A Case of Advanced Recurrent Rectal Cancer With Posterior Reversible Encephalopathy Syndrome During S-1 + Irinotecan + Bevacizumab Therapy / 日本農村医学会雑誌

The patient was a 75-year-old man with advanced rectal cancer underwent abdominoperineal resection and lymph node dissection as conversion surgery after chemotherapy. Intraoperatively, lateral lymph node metastasis was evident in internal iliac vasculature and was deemed unresectable, so chemotherapy was continued after the operation. Due to an elevation in tumor markers and the appearance of lung metastasis, S-1 + irinotecan + bevacizumab therapy was performed as third-line therapy. On day 22 of the third course, he was transported to our hospital with abdominal pain and nausea. Contrast-enhanced computed tomography revealed adhesive bowel obstruction, and chemotherapy was discontinued. Restlessness and diplopia appeared after admission, and magnetic resonance imaging showed a high-intensity area on T2-fluid attenuated inversion recovery images, mainly in the occipital lobe. Because neurological symptoms and imaging findings improved with symptomatic treatment, we diagnosed him with posterior reversible encephalopathy syndrome. Although this disease can develop in association with chemotherapy and, for example, eclampsia, sepsis, renal failure, and autoimmune disease, it is rare and we report this case together with a review of the literature.

A case of splenectomy for spontaneous splenic rupture / 日本農村医学会雑誌

Splenic rupture can be divided into traumatic and atraumatic forms. Causes of atraumatic splenic rupture include hematologic disease, malignancy, and infection, all of which are extremely rare. An 80-year-old man complaining of left upper abdominal pain was referred to our hospital for further examination and treatment. On arrival, his vital signs were stable, but contrastenhanced computed tomography showed a discontinuity of the splenic membrane and fluid accumulation in the perisplenic area and pelvic floor, suggestive of a hematoma. There was no history of trauma, and suspecting atraumatic splenic rupture, we performed an emergency splenectomy. The patient had a good postoperative course and was discharged on postoperative day 11. He had no previous hematologic disease, and there were no clinical findings suspicious of viral infection. Pathological diagnosis was also negative for malignancy, and idiopathic splenic rupture was diagnosed. We describe here this case of splenectomy for spontaneous splenic rupture.

A Case of Hiatal Hernia with Incarcerated Necrotic Transverse Colon / 日本農村医学会雑誌

An 85-year-old woman was transported to our hospital because of nausea and abdominal pain. Contrast-enhanced computed tomography revealed type IV hiatal hernia with incarcerated necrotic transverse colon. Emergency laparotomy was performed. When the incarcerated stomach and transverse colon were returned to the abdominal cavity, the transverse colon was resected and anastomosed due to necrosis. After the hiatal defect was closed, the Toupet method was also performed. No regurgitation or obstruction was observed after the operation, and the patient was discharged 63 days postoperatively. Here we report this rare case of intestinal necrosis due to type IV hiatal hernia and review the literature.