Shin-ichiro Suzuki

SEGMENTAL MEDIOLYTIC ARTERIES : A CASE REPORT WITH REVIEW OF THE LITERATURE

Summary Segmental mediolytic arteritis is a very rare vascular disease which causes sudden intraabdominal hemorrhage. The disease is characterized by degeneration of the arterial media, followed by aneurysmal dilatation and rupture of the involved artery. Up to now, only 13 cases have been reported, and this unique disease is not fully recognized among general pathologists and physicians. Here, we present a case of segmental mediolytic arteritis involving the propria hepatic artery, which resulted in intraabdominal hemorrhage, and consequently hypovolemic circulatory disturbance. Histologically, the rupture focus showed degeneration and desquamation of the intima and media with fibrin-like material covering the exposed adventitia. Inflammatory infiltrates were only noted in the rupture focus as a secondary reactive change. Other than the rupture focus, there were two foci showing similar findings. This disease has rarely been reported and is seldom recognized as a cause of arterial rupture. In cases of sudden intraabdominal hemorrhage, segmental mediolytic arteritis should be considered as a possible cause in addition to atherosclerotic and mycotic aneurysm, traumatic injury and vasculitis syndromes.

MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY FOR AFFERENT LOOP SYNDROME

In April 2006, a 70-year-old man who had undergone a subtotal gastrectomy with Billroth II reconstruction for a benign peptic ulcer in 1955 and cholecystectomy for gallstones in 2005 was admitted to our hospital complaining of abdominal pain, distention and vomiting. Physical examination showed a large cystic abdominal mass with tenderness in the epigastrium. The results of laboratory tests showed serum amylase (AMY) of 518 IU/L, alanine aminotransferase of 641 IU/L, aspartate aminotransferase of 1198 IU/L, lactate dehydrogenas (LDH) of 378 IU/L and white blood cell of 5100/lL. Computed tomography (CT) examination showed fluid-filled loops of bowel (Fig. 1a). The superior mesenteric vessels were displaced anteriorly (Fig. 1a). These findings strongly suggested the diagnosis of afferent loop syndrome.1,2 MRCP clearly showed a long complex afferent loop course with an abrupt cut-off at the site of the gastrojejunostomy anastomosis (Fig. 2).

Laparoscopic surgery using a newly designed suction lifter.

The authors describe a simple and available abdominal wall-lift technique for endoscopic surgery that involves a new suction lifter that they designed for laparoscopic surgery. Since July 1998, the authors have used this technique successfully in eight patients with appendicitis, in one patient with a perforated duodenal ulcer, and in one patient with an adenoma of the ascending colon.