A 44-year-old woman was admitted to our hospital on an emergency basis because of vomiting and abdominal pain. Her abdomen was distended. Laboratory examinations disclosed slight anemia (RBC 321×10⁴/μl, Hb 10.5g/dl, Ht 29.8%). Abdominal CT demonstrated a dense fatty mass at the retroperitoneum, about 17.5cm in diameter, which pressed her left kidney, colon and pancreas to the right side. She complained of severe abdominal pain. Laboratory data revealed severe anemia (RBC 237×10⁴/μl, Hb 7.7g/dl, Ht 23.4%). She underwent an emergency operation with a diagnosis of retroperitoneal tumor with bleeding. A solid tumor with hematoma was located in the retroperitoneum. The tumor was resected together with the left kidney, spleen, tail of pancreas and left adrenal gland. The resected specimen weighed 2460 g, and its histopathological diagnosis was a well-differentiated liposarcoma. She has been followed without any adjuvant therapy, and showed no evidence of recurrence or metastatic disease 26 months after the operation.

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A 77-year-old man was referred to our hospital complaining of edema of the lower extremities and abdominal fullness. Abdominal CT showed a giant mass lesion, measuring 17 × 15 cm in size, in the pelvic cavity. Angiography revealed tumor stain and feeding arteries from the inferior mesenteric artery and bilateral internal iliac artery. We performed a laparotomy based on suspicion of malignant fibrous histiocytoma in the pelvic cavity. During the operation, tumor occupied the whole inside of the pelvis, displacing the urinary bladder, ureter, and iliac artery and vein, probably affecting the rectum, and an abdominoperineal excision of the rectum was performed. The resected specimen was a firm tumor, measuring 20 × 17 × 11 cm in size and weighing 1880 g, and the cut surface was white-yellowish, showing components of hemorrhaging and necrotizing. Histopathologically, the tumor was composed of spindle-shaped cells with abundant patternless collagen. Immunohistochemical staining tests for CD34, CD99, and Bcl-2 protein were positive, and c-kit protein was negative. But tumor cells expressed cytokeratin. Thus, a cytokeratin-positive malignant solitary fibrous tumor was diagnosed by histopathologic examination. The postoperative course was uneventful, but 8 months after surgery, the patient presented with multiple lung metastases and peritoneal dissemination, and died of disease 11 months after surgery. We describe a malignant solitary fibrous tumor in which tumor cells expressed cytokeratin.

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Paraduodenal hernia is a relatively rare type of hernia in which intestinal tract is trapped in the peritoneal fossa. This time we experienced 2 cases of left paraduodenal hernias diagnosed by MD-CT studies preoperatively and operated laparoscopically. Case 1 was a 64-year-old male patient who was found to have a cystic and dilated intestinal segment in the upper abdomen with image of the inferior mesenteric vein (IMV) ventrally by a MD-CT study. The small bowel segment incarcerated into the left paraduodenal fossa was reduced and the hernia orifice was closed laparoscopically. Case 2 was a 40-year-old male patient who was found to have a conglomerated segment of small bowel in the inferior part of the pancreatic tail and the IMV running ventrally by a MD-CT study. The hernia orifice was present in the upper duodenal fossa and an operation was performed through a small laparotomy incision with laparoscopic assistance. MD-CT study is believed to be an excellent diagnostic method for paraduodenal hernia and laparoscopic surgery is an efficient surgical treatment for this pathology.

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A 79-year-old man who had no history of undergoing operation and complained of vomiting and abdominal distention was referred to the hospital after a long tube was placed with a diagnosis of ileus at another hospital. After admission to the hospital, fluoroscopic study through the tube showed interruption of contrast material after the tip of the tube which was located in the right lower abdomen. Abdominal CT scan also suggested that some possible cause of this obstruction might be present in the right lower abdomen. Although the definite diagnosis was not made, laparoscopic surgery was performed to explore the cause and to treat with a suspicion of ileus caused by internal hernia on the 5^th hospital day. Laparoscopic observation of the abdominal cavity identified retrocecal hernia. The impacted small intestine was reduced and the hernia opening was released.
In the treatment of internal hernias including pericecal hernia in which preoperative diagnoses are difficult, laparoscopic surgery which can offer diagnosis and treatment at the same time is considered to be helpful.

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Internal abdominal hernias, which are protrusions of a viscus through a mesenteric or peritoneal defect, are uncommon. Symptoms from internal hernias are uncharacteristic, and most are diagnosed at laparotomy for ileus. This is a report of a 64-year-old female patient with the small bowel protruding through a defect in the sigmoid mesocolon. Laparotomy showed an oval defect of 3cm in diameter in the sigmoid mesocolon that strangulated the small intestine. This could not be preoperatively diagnosed as ileus due to internal hernia, but a retrospective review of abdominal multidetector-row CT (MDCT) showed characteristic findings. An internal hernia involving the sigmoid mesocolon is not common. Of these, only 9 had transmesosigmoid hernia.

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The present patient was a 49-year-old man who had been receiving corticosteroid therapy for psoriasis vulgaris since 1998. The patient visited our hospital after developing abdominal pain and umbilical swelling in December 2004. Emergency surgery was performed following a diagnosis of incarcerated umbilical hernia based on ultrasound and CT findings.
Intraoperative findings included a defect in the linea alba cranial to the umbilicus in addition to presence of a hernia sac in this defect and prolapse and incarceration of hernia contents. The patient was diagnosed with incarcerated epigastric hernia based on these findings. Only simple closure was performed for the hernia orifice because the surrounding tissue was relatively rigid and the tension was mild. Presently, after approximately 2.5 years of postoperative follow-up, no signs of relapse have been confirmed.
Epigastric hernia is considered a relatively rare disease in Japan. In the present study, we report our experience with a case of incarcerated epigastric hernia that was thought to have resulted primarily from long-term corticosteroid therapy with reference to literature.

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A clinical study was performed in 4 patients diagnosed as incarcerated obturador hernia reduced by femoral pressure method. We had tried to reduce the incarcerated intestine in obturator hernia by manual traction method, until we experienced a case of intestinal injury by manual traction method. Since that case we have reduced the intestine by femoral pressure method. Incarcerated intestine was easily reduced by pressing inside of the femoral artery. It has been reported that the reduction of obturador hernia utilizing water pressure method is useful. In addition to water pressure method, this femoral pressure method might be also safe and useful.

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A genetic disorder, von Reckinghausen's disease (VRD), is known to be complicated with non-epidermal tumors. We report here a case of VRD in whom non-epidermal tumors and a carcinoma were observed simultaneously. A 64-year-old female patient was referred to our hospital, complaining of jaundice. Gastroendoscopy revealed a tumor at the papilla Vater, and adenocarcinoma was confirmed in the biopsy specimen. She underwent pylorus-preserving pancreatoduodenectomuy resulting in curative resection. During the surgery, a tumor, 3.5cm in diameter, was found on the jejunum near the Treitz's ligament and was also extirpated. This tumor was diagnosed as gastrointestinal stromal tumor (GIST), with positive staining for c-kit and CD34 by immunohistochemistry. Histlogical examination showed many small tumors, suggestive of premature GIST in the resected duodenum.
We assume that genetic mutations, related to VRD and GIST, might have played some role in carcinogenesis in this case.

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