Masaaki Hashimoto

Antiperistaltic Transverse Colostomy for Massive Bowel Necrosis Following Surgery for an Abdominal Aortic Aneurysm: Report of a Case

We herein report the findings of a 72-year-old man with gangrenous multivisceral necrosis following an operation for abdominal aortic aneurysm. The region of necrosis, which accompanied infarction of the left kidney, included the entire ileum and the ascending, descending, and sigmoid colon. An end ileostomy and transverse colostomy were performed subsequent to massive bowel resection in a second operation. After the second operation, he was managed with total parenteral nutrition and recovered uneventfully except for end-jejunostomy syndrome. A third operation was performed to reconstruct the interrupted bowel. To minimize abandoned bowel, antiperistaltic transverse colostomy was used for jejunocolonal reconstruction. The antiperistaltic colostomy improved the symptoms of end-jejunostomy syndrome and normalized the patients vitamin B12 and bile acid levels. An antiperistaltic colostomy is thus considered to be useful for preventing short bowel syndrome after a massive bowel resection.

A CASE REPORT OF TRACHEAL OBSTRUCTION DUE TO RECURRENT ESOPHAGEAL CANCER SUCCESSFULLY TREATED WITH AN EXPANDABLE METALLIC STENT

A 72-year-old man who underwent a curative resection for a thoracic esophageal cancer in June 1996, developed dyspnea in March 1997. Chest CT revealed recurrence and infiltration at the tracheal bifurcation, causing complete obstruction of the left main bronchus and atelectasis of the left lower lobe. Although radiotherapy was initiated immediately, his dyspnea became more severe, so an expandable metallic stent (EMS) was placed at the site of obstruction on April 1. On the next day after setting, dilatation of the tracheal lumen was achieved to the maximum diameter of EMS without pain or persistent cough. There was a striking improvement in his dyspnea and atelectasis. Four months after the EMS placement, the patient died from exacerbation of pleural effusion and intra-airway bleeding due to perforation of a mediastinal blood vessel by progression of the local lesion. EMS placement for airway obstruction had been suggested to be associated with the risks of hemorrhage on insertion of the dilator and fistula formation to adjacent structures throught long-term pressure from the expandable stent, but it was actually less invasive and dramatically improved the quality of life in this case. EMS insertion is particularly useful in patients with terminal cancer, and should be more widely used in the future.