Chronic idiopathic intestinal pseudo-obstruction caused by acquired visceral neuropathy localised in the left colon: Report of two cases

Two cases of chronic idiopathic intestinal pseudo-obstruction (CIIP) are reported. One is a 51-year-old man, and the other is a 47-year-old woman. Both patients presented with severe constipation and barium enema showed a marked dilation of the right colon, and a narrowing in the left colon. Studies done on the motility of the colon and anorectum revealed normal resting pressure profiles of the anorectom, a normal recto-anal reflex, and a normal resting tone of the collapsed colon. Administration of methacholine chloride, however, provoked large, non-propulsive movements in the collapsed colon, which were inhibited by the administration of atropin sulfate. Histologic examination disclosed a marked decrease in neurons and an increase of Schwann cells in the myenteric plexus of the collapsed colon. CIIP due to acquired visceral neuropathy localised in the left colon, was diagnosed as a result of manometric and histologic findings. One case was cured surgically, by a left hemi-colectomy, and the other was cured medically using choline antagonists and laxatives.     

Chronic recurrent abdominal pain in childhood due to mesenterium ileocolicum commune. Two cases with normal rotation of the intestine

Mesenterium ileocolicum commune with normal rotation of the midgut is described in an 11-year-old girl and a 12-year-old boy. Both had had recurrent abdominal pain for several years before the diagnosis was made. Barium enema showed the entire colon to be located in the middle and left part of the abdomen. Operation showed displacement of the right colon due to the mesenterium ileocolicum commune. The boy also had congenital bands across the duodenum, which could explain previous episodes of vomiting and delayed emptying of the stomach after a barium meal. The girl had only rudimentary transduodenal bands. Fixation of the right colon, lysis of duodenal bands and appendectomy were performed in both cases. Postoperatively both children have been asymptomatic. These two cases, with a common ileocolic mesentery and normal midgut rotation, demonstrate a rare abnormality of intestinal fixation during the third embryonic stage of development. Diagnosis of the cause underlying the chronic recurrent abdominal pain was delayed, but the patients were eventually cured by operation.     

Two cases of spontaneous fistula between urinary tract and gastrointestinal tract

This is a report of two cases of a fistula between the urinary and gastrointestinal tracts. One case was a 56-year-old female patient with a right pyeloduodenal fistula, and the other was a 38-year-old female with a left ureterodescending colon fistula. The chief complaint was right lumbago in the first case, and fever and left lumbago in the second case. Both cases were diagnosed by retrograde pyelography. In both cases, the ailing kidney appeared to be non-functioning, and the former was operated by nephrectomy, fistulectomy, and duodenectomy in the cuneate form, while the latter was operated by nephrectomy and fistulectomy. The cause of the formation of the fistula was considered to be chronic pyelonephritis accompanied by renal stones in the first case, and rupture of the colon diverticulitis in the second case. Postoperative prognosis was satisfactory in both cases.     

原发性慢性假性肠梗阻的诊治分析

目的 分析原发性慢性假性肠梗阻的临床特点及治疗方法,提高对该病的认识。方法 回顾性分析1980～1999年收治的8例原发性慢性假性肠梗阻病例资料。结果 本组患者平均年龄29岁,最早发病年龄为2岁;反复出现腹胀是最常见的症状;行影像学检查均未见器质性病变;胃肠动力试验显示胃肠通过时间明显延长;消化道压力测定提示消化道压力减低、动力减弱;2例行肠道活检,示慢性炎症;对1例病变局限在结肠者行全结肠切除;促胃肠动力药效果不佳,部分患者长期依赖静脉营养。结论 原发性慢性假性肠梗阻是一种少见疾病。保守治疗无明显疗效,手术治疗不是首选方法,患者预后不良。     

Familial spontaneous pneumothorax

A case of familial spontaneous pneumothorax was reported. A 52-year-old man was referred to our hospital complaining of exertional dyspnea. He had experienced right spontaneous pneumothorax and cured with tube drainage last year. Five of his 7 brothers and his son too had had spontaneous pneumothorax. Chest X-ray film and computed tomography (CT) scan on admission showed giant bulla of the left lung with compression of normal lungs. Pulmonary function studies revealed obstructive pulmonary disease and mild hypoxemia. Partial resection of the lung with open thoracotomy surgery was performed. Air leaks sealed in 14 days and the patient discharged the hospital with inadequate expansion of the left lung. Three years later the patient experienced right hemicolectomy for colon cancer and died for recurrence 7 years later with adequate expansion of the left lung.     

