Misdiagnosis of Anterior Superior Pancreaticoduodenal Artery Aneurysm Rupture Likely Due to Segmental Arterial Mediolysis: A Case Report

An aneurysm of the abdominal internal organs is relatively rare. Recently, segmental arterial mediolysis (SAM) and median arcuate ligament syndrome (MALS) were identified as specific causes for aneurysms of the pancreaticoduodenal artery arcade. Herein, we report a ruptured anterior superior pancreaticoduodenal artery (ASPDA) aneurysm due to SAM that was misdiagnosed as acute pancreatitis. The patient was a 59-year-old male with acute, severe, and sharp pain in the upper abdomen. He was clinically diagnosed with acute pancreatitis based on abdominal computed tomography (CT). However, a follow-up CT scan revealed an aneurysm of the ASPDA. We therefore diagnosed this case as retroperitoneal hemorrhage due to aneurysm rupture, and we performed an angiogram and transcatheter arterial embolization to prevent aneurysm re-rupture. Based on a subsequent review of all the findings for this patient, we retrospectively determined the cause of the ASPDA aneurysm to be SAM. Such case reports are rare, and further accumulation of similar cases is necessary in the near future to establish proper diagnostic criteria and appropriate treatment protocols

Efficacy and Safety of an Ultrasonically Activated Device for Sealing the Bile Ducts During Liver Resection

The use of ultrasonically activated devices (USADs) in hepatic resections may be associated with an increased rate of complications, such as postoperative bile leaks. Nonetheless, the safety of USADs for sealing bile ducts during liver surgery has not yet been established. The purpose of this study was to assess the efficacy of a USAD for sealing bile ducts. In animal experiments, the common bile duct of ten anesthetized dogs was individually occluded using a USAD. Additionally, using the prospective liver surgery database from a single institution, we identified 45 consecutive patients who underwent hepatic resection using a USAD (USAD group) and 45 similar patients who underwent hepatic resection without the use of a USAD (NUSAD group). In the occluded and harvested canine bile ducts, the mean burst pressure was 280mmHg, and the lumen of the bile duct was completely sealed morphologically. In the clinical study, there was no significant difference in postoperative mortality or complications between the two groups, and biliary leakage was observed in only one patient (0.7%) in the USAD group. These data demonstrate that the USAD is a safe, efficient, and practical instrument for use during liver surgery to achieve complete hemobiliary stasis

Primary Malignant Melanoma of the Rectum: Report of Two Cases

We report two cases of rectal malignant melanomas. The patients were an 84-year-old male and a 66-year-old female who had blood in their stools. They were preoperatively diagnosed with poorly differentiated adenocarcinoma of the rectum. The clinical diagnosis for each was rectal carcinoma at stage IIIc according to the tumor-node-metastasis classification (6th edition), and the patients underwent abdominoperineal resection with dissection of lymph nodes. Pathological examination of the resected specimens revealed a malignant melanoma. Immunohistochemical analysis results were positive for HMB-45 and negative for cytokeratin AE1/AE3, CD45, and synaptophysin. Primary anorectal melanoma is an uncommon and aggressive disease that carries a poor prognosis. Therefore, it is necessary to provide systemic treatment. To improve prognosis, it is important to detect anorectal melanoma at an early stage

Controlling Nutritional Status is Useful for Predicting Postoperative Complications in very Elderly Patients with Colorectal Cancer: A Retrospective Study

Controlling Nutritional Status (CONUT) is an efficient tool for early detection of malnutrition, measured using two biochemical parameters (serum albumin and total cholesterol) and one immune indicator (total lymphocyte count). The aim of this study was to define the efficacy of CONUT for predicting postoperative complications in very elderly patients with colorectal cancer. This study enrolled 52 patients aged 85 years or older with colorectal cancer for whom we were able to measure CONUT before surgery, conducted at the Department of Gastroenterological and General Surgery of Showa University Hospital in Japan between January 2010 and December 2014. The patients were subdivided into those with complications (Group C, n=9) and those with no complications (Group NC, n=43), and then were retrospectively compared for clinical characteristics, CONUT, and surgical outcomes. Multivariate analysis was finally performed to identify the risk factors of complications. The percentage of patients with a CONUT score of 5 or more in Group C was significantly greater than that in Group NC (7 vs. 12 patients, 77.8% vs. 27.9%, P=0.0079). No other significant difference was observed in the clinical characteristics between Group C and Group NC. Multivariate analysis identified CONUT score as the only significant predictor of complications in this patient cohort (odds ratio=1.374; 95% confidence interval, 1.019-1.949; P=0.0366). Our study suggests that CONUT score is predictive of postoperative complications in very elderly patients with colorectal cancer

Ulcerative Colitis after Multidisciplinary Treatment for Colorectal Cancer with Multiple Liver Metastases: A Case Report

Herein we report on an extremely rare case of ulcerative colitis （UC） with onset after chemotherapy and colorectal resection, and discuss three previously reported cases. A 61-year-old man presented with fecal occult blood and no subjective symptoms. The diagnosis was rectal cancer with multiple liver metastases. Following chemotherapy, the patient underwent laparoscopy-assisted super-low anterior resection, liver resection. On Day 35 following closure of the ileostomy, the patient was referred to Totsuka Kyoritsu Dai-1 Hospital because of diarrhea, bloody stools. Colonoscopy and pathological examination revealed UC. To the best of our knowledge, only three cases of UC following colorectal cancer resection have been described previously. In conclusion, when encountering intractable diarrhea after chemotherapy or surgery, UC should be one of the bowel diseases considered, with prompt systemic examination recommended