Shigenori Sato

Diverticular disease of the colon at a regional general hospital in Japan

PURPOSE: X-ray film registry records were reviewed to better understand the changing nature of diverticular disease (DD) of the colon in Japan. RESULTS: Among 6,849 patients undergoing barium enema examination during a eight-year period from 1985 to 1992, this condition was found in 1,074 patients (15.7 percent), including 702 males (65.4 percent) and 372 females (34.6 percent). During this eight-year period there was an increase in frequency from 10.7 percent in 1985 to 17.8 percent in 1992. The proportion of patients with right-sided, bilateral, and left-sided DD was 69.2 percent, 17.5 percent, and 13.3 percent, respectively. The right-sided DD was more common in the younger age group and was predominant in male patients, whereas the left-sided DD increased with age, especially in female patients. Of the 1,074 patients, 11 (1.0 percent) underwent surgery in the same period. Regarding the rightsided DD, only 2 of 743 patients received surgery (0.3 percent). On the other hand, of the 143 patients with left-sided DD, 9 patients (6.3 percent) received some form of surgery. CONCLUSION: Right-sided diverticular disease of the colon is still common in Japan. It does not appear that this tendency will change in the future. Nearly all patients diagnosed as having diverticula had either no symptoms or only mild symptoms, and only about 1 percent required surgery. Right-sided diverticular disease of the colon seems to have had no serious clinical problems compared with left-sided DD.

Desmoplastic response in biopsy specimens of early colorectal carcinoma is predictive of deep submucosal invasion

PURPOSE: The aim of this study was to evaluate the role of histopathology of biopsy specimens in predicting depth of infiltration in early colorectal carcinomas before treatment. METHODS: Early colorectal carcinomas that had been resected surgically or endoscopically between 1984 and 1995 were analyzed. Histopathologic findings, including differentiation of adenocarcinoma and a desmoplastic response were investigated. RESULTS: One hundred nine early colorectal carcinomas consisted of 73 lesions of carcinomain situ, 13 submucosal carcinomas with minimum invasion, 8 lesions with moderate invasion, and 15 lesions with deep invasion. Of 73 carcinomain situ lesions, 72 (approximately 99 percent) showed well-differentiated adenocarcinomas and no desmoplastic response. Twelve (92 percent) of 13 submucosal carcinomas with minimum invasion also revealed well-differentiated adenocarcinoma without a desmoplastic response. Sixty-three percent (5/8)of lesions with moderate invasion revealed well-differentiated adenocarcinoma. None of the lesions had a desmoplastic response. Among lesions with deep invasion, 73 percent (11/15) demonstrated moderately differentiated adenocarcinoma, and 11 lesions had a prominent desmoplastic response (73 percent;P<0.01). CONCLUSIONS: These results suggest that if histopathologic findings of biopsy specimens taken from them before treatment demonstrated adenocarcinoma associated with a desmoplastic response, the lesions had at least deep invasion carcinomas. These lesions should be resected surgically. Submucosal carcinomas with minimum invasion, which have no desmoplastic response, could be treated endoscopically.

Prednisolone therapy for intra-abdominal desmoid tumors in a patient with familial adenomatous polyposis

The management of intra-abdominal desmoid tumors in patients with familial adenomatous polyposis (FAP) is very difficult. Non-steroidal anti-inflammatory drugs (NSAIDs), anti-estrogenic agents, and steroids are most commonly used, because surgical removal of these tumors may result in severe morbidity, with local recurrence being common. We report a patient with FAP and intra-abdominal desmoid tumors that regressed markedly after prednisolone therapy. The patient, a 38-year-old woman, had undergone total colectomy and ileorectal anastomosis with a diagnosis of FAP with colon cancer. Approximately 17 months after the surgery, she noticed an elastic firm lump in the abdominal wall. She also experienced lower abdominal distension. Computed tomography (CT) of the lower abdomen showed an invasive heterogenous low-density mass occupying the intra-abdominal space. She was treated with sulindac, NSAID, at 300 mg/day, the diagnosis being intra-abdominal desmoid tumors. She exhibited an intestinal obstruction about 9 months after the initiation of sulindac therapy. We changed the treatment and began prednisolone (initial dose, 40 mg/day). This treatment was continued for two years; subsequently the lesions regressed markedly. She is currently well, more than 3 years after the withdrawal of prednisolone.

