スイビブガン ノ ゾウ オ シメシタ スイナイ フクヒ ノ 1レイ

Intrapancreatic accessory spleens exhibit the same computed tomography （CT） findings as the spleen itself. We experienced a case in which an intrapancreatic accessory spleen mimicked pancreatic tail carcinoma. A ５４-year-old female who had a medical history of splenectomy presented with a pancreatic tail tumor, which exhibited low density in the arterial phase and slightly high density in the portal and equilibrium phases on CT. In addition, an accessory spleen was present in the greater omentum. We initially diagnosed the tumor as a pancreatic carcinoma, and scheduled distal pancreatectomy（DP）combined with lymph node dissection（LND）. Intraoperatively, the tumor was found to be elastic-soft, which indicated that it might be benign. We changed the planned procedure from DP combined with LND to DP without LND. The cut surface of the tumor had the appearance of spleen tissue, and the pathological diagnosis was an intrapancreatic accessory spleen. Intrapancreatic accessory spleens can display the same imaging findings as pancreatic carcinomas. Intraoperative palpation and gross pathological examinations were useful for selecting the optimal surgical procedure in the present case. It is important to differentiate pancreatic tail tumors that exhibit low density in the arterial phase on CT from accessory spleens

フククウキョウカ イ ゼンテキジュツゴ ニ 2ド ノ Petersen’s hernia シュウフクジュツ オ ヨウシタ 1レイ

Petersen’s hernia is a type of internal hernia that may occur after Roux-en-Y reconstruction. Some surgeons suture Petersen’s defect for prevention of Petersen’s hernia. We report a case of recurrent Petersen’s hernia. A fifty-something man underwent laparoscopic-assisted total gastrectomy with antecolic Roux-en-Y reconstruction for gastric cancer. Petersen’s hernia occurred ６ months later. We closed Petersen’s defect by absorbable suture. However, he experienced recurrence２months later. The defect had not been successfully closed and there was no adhesion ; thus, we sutured Petersen’s defect again, more tightly than before. Additionally, we investigated different approaches for closing Petersen’s defect due to our experience of recurrent Petersen’s hernia

トウカ ニオケル ダイチョウ センコウ 83レイ ノ リンショウテキ ケントウ

Introduction : Colon perforation easily causes septic shock and multiple organ failure, mortality rate is high. We studied prognostic factors with colon perforation. From January１９９９to December ２００８, ８３ patients with colon perforation underwent emergency surgery in this department. Methods : Subjects were retrospectively divided into survivors（n＝６７）and nonsurvivors（n＝１６）. We studied their clinical factors and compared mortality for each factors. Results : Overall mortality was１９％ １６／８３）. The mean age was７４years, and significantly higher mortality over ８０years. The cause perforation was idiopathic in２５cases, cancer in２１cases, diverticulitis in１９ cases, iatrogenic in８cases, trauma in２cases, others in８cases. The perforation site was the most sigmoid colon. Patients with SOFA score at least five points before surgery and preoperative shock and leucopenia and older than２４hours before surgery was significantly higher mortality. Each was no difference in complications before surgery. PMX-DHP was performed in ３９ cases １３％ mortality. Discussion : In patients with colon perforation, preoperative assessment SOFA score was trusted to reflect the outcome

ジュツゼン シンダン ガ コンナン ダッタ フクジン シュッケツ ノ １レイ

A 73-year-old man was admitted to the hospital because of a growing tumor in his left upper abdomen. The tumor was peripherally enhanced and filled with necrotic tissue by contrast CT. By PET-CT, SUV max was high in the peripheral area of the tumor. Endocrinogical data for adrenal function were within the normal range. Accordingly, we diagnosed a nonfunctional adrenal tumor. Left adrenalectomy was performed, because a possibility of malignant tumor could not be ruled out and abdominal tumor was growing fast for a few months. At laparotomy, we saw the dorsal displacement of the transverse colon by a giant cystic tumor, which has several septums and was filled with old bloody fluid components. The resected tumor was 15cm in maximum diameter and 860g in weight. Histopathological diagnosis was adrenal hemorrhage without malignant findings

