Faculty of Medicine College Hospital The first surgery


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  • A Case of Resection of a Pancreatic Mucinous Cystic Neoplasm in a Man with Acute Pancreatitis

    Wada Takashi, Hiyoshi Masahide, Shimizu Ikko, Nagatomo Kenzo, Hamada Roko, Kitamura Eiji, Hamada Takeomi, Yano Koichi, Imamura Naoya, Nanashima Atsushi

    The Japanese Journal of Gastroenterological Surgery   54 ( 5 )   328 - 336   2021.5

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    Language:Japanese   Publishing type:Research paper (scientific journal)   Publisher:The Japanese Society of Gastroenterological Surgery  

    A 50-year-old man was admitted to our hospital with a chief complaint of abdominal pain. Abdominal CT showed a 17-mm unilocular cystic lesion in the pancreatic tail and dilation of the main pancreatic duct distal to the lesion. The pancreatic parenchyma was swollen. The fat tissue density around the pancreas was increased and indicative of pancreatitis. There was no communication between the main pancreatic duct and the cystic lesion based on MRCP, and endoscopic ultrasound showed a unilocular cystic lesion with no solid components or septal structure. The patient was diagnosed as having a retention cyst and acute pancreatitis, and received conservative therapy. Because of recurrence of pancreatitis due to stenosis of the main pancreatic duct caused by the cystic lesion, laparoscopic-assisted distal pancreatectomy was performed. The lesion was a bilocular cyst, and histopathologically, ovarian-type stroma was observed in the cystic wall. Thus, the lesion was diagnosed as a mucinous cystic adenoma. Pancreatic mucinous cystic neoplasms in males are less frequent than in females, but if suspicious findings are found on imaging, this disease should be considered in the differential diagnosis.

    DOI: 10.5833/jjgs.2020.0053


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  • Validation set analysis to predict postoperative outcomes by technetium-99m galactosyl serum albumin scintigraphy for hepatectomy

    Nanashima A., Hiyoshi M., Imamura N., Yano K., Hamada T., Wada T., Nishimuta M., Shimizu I., Mizutani Y.

    Nuclear Medicine Communications   41 ( 4 )   320 - 326   2020

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    Language:Japanese   Publishing type:Research paper (scientific journal)   Publisher:Nuclear Medicine Communications  

    Background The indocyanine green retention rate at 15 min (ICGR15) is a gold standard parameter of liver function when deciding on the extent of hepatectomy. However, ICGR15 is influenced by several hepatic conditions. To evaluate auxiliary preoperative liver functional reserve, we examined the clinical significance of modified parameters by blood tests and technetium-99m galactosyl human serum albumin (99mTc-GSA) scintigraphy. Methods We measured liver function parameters, including the hepatic uptake ratio (LHL15) and the blood pool clearance index (HH15) of 99mTc-GSA and their modified formulae [LHL/HH15, LHL minus HH15, and converted ICGR15 (cICGR15) from a preliminary study] in 229 patients, including 18 with biliary obstruction. Results The mean values of LHL15/HH15, LHL minus HH15, and cICGR15 were 1.646 ± 0.295, 0.347 ± 0.116, and 13.2 ± 5.3%, respectively. These parameters correlated significantly with other liver functions measured by blood tests except for the bilirubin level (P < 0.05) although the actual ICGR15 level correlated positively with the bilirubin level. The difference of ICGR15 (ICGR15 minus cICGR15) in patients with biliary obstruction tended to be higher in comparison with that in patients without biliary obstruction (P = 0.044). Values of LHL/HH15, LHL minus HH15, and the cICGR15 were not significantly associated with postoperative complications. Conclusion The modified parameters of 99mTc-GSA were useful for evaluating hepatic function in patients with high bilirubinemia due to biliary obstruction. However, it remains difficult to establish a more reliable parameter as a standard hepatic function test instead of ICGR15.

    DOI: 10.1097/MNM.0000000000001162



  • A Case of Perforation of Sigmoid Colon Diverticulum during Taking Sodium Polystyrene Sulfonate

    ASADA Takashi, KAI Masahiro, SHIMIZU Ikkou, OGATA Shoichi, KANEMARU Mikio, TANAKA Shunich, HATAKEYAMA Kinta, KOITA Hiroyuki

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)   81 ( 2 )   292 - 296   2020

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    Language:Japanese   Publishing type:Research paper (scientific journal)   Publisher:Japan Surgical Association  

    An 81-year-old female patient who was prescribed sodium polystyrene sulfonate (SPS : Quixarate<sup>®</sup>) for hyperkalemia had the abrupt onset of abdominal pain 23 days after oral administration of SPS. She was introduced to our department with a diagnosis of acute abdomen. In abdominal findings, strong tenderness and muscular defense were observed throughout the lower abdomen, and general pan-peritonitis was suspected. An abdominal CT scan showed multiple diverticula in the sigmoid and ascending colon and a free gas image in the peritoneal cavity. No storage of ascites was allowed. Contrast enema with amidotrizoic acid revealed leakage of the medium from the sigmoid colon to the outside of the intestinal tract. Perforation of sigmoid colon diverticulum was suspected and an emergency operation was performed on the same day. Intraoperative findings showed two sites of perforation in the sigmoid colon. Postoperative pathological findings showed deposition of SPS crystals in wall of the perforated diverticulum. In this case, it is suggested that taking SPS may be involved in the development of sigmoid diverticular perforation.

    DOI: 10.3919/jjsa.81.292

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