Sort Key 7
Title Alternative A refractory cutaneous-rectovesical fistula complicated with abdominal actinomycosis successfully treated with antibiotic therapy
Author Katsura, Yuki| Matsukawa, Hiroyoshi| Kato, Takuya| Sugihara, Masahiro| Ojima, Yasutomo| Shiozaki, Shigehiro|
Abstract The patient was a 35-year-old Japanese man diagnosed with appendicitis with abscess formation. An appendectomy was performed, but a refractory surgical wound infection developed, and eventually a cutaneous-rectovesical fistula was detected. In a review of the first-time CT scan, a small high-density construction resembling a bone from a fish was detected in the ileum. The histopathological examination revealed granules of actinomyces. These findings suggested that abdominal actinomycosis due to intestinal mucosal breakage by the fish bone caused the secondary appendicitis, and that after the appendectomy, residual actinomyces caused the cutaneous-rectovesical fistula. After the diagnosis, total parenteral nutrition and a long-term administration of antibiotics improved the patient's clinical symptoms, and the fistula closed within a month. Antibiotics were administered for 6 months, and there has been no recurrence for 6-1/2 years. Because actinomycosis is difficult to diagnose based on the typical clinical features, a direct identification of the infecting organism from a tissue sample or from sulfur granules is required for the definitive diagnosis. Actinomyces is also known to cause fistula formation, and intestinal penetration caused by a fish bone may indicate abdominal actinomycosis. A rectovesical fistula requires surgical intervention in most cases, but in cases caused by abdominal actinomycosis, such a fistula may be cured by conservative therapy, as in our patient's case. It is important to consider the possibility of actinomycosis when a refractory rectovesical fistula is observed.
Keywords 放線菌症 (actinomycosis) 皮膚直腸膀胱瘻 (cutaneous-rectovesical fistula) 急性虫垂炎 (appendicitis)
Note 症例報告(Case Reports)
Publication Title Journal of Okayama Medical Association
Published Date 2017-04-03
Volume volume129
Issue issue1
Publisher 岡山医学会
Publisher Alternative Okayama Medical Association
Start Page 35
End Page 39
ISSN 0030-1558
NCID AN00032489
Content Type Journal Article
Official Url http://www.okayama-u.ac.jp/user/oma/|
language 日本語
Copyright Holders Copyright (c) 2017 岡山医学会
File Version publisher
Refereed True
DOI 10.4044/joma.129.35
Eprints Journal Name joma
