maeda kotaro

An 89-year old woman visited the hospital near her house due to abdominal pain and was admitted with a diagnosis of colonic ileus. Rectal cancer was found 15cm from the anal verge by colonoscopy. After examination, abdominal tympanity was aggravated. She was referred to our hospital. Since a plain abdominal X-ray taken of the subject area showed free air in the bilateral subphrenic space, an emergency operation was performed due to suspected diffuse peritonitis caused by colonic perforation. The operation revealed rectal perforation due to Press Through Package (PTP) at the 5 cm oral side of the rectal cancer. The Hartmann's operation was performed. As cases of colonic perforation become severe, the prevention of accidental swallowing is important to avoid intestinal perforation caused by PTP.<br>

Imaging diagnosis and treatment for anorectal functional disease are reviewed. Trananal ultrasound, defecography with or without peritoneography, MRI and CT imaging are useful imaging tools for identifying anorectal functional disease. Conservative treatment should be initially selected for the treatment of this disease, then surgical intervention should be carefully considered after evaluating conservative treatment.

A total of 5, 358 patients with colorectal cancer who underwent curative resection from January 1991 to December 1996 were studied for the incidence of multicentric colorectal cancers and multiple primary cancers of other or-gans.<BR>There were 211 cases of metachronous multiple primary cancers, and gastric cancer was most frequent (24%). The prevalence of synchronous multiple primary cancers was 3.5%, and that of synchronous gastric cancer was 1.6%, which was higher than that of gastric cancer found in mass screening in Japan. Screening for gastric cancer before surgery for colorectal cancer can be considered.<BR>As this study did not demonstrate that patients after surgery for colorectal cancer had a high risk of metachro-nous multiple primary cancers, surveillance for metachronous multiple primary cancers may not need to be included in the follow-up program after surgery for colorectal cancer. The patients are recommended to receive mass screening.<BR>The incidence of metachronous colorectal cancers after colorectal surgery was higher, so periodic follow-up for metachronous multicentric colorectal cancers should be recommended.

A 53-year-old man was admitted to our hospital because of anal bleeding and thin feces. Digital examination revealed a protruding lesion 7 cm above the anal verge at the site of the anterior wall of the rectum. Colonoscopic examination revealed multiple map-like ulcers in the area extending from the anal canal to the upper rectum. Examination of a biopsy specimen failed to demonstrate Treponema pallidum, but syphilitic proctitis was suspected because of positive reaction in the serological tests (TPHA, SLIDE, FTA-ABS) for syphilis. After initiation of amoxicillin treatment, rapid healing of the rectal lesions was confirmed by colonoscopy. Overall, a definitive diagnosis of syphi-litic proctitis was made.

A 77-year-old woman without any history of abdominal surgery was admitted to the hospital because of abdominal pain. She had had repeated episodes of ileus with unknown origin over a period of 15 years. A plain abdominal X-ray and CT examinations showed distention of the small intestine and the presence of calcified bodies in the intestine. Gastrointestinal radiography from an ileus tube revealed two stenoses of the small intestine with an oval defect in the midpoint of the stenotic lesions. The patient was diagnosed as having stenoses of the small intestine with the presence of calcified bodies. Laparotomy showed two stenotic lesions in the ileum locating approximately 40cm orally from the ileocecal valve. Partial resection of the ileum was performed. Incision of the resected segment of the intestine revealed several pieces of shiitake and two hard seed-like calcified bodies. The calcified bodies were found to be calcified seeds of pickled Japanese apricot impacted in the ileum between the stenotic lesions. The patient's postoperative course was uneventful.