鯉沼 広治

Metachronous solitary metacarpal bone metastasis from rectal cancer has not been reported previously. Here, we describe a 54-year-old woman who underwent abdominoperineal resection for rectal cancer following neoadjuvant chemoradiotherapy. The resected specimen contained adenocarcinoma with no lymph node metastases (Stage II, T3N0M0); no adjuvant chemotherapy was administered. Fifteen months after surgery, the patient presented with pain and swelling of the right thumb. Radiography revealed metacarpal bone destruction, and fluorine-18 fluorodeoxyglucose positron emission tomography showed uptake only in the metacarpal bone. Open biopsy revealed an adenocarcinoma, and a right thumb resection was performed. Histological examination indicated features of adenocarcinoma similar to the findings of a rectal lesion, leading to a diagnosis of metachronous solitary metacarpal bone metastasis from rectal cancer. The patient remains free of disease after 6 years of follow-up. Our findings suggest that surgical resection may lead to favorable outcomes in patients with resectable solitary bone metastases.

Objective To investigate the potential use of high mobility group box 1 (HMGB1) as a marker for the surgical course following surgery for colorectal cancer (CRC). Methods Patients with advanced CRC undergoing open colorectal surgery who did not develop postsurgical complications were enrolled in the study. Blood samples were taken preoperatively and at 1 day, 1 week and 3 weeks after surgery for the measurement of the white blood cell count, serum C-reactive protein, serum amyloid A and HMGB1. Results Data from 21 patients were analysed. HMGB1 levels changed significantly during the surgical course, increasing from a preoperative median of 6.8 ng/ml to 12.1 ng/ml at 1 day postoperatively, and then decreasing to 8.1 ng/ml at 1 week postoperatively and 4.0 ng/ml at 3 weeks postoperatively. These changes were similar to but were not completely correlated with the changes seen in the other markers. Conclusion Serum HMGB1 may be a potential marker to monitor the surgical course in patients undergoing surgery for CRC, although further studies are warranted before it can be introduced into routine clinical practice.

We report the case of a patient with Crohn's disease who initially presented with a ceco-urachal fistula. The patient was a 31-year-old female who underwent an appendectomy 6 years before presenting to our institution. She had a one-year history of diarrhea, and had recently developed polyuria and a sensation of residual urine. She was admitted with fever and lower abdominal pain. Endoscopy and computed tomography revealed a ceco-urachal fistula, which was consistent with Crohn's disease. An urachal resection was performed, which included partial cystectomy and ileocecal resection. A ceco-urachal fistula is a rare initial symptom of Crohn's disease. During the surgical management of such cases, it is necessary to resect the urachus, the affected portion of the bladder, the fistula, and the affected part of the digestive tract in order to avoid recurrence.

44歳男性。食事摂取後の心窩部違和感と嘔吐を主訴に近医より紹介となった。上部消化管造影では十二指腸水平脚は認められず、造影剤は十二指腸でループを描いた後に右側腹部小腸を通り、骨盤内小腸へと流出していた。下部消化管造影では回腸末端は左下腹部に存在し、右側結腸の左方偏移が認められた。腸回転異常症(malrotation type)と診断し、待機的に腹腔鏡手術が行われたが、術後半年で腸閉塞を短期間に繰り返した。CTおよび上部消化管造影により上部小腸の癒着に伴う通過障害が疑われた。再手術を行なったところ、十二指腸下行脚〜上部空腸で腸管どうしが癒着しており、上部空腸はねじれるように口側腸管・右側後腹膜と癒着していた。そこで、癒着を剥離し、剥離面に新たにセプラフィルムを貼付した結果、術後は症状の再燃なく経過良好である。