Mahito Imajo

Total colectomy, mucosal proctectomy, and ileoanal anastomosis

A safe and practical procedure for total colectomy and mucosal proctectomy with ileonal anastomosis has been developed and performed by us on 11 patients with adenomatosis coli and two patients with ulcerative colitis. The major features of the operative procedure are 1) total removal of the rectal mucosa to just above the dentate line; 2) preservation of anorectal function by a long rectal cuff procedure achieved by rectal mucosal excision from a level just below the sacral promontory, using a rectal internal stent and gauze packing techniques for rectal mucosal stripping, with, in some patients, an ileal reservoir added; and 3) prevention of pelvic sepsis by intraoperative rectal irrigation, rectal cuff drainage, and a temporary defunctioning loop ileostomy. Of six patients with at least three months of follow-up after reconstruction, each has returned to normal life, averaging two to seven semiformed stools each day. A side-to-end ileoanal anastomosis with a lowlying, loop-type ileal reservoir provided the best functional results.

Self washout method for defecational complaints following low anterior rectal resection

A self washout method was performed by ten patients who had defecational complaints following an anterior resection. A commercially available colostomy washout set was used for this procedure. When the patient sat down, the cone tip of the set was pressed into the anal canal by pushing the cone with the palm of the hand. The volume of water for irrigation used was 500 to 1000 ml and the subsequent defecation time was from 20 to 50 minutes. In all cases, the frequent urge to defecate disappeared and after normal defecational function had been recovered, the self washout was able to be discontinued.

Tracheo-bronchitis as a complication of Crohn's disease —A case report—

A case of Crohns enterocolitis associated with diffuse tracheo-bronchitis is presented herein. Although respiratory tract involvement in Crohns disease is extremely rare, our review of the world literature revealed several common clinical pathologic features. These features include a productive cough with chest X-ray films which are normal except for some peripheral involvement. Bronchoscopy, however, shows diffuse inflammation of the trachea and bronchi with widely scattered whitish lesions while biopsy reveals a granulomatous infiltration of inflammatory cells. This tracheobronchitis typically responds well to treatment with prednisone.

The Peutz-Jeghers Syndrome and Malignant Tumor

In our 19 cases of the Peutz-Jeghers (P-J) syndrome, we experienced two cases of carcinoma of the small intestine and two cases of uterine carcinoma. In 420 reported cases the of the P-J syndrome in Japanese literature there were 70 cases of gastrointestinal carcinoma ( mean age of 34.4 years) and 21 cases of extra gastrointestinal cancer (mean age of 41.2 years). Mucus producing adenocarcinoma was common patho-histological subdivision of gastrointestinal carcinoma (39%). Twelve of 20 cases of extra gastrointestinal cancer were uterine (9 cases) or ovarial (2 cases) carcinoma. Cervical adenocarcinoma (6 cases) was thought to be a specific cancer associated with the P-J syndrome.

Coombs-positive autoimmune hemolytic anemia in ulcerative colitis —A report of two cases—

Two cases of ulcerative colitis with a positive Coombs test are reported herein. In a 30 year old woman, hemolytic anemia was well controlled by excision of a rectal stump left over from a former operation. A 53 year old woman had a positive Coombs test without clinical hemolytic anemia 10 years after undergoing a total procto-colectomy with ileo-anal anastomosis. Thus we concluded that total procto-colectomy may be preventive, as well as therapeutic, for Coombs positive hemolytic anemia associated with ulcerative colitis.

Histology of the healing process after total colectomy, mucosal proctectomy and ileo-anostomy

Total colectomy, mucosal proctectomy and ileo-anostomy were performed on 10 dogs to observe the healing process of the space between the rectal muscle cuff and the pulled through ileum. Adhesion was complete in six cases. The ileal and rectal muscle layers were well preserved, but two weeks after the surgery the healing was not completed. One month after the operation, there was little scar formation between the rectal muscle cuff and the ileum, in the absence of infection. If there was infection between the ileum and the rectal muscle cuff, abscess and scar formation was seen even one month after the operation. This operation is thought to be rational from a histological viewpoint and the most important factor is the prevention of infection in the space between the ileum and rectal muscle cuff.

Report of 3 Cases of Pregnancy and Delivery after lleo-anal Anastomosis due to Familial Adenomatous Polyposis.

女性においては回腸肛門吻合術後の生活の質を評価する重要な要素として, 妊娠, 出産を挙げることができる.家族性大腸腺腫症に対して行われた回腸肛門吻合術後の出産例3例を経験したので報告し, 妊娠中の排便状況の変化および合併症につき検討した.3例とも術後の肛門管最大静止圧は70cmH2O以上 (正常100cmH2O) であった.いずれも帝王切開による出産で, 子に異常を認めなかった.帝王切開の適応は, それぞれ症例1は胎児の横位, 症例2は頻回腹部手術, および症例3は妊娠後期のイレウスによる腸切除術であった.妊娠前の排便回数は1日6～8回であり, 失禁はなかった.妊娠中, および出産前後において排便状況が悪化することはなかった.回腸肛門吻合術後の出産は十分可能で, 子にも問題ないことが示された.妊娠は回腸肛門吻合術後の排便機能に悪影響は及ぼさないと結論された.ただし妊娠中イレウスの発生に注意すべきである.

Indications and Limits of Endoscopic Surgery for Colorectal Diseases.

内視鏡的切除を行った大腸ポリープ1,927病変と早期大腸癌259病変の治療経験を通して, 下部消化管におけるendoscopicsurgeryの適応と限界について検討を行った. 内視鏡的ポリペクトミーが行われたポリープのうち, 最も大きなものは45mm径であった. 合併症の発生頻度は0.7%で死亡例は無く, 内視鏡的切除は安全な手技と思われた. 内視鏡的に切除されたポリープの組織診断では, 腺腫が最も多く67%であり, m癌は5%にみられ, 次いでPeutz-Jeghersポリープ, 若年性ポリープ, 良性の粘膜下腫瘍の順で, これらの疾患が内視鏡的切除の適応と考えられた. 早期大腸癌に対する内視鏡的切除の適応をm癌と考えると, 臨床病理学検討からは, Ipでは大きさにかかわらず可能な限り, Isでは大きさ20mm以内のものが, IIaでは15mm以内のものが適応と考えられた. 陥凹型は小さいうちからsmへの浸潤傾向がつよく, 脈管侵襲陽性率が高く, 外科的切除の適応と考えられた.

Complications and prognosis in patients with large bowel cancer aged 70 years and older.

過去10年間の大腸癌患者280例を70歳以上の高齢者群67例 (24%) と70歳未満の非高齢者群213例 (76%) とに分けて, 臨床病理学的特徴, 合併症および予後の面から検討した.臨床病理学的には非高齢者群でリンパ節転移をきたすものが多く認められたが, ほかには差がなかった.合併症では, 術前合併疾患を有する率が高齢者群で39例 (58.2%) と有意に高く, またそのような例では術後にも合併症を発生する率が高かった.予後においては両群間に差はなく, また術後合併症の有無による差もなかった.以上より, 高齢者といえども積極的に根治術を行い, 術後の合併症に対しても積極的に治療することにより, 良好な予後がえられると結論された.