Inflammatory Polyp of the Gallbladder Mimicking Early Polypoid Carcinoma

We treated a 69-year-old male with a 16-mm polyp of the gallbladder. Enhanced computed tomography demonstrated marked enhancement. With a tentative diagnosis of early polypoid cancer of the gallbladder, open cholecystectomy was performed. Intraoperative ultrasound showed hyperechoic spots on the surface of the polyp with an inner echopenic area. The histological diagnosis was an inflammatory polyp that manifested nonneoplastic, edematous stroma, and infiltration of lymphcytes and plasmacytes

Leiomyoma of the Round Ligament Presenting as a Large Inguinal Mass

A 42-year-old woman was admitted to Kochi Prefectural Seinan Hospital complaining gradual enlargement of painless mass in the left lower quadrant. Physical examination revealed a 15×13 cm, immobile, elastic firm mass protruding from the abdominal wall in the left inguinal region. No bowel or urinary symptoms were present. Gynecological examination was negative. Tumor markers for ovarian carcinomas such as carcinoembryonic antigen, cancer antigen (CA) 125, CA 130 and CA72-4 were within normal limits. Ultrasonography revealed a well-defined tumor consisted of cystic and solid components in the inguinal canal. A plain CT scan demonstrated a large, wellcircumscribed, heterogeneous mass present in the pelvic cavity and inguinal canal consecutively. Barium enema and DIP were normal. Preoperative diagnosis was a soft tissue tumor with cystic degeneration of unknown origin, situated in the intra-and extra-pelvic cavity. Operative finding revealed a large tumor arising from the left intra-abdominal round ligament and grown into the inguinal canal through the internal inguinal ring. The tumor was macroscopically benign neoplasm and easily removed from the round ligament. Resected tumor with various-sized spongy lesions, measured 12×14×5 cm and weighed 665g, was histologically diagnosed as typical leiomyoma with myxoid degeneration

Intestinal Perforation by Ingested Foreign Bodies

Seven cases with intestinal perforation by ingested foreign bodies (IFBs) were surgically treated in our hospital between January 2000 and August 2009. We reviewed the preoperative mental conditions, awareness of ingestion, preoperative diagnosis, the type of foreign bodies, perforation site, treatment and morbidity for these patients. The ratio of males to females was 4 : 3, and patient age ranged from 27 years to 85 years. Three of 7 patients had an abnormal mental condition, including neurosis with medication in 1, severe mental retardation in 1 and dementia in 1. Six patients were not aware they had IFBs. Preoperative diagnoses were perforative peritonitis in 6 cases and ileus in 1 case. The ingested objects consisted of fish bones in 4 cases, toothpicks in 2 cases and a press-through package in 1 case. Computed tomography (CT) showed the ingested fish bones in all 4 cases, while plain abdominal radiography demonstrated fish bone in only one of these cases. Toothpicks and a press-through package were not detected on CT or by plain abdominal radiography. The perforation sites were the small intestine in 5 cases and the large intestine (transverse colon) in 2 cases. Treatments were intestinal resection with or without omentectomy in 5 cases, suture alone in 1 case and omentectomy alone in 1 case. Postoperative complications were seen in 2 patients, including hepatic failure and bleeding from gastroesophageal reflux disease in 1 case, and removal and reinsertion of a V-P shunt tube in 1 case. The mortality rate was 0%

Feasibility and problem in managements of the patients with acute cholecystitis: A historical study at a single province institute.

Objectives: "Practice Guidelines for Acute Cholecystitis and Acute Cholangitis (in Japanese)," issued in 2005 in Japan, recommends early cholecystectomy in patients with acute cholecystitis. We evaluated the feasibility and problems in management of this condition. Method: We analyzed the clinical and laboratory data of 120 consecutive patients in whom cholecystectomy was performed for treatment of acute cholecystitis between April 2003 and March 2010 in our hospital. Results: After the Guidelines were issued, the rate of urgent operations increased (from 2.4% to 35.4%; p < 0.001) and the length of preoperative hospital stay decreased (form 12.5 days to 7.6 days; p < 0.05). Urgent operation, however, was chosen in only 35.4% of the patients even after the Guidelines were issued, mainly because of the shortage of surgeons and anesthesiologists. In these patients with moderate to severe acute cholecystitis, percutaneous cholecystostomy (PC) was performed without severe complications, followed by cholecystectomy. Conclusion: Urgent operation for acute cholecystitis has the advantages of earlier alleviation of symptoms and shorter hospital stays than PC followed by surgery or elective operation. PC followed by surgery may be a suboptimal option for patients with moderate to severe acute cholecystitis who might be able to tolerate an urgent operation, given that appropriate human resources are not available

Primay Malignant Lymphomas Arising from the Ileum and the Ampulla of Vater: Report of a Case

