REPORT OF THREE CASES RECOVERING FROM FAILURE OF THREE ORGANS AFTER THE OPERATION. Haruo FUNAKI, Shuji HIROSE, Sanae OTA and Toru ISOMOTO

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1 REPORT OF THREE CASES RECOVERING FROM FAILURE OF THREE ORGANS AFTER THE OPERATION Haruo FUNAKI, Shuji HIROSE, Sanae OTA and Toru ISOMOTO (Oji National Hospital, Tokyo) CLINICAL STUDY OF CASES WITH ILEUS Tsuyoshi YAMANAKA, Yasuhisa OKUMURA, Toshinori MATSUMURA, Hisashi MINAMIMAGARI, Ichiro YOSHINAKA and Katsuya FUKUMOTO (Miyakonojyo National Hospital, Miyazaki) Of 257 patients with mechanical ileus treated at the Department of Surgery of the Miyakonojo National Hospital during the 10 years since 1973, 225 (87.59%) had simple ileus and 32 (12.5%) had complications. Two hurdred and five patients (91.2%) of these 225 with simple ileus had adhesion ileus. These patients had a history of previous operation for gastrectomy, ileus, or appendectomy. Tumorous ileus was observed in approximately half of the patients without any previous surgical treatment. We report 3 cases recovering from severe failure of 3 organs after the operation. The first case was a 69 year old male. Grafting operation was performed for the abdominal aortic aneurysm. After declamping of the aorta he developed severe shock which resulted in acute renal insufficiency, liver failure and cerebral lesion, and he was treated by artificial hemodialysis of as much as 41 times and artificial liver. The second case was a 60 year old male. Esophageal transection under the left thoracotomy and transdiaphragmatic splenectomy were performed for the esophageal varices (liver cirrhosis). On the 7th postoperative day he fell into the 3rd grade level of unconsciousness of Sherlock. Moreover, esophageal and diaphragmatic suture insufficiency were accompanied, which caused severe respiratory insufficiency requiring artificial respiration for 52 days. The third case was a 53 year old male and had a past history of right upper lobectomy and right thoracoplasty for the lung tuberculosis. For the lower thoracic esophageal carcinoma, we performed thoracic esophageal resection under the right thoracotomy and the esophagus was reconstructed by pulling up of the stomach retrosternally. After the operation he developed severe shock associated with respiratory failure and hepato-renal insufficiency. He was recovered from these complications by careful management of artificial respiration and nutrition

2 Sixty-four (28.4%) of the 225 patients with simple ileus and all of the 32 patients with complications required surgical treatment. As for the operation, 30 patients (46.996) with simple ileus were surgically treated for separation of adhesions, enterectomy in 14 (21.9%), and enterectomy in 18 (56.2%) with complications. Patients with simple ileus were treated surgically evenly for the period from the first day to the 5th day, and approximately half of patients with complicated ileus received operations on the first day or the following day. Seven patients (2.7%) died mostly due to sepsis. SURGICAL TREATMENT OF INTRAHEPATIC STONES EXPERIENCED IN THE YOKOHAMA NATIONAL HOSPITAL DURING THE LAST FIVE YEARS Masaki MUTO, Koichi NAKAMOTO, Akira ISHIYAMA, kazushige HAYASHI, Mamoru KOBAYASHI, Takeshi YONEZAWA and Yasukazu NAKA (Yokohama National Hospital, Kanagawa) We reviewed eight patients with intrahepatic stones (3 men and 5 women, 36 to 74 years of age) experienced in the Yokohama National Hospital over the last 5 years. Both intra- and extrahepatic stones were noticed in 6 patients and only intrahepatic stones in 2 cases. As to the location of the stone in intrahepatic biliary system, 5 patients had the stones in the left intrahepatic bile ducts and 3 had them in the both right and left intrahepatic bile ducts. Ductal strictures of intrahepatic billiary tract were detected in 3 patients and no ductal stricture in 5 patients. Ductal strictures were seen in the biliary tract of left lateral segment in 2 patients, right hepatic duct in one patient and common hepatic duct in one. All patients having no ductal stricture underwent cholecystectomy with choledochotomy and drainage, one with transduodenal papilloplasty and one with hepatic lobectomy. Although complete removal of intrahepatic stones was not done in 2 of the cases, they remained asymptomatic in the follow-up period. Patients with ductal stricture underwent choledochotomy, one with hepatic lobectomy and one had only common hepatic duct drainage. Intrahepatic residual stones were noted at time of the discharge in 2 of the 3 cases. Although one of them was asymptomatic, another became symptomatic again after 6 months. The case was treated with transcutaneous transhepatic cholangioscopy and we finally removed all the stones.

3 (Clinical Yasuhisa OKUMURA Toshinori MATSUMURA Hisashi MINAMIMAGARI Ichiro YOSHINAKA Katsuya FUKUMOTO Study of Cases with Ileus)

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6 9) Bussemaker, J. B. & Lindeman, J.:Comparison of methods to determine viability of small intestine. Ann. Surg., 176, 97, 1972