PURPOSE: To evaluate the usefulness in diagnosing the gallbladder perforation MATERIALS AND METHODS: CT scans of surgically proved 11 cases of gallbladder perforation were retrospectively reviewed. CT findings analyzed were iuminal diameter of GB, GB wall thickness and configuration, presence or absence of fluid collection in the pericholecystic or intraperitoneal space, and observation of pericholecystic anatomic structures. All patients underwent cholecystectomy, and surgical findings were also compared. RESULTS: The GB was distended in 6 cases(55% with a range of 4.0-7.5cm, mean :5.2cm). GB wall was thickened in most cases(9/11,82%) with homogeneous(n=7) or inhomogeneous(n=2) enhancement. At the sites of perforation, focal defect or contour bulging was seen in the GB wall in 3 cases. in 2 cases with gangrene, GB wall showed loss of normal contour with mottled contrast enhancement. Pericholecystic or intraperitoneal fluid co11ection was noted in 9 cases(82%), especially in the region of perforation. In all cases, there was evidence of diffuse infiltration in the pericholecystic space, omenturn or mesentery. Other findings included cholecy-stoenteric fistula in 1 case, and intrahepatic or intraperitoneal abscess formation in 2 cases. CONCLUSION: CT is useful in correct diagnosis of gallbladder perforation.
Abscess ; Cholecystectomy ; Diagnosis ; Fistula ; Gallbladder* ; Gangrene ; Humans ; Mesentery ; Retrospective Studies ; Tomography, X-Ray Computed

A rectocele with a weakened rectovaginal septum can be repaired with various surgical techniques. We performed laparoscopic posterior vaginal wall repair and rectovaginal septal reinforcement without mesh using a modified transperineal approach. A 63-year-old woman with outlet dysfunction constipation complained of lower pelvic pressure and sense of heaviness for 30 years. Initial defecography showed an anterior rectocele with a 45-mm anterior bulge and perineal descent. Laparoscopic procedures included peritoneal and rectovaginal septal dissection directed toward the perineal body, rectovaginal septal suturing, and peritoneal closure. The patient started a soft diet the following day and was discharged on the 5th postoperative day without any complications. The patient had no dyschezia or dyspareunia, and no problem with bowel function; 3-month follow-up defecography showed a decrease in bulging to 18 mm. Laparoscopic posterior vaginal wall and rectovaginal septal repair is safe and feasible for treatment of a rectocele, and enables early recovery.
Constipation ; Defecography ; Diet ; Dyspareunia ; Female ; Follow-Up Studies ; Humans ; Laparoscopy ; Middle Aged ; Rectocele*

No abstract available.
Motor Cortex*

PURPOSE: There are known differences in embryology, clinical symptoms, incidences, molecular pathways involved, and oncologic outcomes of right-sided and left-sided colorectal cancers. However, immunologic study has only been characterized for healthy adults. The present study was designed to identify differences in immune cell populations in patients with right-sided and left-sided colorectal cancers.METHODS: A total of 35 patients who underwent colorectal resection for cancer between November 2016 and August 2017 at a tertiary teaching hospital were enrolled in this study. Patients were excluded if they had a disease affecting their immune system. Populations of immune cells, including mucosal-associated invariant T (MAIT), gamma delta T, invariant natural killer T, T, natural killer, and B cells, were measured in the peripheral blood and cancer tissues using flow cytometry, and then assessed based on the origin of the colorectal cancer.RESULTS: Fifteen had right-side and 20 had left-side colorectal cancer. There were no significant differences between the 2 cohorts for patient characteristics including pathologic stage. Peripheral blood from patients with right-side colon cancers contained fewer MAIT (0.87% right-side vs. 1.74% left-side, P = 0.028) and gamma delta T cells (1.10% right-side vs. 3.05% left-side, P = 0.002). Although the group with right-side colorectal cancer had more MAIT cells in cancer tissues (1.71% vs. 1.00%), this difference was not statistically significant.CONCLUSION: There is a difference in population sizes of immune cells in blood between patients with right-sided and leftsided colon cancers. The immune cell composition was determined to be distinct based on embryologic origin.
Adult ; B-Lymphocytes ; Cohort Studies ; Colonic Neoplasms ; Colorectal Neoplasms ; Embryology ; Flow Cytometry ; Hospitals, Teaching ; Humans ; Immune System ; Incidence ; Population Density ; T-Lymphocytes

Retrorectal space tumors are rare, and so are frequently unrecognized, misdiagnosed, and mistreated. A 57-year-old man visited the outpatient clinic with the chief complaints of thin stool and lower pelvic heaviness. A smooth, round huge palpable mass on the right posterolateral rectal wall was detected and pelvic computed tomography showed a 7.8-cm cystic lesion in the right retrorectal space. Laparoscopic procedures were initiated with perirectal dissection for rectal mobilization. After fixation of the peritoneum and tying the rectum for intracorporeal traction, the rectum was mobilized to identify the cyst. The cyst was removed using an endo-bag, with completion of cyst dissection. The final pathologic diagnosis was a tailgut cyst, or retrorectal cystic hamartoma without evidence of malignancy. The patient was discharged without any complications. The patient had no dyschezia or problems with bowel function. Laparoscopic resection is a safe and feasible method for surgical treatment, even for bulky retrorectal tumors, with an early recovery period.

