A case of annular pancreas in a male adult.

Annular pancreas is a rare congenital anomaly, which consists of a ring of pancreatic tissue partially or completely encircling the descending portion of the duodenum. We reported a case of symptomatic annular pancreas in a 40 year old man admitted to our hospital complaining of abdominal pain, nausea and vomiting without body weight loss in January 2000. The patient underwent laparoscopic cholecystectomy for acalculous cholecystitis in September 1996. Initially, he was diagnosed with duodenal stenosis due to a duodenal ulcer scar, but laboratory data showed no abnormalities. His symptoms did not improve with medication or endoscopic balloon dilatation. Duodenograpy revealed a narrow segment with a smooth mucosal surface in the 2nd portion of the duodenal loop in the duodenum, and a computed tomography (CT) scan demonstrated a thickened pancreas head around this narrow segment. We were therefore able to diagnose annular pancreas. A duodeno-duodenostomy was performed in March 2000. The patient's postoperative course was uneventful, and he was discharged from our hospital on the 19th postoperative day. Although define diagnosis of annular pancreas is frequently made at laparotomy, the development of a recurrent imaging modality might assist in the preoperative diagnosis.

[Management of home care for the advanced cancer patient from the standpoint of home hospice].

We offer home hospice care to patients with bowel obstruction associated with advanced gastrointestinal cancer, who hope to leave hospital and be cared at home, if they understand their condition and if their families also hope to live with the patients, so that the patients can live at home to the last breath. To master various palliative techniques and nursing care services are indispensable to assure home hospice care. In this case, 1. guidance about HPN, 2. guidance about pain control, 3. arrangement of visiting nurse services and 4. application for the long-term care insurance and procurement of the bed and other nursing goods needed to be completed before the discharge from the hospital, and it is important to complete these preparations rapidly in a short period. The 24-hour communication system and appropriate care for new symptoms are the key for successfully shifting to home hospice care. At the final stage, it is important to support families and repeatedly provide guidance for the peaceful death.

[Management of home care for the advanced cancer patient from the standpoint of home hospice].

We offer home hospice care to patients with bowel obstruction associated with advanced gastrointestinal cancer, who hope to leave hospital and be cared at home, if they understand their condition and if their families also hope to live with the patients, so that the patients can live at home to the last breath. To master various palliative techniques and nursing care services are indispensable to assure home hospice care. In this case, (1) guidance about HPN, (2) guidance about pain control, (3) arrangement of visiting nurse services and (4) application for the long-term care insurance and procurement of the bed and other nursing goods needed to be completed before the discharge from the hospital, and it is important to complete these preparations rapidly in a short period. The 24 hour communication system and appropriate care for new symptoms are the key for successfully shifting to home hospice care. At the final stage, it is important to support families and repeatedly provide guidance for the peaceful death.