Tetsuya Ohta

Between 1978 and 1989, gallbladder cancer was diagnosed in 17 out of 48 patients with anomalous union of the pancreaticobiliary system. The clinical, surgical, and pathological features of these 17 patients are described. We classified them into two groups, those with and those without dilation of the common bile duct, and compared the clinicopathological features. Patients with dilation of the bile duct often had early onset of symptoms, so that cancer was detected at a relatively early stage. Most of those without dilation of the common bile duct already had a number of severe symptoms at the first consultation, and the cancer was usually at an advanced stage. We believe that early diagnosis of patients without dilation of the bile duct is an important clinical problem that needs to be resolved.

BACKGROUND: Finding an abdominal mass or hematuria is the initial step in diagnosing Wilms tumor. As the first manifestation of Wilms tumor, it is exceedingly rare for pulmonary tumor embolism to present with cardiac arrest. A case of a patient whose sudden cardiac arrest due to massive pulmonary tumor embolism of Wilms tumor was not responsive to resuscitation is presented. CASE PRESENTATION: The patient was a five-year-old girl who collapsed suddenly during activity in nursery school and went into cardiac arrest in the ambulance. Unfortunately, she was not responsive to conventional resuscitation. A judicial autopsy conducted at the local police department showed the main cause of her sudden cardiac arrest was attributed to multiple pulmonary tumor embolisms of stage IV Wilms tumor. CONCLUSIONS: Except for one reported case, treatments were not successful in all eight cardiac arrest cases with pulmonary tumor embolism of Wilms tumor. These results indicate that it is challenging not only to make an accurate diagnosis, but also to provide proper specific treatment in the cardiac arrest setting. We propose that flexible triage and prompt transfer to a tertiary hospital are necessary as an oncologic emergency to get such patients to bridging therapy combined with extracorporeal membrane oxygenation or immediate surgical intervention under cardiopulmonary bypass.

症例は65歳,男性.飲酒歴:日本酒2合/日. 5カ月前に近医で膵尾部の仮性嚢胞を指摘された.上腹部痛のため近医を受診し,腹腔内出血と診断され当院に紹介された.腹部CTで肝脾周囲の血性腹水,胃体部大彎・後壁～膵尾部の血腫,慢性膵炎による膵臓の石灰化を認めた.血管造影では仮性動脈瘤や造影剤の血管外漏出を認めなかった.腹腔穿刺で血性腹水を確認し,慢性膵炎に合併した膵仮性嚢胞の破裂による腹腔内出血と診断し緊急開腹術を施行した.開腹時,約900mlの腹腔内出血が存在し,膵尾部～胃体部大彎・後壁～脾臓～横行結腸間膜の間に血腫と嚢胞を認め,癒着のため一塊になっていた.膵尾部の嚢胞壁から出血を認めたため,膵尾部切除・脾摘術を施行した.術後経過は良好で術後36日目に退院した.膵仮性嚢胞内出血の破裂による腹腔内出血は非常に稀であり,本例を含めた本邦報告例17例を検討し報告する.