RESUMO
We report a case of focal spared area of segment VIII in fatty liver. The patient was a 73-year-old man. Abdominal ultrasonography showed focal hypo-echogenicity with an irregular margin in segment VIII. Abdominal computed tomography and enhanced computed tomography showed a high-density mass in segment VIII of the right lobe. MRI examination revealed that the mass in S8 was high-intense on the T1 out of phase image and iso-intense on the T1 in phase image. The lesion was not observed on T2 weight images. He had a sigmoid colon cancer and was performed a sigmoidectomy and partial resection of the liver. A microscopic examination of the liver specimen revealed normal hepatic parenchymal cells, while the surrounding liver had a fat deposition.
Assuntos
Fígado Gorduroso/patologia , Fígado/patologia , Idoso , Fígado Gorduroso/diagnóstico por imagem , Humanos , Fígado/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , UltrassonografiaRESUMO
BACKGROUND/AIMS: From the experience of endoscopic examination showing residual gastric varices (GV) after paragastroesophageal devascularization and splenectomy (GEDS) for GV, it was considered that GV could be immediately cleared by additional subserosal variceal ligation (SSVL) after GEDS. We reviewed the outcome of all patients who underwent this surgical technique. METHODOLOGY: GEDS with SSVL was performed for GV on eight consecutive patients whose esophageal varices had already been treated by endoscopy. After intraoperative endoscopic examination revealed residual GV just after GEDS, the serosal surface was carefully incised by a knife, and GV were exposed, ligated by 3-0 silk and buried by interrupted seromuscular suture (3-0 silk). RESULTS: In all eight patients, endoscopic examination that was carried out just after SSVL, and after discharge, revealed no intraluminal bleeding and complete disappearance of GV. CONCLUSIONS: It was concluded that SSVL in addition to GEDS was a simple procedure and was effective for immediate disappearance of GV.
Assuntos
Endoscopia do Sistema Digestório/métodos , Varizes Esofágicas e Gástricas/cirurgia , Varizes Esofágicas e Gástricas/terapia , Esôfago/irrigação sanguínea , Idoso , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/etiologia , Esôfago/patologia , Esôfago/cirurgia , Feminino , Gastroenterologia/métodos , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade , Esplenectomia/efeitos adversos , Estômago/irrigação sanguínea , Estômago/patologia , Estômago/cirurgia , Resultado do TratamentoRESUMO
A 19-year-old man was admitted to our hospital with acute abdominal pain in the right lower quadrant. He had had mild diarrhea, of 1 day's duration, 2 days before admission. Although physical findings were consistent with a diagnosis of acute appendicitis, computed tomography findings showed marked wall thickening from the ascending colon to the cecum, findings which were similar to those in patients with hemorrhagic colitis due to Escherichia coli O157. Instead of emergency laparotomy, the patient was treated with antimicrobial agents, which led to rapid recovery. Diagnosis of intestinal infection due to E. coli O157 was established later, as serum antibody against lipopolysaccharide of E. coli O157 was positive. E. coli O157 infection should be included in the differential diagnosis of diseases that exhibit marked wall thickening of the right colon on CT in patients with acute abdominal pain in the right lower quadrant who have mild transient diarrhea.
Assuntos
Apendicite/diagnóstico por imagem , Infecções por Escherichia coli/diagnóstico por imagem , Escherichia coli O157 , Tomografia Computadorizada por Raios X , Doença Aguda , Adulto , Anticorpos Antibacterianos/sangue , Diagnóstico Diferencial , Escherichia coli O157/imunologia , Humanos , Lipopolissacarídeos/imunologia , MasculinoRESUMO
A 74-year-old woman was admitted to our hospital with a 2-week history of jaundice. Percutaneous transhepatic cholangioscopy revealed a nodular tumor originating in the upper part of the common hepatic duct, which was invading the confluence of the right and left hepatic ducts. Microscopic examination of biopsy specimens revealed adenocarcinoma. Abdominal ultrasonography and computed tomography demonstrated multiple enlarged lymph nodes around the extrahepatic bile duct and the common hepatic artery. Laparotomy revealed lymph node enlargement in the hepatoduodenal ligament, behind the pancreatic head, and along the common hepatic and left gastric arteries. Extended left hepatic lobectomy, caudate lobectomy, and resection of extrahepatic bile duct with extended lymph node dissection were performed. The histology of permanent specimen revealed no tumor metastasis but a sarcoid reaction in the lymph nodes. The patient is in good health 21 months after the operation, without any evidence of recurrence. This is the first successfully resected case of hilar cholangiocarcinoma associated with sarcoid reaction in the regional lymph nodes.
