A 75–year–old man underwent subtotal stomach–preserving pancreatoduodenectomy for lower bile duct carcinoma, and subsequently, pancreatojejunostomy was performed by the modified Blumgart method using ...a 7.5–Fr pancreatic duct tube as a internal stent. Since blood was drawn on the 5th, 7th, and 9th days after the surgery, endoscopy was performed each time. However, in consideration of the burden on the pancreatojejunostomy, observations of the anastomotic part were avoided. No lesion that could cause massive hemorrhage was detected, but a hematoma was found in the region of the Braun anastomosis, which was suspected as the bleeding site; therefore, the Braun anastomosis was clipped under the endoscope on the 7th day after surgery and the same site was opened and re–anastomosis was performed on the 9th day after surgery. On the 11th day after surgery, bleeding occurred again, and contrast–enhanced CT revealed a large hematoma extending from the pancreatojejunostomy to the Braun anastomosis, and bleeding near the pancreatojejunostomy was suspected. Because arterial hemorrhage from the jejunal mucosa opposite the pancreatojejunostomy was confirmed by endoscopic observation, hemostasis was accomplished with clips. The bleeding was considered as having been due to physical stimulation by the internal stent. The patient was discharged on the 35th day after the first operation without any further bleeding episodes.
A 58-year-old man was admitted to our hospital for right upper quadrant pain. He had undergone distal gastrectomy and Roux-en-Y reconstruction and cholecystectomy two years earlier. Findings of ...abdominal computed tomography（CT）were suggestive of duodenal diverticulitis with an enterolith. Endoscopy revealed a diverticulum with an impacted enterolith. Following removal of the enterolith using a gripping forceps, wall thinning and partial necrosis of the diverticulum were observed, and we performed a laparotomy. Because the diverticulum on the outside of the descending duodenum was fragile and easily torn, excision of the diverticulum was difficult; therefore, the mucosa at the base of the diverticulum was closed by sutures and wrapped around the diverticular wall. A 12 Fr gastric tube was inserted from the duodenal stump and a T-tube was placed in the common bile duct for decompression. Although he developed wound infection and liver dysfunction, he was treated conservatively and was discharged on the 35th postoperative day. We report the case of a patient with duodenal diverticulitis with an enterolith that developed after gastrectomy and Roux-en-Y reconstruction, who showed a good course after sewing and decompression.
A 38-year-old man was hospitalized with severe alcoholic acute pancreatitis. Despite treatment, he had persistent abdominal pain and fever. CT examination revealed gastric/duodenal/transverse colonic ...necrosis with fluid collection at twelve days of hospitalization. The patient was treated with percutaneous drainage to avoid surgery in the acute phase. After 47 days, CT indicated walled-off necrosis in the lower abdominal cavity. Percutaneous drainage was performed again. The patient’s condition stabilized, and minimal invasive treatment was employed to ensure adequate time for preparation for the surgery. Necrosectomy, necrotic intestinal resection, and reconstruction were performed 96 days after admission. Total pancreatectomy, total gastrectomy （Roux-en-Y anastomosis）, choledochojejunostomy, colostomy, and jejunostomy were completed. The patient was discharged 44 days after surgery without any postoperative complications.
Background
Endoscopic resection is accepted as the standard treatment for early mucosal gastric cancer, and its indications have recently been expanded while its long-term outcomes are still unclear. ...Herein, we present a didactic case of undifferentiated-type mucosal gastric cancer fulfilling the expanded indication and curative criteria for endoscopic submucosal dissection (ESD), having synchronous multiple lymph node metastases.
Case presentation
A 40-year-old woman was found to have a
Helicobacter pylori
infection at a standard health check with no abdominal symptoms. She received an upper gastrointestinal endoscopy and found to have an undifferentiated-type mucosal gastric cancer with the size of 15 mm in diameter without ulceration, which fulfilled the expanded indication for ESD. According to patient’s preference, we performed laparoscopy-assisted distal gastrectomy with D1+ lymph node dissection, and routine pathological analysis revealed a predominantly signet ring cell carcinoma limited to the mucosa without ulceration or any vessel involvement; on the other hand, 15 lymph node metastases were detected. Then, we added deep sectioning of the whole tumoral area at a thickness of 20 μm and immunohistochemical analyses. As the result, an isolated lymphatic capillary involvement of the extremely superficial submucosa was identified in a single histological section, and pathological diagnosis was corrected to ly1. She received postoperative adjuvant chemotherapy with an S-1 oral agent and had no recurrence under strict surveillance for 1 year postoperatively.
Conclusions
When we perform ESD for undifferentiated-type gastric cancer, deep sectioning of the whole tumoral area into thin slices and immunohistochemical staining using D2-40 should be practically considered.
Herein, we report a case of a gastrointestinal stromal tumor (GIST) at the esophagogastric junction (EGJ) that was successfully treated by a laparoscopic wedge resection (LWR) after dissection of the ...seromuscular layer around the tumor to prevent postoperative deformities and stenosis of the EGJ. Subsequently, the abdominal esophagus was wrapped by the gastric fornix according to Dor’s method in order to prevent reflux esophagitis after surgery.
A 71-year-old female patient was admitted with a diagnosis of a GIST (23 × 20 × 20 mm) at the EGJ. We performed the abovementioned operation.
Gastroduodenal endoscopic examination revealed no deformity or stenosis of the EGJ at 6 months after the operation. The patient has not experienced any reflux symptoms. Tumor recurrence was not noted 26 months after the operation.
This procedure is useful in preventing the deformity and stenosis of the EGJ as well as postoperative reflux esophagitis.
The management of radiant exposure to ultraviolet (UV) radiation, especially in the wavelength range from 100 nm to 280 nm (i.e. UV-C), is important for virus inactivation or photobiological safety. ...Recently, many commercial UV radiometers have been used to measure UV-C irradiance for industrial and public applications. The accuracy of the four types of commercial UV radiometers was investigated by comparing the reference irradiance values obtained from the spectral irradiance standard. It was found that the displayed values of the UV radiometers have discrepancies, such that the measured value can be more than twice the actual value in a certain case. The spectral mismatch between the calibration and test sources is a major factor in the discrepancies in the UV-C measurements. With spectral mismatch correction, most corrected values show a tendency to improve the result to approaching the reference values within 20%. Users need to provide spectral information about the source and radiometer used for UV-C measurement.
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