ABSTRACT
We examined 12 cases of superior mesenteric artery (SMA) embolism experienced at our hospital from January 2012 to February 2022. All patients had a history of atrial fibrillation. In 5 cases, surgery was not performed due to poor general condition. Intestinal resection was performed in 4 of the 7 patients who underwent surgery. Four patients who did not undergo intestinal resection had their clot removed within the golden time of around 10 h since the onset of abdominal pain, while 3 patients who underwent intestinal resection had their clot removed after more than 10 h since onset. Patients who underwent intestinal resection had a longer hospital stay than those who did not (130.5 vs. 32.6 days). All of the patients who underwent surgery were discharged alive. On the other hand, all patients who did not undergo surgery died before discharge. There was no significant difference in age or time between onset and diagnosis in relation to the indication for surgery. SMA embolism is a less common disease occurring in about 1% of cases of acute abdominal disease, but the mortality rate is high at about 50% and the prognosis is poor. Based on our findings, it is important to distinguish SMA embolism for patients with sudden abdominal pain and to diagnose it early after onset and remove the clot to resume blood flow within the golden time when intestinal preservation can be expected. For patients in a stable general condition, treatment such as open or laparoscopic thrombectomy and intestinal resection should be considered regardless of age or time since onset of the disease.
ABSTRACT
The patient was a man in his 80s. PCR test was performed after he developed a fever, and the result was positive for SARS-CoV-2 infection. On admission, CT showed ground-glass opacities and consolidation in both lung fields, leading to a diagnosis of COVID-19 pneumonia. The fever promptly resolved after starting treatment with dexamethasone 6.6 mg injection, but high fever returned the day after discontinuing dexamethasone. We considered bacterial pneumonia as a complication, but antibiotics were ineffective. We suspected cytokine storm and began steroid pulse therapy. The fever temporarily resolved but returned when the steroid dose was reduced. In the differential diagnosis, we considered opportunistic infections such as fungal infection and cytomegalovirus infection, pulmonary tuberculosis, and non-infectious lung diseases such as idiopathic organizing pneumonia. Examination and treatment were performed with these in mind. Finally, we diagnosed pulmonary tuberculosis and cytomegalovirus infection, and treatment was started for each. He was subsequently transferred to a treatment facility for patients with tuberculosis. Steroids are a key drug in the treatment of COVID-19, but they may reduce immune function and increase susceptibility to infection, so caution is required for various infectious diseases.
ABSTRACT
Simultaneous creation of an enterostomy for enteral nutrition during esophagectomy has been useful in our experience, but bowel obstruction associated with intestinal fistula remains a problem. Therefore, in this study, we retrospectively reviewed 18 patients with esophageal cancer who underwent transdiaphragmatic transgastric tube enteral feeding catheter placement during gastric tube reconstruction via the mediastinal route after esophagectomy from November 2012 to March 2014. The catheter was guided from the gastric tube into the gastrointestinal tract, with the tip placed in the jejunum distal to the ligament of Treitz. From the gastric tube, the catheter was guided along the diaphragm to the anterior abdominal wall through the extraperitoneal route. No bowel obstruction associated with catheter placement has been observed in any of the patients from the time of surgery to this writing. Also, the procedure enabled jejunostomy use for more than 5 years, similar to conventional jejunostomy. We experienced 1 case of catheter deviation into the mediastinum. Overall, transgastric tube enteral feeding catheter placement for reconstruction of the posterior mediastinal gastric tube was useful for avoiding intestinal obstruction associated with jejunostomy. However, there may be a risk of catheter displacement into the mediastinum.
ABSTRACT
A 70-year-old man with continuous diarrhea for over 1 month consulted a primary care doctor. He was treated with oral antibiotics and probiotics but his condition worsened. He developed generalized edema and was referred to our hospital. Abdominal ultrasound and computed tomography (CT) scan findings were suggestive of colon cancer with accompanying liver metastasis. Total colonoscopy and endoscopy for pathological diagnosis led to a diagnosis of cancer of the sigmoid colon accompanied with liver metastasis or liver abscess. We planned to perform sigmoidectomy with simultaneous resection of the liver lesion. However, we considered that he was not particularly fit to undergo two concurrent surgeries. Therefore, based on his physical condition, we planned to first do a sigmoidectomy. Before surgery, the fever persisted and a repeat CT scan showed deterioration of the liver lesion. We diagnosed the liver lesion as abscess and performed percutaneous transhepatic abscess drainage (PTAD). Three days after PTAD, we then performed sigmoidectomy. Subsequently, the liver abscess resolved and gradually disappeared. At 5 years after surgery, there has been no recurrence of the cancer or abscess.
ABSTRACT
We report here 2 cases of traumatic diaphragmatic hernia. Case 1 was a 76-year-old man who was injured in a road traffic accident (RTA). Chest X-ray and computed tomography (CT) revealed prolapse of the stomach into the left thoracic cavity. We performed laparotomy with a diagnosis of traumatic left diaphragmatic hernia. A 12-cm hole was seen in the central tendon of the left diaphragm and this was repaired by suturing. Case 2 was a 75-year-old man who was also injured in an RTA. Chest X-ray and CT revealed prolapse of the stomach and transverse colon into the left thoracic cavity. We performed laparotomy with a diagnosis of traumatic left diaphragmatic hernia. A 15-cm hole was seen in the central tendon of the left diaphragm and this was repaired by suturing. Traumatic diaphragmatic hernia is a relatively rare condition and one that requires surgical repair. It is important to make prompt diagnosis with appropriate radiological investigations. Additionally, patients with diaphragm hernia caused by blunt trauma often have injuries to other organs. Care should be taken so as not to miss associated injuries.
ABSTRACT
A 17-year-old male was admitted to our hospital because of strong abdominal pain. His symptoms gradually worsened even after hospitalization, and contrast computed tomography (CT) revealed hemorrhage in the abdominal cavity. Interventional radiology (IVR) was performed to identify the bleeding site. No obvious source of bleeding was identifiable on IVR, so we opted to perform laparoscopic examination and hemostasis. The intraperitoneal finding was hematoma in the omentum, and omentectomy was performed for idiopathic omental hemorrhage because there was no history of trauma. The postoperative course was good and the patient was discharged after postoperative day 4. Performing laparoscopic surgery for omental hemorrhage facilitated minimally invasive treatment with a short hospital stay.
ABSTRACT
In our hospital, we typically perform laparoscopic partial gastrectomy as surgical treatment for extragastric growth type of submucosal tumor (SMT), and laparoscopic intragastric surgery for intragastric growth type. In 2008, laparoscopic and endoscopic cooperative surgery (LECS) was reported for the first time by Hiki et al. Against the background of LECS as laparoscopic local gastric resection with endoscopic resection, we started LECS for gastric SMT from 2015. We performed laparoscopic (LAP) surgery for 15 gastric SMT cases from 2009, and compared 5 cases for which LECS was performed and 10 cases for which LAP was performed. Tumor diameter was 15–21 mm (mean 19.2 mm) in the LECS group, and 20–53 mm (mean 35.5 mm) in the LAP group; the LECS group had a significantly smaller tumor diameter. Operative time was 299 ± 45 min in LECS and 222 ± 25 min in LAP. The volume of blood loss was 24 ± 13 mL in LECS and 33 ± 13 mL in LAP. Hospitalization days was 14.0 ± 3.0 days in LECS and 12.9 ±0.8 days in LAP. There was no significant difference between them.