Jiro Kimura

Idiopathic omental hemorrhage: A case report and review of the literature.

Highlights • Idiopathic omental hemorrhage is a rare cause of an acute abdomen, which is potentially life-threatening.• Idiopathic omental hemorrhage may develop after eating.• Omentectomy is preferred to ligation or transcatheter arterial embolization to rule out an underlying malignancy or aneurysm.

Duodeno-jejunal Intussusception with Acute Pancreatitis in Peutz-Jeghers Syndrome: The First Case Presentation in Childhood

Peutz-Jeghers syndrome (PJS) is a rare condition characterized by autosomal dominant inheritance, mucocutaneous pigmentation, and gastrointestinal hamartomatous polyps, and is a subtype of hereditary gastrointestinal polyposis. Among PJS, there is no difference of incidence among race and sex, and the incidence has been estimated to be 1 in 120,000–150, 000 births. The cause of PJS is a germline mutation of STK11/LKB1 (serine/threonine kinase 11) tumor suppressor gene in most patients (70–80 %). A 13-year-old girl suffered from left upper quadrant pain for 4 days and admitted into our hospital. There were no previous symptoms but she had family history of PJS. On physical examination, her lip was markedly pigment, but no abdominal tenderness was found. Laboratory parameters investigated that white blood cell count was 12,660/μL (normal range, 3800 to 10,100/μL) and serum amylase level was 615 IU/L (normal range, 60 to 200 IU/L). Other laboratory tests, including hematology, tumor markers (carcinoembryonic antigen and carbohydrate 19–9), and viral infection including hepatitis B status and C status, were normal. Computed tomography (CT) revealed a well-enhanced intraluminal mass with a maximum diameter of 4.0 cm in the second portion of the duodenum and was invaginated into the proximal jejunum (Fig. 1a). Furthermore, enhanced-contrast CT demonstrated that peri-pancreatic inflammation around the pancreatic tail results in hazy and/or reticular stranding of the surrounding fat, although a part of the pancreatic head and body enhanced (Fig. 1b). At upper gastrointestinal (GI) endoscopy, brittle mass where the duodenal lumen was occupied was noted in the second portion of the duodenum, and it was not possible to observe the papilla of the Vater (Fig. 1c); therefore, it was difficult to remove the polyp endoscopically. Upper GI series indicated that the polyp was located through the duodenal bulb to descending portion and confirmed that the large solitary mass was invaginated (Fig. 1d). Oral intake of even low fat meal induced high fever, vomiting, and abdominal pain several times. Clinical symptoms also presented that both duodenal obstruction and acute pancreatitis due to the large polyp of the duodenum were repeated. Since the onset of acute pancreatitis, 3 months had past. We chose a surgical treatment for duodeno-jejunal intussusception with acute pancreatitis in Peutz-Jeghers syndrome child. On a gloss appearance at the operation, the delle on the anterior wall of the duodenal bulb was recognized, and at first Hutchinson’s maneuver was performed (Fig. 2a). We intraoperatively judged that the polyp might be removed without hurting the papilla of the Vater (Fig. 2b). The histopathological examination revealed tree branching pattern caused by the * Takehiro Okabayashi tokabaya@gmail.com

Metastatic colon cancer derived from a diverticulum incidentally found at herniorrhaphy: a case report

BackgroundThere are few reports of metastases from colon cancer to an inguinal hernia sac, and few reports of colon cancer originating in diverticula. We report a patient with carcinoma of the sigmoid colon arising in two diverticula, who presented with peritoneal seeding to an inguinal hernia sac, and a review of the literature.Case presentationA 55-year-old male underwent open herniorrhaphy for a left inguinal hernia. At operation, a nodule in the inguinal hernia sac was resected and histologic examination revealed adenocarcinoma, which was suspected to be a metastasis from a distant primary lesion. Postoperative evaluation included colonoscopy and positron emission tomography which showed two suspected lesions in sigmoid diverticula. Laparoscopic subtotal colectomy was performed, and pathology revealed adenocarcinoma in two sigmoid diverticula.ConclusionsIf a nodule is found in an inguinal hernia sac, especially in older patients, peritoneal metastases should be considered. Resection of the nodule with histopathologic evaluation is essential. Colon cancer arising in a diverticulum should be considered as a possible site of the primary lesion.

Colonic ischemia mimicking obstruction due to sigmoid colon cancer: A case report

Highlights • We present a patient with colonic ischemia, initially considered to have colonic obstruction.• The patient died postoperatively of multiple organ system failure.• It is difficult to diagnose colonic ischemia in patients with suspected colonic obstruction.• The imaging studies in these patients may be misleading, resulting in adverse outcomes.• A radiological diagnosis makes sense when it is the same as the “clinical diagnosis”.

Ductal Carcinoma in situ of the breast in sclerosing adenosis encapsulated by a hamartoma: A case report

Highlights • Ductal Carcinoma in situ in sclerosing adenosis encapsulated by a hamartoma is rare.• The diagnosis is difficult due to the appearance of these combined lesions.• Atypical appearance of a hamartoma may suggest a co-existing malignancy.

Yersinia pseudotuberculosis infection intractable by antibiotics: A rare case report

Highlights • Yersinia pseudotuberculosis infection is usually cured only by administering antibiotics.• The operation must have been performed for this patient because of persistent Yersinia pseudotuberculosis infection.• Early diagnosis and administering antibiotics are important for Yersinia pseudotuberculosis infection to avoid unnecessary operations.

A Case of Intrahepatic Biliary Cystadenocarcinoma.

症例は59歳の女性. 検診にて肝機能異常・胆道系酵素の上昇を指摘され, 精査目的に入院となった.腹部CTにて肝内側区域に径4cm大の嚢胞性病変とその内部に不均一な造影効果を伴う乳頭状腫瘤を認めた. 腹部MRIでは, T1強調像で低信号, T2強調像で高信号の嚢胞性病変を認め, 嚢胞内にはT1強調像で肝組織よりやや低信号, T2強調像でやや高信号の乳頭状腫瘤を認めた. 選択的血管造影では肝内動脈枝の圧排伸展および嚢胞の内部に結節状濃染像を認めた. 以上より, 胆管嚢胞腺癌の術前診断にて, 拡大肝左葉切除, 左尾状葉切除, 胆嚢・肝外胆管切除, リンパ節郭清術を施行した. 摘出標本では, 4×3×5cm大の多房性の嚢胞性腫瘍を認め, その内腔には充実性組織が乳頭状に増生していた. 嚢胞は, 粘調透明な液体に満たされていた. 病理組織学的に胆管嚢胞腺癌の診断であった.術後2年2か月経過した現在, 再発の兆候なく健在である.