Pancreatic injury in children: review of 7 cases and the pertinent literature.

BACKGROUND/AIMS: Treatment of blunt injury of the pancreas in children remains controversial. Some prefer non-surgical treatment, whereas others prefer surgical management in selected cases. This report reviews our management strategies of children with blunt pancreatic trauma and their outcomes. METHODOLOGY: Medical records of 7 children with traumatic pancreatic injury were retrospectively analyzed in our institutions. In addition, we reviewed the pertinent literature. RESULTS: There were 2 males and 5 females with a median age of 7.6 years. Pancreatic injury was classified in 3 patients as grade I, in 2 patients as grade II, and in 2 patients as grade III (AAST). The two grade III children underwent ERCP preoperatively. ERCP showed injury to the main pancreatic duct in both of these patients, and emergency surgery was performed for both of them. These operative methods were spleen-preserving distal pancreatectomy and only drainage at the margin of the pancreas with non-resection, respectively. All 7 cases survived. CONCLUSIONS: ERCP is helpful for the diagnosis of suspected cases in pancreatic injury with grade III. In hemorrhagic shock state, appropriate surgical procedures with only drainage at the margin of the pancreas are useful for the treatment of pancreatic fistula in children.

Study of colorectal cancer with Crohn's disease.

BACKGROUND: Crohn's disease (CD) cases have been increasing and prolonged cases are now frequent. In addition, in Japan, more cases with concomitant malignant disease have also recently been reported. There is a particularly high risk of cancer occurring simultaneously in the lower rectum and the anal area. PATIENTS AND METHODS: Two-hundred and eighty-six patients with CD had undergone surgery at this department, up to December, 2005. We studied malignant diseases concomitant with CD, based on empirical examples. RESULTS: Thirteen (4.5%) were cases concomitant with malignant disease: six patients had colorectal cancer, 1 had rectal carcinoid, 1 had stomach cancer, 1 had uterine cancer, 1 had thyroid cancer, 1 had skin cancer and 2 had acute leukemia. Regarding the seven cases other than colorectal cancer, they were all juvenile patients under the age of 50, except for the stomach cancer case (69 years of age). Among the 6 cases of colorectal cancer, 5 cases were anorectal cancer and 1 was lower rectal cancer. The average age was 42.8 years (30-54 years) and the average term from CD occurrence to cancer diagnosis was 208 months (69-387 months). The one case with lower rectal cancer was intramucosal cancer which did not recur after surgery. The five cases of anorectal cancer were advanced, with invasion of the adjacent organs and 2 of them were unresectable. Four cases were of the infiltrative type, and regarding the histological findings, 4 cases were cancer with mucous production and 1 case was a poorly-differentiated endocrine tumor. Four cases had a history of anal fistula, but there was no clear causal relationship. CONCLUSION: In Japan, prolonged CD cases have been increasing and more and more cases of malignant disease with concomitant CD have been reported. There is a particularly high risk of cancer occurring simultaneously in the lower rectum and the anal area. Therefore, careful observation, taking all appropriate diagnostic surveillance modalities into consideration, is thus believed to be important in order to achieve an early detection of such cancer.

[A case of ascending colon cancer with enlarged metastatic lymph nodes around superior mesenteric arterial root that responded dramatically to S-1 and CPT-11 combination chemotherapy].

A 50-year-old man was admitted because of right lateral abdominal pain, easy fatigue and anemia. An endoscopic examination revealed advanced ascending colon cancer, and abdominal CT scan demonstrated enlarged metastatic lymph nodes of superior mesenteric arterial circumference. The Serum CEA rose considerably. The preoperative diagnosis was cStage IV (SS, N(4), P(0), H(0), M(-)), and right colectomy was performed on March 2, 2005. The metastatic lymph nodes around the superior mesenteric arterial root macroscopically remained. From the 20th postoperative day, we started combination chemotherapy using S-1 plus CPT-11 as one course for three weeks. S-1 (120 mg/body/day) was orally administered for 2 weeks continuously, and CPT-11 (80 mg/m(2)) was done intravenously on day 1 and 8. Serum CEA was normalized in the middle of 3 courses. Moreover, after 13 courses, a complete response (CR) was noted on the follow-up abdominal CT scan. No severe side effect more than grade 2 was observed, there was no interruption of the dosage, and PS was sufficiently maintained kept enough through this combination chemotherapy. The course has been without metastasis, recurrence and a rise of serum CEA now in the 16th postoperative month. S-1/CPT-11 combination chemotherapy is a promising and effective cure for unresectable progressive recurrent colorectal cancer in future.