Situs inversus totalis (SIT) is a rare anatomic anomaly, occurring once in every 3000-5000 births in Japan. A 72-year-old woman with SIT visited our hospital for the investigation of fecal occult ...blood. Colonoscopy revealed a type-2 tumor in the ascending colon, and the preoperative diagnosis based on the 8th UICC TNM classification was cT3N0M0 cStage IIA. We planned a laparoscopic right colectomy procedure with medial approach. The surgery was performed using five ports. The main surgeon stood between the patient's legs, while the assistants stood on the right side of the patient as opposed to the usual positioning where they stand on the left side. The operating time was 163 min. and the blood loss was 18 g. She was discharged on the 9th postoperative day, without postoperative complications. Histopathological examination revealed moderately differentiated adenocarcinoma, pT4bN0M0 pStage IIC. Preoperative assessment of the anatomical position and vascular malformations, using three-dimensional computed tomography, was essential for our safe surgical intervention. Furthermore, our co-axial technique and positioning the surgeon between the patient's legs enabled us to perform the procedure in the same way as a normal right-sided colectomy with a medial approach.
We present a case of a membranous tracheal injury caused by a single-lumen tube during thoracoscopic esophagectomy, which was repaired by thoracoscopic direct suture. The patient was a 45-year-old ...woman. She was diagnosed with cancer of the middle to lower thoracic esophagus and underwent thoracoscopic esophagectomy in a prone position under differential lung ventilation, using a single-lumen tube and a bronchial blocker catheter. During surgery, we identified a membranous tracheal injury. While we asked an anesthesiologist to precede with tracheal intubation keeping sufficient respiratory management, the injury was directly sutured under thoracoscopy and covered with a polyglycol acid sheet and fibrin glue. On the 6th hospital day, we confirmed that the injury was closed by a bronchoscope and the tube was removed on the 8th hospital day. On the 12th hospital day, she underwent exploratory laparotomy under general anesthesia for acute abdomen which was done under respiratory management, and no noteworthy adverse events were noted in the air passage. We must keep in mind that a tracheal injury can be caused even by manipulation for intubation by using a single-lumen tube and that the repair can be possible with sufficient respiratory management by working in closer cooperation with the anesthesiology department.
We report a case of retroperitoneal metastasis of invasive ductal breast carcinoma. A 62-year-old woman underwent surveillance computed tomography (CT) one year post-mastectomy. CT revealed bilateral ...hydronephrosis, for which bilateral ureteral stents were placed. The patient also noted the development of nausea and lower extremity edema. CT and upper gastrointestinal examinations revealed severe stenosis of the duodenum and the inferior vena cava, without a space-occupying lesion in the retroperitoneum. She underwent a gastro-jejunostomy with biopsy of the retroperitoneal tissue, for a suspected recurrence of her breast cancer. Histological examination of retroperitoneal tissue revealed breast cancer metastasis. Though chemotherapy was planned, she was diagnosed with meningeal carcinomatosis 1 month later, after presenting with severe headaches. The patient died 2 months after the laparotomy. Despite the rarity of retroperitoneal breast cancer metastasis, it should be considered for patients with a history of breast cancer.
A 54-year-old woman with a history of sigmoid graft vaginoplasty and ulcerative colitis underwent total colectomy and neovaginectomy because of colonic and neovaginal bleeding. This is the first case ...in Japan in which a patient underwent total colectomy and neovaginectomy for ulcerative colitis after vaginoplasty. This case is reported along with a review of the relevant literature.
Cisplatin therapy induces kidney injury as a side effect. Thus, replacement fluid must be administered to prevent kidney injury. In our hospital, we use a Gemcitabine and Cisplatin combination ...chemotherapy (GC) at a total volume of approximately 500 mL for biliary tract cancer. We investigated the safety of GC with a small amount of replacement fluid. As a result, no serious adverse events and renal injury occurred that required discontinuation of treatment. The median overall survival time was 260 d (95% confidence interval, 154-367 d). This study suggests that GC with a small amount of replacement fluid could be performed tolerability. But we need to be careful about choosing patients such as patients who can drink 1 L orally and patients who can be treated as outpatients.
Acute cholecystitis that occurs after cardiovascular surgery is a severe complication that is associated with a high mortality rate. A 25-year-old woman with Turner syndrome underwent aortic arch and ...valve replacement for chronic Stanford type A dissection and aortic valve stenosis at the department of cardiovascular surgery. After the surgery, laboratory examination revealed slight elevation of the total leukocyte count and serum C-reactive protein level. However, no clinical symptoms were observed, and the source of infection was unclear. The findings of abdominal computed tomography performed on postoperative day 14 suggested ischemia and abscess formation in the gallbladder wall, and the patient was diagnosed as having gangrenous cholecystitis. Although the patient had scarce clinical symptoms, we performed urgent laparoscopic cholecystectomy considering the risk of infection of the artificial vascular graft and artificial valve. In this case, laparoscopic surgery might have contributed to minimally invasive surgery and prevented secondary infectious spread.
Lower digestive tract perforation after an upper gastrointestinal series with barium swallow is extremely rare. We encountered eight such cases at our institution between 2009 and 2019. The mean age ...of the patients was 63 years, and the mean period to perforation after barium swallow was 2 days. The perforation site was the sigmoid colon in six cases. Of these, a history of diverticulosis was present in three patients, and two regularly consumed laxatives.Primary anastomosis was performed in five cases. The mean length of hospital stay was 29 days, although there were no mortalities, and all patients had favorable outcomes. We found some reports with similar results when we searched the Japan Medical Abstract Society database using the keywords “barium,” “lower digestive tract perforation,” and “colon perforation.” After performing a gastrointestinal series with barium swallow, it is necessary to look out for a perforation of the lower digestive tract in a patient presenting with severe abdominal pain with a medical history of digestive organic diseases or chronic constipation.
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