Laparoscopic Surgery for Small Bowel Obstruction due to Paracecal Hernia.

Internal hernia related to paracecal hernia is a rare disease and is difficult to confirm by preoperative diagnosis. We recently encountered a case of an 83-year-old woman who had lower abdominal pain in her right quadrant. Based on physical findings and CT findings she was diagnosed as having small bowel obstruction by internal hernia around the cecum. She underwent emergency operation with laparoscopic surgery and was diagnosed with a paracecal hernia and treated laparoscopically. After we dissected the ventral wall of the hernia sac and enlarged the hernia orifice, we reduced the trapped small intestine into the abdominal space. We determined that the herniated portion of the small intestine was not necrotic and therefore did not resect it. Although paracecal hernia is a rare internal hernia, physicians should be aware of it as a differential diagnosis for small bowel obstruction because of its rapid progression to strangulation and necrosis. We highlight the importance of recognizing CT findings of paracecal internal hernia. Laparoscopy was effective both for making a definitive diagnosis and treating paracecal hernia with relatively little invasion.

Non-localized Mycobacterium avium lung disease successfully treated with lobectomy and chemotherapy.

A 17-year-old boy presented with a large cavity and bilateral nodular opacities on his chest roentgenogram. Mycobacterium avium was identified in his sputum. According to the recommendations of the American Thoracic Society, he was not strongly recommended to undergo surgery because of non-localized lesions. But since cavities can provide a means for disease to spread to other lobes, we decided to perform a lobectomy including the cavity combined with chemotherapy. Now he has been well for 4 years without exacerbation. There is a possibility of long-term remission with this combination treatment in cases a destructive lesion of airway such as a cavity which is localized to one lobe, even if other lesions such as nodular opacities exist in many other lobes.

A case of gastrocolocutaneous fistula as a complication of percutaneous endoscopic gastrostomy.

A rare complication of percutaneous endoscopic gastrostomy (PEG) is gastrocolocutaneous fistula which usually occurs after replacement of the PEG tube. As tube feeding is directly delivered to the transverse colon, patients typically present with a sudden onset of transient diarrhea within minutes after PEG tube feeding. A radiographic study using water-soluble contrast material via the PEG tube shows the tip of the tube in the transverse colon. We present here a patient who had this complication after PEG insertion. A PEG tube for enteral feeding was placed in a 27-year-old man with cerebral plasty and a severe scoliosis. After replacement of the PEG tube, he developed diarrhea after each PEG tube feeding. The diagnosis of gastrocolocutaneous fistula was made after injection of gastrografin from the PEG tube. Another gastrostomy tube was placed surgically and the fistula was then also excised. In conclusion, gastrocolocutaneous fistula must be considered as a complication of PEG tube placement when patients with a PEG tube develop a sudden onset of transient diarrhea immediately after PEG tube feeding.

[Invasive thymoma with thymic cyst; report of a case].

A 27-year-old woman was pointed out an abnormal shadow on chest X-ray in 1999. Because of the enlargement of the chest abnormal shadow, she was admitted to our hospital in 2000. Chest computed tomography (CT) revealed anterior mediastinal solid mass with cystic lesion. A thymoma was suspected. The tumor was removed in June 2000, through a longitudinal incision of the sternum. There was a severe adhesion between the tumor and the right brachiocephalic vein. Histological examination revealed a thymoma with thymic cyst. The thymoma had a capsular invasion (stage II). There were few reports for cases of thymoma with thymic cyst.

Chronic lung abscess with Pasteurella multocida infection.

We report a patient with chronic lung abscess due to Pasteurella multocida infection that may be caused by the contact with cows in his workplace. Despite its apparent rarity, chronic abscess due to P. multocida should be considered in the differential diagnosis of solitary pulmonary masses. This case report suggests that P. multocida infection can be potentially caused from saliva of cows as well as dogs or cats.

Mediastinal parathyroid cyst with tracheal constriction.

A 63-year-old man visiting a physician for slight dyspnea, attributed to a lump on his neck, was found in ultrasonography and computed tomography to have a cyst extending from the left lobe of the thyroid gland to the superior mediastinum. Radiography showed right deviation of the trachea. The cyst disappeared after fine-needle aspiration, but cyst fluid subsequently reaccumulated and he was admitted to our hospital. No abnormalities were detected in tests of thyroid and parathyroid function or blood chemical analysis. The cyst was surgically removed and diagnosed as a nonfunctioning parathyroid cyst, based on the high-intact parathyroid hormone in cyst fluid. The patient recovered fully and has shown no recurrence in the 11 months to data since surgery.