The surgical treatment of ruptured thoracic aortic aneurysm with use of permanent bypass

Two surgical cases with ruptured thoracic aortic aneurysm were reviewed. Case 1 was a 74-year-old female, and Case 2 was a 77-year-old female. In both cases, chest X-ray examination revealed a mass like shadow in the left superior mediastinum, and aortography demonstrated a ruptured saccular aneurysm distal to the left subclavian artery. Midsternotomy and an incision over the third left intercostal space were made to approach the aneurysm. Since inflammatory adhesion was marked in the perianeurysmal area, a permanent bypass was placed between the ascending and descending aorta followed by exclusion of the aneurysm. One of the two cases was alive, but the other case was died due to bleeding from the area of permanent aortic clamp.     

咽结肠吻合治疗食管烧伤后瘢痕狭窄

目的 总结采用咽结肠吻合治疗食管烧伤后瘢痕狭窄的经验及效果。方法 回顾分析14例应用咽结肠吻合重建食管治疗累及下咽的广泛食管烧伤后瘢痕狭窄患者的临床资料。均采用左半结肠,旷置胸内瘢痕食管、经胸骨后隧道上提至颈部行咽结肠吻合。结果 全组无手术死亡,术后发生颈部吻合口漏4例,腹部切口裂开1例。随访半年至10年,平均4年,2例分别于术后3个月及4个月发生吻合口狭窄,1例扩张,1例行成形术治愈;1例因移植结肠腹腔段呈袋状而致进食后呕吐,行结肠胃侧侧吻合治愈。结论 咽结肠吻合治疗累及下咽的广泛性食管烧伤后狭窄成功关键是较大的下咽开口及良好的吻合技术,咽结肠吻合是安全、有效的。     

Primary pulmonary leiomyosarcoma: case report and review of literature.

A case of primary leiomyosarcoma of the lung is added to the literature. Previously, 66 cases were documented. This is a case of a 55-year-old male, a pulmonary cripple for many years, with a collapsed left lower lobe found by roentgenogram, verified by bronchoscopy and bronchograms. Biopsy of lesion was reported as low grade leiomyosarcoma. Despite pulmonary function studies showing a vital capacity of 37% of predicted normal, a left pneumonectomy was preformed. Postoperatively, the patient had a tachycardia which gradually decreased in the next several months. Two months following operation pulmonary function studies were essentially unchanged from those made preoperatively. Arterial gas studies are presented pre and postoperatively.     

自发性结肠穿孔致阴囊气肿1例报告及文献复习

报告1例结肠自发穿孔导致阴囊气肿的临床资料。患者男,66岁,发热、腹痛、阴囊肿痛,轻度腹膜炎体征,阴囊肿胀,皮下握雪感。超声示阴囊皮下积气。CT:左腰大肌及髂腰肌肿胀伴积气。手术探查阴囊内积脓向上延续至腹膜后巨大脓腔与降结肠裂孔相通。由于结肠自发穿孔合并阴囊气肿临床罕见,结肠腹膜外穿孔症状相对较轻且出现较晚,故早期出现阴囊气肿应引起重视。     

结肠灌洗用于急诊左半结肠一期手术48例临床分析

为探讨结肠灌洗在急诊左半结肠一期手术中的应用效果,对48例行结肠灌洗、左半结肠一期手术患者资料进行回顾性分析。结果显示,本组患者均未实施肠造口,全部一期治愈,无吻合口漏、腹腔严重感染等并发症。结果表明,术中结肠灌洗、急诊行左半结肠一期手术具有可行性,避免了肠造口的发生,具有操作简便,成本低廉,术后并发症少等优点。     

Hypertension in childhood from renal vein thrombosis.

