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Two extremely rare cases of blind pouch perforation of the colon are reported and discussed with a review of the Japanese literature. Case 1: A 60-year-old man was admitted to the hospital because of a cancer of the sigmoid colon. There were previous histories of undergoing an appendectomy and subsequent laparotomy for intestinal volvulus after the operation at the age of 19, and a gastrectomy for a gastric cancer at the age of 56. After admission a perforation was observed at the blind pouch of the ascending colon following side-to-side jejuno-transverse colostomy. Ascending coiectomy including the perforation of the ascending colon was carried out, but he died on 25th postoperative day. Case 2: A 64-year-old woman was admitted to the hospital because of perforative peritonitis. There were previous histories of undergoing a right colectomy for cecum mobile at the age of 28 and a hysterectomy for hysteromyoma at the age of 50. After admission a stercoraceous perforation of blind pouch of the transverse colon following end-to-side jejuno-sigmoid colostomy was noted, and partial transverse colectomy and end-to-end jejuno-transverse colostomy were performed. Postoperative course was uneventful. She was discharged from the hospital on 25th postoperative day.

A 41-year-old man with mental retardation, deaf and dumb underwent appendectomy under spinal anesthesia for gangrenous appendictis with ileocecal abscess at elsewhere. On the 4th postoperative day, intractable high fever, coma, fasciculation and rigidity on the extrimities developed and rapidly progressed. The patient was transferred to the hospital. We suspected an intraabdominal remnant abscess, but exploratory laparotomy under general anesthesia revealed no evidence of remnant abscess. A lumber puncture also yielded no abnormal findings of cerebrospinal fluid. He died of sudden cardiac arrest on the next day after the second operation. It was found postoperatively that he had been treated with neuroleptic drugs for a long period at slightly manic state, and he was diagnosed as neuroleptic malignant syndrome according to his clinical course and its diagnostic criteria. In this case we failed to make the correct diagnosis preoperatively, because postoperative high fever was considered due to remnant abscess; we had difficulty in evaluation of coma and abdominal symptoms for his mental retardation, deaf and dumb; and we did not confirm his former treatment with neuroleptic drugs (and he had not been diagnosed as psychosis).

A 69-year-old female developed graft-versus-host disease (GVHD) after the transfusion of unirradiated fresh blood donated by her family members when she underwent right hemicolectomy for ascending colon cancer and hepatic metastasis. Two units of blood was transfused during operation, 1 unit on 1st postoperative day (POD) and 1 unit on 4th POD. She developed diarrhea on 8th POD, and skin rash on 10th POD. Then liver dysfunction and pancytopenia rapidly progressed and she died of liver failure on 16th POD. In the findings of autopsy, toxic epidermal necrolysis, centrilobular hepatocytic necrosis, epitherial necrosis of the gastrointestinal tracts and hypoplasty of the bone marrow were revealed. In a retrospective study, the HLA haplotype of the patient was different from her own haplotype presumed by HLA study of her family. Fatal post transfusion GVHD can occur in non-immunosuppressed patient when the blood donor has homozygous HLA haplotype of a part of heterozygous HLA of the patient. Prevention is the first importance.

症例は3歳の男児で, 腹痛, 嘔吐で発症した.黄疸, 腹部膨満を認めたため開腹した.胆汁性腹膜炎を認め, 肝外に露出していた右肝管後区域枝に径2mmの穿孔を認めた.胆嚢摘出後穿孔部肝管にT-tubeを設置した.術後のT-tube造影では前区域枝, 後区城枝, 左肝管が嚢状拡張を呈していた.9年後のendoscopic retrograde cholangio-pancreatography (ERCP) 検査では左肝管が円柱状の拡張を呈し, 左内, 外側枝は嚢状拡張を呈していた.しかし, 3歳時にみられた前区域枝, 後区域枝の拡張程度は減少していた.成長後の拡張形態は原発性肝内結石症にみられる肝内胆管拡張にも類似していたが, ERCP検査時には胆石は認めなかった.この胆管拡張の形態は非常にまれな先天性肝外肝管拡張であったので報告した.