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)
Publication Title Journal of Okayama Medical Association
Published Date 2017-04-03
Volume volume129
Issue issue1
Start Page 35
End Page 39
ISSN 0030-1558
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
DOI 10.4044/joma.129.35
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)
Publication Title 岡山医学会雑誌
Published Date 2015-04-01
Volume volume127
Issue issue1
Start Page 35
End Page 39
ISSN 0030-1558
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
DOI 10.4044/joma.127.35
NAID 130005068351
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)
Publication Title 岡山医学会雑誌
Published Date 2014-04-01
Volume volume126
Issue issue1
Start Page 35
End Page 38
ISSN 0030-1558
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
DOI 10.4044/joma.126.35
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