A 64-year-old man presented with a one-week history of right lower quadrant abdominal pain. A mass with tenderness was felt at the right lower quadrant of abdomen. His white blood cell count was ...within normal range, 6,600/μL, and the C-reactive protein level was as slightly high as 1.86 mg/dL. The CEA and CA19-9 levels were within normal range, 2.8 ng/ml and 4.2 U/ml, respectively. A contrast-enhanced computed tomography showed a 20-mm enhanced mass near the bottom of the appendix and abscess formation around the appendix. He was admitted for further examination. A colonoscopy showed a red bulge located at the orifice of the appendix. Yellowish-white mucus flowed from the orifice. A biopsy of the bulge revealed Group1. But the possibility of a malignant tumor of the appendix could not be ruled out, and laparoscopic ileocecal resection, with D3 lymph node dissection, was performed. The resected specimen showed a hard mass palpable at the bottom of the appendix and abscess formation in the mesoappendix. The cut surface of the mass was yellowish-white in color. The histopathological diagnosis was xanthogranulomatous appendicitis, with no evidence of neoplastic lesion.
We report a case of intra-abdominal desmoid tumor that was diagnosed preoperatively as a pancreatic tumor. The patient was a 71-year-old woman who was followed as pancreatic cyst. Abdominal enhanced ...CT revealed an enhancing tumor recently. The tumor was located anterior to the pancreatic body. We performed resection of the pancreatic body and tail, along with splenectomy. The postoperative histopathological diagnosis was desmoid tumor. Desmoid tumor is rare and histopathologically benign, but clinically borderline, because it can recur locally, and therefore, requires careful follow-up.
A 54-year-old man underwent laparoscopic distal gastrectomy with D2 lymph node dissection and ante-colic Roux-en-Y reconstruction for gastric cancer. The histopathological diagnosis was pT2N3aM0, ...pStage ⅢA, HER2 negative. After 8 courses of S-1 plus oxaliplatin as adjuvant chemotherapy, he was diagnosed as peritoneal dissemination and treated with ramucirumab(RAM)plus paclitaxel(PTX). On the 12th day of course 10, he visited to our hospital with abdominal pain. CT showed free air and massive ascites. Emergent surgery was performed under the diagnosis of gastrointestinal perforation. A small intestinal perforation in front of the jejunal limb near gastric-jejunal anastomosis was identified and there was no peritoneal dissemination. We performed partial resection of remnant stomach and jejunal limb by linear stapler and reconstruction by end to side gastric-jejunal anastomosis. Because the gastric and intestinal wall were quite fragile and RAM impaired wound healing as adverse event, we feared about leakage, but he had no major postoperative complications and discharged on the 33th day after surgery. After 24 courses of nivolumab as third-line chemotherapy, the peritoneal dissemination disappeared. He has been alive without recurrence for about 1 year since then.
The patient, an 83-year-old woman, visited another hospital with the complaint of hematemesis, and was diagnosed as having duodenal diverticular bleeding. She was transported to our hospital for ...further management, as the diverticulum perforated while she was undergoing endoscopic treatment. Abdominal computed tomography showed a hematoma and free gas around the perforation, which were thought to be caused by the perforated duodenal diverticulum, and emergency laparotomy was performed. Intraoperatively, hematoma, emphysema and inflammation were pronounced at the affected site. A perforated diverticulum was noted on the outside of the descending peduncle of the duodenum, which was resected at the site of the healthy intestinal wall using an automatic suture device.At the same operation, the gallbladder was removed and a drainage tube was placed in the cystic duct. After distal gastrectomy and postcolonic Roux-Y reconstruction (duodenal diverticulum), a drainage tube was placed retrogradely in the duodenal stump. The operation time was 3 hours 11 minutes. The postoperative course of the patient was satisfactory and she was discharged 16 days after the surgery.
A Case of Duodenal Stenosis Associated with Chronic Pancreatitis Yoshinouchi, Satoshi; Oono, Ryo; Murase, Hideaki ...
Nihon Gekakei Gakkai Rengokaishi/Nihon Gekakei Gakkai Rengōkaishi/Nihon Gekakei Rengou Gakkaishi,
2021, Volume:
46, Issue:
6
Journal Article
Open access
The patient was a 54-year-old man who had been diagnosed as a case of chronic alcoholic pancreatitis. He developed exacerbations of pancreatitis and abdominal distention due to duodenal stenosis ...associated with pancreatitis several times a year and received conservative treatment. In November 2020, he was hospitalized due to exacerbation of abdominal distention. Upper gastrointestinal endoscopy showed dilatation of the stomach and a stenotic bowel segment extending from the duodenal bulb to the descending limb of the duodenum. Biopsy returned a benign result, although the serum level of the tumor marker CA19-9 was elevated. Therefore, it was difficult to rule out the possibility of pancreatic cancer and a pancreatoduodenectomy was performed with a diagnosis of chronic pancreatitis with duodenal stenosis. Postoperative histopathological examination revealed narrowing of the duodenum due to fibrosis, with no evidence of malignancy, including in the head of the pancreas.
A 21-year-old woman was admitted with the chief complaint of fullness of the upper left abdomen. Her past and family medical history was unremarkable. Abdominal examination revealed a spontaneous ...swelling and tenderness over the ribs on the left side. There were no signs of peritoneal irritation. Laboratory examination at admission showed no abnormalities, except for elevation of the serum level of the tumor marker CA19-9 to 163 U/ml. Abdominal contrast-enhanced CT showed a cystic mass measuring 170×160×100 mm in size in the upper left abdomen, and the contrast enhancement of the cyst margin suggested a splenic origin of the lesion. The imaging findings showed no apparent evidence of infection. A giant splenic cyst was diagnosed and laparoscopic splenectomy was performed. The operation time was 3 hours and 30 minutes, and the intraoperative blood loss was 50 ml. The postoperative course was uneventful and the patient was discharged 10 days after the operation. Histopathological examination showed epithelial cysts and no evidence of malignancy. The serum CA19-9 levels returned to within normal range immediately after the surgery.
A 77-year-old man was given a diagnosis of pT4aN0M1a(PUL2), stage Ⅳ, RAS mutant type, after the operation for advanced ascending colon cancer. He was administered mFOLFOX6 plus Bmab as first-line ...chemotherapy. He showed consciousness disturbance on the 2nd day during the 6 cycles. Because of head computed tomography and magnetic resonance imaging showing no abnormal findings, we diagnosed convulsive seizure. His consciousness level gradually improved after intravenous infusion. He showed consciousness disturbance on the 2nd day during the 7 cycles again. Because blood ammonia level were high at 400μg/dL, he was diagnosed as hyperammonemic encephalopathy. His consciousness level rapidly recovered after branched chain amino acid(BCAA)infusion. SOX plus Bmab therapy was started as a post-treatment, he developed hyperammonemia(NH3 288μg/dL)again, on the 4th day during the 3 cycles. After taking of oral administration of BCAA and lactulose, the recurrence of hyperammonemic encephalopathy was not found. Therefore, 3 cycles of SOX plus Bmab therapy and 12 cycles of IRIS plus Bmab therapy were administered.
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