Partial Resection Of Transverse Colon Research Articles

Pancreatic endocrine carcinoma presenting with gastric varices derived by left-sided portal hypertension: a case report

We herein report a 71-year-old man with pancreatic carcinoma presenting as gastric varices caused by an obstruction of the splenic vein compressed by the tumor, which also invaded the spleen, stomach, transverse colon, left kidney, and left adrenal gland. A complete resection of distal pancreatomy and lymph node dissection with splenenctomy, left adrenalectomy, left nephrectomy, and partial resection of transverse colon and stomach were performed. After the resection, the gastric varices completely disappeared without any interventional therapy. The gastric varices observed in this case were considered to be derived from left-sided portal hypertension secondary to splenic vein occlusion, which is an uncommon complication mostly associated with pancreatitis and pancreatic carcinoma. Now that 17 months have passed after his operation, the patient is alive and in satisfactory condition without any signs of recurrence.

Xanthogranulomatous cholecystitis misdiagnosed as gallbladder carcinoma: retrospective analysis of 10 cases

To investigate the reasons for misdiagnosing xanthogranulomatous cholecystitis (XGC) as gallbladder carcinoma, and to provide differential points between these two diseases. Thirty-three patients with the final diagnosis of XGC in our hospital over a period of 10 years (1996-2005) were reviewed, among which 10 (6 males and 4 females) were misdiagnosed as having gallbladder carcinoma either preoperatively or intraoperatively. 10 misdiagnosed cases were examined preoperatively by B-ultrasound (BUS) and computed tomography (CT). BUS and CT revealed 5 cases of gallbladder carcinoma and 1 of chronic cholecystitis; 2 cases were diagnosed as gallbladder carcinoma on BUS but chronic cholecystitis on CT; other 2 cases were diagnosed as chronic cholecystitis on BUS but as gallbladder carcinoma on CT. Intraoperatively, thickening of the gallbladder wall was found in all of the patients; xanthogranulomatous tissue was found invading into other tissues including gallbladder bed and omentum majus. Intraoperative frozen section investigation was performed on 1 patient revealing that no tumor cell was found. Open cholecystectomy + partial hepatic wedge resection were performed on 3 patients; cholecystectomy + partial hepatic wedge resection + regional lymphadenectomy in the liver duodenum ligament on 6 patients; cholecystectomy + cholecystoenterostomy + colocolic anastomosis after partial resection of transverse colon on 1 patient. Postoperative pathological findings revealed XGC in all these patients. XGC is an uncommon variant of chronic cholecystitis of which clinical and imaging presentations closely resemble gallbladder carcinoma. Thus differentiation is essential by means of intraoperative frozen section investigation to ensure optimal surgical treatment since XGC has its pathological distinctions, which are not that of a precancerous change.

A CASE OF LAPAROSCOPY ASSISTED COLECTOMY WITH COMPLICATION OF POSTOPERATIVE PULMONARY EMBOLISM

A 63year-old man underwent a laparoscopy assisted partial resection of transverse colon for an early cancer of the transverse colon. Operation time was 230min and operative blood loss was 140g. On the second day postoperatively, hypo-oxemia was detected. He complained of no symptoms. He was diagnosed as to have pulmonary embolism with pulmonary perfusion scintigram. Immediately, anticoagulatory and fibrinolytic therapy was performed. Hypo-oxemia improved in a few days. He has been administered an oral anti coagulant, and no recurrent sign has been detected for more than a year. Laparoscopic surgery is rapidly popularized, and the risk for thrombosis of the lower extremities and pulmonary embolism by the disturbance of venous return due to the pneumoperitoneum has been pointed out. But, until now, few reports have been made about the incidence of pulmonary embolism related to laparoscopic surgery in Japan. We have reported here a case of laparoscopy assisted colectomy with complication of pulmonary embolism.

A CASE OF PRIMARY DUODENAL CANCER WHICH WAS SUCCESSFULLY RESECTED FOLLOWING CHEMOTHERAPY

We report a case of primary duodenal carcinoma which had partial responce by preoperative chemotherapy. A 65-year-old man visited a near clinic with the chief complaint of lower abdominal pain. Inspection, palpation and upper gastrointestinal barium studies showed that the patient had a duodenal abnormality. Ulcerative lesion of the duodenum and colon carcinoma were suspected and refersed to our hospital. After admission the abdominal tumor became larger and jaundice developed. From preoperative endoscopy of the duodenum and biopsy, malignant lymphoma was considered most probable and chemotherapy (CHOP) was started. After 2 courses of chemotherapy, significant decrease in the abdominal tumor mass was noted. Pancreatoduodenectomy with partial resection of transverse colon was performed. Postoperative course was uneventful and additional chemotherapy was done. The patient is closely followed on ambulant basis.

A FREE PERFORATION OF THE COLON IN CROHN'S DISEASE

A 44-year-old woman has been followed with Crohn's disease was admitted with the complaint of acute abdominal pain. An emergency operation was performed with the diagnosis of GI tract perforation. A free perforation of the transverese colon was observed. Partial resection of transverse colon was carried out. Pathological examination revealed Crohn's disease of the colon. Postoperatively a fistula of the anastomosis and an abcess of the ascending colon occurred, so the parts of the colon with abnormal lesions were resected in a two-stepapproach. A free perforation of the colon in Crohn's disease is uncommon and 9 cases have been reported in Japan.