Risk factors for postoperative complications in patients on maintenance hemodialysis who undergo abdominal surgery

SummaryBackground/ObjectivePatients on hemodialysis (HD) who undergo abdominal surgery for gastrointestinal disease are at increased risk of postoperative complications. In this study, we retrospectively investigated the predictors of postoperative complications among such patients.MethodsThe study group comprised 36 HD patients who underwent abdominal surgery for gastrointestinal disease between 2003 and 2012. The clinicopathological factors of the patients who did and did not suffer postoperative complications were compared.ResultsThe overall morbidity and mortality rates were 39% (14/36) and 14% (5/36), respectively. Physical status according to the American Society of Anesthesiologists (ASA) classification (p = 0.0203) and intraoperative blood loss (p = 0.0013) were found to differ significantly between the groups.ConclusionThe morbidity and mortality rates of HD patients who underwent abdominal surgery for gastrointestinal disease were high. Physical status according to the ASA classification and intraoperative blood loss were found to be associated with postoperative complications. Therefore, patients with comorbidities, such as heart disease and diabetes mellitus, have to be treated appropriately before surgery. In addition, it is important that surgeons perform operations carefully and avoid excessive blood loss

Adult Intussusception Caused by an Inverted Meckel Diverticulum

Adult intussusception caused by an inverted Meckel diverticulum is rare. We report a 55-year-old Japanese man with intussusception. He was admitted to our hospital with vomiting and abdominal pain. The abdomen was hard with tenderness and muscle guarding. Computed tomography scanning demonstrated a typical inhomogeneous target-shaped mass in the right abdomen. We diagnosed intussusception and performed emergency surgery. At laparotomy, ileocolic intussusception was observed and the ileocecal segment was resected. The surgical specimen comprised an 84 cm segment of resected ileocecum with an elongated polypoid lesion measuring 11 × 2 cm within the ileal lumen. Histopathological examination demonstrated that the polypoid lesion was an inverted Meckel diverticulum. Postoperatively, the patient made an uneventful recovery

Abdominoperineal Resection for Unexpected Distal Intramural Spreading of Rectal Cancer

Introduction: In rectal cancer, distal intramural spread may sometimes occur, but a maximum extent of distal spread of > 6 cm is very rare. Case Presentation: A 65-year-old Japanese male with an advanced rectal cancer tumor with para-aortic lymph node metastasis was admitted. We performed a low anterior resection with lymphadenectomy, but the intraoperative frozen-section analysis of margins revealed malignant cell positivity; we, therefore, performed an abdominoperineal resection. Pathological findings showed that the maximum extent of distal spread was 6 cm. After 12 courses of FOLFOX4 as adjuvant chemotherapy, abdominal computed tomography revealed whole lymph node metastases, including Virchow’s node. Though FOLFIRI + panitumumab was started, he was not eligible for additional chemotherapy after 10 cycles. Conclusion: An intraoperative frozen pathology examination was helpful for the additional resection, when unexpected distal spreading had occurred in rectal cancer. The evidence of a distal negative margin should not be underestimated

Signet-Ring Cell Carcinoma Co-Existing with Adenocarcinoma of the Ampulla of Vater. A Case Report

Context We report a case of signet-ring cell carcinoma admixed with adenocarcinoma of the ampulla of Vater. Signet-ring cell carcinoma of the ampulla of Vater is rarely encountered in clinical practice. Case report A 78-year-old man was admitted to our hospital with jaundice. Computed tomography demonstrated dilatation of the biliary tract and an enhanced mass lesion measuring 1.5 cm in the pancreatic head. Endoscopic examination showed a reddish swollen papilla of Vater, and the pathological findings on a biopsy from the papilla suggested signet-ring cell carcinoma. A pancreaticoduodenectomy was performed with a diagnosis of carcinoma of the ampulla of Vater. Postoperative pathological examination showed that the tumor was composed of signet-ring cell carcinoma and tubular adenocarcinoma. The signet-ring cell carcinoma had infiltrated to the duodenal wall and pancreatic parenchyma. Both the signet-ring cell carcinoma and the adenocarcinoma were positive on immunohistochemical staining with 45M1. Conclusion Several cases of signet-ring cell carcinoma of the ampulla of Vater have previously been reported. In our case, the histological origin of both signet-ring cell and adenocarcinoma was hypothesized to have been pancreaticobiliary epithelial cells.Image: Immunohistochemical findings for CK7

