Spontaneous perforation is a very rare complication of pyometra. We report herein the case of an 88-year-old woman who presented with muscular rigidity and free air on abdominal X-ray films. ...Perforation of the gastrointestinal tract was diagnosed preoperatively, and an emergency laparotomy was performed. A total hysterectomy with bilateral salpingo-oophorectomy was carried out under the diagnosis of generalized peritonitis caused by the spontaneous perforation of pyometra. The culture of purulent fluid from the abdominal cavity showed only Escherichia coli, with no anaerobic bacteria. Histological examination revealed pyometra with necrosis of the endometrium and no evidence of malignancy. The patient was discharged on postoperative day 68 without any major complications. Pyometra is an unusual cause of peritonitis, but it must be considered as a possible diagnosis in elderly women presenting with an acute abdomen. Following this case report, we discuss the problems associated with establishing a correct preoperative diagnosis of generalized peritonitis caused by the spontaneous perforation of pyometra.
We report an extremely rare case of hepatocellular carcinoma accompanied by sarcoid reaction in regional lymph nodes. A 67-year-old man with chronic hepatitis C admitted for back pain had serum ...α-fetoprotein elevated to 60ng/ml. Abdominal ultrasonography showed a hyperechoic tumor about 4cm in diameter in segment 5 of the liver. Dynamic bolus computed tomography (CT) showed peripheral enhancement of the tumor, accompanied by enlarged lymph nodes around the common hepatic artery and the inferior vena cava. Hepatic arteriography showed tumor staining, and CT during arterioportography showed a perfusion defect, yielding a diagnosis of hepatocellular carcinoma. Transcatheter arterial embolization (TAE) of the right hepatic artery was conducted, followed by microwave coagulation therapy to the liver tumor with lymph node dissection under laparotomy. Microscopically, biopsy specimens of the liver tumor showed poorly differentiated hepatocellular carcinoma, and dissected lymph nodes involved tumor metastasis including marked epithelioid granulomas.
A 67-year-old man was admitted to the hospital because of vomiting. An abdominal plain X-ray film showed dilatation of small intestine, and he was diagnosed as having ileus. Abdominal computed ...tomography showed dilatation of small intestine, but ascites and tumor lesion were not revealed. A definitive diagnosis could not be obtained, accordingly a laparotomy was performed under a diagnosis of internal hernia. On laparotomy, about 5cm segment of ileum was incarcerated into paraascending colic fossa, and it was diagnosed as internal hernia in paracolic gutter of ascending colon. We performed partial resection of the ileum and the fossa was closed with a few stitches. A case of internal hernia in paracolic gutter of ascending colon is rare, so we presented the case here together with a review of the literature.
A RECURRENT CASE OF PRIMARY SMALL INTESTINAL VOLVULUS YAMAZAKI, Masanao; NITTA, Atsunori; YAMADA, Shinobu ...
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association),
2006, Letnik:
67, Številka:
7
Journal Article
Odprti dostop
An 83-year-old woman was seen at the hospital for sudden vomiting and a sense of abdominal discomfort. The patient was diagnosed with primary small intestinal volvulus when abdominal computed ...tomography (CT) demonstrated a “whirl sign” in the small intestine loops around the superior mesenteric artery (SMA). In emergency surgery, the jejunum and ileum were twisted 360° counterclockwise around the SMA, and the intestine caused ischemic change. The blood flow recovered quickly after detorsion, eliminating the need for intestine resection. But three months later, the patient was seen at the hospital for the same symptom again. We diagnosed primary small intestinal volvulus recurrence because abdominal CT demonstrated the “whirl sign”. Again, the jejunum and ileum twisted 360° counterclockwise around the SMA. The blood flow recovered quickly after detorsion, but we added bowel fixation to prevent a recurrence. There are a few reports of recurrence, but the necessity of small intestine fixation was suggested in cases of primary small intestinal volvulus.
