Inflammatory Polyp of the Gallbladder Mimicking Early Polypoid Carcinoma

We treated a 69-year-old male with a 16-mm polyp of the gallbladder. Enhanced computed tomography demonstrated marked enhancement. With a tentative diagnosis of early polypoid cancer of the gallbladder, open cholecystectomy was performed. Intraoperative ultrasound showed hyperechoic spots on the surface of the polyp with an inner echopenic area. The histological diagnosis was an inflammatory polyp that manifested nonneoplastic, edematous stroma, and infiltration of lymphcytes and plasmacytes

Pneumatosis Cystoides Intestinalis

We herein present a case of pneumatosis cystoides intestinalis. A 56-year-old woman was admitted to Nagasaki Prefectural Shimabara Hospital with diffuse and mild abdominal pain. A plain abdominal X-ray revealed free air in the right subphrenic space, and computed tomography showed an extraluminal gas-filled lesion adjacent to the small intestine. With a tentative diagnosis of perforation of the small intestine, a laparotomy was performed, although she had little tenderness and no rigidity on physical examination. Upon opening the peritoneal cavity, multiple bullae-like cysts were noted on approximately one meter of the ileal serosa; however, no site of perforation was detected. Removal of the portion of what appeared to be the affected bowel was the procedure of choice. The resected specimens histologically showed pneumatosis cystoides intestinalis without any perforation. Her postoperative course was uneventful and she has been doing well with no evidence of recurrence as of the end of June 2005

Primary Hepatic Carcinoid Tumor Presenting Carcinoid Syndrome and Carcinoid Heart Disease

A 49-year-old man was admitted to our hospital complaining of a large hepatic tumor with edema in the lower extremities. The patient had suffered from hypertension and bronchial asthma in his twenties and from cutaneous flushing in the face in his thirties. Echocardiography revealed tricuspid valve regurgitation and marked dilatation of the right ventricle. In an exploratory laparotomy, a 15 cm-size hepatic tumor was located in the right lobe with multiple satellite lesions in both lobes of the liver. Peritoneal disseminations were present. The tumor was histologically and immunohistochemically diagnosed to be a carcinoid tumor. The levels of serum serotonin and urinary 5-hydroxyindoleacetic acid (5-HIAA) were found to be significantly high. Imaging modalities and intraoperative findings showed no evidence of any tumors elsewhere. These findings led us to the diagnosis of a primary hepatic carcinoid tumor with carcinoid syndrome and carcinoid heart disease. The patient has been treated with hepatic artery embolization, oral chemotherapy and octreotide acetate. After six months of such treatment, the hepatic tumor has decreased slightly in size, and the levels of serum serotonin and urinary 5-HIAA have dropped

Video-Assisted Thoracoscopic Diverticulectomy of the Midesophagus

Video-assisted thoracoscopic surgery (VATS) for a large, midesophageal diverticulum was successfully performed in a 77-year-old male who had dysphagia for one year. Postoperatively, the patient was well without any complications and was relieved of dysphagia. The VATS diverticulectomy was considered to be minimally invasive and constituted a good indication especially for patients of advanced age showing symptomatic esophageal diverticulum

Pneumatosis Cystoides Intestinalis

We herein present a case of pneumatosis cystoides intestinalis. A 56-year-old woman was admitted to Nagasaki Prefectural Shimabara Hospital with diffuse and mild abdominal pain. A plain abdominal X-ray revealed free air in the right subphrenic space, and computed tomography showed an extraluminal gas-filled lesion adjacent to the small intestine. With a tentative diagnosis of perforation of the small intestine, a laparotomy was performed, although she had little tenderness and no rigidity on physical examination. Upon opening the peritoneal cavity, multiple bullae-like cysts were noted on approximately one meter of the ileal serosa; however, no site of perforation was detected. Removal of the portion of what appeared to be the affected bowel was the procedure of choice. The resected specimens histologically showed pneumatosis cystoides intestinalis without any perforation. Her postoperative course was uneventful and she has been doing well with no evidence of recurrence as of the end of June 2005