タイトル(別表記) Thoracoscopic esophagectomy was effective in a case of lower esophageal stenosis due to recurrence of achalasia after myotomy 40 years previously
著者 桂 佑貴| 白川 靖博| 田邊 俊介| 前田 直見| 野間 和広| 藤原 俊義|
抄録 When planning surgery for achalasia, it is important to plan for adequate myotomy and prevention of reflux. However, achalasia may recur if the procedure was inadequate or in patients with a long-term course. The present case is a 68-year-old woman who underwent myotomy of the lower esophageal sphincter 40 years ago, but recently reported difficulty in swallowing. Dilatation of the thoracic esophagus and stenosis of the abdominal esophagus were identified by examination, and the patient was diagnosed with recurrence of achalasia. After percutaneous endoscopic gastrostomy was performed to recover nutritional status, thoracoscopic esophagectomy was carried out. The patient'spost-operative course was uneventful and oral intake was enabled. At the time of writing, there has been no re-recurrence. There is no standard therapy for post-operative recurrence of achalasia. We believe that thoracoscopic esophagectomy for the recurrence of achalasia is a safe and minimally invasive alternative to conventional surgery.
キーワード 食道アカラシア (achalasia) 再手術 (reoperation) 食道亜全摘 (esophagectomy)
出版物タイトル 岡山医学会雑誌
発行日 2017-04-03
129巻
1号
開始ページ 41
終了ページ 44
ISSN 0030-1558
言語 Japanese
著作権者 Copyright (c) 2017 岡山医学会
論文のバージョン publisher
DOI 10.4044/joma.129.41
タイトル(別表記) A refractory cutaneous-rectovesical fistula complicated with abdominal actinomycosis successfully treated with antibiotic therapy
著者 桂 佑貴| 松川 啓義| 加藤 卓也| 杉原 正大| 小島 康知| 塩崎 滋弘|
抄録 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.
キーワード 放線菌症 (actinomycosis) 皮膚直腸膀胱瘻 (cutaneous-rectovesical fistula) 急性虫垂炎 (appendicitis)
出版物タイトル 岡山医学会雑誌
発行日 2017-04-03
129巻
1号
開始ページ 35
終了ページ 39
ISSN 0030-1558
オフィシャル URL http://www.okayama-u.ac.jp/user/oma/|
言語 Japanese
著作権者 Copyright (c) 2017 岡山医学会
論文のバージョン publisher
DOI 10.4044/joma.129.35