Tadao Kubota - Academia.edu (original) (raw)

Papers by Tadao Kubota

Emergency Medicine, Trauma & Surgical Care, 2016

Background: In case of blunt abdominal trauma, the presence of free air, free ascitic fluid and b... more Background: In case of blunt abdominal trauma, the presence of free air, free ascitic fluid and bowel thickening are common findings of hollow viscous injury. Here in, we present a rare case of colonic perforation in which only mesenteric hematoma was observed. Case presentation: 52 year old male was brought to our institute with upper abdominal pain. Several hours before he noticed his pain, he had fallen down on a road. On physical examination his abdomen was almost benign except for the slight tenderness on his epigastric area. Initial CT scan showed a hematoma like lesion localized in the transverse-mesentery. Because there were no free air, no ascitic fluid and no bowel thickening, he had been managed non-operatively. Three days after admission, he had high fever. The repeat CT showed extraluminal air. Emergent surgery was done. Intraoperative finding revealed major laceration of the transverse colon. Postoperative course was almost good. Discussion and conclusion: Free air, intra-peritoneal ascitic fluid and bowel thickening in CT scan are potent evidences of bowel perforation, but none of these findings do not give us a guarantee the absence of surgically important bowel injury.

Trauma Case Reports, 2016

Pharyngeal perforation related to blunt neck trauma is a rare clinical entity. Here in, we report... more Pharyngeal perforation related to blunt neck trauma is a rare clinical entity. Here in, we report a case of pharyngeal perforation secondary to minor blunt neck trauma. A 46 year old female was brought to our emergency room with neck pain. She fell down and hit her neck directly to the edge of a bed. There was no crepitation in physical examination. Neck ultrasound showed a small amount of air in her deep neck space. Followed CT and nasopharyngeal scope supported the presence of pharyngeal perforation. So emergency exploration was done. We found a laceration of hypopharynx and it was repaired. She could discharged without any complication on day 7. The indirect finding of pharyngeal perforation is subcutaneous emphysema. However if the air is localized only in deep cervical space, physical assessment is difficult. Although CT scan is potent modality to find air in the deep organs, ultrasound may be alternatives. Emphasis is based on the suspicion that minor blunt neck trauma may cause pharyngeal perforation.

Journal of the American College of Surgeons, 2006

A 54-year-old man presented to the emergency department with a 2-week history of high fever, head... more A 54-year-old man presented to the emergency department with a 2-week history of high fever, headache, chills, and mild left flank pain. Physical examination, chest x-rays, and laboratory analysis did not reveal the cause of his of 40.1°C temperature. A lumbar puncture showed no abnormality. He had been in the Philippines 3 weeks before admission, so physicians suspected he had a tropical fever like malaria. He was admitted to the Department of Infectious Disease for an additional examination. Two days later, his blood culture grew Escherichia coli. Enhanced abdominal CT revealed gas in the splenic abscess (A, arrow head), superior mesenteric venous gas (B, arrow), intrahepatic portosystemic gas (C, small arrows), and a well-enhanced mass in the splenic flexion of the colon (C, large arrow). Percutaneous drainage using a pigtail catheter was performed for splenic abscess. After 2 weeks of abscess drainage and antibiotic therapy, his condition improved. Colonoscopy revealed advanced colon cancer in the splenic flexion of the colon. The patient was referred to us for surgical indication. Four weeks after admission, colectomy and splenectomy were performed successfully. The specimen showed advanced colon cancer penetrating to the spleen. Colon cancer is known to present with sepsis, often Clostridium septicum. Portosystemic gas is a rare complication of intraperitoneal disease; most cases are related to mesenteric ischemia. Splenic abscesses are also rare; most are related to infectious endocarditis. Some cases of splenic abscess related to penetrating colon cancer have been reported. 1,2 We found only one other report of portal venous gas associated with splenic abscess from colon cancer. 3

Emergency Medicine, Trauma & Surgical Care, 2016

Background: In case of blunt abdominal trauma, the presence of free air, free ascitic fluid and b... more Background: In case of blunt abdominal trauma, the presence of free air, free ascitic fluid and bowel thickening are common findings of hollow viscous injury. Here in, we present a rare case of colonic perforation in which only mesenteric hematoma was observed. Case presentation: 52 year old male was brought to our institute with upper abdominal pain. Several hours before he noticed his pain, he had fallen down on a road. On physical examination his abdomen was almost benign except for the slight tenderness on his epigastric area. Initial CT scan showed a hematoma like lesion localized in the transverse-mesentery. Because there were no free air, no ascitic fluid and no bowel thickening, he had been managed non-operatively. Three days after admission, he had high fever. The repeat CT showed extraluminal air. Emergent surgery was done. Intraoperative finding revealed major laceration of the transverse colon. Postoperative course was almost good. Discussion and conclusion: Free air, intra-peritoneal ascitic fluid and bowel thickening in CT scan are potent evidences of bowel perforation, but none of these findings do not give us a guarantee the absence of surgically important bowel injury.

Trauma Case Reports, 2016

Pharyngeal perforation related to blunt neck trauma is a rare clinical entity. Here in, we report... more Pharyngeal perforation related to blunt neck trauma is a rare clinical entity. Here in, we report a case of pharyngeal perforation secondary to minor blunt neck trauma. A 46 year old female was brought to our emergency room with neck pain. She fell down and hit her neck directly to the edge of a bed. There was no crepitation in physical examination. Neck ultrasound showed a small amount of air in her deep neck space. Followed CT and nasopharyngeal scope supported the presence of pharyngeal perforation. So emergency exploration was done. We found a laceration of hypopharynx and it was repaired. She could discharged without any complication on day 7. The indirect finding of pharyngeal perforation is subcutaneous emphysema. However if the air is localized only in deep cervical space, physical assessment is difficult. Although CT scan is potent modality to find air in the deep organs, ultrasound may be alternatives. Emphasis is based on the suspicion that minor blunt neck trauma may cause pharyngeal perforation.

Journal of the American College of Surgeons, 2006

A 54-year-old man presented to the emergency department with a 2-week history of high fever, head... more A 54-year-old man presented to the emergency department with a 2-week history of high fever, headache, chills, and mild left flank pain. Physical examination, chest x-rays, and laboratory analysis did not reveal the cause of his of 40.1°C temperature. A lumbar puncture showed no abnormality. He had been in the Philippines 3 weeks before admission, so physicians suspected he had a tropical fever like malaria. He was admitted to the Department of Infectious Disease for an additional examination. Two days later, his blood culture grew Escherichia coli. Enhanced abdominal CT revealed gas in the splenic abscess (A, arrow head), superior mesenteric venous gas (B, arrow), intrahepatic portosystemic gas (C, small arrows), and a well-enhanced mass in the splenic flexion of the colon (C, large arrow). Percutaneous drainage using a pigtail catheter was performed for splenic abscess. After 2 weeks of abscess drainage and antibiotic therapy, his condition improved. Colonoscopy revealed advanced colon cancer in the splenic flexion of the colon. The patient was referred to us for surgical indication. Four weeks after admission, colectomy and splenectomy were performed successfully. The specimen showed advanced colon cancer penetrating to the spleen. Colon cancer is known to present with sepsis, often Clostridium septicum. Portosystemic gas is a rare complication of intraperitoneal disease; most cases are related to mesenteric ischemia. Splenic abscesses are also rare; most are related to infectious endocarditis. Some cases of splenic abscess related to penetrating colon cancer have been reported. 1,2 We found only one other report of portal venous gas associated with splenic abscess from colon cancer. 3