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ABSTRACT: Obturator hernia is an important cause of small bowel obstruction and is associated with difficult diagnosis and high mortality.
We reviewed 22 cases of intestinal obstruction due to obturator hernia that necessitated surgical intervention over the last 17 years and evaluated the changes in the number of patients based on the census data.
All cases were elderly females. The Howship-Romberg sign was present in 15 patients (68%). Computed tomography (CT) correctly diagnosed 13/15 (87%) of cases in which it was performed prospectively. The median time to surgery was 7.5+/-5.2 days for those patients with bowel resection, compared to 0.8+/-1.3 days for those without (P <0.05). The number of patients with obturator hernia has increased with an ageing society.
The rising incidence of obturator hernia is probably linked to an ageing society. CT of the pelvis was helpful in obtaining the correct diagnosis. The shorter the delay between admission and surgery, the lower the bowel resection rate. Laparotomy at an early stage is recommended in such patients as it leads to reduced morbidity and mortality.
Annals of the Academy of Medicine, Singapore 06/2007; 36(6):413-5. · 1.25 Impact Factor
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ABSTRACT: We herein present a case of a 75-year-old female with mucosa-associated lymphoid tissue (MALT) lymphoma of the transverse colon with the stage IE (Ann Arbor classification). Colonoscopy revealed the tumor's appearance as a IIa plus II c-like early colon cancer as defined according to the macroscopic classification of the Japanese Research Society for Cancer of Colon, Rectum and Anus, measuring less than 2 cm in diameter. Histologically, the tumor was diagnosed as MALT lymphoma because of the presence of lymphoepithelial lesions consisting of diffuse proliferation of atypical lymphocytes and glandular destruction. The majority of these lymphocytes immunohistochemically stained for the B-lymphocyte marker. The patient first underwent H pylori eradication therapy with Lansap. However, the tumor size gradually increased over the next 4 mo and the patient eventually underwent surgical resection. The operative procedure included a partial colectomy with dissection of the paracolic lymph nodes. The tumor measured 45 mm multiply 30 mm in diameter and histological examination showed that the lymphoma cells had infiltrated the muscle layer of the colon without nodal involvement. The patient has had no recurrence postoperatively without any chemotherapy.
World Journal of Gastroenterology 10/2006; 12(34):5573-6. · 2.47 Impact Factor
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ABSTRACT: Small bowel stenosis is a serious complication of intestinal anisakiosis. The aim of this report is to investigate whether severe stenosis of the small intestine can be conservatively managed. We treated two patients with severe stenosis of the small intestine caused by anisakiosis. Surgical intervention was eventually performed on the 23rd and 35th in the hospital, respectively. Histopathological examination of the resected specimens revealed that the intestinal wall had been completely damaged by the inflammatory reaction of anisakiosis, and that the damage was irreversible, thereby suggesting that laparotomy is needed in cases of severe small bowel stenosis caused by intestinal anisakiosis, even if a long period of conservative treatment for the intestinal anisakiosis allowed the patient to pass successfully through the acute phase.
World Journal of Gastroenterology 08/2006; 12(25):4106-8. · 2.47 Impact Factor
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ABSTRACT: Large gastric trichobezoars usually are difficult to remove gastroscopically without gradual fragmentation. Surgical retrieval of trichobezoars may be recommended, which requires laparotomy and gastrotomy. The authors report a case in which an 11-year-old girl with a trichobezoar underwent successful removal using gastroscopy with laparoscopically assisted fragmentation.
Journal of Pediatric Surgery 03/2003; 38(2):e7. · 1.45 Impact Factor
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ABSTRACT: Gastric necrosis is a rare and often fatal condition. A few reports of gastric necrosis of various etiologies have been published in the literature. This report deals with a case in which gastric necrosis and perforation occurred several years after an infarction of the spleen. Preoperative computed tomography showed the existence of splenic vein thrombosis accompanying splenic infarction. A laparotomy revealed an 8-cm-long laceration with ragged margins in the posterior of the stomach along the greater curvature. Furthermore, massive venous thrombosis was found in the major omentum. As a result, the reduced arterial blood supply and insufficient venous drainage due to splenic venous thrombosis may have together played a major role in the development of gastric necrosis.
