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Development of perianal ulcer as a result of acute fulminant amoebic colitis

World Journal of Gastroenterology 2012年第34期18卷 4794-4797页

作者： Takayuki Torigoe yoshifumi nakayama Koji Yamaguchi Department of Surgery 1 School of MedicineUniversity of Occupational and Environmental HealthKitakyushu 807-8555Japan

We report a case of acute fulminant amoebic colitis that resulted in the development of a perianal ulcer in a 29-year-old Japanese homosexual man with acquired immunodeficiency syndrome (AIDS). The patient was admitted to our hospital with a persistent perianal abscess that was refractory to antibiotic therapy adminis-tered at another hospital. On admission, we observed a giant ulcer in the perianal region. At first, cytomega-lovirus colitis was suspected by blood investigations. Ganciclovir therapy was initiated; however, the patient developed necrosis of the skin around the anus during therapy. We only performed end-sigmoidostomy and necrotomy to avoid excessive surgical invasion. Histopathological examination of the surgical specimen revealed the presence of trophozoite amoebae, indicating a final diagnosis of acute fulminant amoebic colitis. The patient's postoperative course was favorable, and proctectomy of the residual rectum was performed 11 mo later. Amoebic colitis is one of the most severe complications affecting patients with AIDS. Particularly, acute fulminant amoebic colitis may result in a poor prognosis; therefore, staged surgical therapy as a lessinvasive procedure should be considered as one of the treatment options for these patients.

关键词：尖锐暴发性的阿米巴的大肠炎 Perianal 溃疡获得的免疫不全症候群 Cytomegalovirus 大肠炎上演外科

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Excision of a large abdominal wall lipoma improved bowel passage in a Proteus syndrome patient

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World Journal of Gastroenterology 2009年第26期15卷 3312-3314页

作者： yoshifumi nakayama Shinichi Kusuda Naoki Nagata Koji Yamaguchi Department of Surgery 1 School of MedicineUniversity of Occupational and Environmental Health Department of Surgery Moji Medical Center Department of Surgery Kitakyushu General Hospital

Proteus syndrome is an extremely rare congenital disorder that produces multifocal overgrowth of tissue.This report presents a surgical case of a large lipoma in the abdominal wall of a patient with Proteus syndrome.She was diagnosed with Proteus syndrome based on certain diagnostic criteria.The neoplasm increased in size gradually,producing hemihypertrophy of her left lower extremity and trunk,and spread to her retroperitoneum and her left abdominal wall.She experienced gradually progressive constipation,nausea,vomiting,and abdominal pain.Computed tomography (CT) of the abdomen demonstrated a large mass in the subcutaneous adipose tissue of the left lower abdominal wall which measured 12 cm × 8 cm x 6 cm in diameter and encased the left colon.This mass in the abdominal wall was excised.The weight of the excised mass was 1550 g.The histopathological diagnosis of this mass was lipoma.After surgery,the encasement of the left colon was improved,and the patient was able to move her bowels twice per day.The excision of the large lipoma in the abdominal wall contributed to the improved bowel passage in this patient with Proteus syndrome.

关键词：脂肪组织基础变形综合征患者结肠中国气象局病理诊断多焦点

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Novel technique of abdominal wall nerve block for laparoscopic colostomy: Rectus sheath block with transperitoneal approach

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World Journal of Gastrointestinal Surgery 2017年第8期9卷 182-185页

作者： Jun Nagata Jun Watanabe Yusuke Sawatsubashi Masaki Akiyama Koichi Arase Noritaka Minagawa Takayuki Torigoe Kotaro Hamada yoshifumi nakayama Keiji Hirata Department of Gastroenterological and General Surgery Wakamatsu Hospital University of Occupational and Environmental Health Department of Surgery Yokosuka Kyosai Hospital Department of Surgery University of Occupational and Environmental Health Department of Anesthesiology Wakamatsu Hospital University of Occupational and Environmental Health

A 62-year-old man who had acute rectal obstruction due to a large rectal cancer is presented. He underwent emergency laparoscopic colostomy. We used the laparoscopic puncture needle to inject analgesia with the novel transperitoneal approach. In this procedure, both ultrasound and laparoscopic images assisted with the accurate injection of analgesic to the correct layer. The combination of laparoscopic visualization and ultrasound imaging ensured infiltration of analgesic into the correct layer without causing damage to the bowel. Twentyfour hours postoperatively, the patient's pain intensity as assessed by the numeric rating scale was 0-1 during coughing, and a continuous intravenous analgesic was not needed. Colostomy is often necessary in colon obstruction. Epidural anesthesia for postoperative pain cannot be used in patients with a coagulation disorder. We report the use of a novel laparoscopic rectus sheath block for colostomy. There has been no literature described about the nerve block with transperitoneal approach. The laparoscopic rectus sheath block was performed safely and had enough analgesic efficacy for postoperative pain. This technique could be considered as an optional anesthetic regimen in acute situations.

关键词： Colorectal 癌症权利鞘块结肠阻塞手术后的疼痛

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Suspected Anaphylactic Shock Associated with Rocuronium in an Infant: A Case Report

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Open Journal of Anesthesiology 2016年第4期6卷 51-54页

作者： Hideya Katoh yoshifumi Naito Chihiro Aoki Mao Kinoshita Yoshinobu nakayama Teiji Sawa Department of Anesthesiology Kyoto Prefectural University of Medicine Kyoto Japan

We report a case of severe anaphylactic shock in a 5-month-old infant who was scheduled to undergo an external inguinal hernia repair under general anesthesia. Rocuronium used for anesthesia induction was the most likely cause of anaphylaxis. High levels of serum tryptase and histamine detected in the blood sample collected during the anaphylactic reaction confirmed the diagnosis of anaphylactic shock. The patient’s clinical status improved within 90 min of intervention by the intravenous injection of vasopressors and a steroid. Surgery was canceled, and the patient stayed in the pediatric intensive care unit (PICU) under artificial ventilation for 5 h before safe extubation. The patient achieved full recovery the next day, without any sequelae. The rescheduled surgery was successfully completed 5 months later under general anesthesia without the use of neuromuscular blocking agents.

关键词： Anaphylaxis Neuromuscular Blocking Agent Rocuronium Shock

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