Computed tomography findings of intersigmoid hernia

Purpose: To evaluate the computed tomography findings of intersigmoid hernias. Material and methods: Between April 2010 and March 2018, 7 patients who were surgically diagnosed with intersigmoid hernia in 3 institutions were enrolled in this study. Two radiologists evaluated imaging findings for the herniated small bowel, the distance between the occlusion point and bifurcation of the left common iliac artery, and the anatomic relationship with adjacent organs. Results: All patients were male, and their mean age (standard deviation, range) was 61.0 (13.5, 36-85) years. The mean size of the bowel loops was 5.2 (1.3, 4.0-8.3) cm in the caudal direction, 3.6 (0.8, 2.5-5.1) cm in the lateral, and 3.4 (0.6, 2.5-4.7) cm in the anterior-posterior direction. The volume was 37.9 (27.8, 15.6-103.0) cm3 approximated by an ellipse, and 24.0 (17.7, 9.9-65.6) cm3 approximated by a truncated cone. The obstruction point was located 3.6 (0.6, 2.8-4.7) cm inferior to the bifurcation of the left common iliac artery. In all cases, the small bowel ran under the point at which the inferior mesenteric vessels bifurcated to the superior rectal vessels and the sigmoid vessels and formed a sac-like appearance between the left psoas muscle and the sigmoid colon. The ureter ran dorsal to the point of the bowel stenosis, and the left gonadal vein ran outside the small bowel loops. Conclusions: All cases showed common imaging findings, which may be characteristic of men's intersigmoid hernia. In addition, the fossa's position was lower, and the size was larger than in the previous study, which may be a risk factor

Psychosocial twin cohort studies in Japan: the Keio Twin Research Center (KoTReC)

The Keio Twin Research Center (KoTReC) was established in 2009 at Keio University to combine two longitudinal cohort projects — the Keio Twin Study (KTS) for adolescence and adulthood and the Tokyo Twin Cohort Project (ToTCoP) for infancy and childhood. KoTReC also conducted a two-time panel study of self-control and psychopathology in twin adolescence in 2012 and 2013 and three independent anonymous cross-sectional twin surveys (ToTcross) before 2012 — the ToTCross, the Junior and Senior High School Survey and the High School Survey. This article introduces the recent research designs of KoTReC and its publications

A Case of Giant Mesenteric Cyst Originating from the Small Intestine

A 62-year-old man was admitted to Showa University Fujigaoka Hospital because of a giant mass that was discovered approximately 8 weeks after the development of obvious symptoms, namely upper abdominal pain, vomiting, and progressive distension. Ultrasonography revealed a giant cystic mass that was occupying the right upper abdomen, and contrast-enhanced computed tomography revealed a huge, relatively well-defined, and low-density cystic mass that measured 10cm in diameter. Radical resection of the tumor was performed via open laparotomy, along with segmental small intestine resection to address potential invasion into adjacent tissues. Histological findings of the resected specimen indicated mesenteric cyst. The patient\u27s postoperative recovery was uneventful and he was discharged after 11 days. At the 12-month follow-up, the patient was in good health with no signs of recurrence

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

A Case of Total Proctocolectomy by Reduced Port Surgery for Refractory Ulcerative Colitis

We report the case of a 40-year-old woman with refractory ulcerative colitis (UC) whose condition did not improve despite aggressive medical therapy with a corticosteroid and an immunosuppressor. The patient underwent a total proctocolectomy by reduced port surgery (RPS). A vertical incision of 30mm was made through the umbilicus, and a laparoscope port and two working or assistant laparoscopic ports were inserted through the fascia. A 5mm port was used as the terminal ileostomy site and another 5mm port was used as a drain site (marked preoperatively). The operator used a standard laparoscopic 5mm atraumatic grasper for the left hand and a standard laparoscopic dissector or an Enseal energy device for the right hand. An ileal J-pouch was created extra-corporeally from the terminal ileum and then an ileal pouch–anal anastomosis (IPAA) was created by hand suturing. The diverting loop ileostomy was brought out through the right iliac fossa, and there was 30cm of ileum between the diverting loop ileostomy and the IPAA. The surgical procedures were very similar to those normally used in laparoscopic colectomy. The duration of the surgery was 465min, and blood loss was estimated at 240ml. No intraoperative complications occurred, and conversion to conventional laparoscopic or open surgery was not needed. Laparoscopic total proctocolectomy using RPS (compared with standard laparoscopic surgery) may be preferred for young women because it reduces the wound size, minimizes postoperative pain, and enhances cosmesis

A Case of Krukenberg Tumor Metastasized from Colon Cancer Subsequent to Synchronous Multiple Liver Metastasis

A 34-year-old woman with synchronous, multiple liver metastases of stage IV, T4N2M0H2P0 descending colon cancer was referred to our hospital. The lesion was considered unresectable because of insufficient estimated future remnant liver volume resulting from invasion of three hepatic veins and the hepatic hilum, and she underwent laparoscopic left hemicolectomy. The patient underwent 14 courses of mFOLFOX6 (5-flurouracil, leucovorin and oxaliplatin) and 21 cetuximab administrations as first-line chemotherapy, which allowed her to maintain a complete response for 6 months despite adverse reactions such as mild neutropenia and thrombocytopenia. However, abdominal computed tomography (CT) revealed a large ovarian mass 6 months after chemotherapy cessation. A bilateral adnexectomy at another hospital revealed involvement of both ovaries, and immunohistochemistry revealed that the tumor was CK7− and CK20+, compatible with a colon cancer origin. The ovarian lesions were histologically diagnosed as Krukenberg tumor metastasized from the colon cancer. This case highlights the possibility of metastatic tumor development from colon cancer