Percutaneous intestinal drainage for a refractory enterocutaneous fistula: A case report.

INTRODUCTION: Enterocutaneous fistulas (ECFs) that occur following gastrointestinal surgery require long-term hospitalization, and treatment may be difficult in rare cases. Although the morbidity and mortality associated with ECF have decreased with modern medical, the overall mortality is still surprisingly high, up to 30.4 %. PRESENTATION OF CASE: The patient was a 79-year-old male who had undergone laparoscopic sigmoidoscopy for sigmoid colon cancer 5 years previously. He was newly diagnosed with sigmoid colon cancer 5 years following surgery. A laparoscopic high anterior resection was performed. On the 4th postoperative day, he was diagnosed with a suture failure which was treated conservatively; however, the fistula could not be closed, and ileostomy construction was performed. Intestinal fluid leaked from the median surgical incision, leading to the formation of a small intestinal fistula on the proximal side from the ileostomy. Conservative treatment did not improve the condition and skin erosion worsened. Two months after the stoma was constructed, a urethral balloon catheter was percutaneously inserted into the intestinal tract from the small intestinal fistula to drain the intestinal fluid. Following the maneuver, the problem of skin erosion was improved, with the resulting closure of the fistula. DISCUSSION: The basic principles underlying treatment for ECFs are essentially fasting, drainage, and adequate nutritional management. Some studies reported that the average period of negative pressure therapy was four weeks. It seems that four weeks is the breakpoint. CONCLUSION: Percutaneous intestinal drainage for refractory ECFs following gastrointestinal surgery is minimally invasive and is likely to be extremely useful.

Correction: Cost-efficient strategy for reducing PM 2.5 levels in the Tokyo metropolitan area: An integrated approach with air quality and economic models.

[This corrects the article DOI: 10.1371/journal.pone.0207623.].

Efficacy and safety of endoscopic resection for gastric tube cancer after surgical resection of esophageal squamous cell carcinoma.

BACKGROUND: Gastric tube cancers (GTCs) are found frequently, even as the surgical outcomes of esophageal cancer improve. Diagnosing and treating early gastric tube cancer endoscopically has therefore become very important. AIMS: This study aimed to evaluate the clinical characteristics and outcomes of endoscopic resection for GTC. METHODS: We analyzed 29 patients (33 lesions) with metachronous GTC who underwent endoscopic resection from April 2005 to August 2016 and evaluated their clinical characteristics and the short-term outcomes of endoscopic resection. RESULTS: All of the cases were identified by periodic examinations. The lesions were found a median of 6.5 years after surgery (range 9 months-19 years), with six lesions found more than 10 years later. Among the total of 33 lesions, 28 resulted in curative resections (85%), and five were non-curative resections because of lymphovascular invasion, submucosal deep invasion, histological type, and size. None had received additional treatment or had a local recurrence thus far. Regarding the complications, delayed perforation occurred in a case (3%) and precordial skin burn occurred in four cases (12%). CONCLUSION: The safety and efficacy of endoscopic resection for gastric tube cancer were evaluated. Additionally, it is important to continue annual endoscopy even 5 years or more after esophageal surgery.

Cost-efficient strategy for reducing PM 2.5 levels in the Tokyo metropolitan area: An integrated approach with air quality and economic models.

To attain cleaner air, it is important that authorities make informed decisions when selecting a strategy. Concentrations of particulate matter with an aerodynamic diameter of less than or equal to 2.5 µm (PM 2.5) are high in the Tokyo metropolitan area, even though concentrations of particulate matter with an aerodynamic diameter of less than or equal to 10 µm (PM10) have dropped dramatically since the implementation of the NOx-PM Act. Currently, monitored concentration levels continue to exceed the designated ambient air quality standard set by the Japanese Ministry of the Environment. To our knowledge, no study has investigated a cost-efficient strategy for reducing PM 2.5 concentration levels in the Tokyo metropolitan area. This is the first study to examine a proper control strategy for Japan by developing an integrated model that includes both aerosol and economic models. The simulation results show that prefectures in the Tokyo metropolitan area cannot achieve the standards by relying on their own efforts to reduce PM 2.5. That is, prefectural governments in the Tokyo metropolitan areas need to cooperate with prefectures outside of the area to improve their PM 2.5 concentration levels. Thus, we simulated policies under the assumption that emissions from other sources are reduced to levels such that the PM 2.5 concentration declines by approximately 18 µg/m3. We first simulated an efficient policy, i.e., the implementation of a pollution tax. We found that the total abatement cost to meet the air quality standard using the cost-efficient strategy is approximately 142.7 billion yen.

Retrograde Jejunojejunal Intussusception After Gastrectomy: Report of Four Cases.

BACKGROUND: Retrograde intussusception of the small bowel is extremely rare. We experienced four cases of retrograde jejunojejunal intussusception that needed emergency surgery. The aim of the present report was to expand awareness of retrograde jejunojejunal intussusception as an urgent complication following gastrectomy.

Characteristics and Treatment Strategies for Small Bowel Adenocarcinoma in Advanced-stage Cases.

BACKGROUND: Small bowel adenocarcinoma is an uncommon disease with poor prognosis. Therefore, characteristics and treatment strategies for small bowel adenocarcinoma should be elucidated sufficiently, not only for surgery, but also for chemotherapy. PATIENTS AND METHODS: Medical records were abstracted to identify patients with small bowel adenocarcinoma who were treated at the Iizuka Hospital, Fukuoka, Japan, between 2004 and 2014. The results of surgical treatment for stage II/III cases and the efficacy of chemotherapy for unresectable stage IV cases were investigated. RESULTS: The median tumor size was 25.6 ± 19.2 mm, and tumor size was not associated with primary symptoms. Nine of the patients were diagnosed with stage II/III disease and underwent surgical resection. The other three patients were diagnosed with stage IV disease, and two out of those three cases received definitive chemotherapy. In two out of the nine resected cases, recurrence was observed; however, surgical resection of the recurrent tumor was associated with a good prognosis. In stage IV cases that received chemotherapy, survival durations of over 11 months were achieved. In contrast, overall survival in the stage IV case without chemotherapy was 3.3 months. CONCLUSION: Curative resection and definitive chemotherapy for unresectable cases are effective treatment strategies for small bowel adenocarcinoma.

Necessity for resection of gastric gastrointestinal stromal tumors ≤ 20 mm.

BACKGROUND/AIM: To evaluate whether surgical intervention was useful in patients undergoing surgery for gastric gastrointestinal stromal tumors (GISTs), for tumors ≤ 20 mm in size. PATIENTS AND METHODS: Between August 2002 and July 2014, 138 patients with GIST underwent surgery at our Hospital, including 112 patients with gastric GISTs. The medical records of these patients were retrospectively reviewed. RESULTS: Postoperative recurrence was observed in three patients, each having tumors with high mitotic rates and ≥ 21 mm in size. In 89 patients undergoing gastric wedge resection, the incidence of postoperative complications was 10.1%; 5.6% of the patients developed late sequelae, all of which were mild. The group classified as having tumors ≥ 21 mm in size had a higher proportion of elderly patients (p=0.0010), more complications (p=0.0152), and longer hospital stay (p=0.0589). CONCLUSION: To prevent recurrence, definitive diagnosis and aggressive resection while the tumor size is 20 mm or less is recommended. However, because some patients also carry surgical risks, sufficient consideration must be given to the needs of individual patients.