Risk factors for postoperative complications in patients on maintenance hemodialysis who undergo abdominal surgery

Patients on hemodialysis (HD) who undergo abdominal surgery for gastrointestinal disease are at increased risk of postoperative complications. In this study, we retrospectively investigated the predictors of postoperative complications among such patients. The study group comprised 36 HD patients who underwent abdominal surgery for gastrointestinal disease between 2003 and 2012. The clinicopathological factors of the patients who did and did not suffer postoperative complications were compared. The overall morbidity and mortality rates were 39% (14/36) and 14% (5/36), respectively. Physical status according to the American Society of Anesthesiologists (ASA) classification (p = 0.0203) and intraoperative blood loss (p = 0.0013) were found to differ significantly between the groups. The morbidity and mortality rates of HD patients who underwent abdominal surgery for gastrointestinal disease were high. Physical status according to the ASA classification and intraoperative blood loss were found to be associated with postoperative complications. Therefore, patients with comorbidities, such as heart disease and diabetes mellitus, have to be treated appropriately before surgery. In addition, it is important that surgeons perform operations carefully and avoid excessive blood loss

Two cases of laparoscopic simultaneous resection of colorectal cancer and synchronous liver metastases in elderly patients

Introduction: The laparoscopic resection of colorectal cancer and laparoscopic liver surgery are widely considered to be safe. Recently, it has been reported that the simultaneous laparoscopic resection of primary colorectal cancer and liver metastasis is technically feasible and safe when it is performed at experienced centers. However, the feasibility of simultaneous laparoscopic procedures for colorectal cancer and synchronous colorectal liver metastases in elderly patients has not been studied sufficiently. In this study, two cases in which elderly patients with colorectal cancer and synchronous liver metastases were treated with simultaneous laparoscopic resection are reported. Presentation of cases: An 83-year-old female was diagnosed with ascending colon cancer and synchronous hepatic metastases. Simultaneous laparoscopic resection of the primary colon cancer and the liver metastasis was performed. Another tiny hepatic metastasis was subsequently detected in the right hepatic lobe. It was treated with hand-assisted radiofrequency ablation (RFA). The total operative time was 470 min, and 340 g of intraoperative blood loss occurred. The other case involved a 78-year-old male who was diagnosed with ascending colon cancer and synchronous hepatic metastasis in the right hepatic lobe. Simultaneous laparoscopic resection of the primary colon tumor and liver metastasis was performed. The total operative time was 471 min, and 240 g of intraoperative blood loss occurred. The postoperative courses of both patients were uneventful. Discussion and conclusion: Our results indicate that simultaneous laparoscopic resection of colorectal cancer and synchronous liver metastases is feasible and safe in elderly patients

Aneurysms of Pancreaticoduodenal Artery due to Median Arcuate Ligament Syndrome, Treated by Open Surgery and Laparoscopic Surgery

Introduction. There are many possible causes of an abdominal visceral aneurysm, including the obstruction of the celiac artery by the median arcuate ligament (MAL). We report two cases of an aneurysm of the pancreaticoduodenal artery due to MAL syndrome that we treated surgically. Case Presentation. Case 1: a 66-year-old Japanese woman was diagnosed with a rupture of an aneurysm of the inferior pancreaticoduodenal artery. Because of the difficulty of endovascular therapy, we performed an emergency operation. We chose an abdominal operation, and the postoperative course was uneventful. Case 2: a 75-year-old Japanese man presented at our hospital with acute abdominal pain, nausea, and cold sweat. Our experience of treating MAL syndrome in case 1 enabled us to diagnose the disease accurately. We chose laparoscopic surgery, and the postoperative course was uneventful. Discussion. There are several treatment choices for an aneurysm of the pancreaticoduodenal artery due to MAL syndrome. We have performed only a release of the MAL for treatment, but it is difficult to conclude whether only releasing the MAL is enough to ensure a positive long-term prognosis. Regular follow-up is needed in such cases. Conclusion. Laparoscopic surgery can be considered one of the options for MAL syndrome