Acute Fulminant Necrotizing Amebic Colitis and Enterocolitis Associated with Perforation in a Male Breast Cancer Patient

In Japan, amebiasis is typically found in men who have sex with men and in individuals with recent travel to endemic areas. We experienced a patient with fulminant necrotizing amebic colitis and enterocolitis who presented with a severe disorder of the liver and renal function. The patient was a 71-year-old man who had lived in Yokohama City, Japan for 30 years. His stool sample showed no amebic dysentery protozoa and cultured negatively for human immunodeficiency virus. Despite being treated with meropenem, pyrexia of 39-40°C continued for 4 days. On hospital day 8, a colonic abscess and perforation of the transverse colon were detected by computed tomography（CT）. His fever did not improve, suggesting progression of infectious disease. Subsequent emergency laparotomy revealed a perforation in the middle of the transverse colon. Peritoneal lavage and right hemicolectomy were performed; however, a CT scan on hospital day 16 （postoperative day 8） showed re-perforation of the colon and an abscess around the site of anastomosis, prompting emergency intestinal and left hemicolectomy resection. Amebae observed pathologically during the second emergency operation led to a diagnosis of amebic colitis. Endotoxin adsorption therapy was performed, and metronidazole was administered. Despite prompt diagnosis and treatments, the patient’s general conditions became fulminant, and multiple organ failure developed. On hospital day 18 （postoperative day 10）, his C-reactive protein level was 20mg/dl. He was clinically diagnosed as having sepsis and multiple organ failure. The patient died on hospital day 23. Acute colitis is commonly encountered in daily practice, but it is difficult to differentiate between amebic and non-amebic colitis preoperatively and thus, the possibility of amebic colitis should be considered in such clinical presentations

A Case of Pneumatosis Cystoides Intestinalis Mimicking Intestinal Perforation

An 85-year-old man was referred to the Department of Gastroenterological and General Surgery after complaining of abdominal pain and distention. Abdominal computed tomography (CT) revealed intra-abdominal free air, mimicking perforated peritonitis, with air collection within the jejunum bowel wall. On the basis of these findings, we made a diagnosis of pneumatosis cystoides intestinalis (PCI) with intra-abdominal free air. The PCI signs had disappeared completely by Day 7 of hospitalization. The patient was discharged from hospital after 15 days. At the time of writing, the patient’s PCI has not reappeared. This case highlights the clinical importance of PCI, and that the lung window settings of abdominal CT are useful tools to enable an accurate diagnosis of PCI

Chemoradiotherapy for Squamous Cell Carcinoma of the Anal Canal: A Case Report

A 79-year-old woman presented to our hospital with frequent episodes of hematochezia. Colonoscopy revealed an apparent tumor with central ulceration, and analysis of biopsy specimens confirmed the presence of non-invasive squamous cell carcinoma of the anal canal. No distant metastases were identified on enhanced computed tomography (CT). The cancer was classified as stage II (T2N0M0), and chemoradiotherapy (CRT) was selected as the first-line treatment. A continuous intravenous infusion of 5-fluorouracil with daily cisplatin was planned on days 1 to 5 of a 4-week cycle. After the first course, the drug administration was discontinued because the patient experienced diarrhea as an adverse event, and treatment with daily oral titanium silicate-1 (TS-1) was initiated. In addition, a total of 65Gy of radiation was applied to the primary lesion, pelvis, and bilateral groin area. Four weeks after the completion of CRT, colonoscopy showed the disappearance of the tumor and analysis of biopsy specimens confirmed the absence of any viable cancer cells. CT showed no evidence of lymph node metastasis or distant metastases. At 10 months after the completion of CRT, the patient showed no recurrence and with complete response

A Case of Laparoscopic Ileocecal Resection for Intussusception Secondary to Cecal Cancer

