Yuzo Okamoto

A mesocolonic lymphangioma in an adult with peritonitis: a case report

Abstract Cystic lymphangiomas of the mesocolon are very rare in adults. They are usually asymptomatic, but can present with an acute abdomen. We report an adult patient with cystic lymphangioma of the mesocolon that manifested with peritonitis. A 33-year-old man presented with fever and severe pain with muscle guarding in the left abdomen. Laboratory data indicated high-grade inflammation. Enhanced computed tomography (CT) showed multiple low-density masses with peripherally enhancing rims, strongly suspicious for cysts, in the left abdomen. Based on a diagnosis of peritonitis, emergency surgery was performed and revealed many cysts in the descending mesocolon. Histopathological examination findings indicated a cystic lymphangioma. The post-operative course was uneventful, and 1-year follow-up CT showed no recurrence. This case demonstrates that cystic lymphangiomas of the mesocolon in adults can present with acute peritonitis, although this is extremely rare. Complete resection is required for accurate diagnosis and for preventing recurrence.

Assessment of cancer pain in a patient with communication difficulties: a case report

BackgroundThe number of patients who have difficulty with mutual understanding has been increasing recently due to an aging society. This emerging issue needs to be addressed. We report an instructive case of a patient who had communication difficulties due to dementia and sequelae of alcoholic encephalopathy.Case presentationA 66-year-old man of Mongolian race presented with coronary arteriosclerosis, spinal canal stenosis, transverse colon cancer, and alcoholic encephalopathy. We had been requested to remove wires that had been used for the closure of his chest in a coronary artery bypass grafting procedure. However, on admission, a tortured expression and abdominal distention were observed, along with emaciation. We diagnosed terminal stage cancer, and palliative care was offered. An abdominal computed tomographic scan revealed rectal cancer with stenosis and invasion to the adjacent tissues. A metallic stent was inserted, leading to reduction of the abdominal distention and an improvement of tachycardia. However, the patient’s tortured expression was not completely relieved; therefore, an assessment of cancer pain was considered. The Abbey Pain Scale was applied. On the basis of the patient’s score, analgesics and an opioid, among other medications, were administered. These led to relief of the patient’s tortured expression and reduced his Abbey Pain Scale score. Following this, the patient’s vital signs continued to be stable, and he was transferred to the referral institution.ConclusionsManagement of cancer pain in elderly patients with mutual understanding difficulties must be performed carefully. In the case of our patient, staff at the referral institution informed us of the patient’s latent torture, and we applied the Abbey Pain Scale. There was some confusion and uncertainty regarding clinical management throughout the patient’s care; however, his condition eventually stabilized. We believe the application of the Abbey Pain Scale assists in the relief of cancer pain. However, accumulation of further cases and experiences to verify this assessment is required.