Surgery Today 02/2003; 33(11):867-9. · 1.22 Impact Factor
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Journal of Clinical Gastroenterology 08/2002; 35(1):107-9. · 3.16 Impact Factor
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ABSTRACT: We herein present two cases of a colorectal perforation due to uncommon reasons. First, we treated a 45-year-old woman for a stercoral perforation of the sigmoid colon. The pathognomonic etiology was a barium fecaloma originating from an upper gastrointestinal series 9 months before admission. The second case was a 46-year-old woman who was admitted with a perforation of the transverse colon. She had experienced perforations of the sigmoid colon at 32 years of age and of the rectum at 44 years of age, respectively. The second and third conditions were diagnosed to be idiopathic, and were histologically proven by an abrupt obliteration and a thinness of the colonic wall with some infiltration of inflammatory cells. The first condition, however, was most likely a stercoral perforation. The postoperative course of these patients was uneventful, and both are doing well at this writing.
Surgery Today 02/2002; 32(9):836-9. · 1.22 Impact Factor
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ABSTRACT: Biliary obstruction is rarely caused by a foreign body. This report describes the case of a 60-year-old Japanese man with jaundice caused by an impacted shrapnel splinter in the common bile duct (CBD) that had migrated from the right thoracic cavity 36 years after initial injury. Biochemical data showed a total bilirubin level of 4.2 mg/dl with a direct bilirubin level of 3.1mg/dl, an alanine aminotransferase level of 24IU/l, and an alkaline phosphatase level of 18.5KA units. It was serially documented that the shrapnel had migrated toward the diaphragm, then burrowed into the liver, settling in the CBD, and causing obstructive jaundice. Choledochotomy and T-tube drainage was performed and the postoperative course was uneventful. To our knowledge, this is the first case report of this type of occurrence in the Japanese literature. Although there are few reports of combat injury in Japan, this diagnosis should be considered in the evaluation of any patient with jaundice who has suffered a previous chest wound involving a foreign body.
Surgery Today 02/2002; 32(4):383-5. · 1.22 Impact Factor
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Journal of Clinical Gastroenterology 38(10):915-6. · 3.16 Impact Factor
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ABSTRACT: A 46-year-old female was successfuly treated with repeated transcatheter arterial embolization (TAE) for multiple liver metastases from breast cancer. TAE using mitomycin C and epirubicin hydrochloride with lipiodol emulsion and gelatin sponge particles has been administered to the patient eight times over 4 years. She has also received systemic chemotherapy. She has survived for 6 years and 3 months after the detection of liver metastases
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ABSTRACT: A 69-year-old man was admitted to our hospital with loss of appetite, constipation and diarrhea. Upper gastrointestinal barium study and endoscopy revealed a Borrmann type III-like gastric cancer. Biopsy specimens showed poorly differentiated adenocarcinoma. Total gastrectomy with lymph nodes dissection was performed. The tumor histologically consisted of diffuse proliferation of large and round cells presenting as an organoid, trabecular or sheet-like structure accompanied by a small amount of multinuclear giant cells. The tumor cells were histochemically positive for Grimelius stain and were immunohistochemically, extensively and diffusely positive for chromogranin A. These findings led us to a diagnosis of large cell neuroendocrine carcinoma (LCNEC). This entity of the stomach is not clearly recognized at present. Clinicopathological characteristics of LCNEC of the stomach must be defined so that an appropriate treatment can be developed
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ABSTRACT: A 48-year-old woman was admitted to our hospital with abdominal fullness and pain. A barium enema and endoscopy revealed a Borrmann type II-like tumor of the sigmoid colon. Biopsy specimens showed poorly differentiated adenocarcinoma. Sigmoidectomy with lymph nodes dissection was performed. The tumor histologically consisted of proliferation of large and polygonal cells showing an organoid, trabecular or rosette-like pattern. Many mitotic figures were also observed. The tumor cells were immunohistochemically positive for chromogranin A. These findings led us to a diagnosis of large cell neuroendocrine carcinoma (LCNEC). Six months after surgery, liver metastases, para-aortic lymph node metastases and local recurrence were identified, and we commenced to administer FOLFOX, a combination of l-leucovorin and 5-fluorouracil with oxaliplatin. After six courses, a partial response was observed. This entity of the colon is not clearly recognized at present. The clinicopathological characteristics of LCNEC of the colon must be defined so that an appropriate treatment can be developed. Since LCNEC of the lung has been reported to be of high-grade malignancy, LCNEC of the colon must be treated as potentially highly malignant. In addition, the present case suggested that FOLFOX is a promising treatment for LCNEC of the colon