An 83-year-old woman presented with a right lower abdominal mass, lower abdominal pain, and distension. She had no medical or surgical history. Clinical examination revealed a right lower abdominal mass, abdominal distension, and decreased bowel sounds in the lower abdomen. Abdominal computed tomography showed an intussusception involving the ileocecal junction. A Gastrografin enema showed a tumor shadow with an irregular defect caused by the intussusception in the transverse colon. The protruding tumor was also pushed back into the cecum by the enema pressure. Colonoscopy revealed a protruding mass at the leading edge of the intussusception in the ascending colon, and biopsy results of the cecal mass indicated an adenocarcinoma. The patient underwent laparoscopic ileocecal resection of the intussuscepted cecal cancer using reduced port surgery. The resected specimen contained a type 1 tumor measuring 40mm that was histopathologically diagnosed as cecal cancer. The patient remains asymptomatic 8 months after surgery

A New Device Facilitating Intracorporeal Purse-string Suture during Endoscopic Surgery

Standard laparoscopic colorectal surgery requires additional incision or enlargement of the trocar incision for the retrieval of the surgical specimen. A natural orifice specimen extraction （NOSE） procedure, in which the specimen is retrieved through the anus or vagina without any additional skin incision, requires purse-string suture （PSS） of the rostral intestinal segment in order to fix the anvil head of the stapler and perform extracorporeal mechanical anastomosis. Colorectal surgery has a limited NOSE in cases where the end of the rostral segment could be pulled through the anus. Broader application of NOSE depends on intracorporeal PSS. We developed a new forceps for intracorporeal PSS during NOSE and evaluated its efficacy. The PSS instrument was refined to pass through a 12-mm trocar in an intracorporeal PSS and achieve anastomosis using double stapling. In trials utilizing an endoscopic practice box, regular spacing of stitches during PSS were consistent （n＝10）, and tight intracorporeal anastomosis of the porcine colon was successfully performed （n＝2）. We then confirmed efficacy through an operation on a pig. Our novel PSS device will help us perform NOSE not only in laparoscopic colorectal surgery but also in any operation requiring intracorporeal PSS, which should contribute to further advances in endoscopic digestive surgery

Effect of diabetes and prediabetes on the development of disability and mortality among middle-aged Japanese adults : A 22-year follow up of NIPPON DATA90.

Aims/introduction:To examine the association between diabetes and prediabetes at baseline, and disability, mortality over a 22-year period among middle-aged Japanese adults.Materials and methods:Participants consisted of 1,788 adults aged 45-64 years at baseline from the cohort study National Integrated Project for Prospective Observation of Non-communicable Disease and its Trends in the Aged 1990 (NIPPON DATA90). Disability, defined as having a decline in activities of daily living (ADL), was assessed by a modified Katz questionnaire at four time points. Disability and death without disability for 22-year follow up were used as outcomes to test the association with a diagnosis of diabetes or prediabetes at baseline, using multinomial logistic regression. Adjusted odds ratios (ORs) were obtained from four models that contained appropriate adjustment factors, such as age, sex, smoking status, drinking status, body mass index and cardiovascular risk factors (hypertension, hypercholesterolemia, triglycerides, low serum high-density lipoprotein), at baseline.Results:In the present study, 334 participants (18.7%) reported at least one disability, and 350 (19.6%) were reported dead without observation of disability during follow up. Adjusting sex and other risk factors, participants with diabetes and prediabetes had a higher risk for disability (OR 1.43, 95% confidence interval [CI] 1.07-1.91 and OR 1.66, 95% CI 1.10-2.50, respectively) and for mortality (OR 1.56, 95% CI 1.16-2.08 and OR 1.77, 95% CI 1.18-2.65, respectively) than individuals with normal glucose tolerance.Conclusions:In middle-aged Japanese adults, individuals with diabetes and prediabetes were more likely to be associated with disability and mortality. Our findings suggest that prediabetes and diabetes in middle-aged adults should be paid more attention, and requires more intervention to prevent disability and mortality in later life