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

A Rare Case Oesophageal Perforation by a Fish Bone, Leading to Pericardial Penetration and Cardiac Tamponade

An 82-year-old woman swallowed a fish bone and presented to our hospital 3 days later when she had breathing difficulty and became hypotensive. Chest computed tomography (CT) showed a linear structure with high bone density extending from the oesophagus into the pericardium, along with pericardial effusion, air, and a left pleural effusion. We diagnosed the patient with oesophageal perforation by a foreign body (a fish bone) leading to pericardial penetration, cardiac tamponade, and left empyema. The patient underwent emergency surgery. Pericardial fenestration and drainage of the pericardial and thoracic cavities were performed. Chest CT showed a recurrent abscess cavity in the pericardium on day 6. A pigtail catheter was placed in the recurrent abscess cavity under CT guidance for drainage. The patient gradually improved and was discharged after 5 months

A Rare Case of Pylephlebitis as a Complication of Cholecystocolonic Fistula

Pylephlebitis is defined as a septic thrombophlebitis of the portal vein and its tributaries that is associated with multiple suppurative abdominal infections. We report a case of pylephlebitis associated with a cholecystocolonic fistula (CCF). A 41-year-old man presented with upper abdominal pain and anorexia for 1 month. Abdominal contrast-enhanced computed tomography (CT) revealed thrombosis in the left and anterior branch of the portal vein and thickening of the walls of the portal vein and periside portals. The gallbladder was collapsed and pneumobilia was seen in the biliary tract. Blood culture was positive for Streptococcus anginosus. A diagnosis of thrombophlebitis of the portal vein associated with CCF was made, and the patient was immediately managed with an intravenous broad-spectrum antibiotic and anticoagulation. After the portal vein thrombosis (PVT) propagation and inflammation had subsided, cholecystectomy and partial resection of the transverse colon were performed. Pylephlebitis is rare but is a life-threatening complication of intra-abdominal infection. A high index of suspicion is required, and a CT scan should be performed immediately for an early diagnosis and appropriate treatment

Successful treatment of primary advanced gastric plasmacytoma using a combination of surgical resection and chemotherapy with bortezomib: A case report

Introduction: Extramedullary plasmacytoma (EMP) is a plasma cell neoplasm that presents as a solitary tumor. EMP in the gastrointestinal organs are extremely uncommon. Presentation of case: A 36-year-old man was admitted to our hospital with advanced anemia. He had no specific medical history. Gastroendoscopic findings showed an 8.0-cm submucosal tumor with ulcer on the greater curvature of the gastric body. Fine-needle aspiration was performed, and the pathologic diagnosis of the submucosal tumor was a plasmacytoma. Therefore, the patient was diagnosed with gastric plasmacytoma. A total gastrectomy was performed with lymphadenectomy. The result of intraoperative peritoneal lavage cytology was positive. Histological examination revealed serosa-exposed plasmacytoma of the stomach with lymph nodes metastasis. Additionaly the patient received a three-drug chemotherapy regimen (bortezomib, cyclophosphamide, and dexamethasone [VCD]) from 3 weeks after the operation. After 4 cycles of chemotherapy, the patient received autologous peripheral blood stem-cell transplantation (auto-PBSCT). Eighteen months after diagnosis, the patient is in complete remission with no evidence of local relapse or evolution to multiple myeloma. Conclusions: This is the first reported case of advanced gastric plasmacytoma using adjuvant chemotherapy involving bortezomib and auto-PBSCT after the resection, and the patient has maintained a good course over a year. This protocol could be a new way to treat these tumors

High-Output Stoma Leading to the Diagnosis of Antiphospholipid Syndrome

Diverting stoma (DS) is widely created in colorectal surgery. High-output stoma (HOS) is a major complication of DS, which can lead to dehydration and thrombosis. Additionally, antiphospholipid syndrome (APS) is a risk factor for thrombosis, and it rarely occurs in men. Herein, we describe a case of multiple thromboses caused by chronic dehydration after HOS. A 48-year-old man visited our hospital with fever and lower abdominal pain; he was diagnosed with sigmoid diverticulitis. He underwent laparoscopic high anterior resection for relapsing diverticulitis and diverting ileostomy during the same operation. On postoperative day 1, an output of 3,000 mL/day was observed from the ileostomy. The stoma output exceeded 2,000 mL/day, which was diagnosed as HOS, and chronic dehydration persisted despite supplementation and restriction of oral water intake. Three months postoperatively, a computed tomography scan before ileostomy closure showed multiple thrombi in the inferior vena cava, right common iliac vein, and pulmonary artery. After antithrombotic therapy, ileostomy closure was performed. As lupus anticoagulant was positive twice and APS was diagnosed, antithrombotic therapy was changed from warfarin to direct oral anticoagulants. Thrombosis did not recur 6 months postoperatively. This is the first report of a case wherein APS was present in the background of thrombosis caused by HOS or chronic dehydration. It is important to be cautious about APS when there is thrombosis after HOS to select appropriate therapeutic agents

Acute diffuse peritonitis due to spontaneous rupture of a primary gastrointestinal stromal tumor of the jejunum: A case report

Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Overt peritonitis caused by GIST rupture is very uncommon. Three types of GIST rupture have been described: closed perforation due to abscess (abscess type), hemoperitoneum leading to rupture of the hematoma capsule in the tumor (hemoperitoneum type), and perforation of the digestive tract via a fistula leading to central necrosis of the tumor (bowel perforation type). This report describes a patient with spontaneous tumor rupture and diffuse peritonitis, a variant of the bowel perforation type of GIST rupture. Presentation of case: A 74-year-old man presented with symptoms of vomiting and abdominal pain. Computed tomography (CT) scan revealed an approximately 10 × 7-cm mass in the pelvis with free air and fluid collection. Emergency laparotomy revealed a tumor in the jejunum, which was ruptured with a hole measuring 5 mm in diameter. The tumor and part of the jejunum were resected. Immunohistochemically, the mass was diagnosed as a GIST originating from the gastrointestinal tract. Despite chemotherapy with imatinib mesylate, the patient died 22 months after surgery. Conclusions: This report describes a patient with acute diffuse peritonitis due to spontaneous rupture of a primary GIST of the jejunum