Shinya Yokoyama

A CASE OF MULTIPLE PRIMARY NON-SPECIFICULCER OF THE SMALL INTESTINE CAUSING PERFORATION AND MECHANICAL ILEUS

Multiple, primary non-specific ulcer of the small intestine is a relatively rare entity. We experienced a case of the disease causing perforation and mechanical ileus. A 75-year-old woman was seen at the hospital because of abdominal pain and vomiting on June 8, 1995. An emergency operation was performed with a diagnosis of perforative peritonitis. Upon laparotomy, an about 1mm perforation in the ileum on the contralateral to the mesentery and 80cm oral side from the terminal ileum was noted. A wedge resection including the perforation was conducted. Histopathological diagnosis of primary non-specific ulcer of the small intestine was made. After the operation the patient developed intestinal obstruction that was cured by conservative treatment using an ileus tube. He was discharged from the hospital on the 53rd hospital day. Thereafter, the patient experienced two episodes of ileus that were conservatively treated by using an ileus tube. On October 4, 1995, the patient underwent an operation for ileus again that revealed a circular stricture of the ileum 80cm oral side from the terminal ileum where was the same location as the former lesion and was thought to be causative site. A partial resection of the ileum including the stricture was performed. The resected material disclosed that the lumen whole-circumferentially formed the bottom of ulcer. Histopathologically it was diagnosed as primary non-specific ulcer of the small intestine.

A CASE OF SYNCHRONOUS MULTIPLE CARCINOMA OF THE COLON -MUCOSAL CARCINOMA IN THE THREE NOUDLE-AGGREGATING LESIONS ACCOMPANIED BY A TYPE 2 CARCINOMA-

An 80-year-old woman with loss of appetite was admitted to the hospital for evaluation and treatment of a tumor in the colon, which was found by barium enema examination. By colonofiberscopy, three flat elevated noudle-aggregating lesions were detected in the ascending colon, hepatic flexure of the transverse colon and descending colon. Further a type 2 tumor was detected in the hepatic flexure. Under the diagnosis of carcinoma in two lesions confirmed by histological examination, and taking a high incidence of malignant transformation of the adenoma into consideration, a right hemicolectomy and a partial resection of the descending colon were performed on May 15, 1997. In all of the noudle-aggregating lesions, well differentiated adenocarcinomas, limiting within the mucosa were confirmed by histological examination of the resectd spacimen. And these lesions were considered carcinoma in adenoma by the histological formation. The type 2 tumor was also confirmed as moderately differentiated adenocarcinoma, invading the proper muscle layer.

AN OPERATED CASE OF INTRAABDOMINAL BLEEDING OCCURRED 8 HOURS AFTER A PIECE OF IRON STUCK INTO THE LIVER

A 58-year-old man visited another hospital at about 2 p.m. on August 31, 1996, because a piece of iron nail perforated his abdominal wall when he was driving in the nail by a hammer and then an abdominal pain gradually appeared. Simple abdominal X-ray film revealed a piece of iron in the abdomen, and so he was referred to the hospital. Abdomincal CT scan revealed the immigrated iron piece in the S3 of the liver, but no intraabdominal bleeding was noted. A mild abdominal pain still lasted but the general condition was stable. As elective surgery for removal of the foreign body was scheduled for the patient. About 8 hours later, however, severe abdominal pain as well as hypotension occurred and the patient fell into a shock state. Abdominal ultrasonography revealed a pool of liquid under the left diaphragm. With a diagnosis of intraabdominal bleeding due to hepatic injury, an emergency operation was conducted. Upon median incision of the upper abdomen, there were about 1300ml of bloody ascites and a ruptured injury about 6mm in length on the surface of the S3 of the liver that might be made by stabbed iron piece, and the ruptured was bleeding site. After the iron piece was removed, the ruptured wound was sutured. Postoperative course was uneventful and the patient was dischaged from the hospital on the 17th hospital day.