Hideki Saito

Diagnostic peritoneal lavage for diagnosing blunt hollow visceral injury: The accuracy of two different criteria and their combination

PurposeTo test the usefulness of diagnostic peritoneal lavage (DPL) for identifying blunt hollow visceral injury with two different sets of criteria or a combination of the two.MethodsFifty victims with physical examinations and/or computed tomography findings equivocal for blunt hollow visceral injury underwent DPL. Whether or not to perform surgery was determined based on Otomos DPL criteria [lavage white blood cell counts (L-WBC) over lavage red blood cell counts (L-RBC) divided by 150 (L-WBC ≥ L-RBC/150) in the presence of hemoperitoneum, or L-WBC over 500/mm3 (L-WBC ≥ 500) in the absence of hemoperitoneum]. The cell count ratio, a comparison of L-WBC, L-RBC, peripheral WBC (P-WBC), and peripheral RBC (P-RBC) [(L-WBC/L-RBC)/(P-WBC/P-RBC) ≥ 1] were all calculated retrospectively.ResultsThere were one and two false-positive cases based on Otomos criteria and the cell count ratio, respectively, with corresponding accuracies of 97.8% and 95.7%, respectively. There were no false-positive or -negative cases according to the combined use of Otomos criteria and cell count ratio, yielding an accuracy of 100%.ConclusionAlthough each criterion alone is very accurate in predicting the presence of blunt hollow visceral injury, the combined use of the two would further improve the accuracy of the diagnosis and thereby reduce the number of unnecessary celiotomies.

Jejunal Loop Obstruction by a Gallstone from Hepaticojejunostomy-Induced Acute Cholangitis : Report of a Case

We report a case of jejunal loop obstruction by a large gallstone caused by Roux-en-Y hepaticojejunostomy-induced acute cholangitis. The patient was admitted with sepsis as well as abdominal and back pain. Abdominal computed tomography showed a dilated jejunal loop and an obstructing large mass. After his clinical condition and laboratory values improved, we performed laparotomy, which revealed a dilated jejunal loop with a palpable mass, and a gallstone was removed via enterotomy. After the disimpaction of the stone and control of the infection, his clinical condition and laboratory values continued to improve. Gallstone formation is rare after hepaticojejunostomy and to our knowledge, no other cases of acute cholangitis caused by a stone obstructing the jejunal loop have ever been reported. As with other major complications, early diagnosis and prompt initiation of surgical treatment are important to prevent any deterioration in the patients general condition.

Safety and efficacy of a novel continuous incision technique for laparoscopic transcystic choledocholithotomy

The purpose of this study was to evaluate the safety and efficacy of a novel continuous incision technique for the cystic duct and the bile duct over the orifice for laparoscopic transcystic choledocholithotomy (LTCL).

A Resected Case Report of Retroperitoneal Leiomyosarcoma Invading the Inferior Vena Cava

症例は44歳の男性で, 上腹部痛を主訴として近医を受診, 腹部CTを施行し後腹膜腫瘍を指摘され当院に紹介, 入院した. 入院時右上腹部に巨大腫瘤を触知し, CTでは肝下面に接する巨大な腫瘤を認めた. 血管造影検査では門脈は腫瘍により圧排されていたが, 浸潤像は認めなかった. 下大静脈には右腎静脈より頭側に浸潤像を認めた. 後腹膜腫瘍の診断で開腹手術を施行した. 肝下面, 右腎静脈, 右副腎に接する巨大な腫瘍を認めた. 下大静脈には約10cmにわたり浸潤しており, 浸潤部を合併切除し腫瘍を摘出した. 下大静脈切除部は連続縫合により閉鎖した.腫瘍は大きさ19×14×12cm, 組織診断で平滑筋肉腫と診断された. 平滑筋肉腫に対する治療は外科的完全摘出が第1選択である. 特に, 後腹膜原発の場合, 大血管との関係を画像診断により十分に明らかにしておく必要がある. また, 術後再発も念頭におき, 画像所見による早期診断, 治療が求められる.