Shigehiro Koga

Ehime University · Second Department of Surgery

Background Complete mesocolic excision (CME) and central vascular detachment are very important procedures in surgery for colorectal cancer. Preoperative and intraoperative assessments of the anatomy of major colorectal vessels are necessary to avoid massive bleeding, especially in endoscopic surgery. A case with a rare anomaly in which the middle...

Objectives: A low rate of the incidence of venous thromboembolism (VTE) after surgeries that are preoperatively classified as having high risk of VTE has been reported in recent years. We seek to identify the optimal cases to receive perioperative pharmacologic thromboprophylaxis. In this study, we evaluated the incidence rate of VTE among patients...

Background Laparoscopic and robotic surgery for transverse colon cancer are difficult due to complex fusion of the foregut and midgut and variation of the vessels of the transverse colon. Although the vessels of the right colon have been investigated, middle colic artery (MCA) variation and the relationship with vessels around the transvers colon a...

Background. Laparoscopic and robotic surgery for transverse colon cancer are difficult due to complex fusion of the foregut and midgut and variation of the vessels of the transverse colon. Although the vessels of the right colon have been investigated, middle colic artery (MCA) variation and the relationship with vessels around the transvers colon...

Purpose: Few studies have reported on the interactions between gastrectomy and antithrombotic therapy, especially the long-term prognosis. We aimed to clarify the short- and long-term prognosis of gastrectomy for patients on antithrombotic therapy. Methods: We reviewed the perioperative data and survival rate of patients who underwent laparoscop...

Purpose During the perioperative period, coagulofibrinolytic activation occurs, which occasionally results in thromboembolic complications. However, natural perioperative coagulofibrinolytic responses have not been well investigated. The present study examined perioperative coagulofibrinolytic changes and their association with the development of v...

Indocyanine green (ICG) fluorescence angiography has recently been reported useful as a method for predicting intestinal blood flow and may reduce anastomotic leakage. However, the quantification method for ICG fluorescence angiography has not been established. We usually measure the tissue oxygen saturation (StO2) in the intestinal tract via near-...

Background: Recently, aging in patients with severe motor and intellectual disabilities (SMID) has been causing serious problems. There have been few reports about treatment for tumors in patients with SMID. Methods: The treatments performed for tumors of 12 SMID patients were examined. Results: Blood tests and ultrasonography were useful in screen...

Wilms tumor (WT) is the most common malignant kidney tumor in children. High blood pressure is seen in up to 55% of children with WT. However, hypertensive cardiomyopathy with congestive heart failure due to WT is remarkably rare, with only several cases reported worldwide. In this report, a pediatric case of WT with hypertension causing hypertensi...

Rubinstein–Taybi syndrome is an extremely rare autosomal dominant genetic disorder that occurs in 1/125,000 and is characterized by distinctive facial appearance, short stature, mild to severe mental retardation, and higher risk for cancer. In addition, variable organ anomalies had been reported. Paraovarian cyst causing torsion of the ipsilateral...

Local recurrence of rectal cancer is defined as any evidence of relapse within the small pelvis after surgical resection of the primary tumor. After removal of a rectal tumor, necrotic cellular debris and viable exfoliated cancer cells are present in the rectal lumen; using saline or povidone-iodine solution, many surgeons perform rectal washout be...

Obstructive colitis (OC) is a nonspecific inflammatory condition that occurs at the proximal side of a completely or partially stenotic lesion typically caused by colorectal cancer. Impaired blood flow caused by these stenotic changes in the colon or rectum results in this condition. During surgery for sigmoid colon carcinoma with OC, complete surg...

Background: Elderly patients usually have concurrent ailments, and the safety and effectiveness of laparoscopy-assisted distal gastrectomy (LADG) for these patients have been controversial. This study aimed to evaluate whether laparoscopy-assisted distal gastrectomy is safe and effective for elderly patients aged 80 years and over, as well as to c...

