Search

A 49-year-old woman who had an intellectual disability was examined during an emergency visit at our hospital because of abdominal swelling. Her abdomen was remarkably distended but without tenderness. Abdominal plain radiography revealed an enlarged colon in the upper abdomen. As abdominal contrast-enhanced computed tomography （CT） revealed volvulus of the descending colon, she underwent emergency surgery. The descending colon was mostly not fixed at the retroperitoneum and was rotated 180° counter-clockwise. The thin and ischemic parts of the colon were resected, and Hartmannʼs operation was performed. She underwent reconstruction surgery 2 months later. Volvulus of the colon with megacolon carries a high risk and requires emergency surgery. In patients with intellectual disabilities, notification of symptoms and diagnosis of volvulus are usually delayed because of the patientsʼ difficulty in communication. Clinical history taking, careful examination of the patient and taking a CT scan in the early stage are highly important. The appropriate surgical procedures must also be decided in consideration of the risk of complications and reduced quality of life.

63歳，男性．前医にてS状結腸癌穿孔，腹膜播種の診断でS状結腸切除，小腸部分切除，横行結腸人工肛門造設術を施行．化学療法目的に当院紹介となり，外来化学療法中であった．傍ストマヘルニアを伴うストマ脱を認め，腹痛を繰り返すようになったため，ストマ修復およびヘルニア修復術を施行した．\n術前まで血清CEA値は504ng/mlと高値を示していたが，術後に10ng/mlと著明な低下を認めた．また，精査では約4.5cm大の播種巣1箇所のみであったため，ストマ脱手術の3カ月後に播種巣切除術を施行した．術後再発なく経過している．\n本症例のCEA高値の機序はストマ脱腸炎による可能性が示唆された．\n今回，腹膜播種を伴う進行下行結腸癌術後に発症した傍ストマヘルニアおよびストマ脱に対する手術後，著明なCEA値の低下を認めたため，播種に対する根治術が可能であった症例を経験したので，若干の文献的考察を加え報告した．, 論文

17歳，女性．夕食後に腹痛が出現したため，近医の救急外来を受診．右卵巣腫瘍の診断にて精査加療目的に当院婦人科を紹介受診．婦人科での精査では小腸腫瘍の診断で，手術目的に当科紹介となった．腹部造影CT検査では骨盤内に9cm大の辺縁不整な腫瘤を認め，小腸腫瘍が疑われた．小腸腫瘍の診断で腹腔鏡下腫瘍摘出術を施行．骨盤内に9cm大の分葉状腫瘍を認め，小腸壁より発生した腫瘍と判明した．また，小腸は腫瘍を軸に時計方向に540度捻転していたが，明らかな血流障害はみられなかった．病理検査では紡錘形細胞が密に増殖し，核分裂像は5/50HPFであった．免疫染色でc-kit陽性でGISTと診断された．術後経過は良好で術後第5病日に退院．c-kit遺伝子exon11に変異を認め，imatinibによる術後補助化学療法を開始した．若年者小腸GISTは非常に稀であり，文献的考察を含め報告する．, 論文

62-year old woman with stage Ⅱ sigmoid colon cancer underwent sigmoidectomy with D3 lymphadenectomy at another hospital in December 2004. One year later, she experienced atypical genital bleeding. She was referred to our hospital for examination and treatment. She was diagnosed with a peritoneal recurrence of sigmoid colon cancer, with disseminated nodules that had invaded the intestinal wall and uterus. High anterior resection, total abdominal hysterectomy, and bilateral salpingo-oophorectomy were performed, subsequent histopathological examination revealed a well-differentiated adenocarcinoma. Because carcinoembryonic antigen (CEA) levels were increased rapidly after adjuvant chemotherapy, she received bimonthly oxaliplatin plus infusion fluorouracil with leukovorin regimen (mFOLFOX6). Although mFOLFOX6 8 courses were administered, computed tomography (CT) showed disseminated nodules, ranging in size from 7 to 30 mm, at the pelvic floor, around the anastomosis site, in the mesentery of the small intestine and in the greater omentum. In July 2007, Hartmannʼs operation, partial resection of the small intestine, and greater omentum, left ureterovesical anastomosis, and hyperthermic intraperitoneal chemotherapy was performed. Histopathological examination revealed a well-differentiated adenocarcinoma. Bimonthly irinotecan plus infusion fluorouracil with leukovorin regimen (FOLFIRI) 20 courses and Tegafur-uracil (UFT) following FOLFIRI were administered as adjuvant chemotherapy. In February 2010, CT showed disseminated nodules at near the stump of rectum, right side of urinary bladder. Then, peritoneal metastasectomy was performed. Histopathological examination revealed a moderately differentiated adenocarcinoma. She was disease-free for 5 years after the last surgery. We reported a case of patient with peritoneal recurrence of sigmoid colon cancer that received multidisciplinary treatment and remained disease free for a long duration. And we also reviewed previous studies and case reports.

