Despite recent improvements in the performance of computed tomography (CT), the results of treatment for bowel obstruction have not demonstrated any substantial improvement. It is difficult for general and primarily attached doctors to read the CT images of bowel obstruction. The aim of this study was to clarify the appropriate way to read contrast enhanced CT (CECT) images of bowel obstruction. We retrospectively analyzed the cases of 115 patients with bowel obstruction who underwent CECT scans. A multivariate analysis revealed that the reduced enhancement of the bowel wall abnormalities showed the highest usefulness for the diagnosis of bowel ischemia.

A 30-year-old woman was transferred to our emergency room with gunshots. She had perforating gunshot wounds in the both arms and the left breast. She also had a penetrating gunshot wound in the right chest. Computed tomography revealed injuries to the right lung, the liver and the spleen, and also showed perforation of the digestive tract. A bullet was detected around the transverse colon. An emergency laparotomy was performed. The liver and the spleen injury were primarily sutured. Two gunshot wounds on the anterior gastric wall could be seen. No bullet could be found, however, after a thorough search in the abdominal cavity. Intraoperative X-ray showed no bullet, but a chest X-ray revealed it in the lower mediastinum. Intraoperative esophagogastroscopy confirmed the presence of the bullet in the lower esophagus, and it was exposed through the wound in the gastric wall. In the case of an abdominal gunshot wound, especially when a bullet is in the digestive tract, it could migrate to any part. X-ray is helpful for removal.

A 74-years-old woman had undergone a hepatectomy for hepatocellular carcinoma in March, 2014. Seven months after the surgery, she began to complain of nausea and abdominal pain and was brought to our hospital. Chest X-ray showed an abdominal gas shadow above the right diaphragm and contrast enhanced CT showed herniation and bad contrast of the intestinal tract into the right thoracic cavity. We diagnosed a diaphragmatic hernia based on these findings. We performed an emergency operation, which revealed incarceration of the terminal ileum at the hernia orifice. After prolapsed terminal ileum was replaced into the abdominal cavity, the diaphragmatic hernia orifice was repaired. The postoperative course was good. The hernia orifice was the scar of the hepatectomy in the diaphragm. Iatrogenic diaphragmatic post-hepatectomy hernias are rare, however, diaphragmatic hernias with an extremely poor prognosis have been reported. Therefore, diaphragmatic hernia formation is one of the postoperative complications which should be considered after a hepatectomy.

An 88-year-old woman presented with right hypochondralgia. An abdominal CT scan showed a shrunken gallbladder surrounded by a low density area. Our diagnosis was biliary peritonitis due to gallbladder perforation, and we performed an emergency cholecystectomy. Surgical findings showed dark red ascites, dark red gallbladder, and an induration in the fundus of the gallbladder. In the resected specimen, the induration in the fundus of gallbladder appeared to be a hematoma. No perforation of or inflammation in the mucosa of the gallbladder was found. The surgical and macroscopic findings suggested a gallbladder intramural hematoma caused by subserous hemorrhage in the gallbladder fundus. The patient had a past medical history of coronary artery stent placement and had been prescribed antithrombotic drugs. Furthermore, it was unclear whether she had any history of trauma because she had dementia. Recently in Japan, the number of patients receiving antithrombotic therapy is increasing. In addition, in elderly people their physical ability and cognitive function have often declined. These backgrounds may lead to such rare cases with difficulty in understanding, requiring detailed pathophysiology to obtain the correct preoperative diagnoses just as we experienced.

A 23-year-old woman was admitted to a previous hospital after crush injury in a car accident. She was diagnosed as having blunt abdominal injury combined with a type Ⅲb liver injury and underwent partial hepatectomy of segment Ⅳ. Although bile leakage presented after surgery, she recovered with conservative management. Six months after surgery, she presented with abdominal pain and increased levels of her biliary enzymes. One year after surgery, a CT scan showed left-side dominated intrahepatic bile duct dilatation and she was diagnosed as having a delayed biliary stricture. After failure of IVR therapy for the biliary stricture, she underwent a cholangiojejunostomy via the transhepatic approach based on the difficulty of biliary reconstruction in the hepatic portal region. The postoperative course was uneventful and the patient was free of any symptoms at 24 months.

