Muneyuki Yamaguchi

Meckel's diverticulum: Investigation of 600 patients in Japanese literature

A total of 600 cases, comprising 4 of our cases and 596 others in Japan, was analyzed, and the diagnosis of Meckels diverticulum was made in only 34 of them. The rate of diagnosis was 5.7 per cent, which is very low. The most common complication of this disease was intestinal obstruction, the second most common was intussusception, the third was inflammation, and the fourth was rectal bleeding. Ectopic tissue, present in ninety-three patients, consisted of ectopic gastric mucosa in fifty-eight. 99mTc-P scanning was performed on fifteen patients. In twelve of them ectopic gastric mucosa was observed. However, it was not found in three, all of whom had false-positive scans.

Congenital choledochal cyst. Analysis of 1,433 patients in the Japanese literature.

Five of the authors cases and 1,428 cases from Japans literature are discussed. Half of the patients were infants. The ratio of men to women was 1 to 3. One hundred fifty-one patients had malformation of the pancreaticobiliary system, which is said to be a cause of congenital choledochal cyst. All of the patients have been followed up. Excision of the cyst is the best procedure for preventing ascending cholangitis and cystic cancer. Roux-Y hepaticojejunostomy is also effective for reconstruction of the bile duct because it rarely causes ascending cholangitis.

Scientific paperCongenital choledochal cyst: Analysis of 1,433 patients in the Japanese literature

Five of the authors cases and 1,428 cases from Japans literature are discussed. Half of the patients were infants. The ratio of men to women was 1 to 3. One hundred fifty-one patients had malformation of the pancreaticobiliary system, which is said to be a cause of congenital choledochal cyst. All of the patients have been followed up. Excision of the cyst is the best procedure for preventing ascending cholangitis and cystic cancer. Roux-Y hepaticojejunostomy is also effective for reconstruction of the bile duct because it rarely causes ascending cholangitis.

Scientific paperMeckel's diverticulum: Investigation of 600 patients in Japanese literature

A total of 600 cases, comprising 4 of our cases and 596 others in Japan, was analyzed, and the diagnosis of Meckels diverticulum was made in only 34 of them. The rate of diagnosis was 5.7 per cent, which is very low. The most common complication of this disease was intestinal obstruction, the second most common was intussusception, the third was inflammation, and the fourth was rectal bleeding. Ectopic tissue, present in ninety-three patients, consisted of ectopic gastric mucosa in fifty-eight. 99mTc-P scanning was performed on fifteen patients. In twelve of them ectopic gastric mucosa was observed. However, it was not found in three, all of whom had false-positive scans.

A case of mesenteric cyst diagnosed by ultrasound examination and a review of Japanese literatures.

Mesenteric cyst is relatively rare, and its diagnosis is difficult. We carried out an ultrasound examination on a 6-year-old boy who showed intestinal obstruction. This examination revealed an abdominal mass, and he was diagnosed as mesenteric cyst. Later it was confirmed by operation. The histopathological examination revealed that it was a lymphangioma. A review was also carried out on 288 cases of mesenteric cyst in Japan.

Observation of cystic dilatation of the common bile duct by ultrasonography

We have studied a patient with congenital cystic dilatation of the common bile duct who had undergone ultrasonography five times in 6 mo before operation. Ultrasonography revealed that the duct was distended with inflammation, and was deflated when inflammation was not present.

Reconstruction after Distal Gastrectomy by Interposition of a Double-jejunal Pouch Using a Triangulating Stapling Technique

Sustaining good nutrition and preventing postgastrectomy syndrome are important for increasing the quality of life after distal gastrectomy. Many surgeons have proposed surgical methods designed to enhance long-term patient quality of life. An immediate, safe method based on current physiologic reconstructive principles shown to reduce postoperative patient complaints is presented. A reconstructive method using a modified interpositioned double-jejunal pouch after distal gastrectomy in 18 cancer patients was reviewed. This method uses a triangulating stapling technique with wide end-to-side anastomosis between the residual stomach and the pouch. In all patients, the anastomosis site was without leakage or stenosis, and there were no episodes of severe reflux esophagitis, residual gastritis, or dumping syndrome. The mean pooling rate was 44.2%, and emptying half-time was 73.0 minutes. After 2 years the body weight was 91.3% of the preoperative weight, the food volume was 89.2% of normal intake, and meal frequency was 3.0 per day. This method of reconstruction is useful for immediate and safe creation of a wide anastomosis between the residual stomach and the double-jejunal pouch after distal gastrectomy and in the prevention of esophagitis and residual gastritis.

Fournier's gangrene progressing from the buttocks to the scrotum following a perianal abscess

We describe a case of gas-producing infection following a perianal abscess. A 61-year-old man was admitted to our hospital complaining of perineal pain and was found to have a perianal abscess. He was diabetic but had not received treatment for the disease. Although the perianal abscess was drained and antibiotic treatment started, severe swelling of the scrotum, with crepitation, redness, and partial necrosis progressed rapidly. Computed tomography revealed subcutaneous gas formation in the scrotum. A culture study revealed Clostridium, Enterococcus, and numerous other types of bacteria. The patient was diagnosed with Fournier’s gangrene caused by infection with Clostridium in combination with other species of bacteria. The infection was refractory to drainage and antibiotic therapy. Thus, repeated extensive debridement of all necrotic tissue in the scrotum was required until healthy granulation was present in the wound. Our case shows that, in patients with Fournier’s gangrene caused by infection with Clostridium in combination with other species of bacteria, the mainstay of treatment should be open drainage and aggressive surgical debridement of all necrotic tissue, followed by broadspectrum antibiotic therapy.