A case is presented of a 1-year-old boy with hypertension resulting from abnormal renin production by the right kidney. The kidney had undergone infarction and atrophy secondary to renal vein thrombosis. The left kidney remained normal despite inferior vena cava thrombosis because of the development of collateral venous circulation. The hypertension was cured by right nephrectomy. The child remains normotensive and with a normal serum creatinine at 1-year followup.     

Multiple-stage correction of caudal duplication syndrome: a case report

Caudal duplication syndrome is a very rare congenital deformity. A 13-year-old boy was born with duplicated colon-rectum and anus, diphallus, hydronephrosis of left kidney with megaureter, double bladders and urethras, and vertebral abnormalities. Multiple-stage correction was performed to remove the duplicated colon and the mucosa of the duplicated rectum. A new colon was reconstructed. The left kidney and megaureter were excised. The septum in the bladders was removed to convert the double bladders into a single bladder. The double phalluses were fused into a single penis. After these staged procedures, the boy is now living a normal life.     

左半结肠切除术中高渗灌洗液的应用观察

目的 总结在左半结肠切除一期肠吻合术中高渗液甘露醇结肠灌洗的临床效果.方法 我院对31例左半结肠切除患者,术中依次行生理盐水、甲硝唑和20%甘露醇结肠灌洗,病变切除再行一期肠吻合.结果 除3例切口感染外,其余病例均在4～5天后开始进食,未发生吻合口瘘,痊愈出院.结论 左半结肠梗阻性病变需行结肠切除时,采用生理盐水、甲硝唑和甘露醇结肠灌洗,再行一期吻合术,术后肠功能恢复快,可防止吻合口瘘的发生.     

Case of recurrent retroperitoneal malignant paraganglioma 25 years after surgery

A 41-year-old man was referred to our hospital for a left renal mass detected by screening computed tomography for hypertension. He had undergone surgery for left pheochromocytoma at 16 years of age in 1981, and the last follow-up was in 1986. Although a 131I-metaiodebenzylguanidine (MIBG) scintigram did not show abnormal uptake, elevated levels of serum cathecholamines were demonstrated. The left renal mass positioned in the upper pole and inside of the kidney had invaded the pancreas, colon and spleen. Surgical resection was done under a diagnosis of recurrent pheochromocytoma, and the tumor was removed with other organs, including normal left adrenal gland that was confirmed histologically. Histologically and immunohistochemically, the resectioned tumor was invasive malignant paraganglioma and diagnosed as the local recurrence or metastasis of previously resectioned retroperitoneal paraganglioma, which was believed to have grown slowly.     

Total colectomy and J-pouch ileorectal anastomosis for obstructed tumours of the rectosigmoid junction

Background : Subtotal colectomy with ileosigmoid or ileorectal anastomosis is one of the standard procedures for obstructed tumours of the left colon. The lower the level of the anastomosis, the greater the number of bowel motions per day. The aim of the present study was to assess whether an ileal pouch–rectal anastomosis is associated with fewer bowel motions per day. Methods : In four patients with obstructed carcinoma of the rectosigmoid junction and upper rectum, a total colectomy with removal of the upper rectum for adequate tumour clearance was used, followed by construction of a 10 cm ileal J‐pouch that was subsequently anastomosed to the distal rectal stump. Results : Postoperative recovery was uneventful in all patients. At 3 months postoperatively, anorectal manometry showed anal resting and squeeze pressures at lower normal limits and a neorectal capacity ranging from 160 to 310 mL. One year postoperatively, all patients experienced one to three normal bowel motions daily and no episodes of incontinence. Conclusions : Total colectomy with ileal J‐pouch–rectal anastomosis is a reasonable operative alternative in cases with obstructed tumours of the rectosigmoid junction, which necessitate removal of the upper rectum.     

Acute Massive Pulmonary Embolism Following High Ligation Combined with Compression Sclerotherapy for Varicose Veins

A case of acute pulmonary embolism following high ligation and compression sclerotherapy for varicose veins is reported. A 54-year-old women developed superficial varicosities and stasis pigmentation on her left leg 1 year prior to her first visit to hospital. No deep vein thrombosis was detected by ascending phlebography performed 3 months prior to operation. High ligation combined with compression sclerotherapy was performed for the varicose veins. One day after treatment, the patient complained of chest pain and discomfort, and then collapsed. Perfusion scintigraphy revealed multiple embolisms in the bilateral lungs. The patient recovered after aggressive anticoagulant and thrombolytic therapy. Although pulmonary embolism is a rare complication of sclerotherapy, it is potentially one of the most serious.     

