Successful resection of liver metastasis detected by exacerbation of skin symptom in a patient with dermatomyositis accompanied by rectal cancer: a case report and literature review

Abstract Background Dermatomyositis (DM) is a rare syndrome that belongs to the group of idiopathic inflammatory myopathies. The association between DM and malignancy is well recognized, and the severity of DM symptoms has been linked to the progression of metastatic disease. Case presentation We report the case of a 42-year-old man that was diagnosed with dermatomyositis (DM) and rectal cancer. Proctectomy was performed, and DM symptoms were resolved postoperatively. One year and 9\ua0months after the surgery, liver metastasis occurred accompanied by the exacerbation of DM symptom. Partial resection of the liver was performed, and postoperative course was uneventful. DM symptoms improved postoperatively, and no evidence of cancer recurrence or DM symptoms was observed 2\ua0years after the second surgery. To date, few reports have described recurring cases of DM accompanied by colorectal cancer in detail. We reviewed four similar cases that were reported poor prognoses with treatment resistance. However, our case report demonstrates good long-term results with resection of metastatic lesion. Conclusions It is important to check the exacerbation of DM symptoms, as this symptom sometimes preceded cancer relapse during the follow-up of our patient with DM and colorectal cancer

Transabdominal Approach for Spontaneous Oesophageal Perforation: A Review of Four Cases

Spontaneous oesophageal perforation is an uncommon and life-threatening disease. Although several methods of treatment have been proposed, surgical treatment is considered the standard procedure. Primary repair using the transthoracic approach is the most common. However, few studies have evaluated the characteristics of the transabdominal approach. This study aimed to investigate the clinical outcomes of spontaneous oesophageal perforation that was surgically treated using the transabdominal approach. We retrospectively reviewed all patients with spontaneous oesophageal perforation who were admitted to the surgical department of our institution between November 2010 and April 2017, and identified a total of four patients. Data including demographic factors (age and sex), location of perforation, time to operation, operative method, complications, length of hospital stay, and postoperative recovery were reviewed. In all four cases, we treated the defect using the transabdominal approach, which provides a good surgical field of view. The aims of operative intervention, namely primary repair and access for enteral feeding, can be achieved using this approach. The most commonly observed complication was pyothorax, and we suggest the addition of intrapleural drainage for its prevention. Dysgraphia was observed in two patients, which improved with conservative treatment. The overall mortality rate was 0%. Our results demonstrate that primary repair using the transabdominal approach is safe and effective for the management of spontaneous oesophageal perforation. Addition of intrapleural drainage can improve the outcome associated with this approach

Effective Appendix Stump Closure Using the Doubleshanked Titanium Ligation Clip (DS Clip): A Case Report

Background: During laparoscopic appendectomy, several methods and devices can be used to close the appendicular stump, such as endoloops, linear staplers, clips, and open purse-string sutures. The Double-shanked Titanium Ligation Clip® (DS clip; B. Braun Aesculap, Tuttlinger, Germany), a new device that can be used to close the appendicular stump, was approved for use in Japan in March 2015. We report a case of effective appendix stump closure using DS clips. Case presentation: An 81-year-old man was admitted to our hospital with complaints of severe pain in the right lower quadrant of the abdomen. Abdominal contrast-enhanced computed tomography showed a thickened appendix (1.7 cm in diameter) with fecal stones, while acute inflammatory signs were visible around the appendix. He was diagnosed with acute appendicitis for which laparoscopic appendectomy was performed with a curative intent. It was difficult to mobilize the cecum because of inflammation, so we attempted to use DS clips instead of linear staplers. A histological examination revealed gangrenous appendicitis. The patient’s postoperative course was uneventful and he was discharged 10 days postoperatively. We also used DS clips to close the appendicular stump in 12 other cases. We observed no intra- or postoperative complications and no cases of mortality. Conclusion: The management of an appendicular stump using DS clips during laparoscopic appendectomy was simple, safe, and cost-effective. DS clips may be an alternative method to linear staplers

