maeda kotaro

We report a case of lipoma of the ileum with massive bleeding treated by laparoscopy-assisted partial resection of the ileum and review 49 cases of lipoma of the small intestine reported in Japan in the last 16 years. A 75-year-old woman with massive anal bleeding was admitted to the hospital. He had been examined for the same symptom 6 months earlier. Although colonoscopy suggested bleeding from the small intestine, we could not identify any lesions. We conducted laparoscopic surgery to identify the cause of the massive bloody stool. A tumor was detected in the ileum 90 cm proximal to Bauhin's valve, necessitating partial resection of the ileum. The resected specimen was a 2.5×2.1×3.5 cm submucosal tumor diagnosed histopathologically as lipoma. The patient has remained asymptomatic in the 4 years since surgery.

We report a rare case of multiple liposarcoma with dedifferentiation like a malignant granular cell tumor. An 84-year-old woman complaining of abdominal distention underwent a laparotomy with a suspicion of an ovarian tumor. Both a mesenteric tumor 10×10×10 cm in dimension and a retroperitoneal tumor 15×15×15 cm in dimension were excised. Preoperative CT and magnetic resonance imaging scans showed two tumors with different structures and there was nocommurication between them. Pathological examination revealed that both lesions were liposarcoma, one of them having the outline of a malignant granular cell tumor. Finally we diagnosed the case as multiple liposarcoma with dedifferentiation like a malignant granular cell tumor.

A novel transanal local excision, named minimally invasive transanal surgery (MITAS ; 89 cases), was retrospectively compared with conventional transanal excision (27cases) in perioperative outcome. MITAS includes usage of a new anal retractor and a stapler with several modified surgical techniques. Age, gender, tumor size, and complication rate were equivalent in both methods. Tumors were located higher up in MITAS than in the conventional method (p<0.01). Operative time, blood loss, and date of oral intake were less in MITAS (p<0.04). MITAS was considered to be a minimally invasive transanal local excision procedure, which is accessible to proximal tumors less invasively than conventional method for rectal tumors.

We reported a case with necrosis of the colon proximal to the anastomosis 3.5 years after low anterior resection. A 69-year-old woman with nausea and abdominal pain was admitted to our hospital. She had undergone a low anterior resection, with division of the inferior mesenteric artery at its root, for rectal cancer, 3.5 years previously. Emergency surgery was performed for increasing abdominal symptoms after conservative therapy. A laparotomy revealed necrosis of the colon proximal to the anastomosis after the low anterior resection. A colectomy with a colostomy in the transverse colon, and closure of the remnant rectum, were performed for the condition. She died eight months following the surgery, due to multiple organ failure.

A 42-year-old woman with anal bleeding at menstruation consulted a nearby clinic. She was diagnosed as having endometriosis, by biopsy under colonoscopy, and had been treated by endocrine hormone therapy for six months, without success. Colonoscopy and a barium emena study showed a stenosis with a mass in the sigmoid colon. Bilateral oophorectomy and partial resection of the sigmoid colon were performed under laparoscopy. Histopathological findings revealed endometriosis affecting the sigmoid colon, with fibrosis causini obstruction. The nostonerative course was uneventful.

極めてまれな腹壁正中ヘルニア嵌頓例を経験したので, 文献的考察を加えて報告する. 症例は80歳女性で. 1～2年程前から臍上部の腫瘤を自覚したが放置していた. 最近になり間欠的腹痛を伴い来院した. 上腹部に手拳大の腫瘤を触知し, 腹部CT検査で正中の筋膜欠損部より横行結腸が脱出, 嵌頓していた. 腹壁正中ヘルニア嵌頓の診断で緊急手術を施行した. ヘルニア門まで剥離後, 嚢を開放したところ, 内容は横行結腸および大網であった.壊死所見は認められなかったため, 腹腔内に還納可能で他に筋膜欠損部がないことを確認後, 前鞘と後鞘を2層に縫合し, ヘルニア門を閉鎖した. 術後は経過良好で現在まで再発は認められない. 腹壁正中ヘルニアは本邦では比較的まれな疾患であり, 結腸嵌頓例は極めてまれで定型的な術式がない. 詳細が明らかな本邦62例の集計も合わせ文献的考察を加えて報告する.

We report a rare case of multiple liposarcoma with dedifferentiation like a malignant granular cell tumor. An 84-year-old woman complaining of abdominal distention underwent a laparotomy with a suspicion of an ovarian tumor. Both a mesenteric tumor 10×10×10 cm in dimension and a retroperitoneal tumor 15×15×15 cm in dimension were excised. Preoperative CT and magnetic resonance imaging scans showed two tumors with different structures and there was nocommurication between them. Pathological examination revealed that both lesions were liposarcoma, one of them having the outline of a malignant granular cell tumor. Finally we diagnosed the case as multiple liposarcoma with dedifferentiation like a malignant granular cell tumor.

We report a case of lipoma of the ileum with massive bleeding treated by laparoscopy-assisted partial resection of the ileum and review 49 cases of lipoma of the small intestine reported in Japan in the last 16 years. A 75-year-old woman with massive anal bleeding was admitted to the hospital. He had been examined for the same symptom 6 months earlier. Although colonoscopy suggested bleeding from the small intestine, we could not identify any lesions. We conducted laparoscopic surgery to identify the cause of the massive bloody stool. A tumor was detected in the ileum 90 cm proximal to Bauhin's valve, necessitating partial resection of the ileum. The resected specimen was a 2.5×2.1×3.5 cm submucosal tumor diagnosed histopathologically as lipoma. The patient has remained asymptomatic in the 4 years since surgery.