Zollinger-Ellison syndrome associated with parathyroid adenomas and ectopic gastric tissue in the lower esophageal mucosa.

A rare case of the Zollinger-Ellison syndrome associated with hyperparathyroidism and ectopic gastric tissue in the lower esophageal mucosa is reported. Preoperatively the patient, a 53-year-old woman, had hyperchlorhydria and her fasting serum gastrin concentration was mildly elevated. There was a considerable increase in the gastric acid output and concentration of serum calcium after secretin infusion. At operation the patient had a gastric ulcer 10 cm in diameter, an islet cell tumour of the pancreas 14 cm in diameter, and ectopic gastric mucosa in the distal third of the esophagus. A gastrectomy was perfomed, the pancreatic tumour excised and part of the distal esophagus removed through a left thoracotomy. Four months after the operation the gastrin concentration had returned to low normal, but the serum calcium values remained high. One month later two parathyroid adenomas were removed which effectively cured the hypercalcemia.     

一期切除吻合术治疗左半结肠癌并急性肠梗阻临床疗效观察（附46例报告）

目的 探讨左半结肠癌并急性肠梗阻行一期切除吻合术的安全性及其临床应用.方法 对46例左半结肠癌并梗阻患者行一期肠切除肠吻合术,术中进行有效的结肠减压及清洁灌洗,术后观察疗效.结果 有31例患者左半结肠恶性梗阻患者经保守治疗肠梗阻缓解改限期手术行一期肠切除吻合术,其余15例患者一般情况较好,经全结肠灌洗后一期肠切除吻合术,所有手术均顺利完成,术后并发切口感染8例（17.4％）,吻合口漏4例（8.7％）,经保守治疗痊愈.结论 左半结肠癌并发急性肠梗阻患者行一期肿瘤切除吻合术是安全有效的.     

腹腔镜左半结肠癌根治性切除术的手术体会

目的:探讨腹腔镜左半结肠癌根治性切除术的临床疗效及操作体会。方法:回顾分析2015年9月至2016年7月11例患者行腹腔镜下标准左半结肠癌根治术的临床资料,采用五孔法中间入路,操作过程中严格遵循层面间隙内游离及结肠恶性肿瘤根治原则。结果:11例患者均顺利完成标准腹腔镜辅助左半结肠癌根治术,手术时间平均(142.25±35.26)min,术中出血量平均(21.53±8.76)ml,清扫淋巴结数量平均(18.45±4.28)枚,肛门排气时间平均(30.48±8.23)h,平均住院(10.23±5.26)d。术后无切口愈合不良表现,术后出现肺部感染1例,腹腔感染1例,吻合口瘘1例,经营养支持、消炎、引流等保守治疗后痊愈,术后肠梗阻1例,保守治疗成功,术后1例发生腹腔内出血,再次行腹腔镜探查,发现为胰腺尾部创面边缘出血,行止血治疗。无围手术期死亡病例,患者均获随访,未发现切口肿瘤种植。结论:只要熟悉各个解剖层次,术中保持层面间隙内游离,避免过度牵拉,腹腔镜辅助左半结肠癌根治术是安全、有效的。     

肺移植术后的结核感染一例

目的 探讨肺移植后结核杆菌感染的诊断与治疗。方法 １例接受左单肺移植的患者术后１３个月发生胸壁结核感染,曾疑为急性排斥反应而予以激素冲击治疗,后经左前胸季肋部局部肿块穿刺抽吸物（脓液）涂片及培养,发现结核杆菌而诊断为胸壁结核脓肿,后又发生混合感染,给予抗结核药头及头孢他定治疗,同时行脓肿切开引流。结果 经治疗,患者的病情迅速得到控制,体温恢复正常,３个月后伤口愈合。结论 肺移植后发生结核病,其症状