maeda kotaro

We report a rare case of lymphoid lymphoma in the upper rectum resected by minimal invasive transanal surgery (MITAS). A 13-year-old woman complained of anal bleeding and progressive constipation. The rectal tumor with poor mobility was found by digital examination and colonoscopy revealed a 30 mm-diameter sub-mucosal tumor at the upper rectum. Endoscopic mucosal resection was difficult. Endoscopic ultrasonography revealed gastrointestinal stromal tumor and microscopic findings by endoscopic biopsy demonstrated an ulcer without malignancy. We performed local resection of the tumor with total rectal wall by MITAS for preoperative diagnosis and her quality of life. The pathological diagnosis demonstrated a lymphoid lymphoma with fibrotic changes in the submucosa. Immunohistochemical staining showed bcl-2, CD-20, CD-5, CD-3 and FDC positive in the submucosal tumor. During two-year follow-up, no lesion was observed in the colon and ileum. MITAS is an effective maneuver for the therapy or diagnosis of a submucosal tumor in the upper rectum.

An 89-year-old woman admitted to the hospital because of lower abdominal pain and appetite loss was found to have an ovarian tumor 10cm in diameter and massive ascites on CT examination. Jerry like mucus was aspirated and diagnosed as pseudomyxoma peritonei by cytological examination. Operation was carried out after her general condition became stable though her advanced age. A large amount of the jerry like mucus was full in the abdomen, and the ovarian tumor which had an elastic soft septum was confirmed in the pelvis. The appendix did not show any significant macroscopic changes. The jelly like mucus was removed and appendectomy and excision of the ovarian tumor were performed, followed by repeated irrigation with 5% glucose solution. Histopathological examination of the resected specimen revealed pseudomyxoma due to mucinous cystadenoma of the appendix with a mature ovarian teratoma. The postoperative course was uneventful. The operative treatment can be an option for pseudomyxoma peritonei even if the patient is of great age.

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 <i>shiitake</i> 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.

Several researchers have reported the possible association between colorectal cancer and schistosomiasis japonica. However, it remains to be determined whether this association is significant. We report a case of sigmoid colon cancer associated with schistosomiasis japonica and discuss the relationship between schistosoma japonica and the development of colorectal cancer from a review of the Japanese literature. An 82-year-old man was referred to our hospital because of bloody stool. He had worked as a fisherman for 30 years in an endemic schistosomal area. A tumor was detected in the sigmoid colon without distant metastases. Sigmoidectomy with lymph node dissection was performed. A type-1 tumor measuring 2.5 × 2 × 1.5 cm was revealed in the resected specimen. Histological findings demonstrated well differentiated adenocarcinoma with muscular invasion, moderately lymphatic vessel invasion and lymph node metastases (n1). Many calci-fied eggs of schistosomiasis japonica were also seen in the colonic wall of both the tumor and normal tissue, mainly in the submucosal layer. The eggs were more often seen in the tumor than in the normal tissue. The patient also underwent transanal local excision for rectal adenoma 16 months later and survived for 50 months after the initial operation without recurrence.

Twenty-seven patients with ischemic colitis who were referred to Fujita Health University between 1988 and 2002 were studied to clarify the clinical features of ischemic colitis after colorectal surgery. The patients were divided into two groups : the patients undergoing colorectal surgery (POIC, 10 cases) and the patients without previous colorectal surgery (NOIC, 17 cases). Gangrenous colitis was seen in 1 of POIC and transient colitis was seen in 26. Among 10 patients of POIC, low anterior resection was performed in 8 patients, sigmoidectomy and right hemicolectomy in 1 patient each. The main feeding artery was divided at its root in every operative case. Predisposing factors of ischemic colitis were seen in 5 (63.6%) of POIC. They were more frequently seen in NOIC than in POIC with a significant difference. Abdominal pain appeared in 3 (33.3%) of POIC as the first symptom and in 4 (44.4%) of POIC during the course. It more frequently ap-peared in NOIC than in POIC as the first symptom and the symptom during the course, although there were no significant differences. Ischemic change occupying more than a half the circumference of intestinal wall was found in 2 (22.2 %) of POIC. Although transient ischemic colitis after colorectal surgery tended to occur without an underlying disease or conditions, severe symptoms rarely occur. However, if ischemic colitis occurs in a patient with severe underlying disease, it is important to remember that severe colitis such as gangrenous colitis could occur.

