Naoyuki Taenaka

Prepancreatic postduodenal portal vein: report of a case.

We report an unusual case of a prepancreatic postduodenal portal vein (PPPV), incidentally discovered during total gastrectomy. If it had not been noticed, this portal vein might have been ligated and divided with disastrous consequences. This anomaly was not diagnosed preoperatively, but it could have been. Although embryological anomalies of the portal venous system, such as PPPV and preduodenal portal vein, are rarely encountered in abdominal surgery, surgeons must be aware of their possibility and be able to recognize them to avoid major intraoperative injury.

Laparoscopic resection of ileal lipoma diagnosed by multidetector-row computed tomography.

Intussusception is rare in adults and it is difficult to diagnose on admission. We present the case of a 43-year-old woman with the chief complaint of nausea and upper abdominal pain. Abdominal multidetector-row computed tomography showed ileo-ileal small bowel intussusception with an intraluminal soft tissue mass with attenuation numbers suggestive of a lipoma. The patient was treated with a laparoscopic-assisted extracorporeal partial resection of the small bowel including ileal lipoma, followed by a functional end-to-end anastomosis. Histologic diagnosis of the resected tumor, 2.4×2.0×2.0 cm, was an intestinal lipoma. This case serves as the basis of a review of small bowel intussusception in adults secondary to lipomas. It focuses on the utility of multidetector-row computed tomography and the cosmetic, physical, and economic benefits of laparoscopic surgery as well as the rarity of the disease.

Clinical and histopathological study on colorectal carcinoma in young adults.

当教室で最近13年間に経験した大腸単発癌手術施行例570例を対象とし, 39歳以下の若年者大腸癌の臨床病理学的所見ならびに手術成績について検討した.若年者大腸癌は570例中57例 (10.0%) であり, 女性が多かった.若年者大腸癌では, 組織型は粘液癌が多く, 壁深達度, リンパ節転移率, 腹膜播種, 組織学的進行程度において進行度の進んだ症例が有意に多かった.若年者の全手術例の累積5年率は41.0%と非若年者とくらべ有意に低率であったが, 治癒切除例の累積5年率は71.6%と非若年者の76.3%とくらべ有意差はなかった.若年者における大腸癌の早期診断ならびに治癒手術への努力が重要であると思われた.