A Case of Single-Incision Laparoscopic Surgery for Lipoma of the Terminal Ileum

A 52-year-old woman presented with a right lower abdominal mass, lower abdominal pain, and distension in July 2011. She had myasthenia gravis, but did not have any surgical history. Clinical examination showed a right lower abdominal mass, abdominal distension, decreased bowel sounds, and rebound tenderness in the lower abdomen. Abdominal computed tomography showed an intussusception involving the ileocecal junction. A gastrografin enema image of the colon showed a 30-mm filling defect in the ascending colon. The patient underwent resection of the intussuscepted intestine by single-incision laparoscopic surgery (SILS). The resected specimen contained a round tumor measuring 35 × 35 × 20 mm, which was diagnosed histopathologically as lipoma of the terminal ileum. The patient remains asymptomatic eight months after surgery

A Case of Gallstone Ileus

A 57-year-old woman was admitted to our hospital with abdominal pain and vomiting. Her abdomen was distended, and obstructive bowel sounds were discovered on examination. Diffuse abdominal tenderness was present, but no palpable masses were apparent. Abdominal computed tomography confirmed a large gallstone obstructing the small bowel. Colonoscopy revealed a large gallstone lodged at the terminal ileum, which was subsequently fragmented using electronic hydraulic lithotripsy (EHL). The patient has remained asymptomatic for over 3 years of follow-up after the EHL treatment. Here, we present this case of small intestinal obstruction caused by a large gallstone in the lower ileum

A Case of Ischemic Colonic Stenosis of the Splenic Flexure

Ischemic colitis is characterized by lesions arising from colonic ischemia. The treatment of choice is surgery, and resection of the affected segment is often life saving. This study presents a case of segmental ischemic colonic stenosis of the splenic flexure. A 70-year-old woman was admitted to our hospital with abdominal pain and distension. Physical examination revealed mild tenderness of the left-upper abdomen but no peritoneal signs. A computed tomography scan demonstrated a thickening of the splenic flexure of the colon with active inflammation. A gastrografin enema revealed a 5-cm-long tight stricture at the left transverse colon, which suggested a subileus. Surgery for segmental ischemic colonic stenosis was performed because the stricture did not respond to treatment. Pathological examination revealed features typical of ischemic colitis, including ulceration and segmental colonic stenosis of the splenic flexure, but revealed no evidence of tumors, lymph node swelling, or vascular disorder

Anastomotic Recurrence due to Tumor Implantation using the Double Stapling Technique after Curative Surgery for Sigmoid Colon Cancer

Recurrence at the site of a stapled anastomosis is generally believed to result from the luminal implantation of viable cancer cells during stapling. We report a 57-year-old woman who underwent radical surgery for sigmoid colon cancer and developed anastomotic recurrence ten months after the initial operation. Her serum carcinoembryonic antigen (CEA) levels were within normal limits during the postoperative follow-up. The patient subsequently underwent a partial colon resection for the anastomotic recurrence. The clinicopathological findings revealed that possible tumor cell implantation caused the recurrence. We encountered a case of anastomotic recurrence due to possible tumor implantation after curative surgery for sigmoid colon cancer. Follow-up colonoscopy was more helpful for the diagnosis of anastomotic recurrence than CEA monitoring

Case Report of a Crohn\u27s Disease (CD) Patient with Anastomotic Stenosis Unrelated to Postoperative Recurrence of CD

Crohn\u27s disease (CD) is an idiopathic inflammatory bowel disease that can involve any part of the gastrointestinal tract. It frequently involves the ileum, colon, and anorectum. A 66-year-old man with CD had undergone a partial intestinal resection of the ileum for CD 27 years previously, and had been hospitalized several times, including two months prior to referral. The patient was admitted to our hospital with abdominal pain and distension. A computed tomography (CT) scan demonstrated an anastomotic stenosis with active inflammation and proximal intestinal extension. Colonoscopic examination revealed no abnormalities in the colon or rectum. A contrast Gastrografin enema revealed a stenosis in the ileum and a tight stricture at 3 cm with inflammation. We performed an ileocecal resection for an anastomotic stenosis due to possible recurrence of CD. Pathological examination showed no evidence of CD activity at the anastomotic region, indicating no recurrence of CD

A Case of Intestinal Obstruction Secondary to a Strangulated Obturator Hernia in an Elderly Woman

In this report, we present a case of intestinal obstruction secondary to a strangulated obturator hernia in an elderly woman. An 88-year-old woman was admitted to our hospital because she had been experiencing abdominal pain and vomiting for 24h. Her abdomen was distended, and bowel sounds indicating obstruction were heard on auscultation. Diffuse abdominal tenderness was present, but no palpable masses were apparent. The diagnosis of an obturator hernia was confirmed preoperatively by computed tomography. During the emergency laparotomy, the incarcerated intestine was reduced and removed. The obturator foramen was repaired using a simple suture. The patient recovered completely and was discharged seven days after the surgical procedure because no postoperative complications occurred. An early diagnosis and prompt surgical treatment are important to reduce the morbidity and mortality associated with an obturator hernia

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

A Case of Ischemic Ileal Obstruction Secondary to Seat Belt Trauma

We report a case of seat belt trauma with delayed ischemic ileal obstruction. A 62-year-old woman presented with symptoms and signs of bowel obstruction three weeks after an automobile traffic accident. A plain radiograph of the abdomen showed dilated small bowel loops with air fluid levels that were consistent with intestinal obstruction. Enhanced computed tomography clearly demonstrated a stenotic ileal loop with mural thickening that was associated with a mesenteric hematoma. Upper endoscopy revealed an ulcer of the ischemic ileal obstruction. The patient underwent resection of the stenotic ileal loop by single-incision laparoscopic surgery. The stenotic ileal loop was located 120 cm oral side from the terminal ileum. In gross finding, the wall of stenotic ileal loop was thickened and the adjacent mesentery was shortened with a hematoma. The mucosa of the ischemic ileal obstruction showed ulcerative changes. The abnormal ileal loop, which was 15 cm in length, was resected. Postoperative recovery was uneventful

Mental Condition and Treatment of Patients after Disclosure of Cancer Diagnosis

In Japan, historically, doctors had refrained from disclosing a cancer diagnosis to patients, but attitudes regarding disclosure have recently been changing. We investigated the mental condition and treatment of patients after disclosure of cancer. Thirty-seven cancer patients (7 gastric cancer, 23 colorectal cancer, 5 breast cancer, 2 hepatocellular carcinoma) participated in this study. We divided the patients at Week 1 after disclosure of the diagnosis of cancer into two groups according to their score of Hospital Anxiety and Depression Scale (HADS): one group whose HADS was 8 points or more (Group A), and another group whose points were below 8 (Group B) at Week 1 after disclosure. There were 11 (29.7%) patients in Group A, and 26 (70.3%) in Group B. The average HADS differed between the two groups before disclosure, and at Weeks 1 to 5 after disclosure. Group A was treated with paroxetine hydrochloride hydrate (PAX) and about 70% of the patients showed an improvement of anxiety or depression by Week 5. While, there was 0% in HADS of 8 or more in breast cancer patients after disclosure. Some patients felt anxiety and depression unrelated to the stage of cancer. Furthermore, we noted that anxiety and depression were not detected after the cancer disclosure in any of the breast cancer patients, suggesting the possibility that anxiety and depression were alleviated by events such as surgery. It is necessary for medical treatment to advance to new steps in the treatment of cancer, providing enough support to the patients in the future

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