Takafumi Sato

Undifferentiated carcinoma of the duodenal ampulla

This report demonstrates a case of undifferentiated carcinoma of the duodenal ampulla. A 74-year male experienced jaundice lasting for 3 weeks. An upper gastrointestinal series demonstrated a polypoid, ovoid filling defect in the second portion of the duodenum, and duodenoscopy disclosed a protruding mass involving the orifice of the papilla of Vater. Cholangiography demonstrated obstruction due to compression in the terminal common bile duct. Pylorus-preserving pancreatoduodenectomy was performed on the diagnosis of ampullary carcinoma. The gross specimen showed a polypoid mass, measuring 3.5 cm in diameter, in the ampulla, located mainly in the duodenal submucosal layer and invading the terminal common bile duct. Histologically, the tumor was small cell type, undifferentiated carcinoma, arising from the duodenal epithelium adjacent to the ampulla.

Mucinous cystadenoma of appendix concomitant with perityphlic granuloma.

We describe a case of mucinous cystadenoma of the appendix with perityphlic granuloma. The patient developed a hard palpable mass in the right lower quadrant and barium enema inducted irregular bowel wall at the cecum. Based on a preoperative diagnosis of carcinoma of the appendix, we performed a laparotomy. On operation, we found a tumor mass in the region of the appendix; the mass adhered strongly to the retroperitoneum and cecum. Right hemicolectomy was carried out on a diagnosis of carcinoma of the appendix. Microscopic examination revealed mucinous cystadenoma of the appendix with perityphlic granuloma. Mucinous cystadenoma in the appendix is a rare tumor. In this patient, the tumor was accompanied by granuloma formation in adjacent tissues because of mucin expelled from the appendix. This case emphasizes that granuloma formation can make of difficult to differentiate mucinous cystadenoma in the appendix from cancer.

Pathogenesis and the role of bacteria in acute cholecystitis

The objective of this study was to clarify the etiology of acute cholecystitis and the role of bacteria in the bile in this condition. We evaluated 52 patients with acute cholecystitis; 46 had cholesterol stones and 6 had no claculi. In the presence of cystic duct obstruction, circulatory disturbance occurs gradually, but circulatory disturbance alone cannot cause severe inflammation unless a bacterial infection is present. If there is no obstruction, rapid circulatory disturbance produces necrotic changes of the gallbladder wall, which are implicated in a fulminant course. In both instances, bacterial infection may play an important role in fulminant cholecystitis. Bacteria implicated in acute cholecystitis are usually present in the bile before the onset of this disease.

A Case Report of Laparoscopic Right Hemicolectomy with Intracorporeal Anastomosis for Crohn's Diesase.

症例は18歳の男性. 大腸クローン病で上行結腸に高度の狭窄を来したため, 腹腔鏡下右半結腸切除術を施行した. 手術はすべて体内操作で行い, 回腸横行結腸吻合は自動吻合器を用い, 側側吻合いわゆるfunctional end to end ananstomosisを施行した. 摘出標本では, 上行結腸に広範に敷石状外観と縦走潰瘍がみられたが, 両側断端には病変の遺残はなかった. 術後経過は良好で, 早期に排ガス, 排便や完全な歩行が得られ, 開腹例に比べ回復が早いと思われた. 術後透視で吻合口は大きく保たれ, 9か月続過した現在, 再発の徴なく健常である. 以上から, 早期回復や腹腔内癒着の軽減が期待される腹腔鏡下腸手術は, その手技に熟練すれば, クローン病などの炎症性腸疾患にも, 積極的に施行されるべきと考えられた. しかし, 腹腔鏡下右半結腸切除術は手技が煩雑で簡単でなく, トロッカーの位置を含め手技の定型化や簡便化が今後の問題と思われた.