Yasutomo Goto

True left-sided gallbladder with a portal anomaly: report of a case.

A 65-year-old female who presented with back pain was diagnosed to have the presence of biliary sludge in the gallbladder. Computed tomography showed that the round ligament connected to the left portal umbilical portion was in the normal anatomical position. However, the gallbladder was located to the left of the middle hepatic vein and the round ligament, attached to the left lateral segment of the liver. The right posterior portal vein diverged alone from the main portal vein, and there was a long stem from the right anterior and left portal veins. Laparoscopic cholecystectomy confirmed the abnormal location of the gallbladder. Most reported cases of left-sided gallbladder are caused by a right-sided round ligament, which is called a “false” left-sided gallbladder. A case of left-sided gallbladder with a normal left-sided round ligament, which is designated as a case of “true” left-sided gallbladder, is extremely rare.

Early carcinoma of the appendix vermiformis.

It is difficult to preoperatively diagnose early carcinoma of the vermiform appendix because of its rarity and few specific clinical features. In the present study, we report a preoperatively diagnosed mucosal carcinoma of the vermiform appendix.

Short- and long-term outcomes of open inguinal hernia repair: comparison of the Prolene Hernia System and the Mesh Plug method

PurposeTension-free mesh repair of adult inguinal hernias has become a standard procedure, but there have been few comparisons of the postoperative outcome after hernia repair using the Prolene Hernia System (PHS) vs. the Mesh Plug (MP) method in a large number of patients from a single institution.MethodsWe reviewed the medical records of patients to investigate the short- and long-term outcomes of the different types of hernia repair. Late symptoms were evaluated by questionnaire. A total of 1,141 repairs performed from 1999 to 2008 (PHS in 957 and MP in 184 repairs) were evaluated.ResultsThere were 93 early postoperative complications (8.2xa0%). A subcutaneous hematoma was found more frequently after MP repair compared with after PHS repair (3.8 vs. 1.3xa0%, Pxa0=xa00.013). Seven hundred and ten patients (62.2xa0%) could be followed up for more than 2xa0years. Recurrence was detected in 14 patients with PHS repair and two patients with MP repair (1.5 vs. 1.1xa0%, Pxa0=xa00.956). Wound infections occurred in three patients (0.3xa0%) with PHS repair vs. none with MP repair (Pxa0>xa00.999). Patients with PHS and MP repair showed no significant differences in the long-term wound pain.ConclusionsThe recurrence and wound infection rates were similar after hernia repair using the PHS and MP methods. Patients undergoing PHS repair developed fewer subcutaneous hematomas. An older age (≥65xa0years) was a significant independent risk factor for recurrence.

Twisted cystic artery disclosed by 3-dimensional computed tomography angiography for torsion of the gallbladder

Torsion of the gallbladder is a rare condition that most commonly affects elderly women. The symptoms of torsion mimic acute cholecystitis, but several clinical features and imaging findings can be useful for distinguishing it from typical acute cholecystitis. However, preoperative identification remains difficult. Three-dimensional angiography reconstructed by preoperative multidetector row computed tomography is useful for definitive diagnosis of torsion of the gallbladder. Demonstration of a twisted cystic artery by 3-dimensional computed tomography angiography represents specific and direct evidence of this condition, which allows immediate diagnosis and treatment.

Massive pneumoperitoneum after esophagectomy

A 79-year-old man presented for routine follow-up computed tomography after esophagectomy (reconstruction had been done by intrathoracic esophagogastrostomy) had been performed 18 months earlier for thoracic esophageal cancer (pT2, pN1, M0, stage IIB according to International Union Against Cancer classification). Although he had no symptoms, plain abdominal radiography and computed tomography revealed massive pneumoperitoneum and a small right pneumothorax. On the day after admission, upper gastrointestinal endoscopy showed no ulcers or strictures of the remnant esophagus, gastric tube, and duodenum. Air was released by spontaneous rupture of blebs in the right lung, after which it passed through the esophageal hiatus, which had been opened at the time of esophagectomy, and accumulated in the abdominal cavity. The origin of the gas can be understood from the postoperative anatomic changes, as can the mechanism of air retention in the abdominal cavity. When a patient has a history of operation, accurate understanding of operative procedure and postoperative anatomic change may provide a clue to appropriate diagnosis.