Fumio Yamamoto

Small Bowel Obstruction Caused by Anisakiasis of the Small Intestine: Report of a Case

Abstract.Enteric anisakiasis is a relatively rare disease that is difficult to diagnose preoperatively. We report a case of small bowel obstruction caused by enteric anisakiasis in a 59-year-old Japanese man who presented with abdominal pain a few hours after eating sliced, raw fish. Because of signs of an intestinal obstruction, a laparotomy was performed. Focal thickening and stenosis of the ileocecal region were seen about 100 cm from the end of the ileum and the lesion was excised. We found a moving anisakis thrusting its head into the mucosa of the excised small intestine. Histopathological examination revealed the infiltration of eosinophils in all layers of the intestinal wall and severe edema. Enteric anisakiasis is very rare, and its diagnosis is usually only made after laparotomy. Nevertheless, when signs of acute abdomen develop after the ingestion of raw fish, such as sushi or sashimi, the possibility of enteric anisakiasis should be borne in mind.

Transmesosigmoid Hernia: Report of a Case

Abstract.Sigmoid mesocolon hernia is an uncommon type of internal hernia. A 63-year-old man who presented with pain in the left side of the abdomen and nausea was referred to our department for treatment of ileus. He was initially managed conservatively, but as his symptoms became progressively worse, a laparoscopy was done, which revealed hemorrhagic ascites and necrosis of the small intestine in the lower abdomen. An open laparotomy was subsequently performed and the intraoperative findings were consistent with a transmesosigmoid hernia. There was an abnormal defect in the sigmoid mesocolon and protrusion of about 30 cm of small bowel through this abnormal opening, which had resulted in strangulation of the bowel. The necrosed part of the intestine was resected and the defect was closed.

Necrotizing enteritis with hepatic portal venous gas and pneumatosis intestinalis: report of a case

A 73-year-old woman visited our hospital because of increasing abdominal distension and lower abdominal pain. On abdominal computed tomography (CT), hepatic portal venous gas (HPVG) and pneumatosis intestinalis of the small intestine were found. HPVG caused by intestinal necrosis was diagnosed, and an emergency laparotomy was thus performed. Necrosis of the small intestine over a 40-cm area from the ileocaecal region toward the mouth was found, and the lesion was resected. Histopathologically, haemorrhagic necrotic enteritis was diagnosed. The patient is alive as of the seventieth day after operation. The prognosis of intestinal necrosis accompanied by HPVG and pneumatosis intestinalis is poor. The presence of HPVG suggests the occurrence of a serious lesion in the abdominal cavity. Therefore, appropriate treatment should be performed immediately.

A useful cholesterol solvent for medical dissolution of gallstones

SummaryDissolution of cholesterol gallstones by direct instillation of an agent into the biliary tract has been considered an alternate to surgical procedures. We developed an excellent direct solubilizer by combiningd-limonene and medium-chain monoglyceride. This mixture enhances the advantages of each individual solvent and minimizes the disadvantages. In vitro experiments were done to determine the viscosities and the cholesterol dissolving rates of various combinations, and in vivo experiments were conducted to study their irritation effects on tissues. The optimal combination was a 3:2 mixture ofd-limonene and medium-chain monoglyceride. It could quickly dissolve cholesterol gallstones with minimal or no observable side effect.