Basaloid carcinoma of the anal canal is a rare disease that shows histopathological resemblance to basal cell carcinoma of the skin. We experienced a case of basaloid carcinoma of the anal canal. A 76-year-old woman with anal pain was admitted for further examination and was diagnosed as basaloid carcinoma. Abdominoperineal rectum amputation with partial resection of vagina and lymph node dissection were per-formed. Histo-pathological examination of the resected specimen showed the tumor consisted of peripheral palisading of spindle shaped cells and basaloid cell carcinoma was diagnosed. The postoperative course was uneventful and there were no signs of recurrence after operation.

Ulcerative colitis generally occurs in young people under 30 years old ; the occurrence of ulcerative colitis in patients more than 70 years old is uncommon. We report a case of ulcerative colitis induced by barium enema study and colonoscopy at the age of 75 with a review of 29 cases with ulcerative colitis that occurred among those more than 70 years old reported in Japan. A 75-year-old man with paralysis of his left hand due to poliomyelitis was referred to Rokuwa hospital to check the large bowel because of constipation. Barium enema study and colonoscopy did not show any findings. However, he had bloody stool, abdominal pain and diarrhea 10 days after the barium enema study and 6 days after the colonoscopy. Colonoscopy was performed to check the origin and the findings were compatible with ulcerative colitis, but histopathological findings with a biopsy specimen did not support clinical diagnosis. He was treated for colitis by intravenous hyperalimentation, but symptoms did not improve much. Biopsy specimens taken 20 days after the onset of the colitis confirmed that his illness was ulcerative colitis. Mesalazine was administered and clinical symp-toms improved together with endoscopic remission. The patient has remained asymptomatic for 1 month after his discharge.

We report herein surgical treatments for vaginal vault and complete genital prolapse with rectocele, peritoneocele, cystocele, and sphincter dysfunction.<BR>A 51-year-old woman, who had a 13-year history of vaginal vault and complete genital prolapse with urinary incontinence and dysfunction, constipation, and soiling of stool, was referred to our department for surgery. One-fourth of the anal sphincter was interrupted anteriorly by digital examination, and defecogra-phy revealed an enterocele. Anterior levatorplasty with sphincteroplasty was performed in addition to a transvaginal hysterectomy, anterior colporraphy. Partial excision and closure of the cul de sac of the perito-neum with pexy of the vaginal wall was added during surgery. The postoperative course was essentially uneventful without further recurrence or appearance of symptoms during a six-month follow-up.

We report a case of delayed multiple penetration of the sigmoid colon by a transanal foreign body. A 39-year-old man with abdominal pain was referred to our hospital due to the presence of a transanal foreign body. Physical examination revealed a palpable abdominal tumor with tenderness, but no muscular rigidity. Abdominal CT showed a foreign body in the pelvic cavity, without free air. Emergency laparotomy demonstrated purulent ascites and a shaped foreign body in the sigmoid colon. Multiple penetration due to pressure necrosis by the foreign body was observed in the sigmoid colon. Partial resection of the colon with covering colostomy was performed. The postoperative course was uneventful.

A 48-year-old woman was seen at the hospital because of an anterior neck mass in April, 2000. She had progressive muscular dystrophy since the age of 20, and used a wheelchair in her life. The neck mass was diagnosed as a follicular tumor of the thyroid in the left lobe by US and fine needle aspiration cytology, then she was under observation at the outpatient unit. She had the sudden onset of massive anal bleeding in November, 2002, and was diagnosed as having rectal cancer with multiple metastases to the bilateral lungs. She was treated by partial resection of the rectum with artificial anus construction, and followed up with 150 mg of 5-FU oral administration.<br>In April, 2003, she was seen at the hospital again because of the growing neck tumor and a sense of compression. Although US and cytology showed no malignant findings, she was admitted to the hospital for her strong desire to relieve the serious compression sensation by removing the tumor. The tumor was a 6×5 cm, well defined and smooth surfaced mass in the left lobe of the thyroid, and it had a hard node (1.0×1.0 cm). Laboratory examinations showed normal thyroid function and a slight elevation in serum thyroglobulin, whereas remarkable elevations in serum CEA and CA19-9 levels suggested an advance of recurrence of the rectal cancer.<br>The thyroid tumor was excised by left thyroid lobectomy in May, 2003. The tumor was localized in the thyroid gland without either invasion to adjacent tissue or regional lymph nodes. Histological examination revealed that adenocarcinoma cells conformed of the tumor nest with necrosis inside the follicular tumor of thyroid. Metastasis of rectal cancer into the preexisted thyroid follicular tumor was thus diagnosed.<br>It is extremely rare that metastasis of other carcinoma occurs inside of a thyroid follicular tumor, then we present this interesting case together with some discussion based on the relating several previous reports.

