Transabdominal Approach for Spontaneous Oesophageal Perforation: A Review of Four Cases

Spontaneous oesophageal perforation is an uncommon and life-threatening disease. Although several methods of treatment have been proposed, surgical treatment is considered the standard procedure. Primary repair using the transthoracic approach is the most common. However, few studies have evaluated the characteristics of the transabdominal approach. This study aimed to investigate the clinical outcomes of spontaneous oesophageal perforation that was surgically treated using the transabdominal approach. We retrospectively reviewed all patients with spontaneous oesophageal perforation who were admitted to the surgical department of our institution between November 2010 and April 2017, and identified a total of four patients. Data including demographic factors (age and sex), location of perforation, time to operation, operative method, complications, length of hospital stay, and postoperative recovery were reviewed. In all four cases, we treated the defect using the transabdominal approach, which provides a good surgical field of view. The aims of operative intervention, namely primary repair and access for enteral feeding, can be achieved using this approach. The most commonly observed complication was pyothorax, and we suggest the addition of intrapleural drainage for its prevention. Dysgraphia was observed in two patients, which improved with conservative treatment. The overall mortality rate was 0%. Our results demonstrate that primary repair using the transabdominal approach is safe and effective for the management of spontaneous oesophageal perforation. Addition of intrapleural drainage can improve the outcome associated with this approach

Effective Appendix Stump Closure Using the Doubleshanked Titanium Ligation Clip (DS Clip): A Case Report

Background: During laparoscopic appendectomy, several methods and devices can be used to close the appendicular stump, such as endoloops, linear staplers, clips, and open purse-string sutures. The Double-shanked Titanium Ligation Clip® (DS clip; B. Braun Aesculap, Tuttlinger, Germany), a new device that can be used to close the appendicular stump, was approved for use in Japan in March 2015. We report a case of effective appendix stump closure using DS clips. Case presentation: An 81-year-old man was admitted to our hospital with complaints of severe pain in the right lower quadrant of the abdomen. Abdominal contrast-enhanced computed tomography showed a thickened appendix (1.7 cm in diameter) with fecal stones, while acute inflammatory signs were visible around the appendix. He was diagnosed with acute appendicitis for which laparoscopic appendectomy was performed with a curative intent. It was difficult to mobilize the cecum because of inflammation, so we attempted to use DS clips instead of linear staplers. A histological examination revealed gangrenous appendicitis. The patient’s postoperative course was uneventful and he was discharged 10 days postoperatively. We also used DS clips to close the appendicular stump in 12 other cases. We observed no intra- or postoperative complications and no cases of mortality. Conclusion: The management of an appendicular stump using DS clips during laparoscopic appendectomy was simple, safe, and cost-effective. DS clips may be an alternative method to linear staplers

Anti-malarial activity of leaf-extract of hydrangea macrophylla, a common Japanese plant.

To find a new anti-malarial medicine derived from natural resources, we examined the leaves of 13 common Japanese plants in vitro. Among them, a leaf-extract of Hydrangea macrophylla, a common Japanese flower, inhibited the parasitic growth of Plasmodium falciparum. The IC50 of Hydrangea macrophylla leaf extract to Plasmodium falciparum was 0.18 microg/ml. The IC50 to NIH 3T3-3 cells, from a normal mouse cell line, was 7.2 microg/ml. Thus, selective toxicity was 40. For the in vivo test, we inoculated Plasmodium berghei, a rodent malaria parasite, to ddY mice and administered the leaf-extract of Hydrangea macrophylla (3.6 mg/0.2 ml) orally 3 times a day for 3 days. Malaria parasites did not appear in the blood of in the treated mice, but they did appear in the control group on day 3 or 4 after inoculation with the parasites. When leaf extract was administered to 5 mice 2 times a day for 3 days, malaria parasites did not appear in 4 of the mice but did appear in 1 mouse. In addition, the leaf-extract was administered orally 3 times a day for 3 days to Plasmodium berghei infected mice with a parasitemia of 2.7%. In the latter group, malaria parasites disappeared on day 3 after initiating the treatment, but they appeared again after day 5 or 6. Although we could not cure the mice entirely, we confirmed that the Hydrangea macrophylla leaf extract did contain an anti-malarial substance that can be administered orally.</p

A Rare Case of Pylephlebitis as a Complication of Cholecystocolonic Fistula

Pylephlebitis is defined as a septic thrombophlebitis of the portal vein and its tributaries that is associated with multiple suppurative abdominal infections. We report a case of pylephlebitis associated with a cholecystocolonic fistula (CCF). A 41-year-old man presented with upper abdominal pain and anorexia for 1 month. Abdominal contrast-enhanced computed tomography (CT) revealed thrombosis in the left and anterior branch of the portal vein and thickening of the walls of the portal vein and periside portals. The gallbladder was collapsed and pneumobilia was seen in the biliary tract. Blood culture was positive for Streptococcus anginosus. A diagnosis of thrombophlebitis of the portal vein associated with CCF was made, and the patient was immediately managed with an intravenous broad-spectrum antibiotic and anticoagulation. After the portal vein thrombosis (PVT) propagation and inflammation had subsided, cholecystectomy and partial resection of the transverse colon were performed. Pylephlebitis is rare but is a life-threatening complication of intra-abdominal infection. A high index of suspicion is required, and a CT scan should be performed immediately for an early diagnosis and appropriate treatment

Acute diffuse peritonitis due to spontaneous rupture of a primary gastrointestinal stromal tumor of the jejunum: A case report

Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Overt peritonitis caused by GIST rupture is very uncommon. Three types of GIST rupture have been described: closed perforation due to abscess (abscess type), hemoperitoneum leading to rupture of the hematoma capsule in the tumor (hemoperitoneum type), and perforation of the digestive tract via a fistula leading to central necrosis of the tumor (bowel perforation type). This report describes a patient with spontaneous tumor rupture and diffuse peritonitis, a variant of the bowel perforation type of GIST rupture. Presentation of case: A 74-year-old man presented with symptoms of vomiting and abdominal pain. Computed tomography (CT) scan revealed an approximately 10 × 7-cm mass in the pelvis with free air and fluid collection. Emergency laparotomy revealed a tumor in the jejunum, which was ruptured with a hole measuring 5 mm in diameter. The tumor and part of the jejunum were resected. Immunohistochemically, the mass was diagnosed as a GIST originating from the gastrointestinal tract. Despite chemotherapy with imatinib mesylate, the patient died 22 months after surgery. Conclusions: This report describes a patient with acute diffuse peritonitis due to spontaneous rupture of a primary GIST of the jejunum