Laparoscopy endoscopy cooperative surgery for gastric plexiform fibromyxoma: a case report

[Background] Gastric submucosal tumors are commonly treated by partial resection under laparoscopy. However, the surgical resection of gastric submucosal tumors sometimes causes deformation of the stomach, especially in the case of intraluminal tumors located near the pylorus or esophagogastric junction. Such deformations can result in impaired diet intake and reduced quality of life. Laparoscopic endoscopic cooperative surgery has been developed to overcome these problems. This is the first report to describe a case of gastric plexiform fibromyxoma, a rare gastric submucosal tumor, that was successfully resected by laparoscopic endoscopic cooperative surgery. [Case presentation] A 36-year-old Japanese woman presented with epigastric pain and anemia. Gastrointestinal endoscopy revealed a submucosal tumor in the gastric antrum. Because a definitive diagnosis could not be obtained and the tumor was located near the pylorus, we performed laparoscopic endoscopic cooperative surgery as diagnostic therapy. The postoperative course was favorable with no complications, such as delayed gastric emptying or outlet obstruction. The tumor was pathologically diagnosed as gastric plexiform fibromyxoma. [Conclusions] Laparoscopic endoscopic cooperative surgery is a useful approach for diagnostic therapy for rare submucosal tumors to avoid the deformation of the stomach, especially when the tumor is located near the pylorus

ゼラチン微粒子を用いた高用量シスプラチン徐放化製剤による癌性腹膜炎治療

京都大学0048新制・課程博士博士(医学)甲第17949号医博第3833号新制||医||1000(附属図書館)30779京都大学大学院医学研究科医学専攻(主査)教授 武藤 学, 教授 上本 伸二, 教授 野田 亮学位規則第4条第1項該当Doctor of Medical ScienceKyoto UniversityDA

Aortoenteric fistula at the site of esophagojejunostomy after laparoscopic total gastrectomy: report of a case.

A fistula between the aorta and the digestive tract is a rare complication of gastrointestinal tract or vascular surgery. There are occasional reports of aortoesophageal fistula as a fatal complication after esophagectomy or esophageal stent implantation and of aortoenteric fistula (AEF) as a complication after aortic or other vascular procedures. However, AEF after gastrointestinal surgery is rare. We report a case of AEF after laparoscopic total gastrectomy for advanced gastric cancer, using the so-called overlap method of esophagojejunal anastomosis. The patient was a 77-year-old Japanese woman who underwent laparoscopic total gastrectomy and esophagojejunal anastomosis with Roux-en-Y reconstruction for advanced gastric cancer. Bacterial peritonitis was diagnosed 5 days after the operation, manifesting as partial necrosis and perforation of the small intestine. The patient was treated successfully with laparoscopic partial resection of the small intestine, but ultimately died of massive hematemesis caused by the AEF 30 days after her primary surgery

A novel drug delivery system of intraperitoneal chemotherapy for peritoneal carcinomatosis using gelatin microspheres incorporating cisplatin.

[Background]Peritoneal carcinomatosis is a poor prognostic factor for patients with gastrointestinal, gynecologic, and pancreatic cancer. Cisplatin (CDDP) is among the most effective anti-cancer agents, although its adverse effects remain unresolved. For the treatment of peritoneal carcinomatosis with high-dose CDDP, it is necessary to design a new delivery system of CDDP that can decrease systemic toxicity and achieve a better targeted, high-dose chemotherapy. [Methods]Microspheres were prepared from gelatin of a nontoxic, biodegradable material for the sustained release of CDDP. The gelatin microspheres incorporating CDDP (GM-CDDP) were injected intraperitoneally into a mouse model of peritoneal carcinomatosis; their therapeutic efficacy and adverse effects were evaluated in comparison with intraperitoneal administration of free CDDP. [Results]GM-CDDP released CDDP in the peritoneal cavity as a result of gelatin biodegradation. Mice treated with microspheres in the peritoneal cavity lived longer than mice treated with free CDDP (74 ± 23 vs 40 ± 23 days;P < .05). The mice treated with GM-CDDP also lost no weight, whereas the free CDDP group lost approximately 20% body weight (106 ± 5% vs 80 ± 7%; P < .001; body weight on day 1 = 100%). GM-CDDP significantly decreased the nephrotoxicity and hematotoxicity of CDDP. [Conclusion]GM decreased the adverse effects of CDDP and allowed high-dose intraperitoneal chemotherapy with the control of CDDP. This technique of gradual local release may allow us to provide a high-dose, targeted, intraperitoneal chemotherapy with CDDP, resulting in enhanced anti-cancer effects. These gelatin microspheres may be useful as a drug carrier for the treatment of peritoneal carcinomatosis

