We report a rare case of intractable hepatic lymphorrhea following laparoscopic cholecystectomy. A 54-year-old man with chronic hepatitis was given a diagnosis of gallstones and underwent ...laparoscopic cholecystectomy. After the operation, ascites appeared and his condition worsened in spite of medication. Hepatic lymphorrhea was suspected, because of high specific gravity, high protein density, and the presence of lymphocytes. Five months after surgery, we performed laparotomy and sutured the fistula. It has been reported that intractable ascites is a potential complication after cholecystectomy in patients with liver disease such as chronic hepatitis or liver cirrhosis. Hepatic lymphorrhea after laparoscopic cholecystectomy is very rare. However, hepatic lymphorrhea should be considered in patients with massive and intractable ascites.
In three patients with peritoneal dissemination, two patients had Class IV and one patient had Class V. Conclusion: The result of IWC is not necessarily a contraindication of surgery for patients ...with invasive ductal pancreatic adenocarcinoma.
Backgrounds
Many patients with gastric cancer relapse during or early after adjuvant chemotherapy. The standard treatment for early relapse patients is a second-line chemotherapy (SLC) based on ...irinotecan, taxanes, or a platinum-based chemotherapy. The platinum-containing biweekly irinotecan plus cisplatin (IRI/CDDP) combination was assumed to be promising in several reports of clinical trials as SLC. TRICS trial, a randomized phase III study of IRI/CDDP vs. IRI in platinum-naïve gastric cancers refractory to S-1 monotherapy, revealed that both irinotecan-based chemotherapies were effective and well tolerated.
Methods
This study analyzed 108 patients in the TRICS trial who experienced early relapse. Patients receiving IRI/CDDP (IRI, 60 mg/m
2
; CDDP, 30 mg/m
2
, q2w) versus IRI (150 mg/m
2
, q2w) were compared regarding overall survival (OS), progression-free survival (PFS), overall response rate (ORR), and safety.
Results
The OS was 14.0 (95% confidence interval CI: 11.0–21.2) and 14.0 (95% CI: 10.7–16.5) months for IRI/CDDP and IRI, respectively (hazard ratio HR: 0.782; 95% CI: 0.515–1.188,
P
= 0.249). No significant differences were observed for PFS (5.0 vs. 4.5 months, respectively; HR: 0.802; 95% CI: 0.543–1.185,
P
= 0.268) or ORR (19.6% 95% CI: 9.4–33.9% vs. 23.3% 95% CI: 11.8–38.6%, respectively). The incidence of grade 3–4 anemia was higher for IRI/CDDP than for IRI (20% vs. 0%, respectively;
P
= 0.0006).
Conclusion
Our study showed no significant survival differences between IRI/CDDP and IRI in platinum-naïve patients who relapsed during or within 6 months after S-1 adjuvant therapy; therefore, IRI may be a good option in this population.
Clinical trial information
UMIN 000002571.
A case of a lymphangioma of the jejunal mesentery WATANABE, Takahiro; OHATA, Kou; SATO, Shinsuke ...
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association),
2012, 2012-00-00, Volume:
73, Issue:
8
Journal Article
Open access
We report a case of a lymphangioma of the jejunum which was surgically resected. The case involved a 16-year-old male who had realized a sense of abdominal distension for the past 5 years. He visited ...a hospital because of a 2-week history of abdominal pain and ultrasound examination revealed an abdominal tumor. He was referred to our hospital. Abdominal CT scan and MRI showed a multilocular cystic mass, about 13cm in longer diameter, without enhancement effect at the midline of the abdominal cavity and the mass had fluid-fluid level formed by high and low density components. We diagnosed the mass as mesenteric lymphangioma with repeated bleeding and performed operation. On laparotomy, the 10-cm diameter mass was found in the mesentery of the jejunum near the ligament of Treitz and was resected with a part of the jejunum close to the mass. The histopathological diagnosis was lymphangioma of the jejunal mesentery. Lymphangioma of the jejunal mesentery is relatively rare. We review 30 cases reported in Japan, including this case.
A 28-year-old woman resident of a nursing home with mental retardation and a history of recurrent abdominal pain was transported to our hospital one morning with acute-onset of abdominal pain. ...Abdominal computed tomography showed type 2 cecal volvulus (loop type) and the patient was diagnosed as having Chilaiditi syndrome. Emergent laparoscopic surgery was performed. The wedged cecum between the liver and right diaphragm was released. The twisted ascending colon was rotated 180 degrees counterclockwise and the torsion was released. The intestine showed no signs of necrosis. We fixed the ascending colon to the right lateral abdominal wall with seven stitches. The postoperative course was uneventful. Until over 2 years after the surgery, the patient showed no recurrence of the condition. Provided the condition of the intestine is assessed carefully, laparoscopic cecopexy may be considered as a useful procedure for cecal volvulus without intestinal necrosis.
The prognosis of hepatocellular carcinoma patients with tumor thrombosis of the inferior vena cava (Vv3 HCC) has been reported to be poor. However, because the condition can cause sudden death, a ...so-called “oncological emergency”, resection is sometimes required as soon as possible. A Vv3 HCC case with ascites that could be resected after control of ascites with tolvaptan and hepatic arterial infusion chemotherapy (HAIC) is reported.A 55-year-old man with alcoholic hepatitis was diagnosed with Vv3 HCC by tumor marker (AFP, PIVKA-II) elevations and computed tomography (CT). He had been treated by trans-catheter arterial chemoembolization (TACE) with no therapeutic effect. He was referred to our hospital for surgical therapy. Hepatectomy was planned, but preoperative CT indicated ascites. The operation was postponed, and HAIC and control of ascites by tolvaptan were started. The ascites disappeared after one month, and right hepatectomy and tumor thrombectomy were performed.After 6 months, metastases at the remnant liver and lung were found, but with HAIC and radiotherapy for recurrence, he has survived for 2 years and 6 months.
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