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ABSTRACT: An internal hernia may be either congenital or acquired. The reported incidence of such hernias is 1-2%. In rare cases, internal hernias are the cause of small bowel obstruction, with a reported incidence of 0.2-0.9%. Transmesocolic hernia of the ascending colon is especially rare. We report a case of transmesocolic hernia of the ascending colon with intestinal obstruction diagnosed preoperatively. A 91-year-old Japanese female was admitted to our hospital with abdominal distention and vomiting of 3 days duration. She had no past history of any abdominal surgery. Abdominal examination revealed distention and tenderness in the right iliac fossa. Abdominal computed tomography revealed ileus in the sac at the left side of the ascending colon and dilatation of the oral side of the intestine. We diagnosed a transmesocolic hernia of the ascending colon with intestinal obstruction and performed emergency surgery. At the time of operation, there was internal herniation of ileal loops through a defect in the ascending mesocolon, without any strangulation of the small bowel. The contents were reduced and the tear in the ascending mesocolon was closed. The postoperative course was uneventful and the patient was discharged 14 days after surgery. In conclusion, preoperative diagnosis of bowel obstruction caused by a congenital mesocolic hernia remains difficult despite the techniques currently available, so it is important to consider the possibility of a transmesocolic hernia when diagnosing a patient with ileus with no past history of abdominal surgery.
Case Reports in Gastroenterology 01/2012; 6(2):344-9.
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Hiroshi Yoshida,
Yasuhiro Mamada,
Nobuhiko Taniai,
Yoshiaki Mizuguchi,
Tetsuya Shimizu,
Shigeki Yokomuro,
Takayuki Aimoto,
Yoshiharu Nakamura,
Eiji Uchida,
Yasuo Arima, Manabu Watanabe,
Eiichi Uchida,
Takashi Tajiri
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ABSTRACT: To describe a simple one-step method involving percutaneous transhepatic insertion of an expandable metal stent (EMS) used in the treatment of obstructive jaundice caused by unresectable malignancies.
Fourteen patients diagnosed with obstructive jaundice due to unresectable malignancies were included in the study. The malignancies in these patients were a result of very advanced carcinoma or old age. Percutaneous transhepatic cholangiography was performed under ultrasonographic guidance. After a catheter with an inner metallic guide was advanced into the duodenum, an EMS was placed in the common bile duct, between a point 1 cm beyond the papilla of Vater and the entrance to the hepatic hilum. In cases where it was difficult to span the distance using just a single EMS, an additional stent was positioned. A drainage catheter was left in place to act as a hemostat. The catheter was removed after resolution of cholestasis and stent patency was confirmed 2 or 3 d post-procedure.
One-step insertion of the EMS was achieved in all patients with a procedure mean time of 24.4 min. Out of the patients who required 2 EMS, 4 needed a procedure time exceeding 30 min. The mean time for removal of the catheter post-procedure was 2.3 d. All patients died of malignancy with a mean follow-up time of 7.8 mo. No stent-related complication or stent obstruction was encountered.
One-step percutaneous transhepatic insertion of EMS is a simple procedure for resolving biliary obstruction and can effectively improve the patient's quality of life.
World Journal of Gastroenterology 05/2006; 12(15):2423-6. · 2.47 Impact Factor
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Hiroshi Yoshida,
Yasuhiro Mamada,
Nobuhiko Taniai,
Yoshiaki Mizuguchi,
Yoshiharu Nakamura,
Tsutomu Nomura,
Takeshi Okuda,
Eiji Uchida,
Yuh Fukuda, Manabu Watanabe,
Takashi Tajiri
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ABSTRACT: Calcifications within primary gastrointestinal tumors are rare. Gastrointestinal stromal tumor (GIST) is an unusual nonepithelial tumor that develops in the gastrointestinal tract. In this paper we describe a case of spurt bleeding from a calcificated GIST in the stomach successfully treated by partial gastric resection. A 77-year-old man was admitted for chest discomfort and loss of consciousness. Endoscopic examination revealed spurt bleeding from the top of the submucosal tumor. No other lesions or points of bleeding were found in the stomach. Emergency partial gastrectomy was performed, and the stomach was closed. The cut surface of the tumor had a firm, solid, whitish-gray parenchyma with patchy calcification. Microscopic observation revealed a profusion of spindle-shaped tumor cells with calcification growing from the gastric muscular propria to the submucosa. The cells exhibited low mitotic activity and no prominent signs of nuclear atypia. Immunohistochemical staining of the tumor demonstrated positive reactivity for CD34, KIT, and vimentin, but negative reactivity for alpha-smooth muscle actin, desmin, and S-100 protein. Tumor cells positive for Mib-1 were rare. The diagnosis of the tumor was established as GIST.
Journal of Nippon Medical School 11/2005; 72(5):304-7.