Successful treatment of an iatrogenic gastro-colo-cutaneous fistula in a patient with Chilaiditi syndrome: A case report

Abstract: Chilaiditi syndrome is an occasional radiographic anomaly characterized by the interposition of the bowels between the liver and the diaphragm. The presence of Chilaiditi syndrome can cause serious problem on percutaneous endoscopic gastrostomy (PEG) procedure, because the anomalous position of the transverse colon can obstruct the procedure and might lead to occurrence of complications. Our report describes a PEG-induced gastro-colo-cutaneous fistula in a patient with Chilaiditi syndrome which resulted in minimally invasive laparoscopic gastrostomy. As most patients who need a PEG placement have impaired consciousness, the majority of PEG-related complications are overlooked or discovered long after the procedure. However, we recognized the complication immediately after the PEG procedure and successfully treated by laparoscopic surgery

Successful outcome after laparoscopic surgery for sporadic colonic desmoid tumor with β-catenin mutation: a case report.

[Introduction]Desmoid tumors (also called aggressive fibromatosis) are histologically benign, but have a strong tendency to recur locally after resection. They are rare neoplastic tumors that may occur sporadically or in association with familial adenomatous polyposis caused by a germline mutation in the adenomatous polyposis coli gene. The etiology of desmoid tumors is unknown, but their association with a history of abdominal surgery, trauma, and estrogen therapy is well known. [Case presentation]A 36-year-old Asian woman was referred complaining of an abdominal tumor. She had no history of familial adenomatous polyposis, abdominal surgery, trauma or pregnancy. A laparoscopy-assisted right hemicolectomy with a minilaparotomy was conducted for resection of her right-side colon and the anterior wall of her duodenum. The histopathological diagnosis was a desmoid tumor that grew from the transverse mesocolon. Mutational analysis indicated a mutation of the β-catenin gene (CTNNB1), consisting of a substitution of threonine for alanine at codon 41. The patient has been followed postoperatively for more than 3 years without any sign of recurrence. [Conclusion]We report a case of sporadic colonic desmoid tumor which was resected by laparoscopic surgery. A successful outcome was achieved because there has been no local recurrence for more than 3 years. The tumor grew from the transverse mesocolon, and harbored a mutation of the CTNNB1gene. Mutational analysis of CTNNB1 gene may play an important role as a prognostic marker of desmoid tumors

Successful treatment of an iatrogenic gastro-colo-cutaneous fistula in a patient with Chilaiditi syndrome: A case report

Chilaiditi syndrome is an occasional radiographic anomaly characterized by the interposition of the bowels between the liver and the diaphragm. The presence of Chilaiditi syndrome can cause serious problem on percutaneous endoscopic gastrostomy (PEG) procedure, because the anomalous position of the transverse colon can obstruct the procedure and might lead to occurrence of complications. Our report describes a PEG-induced gastro-colo-cutaneous fistula in a patient with Chilaiditi syndrome which resulted in minimally invasive laparoscopic gastrostomy. As most patients who need a PEG placement have impaired consciousness, the majority of PEG-related complications are overlooked or discovered long after the procedure. However, we recognized the complication immediately after the PEG procedure and successfully treated by laparoscopic surgery