A 38-year-old male with no past history of illnesses visited the out-patient clinic of Nerima Hikarigaoka Hospital complaining of dizziness and persistent anal bleeding. There was a significant anemia on a blood test and colonoscopy showed a thrombus in a markedly swollen internal hemorrhoid. Contrast-enhanced computed tomography (CT) showed a poorly demarcated area with early face enhancement on the right side of the rectum and anal canal. Based on these findings, an arterio-venous malformation (AVM) of the rectum was suspected. Abdominal angiography showed abnormal vessels receiving a blood supply from the bilateral superior rectal arteries. We suspected that the AVM in the rectum was the cause of the hemorrhage from the internal hemorrhoid, and therefore performed embolization of the AVM. Thereafter, the hemorrhage from the internal hemorrhoid stopped completely and the anemia improved to the normal level, without the need for treatment for the internal hemorrhoid. Colonoscopy performed 6 months after embolization showed shrinkage of the internal hemorrhoid. To the best of our knowledge, there are no reports stating a relationship between rectal AVM and internal hemorrhoids. However, we consider that contrast-enhanced CT can be used to detect vessel abnormalities related to severe bleeding of the internal hermorrhoids in patients with internal hemorrhoids and severe anemia.
Objection: The elderly population, which carries an increased risk of postoperative complications, is increasing in size. "Frailty" is a new concept for assessing the surgical risk in elderly patients. We analyzed the usefulness of assessing frailty for predicting postoperative complications in patients ≥ 60 years of age undergoing colorectal cancer surgery. Methods: We conducted this prospective evaluation in 65 colorectal cancer patients ≥ 60 years of age who were underwent surgery for colorectal cancer. As relatively simple tools to predict the risk of postoperative complications, we evaluated the performance status, Barthel index, American Society of Anesthesiologists physical status, prognostic nutritional index and frailty. We also recorded the incidence of Grade ≥Ⅱ postoperative complications according to the Clavien-Dindo Classification. Results: A bivariate analysis showed that frailty was significantly associated with the risk of postoperative complications (p = 0.049). A multivariate analysis also identified frailty as being significantly associated with the risk of postoperative complications (p < 0.030). Conclusion: Assessment of frailty may be a useful tool for predicting the risk of postoperative complications in patients aged ≥ 60 years old.
There are 8 reported cases in which laparoscopic procedures were selected to treat small bowel obstruction caused by a mesodiverticular band. We herein report the case of a 9-year-old male who presented with intermittent abdominal pain around the umbilicus. He was diagnosed with small bowel obstruction associated with Meckelʼs diverticulum based on the CT findings. Laparoscopy was performed and a diagnosis of small bowel obstruction caused by a mesodiverticular band was made. Subsequently, we performed laparoscopic-assisted diverticulectomy and band resection. The patientʼs postoperative course was uneventful. Laparoscopicassisted surgery for small bowel obstruction caused by mesodiverticular bands has advantages over open procedures due to its ability to be use to make a diagnosis, reduced invasiveness and better cosmesis.
An 81-year-old man was admitted with general malaise and constipation. Colonoscopy showed a type 2 circular tumor 5cm from the anal verge. CT and MRI showed signs of invasion in the prostate and the sacrum (cT4b). Because he had bowel obstruction symptoms, we firstly constructed a colostomy.After that, six cycles of mFOLFOX6 systemic chemotherapy was administered. CT and MRI after chemotherapy showed reduction in tumor size and disappearance of tumor invasion. Seven weeks after chemotherapy, he underwent abdominoperineal resection without any other organ resection. Histological examination revealed negative margin. Tumor regression grading of chemotherapy was Grade 2. At the follow-up 20 months after surgery, he was alive without recurrence. With our present experience, we consider that mFOLFOX6 preoperative chemotherapy regimen could have a local effect comparable with chemo radiation for locally advanced rectal cancer.
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