Nobuhiro Takashima

A rare case of secondary small bowel volvulus laparoscopically repositioned: literature review and classification

BackgroundSecondary small bowel volvulus is a rare condition caused by adhesions after laparotomy or tumors. There are no clear guidelines for indication of laparoscopic surgery.Case presentationA 69-year-old male visited our hospital complaining of epigastric pain. He had a history of hypopharyngeal carcinoma treated via pharyngolaryngoesophagectomy with restoration of esophageal continuity by harvesting a free jejunal autograft 6xa0years ago.Enhanced computed tomography revealed the whirl sign. An emergency laparoscopic operation was performed following a diagnosis of small bowel volvulus. This revealed rotation of the whole small bowel, involving the superior mesenteric artery as the center, and originating at the adhesion of the proximal and distal small bowel. Laparoscopic manipulation of volvulus and lysis of the adhesion were performed. The patient’s postoperative course was uneventful, and he was discharged on hospital day 5.ConclusionsLaparoscopic surgery may be useful for treating small bowel volvulus; however, the patient’s treatment indications should be judged carefully.

Two patients with spontaneous transomental hernia treated with laparoscopic surgery: a review

Abstract Here, we report two patients with transomental hernia who were successfully treated with laparoscopic surgery. The first patient was a 58-year-old female who presented to our hospital with abdominal pain and vomiting; she had no history of abdominal surgery. Enhanced computed tomography revealed strangulation ileus due to an internal hernia. The second patient was a 36-year-old male who presented to our hospital with abdominal pain and no history of abdominal surgery. Enhanced computed tomography indicated transomental hernia. Emergency laparoscopic surgery in both patients revealed incarcerated bowel loops through defects in the greater omentum. The bowel segments were laparoscopically released, and the patients were uneventfully discharged on postoperative Days 4 and 8. Laparoscopic surgery is useful for the diagnosis and treatment of small bowel obstruction due to transomental hernia through the greater omentum.

Sigmoid gallstone ileus: A case report and literature review in Japan

Highlights • We present a unique case of gallstone ileus with inguinal hernia.• A one-stage operation can be considered for patients with gallstone ileus associated with cholecystocolonic fistula.• A review of the literature pertaining to colonic gallstone ileus is presented.

Arteriovenous malformation in the sigmoid colon of a patient with Cowden disease treated with laparoscopy: a case report

BackgroundCowden disease is a genetic disorder associated with a mutation of the PTEN gene and is known to be easily complicated by generalized vascular malformations and malignant tumors. However, only a few reports have investigated the relationship between Cowden disease and vascular malformations. We present a case of Cowden disease along with a review of the literature.Case presentationThe patient was a 48-year-old man who visited our hospital complaining of fresh blood in his stools and shortness of breath. Hematological tests showed the patient had severe anemia. On physical examination, white papules—several millimeters in size—were observed between the patient’s eyebrows. White papules were also observed on the left corner of his mouth and buccal mucosa. An upper gastrointestinal endoscopy showed densely-packed, white, flat protrusions in the esophagus. While lower gastrointestinal endoscopy revealed a mass accompanied by arterial pulsation in the sigmoid colon. A diagnosis of Cowden disease was confirmed and a laparoscopic sigmoidectomy was performed to address the arteriovenous malformations in the sigmoid colon. Post-surgery, the patient had an unremarkable recovery and was discharged 7 days later.ConclusionsWe present a very rare case of Cowden disease with arteriovenous malformations occurring in the colon. Surgical resection is believed to be the first choice for treating congenital arteriovenous malformations of the intestines. However, the arteriovenous malformations in the colon in our patient were treated under laparoscopic guidance, making ours the first report describing laparoscopic treatment of colonic arteriovenous malformations occurring in the inferior mesenteric artery. Thus we demonstrate that laparoscopic treatment of arteriovenous malformations in the intestines is a minimally invasive and can be successfully applied in such cases.

A CASE OF EOSINOPHILIC GASTROENTERITIS CAUSING INTESTINAL OBSTRUCTION WITH ASCITES

症例は35歳,女性.腹痛と嘔吐を主訴に来院.精査にて腸閉塞と診断し,強い臨床症状を認めたため,同日,緊急手術を施行した.手術所見では腹水と,回腸末端より約210cm口側の部位で壁が肥厚狭窄し,これより口側で腸管が拡張していた.小腸部分切除術が施行され,腹水細胞診にて多数の好酸球と,切除された小腸の病理組織所見で全層性の好酸球浸潤を認め,好酸球性胃腸炎と診断した.好酸球性胃腸炎は消化管壁への好酸球浸潤を特徴とする比較的稀な疾患で,本邦報告例は現在まで120例あまりある.さらに手術例は調べ得た限り,自験例を含め32例と稀である.今回われわれは腸閉塞を来し,好酸球性腹水を伴った好酸球性胃腸炎の1手術例を経験したので若干の文献的考察を加え報告する.