We report herein on a case of intraabdominal bleeding due to traumatic accessory spleen injury, in which hemostasis was obtained using transcatheter arterial embolization (TAE). The patient was a 15-year-old boy. He experienced abdominal pain after colliding with another player during a soccer game and consulted a local physician after the game. Abdominal contrast-enhanced computed tomography (CT) suggested intra-abdominal bleeding, and the patient was referred to our hospital. In addition, the CT image showed extravasation of contrast agent around the accessory spleen.Emergency angiography was performed and splenic artery imaging revealed extravasation from the arterial branches to the accessory spleen. Selective embolization and occlusion of the affected blood vessels was performed using an n-butyl-2-cyanoacrylate (NBCA)-lipiodol admixture. The post-TAE course was good and the patient was transferred to the referral physician on the sixth day after embolization. Traumatic accessory spleen injury is rare and there is no consensus on treatment. In most previous reports, laparotomy has been performed, but in our case we chose TAE to achieve hemostasis. Selective embolization of the artery branching to the accessory spleen was minimally invasive, and quick hemostasis was obtained. This outcome suggests that TAE may be a useful treatment for traumatic accessory spleen injury.

A 92-year-old man was admitted to this hospital complaining of abdominal pain and vomiting occurring over the previous few days. Physical examination revealed abdominal distention and muscle guarding. Abdominal computed tomography (CT) showed a dilated descending and sigmoid colon with a large amount of stool and a small amount of ascites with high CT density. An emergency laparotomy was performed, and a paper-thin, dilated sigmoid colon with an approximately 15 cm tear in the seromuscular layer on the opposite mesenteric side was observed, together with herniation of the untorn mucosa through the seromuscular tear (SMT) without perforation. Advanced sigmoid colon cancer was present at the anal end of the SMT. We hypothesize that increased intraluminal pressure caused by stool compaction at the site of the sigmoid colon cancer and weakness of the colon wall may have played a role in the development of the SMT. Furthermore, circulatory failure in the submucosal layer caused by increased intraluminal pressure likely led to dissociation between the muscular and submucosal layers, and the untorn mucosa herniated through the SMT to span the tear. This rare case is noteworthy because only one other report of a similar morbid condition without trauma could be found.

We report herein on a case of small intestine duplication found out with bowel obstruction. A 68-year-old man with chronic renal failure was undergoing extracorporeal dialysis. He presented at our hospital with abdominal pain. Abdominal CT showed the small intestine gathered in clusters and collapsed in the pelvic cavity. Treatment with a long tube was not effective, so he underwent an ileotomy. There were no neoplastic changes. On opening one lumen of the resected specimen, one more lumen was found. Histological findings showed a sequential muscular layer in the resected ileum. No abnormal mucosa is found. We consider that a bowel obstruction of an unidentified origin may be caused by small intestine duplication.

A 79-year-old man complaining of epigastralgia in the early morning was immediately admitted our hospital. The patient had previously undergone laparoscopic nephrectomy via the retroperitoneal approach for left renal cell carcinoma. Abdominal computed tomography （CT） provided a diagnosis of small-bowel obstruction. A long naso-intestinal tube was placed. Intestinal contrast examination through the long naso-intestinal tube revealed incarceration of the small intestine at the retroperitoneal site of the 12mm port incision at the nephrectomy. Abdominal 3D-CT revealed that the small intestine prolapsed into the retroperitoneal cavity. After incarceration at the retroperitoneal port site, the small intestine returned to the abdominal cavity. We diagnosed the case as an internal hernia with retroperitoneal port site hernia. An emergency operation was performed and a defect was observed at the mesentery of the left colon. The small intestine had prolapse from this defect into the retroperitoneal cavity, and a part of intestine was incarcerated in the retroperitoneal port site from the first operation. These findings established a diagnosis of retroperitoneal port site Richter type hernia in which the incarcerated part of the small intestine had prolapsed through the left mesentery of the transverse colon. We report our experience with a case of this rare condition accompanied by a review of the literature.

A 45-year-old man was admitted to our hospital complaining of abdominal pain after a traffic accident. A computed tomography examination revealed free air in the peritoneal cavity, but did not suggest the presence of any pelvic fracture. Peritonitis caused by a gastrointestinal perforation was suspected, and an emergency operation was planned. Bladder rupture and a rectal injury were identified, a Hartmann procedure and cystorrhaphy were performed. It is necessary to keep this case in mind when we examine any traffic accident patient with abdominal involvement.

