No abstract

Our patient positioning protocol appears to have prevented laparoscopic colectomy-related IPNI. Future studies are warranted to confirm the relationship between patient positioning and IPNI and, if necessary, to further refine the protocol to ensure prevention of IPNI during laparoscopic colorectal surgery.

A 61-year-old woman presented to the emergency department with midepigastric pain for the last 24 hours. Pancreatitis was initially suspected based on the patientʼs history, physical examination results, and elevated serum amylase levels. However, computed tomography (CT) revealed the presence of a linear foreign body (FB) in the duodenum and air bubbles outside the intestinal lumen. Penetration into the medial aspect of the third portion of the duodenal wall was observed, but the FB could not be successfully removed. Hence, endoscopic removal of the fish bone was performed with gentle traction on the first postoperative day. The patient was completely relieved of the pain after the surgery and endoscopic removal of the fish bone. The strategic location of the penetration in the visceral wall was responsible for the gastrointestinal (GI) tract injury pattern. The patient was unaware of the FB ingestion. However CT and the retrospective alimentary question revealed the consumption of fish.

In Japan, amebiasis is typically found in men who have sex with men and in individuals with recent travel to endemic areas. We experienced a patient with fulminant necrotizing amebic colitis and enterocolitis who presented with a severe disorder of the liver and renal function. The patient was a 71-year-old man who had lived in Yokohama City, Japan for 30 years. His stool sample showed no amebic dysentery protozoa and cultured negatively for human immunode ciency virus. Despite being treated with meropenem, pyrexia of 39-40 C continued for 4 days. On hospital day 8, a colonic abscess and perforation of the transverse colon were detected by computed tomography CT . His fever did not improve, suggesting progression of infectious disease. Subsequent emergency laparotomy revealed a perforation in the middle of the transverse colon. Peritoneal lavage and right hemicolectomy were performed ; however, a CT scan on hospital day 16 postoperative day 8 showed re-perforation of the colon and an abscess around the site of anastomosis, prompting emergency intestinal and left hemicolectomy resection. Amebae observed pathologically during the second emergency operation led to a diagnosis of amebic colitis. Endotoxin adsorption therapy was performed, and metronidazole was administered. Despite prompt diagnosis and treatments, the patient s general conditions became fulminant, and multiple organ failure developed. On hospital day 18 postoperative day 10 , his C-reactive protein level was 20 mg/dl. He was clinically diagnosed as having sepsis and multiple organ failure. The patient died on hospital day 23. Acute colitis is commonly encountered in daily practice, but it is dif cult to differentiate between amebic and non-amebic colitis preoperatively and thus, the possibility of amebic colitis should be considered in such clinical presentations.

Standard laparoscopic colorectal surgery requires additional incision or enlargement of the trocar incision for the retrieval of the surgical specimen. A natural orifice specimen extraction NOSE procedure, in which the specimen is retrieved through the anus or vagina without any additional skin incision, requires purse-string suture PSS of the rostral intestinal segment in order to fix the anvil head of the stapler and perform extracorporeal mechanical anastomosis. Colorectal surgery has a limited NOSE in cases where the end of the rostral segment could be pulled through the anus. Broader application of NOSE depends on intracorporeal PSS. We developed a new forceps for intracorporeal PSS during NOSE and evaluated its efficacy. The PSS instrument was refined to pass through a 12-mm trocar in an intracorporeal PSS and achieve anastomosis using double stapling. In trials utilizing an endoscopic practice box, regular spacing of stitches during PSS were consistent n 10 , and tight intracorporeal anastomosis of the porcine colon was successfully performed n 2. We then con rmed ef cacy through an operation on a pig. Our novel PSS device will help us perform NOSE not only in laparoscopic colorectal surgery but also in any operation requiring intracorporeal PSS, which should contribute to further advances in endoscopic digestive surgery.