Norichika Matsui

Laparoscopic resection of an ileal lipoma : Report of a case

A 63-year-old woman was admitted to our hospital for investigation of upper abdominal pain and vomiting. Ultrasonography (US) showed a hyperechoic mass in the right lower abdomen, and computed tomography (CT) showed a low-density mass and intestinal invagination. Thus, we made a diagnosis of intestinal lipoma with intussusception and performed laparoscopic partial resection of the ileum, including the tumor. The resected specimen contained a round tumor, 25 × 22 × 20 mm, which was identified as an intestinal lipoma histopathologically. Our experience supports earlier reports that US and CT are effective tools in the diagnosis of bowel lipoma. Laparoscopic surgery is the treatment of choice for benign tumors of the small intestine because it is minimally invasive, with cosmetic, physical, and economic benefits.

Stomal varices: Treatment by percutaneous transhepatic coil embolization

Bleeding from stomal varices in a patient with portal hypertension, uncontrolled by surgical ligation and sclerotherapy, was well controlled by percutaneous transhepatic embolization with platinum and stainless-steel coils.

Early laparoscopic cholecystectomy for acute gangrenous cholecystitis.

Treatment of severe acute cholecystitis by laparoscopic cholecystectomy remains controversial because of technical difficulties and high rates of complications and conversion to open cholecystectomy. We investigated whether early laparoscopic cholecystectomy is appropriate for acute gangrenous cholecystitis. Pathologic diagnoses and outcomes were analyzed in patients who underwent laparoscopic or open cholecystectomy at our hospital, January 2002 to September 2005. Of 30 patients with acute gangrenous cholecystitis, 16 underwent early laparoscopic cholecystectomy, 10 underwent open cholecystectomy, and 4 were converted to open cholecystectomy (conversion rate, 20.0%). There was no significant difference in operation time or intraoperative bleeding. The requirement for postoperative analgesics was significantly lower (6.4±7.3 vs. 1.5±1.2 doses, P<0.05) and hospital stay significantly shorter (8.6±2.1 vs. 15.6±6.3 d, P<0.01) after laparoscopic cholecystectomy. There were no postoperative complications in either group. Thus, early laparoscopic cholecystectomy seems appropriate for acute gangrenous cholecystitis. Conversion to open cholecystectomy may be required in difficult cases with complications.

A Case of Primary Adrenal Lymphoma with Invasion to the Right Kidney and the Liver

症例は78歳の男性で, 右季肋部痛・背部痛を主訴に近医を受診し, 後腹膜腫瘍の診断で当科に紹介された. 血液検査ではLDHの上昇を認め, 腹部CT・MRIで右副腎に造影効果のあるφ15×15cm大の腫瘍を認め, 肝・右腎への浸潤も疑われた. 腹部血管造影では右下副腎動脈をfeeding-arteryとするtumor-stainを認めた. 以上より, 肝・右腎浸潤を伴う右副腎原発悪性腫瘍と診断し肝右葉・右腎と腫瘍を一塊に切除した. 摘出標本は1.3kg, 腫瘍は白色充実性・弾性硬腫瘤で肝右葉および右腎への直接浸潤を認めた. 病理組織では悪性リンパ腫 (diffuse mixed sized B-cell type) であった. 術後第29病日に退院. 自宅療養の後CHOP療法を4クール施行した. 現在, 術後2年を経過した現在も再発の兆候はなく経過観察中である. 副腎原発悪性リンパ腫に対しては早期発見・積極的治療が重要と考える.

COLONIC CANCER WITH INTUSSUSCEPTION PROLAPSING THROUGH THE ANUS -REPORT OF 3 CASE

Colonic cancer as the leading point prolapsing through the anus is a rare disease, . We experienced three cases of this disease for the past 10 years. Case 1: A 72-year-old woman had an extraanal prolapse of the egg size tumor. On laparotomy, the intussusception was reduced colonic was performed. Case 2: An 86-year-old woman was found having an extraanal prolapse of the walnut size tumor. A high anterior resection was performed without reducing the intussusception. This case was of sigmoid colonic cancer. Case 3: A 91-year-old woman had an extraanal prolapse and incarceration of the elastic soft tumor (8.0×5.0cm). Resection of the sigmoid colonic was performed. This cancer developed on Rs region. Sigmoid colonic cancer rarely protrudes through the anus. Another 8 cases of this disease reported in Japan and these 3 cases were examined about the clinic opathological features.