Application of Different Anastomotic Methods for a Patient with Crohn\u27n Disease : Long-term Endoscopic Appearances of Hand-sewn Versus Biofragmentable Anastomosis Ring Method

After resection for ileocecal or ileocolonic Crohn\u27s disease (CD), anastomotic recurrence is common, and roughly one half of the cases who undergo hand-sewn anastomoses require further surgery for suture line recurrence. The other anastomoses methods, stapled anastomoses, had been compared with that of patients having hand-sewn anastomoses. But the type of anastomosis, whether stapled or hend-sewn, did not affect the rates of symptomatic or operative recurrence. A compression anastomosis device consisting of a biofragmentable anastomosis ring (VALTRAC^[○!R]) is used with new anastomosis methods, and no fragments remain in the anastomosis unlike with other anastomotic materials. There have been few reports regarding the employment of VALTRAC^[○!R] methods for anastomoses of patients with CD. We reported a 30-year-old male with a 14-year history of CD. In 1991, he was referred to our hospital for surgery because of stenoses of the ileum and terminal ileum, and underwent ileocecal resection. Ileocolic anastomosis was performed with a hand-sewn method. In 1996, the patient was referred to our hospital again for surgery because of an ileoileal fistula and multiple stenoses in the ileum and the anastomosis. Resection of the previous anastomosis was performed. Next, ileocolic anastomosis was performed using a VALTRAC^[○!R] method. Comparisons of the long-term appearance of two different anastomoses (one hand-sewn and the other done by VALTRAC^[○!R] methods) of the same portion of the intestine in the patient were reported herein

Biliary ICG Concentrations as an Indicatr of the Effect of Biliary Decompressions : Peak and two-hour ICG Concentrations

To quantitate the effects of biliary decompression on hepatic functional reserve prior to a definitive operation in patients with obstructive jaundice, indocyanine green (ICG) concentration in the bile was measured before and at 15 minute intervals for six hours following its administration. The maximal excretion rate of ICG in the bile as a function of time (ICG Bmax) was calculated by the following equation : ICG Bmax=loge (loge(10Xpeak concentration)] peak concentration time Determination of ICG Bmax has a shortcoming in that it requires prolonged restriction of the patients. Therefore, for the purpose of simplification, the natural logarithm of the ICG concentration two hours after ICG administration (ICG B2hr) was obtained : ICG B2hr=loge (biliary ICG concentration at two hours) There was a significant correlation between ICG Bmax and ICG B2hr\u27 with a correlation coefficient of 0.865 as determined in 131 subjects. ICG Bmax is a reliable indicator in the assessment of hepatic functional reserve in jaundiced patients after biliary decompression and prior to further surgical interventions ICG B2hr assessment is a simplified method of ICG Bmax assessment. ICG B2hr values of less than 0.5 are considered to be contraindication for surgery, with a high probability of prolonged jaundice and poor prognosis. Values of more than 0.5 indicate the advisability of surgery, while those between -0.5 and 0.5 also indicate this if there is a trend to improvement

Amyloidosis-induced Lower Gastrointestinal Bleeding in a Patient with Multiple Myeloma

We reported a case of gastrointestinal amyloidosis associated with multiple myeloma (MM), presenting with an unusual abdominal condition causing right upper abdominal pain and hematochezia. An abdominal examination revealed a huge tender mass below the right costal margin. A barium enema examination demonstrated a filling defect in the transverse colon and abdominal computed tomography disclosed an inhomogeneous mass. There was no evidence of thrombocytopenia or a coagulation factor deficiency. A surgical specimen showed deposit of amyloid substance in the colon. As this case illustrates, the absence of systemic symptoms of amyloidosis and nonspecific radiological findings in gastrointestinal amyloidosis may make the diagnosis difficult. Therefore, we recommend that a diagnosis of amyloidosis-induced bleeding of the colon should be considered in patients with multiple myeloma with obscure hemorrhaging

Disappearance of the spleen as a rare complication of infected pancreatic pseudocyst following acute relapsing phase of chronic pancreatitis.

Splenic involvement of an infected pseudocyst is known to be a rare complication of infected pancreatic necrosis following pancreatitis. We present herein a case of chronic alcoholic pancreatitis complicated by a major infected pseudocyst formation involving the spleen, with subsequent rupture and complete disappearance of the entire spleen. A 60-year-old Japanese man with a history of chronic alcoholic pancreatitis with a pancreatic tail pseudocyst was referred to us because of severe epigastralgia. CT revealed spontaneous rupture of the pseudocyst into the stomach and free air in the pseudocyst. The body and tail of the pancreas were disrupted due to pancreatic necrosis, and the splenic parenchyma was also partially ruptured and disrupted with large tears of the splenic surface. One month later, CT showed almost complete disruption of the splenic parenchyma. Three months later, CT showed remarkable regression of the pseudocyst and complete disappearance of the entire spleen. Although splenic involvement of pancreatic pseudocysts should be considered to be a potentially lethal complication because of hemorrhage or infection, it can possibly be treated conservatively. In the present case, complete obstruction of both the splenic artery and vein due to chronic inflammation, and spontaneous drainage into the stomach were the most probable causes for the spontaneous regression without surgical treatment. This is the first report of splenic disappearance after splenic rupture demonstrated by CT