Extensive Perineal hemangioma is rare. Only one case has been reported in the Japanese literature. We herein report a case of a very extensive perineal hemangioma, which extended from subcutaneous tissue of the penis to the rectal wall in the pelvic cavity.<BR>An 18-year-old man visited our hospital with anal pain, anal bleeding, and remittent fever. Helical CT, MRI, and angiography revealed a very extensive perineal hemangioma in the subcutaneous tissue of the penis, perineoscrotum, submucosa of the anus, rectal wall, and pelvic cavity. Complete excision of the tumor. was considered impossible due to its extensive growth. Other possible treatment modalities ; radiation, laser, compression, cryotherapy, and embolization of the feeding artery, were abandoned as well, due to their incompleteness of treatment. Finally, we selected conservative observation, because his compliant is controllable by maintaining the stool loose and using ointment for his anus. He is enjoying daily life in a university without sufferings from symptoms associated with his perineal hemangioma.

Radiation therapy is one choice for malignant disease of the lower abdomen. However, radiation sometimes induces radiation colitis as a severe side effect. Radiation colitis sometimes causes severe bleeding, and it is often difficult to treat, A 66-year-old man received radiation therapy (external radiation with 65.2 Gy) for carcinoma of the bladder. Bleeding in the rectum occurred approximately 15 months after irradiation. Severe bleeding and anemia could not be controlled by Salazosulfapyridine and steroid enemas, and frequent blood transfusion was needed. Therefore, we gave ecabet sodium enemas to this patient, twice every day, for four weeks. Bleeding and anemia could be controlled by this treatment. It is suggested that ecabet sodium enema can be an available treatment for radiation colitis.

Sacrococcygeal teratoma is rare tumor in adults. It is usually diagnosed and resected in infancy. Only 29 cases have been reported in the Japanese literature.<BR>We report a rare case of an adult sacrococcygeal teratoma with usefulness of multi planer reconstruction (MPR) and three-dimensional imaging (3D) by Helical CT for selecting an operation method and position.<BR>A 52-year-old man visited our hospital with dull oppression in his buttocks. Barium enema and MRI revealed a sacroccygeal cystic tumor in the presacral space between the coccyx and the rectum. We studied the tumor by MPR and 3D, to select its operation method and position. We completely resected the tumor, including the coccyx and the 5th sacrum, through a trans-sacral approach with a jackknife position. The excised tumor was a benign mature teratoma, 13×12×8.5cm in size. The postoperative course was uneventful. He Is well, without defecatory or urination disturbance.

Endocrine cell carcinoma of the colon is highly malignant, matastasizes to other organs early, is often detected in an advanced stage, and consequently has a very poor prognosis. A rare case of endocrine cell carcinoma coexisted with adenocarcinoma in the ascending colon following a resection of early cancer of the tranverse colon is reported. A 69-year-old woman was admitted to the hospital because two independent tumors were found in the ascending colon. There was a history of undergoing a resection of an early stage of colon cancer one and half years before admission. Bariun enema study and colonoscopy revealed an early stage carcinoma of IIa type and a yellowish submucosal tumor with central indentation in the ascending colon. Ileocecal resection was performed for these tumors. The submucosal tumor, 13×8×10mm in size, penetrated into the musuclaris propria. The tumor was consisted of large atypical polygonal cells which were positive for chromogranin and synaptophysin stainings. Electron micrograph showed an inclusing of neuroendocrine granules of the neoplastic cells in the cytoplasm. Histology of the submucosal tumor revealed endocrine cell carcinoma. Neuroendocrine cell carcinoma of the colon is a rare condition, and only 42 cases have been reported in the Japanese literature. This is the first case of the endocrine cell carcinoma with synchronous adenocarcinoma in the colon after metachronous adenocarcinoma of the colon. The patient has survived 2 years and 6 months after the surgery with no signs of recurrence.

Rectocele is an anatomical disorder in which the rectal wall protrudes anteriorly and causes defecatory disorders. A rectocele with clinical symptoms, such as difficulty in defecation, sould be considered for treatment. Conservative treatment should be conducted initially for a symptomatic rectocele, and surgical treatment should follow if conservative treatment fails. Conventional surgical treatments, with excision or ligation of the rectum or vaginal wall, have sometimes failed to improve the defecatory disorders and anatomical disorders. These conventional treatments are not suitable for improving urinary or stool incontinence. Technique and results of anterior levatorplasty, to improve these combined disorders, are described herein.

Questionnaires were sent to 91 colostomy patients to assess the present state of worry of irrigation and psychological problems. Ninety-two percent of colostomy patients have experienced irrigation. Sixty-two percent of them has undergone irrigation for more than five years, and 76.5 percent of them was more than 60 years old. Eighty-two percent of them performed continuous irrigation. Patients with irrigation had a fear of continuous irrigation in the future. More than 8 percent of irrigation patients were istructed how to irrigate at institutes other than hospital. Irrigation was performed once every one to three days in 92 percent of irrigation patients. Male patients irrigated more often than female patients. Volume of irrigation fluid was 500 to 1000 ml in 63 percent of irrigation patients, and it was more than 1000 ml in 15 percent of them. Many of them irrigated at a speed of more than 100 ml per minute, but no trouble occurred. Female patients with irrigation worried about the sound of gas more often than male patients. Irrigation patients had a fear of irrigation treatment in case of emergent events like earthquakes.