. This technique uses curved Doyen forceps introduced through the wound just above pubis symphysis for clamping the rectal wall at the anal side of the tumor. An endolinear stapler (length 60 mm) is inserted through the same wound, applied at the rectal wall parallel and caudal to the Doyen forceps, and transects the rectum under pneumoperitoneum. We used this technique for eight cases of rectal surgery.
The laparoscopic double-stapling technique provided secure bowel clamping and rectal irrigation. The number of cartridges used in laparoscopic double-stapling technique cases was not more than 2, with an average of 1.6 per patient. None of the laparoscopic double-stapling technique cases experienced major complications.
We consider that many cases of rectal cancer that are suitable for laparoscopic low anterior resection can undergo laparoscopic surgery by using this technique, which will improve the quality of rectal surgery.
Diseases of the Colon & Rectum 01/2008; 50(12):2247-51. DOI:10.1007/s10350-007-9035-0 · 3.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We herein report a case of rectosigmoid cancer metastasizing to a fistula in ano. A 53-year-old man complaining of anal bleeding consulted another hospital. He had been suffering from an anal fistula since 7 years. On the left upper side of the skin surface around the anus a fistula end was seen as a hole that tunneled down into the back passage, although no hard tumor was palpable on the hole. Complete colonoscopy revealed an ulcerative tumor in the rectosigmoid colon. On 5 February 2004, anterior resection and lymphadenectomy was performed. The post-operative pathological diagnosis was rectosigmoid cancer, Type 2, T2, N0, M0, stage II. The anal fistula was a simple type and mucinous discharge was not observed. On 23 February 2004, coring out the anal fistula was performed by the former hospital. Pathological diagnosis of the excised fistula revealed well-differentiated adenocarcinoma; identical to the colon tumor. Immunohistochemical staining of these two lesions were negative for (CK) 7 but staining with CK20 revealed some stained tumor cells in two lesions. We diagnosed this tumor as metastatic adenocarcinoma from a rectosigmoid cancer. Recurrent lesions were not seen during the first year after the first operation.
Japanese Journal of Clinical Oncology 12/2005; 35(11):676-9. DOI:10.1093/jjco/hyi181 · 2.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We herein report the case of a patient with mucinous gastric carcinoma with peritoneal dissemination that disappeared after neoadjuvant chemotherapy with S-1 alone. The patient has survived for over 23 months after surgery, without recurrence. A 60-year old man was referred to our hospital because of an advanced gastric cancer, detected by upper gastrointestinal endoscopy at another hospital. Staging laparoscopy was performed on October 25, 2002, and revealed massive peritoneal dissemination. Two courses of neoadjuvant chemotherapy with S-1 were administered, at 120 mg/day for 28 days, as one course. Total gastrectomy, with D2 lymph node dissection, was performed on January 24, 2003. The peritoneal dissemination had macroscopically disappeared and the cytology of the peritoneal lavage fluid was class III. His final diagnosis was gastric carcinoma, MLU, type 3, T2(SS), P0, H0, M0, N3, CY0, stage IV.
Gastric Cancer 02/2005; 8(1):50-4. DOI:10.1007/s10120-004-0309-0 · 3.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Total pelvic exenteration (TPE) generally requires the construction of double stomas after surgery, dramatically and adversely affecting the patient's quality of life (QOL). Stoma-free TPE for invasive rectal cancer has been reported with good prognosis and improved QOL. A 61-year-old man with constipation was found in total colonoscopy to have an ulcerative tumor in the lower rectum, and biopsy revealed moderately differentiated adenocarcinoma of the rectum. Diagnostic imaging showed that advanced rectal cancer had widely invaded the bladder. There was no evidence of metastasis to other organs. We conducted TPE with bladder reconstruction using Studer's procedure on July 9. The patient was discharged on September 30, maintaining full continence in the daytime and residual urine volumes after straining below 50 ml. TPE with Studer's neobladder may thus be a viable option after curative surgery for rectal carcinoma infiltrating the bladder.