Duodenal ulcer penetration into the superior mesenteric artery after percutaneous transluminal angioplasty and stent placement for acute mesenteric ischemia: report of a case

A 78-year-old male presented with the chief complaints of abdominal pain and vomiting. Contrast-enhanced computed tomography and abdominal angiography showed occlusion of the superior mesenteric artery due to thrombosis, and emergency percutaneous transluminal angioplasty and stent placement were carried out. Two months later, stent thrombosis developed, and a second stent was placed. Eight months later, he complained of general fatigue and anorexia. Gastrointestinal endoscopy revealed a duodenal ulcer at the third portion close to the superior mesenteric artery. Thirteen days after conservative management, duodenal ulcer penetration into the superior mesenteric artery with subsequent air embolism developed, and the patient died of multiple organ failure

Assessment of QOL Using the ESAS-r-J

Purpose To evaluate the perioperative symptoms of gastric cancer patients undergoing gastrectomy using the Edmonton Symptom Assessment System Revised Japanese version (ESAS-r-J), which is a nine-item visual analogue scale to rate patient symptoms. Methods Between February 2015 and March 2017, 246 patients completed the ESAS-r-J before and after gastrectomy. We evaluated the changes in the prevalence and score of each ESAS-r-J item before and after gastrectomy. In addition, we compared them after gastrectomy between patients who underwent the different approaches. Results Before gastrectomy, anxiety and well-being were the most prevalent items (80%), followed by depression (45%). After gastrectomy, well-being was the most prevalent item (87%), followed by pain (68%). The prevalence of anxiety decreased from 80% to 59% (P = 0.002). The depression and anxiety scores decreased from 1.6 to 1.1 (P < 0.001) and from 2.6 to 1.7 (P = 0.002), respectively. The total score was higher in patients who underwent open surgery than in patients who underwent laparoscopic surgery (16.9 vs 12.9 ; P = 0.031). Conclusions After gastrectomy, psychological symptoms such as depression and anxiety improved despite more physical complaints than before gastrectomy. The laparoscopy was less invasive. It is very important to take care of psychological aspects before gastrectomy

LPD after RHC for ascending colon cancer

Laparoscopic pancreaticoduodenectomy (LPD) has been widely adopted in institutions with sufficiently skilled practitioners. This technique requires attentive dissection around the superior mesenteric vein (SMV) and artery. Dissection around the SMV and Henle’s trunk is one of the key aspects of right hemicolectomy (RHC) ; adhesions and fibrosis around these vessels may impede LPD in patients with a history of RHC. We encountered three cases of periampullary tumors in patients with a history of RHC who were successfully treated with LPD. Cases 1, 2, and 3 were of 60-, 73-, and 74-year-old men with periampullary tumors. The operative durations in cases 1, 2, and 3 were 316, 267, and 265 min, respectively. The estimated blood loss volumes in cases 1, 2, and 3 were 20, 50, and 720 mL, respectively. The postoperative hospital stay durations in cases 1, 2, and 3 were of 13, 35, and 15 days, respectively. In conclusion, LPD following RHC may be safely completed with laparoscopy