症例は71歳，女性．2013年に他院にて盲腸癌に対して腹腔鏡補助下回盲部切除術を施行（T3N1H0P0 Stage IIIa）．術後補助化学療法終了後，同院にて経過観察となった．術後7カ月頃より不正性器出血を認めたため，近医産婦人科を受診．精査の結果，子宮体癌IIIB期，子宮頸部浸潤が疑われ，当院産婦人科へ紹介された．CTおよびMRI検査にて子宮頸部後壁に腫瘤性病変を認め，直腸との境界が一部不明瞭であった．また，子宮頸部生検では腺癌の診断で，免疫組織化学染色ではCK7陰性，CK20陽性であったため，盲腸癌の子宮転移が疑われた．婦人科と合同で広汎子宮全摘術，直腸部分切除術を施行した．術後経過は良好で第12病日に退院．術後病理組織学的検査にて高分化～中分化管状腺癌であり，盲腸癌の子宮頸部転移の診断となった．現在，無再発生存中である．大腸癌の子宮頸部転移は非常に稀であるため報告する．, 論文

症例は58歳，男性．倦怠感と腹痛を主訴に近医を受診．胸腹部CT検査にて両側肺野に粒状影・空洞性病変を認め，腹部にガス像を伴う巨大な腹腔内膿瘍の所見を認めた．喀痰よりガフキー1号，PCRにて結核菌が検出され，胃液よりガフキー6号を認めた．活動性肺結核および腸結核による消化管穿孔の診断で，腹腔内膿瘍に対して経皮的にドレナージチューブを挿入後，加療目的に当院へ転院となった．腹部症状および腹部所見が軽度であったことや，低栄養状態で結核性腹膜炎による腹腔内の強い炎症および癒着が危惧されたため，先に保存的加療を行い，栄養状態の改善後に手術を施行する方針とした．抗結核薬の投与を開始し，腹腔内膿瘍に対してはドレナージを継続し，抗生剤の投与を行った．腹腔内膿瘍は徐々に縮小・瘻孔化し，第115病日に退院となった．今回，われわれは保存的に治療しえた腸結核による空腸穿孔の1例を経験したので，文献的考察を含めて報告する．, 論文

A 49-year-old man was admitted to hospital because of abdominal pain. A 67×55mm tumor in the small intestine and a 15×13mm umbilical nodule were detected on computed tomography (CT) scans. The small bowel series showed an irregularity of the surface of the tumor, but a balloon endoscopy failed to detect the tumor in the small intestine. In addition, colonoscopy revealed an 25×25mm rectal tumor, type0-Ⅰs, with uneven surface. The rectal tumor seemed to be a submucosal (SM) invasion. The resection of the small intestine and the umbilical nodule preceded the treatment of the rectal tumor because of his severe symptom of bowel obstruction. Histopathological examination and immunohistochemistry showed moderately differentiated tubular adenocarcinoma and cytokeratin (CK) 7 positive cells in small intestinal tumor. These findings revealed the diagnosis of adenocarcinoma of the small intestine with an umbilical metastasis. Adjuvant chemotherapy (mFOLFOX6) was administered after the surgery because adenocarcinoma of the small intestine seemed a poor prognosis. Repeated colonoscopy disclosed other early cancers in the cecum and ascending colon before surgery for the rectal cancer. A right hemicolectomy and a low anterior resection were performed. We reported a case of double primary cancers of small intestine with an umbilical metastasis and multiple colorectal cancer, and reviewed previous literatures.