References 1 ) Smego RA Jr, Foglia G : Actinomycosis. Clin Infect Dis (1998) 26, 1255-1261. 2 ) 服部尚子, 三上 襄 : 放線菌症, ノカルジア症. MB Derma (2007) 127, 71-80. 3 ) 横山純二, 本田 穣, 河合裕介, 小林正明, 佐藤祐一, 成澤林太郎, 青柳 豊 : 放線菌症. 消化器内視鏡 (2009) 21, 481-484. 4 ) 加藤浩樹, 國枝克行, 八幡和憲, 伊藤元博, 河合雅彦, 古市信明 : 虫垂切除後に病理診断された腹部放線菌症の1例. 日臨外会誌 (2007) 68, 904-907. 5 ) 田中伸佳, 服部昌和, 道傳研司, 宮永太門, 海崎泰治, 吉川淳 : 腹部放線菌症の1例. 日臨外会誌 (2009) 70, 3162-3165. 6 ) 徳元伸行, 青山博道, 石川千佳, 平山信男 : クラリスロマイシンが奏効した難治性腸管放線菌症の1 例. 日臨外会誌 (2007) 68, 2558-2564. 7 ) 常光洋輔, 濱野亮輔, 西江 学, 徳永尚之, 大塚眞哉, 大崎俊英 : 下腹壁放線菌症の1例. 外科 (2009) 71, 439-441. 8 ) 山下博司, 福知 工, 伊藤 大, 川村梨那子, 栗島亜希子, 藤山徹, 渡邉実香, 亀井宏治, 可児弘行, 高橋 元, 永松良介, 蘆田 潔, 他 : 経皮的肝生検で放線菌塊を確認し, 抗生剤投与が有効であった原発性肝放線菌症の1例. 日消誌 (2007) 104, 698-702. 9 ) 石黒 卓, 高柳 昇, 田中香お里, 米田紘一郎, 杉田 裕, 渡邉邦友 : Capnocytophaga sp. とActinomyces israelii による膿胸の1例. 日呼吸会誌 (2009) 47, 906-911. 10) 品川長夫 : 抗菌薬の選択と使い方, 外科領域 改訂4版, 医薬ジャーナル社, 大阪 (2006) pp237-238. 11) 柴田佳久, 加藤岳人, 鈴木正臣, 尾上重巳, 長沢圭一 : 直腸膀胱瘻の1例. 日臨外会誌 (2004) 65, 444-448. 12) 中島正夫, 内山哲史, 足立 淳, 内迫博幸, 田中慎介 : 二期的手術が有効であった直腸憩室炎による直腸膀胱瘻の1例. 日消外会誌 (2013) 46, 611-617. 13) Fernandez Lobato R, Pinto I, Maillo C, Paul L, Fradejas JM, MorenoAzcoita M : Rectovesical fistula treated by covered selfexpandingprosthesis. Dis Colon Rectum (1999) 42, 812-815. 14) 金城 満, 鷺山和幸, 山口秋人, 原 三信, 宮地 洋 : 炎症性偽腫瘍を伴うS状結腸膀胱瘻の1 例. 西日本泌尿器科学会雑誌 (1989) 51, 131-134. 15) 宮永克也, 多保孝典, 林 秀樹, 千葉幸夫, 稲井邦博, 内木宏延 : 肝下面から右臀部まで腹腔内外に腫瘍様浸潤をきたした放線菌症の1例. 日臨外会誌 (2015) 76, 2582-2586.
Sort Key 8
Title Alternative Cholelithiasis with a cholecystoduodenal fistula complicated with paroxysmal nocturnal hemoglobinuria
FullText URL 127_35.pdf
Author Kato, Takuya| Matsukawa, Hiroyoshi| Shiozaki, Shigehiro| Fuji, Tomokazu| Fujiwara, Yasuhiro| Ninomiya, Motoki|
Abstract  In cases of paroxysmal nocturnal hemoglobinuria (PNH), attention must be paid to potential complications such as thrombosis and hemolysis due to perioperative stress and infection from complement activation. Here we present the case of a 61-year-old Japanese woman with PNH. We made the diagnosis of PNH when she was 28 years old, and we administered repeated steroid medication and erythrocyte transfusion. The patient's cholecystocholedocholithiasis with a cholecystoduodenal fistula was diagnosed based on a survey of the right hypochondriac pain. We performed endoscopic nasobiliary drainage (ENBD) for the prophylaxis of perioperative infection, plus a cholecystectomy and fistulectomy. There were no complications, including hemolysis attack, infection, thrombosis with irrigation erythrocyte transfusion, steroid cover, or the need for heparin administration during the perioperative period. The reduction of the complement activation is necessary in the perioperative management of PNH patients. The prevention of the development of acidosis and hypoxemia, the selection of washed red blood cells, steroid use, appropriate infection measures and thrombosis prophylaxis are all important for the prevention of complications.