Assuntos
Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos , Colangiocarcinoma/cirurgia , Hepatectomia/métodos , Doenças Linfáticas/cirurgia , Sarcoidose/cirurgia , Idoso , Neoplasias dos Ductos Biliares/complicações , Neoplasias dos Ductos Biliares/diagnóstico , Colangiocarcinoma/complicações , Colangiocarcinoma/diagnóstico , Feminino , Humanos , Excisão de Linfonodo/métodos , Linfonodos , Doenças Linfáticas/complicações , Doenças Linfáticas/patologia , Sarcoidose/complicações , Sarcoidose/patologia , Resultado do TratamentoRESUMO
BACKGROUND/AIMS: From the experience of laparoscopic-assisted distal gastrectomy, it was considered that a gastrectomy with lymph node dissection could be performed through a minilaparotomy, placed as for gastroduodenostomy in laparoscopic-assisted distal gastrectomy. METHODOLOGY: Ten patients with early gastric cancer underwent gastrectomy with lymph node dissection via minilaparotomy. Minilaparotomy was performed via a seven-centimeter midline incision placed at the mid-upper abdomen. Two six-centimeter-wide Kent retractors were used to suspend the abdominal wall on each side, and a multipurpose surgical arm to retract the liver. The abdominal wound could be moved horizontally by pulling these retractors to the right or left. This movable wound allowed direct visualization of almost all the operative field for gastrectomy. RESULTS: No operation was converted to a standard open gastrectomy. The patients who had a tumor in the lower third of the stomach underwent complete D2 lymph node dissection. In the patients who underwent pylorus-preserving gastrectomy, near complete D2 lymph node dissection was performed. Mean operation time was 175 minutes. No significant complication was encountered. CONCLUSIONS: It was concluded that minilaparotomy could be used as an alteration to the standard open gastrectomy.
Assuntos
Gastrectomia , Excisão de Linfonodo , Procedimentos Cirúrgicos Minimamente Invasivos , Lesões Pré-Cancerosas/cirurgia , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Gastrectomia/instrumentação , Humanos , Laparoscopia , Excisão de Linfonodo/instrumentação , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Estadiamento de Neoplasias , Lesões Pré-Cancerosas/patologia , Neoplasias Gástricas/patologia , Instrumentos Cirúrgicos , Resultado do TratamentoRESUMO
The tendency to perform abdominal wall reinforcement using various types of mesh (tension-free repair) is increasing. A questionnaire to poll Japanese surgeons on their current surgical modalities for groin hernias was sent to 105 hospitals and was returned by 83 hospitals. The majority (83%) of responders to this survey supported the tension-free repair as a standard operation for adult groin hernias. Of these 69 tension-free repairs, the mesh-plug repair was the most frequent standard operation ( n = 53, 64%) and was performed by all responders. Ten (12%) opted for the prolene hernia system (PHS) repair as a standard operation and 52% of responders had experience of the PHS repair. Laparoscopic repair was performed as a standard operation by only one responder and was performed by only 34% of responders.
Assuntos
Hérnia Inguinal/cirurgia , Adulto , Coleta de Dados , Humanos , Japão , Telas CirúrgicasRESUMO
A metastatic liver carcinoma which developed from the pons hepatis and presented as an extrahepatic mass on ultrasonography and computed tomography is reported. There have been no other reports of hepatoma documenting the extrahepatic growth developed from the pons hepatis. Herein we study the frequency of the pons hepatis and classify the form of REX's recessus. Of 125 cases that underwent upper abdominal operation, 46 cases (38%) had nothing under REX's recessus (Type I), 48 cases (37%) had a fibrous tissue under REX's recessus (Type II), and 31 cases (25%) had a pons hepatis (Type III). In Type III, some cases suggested that the pons hepatis was ready to disconnect from side to side. We conclude that Type II is a modified form of Type III, and Type I is a modified form of Type II.