A 71-year-old man was admitted with complaints of right lower quadrant pain and abdominal fullness. Barium enema and computed tomography (CT) scan demonstrated a tumor in the terminal ileum. There was no enlargement of superficial lymph nodes. Colonofiberscopy revealed a narrowing of the terminal ileum and biopsy specimens showed evidence of B-cell lymphoma. Laparotomy was performed in view of the small bowel obstruction. An elastic firm tumor, measuring 5.2 by 4.5 cm, was found in the terminal ileum, and the regional mesenteric nodes were enlarged. lleo-cecal resection with dissection of lymph nodes was performed. The resected specimen revealed a diffuse, B-cell lymphoma with 1gM heavy-chain and kappa light-chain restrictions. The patient developed obstructive jaundice 2 weeks after surgery, and CT scan demonstrated tumor in the ampullary region of the duodenum. Endoscopic examination showed an ulcerated tumor in the ampulla of Vater and biopsy specimen again showed B-cell lymphoma. Chemotherapy with cyclophosphamide, prednisolone, adriamycin and vincristine was effective and complete remission was achieved. To our knowledge, this is the first case of simultaneous occurrence of malignant lymphomas in the ileum and the ampulla of Vater

Successful Repeated Transcatheter Arterial Embolization (TAE) for Multiple Liver Metastases from Breast Cancer

A 46-year-old female was successfuly treated with repeated transcatheter arterial embolization (TAE) for multiple liver metastases from breast cancer. TAE using mitomycin C and epirubicin hydrochloride with lipiodol emulsion and gelatin sponge particles has been administered to the patient eight times over 4 years. She has also received systemic chemotherapy. She has survived for 6 years and 3 months after the detection of liver metastases

A Large Hepatic Cyst with Obstructive Jaundice Successfully Treated with Single-Incision Laparoscopic Deroofing

We herein present a case of hepatic cysts causing obstructive jaundice that was treated with single-incision laparoscopic deroofing. A 72-year-old female patient was referred to hospital due to a large hepatic cyst that compressed the intrahepatic bile ducts. The patient was scheduled to undergo single-incision laparoscopic deroofing. The EZ ACCESS? oval type (Hakko Co. Ltd.) was placed at the umbilicus using a 25-mm incision with two 5-mm trocars. An additional 12-mm port was placed at the left epigastric region. We unroofed and excised the cyst wall using a vessel sealing system in liver segment 4. After surgery, the patient was found to be asymptomatic. The unroofed cysts were completely diminished. Notably, the remnant liver had fairly regenerated. The estimated regeneration volume of the normal liver was 153 cm3. To prevent surgical complications, clinicians should perform adequate management and use of devices. To prevent postoperative recurrence of cysts, performing complete deroofing is essential. Single-incision laparoscopic deroofing contributes to improving the quality of life of patients and should be considered a standard treatment

Acute appendicitis in a rheumatoid arthritis patient treated with tocilizumab: report of a case

A 55-year-old woman had been treated for rheumatoid arthritis with tocilizumab 1 month prior to the onset of mild abdominal pain. Computed tomography revealed swelling of the appendix and ascites around the appendix. She was diagnosed with acute appendicitis and underwent emergency surgery. Although her symptoms and laboratory data indicated mild infection, surgery was conducted because of the computed tomography findings and because we believed that the physical findings and laboratory data were not dependable due to the tocilizumab.Upon surgery, a perforated inflamed appendix and abscess formation around the appendix were confirmed. Tocilizumab, which is relatively new, may conceal signs of infection or dull response to tests such as the Blumberg sign for peritonitis. It should be widely noted that the physical findings and laboratory data of patients with abdominal distress under tocilizumab treatment may be misleading

Gastric perforation caused by Candida infection：Report of a case

An 89-year-old female was admitted to our hospital because of fever and abdominal pain. The patient had used an antihypertensive agent, but had not used either antibiotics, steroids, or potent antacids. An abdominal CT scan revealed free air and ascites. An emergency operation was performed for acute peritonitis caused by a gastrointestinal perforation. A perforated ulcer was observed at the posterior wall of the gastric body. A distal gastrectomy with intraperitoneal drainage and a Billroth II reconstruction was performed. A histological examination demonstrated a perforated ulcer surrounded by Candida infection. The patient developed an abscess in the abdominal cavity, but was discharged on the 52nd postoperative day. Although gastrointestinal Candida infection is commonly seen in immunocompromised host with diabetics or malignant diseases, habitual use of strong antacids can also cause severe Candida infection of the stomach in healthy persons. In this case, it was thus concluded that there may have been a decrease in immunity in this patient because of her advanced age 89 years old and malnutrition

PRIMARY MALIGNANT LYMPHOMA OF THE BREAST A Case Report and Review of the Japanese Literature

A 26-year-old pregnant woman was admitted to Nagasaki University Hospital complaining rapid enlargement of masses in the bilateral breasts and the right axilla. Biopsy of the right breast revealed malignant lymphoma. Simple mastectomy plus axillary node dissection on the right side (Br+Ax) and excision of the tumor in the left breast were performed. Histologically, the tumor was a diffuse lymphoma of the medium-size cell type according to the LSG classification, originated from B cells. After operation, Vincristine, Adriamycin, and Cyclophosphamide were administrered, but chemotherapy was terminated because of marked leukopenia. The patient has remained asymptomatic for 7 years without any treatment, and there is no evidence of recurrence. We have collected 79 cases of malignant lymphoma of the breast reported in the Japanese literature, including the present case, and examined factors that might affect the prognosis of patients. However, age, size of tumor, axillary lymph node involvement, histological findings, and type of therapy did not exert a significant influence. The most critical factor in a poor prognosis was the extramammary involvement of malignant lymphoma