Tomoaki Morita

Laparoscopic resection of an ileal lipoma : Report of a case

A 63-year-old woman was admitted to our hospital for investigation of upper abdominal pain and vomiting. Ultrasonography (US) showed a hyperechoic mass in the right lower abdomen, and computed tomography (CT) showed a low-density mass and intestinal invagination. Thus, we made a diagnosis of intestinal lipoma with intussusception and performed laparoscopic partial resection of the ileum, including the tumor. The resected specimen contained a round tumor, 25 × 22 × 20 mm, which was identified as an intestinal lipoma histopathologically. Our experience supports earlier reports that US and CT are effective tools in the diagnosis of bowel lipoma. Laparoscopic surgery is the treatment of choice for benign tumors of the small intestine because it is minimally invasive, with cosmetic, physical, and economic benefits.

Laparoscopic cecopexy for mobile cecum syndrome manifesting as cecal volvulus: Report of a case

A 44-year-old woman was admitted to our hospital for investigation and treatment of sudden abdominal pain and distention. Plain abdominal radiography and abdominal computed tomography (CT) findings were suggestive of sigmoid volvulus. She underwent an emergency colonoscopy, and the scope passed easily through the sigmoid colon and reached the ascending colon quickly. However, stenosis with concentricity of the fold was observed in the cecum, which was shifted upward and to the left. Based on these findings, we diagnosed cecal volvulus caused by mobile cecum syndrome. The patient’s symptoms resolved quickly after colonoscopic reduction and elective laparoscopic surgery was performed 18 days after admission. Perioperative examination revealed a mobile cecum caused by an elongated ascending colon. We sutured the cecum and ascending colon to the lateral peritoneum laparoscopically with interrupted sutures. The patient recovered well and was discharged on postoperative day 7. An unfixed intestine can be detected easily during laparoscopic surgery, which is minimally invasive and cosmetically, physically, and economically beneficial. Thus, we recommend laparoscopic cecopexy for mobile cecum syndrome.

Early laparoscopic cholecystectomy for acute gangrenous cholecystitis.

Treatment of severe acute cholecystitis by laparoscopic cholecystectomy remains controversial because of technical difficulties and high rates of complications and conversion to open cholecystectomy. We investigated whether early laparoscopic cholecystectomy is appropriate for acute gangrenous cholecystitis. Pathologic diagnoses and outcomes were analyzed in patients who underwent laparoscopic or open cholecystectomy at our hospital, January 2002 to September 2005. Of 30 patients with acute gangrenous cholecystitis, 16 underwent early laparoscopic cholecystectomy, 10 underwent open cholecystectomy, and 4 were converted to open cholecystectomy (conversion rate, 20.0%). There was no significant difference in operation time or intraoperative bleeding. The requirement for postoperative analgesics was significantly lower (6.4±7.3 vs. 1.5±1.2 doses, P<0.05) and hospital stay significantly shorter (8.6±2.1 vs. 15.6±6.3 d, P<0.01) after laparoscopic cholecystectomy. There were no postoperative complications in either group. Thus, early laparoscopic cholecystectomy seems appropriate for acute gangrenous cholecystitis. Conversion to open cholecystectomy may be required in difficult cases with complications.

Leiomyoma of the left posterior tibial artery: A case report

A case of leiomyoma of the left posterior tibial artery is presented. This tumor produced aneurysmal dilatation of the artery and was treated successfully by surgery. This may be the first documented case of a benign smooth muscle tumor, although nearly 100 leiomyosarcomas arising from large arteries and veins have been described in the literature.

A Case of Primary Adrenal Lymphoma with Invasion to the Right Kidney and the Liver

症例は78歳の男性で, 右季肋部痛・背部痛を主訴に近医を受診し, 後腹膜腫瘍の診断で当科に紹介された. 血液検査ではLDHの上昇を認め, 腹部CT・MRIで右副腎に造影効果のあるφ15×15cm大の腫瘍を認め, 肝・右腎への浸潤も疑われた. 腹部血管造影では右下副腎動脈をfeeding-arteryとするtumor-stainを認めた. 以上より, 肝・右腎浸潤を伴う右副腎原発悪性腫瘍と診断し肝右葉・右腎と腫瘍を一塊に切除した. 摘出標本は1.3kg, 腫瘍は白色充実性・弾性硬腫瘤で肝右葉および右腎への直接浸潤を認めた. 病理組織では悪性リンパ腫 (diffuse mixed sized B-cell type) であった. 術後第29病日に退院. 自宅療養の後CHOP療法を4クール施行した. 現在, 術後2年を経過した現在も再発の兆候はなく経過観察中である. 副腎原発悪性リンパ腫に対しては早期発見・積極的治療が重要と考える.

COLONIC CANCER WITH INTUSSUSCEPTION PROLAPSING THROUGH THE ANUS -REPORT OF 3 CASE

Colonic cancer as the leading point prolapsing through the anus is a rare disease, . We experienced three cases of this disease for the past 10 years. Case 1: A 72-year-old woman had an extraanal prolapse of the egg size tumor. On laparotomy, the intussusception was reduced colonic was performed. Case 2: An 86-year-old woman was found having an extraanal prolapse of the walnut size tumor. A high anterior resection was performed without reducing the intussusception. This case was of sigmoid colonic cancer. Case 3: A 91-year-old woman had an extraanal prolapse and incarceration of the elastic soft tumor (8.0×5.0cm). Resection of the sigmoid colonic was performed. This cancer developed on Rs region. Sigmoid colonic cancer rarely protrudes through the anus. Another 8 cases of this disease reported in Japan and these 3 cases were examined about the clinic opathological features.

A CASE OF OBTURATOR HERNIA AND A COLLECTIVE REVIEW OF THE CASES REPORTED IN JAPAN

最近 我 々は比較 的 まれ な疾 患 と され る閉鎖孔 ヘ ル ニアを経 験 した ので報 告 す る とと も に,本 邦報 告 例 を集計 し検 討 を加 えた. 本症 はやせ 形で 高齢 の婦 人 に多 く,分 娩回 数の 多い もの に多発 す る傾 向に あ った.イ レウス症状 に よ り発症 す る ものが殆 ん どであ り, Howship-Romberg徴 候 は80%に 認 め られ た.術 前 診断 率 は27%と 未 だ低値 で はあ るが,年 を追 うに従 い上 昇 して いた.ヘ ル ニア門の 処置 と して は,結 節縫 合 に よる閉鎖 法が最 も多 用 されて い たが,壁 側 腹膜 を結 節縫 合す る場 合 には再 発の危 険 が あるた め骨膜 と閉 鎖膜 を縫 合す るこ とが望 ま しい. 高齢 女性 で 突然 イ レウス症 状 を呈 した場 合 には本 症 を も念 頭に置 くベ きで あ る.