Reconstruction of the esophagojejunostomy by double stapling method using EEA™ OrVil™ in laparoscopic total gastrectomy and proximal gastrectomy

Here we report the method of anastomosis based on double stapling technique (hereinafter, DST) using a trans-oral anvil delivery system (EEATM OrVilTM) for reconstructing the esophagus and lifted jejunum following laparoscopic total gastrectomy or proximal gastric resection

Adhesion-induced chronic abdominal pain: a case report on the diagnostic value of Carnett’s test

Abstract Background Chronic abdominal pain is a common clinical problem. However, diagnosing chronic abdominal pain often requires detailed diagnostic evaluations in addition to sufficient history taking and physical examination, owing to its uncertain etiology. Case presentation We report a case of a 36-year-old man with chronic abdominal pain originating from postoperative adhesions. Postoperative adhesions are common phenomena, and abdominal surgery can cause severe abdominal pain, the source of which can be difficult to detect. Carnett’s test is useful to detect abdominal wall tenderness and to determine the affected abdominal quadrant. Incorporating its use with a detailed chronological clinical history contributes to the improvement of diagnostic accuracy. In addition to the above-mentioned information, attention to subtle imaging findings may provide greater diagnostic accuracy. Conclusions Abdominal pain induced by postoperative adhesions was reduced by laparoscopic adhesiolysis. Carnett’s test is an effective tool for evaluating pain and detecting its cause

Bevacizumab-induced intestinal perforation in a patient with inoperable breast cancer: a case report and review of the literature

Abstract Background Gastrointestinal perforation is known as a serious adverse event, but, for breast cancer, there are very few reports of gastrointestinal perforation. This report highlights gastrointestinal perforation caused by bevacizumab for breast cancer, which is of special interest because gastrointestinal perforations caused by bevacizumab are very rare in breast cancer. Case presentation We describe the case of 54-year-old Japanese woman. She was diagnosed as having inoperable breast cancer T2 N1 M1 (pleura, peritoneum), Stage IV, and received chemotherapy by paclitaxel. There was reduction in the primary tumor and disappearance of the pleural effusion; however, the ascites did not change. We performed diagnostic laparoscopy which revealed that her whole peritoneum was thickened, and her small intestine, colon, and her omentum were grouped and formed an omental cake. We submitted a part of her peritoneum to pathological examination and diagnosed the peritoneum dissemination of breast cancer. On the basis of these results, paclitaxel and bevacizumab combination chemotherapy was started, and a decrease in ascites was seen. However, a gastrointestinal perforation occurred on 26th day of second cycle of bevacizumab + paclitaxel, and we performed an emergency operation. In the operation, the omental cake was resolved, and we could search the full length of the gastrointestinal tract. Two small perforations of her small intestine were seen. We performed simple closures for perforations, and peritoneal lavage and drainage. She was in a state of septic shock, but it improved. It was thought that the small intestinal perforations were caused by the bevacizumab-additional chemotherapy which was very effective. Conclusions We report a very rare and valuable case. This case suggests that the risk of gastrointestinal perforation must be considered in a case of bevacizumab administration, and it is necessary to determine carefully the patient administered bevacizumab, regardless of the type of cancer