[Thoracoscopic repair of diaphragmatic eventration sustained at knife injury: a case report]
Yoshida J. Iwai T. Koike E. Akao M. Shimura H.
Division of General Thoracic Surgery, Shimonoseki City Hospital, Japan.
A 46-year-old male taxi driver was stabbed onto the left chest while on duty. On arrival soon after, he was hemodynamically stable. Computed tomography showed omental prolapse into the left thorax through the diaphragm. On the 11th day, he underwent thoracoscopy revealing omental prolapse via a 3-cm rent in the left diaphragm, which was reduced manually. The diaphragmatic orifice was lifted and debrided with suturing using a stapling cutter. The post-operative course was uneventful. Finger palpation through the orifice enabled safe suturing of the left diaphragm facing the omentum, the colon, and the stomach, all of which may suffer iatrogenic injury.
[A case of acute empyema who underwent omentopexy and was found to have gastric cancer during operation]
Kaneko T. Uemura S. Harada H. Sugihara S. Egami T.
Department of Surgery, Shimonoseki Kousei Hospital, Yamaguchi, Japan.
A 76-year-old man had undergone omentopexy for empyema. He was found to have gastric cancer and revealed Borrmann III by gastroendoscopy intraoperative period. Segmental gastrectomy was performed without dissection of lymph nodes, because his general condition was poor. After operation, the patient showed septic shock, ARDS and hepato-renal failure but his condition was getting improved by conservative therapy. After 5 years later, he was examined gastro-endoscopy, abdominal and chest CT and revealed no recurrence sign.
[A case of synchronous resection of double cancers in the lung and stomach through median sternotomy and abdominal incision]
Morio A. Miyamoto H. Ou T. Izumi H. Futagawa T. Hosoda Y.
Department of Thoracic Surgery, Juntendou University, Tokyo, Japan.
A 72-year-old male was admitted to our clinic for the treatment of early stomach cancer. A chest X-ray film on admission showed a mass in the right lung field. CT scan and transbronchoscopic lung biopsy revealed lung cancer (C-T2N2M0-stage IIIA). Histologically it was poorly differentiated adenocarcinoma, which was different from stomach cancer. We underwent synchronous resection of this double cancer through median sternotomy and abdominal incision. We conducted lobectomy, bilateral mediastinal lymph node dissection, and wedge resection of stomach. Postoperative diagnosis was early lung cancer (p-T2N0M0-stage I) and advanced stomach cancer (A-IIc+IIa advanced t2 (mp) n1H0P0M0-stage II). Postoperative course was stable and the patient was healthy at present. As such, this case report suggests that synchronous double cancers involving the lung and stomach, if both cancer are early stage, should be resected synchronously.
[Clinical study of synchronous double cancers of the lung and digestive tract]
Nosaka S. Yamauchi N. Sasaki T. Hanada T. Tamura K.
First Department of Surgery, Shimane Medical University, Izumo, Japan.
Among 64 cases of surgically resected primary lung cancer from 1991 to 1997, there were 5 cases of synchronous double cancers of the lung and digestive tract. They were consisted of 4 males and 1 female and the patient age at the time of the lung resection ranged from 65 to 81 years (average: 74.6). One male was diagnosed as having lung cancer (squamous cell carcinoma) along with sigmoid colon cancer (adenocarcinoma) and others were lung cancer (adenocarcinoma) and gastric cancer (adenocarcinoma). In two patients with early gastric cancer, lobectomies were performed following endoscopic resection of gastric cancer. In three patients including two old man and woman (over 80 years old), lobectomies and gastrectomies (or sigmoidectomy) were performed at the same time. We omitted mediastinal lymph nodes dissections in two old patients and no operative complications occurred. All patients are alive now. It can be concluded that in cases of synchronous double cancers of the lung and digestive tract, we must select the best treatment that is not invasive for the patient and that simultaneous operation for double cancer can be safely performed.