An 85-year-old woman visited her doctor because of acute onset of abdominal pain after breakfast. Contrast-enhanced computed tomography showed dilation, a beak sign in the pelvis, and part of the small intestine with lower contrast. A strangulating intestinal obstruction was diagnosed. The patient was referred to our hospital and an emergency exploratory laparoscopy was performed. An oval defect 5cm in diameter was observed in the right sigmoid mesocolon, and part of the small intestine approximately 30cm in length was trapped in the defect. After the small intestine was pulled out of the defect, about 50cm was resected during the laparotomy, including the 30-cm ischemic part. A functional end-to-end anastomosis and additional incision to the defect was performed. The patient was discharged on the 10th postoperative day without complications. Intramesosigmoid hernias are rare, and preoperative diagnosis is difficult, but laparoscopy is useful for both diagnosis and treatment.

A 29-year-old man visited our hospital with a high fever and lower abdominal pain. Abdominal CT revealed free air and a cystic mass of 3cm in diameter with calcification, which continued from the small intestine. Because of peritonitis due to perforation of Meckel’s diverticulum by a foreign body such as an enterolith, an emergency laparotomy was performed. Meckel’s diverticulum communicated to the terminal ileum on the mesenteric side, thus a diverticulectomy was performed. Histopathological findings showed the perforation of Meckel’s diverticulum near its tip with an enterolith incarcerated in the base of the diverticulum. It was confirmed as a true enterolith since analysis of the stone showed it to consist of 99％ calcium oxalate. No ectopic tissue was found. With the recent advances in diagnostic imaging, the preoperative diagnosis rate of Meckel’s diverticulum has been increasing. Preoperatively we were able to diagnose a rare case of perforated Meckel’s diverticulum caused by a true enterolith.

Although the indications for endoscopic treatment of gastrointestinal diseases have been expanded, such treatment of diseases related to the duodenum is less than the more common treatment of diseases of the stomach and colon. Therefore, the indications and safety of endoscopic treatment for duodenal tumors, as well as the short-term and long-term results, are currently unknown. Endoscopic submucosal dissection (ESD) of duodenal tumors is difficult to perform because of the difficulties of duodenal autopsy and endoscopic manipulation. We report herein on two cases of emergency laparotomy surgery performed for duodenal perforation after ESD, and provide a literature review. In the first case, a 67-year-old man underwent ESD for an adenoma of the duodenum. On the second day after ESD, a duodenojejunostomy was performed on the perforation. In the second case, a 71-year-old man underwent ESD for early gastric cancer in the duodenum. The next day, perforation suture closure and omental covering were performed on the perforation. Since the repaired part is exposed to bile and pancreatic juice, there are many complications such as suture failure associated with the procedure. These cases also had postoperative complications that were difficult to treat.

An 80-year-old man with inappetence and dyspnea was taken to our hospital by ambulance. His abdomen was distended and hard. A bladder diverticulum perforation was suspected based on an abdominal computed tomography (CT) examination. We consulted a urologist, who placed an indwelling bladder catheter and washed the bladder, however the patient showed signs of septic shock. A subsequent CT scan performed 110 minutes after the previous scan showed portal venous gas, intraperitoneal free gas, and bilateral femoral vein gas. Emergency abdominal surgery revealed a perforation of the bladder diverticulum and acute pan-peritonitis. We performed perforation closure and drainage, with intensive care after the operation, however the patient died from multiple organ failure 40 hours after the operation. In this case, gas in the portal vein, abdominal cavity, and femoral vein appeared in a short time. The case of portal venous gas accompanied by systemic venous gas is rare and valuable, since it suggests that the gas in the portal vein enter the systemic vein through a portosystemic shunt.

We report herein on the case of a 58-year-old woman with epigastric pain, vomiting and loss of consciousness who was rushed to a nearby hospital and then to our hospital for further observation and investigation. CT revealed stenosis of the second portion of the duodenum and intestinal malrotation. The abdominal findings improved following nasogastric tube insertion. Because there was no intestinal ischemia, it was decided to treat the patient conservatively. Upper gastrointestinal endoscopy revealed a duodenal stenosis. Although the scope passed the stenosis, fluoroscopic study showed no contrast reflex. We diagnosed it as mechanical duodenum stenosis, and operated. An intestinal malrotation, turned 180 degree in a counterclockwise direction, was revealed. The duodenum became narrow because of adhesion with the mesenterium of terminal ileum, so we peeled off those adhesions. The postoperative course was good, and the patient was discharged on the sixth postoperative day. This disorder should be considered as one of cases of duodenal stenosis in cases without past surgical history.

