Takatoshi Furuya

Iliopsoas Muscle Hematoma Secondary to Alcoholic Liver Cirrhosis

Iliopsoas muscle hematoma in a patient with alcoholic liver cirrhosis is rarely seen, however it has a high mortality. Thus we should cautiously make a diagnosis and treatment. This is the case of a 60-year-old male. He had a 15-year history of alcoholic liver disease and emphysema. He presented with low back pain after a fall that had happened 2 months before. Due to persistent back pain, he went to see a local physician who, after detailed examination, suspected rupture of bilateral common iliac artery aneurysms and transferred the patient to our hospital. The same presumptive diagnosis was made, and on this basis, an aortic bifemoral Y-graft was implanted. He developed aspiration pneumonia and hepatic and renal dysfunction postoperatively, which led to multiple organ failure and subsequent in-hospital death on postoperative day 62. This was believed to be a case of iliopsoas muscle hematoma developed in a patient with liver cirrhosis, and considering it was a case with poor surgical risk, a conservative treatment option such as transcatheter arterial embolization should also have been considered. Although iliopsoas muscle hematoma with alcoholic liver cirrhosis is rare, an appropriate treatment plan should be determined on a case-by-case basis despite its poor prognosis.

Hemodynamic benefits of celiac artery release for ruptured right gastric artery aneurysm associated with median arcuate ligament syndrome: a case report

BackgroundIt has been reported that median arcuate ligament syndrome is closely associated with gastric or pancreaticoduodenal artery aneurysms. Hemodynamic state plays an important role in the formation of the aneurysms. These aneurysms are treated with open resection or endovascular exclusion. However, whether revascularization of the celiac artery can prevent the aneurysm formation is unknown. This report indicated a possibility that prophylactic revascularization for celiac artery stenosis resulted in decreased shear stress on the collaterals, which may otherwise be susceptible to new aneurysms.Case presentationThis report describes a 51-year-old man who presented with epigastric pain at our hospital. According to contrast enhanced computed tomography (CT), he was diagnosed with a ruptured right gastric artery aneurysm and celiac artery stenosis caused by the median arcuate ligament (MAL). He had a vascular anomaly of the common hepatic artery arising from the superior mesenteric artery (SMA). His vital signs were stable. We informed him of the situation and he chose open surgery rather than endovascular treatment. Following, we resected the aneurysm and transected the MAL. Intraoperative angiography after transection of the MAL showed the antegrade blood flow to the splenic artery instead of the retrograde flow via the prominent collaterals. Follow-up CT confirmed narrowed collateral vessels between the SMA and the celiac artery without de-novo aneurysms.ConclusionWhile the necessity of celiac artery release could be questioned, the present case supports the hemodynamic benefits of MAL transection in terms of de-novo aneurysm prevention.

Pancreatic insulinoma combined with glucagon positive cell: A case report

We present a 70-year-old man who was referred for surgery with uncontrollable hypoglycemia. Ultrasonography and abdominal contrast computed tomography revealed a hypervascular tumor of 1 cm in diameter in the pancreatic tail. With a diagnosis of insulinoma, we performed a distal pancreatectomy. The patient showed a good postoperative course without any complications. The patients early morning fasting hypoglycemia disappeared. The respective levels of C-peptide and insulin dropped from 14.9 ng/mL and 4860 μIU/mL preoperatively to 5.3 ng/mL and 553 μIU/mL after surgery. A histopathological examination demonstrated that the tumor was a pancreatic neuroendocrine tumor, grade 1. Immunostaining was negative for insulin and positive for CD56, chromogranin A, synaptophysin and glucagon. These findings suggested that the tumor was clinically an insulinoma but histopathologically a glucagonoma. Among all insulinoma cases reported between 1985 and 2010, only 5 cases were associated with independent glucagonoma. In this report, we characterize and discuss this rare type of insulinoma by describing the case we experienced in detail.

PC012. Surgical Training of Young Vascular Surgeons for Open Abdominal Aortic Aneurysm Repair Considering the Learning Curve

Objectives: Because endovascular aneurysm repair has become a predominant alternative, it has a high profile how to train young vascular surgeons in open surgery. The objective was to analyze the learning curve and determine the number needed to treat to establish sufficient surgical skills of open surgery for intact abdominal aortic aneurysm. Methods: This was a retrospective study of a prospectively accumulated database at Asahi General Hospital in Japan between 2003 and 2017. A total of 562 consecutive patients who underwent open repair for intact abdominal aortic aneurysm or iliac artery aneurysms either by an attending surgeon or by six young vascular surgeons (>20 experiences) were included. All young vascular surgeons had accomplished general surgery training. Analysis was conducted by every 10-cases experience performed by young vascular surgeons (Y group) to investigate the learning

Reply to three Editorials by Luris N et al ., Sussmann N, and Vather R, et al .

We are grateful to read three editorials by Lluis et al ., Sussmann, and Vather, et al . (1-3) for our recent study entitled “Perioperative factors predicting prolonged postoperative ileus after major abdominal surgery” in Journal of Gastrointestinal Surgery (4). We devised a nomogram to predict the development of prolonged postoperative ileus (PPOI) based on the multivariable logistic regression analysis for patients undergoing major abdominal surgery.

Influence of Cancer Cell Infiltration at Resection Margin of Hepatic Duct on Prognosis and Treatment of Middle and Lower Bile Duct Carcinoma.

1978年から1993年までの15年間に切除した乳頭部癌を除く中下部胆管癌28症例を対象とし, 肝側面除縁における癌浸潤陽性 (hw (+)) の予後に及ぼす影響につき検討を加えた.hw (+) 症例は10例36%に認めた.病理学的背景因子にhw (+) とhw (-) とでd因子以外差は認められなかった.入院死の2例を除く5年生存率は, hw (+) 30%, hw (-) 43.8%と両者で差が認められなかった.hw (+) 症例の術中迅速診によるhwの判定は6例で (+), 4例で (-) であった.術後判明の3例は5年以上生存した.再発形態は, hw (+) の有無にかかわらず5年以上生存例では吻合部再発であるのに対し, 5年未満死症例では, 遠隔転移, 癌性腹膜炎であった.以上よりhw (+) は単独で予後規定因子とならず, また5年予後の期待できない進行癌においては, 重要な再発因子とならないため, 治癒切除の根治性と病変の進展に配慮した, hwのみにとらわれないような切除術がのぞましいと考えられた.