Benign Papillary Mesothelioma of the Peritoneum Associated with Gastric Cancer : Report of a case

Benign papillary mesothelioma of the peritoneum is an uncommon lesion that is usually discovered by chance during a surgical procedure. This lesion resembles metastatic carcinoma in gross appearance; therefore, intraoperative diagnosis can be difficult. This report presents a case of benign papillary mesothelioma concurrent with gastric cancer. The tumor was located on the hepatogastric ligament and resembled a metastatic peritoneal implant. A pathological review confirmed the diagnosis to be benign papillary mesothelioma

Percutaneous Trans-Esophageal Gastrostomy for Oral Intake in a Case of Anastomotic Obstruction following Total Gastrectomy

Gastric cancer is one of the most common diseases globally. Total gastrectomy is often performed surgically. However, late-stage anastomotic passage obstruction after total gastrectomy is relatively rare. Here, we report a case involving a 73-year-old male patient who experienced repeated aspiration pneumonia due to anastomotic passage obstruction 22 years after a total gastrectomy for gastric cancer. He was eventually hospitalized in the Department of Gastroenterology at our hospital because of difficulty eating. Computed tomography revealed prominent dilation of the esophagus and the blind end of the elevated jejunum. Upper gastrointestinal endoscopy revealed a poorly extended site on the main side of the elevated jejunum; however, the passage through the scope was good. A percutaneous trans-esophageal gastrostomy was performed for oral intake. The patient experienced decreased nausea and vomiting. He gained weight, and his general condition improved. He did not feel inconvenienced by percutaneous trans-esophageal gastrostomy and had no desire for surgery. Follow-up observations are currently being conducted, with tubes exchanged every 6 months. There are no reports of percutaneous trans-esophageal gastrostomy for oral intake for anastomotic passage obstruction following total gastrectomy; therefore, we report this as a reference when similar cases are encountered

Possible therapeutic effect of lipid supplementation on neurotoxicity in liver transplant recipients

Neurotoxicity represents a serious complication following liver transplantation and may be evoked by various perioperative factors or develop due to toxicity of immunosuppresion. The symptoms of neurotoxicity associated with calcineurin inhibitors (CNIs) may be reversed by discontinuing or reducing the dose of CNIs; however, this may increase the risk of rejection. To address this issue, we examined 45 adult living donor liver transplant recipients. At the time of neurotoxicity diagnosis, serum cholesterol values were significantly lower in the patients with neurotoxicity than in those without neurotoxicity. Based on our hypothesis that lipid supplementation prevents lipophilic CNIs from crossing the blood-brain barrier, soybean oil was administered to 5 patients with neurotoxicity. In all these patients, the neurological symptoms improved without discontinuing or reducing the dose of CNIs. This use of this therapy may help in avoiding insufficient immunosuppressive therapy because neither dose reduction nor substitution of CNIs would be then required

Hemorrhagic Cholecystitis in a Patient on Maintenance Dialysis

The present paper describes a case of hemorrhagic cholecystitis in a patient on maintenance dialysis. The patient presented with right upper quadrant abdominal pain. Computed tomography revealed swelling of the gallbladder, high- and isodensity contents of the gallbladder, and high-density stone in the gallbladder neck. He was hospitalized for suspected acute cholecystitis. After hospitalization, his levels of total bilirubin, aspartate aminotransferase, and alanine aminotransferase increased. T2-weighted magnetic resonance imaging showed low-intensity contents expanded to include a wide area from the common bile duct to the cystic duct and gallbladder neck. Endoscopic retrograde cholangiopancreatography revealed clotting from the duodenal papilla. After cannulation of the bile duct, old blood and pus began to flow from the mammary papilla, and an endoscopic nasobiliary drainage tube was placed. After his liver function had improved, the patient underwent laparoscopic cholecystectomy. His sample revealed that the gallbladder was filled with blood clots and stones. His postoperative course was uneventful and he was discharged on day 19 after the procedure. Although hemorrhagic cholecystitis is rare, it should be considered as a differential diagnosis for patients on dialysis who have acute abdominal symptoms