Keywords 発作性夜間血色素尿症(PNH)(paroxysmal nocturnal hemoglobinuria (PNH)) 胆嚢十二指腸瘻(cholecystoduodenal fistula) 溶血発作(hemolysis)
Note 症例報告 (Case Reports)
Publication Title 岡山医学会雑誌
Published Date 2015-04-01
Volume volume127
Issue issue1
Publisher 岡山医学会
Publisher Alternative Okayama Medical Association
Start Page 35
End Page 39
ISSN 0030-1558
NCID AN00032489
Content Type Journal Article
Related Url http://www.okayama-u.ac.jp/user/oma/
language 日本語
Copyright Holders Copyright (c) 2015 岡山医学会
File Version publisher
Refereed True
DOI 10.4044/joma.127.35
NAID 130005068351
Eprints Journal Name joma
References 1) 七島 勉 : 発作性夜間ヘモグロビン尿症の診断・治療の実際. 血腫瘍(2010)60, 777-786. 2) Le XF, Yang TY, Yang XY, Wang XM : Characteristics of paroxysmal nocturnal hemoglobinuria in China. Chin Med J (1990) 103, 885-889. 3) 中平淳子, 澤井俊幸, 宮崎信一郎, 南 敏明 : 発作性夜間血色素尿症患者の周術期管理の1症例. 麻酔(2011)60, 866-869. 4) Kathirvel S, Prakash A, Lokesh BN, Sujatha P : The anesthetic management of a patient with paroxysmal nocturnal hemoglobinuria. Anesth Analg (2000) 91, 1029-1031. 5) Taylor MB, Whitwam JG, Worsley A : Paroxysmal nocturnal haemoglobinuria. Peri-operative management of a patient with Budd-Chiari syndrome. Anaesthesia (1987) 42, 639-642. 6) 七島 勉, 野地秀義 : PNH患者の手術. 血腫瘍(2003)47, 295-300. 7) OginGA : Cholecystectomy in a patient with paroxysmal nocturnal hemoglobinuria : anesthetic implications and management in the perioperative period. Anesthesiology. (1990) 72, 761-764. 8) DacieJV : Transfusion of saline-washed red cells in nocturnal haemoglobinuria (Marchiafava-Micheli disease). Clin Sci (1948) 7, 65-75. 9) Brecher ME, Taswell HF : Paroxysmal nocturnal hemoglobinuria and the transfusion of washed red cells. A myth revisited. Transfusion (1989) 29, 681-685. 10) Gralnick HR, Vail M, Mckewon LP, Merryman P, Wilson O, Chu I, Kimball J : Activated platelets in paroxysmal nocturnal hemoglobinuria. Br Haemtol (1995) 91, 697. 11) Rother RP, Rollins SA, Mojcik CF, Brodsky RA, Bell L : Discovery and development of the complement inhibitor eculizumab for the treatment of paroxysmal nocturnal hemoglobinuria. Nat Biotechnol (2007) 25, 1256-1264. 12) 伊藤良和, 安藤恵子, 本定三季, 松土尊映, 西村浩輔, 近澤悠志, 福島慎二 : エクリズマブ併用によって開腹胆嚢摘出術を行った再生不良性貧血発作性夜間ヘモグロビン尿症症候群. 東医大誌(2012)70, 485-496. 13) Braren V, Jenkins DE Jr, Phythyon JM, Hartmann RC, Clark DA : Perioperative management of patients with paroxysmal nocturnal hemoglobinuria. Surg Gynecol Obstet (1981) 153, 515-520. 14) 松田 信, 大越 透, 神林裕行, 田中鉄五郎, 佐久間秀夫, 志賀 隆, 七島 勉, 丸山幸夫 : 胆嚢摘出術を施行した発作性夜間血色素尿症の1例. 臨血(1991)32, 1515-1520. 15) Covey WG, Duerr S : Laparoscopic cholecystectomy in paroxysmal nocturnal hemoglobinuria. Conn Med (1992) 56, 63-64.
Sort Key 7
Title Alternative A case of colon lipoma presenting with intussusception
FullText URL 126_35.pdf
Author Ninomiya, Takayuki| Ojima, Yasutomo| Harano, Masao| Ohno, Satoshi| Shiozaki, Shigehiro| Ninomiya, Motoki|
Abstract  An 84-year-old man, who had been found to have a submucosal tumor in the ascending colon two years before, was admitted to our hospital for right lower quadrant abdominal pain and melena. An abdominal computed tomography (CT) scan showed intussusception in the ascending colon, resulting from a fat-density tumor. The intussusception was located by colonoscopy. Since the colonic tumor was enlarged in comparison with two years ago and had an ulcer at the top of the tumor, there was the possibility of malignancy and recurrence of intussusception. He underwent a laparoscopy-assisted right colectomy with lymph node dissection. Pathologically, the tumor of the ascending colon was a benign lipoma.