We report three cases of enterocele combined with rectocele diagnosed by CT-defecography. Rectocele refers to a morphological abnormality in which the anterior wall of the rectum protrudes forward, and is mostly seen in female patients. The diagnosis of rectocele is usually based on clinical symptoms and defecography, but enterocele cannot always be detected by clinical examinations. Defecography with peritoneography and/or barium meal intake has recently been developed as a new method for identiflying enterocele. Multislice-CT was performed at rest and during simulated defecation to evaluate three patients with defecation disorder who were diagnosed as having rectocele based on the results of clinical findings and defecography. Multiplanar reconstruction images were generated for image evaluation. Using CT-defecography it was possible to confirm that rectocele was combined with enterocele in these cases.

In order to clarify the significance of both chest X-ray and CT for postoperative lung metastasis from colorectal cancer, we studied 27 patients with lung metastasis detected by X-ray or CT among 543 patients after curative resection for colorectal cancer. Although there was no significant difference in the size of the lesions detected by X-ray or CT, only one of nine lesions (11.1%) detected by CT could be identified by X-ray when the lesions were 5 mm or smaller whereas five of six lesions (83.3%) could be detected when 6 mm or greater. The lesions could be identified by retrospective review of the chest X-ray in 12 of 27 patients (44.4%). The lesions overlapping on heart, aorta, pulmonary artery and bone shadow were often overlooked on chest X-ray. Detectable lesions on X-ray have been checked and overlooked by a single doctor in patients. Therefore, a double-checking system might help prevent delayed detection of metastatic lung lesions.

We report a case of ASPS with special reference to the usefulness of multi planer reconstruction (MPR) and 3D-angio by MSCT for selecting an operation method and approach. A 31-year-old man with anal pain and bleeding during defecation was admitted to our hospital for further examination. Diagnostic imaging studies revealed a suspectable sarcoma. MPR and 3D-angio were used to select the approach to the tumor and operation method. Tumorectomy, combined with partial resection of the anal sphincter, and puborectal and external sphincter muscle plication, were successfully performed. Histological findings of the resected specimen showed the tumor grown like an alveolar origined from the striate muscle. Immunohistochemical testing was negative for HMB-45 and positive for myoglobin, and the tumor was diagnosed as ASPS. The postoperative course was uneventful.

A 58-year-old female with anal bleeding. soiling and defecating disturbance was admitted to our hospital. She was diagnosed as rectal prolapse (Tuttle II type) with rectocele on defecography. Manometry revealed an obscure high-pressure zone, low maximum resting pressure and maximum squeezing pressure. She underwent laparoscopic rectopexy and anterior levatorplasty with sphincter plication. She had no significant complications postoperatively, and preoperative symptoms disappeared after the surgery.

1988年から2002年の間に手術を施行した直腸脱37症例 (完全直腸脱28例, 不完全直腸脱9例) について検討した。男女比は1 : 1.5と女性に多く, 年齢は24歳から87歳であった。病悩期間は5年以上の症例が約50%に認められ, 多くは脱出を主訴に来院した。全体の6例 (16%) には, 括約筋不全に伴う排便困難, 便漏れ症状を認めた。治療は症状が軽度の症例や高齢者には三輪-Gant手術を施行し, それ以外の症例には直腸後方固定術を基本的に行い, 症例によっては全骨盤底修復術も付加した。また近年では腹腔鏡下手術も導入し, 腹腔鏡下後方固定術を7例に施行した。経過観察期間が短いものの, 開腹および腹腔鏡下後方固定術を施行した全例に再発は認めず, 排便機能面においても充分な満足度が得られたが, 三輪-Gant手術施行例では全体の5例 (36%) に再発を認めた。