A 70-year-old woman was seen at the hospital because of right lower abdominal pain. She was diagnosed as having acute appendicitis, and underwent laparoscopic appendectomy. Histopathological ...examination revealed that the tumor was goblet cell carcinoid. Because the tumor cells invaded the mp layer, a laparoscopy assisted ileocecal resection was added on the 43rd day after the initial operation. No residual tumor cells were found in the resected specimens. There have been no signs of recurrence, as of 3 years after the operation. Goblet cell carcinoid is a rare tumor, and is known to be almost as malignant as adenocarcinoma. No therapeutic guidelines or clear notion of the prognosis have been established as yet. Laparoscopic surgery for goblet cell carcinoid of the appendix is rarely performed, and so we present this case here together with a review of the literature.
We present a case of gastrointestinal stromal tumor (GIST) of the rectum. A 55-year-old man was admitted to the hospital because of a rectal tumor detected at a medical checkup in April 2003. Digital ...examination revealed an about 3-cm sized elastic-hard mass with a smooth surface, locating about 3cm oral from the anal verge. Colonoscopic examination showed a submucosal tumor encircling about 1/4 of the lumer in the lower rectum which had the smooth surface without ulcer. A transanal core needle biopsy was performed. HE staining showed a solid growth of spindle-shaped cells, and immunohistochemically the tumor cells were positive for CD34 but negative for SMA and S100. GIST was thus diagnosed. Considering that lymph node dissection was unnecessary and the anal function was able to be preserved, we performed a transsacral partial resection of the rectum. No local recurrence or distant metastasis has occurred, as of 20 months after the operation.
We investigated the correlation between tumor angiogenic activity and progression of gastric carcinoma using immunohistochemical staining with antifactor VIII-related antigen (F-VIII RAg) antibody.
...One hundred twenty-four specimens resected from patients with gastric carcinoma were investigated by staining with a monoclonal antibody against F-VIII RAg. Correlations between the microvessel count (the mean number of microvessels in the five areas of highest vascular density at 200 times magnification), various clinicopathologic factors, and prognosis were studied.
The microvessel count increased with histologic stage. The microvessel count was significantly higher in patients with lymph node metastases than in those without such metastases. Moreover, in patients with a high microvessel count (> or = 16), prognosis was significantly poorer than in those with low count (< 16). Multivariate analysis indicated that the microvessel count is an independent prognostic factor in patients with gastric cancer. According to the mode of recurrence, the frequency of hepatic metastases was significantly increased in patients with a high count.
Microvessel count may be a good prognostic indicator and may be useful as a predictor for the mode of recurrence in patients with gastric carcinoma.
We report two resected cases of extragastric gastric cancer growth with gastrocolic fistula whose prognoses were fairly good with surgery and chemotherapy. CASE 1: A 45-year-old man was admitted to a ...nearby clinic complaining of fever and abdominal pain. Endoscopy revealed gastric mucosa-associated white moss under tumor-like lesions to the mucous cancer biopsy results. The patient underwent surgery; the transverse colon had adhered to the posterior wall of the stomach, so a distal gastrectomy and a partial resection of the transverse colon were performed. He enjoyed a good QOL for 56 months after the surgery. CASE 2: A 69-year-old man. An upper GI examination revealed a protrusion at the posterior wall of the stomach, and the barium leaked from the lesion to the colon. Diagnosis of stomach cancer surgery took place. He died 20 months after the surgery.
Intractable pancreatic fistula, especially if completely external, remains a critical complication after panceaticoduodenectomy, even though most such fistulas are cured by conservative therapy. ...Attempts at surgical correction are reported to be very difficult. We report a case of intractable external post-panceaticoduodenectomy pancreatic fistula successfully treated by interventional internal drainage. A 77-year-old woman underwent pancreaticoduodenectomy for an intraductal papillary mucinous neoplasm. After the stent tube inserted into the pancreatic duct was removed, pancreatic juice began being discharged from the drain. Fistulography showed no communication between the main pancreatic duct and the elevated jejunum, so we conducted puncture at the elevated jejunum through the sinus tract under X-ray to implement communication. About 3 months later, the drainage tube was removed and the fistula closed.
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