As of June 2014, among six patients who had severe fever with thrombocytopenia syndrome (SFTS) at our hospital, an 83-year-old man died despite receiving appropriate critical care. An autopsy revealed extensive ischemic damage of the intra-abdominal organs, including the liver, spleen, stomach and gut, due to severe celiac atherosclerotic stenosis and superior mesenteric arterial thrombosis. Many SFTS virus nucleoprotein antigen-immunoreactive cells were detected in a paraaortic node, where necrotizing lymphadenitis was seen, and in the spleen. Fewer such cells were seen in the liver, bone marrow and adrenals. Conclusion: Atherosclerosis, in addition to hemophagocytic lymphohistiocytosis syndrome, can be lethal in elderly SFTS patients.

Background and Aim Cases of colorectal endoscopic submucosal dissection (ESD) with poor maneuverability are often encountered. We aimed to evaluate the efficacy of balloon‐assisted endoscopy (BAE) for such cases. Methods We confirmed maneuverability preoperatively in 400 consecutive cases of colorectal ESD performed at a single center from April 2011 to April 2018. A total of 83 deep colon cases judged as having poor maneuverability were retrospectively reviewed; 54 cases underwent BAE with a single balloon endoscope (group B), and 29 cases underwent conventional procedures without BAE (group C). Tumor size, procedure duration, dissection speed, en bloc resection rate, histology, and associated complications were compared between groups. Results The mean tumor size, tumor invasiveness, fibrosis, and complications did not differ between groups. Although the en bloc resection rate did not differ (both 98%), the groups significantly differed with regard to the R0 resection rate (B: 96%; C: 83%; P = 0.048). Overall, the procedure duration (B: 51 min; C: 70 min; P = 0.17) and dissection speed (B: 19.4 mm2/min; C: 17.4 mm2/min; P = 0.13) were not significantly different between groups. However, the dissection speed for lesions in the cecum/ascending colon was significantly faster in group B than in group C (B: 22.3 mm2/min; C: 11.3 mm2/min; P = 0.037). Conclusions In cases of colorectal ESD with poor maneuverability, the use of BAE contributed to an improvement in the R0 resection rate. In addition, BAE contributed to a quicker dissection speed for lesions located in the cecum/ascending colon.

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