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ABSTRACT: The aim of the present study was a clinical analysis of small bowel obstruction caused by bezoars surgically treated. Seven patients with small bowel obstruction caused by bezoars were retrospectively reviewed. Two patients had undergone gastric surgery. The symptoms before surgery lasted from 1 to 3 days in the non-ileus tube group and from 9 to 30 days in the ileus tube group. Four patients were preoperatively diagnosed with bezoar ileus, and one had intestinal tumor. The remaining two patients were diagnosed with postoperative adhesive ileus. The operative procedure was evacuation of bezoars for all patients. One patient needed incisions of the small intestine and the stomach for the complete evacuation of bezoars. The site of the small bowel obstruction was the ileum in all patients, and bezoars ranged from 30 to 60 mm in diameter. Morbidity was present in one patient who underwent insertion of ileus tube for a long-term treatment. Small bowel obstruction caused by bezoars is not uncommon in patients without any gastric surgery. It is important, preoperatively and intraoperatively, to examine the entire gastrointestinal tract for the presence of bezoars. When bezoars ileus was suspected, insertion of ileus tube should be avoided
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ABSTRACT: We herein present two cases of solitary fibrous tumor (SFT) of the pleura. In case 1, a 66-year-old female was admitted with a nodule in the left lung field gradually inceasing in size for a period of two years. During video-assisted thoracoscopic surgery (VATS), the tumor showed a pedunculated tumor arised from the visceral pleura. Resected specimens were diagnosed to be SFT of the pleura with a malignant potential. In case 2, a 69-year-old female was admitted with a mass lesion in the left lower lung field. MRI showed a tumor with very low signal intensity on T2 weighted images, which was compatible with SFT of the pleura. During VATS, the tumor adhered to the parietal pleura with some fibrous bands but was easily removed. Resected specimens were diagnosed to be a benign SFT of the pleura. MRI was considered to be a helpful modality for the preoperative diagnosis of SFT
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ABSTRACT: Video-assisted thoracoscopic surgery (VATS) for a large, midesophageal diverticulum was successfully performed in a 77-year-old male who had dysphagia for one year. Postoperatively, the patient was well without any complications and was relieved of dysphagia. The VATS diverticulectomy was considered to be minimally invasive and constituted a good indication especially for patients of advanced age showing symptomatic esophageal diverticulum
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ABSTRACT: A 60-year-old woman was admitted to Nagasaki Prefectural Shimabara Hospital, with a painful tumor in her umbilical region. The tumor was about 1×1 cm in size. Histological examination of biopsied specimens revealed it to be a metastatic adenocarcinoma. Abdominal computed tomography and ultrasonography revealed a cystic tumor of about 23 mm in diameter in the pancreatic body. In addition, serum levels of cancer antigen 19-9 were elevated. With a tentative diagnosis of pancreatic tumor, she underwent surgery. When we opened her peritoneal cavity, there was no evidence of intra-abdominal disseminations, liver metastases or ascites. At that time, distal pancreatectomy accompanied by splenectomy was the procedure of choice. Histological examination revealed a moderately differentiated adenocarcinoma in the pancreatic body along with fatty replacement of the pancreatic tail. The umbilical tumor was a metastatic adenocarcinoma, which is referred to as a Sister Mary Joseph's nodule
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ABSTRACT: We treated three patients with Fournier's gangrene, in whom a male aged 75 years and a female aged 65 years were cured while a female aged 78 years died. None of them had a history of anorectal or urogenital disease. Debridement and colostomy were performed for all patients. After debridement, two patients were given imipenem cilastatin sodium and clindamycin phosphate, while the remaining one was given only imipenem cilastatin sodium. The patient who died had necessitated a continuous dopamine injection for stabilizing the blood pressure. The infectious disease was progressive, despite the extensive debridement. In Fournier's gangrene with the involvement of deep fascia, particular attention should be paid for the development of sepsis
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ABSTRACT: We described a 75-year-old female with recurrent breast cancer that presented as stenosis of the ascending colon and right hydronephrosis. The patient underwent a left mastectomy for breast cancer and a right mastectomy for metachronous breast cancer at the ages of 45 and 69, respectively. Histological findings showed primary invasive ductal carcinoma (scirrhous carcinoma). At the age of 73, she suffered from right hydronephrosis, which was suspected to have been caused by metastasis to the ureter. Two years later, stenosis of the ascending colon occurred. Right hemicolectomy and partial resection of the ureter were performed. Resected specimens revealed infiltration of tumor cells in all layers of the colon and the ureter which resembled invasive ductal carcinoma of primary breast cancer. Metastatic breast cancer can manifest itself in a variety of recurrences, including ureteral and colonic metastatic sites