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Hiroshi Yoshida,
Takashi Tajiri,
Yasuhiro Mamada,
Nobuhiko Taniai,
Youichi Kawano,
Yoshiaki Mizuguchi,
Tetsuya Shimizu,
Tsubasa Takahashi,
Eiji Uchida, Manabu Watanabe,
Eiichi Uchida
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ABSTRACT: An unusual case involving an infected hepatic cyst in which the correct diagnosis was made without operation is reported. A 93-year-old woman presented with acute onset of right upper quadrant abdominal pain, mild left lower quadrant abdominal pain, diarrhea, and fever. On admission, computed tomography revealed a 15 cm solitary hepatic cyst in the anterior-superior segment of the liver with a thickened wall that enhanced with contrast media. Ultrasonography demonstrated a 15 cm anechoic lesion with a hypoechoic area in the dependent portion of the cyst and a thickened wall. The serum concentration of C-reactive protein was 24.3 mg/dL, and the white blood cell count was 13,800/microL. A diagnosis of infected hepatic cyst was suspected, and percutaneous transhepatic drainage of the cyst was performed. Milky yellow fluid was obtained and the patient's right upper quadrant abdominal pain resolved after drainage. Klebsiella pneumoniae was cultured from the drainage fluid. The patient was discharged 20 days after drainage. Infection has not recurred and the hepatic cyst has not enlarged after 18 months.
Journal of Nippon Medical School 01/2004; 70(6):515-8.
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Hiroshi Yoshida,
Takashi Tajiri,
Yasuhiro Mamada,
Nobuhiko Taniai,
Youichi Kawano,
Yoshiaki Mizuguchi,
Shigeki Yokomuro,
Eiji Uchida,
Yasuo Arima,
Koho Akimaru, Manabu Watanabe,
Eiichi Uchida
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ABSTRACT: This report describes a one-step insertion of an expandable metallic stent to treat obstructive jaundice due to unresectable common bile duct carcinoma.
A percutaneous transhepatic cholangiogram is obtained, and the bile duct obstruction is negotiated with a guide wire. After advancing the catheter into the duodenum, contrast material is injected to measure the length of the stenosis. After an expandable metallic stent is positioned, an external biliary drainage catheter is left in place to provide temporary drainage. The catheter is removed after stent patency is confirmed after 3 days.
One-step insertion of an expandable metallic stent for biliary obstruction is a useful method that shortens hospitalization. Once it has been decided to use stent palliation, the stent should be inserted without undue delay to maximize symptomatic relief and cost benefits.
Journal of Nippon Medical School 05/2003; 70(2):179-82.
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Hiroshi Yoshida,
Masahiko Onda,
Takashi Tajiri,
Yasuhiro Mamada,
Nobuhiko Taniai,
Atsushi Hirakata,
Youichi Kawano,
Yoshiaki Mizuguchi,
Ichiro Tahara,
Moto Kashiwabara,
Yoshinori Ishikawa, Manabu Watanabe,
Koho Akimaru
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ABSTRACT: We describe an unusual case of extreme hepatic left lobar atrophy with hilar cholangiocarcinoma. A 67-year-old woman was referred to Nippon Medical School with obstructive jaundice. On admission, computed tomography revealed dilated intrahepatic bile ducts and a defect in the area drained by the left side of the middle hepatic vein. A Spiegel lobe was demonstrated, but the left lobe could not be detected to the left side of the gallbladder. Percutaneous transhepatic cholangiography was performed and demonstrated obstruction of the intrahepatic bile duct at the hepatic hilum. A drainage catheter was left in place. Angiography revealed that the left hepatic artery was present, but there was narrowing of the left portal vein. A diagnosis of agenesis of the left hepatic lobe with hilar cholangiocarcinoma was made. At surgery, the left lobe appeared extremely atrophic without atrophy of the Spiegel lobe. The right anterior branches of the hepatic artery and portal vein had been invaded by carcinoma, so a left trisegmentectomy was performed. Final pathology was advanced hilar cholangiocarcinoma with invasion of the hepatic parenchyma, portal vein, and nervous system. The left lobe was atrophic without hepatolithiasis. The left portal vein was narrow distal to the Spiegel branch. The serum total bilirubin concentration was elevated postoperatively, and the patient was treated for hepatic failure. The patient died of pneumonia without recurrence 7 months after surgery. This rare case of extreme hepatic left lobar atrophy with hilar cholangiocarcinoma was successfully treated by left trisegmentectomy. Preoperative portal embolization was unnecessary because the left lobe was already atrophic.
Journal of Nippon Medical School 07/2002; 69(3):278-81.
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ABSTRACT: A case of esophageal leiomyosarcoma, for which CT scan, endoscopie ultrasonography (EUS) and angiography were employed for
preoperative diagnosis is reported. CT scan identified an exophytic mass which had no rim-enhancement in the lower end of
the esophagus. EUS revealed a homogeneous mass originating from the muscularis propria. Angiography showed a mildly hypervascular
tumor. Histologically, the resected specimen was a leiomyosarcoma. These results suggest that the evaluation by EUS combined
with CT scan and angiography is useful in differentiating smooth muscle tumors from other submucosal tumors.
Journal of Gastroenterology 01/1992; 27(6):773-779. · 4.16 Impact Factor
