[Subcutaneous Metastasis from Rectal Carcinoma after Low Anterior Resection-A Case Report].

A 63-year-old woman was admitted to our hospital owing to advanced rectal carcinoma. The patient underwent laparoscopic lowanterior resectionwith D3 lymph node dissection and partial resection of the uterus. The histopathological diagnosis was fT4bN2M0, fStage Ⅲb. Thus, capecitabine plus oxaliplatin(CapeOX)therapy as adjuvant chemotherapy was scheduled for 6 months. However, after the 4th course of chemotherapy, contrast-enhanced CT revealed multiple metastases of the rectal carcinoma including metastases in the liver, peritoneum, retroperitoneum, and subcutaneous tissue of the left lower back. The patient received palliative treatment and died 8 months after surgery. Only a fewcases of subcutaneous metastasis of rectal carcinoma have been reported. Therefore, we herein report this case with a review of the literature.

[A Case of Synchronous Multiple Colon Carcinoma-A Case Report].

A 67-year-old woman with anemia was referred to us for further study. A colonoscopy exhibited multiple tumors(tub1)in the transverse and sigmoid colon(two regions)and rectum. Contrast-enhanced CT revealed no apparent distant and lymph node metastases. Thus, subtotal colectomy with D3 lymph node dissection was performed. Pathologically, the tumor was diagnosed as pStage Ⅱand pStage 0. After surgery, the patient had no recurrence for 8 months. We herein report a rare case of four synchronous colorectal carcinomas that were successfully treated.

[A Case of Ampullary Region Carcinoma in a Young Woman - A Case Report].

A 19-year-old woman with general fatigue who initially consulted a local hospital was referred to us for further examination of jaundice. Contrast-enhanced CT revealed apparent dilatation of the bile duct. Gastrointestinal endoscopy exhibited a tumor of the papilla of Vater(adenocarcinoma, tub2). Thus, pylorus-preserving pancreatoduodenectomy with D2 lymph node dissection was performed. Pathologically, she was diagnosed with a T3bN1M0, pStage ⅡB tumor. After surgery, the patient underwent adjuvant chemotherapy containing S-1 for 6 months. We herein report a juvenile case of ampullary region carcinoma that was successfully treated.

[Curatively Resected Stage â £Gastric Cancer with Positive Peritoneal Cytology Due to SOX Therapy-A Case Report].

A 70-year-old man with epigastralgia who initially visited a local hospital was referred to us for further examination. Gastrointestinal endoscopy exhibited a type 3 tumor of the stomach from the body to the antrum(adenocarcinoma, por1). Contrast-enhanced CT revealed thickness in the wall of the gastric body with bulky lymph nodes and ascites. Staging laparoscopy showed that the patient was diagnosed with sStage Ⅳ gastric cancer with positive peritoneal cytology. Therefore, SOX therapy was administered. Subsequently, total gastrectomy with D2 lymph node dissection was performed, since the primary tumor and lymph nodes were significantly reduced. Histopathologically, the residual lesion was only observed in the mucosal layer without lymph node metastases. We herein report a case of Stage Ⅳ gastric cancer, which was successfully treated by conversion surgery after SOX therapy.

Comparison of Strength of Anastomosis Between Four Different Techniques for Colorectal Surgery.

BACKGROUND/AIM: Advances in stapling devices have led to their widespread use in colorectal surgery. We compared the strength of four types of anastomoses using bursting pressure. MATERIALS AND METHODS: We created stapled anastomosis models [double stapling technique (DST), functional end-to-end anastomosis (FEEA) unbuttressed or buttressed, and triangulating anastomosis (TA) with two- or three-row stapling] and a hand-sewn anastomosis model. Bursting pressures of each method were measured. The primary end point was the bursting pressure. The effectiveness of buttressing and three-row stapling were the secondary endpoints. RESULTS: The DST group had significantly lower bursting pressure than TA with three-row stapling, FEEA buttressed, and hand-sewn groups. No significant difference was found between the bursting pressure of the FEEA unbuttressed and FEEA buttressed groups and that of the TA with two-row and three-row stapling groups. CONCLUSION: DST has the lowest bursting pressure compared to other anastomotic techniques. Buttressing suture and three-row stapling have no effect on the strength of anastomosis.

Intestinal obstruction caused by primary adenosquamous cell carcinoma of the small intestine: A case report and review of the literature.

Primary adenosquamous cell carcinoma (ASCC) arising from the ileum is an exceptionally rare malignant neoplasm exhibiting mixed glandular and squamous differentiation. The clinicopathological characteristics of ASCC have not been clearly determined due to its rarity. We herein report a case of a 74-year-old man with a successfully treated ASCC of the ileum. The patient visited a medical clinic due to abdominal pain. Abdominal computed tomography imaging revealed an intestinal tumor in the ileum. Prior to undergoing capsule endoscopy, the patient complained of severe abdominal pain due to intestinal obstruction from the patency capsule and the tumor. Thus, the patient was referred to our hospital for emergency surgery. Upon relieving the obstruction by partial resection of the ileum, an impacted patency capsule with a tumor with ulceration was identified. On histological examination, the tumor consisted of malignant glandular and squamous cell elements. The postoperative course was uneventful, without complications. The patient subsequently received adjuvant chemotherapy with oxaliplatin and capecitabine for 6 months. The patient has no evidence of recurrence 20 months after surgery. To the best of our knowledge, only 8 cases of ASCC have been reported in the English literature to date. This case serves as an important reminder to consider small intestinal carcinoma, including ASCC, in the differential diagnosis of intestinal obstruction.

Which Is the Safer Anastomotic Method for Colon Surgery? - Ten-year Results.

BACKGROUND/AIM: In colon surgery, the anastomotic method is generally selected by surgeon's preferences or by local conditions. In this study, we retrospectively analyzed anastomotic complications to assess safe methods of anastomosis in colonic resection. PATIENTS AND METHODS: We retrospectively analyzed a total of 684 cases, performed between July 2003 and June 2013 in our Hospital. Anastomosis complications, such as leakage, stricture and bleeding, were analyzed in relation to the three methods of anastomosis, hand-sewn (HS), functional end-to-end (FEEA) and triangulating anastomosis (TRI). RESULTS: Univariate analysis indicated that the incidence of leakage was significantly lower in laparoscopic surgeries (p=0.034) and TRI (p=0.047). The results of the multivariable analysis indicated that anastomotic leakage was significantly less with TRI (p=0.029). CONCLUSION: In colon surgery, TRI seems to be associated with a low risk of anastomotic leakage compared to HS and FEEA.