Neoplasm of a colonic graft after esophageal reconstruction is rare. We treated a colon cancer patient who developed malignancy in a colonic graft after esophagectomy and reconstruction through a ...retrosternal route. A male had undergone esophagectomy in his 50s due to a benign esophago-bronchial fistula. His dysphagia became exacerbated 20 years later, and further examinations showed a circumferential tumor on the esophagocolonic anastomosis. He underwent resection of the colonic graft adenocarcinoma with median sternotomy after neoadjuvant chemotherapy. Gastric tube reconstruction was performed through a retrosternal route. This report should be informative in terms of making decisions from an initial reconstruction to follow-up and choosing a therapeutic strategy for colonic graft cancer in the future. J. Med. Invest. 66 : 190-193, February, 2019
About 50% of patients who have a permanent stoma experience some degree of parastomal hernia formation. To prevent this complication, the extraperitoneal route is considered to be more effective than ...the transperitoneal route in the case of open colorectal surgery. This technique also has superiority in avoiding postoperative intestinal obstruction. Although laparoscopic surgery for rectal cancer has not been proved to be as safe as open surgery by a randomized-controlled trial, some studies have shown the equality of long-term results with laparoscopic low anterior resection and laparoscopic abdominoperineal resection. It is anticipated that cases of laparoscopic abdominoperineal resection will increase in the near future. However, a laparoscopic technique for creation of a permanent stoma has hardly been discussed. Most operative procedures for laparoscopic stoma creation have been performed with transperitoneal route, which may cause parastomal hernia and/or intestinal obstruction. This report describes a laparoscopic technique for permanent sigmoid stoma creation through the extraperitoneal approach.
Glycemic control is important for maintaining gastric motility in diabetic patients, but gastric motility has not yet been studied ultrasonographically in relation to glycemic control.
We made such ...observations before and after establishing glycemic control in diabetic patients with gastroparesis. We studied 30 diabetic patients with upper abdominal digestive symptoms who were hospitalized for correction of poor blood sugar control and who underwent upper digestive tract endoscopy to rule out structural causes such as gastric/duodenal lesions. Gastric motility was evaluated by transabdominal ultrasonography, using a test meal, before and after attainment of glycemic control (within 3 days after admission and 3 days before discharge). Also, upper abdominal digestive symptoms present on admission and at discharge were compared.
After glycemic control was established, contractions of the antral region were more frequent than before the attainment of control (8.93 +/- 1.17/3 min vs 7.63 +/- 2.22/3 min, respectively; P < 0.001). Glycemic control also significantly improved gastric emptying (before glycemic control, 49.2 +/- 14.8%; after, 67.1 +/- 11.5%; P < 0.001). This was also true for the motility index, concerning antral gastric contractility (before control, 2.97 +/- 1.57; after, 3.75 +/- 1.09; P < 0.05). Upper abdominal symptom scores were also significantly lower after attainment of control than before (0.47 +/- 0.78 vs 3.17 +/- 2.00, respectively; P < 0.001).
These findings suggest that attaining glycemic control improves gastric motility and attainments upper abdominal symptoms in diabetic patients with gastroparesis.
In a 58-year-old male, upper digestive endoscopy revealed a protruding lesion in the esophagus on a medical examination. The patient was referred to the Department of Surgery in our hospital to ...undergo surgery. On the initial consultation, upper digestive endoscopy showed a smooth, soft, black purple, typeII protruding lesion measuring approximately 25 mm at 35 cm apart from the incisor. For diagnotic treatment and patient’s request, endoscopic mucosal resection (EMR) was performed. The resected specimen measured 25 mm × 25 mm. The histological findings suggested cavernous hemangioma. To treat esophageal hemangioma, esohagectomy, tumor enucleation, or sclerotherapy has been performed. However, recently, thorough preoperative examination, such as endoscopic ultrasonography (EUS), has facilitated endoscopic resection, such as EMR. J. Med. Invest. 53: 177-182, February, 2006
Xanthogranulomatous changes in the pancreas are extremely rare. A 66-year-old man presented with a 2-year history of epigastralgia. Computed tomography scan revealed a 4-cm low-density area around ...the body of the pancreas. Magnetic resonance imaging demonstrated that the mass appeared hyperintense on a T2-weighted image and isointense on a T1-weighted image. Based on a diagnosis of invasive ductal carcinoma of the pancreas, distal pancreatectomy and splenectomy were performed. Sections examined from the mass showed an aggregation of many foamy histiocytes, lymphocytes, and plasma cells. The surrounding pancreatic tissue showed fibrosis and chronic inflammation. These findings suggested a xanthogranulomatous inflammation, and resulted in a diagnosis of xanthogranulomatous pancreatitis.