The Use of Autologous Fibrin Glue for the Treatment of Postoperative Fecal Fistula Following an Appendectomy: Report of a Case

We herein report a case of postoperative fecal fistula following an appendectomy which was successfully treated by the use of autologous fibrin glue. An 82-year-old man had acute appendicitis and underwent an appendectomy. Later, a fecal fistula developed and he underwent drainage treatment twice. After 4 weeks of drainage and during the third recurrence, the remaining fistula was successfully treated using autologous fibrin glue, instead of surgery, due to potential complications and the risks of associated with advanced age. No recurrence has been observed for 5 months. In conclusion, autologous fibrin gluing for fecal fistula was found to be a safe, economical, and effective treatment. A search of Medline from 1980 until 2002 revealed no other report of this treatment for postoperative fecal fistula following an appendectomy.

Transperitoneal drainage for a large cystic degeneration after regression of an intra-abdominal desmoid tumor.

A new technique is described for treating a large cystic degeneration after regression of an intra-abdominal desmoid tumors in patients with familial adenomatous polyposis. A cysto-peritoneal shunt is made for the relief of large cystic degeneration by creating a channel between the mesenteric cyst and the peritoneal cavity by means of a silicone tube to facilitate transperitoneal drainage.

Surgical Management for Villous Tumors of the Rectum

We describe 10 patients with villous tumors of the rectum. Seven tumors showed severe dysplasia but only one invasion of the muscularis propria of the bowel wall. All patients underwent a sphincter-conserving operation. There was one local recurrence which was treated by further local excision. One patient died of other causes, but the remainders recovered.Villous tumors of the rectum, even those showing severe dysplasia, can be adequately treated by local excision because they are adenomas. However, anterior resection is indicated when the tumor is too large for local excision, is located in the upper rectum, or when invasive cancer cannot be ruled out.ZusammenfassungEs werden zehn Patienten mit villösen Rektutumoren beschrieben. Sieben Tumoren zeigten eine schwere Dysplasie, aber nur einer eine Invasion in die Lamina muscularis propria der Darmwand. Alle Patienten wurden einer sphinktererhaltenden Operation unterzogen. Es trat ein Lokalrezidiv auf, das mit einer weiteren lokalen Exzision behandelt wurde. Ein Patient starb aus anderen Gründen, die übrigen erholten sich.Villöse Tumoren des Rektums, auch solche mit schweren Dysplasien, können angemessen mit lokalen Exzisionen behandelt werden, weil es sich bei ihnen um Adenome handelt. Trotzdem ist die vordere Resektion indiziert, wenn der Tumor zu groß für eine lokale Exzision ist, wenn er im oberen Rektum lokalisiert ist oder wenn ein invasiv wachsendes Karzimon nicht ausgeschlossen werden kann.

Early Triple Carcinomas Metachronously Involving the Sigmoid Colon, Stomach and Gallbladder Report of a Case

We present a case of early triple carcinomas metachronously involving the sigmoid colon, stomach and gallbladder in order to emphasize that a mass screening is useful in the detection of early cancer of the alimentary tract.A 61-year-old male was admitted to the hospital for investigation of a flat elevated lesion of the sigmoid colon. The patient received partial resection of the sigmoid colon with the diagnosis of carcinoma.Pathologic findings showed adenocarcinoma confined to the mucosa. Sixteen months after surgery, a depressed stomach lesion was found through a mass screening. Distal gastrectomy was performed because of carcinoma, which was histologically confined to the mucosa. Sixty-five months later, he underwent cholecystectomy because of a polypoid lesion of the gallbladder. Pathologic findings disclosed adenocarcinoma infiltrated into the muscular layer of the gallbladder. The patient is currently in good health about 4 years after undergoing cholecystectomy.ZusammenfassungWir berichten über einen Fall von drei Frühkarzinomen, die metachron in Sigmoid, Magen und Gallenblase auftraten, um darauf hinzuweisen, dass ein Massenscreenig zur Entdeckung von Frühkarzinomen des Verdauungstraktes sinnvoll ist.Ein 61-jähriger Mann wurde zur Abklä,rung einer flach erhöhten Läsion des Sigmoids stationär aufgenommen. Der Patient unterzog sich einer Teilresektion des Sigmoids mit der Diagnose eines Karzinoms.Die pathologische Aufarbeitung ergab ein Adenokarzinom, das auf die Mukosa beschränkt war. 16 Monate nach der Operation zeigte sich bei einer Reihenuntersuchung eine indurierte Magenläsion. Es folgte eine distale Gastrektomie aufgrund eines Karzinoms, das auf die Mukosa begrenzt war. 65 Monate später musste sich der Patient wegen einer polypoiden Läsion der Gallenblase einer Cholezystektomie unterziehen. Die pathologischen Befunde ergaben ein Adenokarzinom, das die Muskelschicht der Gallenblase infiltriert hatte. Der Patient is zur Zeit, etwa vier Jahre nach der Cholezystektomie, bei guter Gesundheit.