Noriji Niinomi

Anatomical reconstruction of the thyroglossal duct

The high postoperative recurrence rate of the thyroglossal duct cyst is well known. Since Sistrunks operation was used, the recurrence rate was remarkably reduced, but the anatomical description of the thyroglossal duct through the entire tract has not been clarified in detail. For a more accurate anatomical understanding of the thyroglossal duct, 10 specimens obtained from Sistrunks operation were studied using histological reconstruction, and a common running pattern of the thyroglossal duct was found. The cyst is usually located caudal to the hyoid bone mostly at the midline. The duct extends upward from the cyst ventral to the hyoid bone, with many or a few branches and secretory glands. These ducts or branches merge into a single duct at the level of the cranial portion of the hyoid bone. However, as it leaves the hyoid bone and approaches the foramen cecum, a single duct spreads out into many ductuli like the tip of a broom, which communicate with many secretory glands. There were three cases in which the duct was found behind the hyoid bone, but in no case did the thyroglossal duct run through the back of the hyoid bone. The duct behind the hyoid bone was recognized as a branch from the main duct in the dorsal direction. It ascended to the dorsal surface of the hyoid bone and terminated blind. These findings emphasized the importance of Sistrunks operation to prevent a recurrence.

What is the optimal depth for core-out toward the foramen cecum in a thyroglossal duct cyst operation

The high recurrence rate of thyroglossal duct cyst operations is well documented. Sistrunks operation is widely accepted as the best procedure to prevent recurrence. Nonetheless, the optimum depth of core-out is still not well documented. We previously reported a standard running pattern of the thyroglossal duct in an anatomical reconstruction study. In more detailed pathological studies, we have tried to determine the optimal depth for core-out toward foramen cecum and the optimal width of the hyoid bone to be resected. The following items were clarified. (1) Double the horizontal distance from midline to the most distant thyroglossal duct in front of the hyoid bone was 2.4 to 9.6 mm. (2) The length of the single duct above the hyoid bone which spreads into many ductuli as it approaches the foramen cecum was about 3 to 5 mm in 2- to 6-year old children. (3) The diameter of the thyroglossal duct at the level of the cranial top of the hyoid bone was 175 to 1,400 microns. Half of the examined cases were less than 500 microns, which may have rendered direct dissection impossible. Based on these studies, we propose: (1) that a minimum of 10 mm of the hyoid bone should be resected, and for the sake of safety, more than 15 mm is preferable; and (2) that the depth of the core-out should be less than 5 mm in young children to avoid the breakdown of the branched ductuli near the foramen cecum.

Thyroglossal duct remnant penetrating the hyoid bone—A case report

Examination of the thyroglossal duct (TGD) in a senile patient with a thyroglossal duct cyst (TGDC), as well as in children, is very valuable in understanding the pathology of TGDC. The precise anatomy of TGDC was studied in a specimen obtained from a 59-year-old man using three-dimensional reconstruction. The authors found the TGD penetrated the hyoid bone. This pathological evidence has not previously appeared in the literature. Penetration of the hyoid bone by the TGD is the result of a forward growth of the hyoid bone after development of a TGD, which had appeared ventral to the hyoid bone. In this gradual forward growth, the hyoid bone had first started to press against, before eventually engulfing, the TGD.

Intestinal Obstruction in the Terminal Ileum Caused by an Anomalous Congenital Vascular Band Between the Mesoappendix and the Mesentery: Report of a Case

We report a case of intestinal obstruction caused by a congenital abnormal vascular band in a 17-year-old boy. The patient was admitted with acute colicky abdominal pain, and an emergency laparotomy revealed that the ileum was strangulated by a fibrous band with vessels about 2 mm in diameter and 7 cm in length, extending from the antemesenterium of the terminal ileum to the mesoappendix. The affected intestine was resected with the band and the appendix. Histologically, the fibrous band was composed of loose connective tissue containing arteries, veins, and nerve fibers, suggesting that it was congenital and originated from a remnant of the ventral mesentery in the embryonic period. There have been few reports of intestinal obstruction being caused by a congenital vascular band, especially in patients beyond the pediatric age group.

Transduodenal Intraductal Cannulation for Traumatic Pancreatic Head Disruption Without Primary Repair of the Pancreatic Duct. Report of a Case.

ハンドル外傷による主膵管断裂を伴った膵頭部断裂を経験した.主膵管は修復不能であったが, 経十二指腸的膵管内カテーテル挿入術が有効であったので報告する.症例は57歳男性.飲酒運転で衝突し腹部を打撲.受傷後16時間後に呼吸困難, 心窩部痛, 嘔吐のため救急車で来院した.諸検査より膵頭部損傷, 腹腔内出血, 外傷性膵炎と診断され緊急開腹術を行った.膵頭部前壁に上腸間膜静脈の露出を見る4cmの断裂があり, 主膵管は後壁がわずか燵続して6mmにわたって欠損していた.膵散損部を橋渡しさせカテーテルを挿入固定後に膵実質断裂部を縫合し, カテーテルの他端を経十二指腸的に体外に誘導留置した.術後の膵液瘻は難治であったが, 治癒後の内視鏡的逆行性膵管造影で膵管の開存は十分に保たれた, 本術式は膵の正常解剖と生理機能を温存でき, 膵挫滅が軽度で主膵管の縫合再建困難な膵頭部損傷に有効であると考えた.

A case report of malignant lymphoma of the ileum with intussusception.

成人 腸重積 症 は全腸 重 積症 の5~10%を 占め る と言 わ れ1),乳 幼児 に比 べ 器質 的 疾 患が 原 因 とな る場 合 が 多 い.著 者 らは回腸 悪性 リンパ腫 が原 因 とな った回盲 部 腸重 積症 を経 験 した ので若 干 の文献 的考察 を加 え報 告 す る. 症 例 症 例:38歳,男 性. 主訴:間 歇 的腹 痛. 既 往歴 ・家 族歴:特 記す べ き こ とな し. 現病 歴:昭 和58年1月10日 頃 よ り間歌 的腹 痛が 出現 した.近 医 受診 し胃透 視受 ける も異 常 はな か った.2 月2日 本院 受診 し,注 腸 にて 回盲部 に陰 影欠 損 がみ ら れた.2月15日 精 査 ・加療 のため 入院 した. 入院 時現 症:両 腋 窩 ・両承 径部 に リンパ 節 を触 知 し た.腹 部 はやや 膨隆 し,や や 硬 く,腸 音 は亢進 してい た.右 上腹 部 ・右 下腹部 に圧 痛 が存在 した.腫 瘤 は触