A 57-year-old man referred for epigastragia was found on endoscopic examination to have a submucosal tumor in the lower thoracic esophagus. Esophagectomy with gastric tube reconstructuion was ...performed in October 2001. The histopathological diagnosis was GIST and because the tumor size was 5 cm, with 50 mitoses per 50 HPF, the tumor was considered to be a high-risk GIST (c-kit(+), CD34(+),α-SMA(+)). He came to our hospital with complaint of pain on his right upper arm and was found to have an upper arm bone tumor. So we performed a bone resection in April 2010. Hisotopathological examination was metastatic GIST with >50 mitoses per 50 HPF (c-kit(+), CD34(+), α-SMA(-)). He was found on abdominopelvic CT to have a cystic intrapelvic tumor and underwent an operation in August 2010. The tumor was found on the jejunum at 40 cm on the distal side from the Treiz ligament with extraluminal growth, and was resected by wedge excision. Histopathological diagnosis was a moderate-risk GIST because the tumor size was 6 cm, 2 mitoses per 50 HPF, c-kit(+), CD34(-), and α-SMA(+). Histopathological and immunohisitochemical findings suggested that the bone metastasis was a recurrence of the primary esophageal GIST 9 years after the esophagectomy and the intestinal GIST was a second primary tumor.
New laparoscopic double-stapling technique Hamada, Madoka; Nishioka, Yutaka; Kurose, Yohei ...
Diseases of the colon & rectum,
2007-December, Volume:
50, Issue:
12
Journal Article
Peer reviewed
Laparoscopic surgery for colon cancer has been shown by several randomized, controlled trials to be an acceptable alternative to open surgery; however, laparoscopic rectal surgery has not been ...evaluated in a randomized trial. One of the most serious problems associated with laparoscopic rectal surgery are bowel clamping, irrigation, and transection of the rectum, and laparoscopic rectal surgery has not been as reliable as open rectal surgery.
We present our new technique, the laparoscopic double-stapling technique, which eliminates these problems. This technique uses curved Doyen forceps introduced through the wound just above pubis symphysis for clamping the rectal wall at the anal side of the tumor. An endolinear stapler (length 60 mm) is inserted through the same wound, applied at the rectal wall parallel and caudal to the Doyen forceps, and transects the rectum under pneumoperitoneum. We used this technique for eight cases of rectal surgery.
The laparoscopic double-stapling technique provided secure bowel clamping and rectal irrigation. The number of cartridges used in laparoscopic double-stapling technique cases was not more than 2, with an average of 1.6 per patient. None of the laparoscopic double-stapling technique cases experienced major complications.
We consider that many cases of rectal cancer that are suitable for laparoscopic low anterior resection can undergo laparoscopic surgery by using this technique, which will improve the quality of rectal surgery.
A CASE OF LYMPHOEPITHELIAL CYST OF THE PANCREAS NAKAMURA, Toshio; YAGI, Makoto; MIKI, Akira ...
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association),
2004, Volume:
65, Issue:
4
Journal Article
Open access
We report a case of lymphoepithelial cyst of the pancreas. A 70-year-old man with left flank pain found in abdominal ultrasonography to have a mass in the pancreatic tail was admitted for detailed ...examination. Enhanced computed tomography showed a 4 cm multilocular cystic lesion in the tail of the pancreas. Endoscopic retrograde pancreatography showed a normal duct system. Since we could not exclude possibility of a malignant tumor because elevated serum CA19-9 and CEA, we conducted laparotomy. The mass resected in combination with distal pancreatectomy and splenectomy was diagnosed histopathologically as a lymphoepithelial cyst of the pancreas. The postoperative course was satisfactory. Elevated serum CA19-9 and CEA decreased to within normal range after surgery. Preoperative diagnosis of lymphoepithelial cysts of the pancreas is still difficult because it resembles other cystic neoplasms of the pancreas in imaging and elevated serum tumor markers such as CA19-9 are often detected.
Actinomycosis of the ileocecal region, which is a favored site for abdominal actinomycotic infection, is often difficult to diagnose and treat in the presence of any complication. We report a case of ...ileocecal actinomycosis after chemoradiotherapy for uterine cervical cancer. A 46-year-old woman received chemoradiotherapy for uterine cervical cancer in September 2009. A positron emission tomography-computed tomography (CT) examination in May 2010 showed abnormal fludeoxyglucose accumulation in the pelvic lymph nodes and on the dorsal side of the ascending colon; therefore, we suspected recurrence of uterine cervical cancer. The patient presented at our hospital with a complaint of pain in the right lower abdomen in June 2010. Abdominal CT examination showed a periappendiceal abscess. Blood tests suggested an inflammatory reaction. Because of signs of peritoneal irritation, the patient underwent emergency surgery and ileocecal resection. Histopathological examination indicated actinomycosis. The patient started taking ampicillin orally for 6 months. At the same time, she received anticancer drug therapy for uterine cervical cancer. Actinomycosis did not worsen during cancer treatment.
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