Okihiko Shibata

Occurrence of peptic ulcer in the gastric tube used for esophageal replacement in adults

Reported in this paper are two cases of peptic ulcer which developed in the gastric tube used for esophageal replacement following esophagectomy for esophageal tumors in adults. The results of our cases suggest that acid secretion from the mucosa of the gastric tube, in spite of truncal vagotomy and the state of the tube, seems to play important roles in the pathogenesis of peptic ulcer of the gastric tube after esophageal replacement, even though circulatory disturbances, due to postoperative irradiation and gastric tube formation, have been suspected as the cause. Therefore, in those cases of gastric tube stasis, surgical drainage of the gastric tube should be performed.

Carcinoma in adenoma of the papilla of Vater

Carcinoma in adenoma of the papilla of Vater is extremely rare. We now report a case of adenocarcinoma in adenoma of the papilla of Vater and the clinicopathological findings are discussed. A 73-year-old Japanese woman was endoscopically diagnosed as a case of carcinoma combined with adenoma of the papilla of Vater. She underwent pancreatoduodenectomy and the postoperative course was statisfactory. Histological examination of the resected tissues revealed a superficial adenocarcinoma in the adenoma of the papilla of Vater. In certain cases, carcinoma of the papilla of Vater may develop from a pre-existing adenoma in the region. Therefore, we recommend that pancreatoduodenectomy should be done when an adenoma presents in this region.

A Case of Successful Management of an Abdominal Aortic Aneurysm extending to the Sigmoid Colon with Hemorrhagic Shock.

腹部大動脈瘤-腸管瘻は腹部大動脈瘤破裂の特殊な形であり予後不良で手術成功例は稀である. 今回われわれは腹部大動脈瘤-S状結腸瘻の一手術例を報告する. 症例は腹部大動脈瘤の診断にて経過観察中であった58歳男性で, 腹痛・腰痛・乏尿を主訴に来院, 臍部を中心に手挙大の拍動性腫瘤を触知, 疼痛を訴え緊急入院した. 入院後5日目大量下血を生じショックに陥った. 腹部大動脈瘤-腸管瘻と診断し動脈瘤切除と right axillo-bifemoral bypass 術および Hartmann 手術を行った. 緊急手術を施行し術後発症した後腹膜膿瘍は持続的経皮ドレナージにて治癒したが術前より合併していた拡張型心筋症のため術後4か月半で死亡した. 腹部大動脈瘤は破裂や消化管瘻などの合併症をきたす前に早期手術を施行することが最重要であると思われた.

Identification of Hemorrhagic Site of the Intestine by RI-angiography

A 36-year-old man was transferred to our department because of massive malena followed by shock. Gastroduodenal endoscopy revealed no bleeding source in the stomach or the duodenum. RI-angiogram performed immediately after admission revealed a bleeding area at the jejunum and laparotomy was done. The bleeding lesion was detected by exploratory jejunotomy and a jejunectomy was successfully performed over 15 cm, including the lesion. RI-angiogram is useful as selective antiography in the diagnosis of intestinal bleeding and is less invasive.