PURPOSE: Appendiceal tumoral lesions can occur as benign, malignant, or borderline disease. Determination of the extent of surgery through accurate diagnosis is important in these tumoral lesions. In this study, we assessed the accuracy of preoperative CT and identified the factors affecting diagnosis. METHODS: Patients diagnosed or strongly suspected from July 2016 to June 2019 with appendiceal mucocele or mucinous neoplasm using abdominal CT were included in the study. All the patients underwent single-incision laparoscopic cecectomy with the margin of cecum secured at least 2 cm from the appendiceal base. To compare blood test results and CT findings, the patients were divided into a mucinous and a nonmucinous group according to pathology. RESULTS: The total number of patients included in this study was 54 and biopsy confirmed appendiceal mucinous neoplasms in 39 of them. With CT, the accuracy of diagnosis was 89.7%. The mean age of the mucinous group was greater than that of the nonmucinous group (P = 0.035). CT showed that the maximum diameter of appendiceal tumor in the mucinous group was greater than that in the nonmucinous group (P < 0.001). Calcification was found only in the appendix of patients in the mucinous group (P = 0.012). Multivariate analysis revealed that lager tumor diameter was a factor of diagnosis for appendiceal mucinous neoplasm. CONCLUSION The accuracy of preoperative diagnosis of appendiceal mucinous neoplasms in this study was 89.7%. Blood test results did not provide differential diagnosis, and the larger the diameter of appendiceal tumor on CT, the more accurate the diagnosis.

Castleman's disease (CD) is a rare lymphoproliferative disorder that can involve single or multiple lymph nodes in the body. Especially, the localized form of CD is known to be well-controlled by using a surgical resection. On occasion, the surgeon may confront an abdominal and retroperitoneal mass of unknown origin. Thus, we present this case in which we treated a 16-year-old female patient for CD and investigated how to evaluate and manage the situation from the standpoint of CD. Also, we give a review of the pathology, clinical manifestation, diagnosis, and treatment of CD.
Abdomen* ; Adolescent ; Diagnosis ; Female ; Giant Lymph Node Hyperplasia* ; Humans ; Lymph Nodes ; Lymphoproliferative Disorders ; Pathology, Clinical

PURPOSE: To report a case of subretinal hematoma secondary to polypoidal choroidal vasculopathy (PCV) misunderstood as a subretinal mass. CASE SUMMARY: A 73-year-old man with no specific medical history visited our clinic with decreased vision in the right eye. Slit-lamp examination revealed no specific findings for the anterior segment of the right eye. Upon fundus examination, an elevated macular lesion with some subretinal hemorrhages was observed, and a subretinal mass lesion was found on ultrasonography. After performing fluorescein angiography, indocyanine green angiography, and magnetic resonance imaging, we presumed that this lesion was a subretinal hematoma or ocular tumor and recommended observation. One month later, the subretinal mass had decreased in size. One year later, PCV with large retinal pigment epithelial detachment (RPED) was observed. After the intravitreal bevacizumab injection, RPED and macular edema were improved. CONCLUSIONS: We confirmed PCV with a subretinal hematoma and large RPED which seemed to be a subretinal mass and was difficult to differentiate from ocular tumors.
Aged ; Angiography ; Antibodies, Monoclonal, Humanized ; Choroid ; Eye ; Fluorescein Angiography ; Hematoma ; Hemorrhage ; Humans ; Indocyanine Green ; Macular Edema ; Magnetic Resonance Imaging ; Retinal Detachment ; Vision, Ocular ; Bevacizumab

Purpose: There is a concern that enhanced recovery after surgery may affect other proposed quality measures, including the rate of readmission due to early discharge. We examine the 30-day readmission rate, risk factors associated with readmission after elective colorectal surgery for colon cancer, causes of readmission, disease-free survival (DFS), and overall survival (OS) in a single institution. Methods: We retrospectively investigated 292 patients who underwent elective colorectal surgery for colon cancer between 2010 and 2015. Baseline data including age, sex, body mass index, American Society of Anesthesiologists physical status classification, preoperative comorbidities, previous operation history, TNM stage, surgical approach, operation time, gas passage time, and length of hospital stay were obtained. Univariate and multivariate logistic regression analyses were performed to identify risk factors associated with 30-day readmission. Results: A total of 229 patients who underwent elective colorectal surgery were enrolled. Twenty-four patients were readmitted 30 days after discharge. The most common readmission diagnoses were wound bleeding or surgical site infection. Multivariate analysis indicated that patients who had preoperative hepatic disease were at the highest risk of readmission (odds ratio [OR], 8.98; 95% confidence interval [CI], 7.35–10.61). Survival outcomes were significantly better in the nonreadmitted group (OS, P=0.00; DFS, P=0.04). Conclusion This study identified that preoperative comorbidities including hepatic and pulmonary diseases were associated with higher readmission rates after elective colorectal surgery. Moreover, the most common cause of readmission in patients who underwent elective colorectal surgery was wound bleeding or surgical site infection.