Usefulness of multi-slice CT in a case with internal fistulas in Crohn's disease.

A case of Crohn's disease with an ileo-ileo fistula, ileal strictures and an ileo-cyst fistula is reported. Laparoscopic operation that included partial ileoectomy, ileal stricturoplasty and dissection of the ileo-cyst fistula was performed. Multi-slice computed tomography (MSCT) that was performed before the operation showed an ileo-cyst fistula that was not detected by small bowel follow-through or MRI. In this case, MSCT, including multi-planar reconstruction images, was significantly useful for evaluation of internal fistulas in Crohn's disease.

[A case of advanced gastric cancer with a tumor embolus in the portal vein successfully treated with TS-1 and CDDP].

A 71-year-old man was admitted to our hospital in February 2002 with a diagnosis of advanced gastric cancer with a tumor embolus in the portal vein. TS-1 (120 mg/day) was administered orally daily for 21 days, and CDDP (90 mg/day) was infused intravenously on day 8. After 1 course of this regimen, medication was discontinued in accordance with the patient's request. The patient was readmitted with a history of tarry stools in July 2003. Despite no cancer treatment for almost 1.5 years, the primary lesion and the metastatic lymph nodes had decreased significantly in size and the tumor embolus in the portal vein had disappeared completely on the CT scan. He was therefore treated with TS-1 alone (120 mg/day) under a 4-weeks-on and 2-weeks-off regimen. After 1 course of TS-1 administered alone, the primary lesion showed a further significant decrease in size as viewed by GI endoscopy, and biopsies did not reveal any evidence of malignancy.

Laparoscopic function-preserving surgery for early gastric cancer in the upper third of the stomach: vagus-sparing proximal gastrectomy with side-to-side esophagogastric-tube anastomosis.

OBJECTIVE: Proximal gastrectomy with an anti-reflux procedure has been a treatment option for gastric cancer in the upper third of the stomach. For early gastric cancer, laparoscopic function-preserving gastrectomy with limited lymphadenectomy can be performed. Objective of this study was to develop a new surgical technique for gastric cancer in the upper third of the stomach. METHODS: We present here our totally laparoscopic proximal gastrectomy with vagus-sparing lymphadenectomy and gastric-tube reconstruction. Six patients (five males and one female; mean age 74 years) with gastric cancer in the upper third of the stomach underwent the procedure. Detailed operative procedure and preliminary results were presented. RESULTS: We have successfully performed the procedure with no conversion to open surgery. The mean operative time and blood loss were 413 minutes and 85 mL. No intraoperative and postoperative complications occurred except for reflux esophagitis in one patient. At the mean follow up of 25 months, all patients were alive without any sign of recurrence. CONCLUSION: Although long-term follow up and a larger number of patients are required to evaluate functional outcomes and oncological adequacy, our new technique provides a minimally invasive surgical option for early gastric cancer in the cardiac area.

Laparoscopy-assisted resection of an appendiceal mucinous cystadenoma.

We present a 48-year-old man with a complaint of dull right-lower abdominal pain who was diagnosed with mucocele of the appendix. He underwent laparoscopy-assisted resection of the tumor. In the procedure, the entire right colon was freed from the retroperitoneal structures without rupturing the tumor; and ileocecal resection and anastomosis were performed extracorporeally. The pathological diagnosis of the tumor was mucinous cystadenoma of the appendix, measuring 9.0 cm × 8.0 cm × 4.0 cm. The postoperative course was uneventful, and he had no recurrent disease at a 2-year follow up. When resecting an appendiceal mucinous tumor laparoscopically, it is essential (1) to keep the tumor intact during manipulation, and to use a wound-protecting device when delivering the lesion; (2) to consider the extent of tumor resection with a negative surgical margin as well as prophylactic lymph node dissection in cases of suspected adenocarcinoma, even though the oncological adequacy of the laparoscopic procedure for carcinoma remains to be elucidated; and (3) to check whether any mucinous fluid has accumulated in the abdominal cavity, which represents an indication for open surgery.