Coexistent poorly-differentiated neuroendocrine cell carcinoma and non-invasive well- differentiated adenocarcinoma in tubulovillous adenoma of the rectum : report of a casel

A 74-years old man was referred to our hospital for treatment of a rectal mass. Colonoscopy revealed villous tumor covering all the lower rectal lumen. Biopsy yielded a diagnosis of adenoma. CT examination showed tumor shadows of the rectum and the liver. Pelvic MRI examination showed a 10.5 8 7 cm tumor with high signal intensity on the T2 weighted images in the rectum. Rectosigmoidectomy with lymph node dissection was performed with the diagnosis of rectal cancer that metastasized to the liver. Histological and immuno- histochemical features showed coexistent poorly-differentiated small cell neuroendocrine cell (NEC) carcinoma and non-invasive well-differentiated adenocarcinoma in tubulovillous adenoma. However the chemotherapy with FOLFOX and Bevacizumab was performed postoperatively, the patient died in cancer 3 months after surgery. Rectal poorly-differentiated NEC carcinomas are thought to be a tumor with a high malignant potential. Recently, the UICC TNM classifications of malignant tumors, 7th edition and the Guidelines for colorectal NEC tumors of European Neuroendocrine Tumor Society have been published. They would be evaluated, and effective multimodal therapy for NEC carcinomas should be established

A case of perinephric liposarcoma which recurred ten years later from the initial operation

A 58-year old man was referred to our hospital for treatment of an abdominal mass. As for him, tumor resection with right nephrectomy had been performed ten years ago for a giant well-differentiated perinephric liposarcoma. CT examination showed a huge tumor shadow in the abdominal cavity. Abdominal MRI examination showed a 15 8 cm tumor with almost high signal intensity on the T2 weighted images. At lapalotomy, a large bulky retroperitoneal tumor pointed out before an operation was found. Surgical extirpation of the tumor was performed. Besides, several tumors of the thumb head size were detected into right retroperitoneal fatty tissue. The right side mesocolon and the tumors were not able to exfoliate, therefore right hemicolectomy was performed. Histological features showed dedifferentiated liposarcoma. The postoperative course was uneventful. But eight months after surgery, he was admitted again for treatment of a 4 3 cm retroperitoneal tumor. Extirpation of the tumor was performed. Histological finding of this tumor also showed dedifferentiated liposarcoma. Dedifferentiation, occurring in 15% of the well-differentiated liposarcomas, sometimes may develop later. Long-term detailed follow-up is necessary for well-differentiated liposarcoma

イガン ジュツゴ ニ チョクチョウ テンイ オ キタシタ 1レイ

We report a case of rectal metastasis from gastric cancer. The patient was a 69-year-old man with diarrhea as his major symptoms, who underwent a distal gastrostomy for gastric cancer 2 years previously. We suspected primary or metastatic rectal cancer from colonoscopic examination and barium enema. A lower anterior resection was performed. Postoperative historical examination identified poorly differentiated adenocarcinoma and signet cell carcinoma identical to the gastric cancer. Finally the lesion was diagnosed as metastatic rectal cancer from gastric cancer that showed same pattern in PAS stain. There were only 40 cases in reports in the literature from 2002 to 2012, to our knowledge. We report a rare case

Successful cricothyrotomy for emergency airway management : a case report

A ６０ year-old male was brought to our emergency department by ambulance due to sudden onset of dyspnea. On examination, he was in coma since his level of consciousness decreased during transport, blood pressure was １９９／１１１mmHg, heart rate was１００ beats per minute, respirations were １０ per minute, blood oxygen saturation level（SpO２）was１００％ via assisted ventilation with Bag-Valve-Mask, and stridor was heard on auscultation. Those findings indicated airway emergency and endotracheal intubation was required. However, attempts at intubation were unsuccessful due to restriction of mouth opening. Muscle relaxant was then given to perform rapid sequence intubation, which caused vomiting. Failure to ventilation and intubation resulted in cardiopulmonary arrest. Chest compression was started immediately and decision for cricothyrotomy was made. １０ minute after cricothyrotomy, he revived. Subsequently, systemic management including therapeutic normothermia was performed at intensive care unit, then he regained consciousness. He was discharged １ month after admission