Search

Although endoscopic repair is often performed for sigmoid colon volvulus without intestinal necrosis, surgery is the common choice of treatment due to recurrence. With no established treatment, Hartmann’s operation or sigmoid colon resection is often performed. We report a case of a 65-year-old man with transanal ileus tube placement before surgery for sigmoid colon volvulus to prevent recurrence and achieve intestinal decompression followed by Sharon’s operation to achieve one-stage anastomosis. The patient showed good postoperative course, with no recurrence 3 months after surgery. This report discusses the usefulness of the transanal ileus tube and Sharon’s operation for sigmoid colon volvulus without intestinal necrosis along with a review of the literature.

Reports of recurrence after obturator hernia repair are few. We describe the case of an 89-year-old woman who presented to us with a thrice recurrent obturator hernia. She had undergone open non-mesh repair twice and then laparoscopic non-mesh repair. She was readmitted to our hospital 6 months after the laparoscopic repair. Manual reduction was successful, paving the way for elective transabdominal preperitoneal repair. During the endoscopic repair, surgical mesh was placed extraperitoneally over the hernia defect and then fixed to Cooper's ligament with absorbable tacks. The patient was discharged on postoperative day 2 without complications. In the 2 months that have passed since the surgery there has been no sign of recurrence, but the patient will be carefully followed up. Repair of a recurrent obturator hernia is technically challenging; however, the transabdominal preperitoneal approach seems to be reliable and safe.

The de Garengeot hernia is a femoral hernia in which the appendix migrates into the hernia sac. It is usually diagnosed intraoperatively due to its rarity and lack of clinical presentation typical to acute appendicitis. Although most cases need emergency operation due to incarceration, no standard procedure exists. We report the case of a 49-year-old woman who was diagnosed with a de Garangeot hernia preoperatively by contrast-enhanced computed tomography. She underwent one-stage laparoscopic surgery via a totally extraperitoneal approach followed by laparoscopic appendectomy. She recovered uneventfully and was discharged on postoperative Day 3. Generally, hernioplasty and appendectomy are required for the de Garengeot hernia treatment. Avoiding a peritoneal incision around the herniation and performing a mesh repair prior to appendectomy is expected to carry a lower infectious risk than other laparoscopic procedures. With accurate diagnosis, this procedure could be a useful modality for de Garengeot hernia.

Background/aim The KIAA1199 gene has been associated with cancer-cell proliferation, but its functions remain poorly studied. Here, we examined the clinical significance of the KIAA1199 mRNA levels in locally advanced gastric cancer (GC). Materials and Methods/Results: Using samples from 254 patients with stage II/III GC, we found significantly higher KIAA1199 levels in cancerous tissues compared to adjacent normal mucosa (ANM). There was no significant relationship between KIAA1199 expression and clinical features. Although overall survival rates (OSR) of patients, who underwent surgery did not correlate with KIAA1199 expression, patients who underwent adjuvant chemotherapy with S-1 and had high KIAA1199 levels displayed significantly lower OSR. KIAA1199 knock down (KIAA1199-KD) suppressed proliferation, invasiveness, and sensitivity of GC cells to 5-fluorouracil (5-FU). Conclusion KIAA1199 expression appears to be a promising prognostic marker in patients with locally advanced GC, who underwent postoperative adjuvant chemotherapy with S-1. KIAA1199 may represent a novel target for GC pharmacotherapy.

A case of mucinous adenocarcinoma arising on a long-standing anorectal fistula is described. A 60-year-old man with a long history of mucinous discharge, pain and perianal induration underwent a biopsy of the external opening of the fistula that showed a mucinous infiltrating adenocarcinoma. Due to the large size of the tumor and the fact that it had extended into the surrounding tissue, preoperative radiotherapy was performed. Radiotherapy was given with 40 Gy in 25 fractions for 5 weeks through posterior and bilateral portals. After radiotherapy the tumor was markedly shrunk and the serum level of carcinoembryonic antigen was also improved. Abdominoperineal resection was performed 8 weeks after the termination of radiotherapy. Histological examination of the resected specimen revealed that the invasion of the tumor remained within the sphincter muscle and that no cancer cells were present on the surgical margin. The histological effect of radiotherapy was judged as grade 1b. This treatment can result in downstaging and R0 resection, which also has a possibility to prevent local recurrence. This case suggests that preoperative radiotherapy may play an important role in the definitive treatment of locally advanced perianal mucinous adenocarcinoma.