A 55-year-old male was referred to our hospital because of abdominal pain with onset from the early morning. We diagnosed it as constipation and followed the patient up. In the afternoon of the same day, he was admitted because of increased fever, abdominal pain and tenderness. An abdominal CT scan showed fecal retention from the sigmoid colon to the transverse colon with mild swelling of the appendix and storage of ascites, but free-air was not observed. We performed an appendectomy via an alternate incision under the diagnosis of acute appendicitis. When we searched the inside of the abdominal by hand, we palpated an irregularity in the wall of the sigmoid colon, so we added a midline abdominal incision. We confirmed the serosa and muscle layer of the sigmoid colon was ruptured, but the mucosa layer was intact. We performed a sigmoidectomy and single barrel colostomy under the diagnosis of idiopathic colon perforation. The patient was discharged on the 7th postoperative day.

We report herein on a case of spontaneous esophageal perforation with bezoars. A bezoar had been discovered in a 77-year-old male in the course of an upper endoscopic examination. Sudden chest and back pain subsequently appeared after vomiting. CT scan findings showed esophageal perforation and mediastinal emphysema. An upper gastrointestinal series showed a filling defect in the lower thoracic esophagus. A left seventh intercostal thoracotomy and extra-pleural approach revealed a lacerated lesion at the left-side wall of the lower thoracic esophagus and two incarcerated bezoars in the oral side of the perforated site. We removed the bezoars and performed direct closure of the lacerated lesion with an omentopexy. Another bezoar was found in the jejunum. Firstly, the bezoars had caused upper intestinal obstruction and vomiting. Secondly, the two incarcerated bezoars in the esophagus elevated the intramural pressure and resulted in the esophageal perforation. The patient underwent mediastinal drainage after the second esophageal perforation 15 days after the first operation, but he died from aortic rupture on the fifty-second day. Bezoars should be treated by endoscopic removal or lithotripsy to prevent intestinal obstruction and esophageal perforation.

A 79-, an 84-, and an 86-year-old man with vomiting or anorexia were referred to our hospital. Computed tomography examination showed a dilated cecum located in the left upper abdomen in all cases. Preoperative diagnosis was volvulus of transverse colon in case I, and cecal volvulus in case 2, 3. In cases 1 and 2, a colonoscopy was performed as endoscopic therapy, however mucosal necrosis was found and all cases underwent emergency surgery. The fixation of the cecum to the retroperitoneum was poor in all cases. In cases 1 and 2 the cecum was twisted and strangulated, resulting in necrosis. In case 3 the dilated cecum was found folded anteriorly with a tear in the serosa. Intestinal resection was performed in all cases. Although cecal volvulus is comparatively rare, when elderly patients present with symptoms of intestinal obstruction this disease must be kept in mind and attention should be paid not to miss blood flow insufficiency.

We report hereon on a rare case of a 72-year-old female with abdominal compartment syndrome (ACS) following embolization for massive bleeding from the inferior pancreaticoduodenal artery who was saved by open abdominal surgery. She came to our hospital by ambulance diagnosed as having massive bleeding from the retroperitoneal vasculature and she was in a state of severe hemorrhagic shock. Angiography revealed that the extravasation was from the inferior pancreaticoduodenal artery and we performed embolization of the artery. After the embolization, she had ACS and we quickly performed open abdominal surgery to remove a large hematoma from her abdomen. After the operation, she recovered. As we can stop bleeding quickly, embolization is an effective treatment for arterial hemorrhage shock. On the other hand there is so a big risk for the occurrence of ACS, as a large amount of hematoma could be left in the abdomen. It is important that we recognize the risk for ACS after embolization for massive bleeding.

