Manabu Kikuchi

Malignant Lymphoma of the Gastric Stump Developing 25 Years After a Distal Gastrectomy for Benign Gastric Disease : Report of a Case

We report herein the case of a 57-year-old man in whom malignant lymphoma originating in the gastric remnant was confirmed 25 years after a subtotal gastrectomy with Billroth II reconstruction had been performed for gastric ptosis. Gastroscopy revealed an ulcerated tumor on the fornix, and histologic examination of the endoscopic biopsy specimens demonstrated malignant lymphoma. Thus, total gastrectomy with splenectomy, pancreatectomy, and resection of the previously anastomosed jejunal stoma were performed. Histologic examination of the stomach remnant comfirmed a diagnosis of B-cell lymphoma of the large-cell type. Although we were unable to study the surgical specimen from the initial operation, the possible relationship between pseudolymphoma and malignant lymphoma has been presented in the literature, which is reviewed following this case report.

Staged seton fistulotomy after restorative proctocolectomy with ileal pouch–anal anastomosis accompanied by a decline in anal pressure during manometry

Dear Editor: Pouch-related fistula (PRF) develops in 5–10 % cases after restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) [1]. According to a previous report, postoperative perianal fistula after IPAA is categorized as a PRF even if it originates in the residual anal canal instead of originating in a part of the pouch body [2]. Although the basic therapeutic principle of perianal fistulae is fistulotomy, preliminary division of the sphincter may impair continence because patients who undergo IPAA are prone to fecal incontinence caused by the lack of rectosigmoid function and a constitutive unformed stool. From this perspective, a long-term drainage seton often has to be placed to manage perianal fistulae; however, the manner and timing of seton removal are controversial for patients with persistent purulent discharge. Here, we report a case of a perianal fistula that developed after IPAA and that was successfully cured after staged seton fistulotomy with anal manometry.