A 64-year-old woman with rectal cancer underwent laparoscopic low anterior resection. Postoperative diagnosis was fStage IV (moderately differentiated adenocarcinoma (tub2), pT2 (MP), pN2 (6/15), ...cH1, cP0, cM0, EGFR (+), K-RAS mutation). Chemotherapy with XELOX+Bevacizumab (Bev) was started on post operative days 32, but capecitabin intake was stopped on the 11th day due to grade 2 diarrhea and vomiting from the 9th day of initiating chemotherapy. She then suffered grade 4 leukocytopenia, grade 4 thrombocytopenia, grade 2 fever, grade 3 diarrhea and vomiting. Hematotoxicity was improved by the administration of G-CSF and platelet transfusion in addition to antibiotics and antimycotics, while diarrhea and vomiting continued and the drug-induced enteritis with cytomegalovirus enteritis was diagnosed. After the general state improvement, partial hepatectomy was performed and chemotherapy with CPT-11+Bev was conducted, but she died with progression of disease fifteen months after the first operation. The dihydropyrimidine dehydrogenase (DPD) activity in pheral mononuclear blood cells showed remarkably low, so this case was diagnosed as DPD deficiency. DPD deficiency is very rare, and no diagnosis nor screening system has been established for its detection. In DPD deficiency, 5-fluorouracil can lead to severe and sometimes life-threatening adverse events, therefore prompt and adequate treatment must be considered for this condition.
Laparoscopic surgery is performed for many cases of acute abdomen； however, its application to trauma cases is limited. We present our experiences of laparoscopic surgery in two cases of traumatic ...rectal injury. In the first, an 80-year-old man fell down on a back scratcher, called a magonote in Japan, and presented with injuries to the rectum, prostate and bladder. Emergency suturing of the rectal lacerated wound was performed, with compression to stop the bleeding. A diagnostic laparoscopy following the rectal repair revealed no peritoneal damage. A loop ileostomy was created for proximal diversion of the fecal stream without laparotomy. On the 128th postoperative day, after the rectovesical fistula had closed spontaneously, the ileostomy was closed. In the second case, a 79-year-old man presented to us with rectal injury caused by an enema. An emergency diagnostic laparoscopy revealed no intra-abdominal organ injuries. A sigmoid colostomy was created for proximal fecal diversion without laparotomy. The patient’s postoperative course was uneventful. The colostomy was closed on the 86th postoperative day. Laparoscopic surgery is useful in some cases of abdominal trauma, such as patients with traumatic rectal injuries, who can be safely managed by diagnostic laparoscopy and diverting colostomy without the need for a laparotomy.
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