We report on two patients with gastric tumors (early cancer and adema) and diabetes mellitus who were treated with argon plasma coagulation (APC) therapy. Case 1. A 78-year-old woman visited the Nippon Medical School Musashi Kosugi Hospital because of epigastric pain. An early gastric cancer (IIc) in the anterior wall of the gastric antrum was diagnosed on the basis of the results of a gastric endoscopy examination. The patient had had diabetes mellitus for 18 years and had injected insulin (NovoRapid 30 Mix®, 72 units/day) by herself everyday for 10 years. Case 2. A 61-year-old man was referred to our hospital because of a gastric tumor. A gastric adenoma in the anterior of the gastric antrum was diagnosed on the basis of the results of a gastric endoscopy examination. The patient had had diabetes mellitus for 12 years and had been taking oral medication for 2 years. Endoscopic APC was performed in both patients to remove the gastric tumors. These patients have been well for 28 months and 30 months, respectively, after undergoing APC treatment. APC therapy appears to be a safe and useful treatment for patients with diabetes and gastric mucosal lesions.
Background/Aim: Although the frequency of small bowel obstructions after liver surgery is generally considered low, previous studies have followed-up patients for less than a year, thus the incidence of small bowel obstructions several years after surgery is unknown. Furthermore, the rise in laparoscopic surgeries and the use of adhesion prevention materials may influence the occurrence of small bowel obstructions. This study aimed to assess the incidence of small bowel obstructions within a five-year period following liver surgery and identify the associated risk factors. Patients and Methods: This case series analysis analyzed patients who underwent liver surgery between April 2012 and March 2014 from 32 participating hospitals. Multivariate analysis was conducted to examine risk factors for small bowel obstructions. Results: A total of 953 patients were included in the analysis, and the incidence of small bowel obstructions was 1.6%. The incidence was significantly higher at 3.4% for surgeries related to metastatic liver cancer compared to other types of surgeries. Laparoscopic surgery had no significant effect on the incidence of SBO (p=0.72). There was no significant difference in the incidence of small bowel obstructions between surgeries that employed adhesion prevention materials and those that did not. Multivariable analysis revealed that longer surgical time and re-operation were independent risk factors for small bowel obstructions. Conclusion: The incidence of small bowel obstructions following surgery for metastatic liver cancer is significantly higher compared to other liver surgeries. Neither laparoscopic surgery nor adhesion prevention materials reduce its occurrence. Longer surgical time and re-operation are independent risk factors for small bowel obstructions.
We report an intra-abdominal endocrine tumor possibly arising from an ectopic pancreas. A 45-year-old woman visited the Nippon Medical School Musashi-Kosugi Hospital because of right-sided hypochondralgia and upper abdominal discomfort of 1 years duration. An intra-abdominal tumor was diagnosed on the basis of the results of an ultrasound examination, computed tomography and magnetic resonance. Surgery was subsequently performed using laparoscopic techniques, and a tumor without firm adhesions was found near the wall of the duodenal bulbus. The tumor was easily removed; the resected specimen (55 × 45 × 25 mm, 50 g) was composed of bloody fluid within a cystic tumor. Histological and immunohistochemical examinations of the tumor showed a type 3 ectopic pancreas, according to the classification proposed by Heinrich. The patients recovery was uneventful.
A 6-year-old boy was hospitalized because of dark feces and facial pallor of 1 weeks duration. Other gastrointestinal symptoms, including vomiting and abdominal pain, were absent, but he felt dizziness when standing and fatigue on effort. Hematologic studies revealed iron-deficiency anemia, and endoscopy showed gastric erosions and a duodenal ulcer. All test results for Helicobacter pylori infection, including H. pylori antigen in stool, anti-H. pylori IgG immunoassay in serum, and the (13)C-urea breath test, were positive. Because an H. pylori-associated gastric ulcer had been diagnosed with endoscopy in the patients father 3 years earlier, father-son transmission was suspected. The patient was treated with triple-agent eradication therapy (proton pump inhibitor [lansoprazol], amoxicillin, and clarithromycin) for 2 weeks. One month after therapy was completed, eradication of H. pylori was confirmed by negative results on the stool antigen test. Peptic ulcer disease can occur in young children, as in this case. The stool antigen test kit is a useful and reliable method that can be used even in preschool children to diagnose H. pylori infection.
