Naoji Takeuchi

Colonic J-pouch rectal reconstruction—Is it really a neorectum?

PURPOSE: The aim of this study was to determine whether a colonic J-pouch has similar properties to that of a normal rectum, including recovery of rectoanal coordination. METHODS: Ten patients with colonic J-pouch-anal anastomosis (anastomotic distance from anal verge, 3–5 (range, 2.0–4.5) cm for low rectal cancer (7 men; mean age, 64.7 (range, 44–76) years) were studied clinically and in the anorectal physiology laboratory at least one year after operation. Results were compared with a series of ten matched patients who underwent high anterior resection for upper rectal carcinoma (anastomotic height, 12.7 (range, 9.5–16) cm). RESULTS: Although results seemed to be slightly better in the group with the rectum preserved, no statistical differences could be found either in functional outcome or anorectal physiology. One-half of the patients with colonic J-pouch (neorectum) had a positive rectoanal inhibitory reflex. CONCLUSION: Addition of a colon pouch neorectum would appear to improve function to the level of those patients with a high anastomosis and “normal” rectum.

Atheromatous Embolization Report of Two Cases with Unusual Complications

Two cases of spontaneous atheromatous embolization associated with unusual complications are presented. One is an 85‐year‐old man who developed an acute abdomen and underwent a surgical resection of totally infarcted left‐sided colon. Histologically, multiple acute atheromatous emboli were found occluding the serosal and pericolic mesenteric arteries causing transmural necrosis of the involved portion of bowel. The other is an 80‐year‐old woman who had had a coronary heart disease, hypertension, and renal insufficiency, and terminally developed a rapid deterioration of renal function and melena. Postmortem examination showed a severely, ulcerated, aortic atherosclerosis and widespread, recurrent, atheromatous emboli in many abdominal organs with the resultant severe nephrosclerosis, gastrointestinal mucosal hemorrhagic necrosis, and multiple infarcts in the pancreas and spleen. In addition, there was focal cortical necrosis of the kidenys accompanied with glomerular capillary fibrin thrombi indicating disseminated intravascular coagulation (DIC). These findings seen in the present two cases were briefly discussed in light of the previous pertinent literature.