サルコイドーシスは非乾酪性類上皮細胞肉芽腫を形成する原因不明の全身性疾患である．今回我々は，肺サルコイドーシスが併存した若年発症盲腸癌の1例を経験したので報告する．症例は29歳男性．大腸癌の家族内発症はなかった．肺サルコイドーシスにて近医フォロー中，2008年10月中旬に下血を生じ当院受診．大腸内視鏡検査にて盲腸に2型の腫瘍を認め，生検にて中分化腺癌であった．明らかな遠隔転移はなく，結腸右半切除術（D3）を行った．腫瘍は5cm大で回結腸動脈周囲に腫大したリンパ節を認めた．病理組織診では一部低分化成分をともなう中分化腺癌であり，深達度SSで回結腸動脈リンパ節に非乾酪性類上皮細胞肉芽腫をともなう転移巣を認めた．悪性腫瘍との因果関係は不明であるが，サルコイドーシスは免疫学的に遅延型過敏症反応の抑制や細胞性免疫の異常をともなうとされており，大腸癌若年発症への関与が示唆された．

We report a schwannoma of the gallbladder in a 58-year-old man who was diagnosed as cholecystolithiasis. He presented with recurrent episodes of abdominal pain in the right upper quadrant. The abdominal computed tomography scan and ultrasonography revealed stones about 15 mm in diameter in the gallbladder. Under the diagnosis of cholecystolithiasis, laparoscopic cholecystectomy was performed. The resected specimen showed chronic cholecystitis and no suspicion of neoplasm. Pathological examination revealed that the tumor consist of spindle cells without atypical appearance at small area of fundus. Immunohistologically, tumor cells were positive for S-100 protein and negative for alpha-SMA and c-kit, the lesion was diagnosed as schwannoma.

症例は72歳の女性で，右鼠径部腫瘤を主訴に来院された．腹部CTにて右大腿輪より突出するヘルニア嚢が存在し内部に嵌頓した虫垂を認めた．用手的に還納は不能であった．症状は軽微で炎症所見はなかったが，発症から長時間経過し虫垂壊死を示唆する所見を認めたため手術を行った．鏡視下に腹膜外アプローチにて腹膜前腔より鼠径部を観察したところ，右大腿輪に嵌頓したヘルニアを認めた．これを剥離して内容物を腹腔内に還納した後，meshにて大腿輪を修復した．その後，気腹して腹腔内を観察すると，虫垂に明らかな血行障害は認めなかったが肉眼的に炎症所見を認め，腹腔鏡下虫垂切除術を併施した．本術式は鼠径部の観察が容易でヘルニアの整復が直視下にでき，腹腔内操作にて虫垂切除を行え，それぞれ操作が独立しており，人工膜による感染発症予防の観点からも有用な術式と考えられた．

A 65-year-old woman underwent iliocecal resection for cecal cancer. During post-operative follow-up, she was diagnosed with metastasis to the abdominal wall and a curative resection was performed. After 12 courses of adjuvant chemotherapy with a modified combination of folinic acid, 5-fluorouracil, and oxaliplatin (mFOLFOX6), recurrence was noted in the lung. A curative resection was successfully performed and she was subsequently treated with bevacizumab and a combination of folinic acid, 5-fluorouracil, and irinotecan (FOLFIRI). One year after surgical resection, recurrence in the remnant lung was diagnosed. Because of the KRAS mutation, she could not be treated with anti-epidermal growth factor antibodies. The metastatic lung tumor continued to enlarge. Therefore, we selected regorafenib as third-line chemotherapy. After treatment with regorafenib, the size of the target lesion decreased significantly.

A 59-year-old man with type 3 gastric cancer(signet-ring cell carcinoma)underwent simple laparotomy because of peritoneal dissemination.S -1/CDDP was started.Since the icterus of Grade 2 had appeared after 2 courses, S-1 and biweekly paclitaxel combination chemotherapy was started as second-line treatment.Throughout treatment, there was no adverse event, and this regimen was continued for 14 courses(25 months).He died 32 months after his first visit.S -1/PTX may play an important role as second-line chemotherapy for patients with unresectable advanced gastric carcinoma.