No abstract

A 32-year-old woman with a previous history of undergoing laparoscopic hysterectomy for cervical cancer was admitted to our hospital because of abdominal pain and vomiting. She had a peritoneal irritation sign in the right lower quadrant of abdomen. Abdominal contrast-enhanced computed tomography showed the distended small intestine with a closed loop and the dilated right ureter which had interrupted at the right lower quadrant. An emergency surgery was performed with the diagnosis of strangulation ileus. Operative findings included a loop of necrotic small intestine obstructed by a constricting band crossing the right pelvic cavity. The band was suspected to be the right ureter, but the strangulation was severe. We had to cut the band to reduce the strangulation and performed segmental resection of the small intestine. The band was proved to be the right ureter, and a repair of the ureter was performed. It was considered that the small intestine invaginated in the back side of the right ureter which was isolated during previous laparoscopic hysterectomy. As we encountered an extremely rare case of strangulation ileus with a ureteric band after gynecologic surgery, we report this case here, with a review of the literature.

No abstract

A 71-year-old woman who had been observed for an asymptomatic abdominal mass for ten years visited our hospital because of a one-month history of abdominal distention. Abdominal CT scan showed a 22×15 cm multilocular cystic tumor in the left abdomen and a left hydronephrosis. The tumor had a tendency to increase, and so we performed an operation with a diagnosis of a retroperitoneal cystic tumor. The infant's head sized tumor was located in the retroperitoneal space from dorsal side of the mesosigmoid to the left diaphragm, and it was totally resected. There was brown turbid fluid retention within the tumor and the wall of the tumor showed a necrotic change. Pathological findings showed no malignant cells and the diagnosis was a retroperitoneal cystic tumor with xanthogranulomatous change. Follow-up studies for half a year have shown no evidence of recurrence.

Introduction: Primary hyperparathyroidism (PHP) is a curable disease because most patients have only one adenoma and can fully recover after adenoma removal at the location determined by preoperative imaging. However, many Japanese surgeons believe that intraoperative intact PTH measurement (IOPM) is essential to the surgery. Hence, many general surgeons in Japan are unable to perform surgeries for PHP in their local hospitals and must refer the patients to urban high volume centers that have introduced IOPM, even though they are experienced in general surgery and the surgery for PHP is technically simple and related to general surgery. So, we analyzed the relationship of surgical outcomes, with and without IOPM.