Raman spectroscopy provides a wealth of diagnostic information to the surgeon with in situ cancer detection and label-free histopathology in clinical practice. Raman spectroscopy is a developing optical technique which can analyze biological tissues with light scattering. The difference in frequencies between the incident light and the scattering l...

We developed a near infrared fluorophore-conjugated anti-Carcinoembryonic antigen (CEA) antibody for mice bearing tumor of CEA expressing cells, and demonstrated in vivo optical imaging by macro zoom microscopy. In the result, tumors of CEA-expressing cancer cells were specifically detected in vivo. Furthermore, cancer-specific fluorescence images...

われわれは，外傷性胸部大動脈損傷の1例を経験したので報告する．症例は22歳，男性．作業中に1.5mの高さから転落し，当院救命救急センター搬入．レントゲン検査．CT検査にて，胸部大動脈損傷，肝損傷，下顎骨骨折，腰椎骨折，左大腿骨骨折，左脛骨骨折，左腓骨骨折の診断．肝損傷については保存的加療，多発骨折については，後日，観血的手術の方針とし，胸部大動脈損傷に対して緊急手術施行．大動脈は遠位弓部で損傷しており，周囲の血腫と胸腔内出血を認めた．胸部大動脈人工血管置換術を施行．術後経過は良好で，下顎骨骨折，腰椎骨折，左大腿骨骨折に対する手術を経たのち，119日目に軽快退院となった．

症例は65歳, 男性. 食欲低下, 全身倦怠感, 下血を主訴に2006年5月15日近医を受診, 貧血, 血圧低下を認め, 同日当科紹介となった. 来院時血圧70mmHg前後であり, 血液検査にて高度貧血, 代謝性アシドーシスを認めた. 緊急胃内視鏡検査を施行したところ, コーヒー残渣様の貯留液および黒色調の巨大な胃石を認めた. 全身状態改善後, 精査をしたが胃石の他には著変なく, 6月6日, 開腹胃切開胃石除去術を施行した. 胃石は13×10cm大で胃の鋳型を呈していた. 結石分析では一部タンニン酸と類似の吸収がみられた.本症例は巨大胃石により胃粘膜が損傷され, 出血さらには高度貧血をきたし, また通過障害により栄養障害等きたし, ショック, 代謝性アシドーシスをきたしたと思われた. 胃石の...

症例は71歳,男性.主訴は嘔吐・腹痛で,腸閉塞の疑いで当科を紹介された.既往歴として34年前に胃潰瘍で胃切除術があった.腹部超音波検査とCT検査により腸重積症と診断し,緊急手術を施行した.輸出脚空腸がBraun吻合部を経由し,輸入脚より残胃に嵌入する腸重積症を認めた.手術は,用手的整復術を施行し,良好な結果がえられた.胃切除術後腸重積症のなかでも,自験例は稀な重積様式であり,このBraun吻合部空腸残胃重積症の報告は,本邦では6例目であった.

A 58-year-old woman admitted with abdomina pain and abdominal distension, had been diagnosed with ileus at an other hospital. Upper gastrointestinal tract examination showed a duodenum diverticulum and a jejunal diverticulum. We diagnosed ileus due to a jejunal diverticulum. Conservative therapy with an ileustube, and intravenous hyperlimentation a...

Blue rubber bleb nevus syndrome is characterized by gastrointestinal and cutaneous hemangiomas and gastrointestinal bleeding causing anemia. We report a unique case of this syndrome in an adult woman. It was associated with congenital heart disease, for which the patient underwent surgery at 12 months of age, and cutaneous hemangiomas, for which su...

The principle of treatment of choledochal cysts is total cyst excision with hepaticojejunostomy because of the high rate of associated malignancy of the biliary system. The authors used a minimally invasive laparoscopic procedure to treat a patient with nonmalignant choledochal cyst. Although a large median laparotomy is usually used for cyst excis...