A 72-year-old man diagnosed with esophageal cancer, cT3N1M0, cStage III, underwent neoadjuvant chemoradiotherapy (NACRT) followed by subtotal esophagectomy by laparoscopy-right thoracotomy approach ...with 3-field lymph node dissection and retrosternal reconstruction. His postoperative course was uneventful and oral intake was resumed on the 7th postoperative day. However, high fever and chill developed in the next early morning, and a blood culture yielded Acinetobacter species. The patient also developed DIC. Although no apparent source of infection could be identified, his general condition gradually improved with chemotherapy associated with treatments for DIC. Thereafter he did not have demonstrable complications and was discharged from our hospital on the 28th postoperative day. Histopathology revealed disappearance of tumor cells by NACRT. NACRT is considered to be an effective therapy, but particular attention should be paid to opportunistic infections due to weakened immune system during perioperative period, like in our case.
A 74-year-old woman was admitted to our hospital because of back pain and difficulty of breathing, which started the previous night. She had a history of multiple traumas caused by a traffic accident ...4 months prior. She was developing a shock but showed no signs of peritonitis. A computed tomography scan showed dilation of the small intestine and effusion in the right pleural cavity. The diagnosis of delayed traumatic diaphragmatic hernia was confirmed, and emergent laparotomy was performed immediately. The ileum was incarcerated in the right pleural cavity through an orifice approximately 2cm in diameter at the top of the right diaphragm. The orifice was incised and widened enough to pull back the ileum. The necrotic segment was resected and anastomosed. The hernia orifice was closed with a 3-0 Prolene™ knotted suture. Her postoperative course was uneventful. Obstructive posttraumatic diaphragmatic hernia has been rarely reported, but recently, its incidence has increased in Japan. Obstructive posttraumatic diaphragmatic hernia often requires organ excision and lead to a life-threatening event.
We report two cases of laparoscopic repair of perineal hernias following previous laparoscopic abdominoperineal resection. Generally, repair with a mesh using a laparoscopic approach is useful in ...cases with few adhesions in the abdominal cavity. However, owing to the effect of previous surgeries, it is sometimes difficult to identify important structures, such as the ureter, internal iliac artery, and internal iliac vein. Therefore, careful fixation of the mesh is required. In order to avoid damage to important structures, we fixed the mesh by hand suturing using non-absorbable sutures, rather than with a hernia stapler. This technique can be useful for cases in which identification of anatomical structures is difficult.
A 61-year-old man visited our hospital with a three-week history of abdominal pain. An abdominal enhanced computed tomography examination revealed arterial bleeding as a localized accumulation of ...contrast material extravasation near the blood vessels of a dilated right gastroepiploic artery. A ruptured aneurysm of the right gastroepiploic artery was suspected. Abdominal angiography revealed multiple aneurysms of the right gastroepiploic artery. Although massive contrast extravasation was not demonstrated from the gastroepiploic artery, continuous bleeding was suspected. Transarterial embolization was performed, but hemostasis was not achieved. The ruptured aneurysm of the right gastroepiploic artery was resected, and the patient had an uneventful postoperative course. A histopathological examination revealed a ruptured aneurysm of the right gastroepiploic artery caused by segmental arterial mediolysis.
A woman in her forties visited a nearby clinic because of severe inguinal pain, and was referred to our hospital for a suspected incarcerated right-sided inguinal hernia. Physical examination ...revealed that the mass in the right inguinal region, measuring 30mm, was tense and painful. The morbidity of the mass was poor, and reposition of the mass was not possible. Non-communicating cystic mass was detected by computed tomography, ultrasonography, and magnetic resonance imaging. Preoperatively, the suspected diagnosis was hydrocele of the canal of Nuck, and the round ligament with cystic mass was excised by anterior approach, although inguinal pain had reduced. Inguinal pain disappeared after the operation. Pathologic findings were consistent with a hydrocele of the canal of Nuck without malignancy or endometriosis. Although hydrocele of the canal of Nuck has been stated to be often painless in the past, 73.7％ of the reported cases in Japan report pain. As in our case, hydrocele may present with strong pain similar to that in inguinal hernia incarceration. Therefore, it should be considered as a differential diagnosis when there is inguinal pain and/or mass in an adult female patient.
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