Keywords 結腸脂肪腫(lipoma of the colon) 腸重積(intussusception) 腹腔鏡下手術(laparoscopic surgery)
Note 症例報告 (Case Reports)
Publication Title 岡山医学会雑誌
Published Date 2014-04-01
Volume volume126
Issue issue1
Publisher 岡山医学会
Publisher Alternative Okayama Medical Association
Start Page 35
End Page 38
ISSN 0030-1558
NCID AN00032489
Content Type Journal Article
Related Url http://www.okayama-u.ac.jp/user/oma/
language 日本語
Copyright Holders Copyright (c) 2014 岡山医学会
File Version publisher
Refereed True
DOI 10.4044/joma.126.35
Eprints Journal Name joma
References 1) Helwig EB : Benign tumor of the large intestine. Incidence and distribution. Surg Gynecol Obstet (1943) 76, 419-426. 2) 正岡一良, 中村孝志 : 大腸良性腫瘍, 臨床的事項. 日臨(1988)46, 348-355. 3) 藤野啓一, 長谷和生, 森田大作, 宇都宮勝之, 渡邉千之, 山本哲久, 望月英隆 : 大腸脂肪腫23例の臨床的検討. 日臨外会誌(1999)60, 1737-1740. 4) 佐藤 洋, 矢島和人, 冨田 広, 松澤岳晃, 小海秀央 : 腸重積を併発した腸管原発脂肪腫に対する腹腔鏡補助下切除の2例. 日臨外会誌(2009)70, 3061-3065. 5) 梅原松臣, 高井 淳, 有馬保生, 木内博之, 内藤委仲, 吉村和泰, 横井公良, 恩田昌彦 : 横行結腸脂肪腫の1例. 日消外会誌(1990)23, 1937-1941. 6) 笠間和典, 加納宣康, 山田成寿, 草薙 洋, 渡井 有, 武士昭彦 : 腸重積をきたした横行結腸脂肪腫に対して腹腔鏡下手術を施行した1例. 日臨外会誌(1999)60, 2954-2958. 7) 丸山 聡, 田中典生, 下田 聡, 武田信夫, 小山俊太郎, 岡本春彦, 畠山勝義 : 腸重積をきたした下行結腸脂肪腫に腹腔鏡下手術を施行した1例. 新潟医会誌 (2004) 118, 217-222. 8) 前山 良, 八谷泰孝, 佐古達彦, 福山時彦, 平野 豊 : S状結腸脂肪腫に起因した成人逆行性腸重積症の1例. 日臨外会誌(2008)69, 100-104. 9) 金川泰一朗, 田中屋宏爾, 金澤 卓, 村田 宏 : 成人腸重積症で発見された潰瘍をともなう上行結腸脂肪腫の1例. 日本大腸肛門病会誌(2008)61, 81-84. 10) 林 雅規, 瀬山厚司, 原田剛佑, 井口智浩, 守田知明 : 術前CT検査が有用であった腸重積を呈した結腸脂肪腫の一切除例. 山口医学(2009)58, 85-89. 11) 猪口晃一, 長畑洋司, 今中洋子 : 大腸脂肪腫の1例. 医研究(1987)48, 101-105. 12) 西原修一郎, 牟田俊明, 小田原恵二 : 内視鏡的ポリペクトミーにより摘出した大腸脂肪腫の1例-本邦報告例の文献的考察-. 日消誌(1984)26, 79-83. 13) 柴田佳久, 加藤岳人, 鈴木正臣, 尾上重巳, 長澤圭一, 吉原 基 : 当院における結腸脂肪腫の検討-治療方針の面から-. 日消外会誌(2006)39, 1361-1367. 14) 小熊潤也, 田村 光, 青木真彦, 細田 桂, 城戸 啓, 夏 錦言, 雨宮 哲 : 成人腸重積の原因となった大腸lipomatous tumorに対し腹腔鏡補助下手術を施行した1例. 日消外会誌(2007)40, 1955-1959. 15) 福田直人, 土用下和之, 丸野 要, 山川達郎 : 腸重積をきたしたS状結腸脂肪肉腫の1例. 日臨外会誌(2004)65, 429-432. 16) 杉本起一, 永仮邦彦, 菅野雅彦, 杉山和義, 津村秀憲, 福永正氣 : 腸重積を発症した巨大横行結腸脂肪腫の1例. 日外科系連会誌(2009)34, 238-242.
Author Ninomiya, Takayuki| Ojima, Yasutomo| Harano, Masao| Ohno, Satoshi| Shiozaki, Shigehiro| Ninomiya, Motoki|
Published Date 2013-12-02
Publication Title 岡山医学会雑誌
Volume volume125
Issue issue3
Content Type Journal Article