A 57-year-old man was transferred to our emergency department with acute abdominal sharp pain. Strangulation obstruction was suspected based on the CT findings. An exploratory laparotomy revealed volvulus of the entire small intestine without any associated obvious cause or pathology, leading to the diagnosis of primary small bowel volvulus (PSBV). The small bowel volvulus was repaired by simple devolvulation, and the patient was discharged. A year and 1 month later, the man was transported to our emergency department with similar symptoms. Based on the CT findings, the patient was diagnosed as having recurrence of the PSBV. An exploratory laparotomy revealed that almost the entire small intestine was twisted clockwise about one and a half turns. After simple devolvulation, the small bowel was fixed to the retroperitoneal wall. Recurrence of PSBV after simple devolvulation are rare in Japan, with only 4 cases having been reported including our case. Fixation to the retroperitoneal wall was used to prevent recurrence of the PSBV.

A 37-year-old woman visited our emergency room with abdominal pain. Her blood chemistry showed evidence of an inflammatory reaction (elevated levels of white blood cell count and C-reactive protein). Contrast-enhanced computed tomography revealed a moderate amount of ascites in the pelvic cavity, and evidence of an inflammatory change surrounding the appendix or the left uterine appendage. We made a diagnosis of perforated appendicitis or pelvic inflammatory disease. We planned a laparoscopic exploration to make a definitive diagnosis, and subsequently perform appropriate surgery. The laparoscopic findings demonstrated necrosis of the left hydrosalpinx due to torsion, and a secondary inflammatory change was seen in the appendix. We made a definitive diagnosis of hydrosalpinx torsion. A left salpingectomy and appendectomy were performed laparoscopically. In general, hydrosalpinx torsion is a rare disease, and a preoperative diagnosis is often achieved with difficulty. The safety and utility of laparoscopic surgery for treatment of various diseases of the uterine appendages have been documented. Diagnostic laparoscopy and subsequent less invasive surgery is a therapeutic option for a rare disease.

Gangrenous ischemic colitis spreading to the entire colorectum is very rare and few cases have been reported. A 73-year-old male with a previous history of hypertension had abdominal pain and general malaise. On the following day he was admitted to our hospital because of aggravation of his symptoms. Upon arrival he was in a state of shock with severe metabolic acidosis. An abdominal CT scan showed ascites, portal venous gas, thinning of a wide area of the colon wall, and increased density of the adipose tissue around the colon which led to an emergency laparotomy under the diagnosis of bowel necrosis. A gangrenous area of the bowel was observed including 200 cm of the ileum and extending to the upper rectum including the total colon. Furthermore, the mucosal side of the lower rectum demonstrated an ischemic change. Two hundred centimeters of the ileum and the entire colorectum were resected and an ileostomy was carried out. In principle, resection of the necrotic bowel is necessary for gangrenous ischemic colitis and non-occlusive mesenteric ischemia. We resected the entire colorectum due to mucosal necrosis of the lower rectum. We present this case, with as analysis of the pertinent literature regarding gangrenous ischemic colitis spreading to the entire colorectum.

A 76-year-old woman complaining of lower abdominal pain and high fever for about 2 weeks was hospitalized with a diagnosis of right lower abdominal abscess detected by contrast CT. The location of the abscess was suspected to be in the mesentery based on the MRI and CT findings. The patient partially recovered following conservative therapy with antibiotics but slight abdominal pain after every meal remained. With the abscess not disappearing on CT, we performed laparoscopic-assisted surgery. Laparoscopic findings revealed that the abscess was situated in the mesentery of the ileum about 15 cm from Bauhin’s valve. We performed ileocecal resection with an incision wound of about 4 cm after peeling an ileocecal part from the retroperitoneum laparoscopically. The cause of the abscess was not able to be specified by the macro-and microscopic specimen findings. Laparoscopic-assisted surgery was effective in the case of an abdominal abscess which proved difficult to locate in terms of diagnosis and treatment.

A 35-year-old man presented to our hospital complaining of lower abdominal pain and palpable induration. An Abdominal CT scan using the conventional gradation processing technique (WW: window width=270, WL: window level=10) showed sigmoid colon dilatation as a finding of mechanical obstruction. However, on changing to a lung CT setting (WW: 1,800/WL: -700), the scan showed a foreign body in the sigmoid colon. An emergency open laparotomy was performed and a 20×7cm sized sex toy was removed from the intestine. In many cases of foreign objects in intestine, CT scanning is very useful to detect foreign bodies. However, some materials are hard to detect with a conventional abdominal CT scan. We suggest that in cases of suspected foreign objects, the wider WW CT technique would be preferred to the conventional technique.

A 50-year-old man had been experiencing abdominal discomfort persisting for about 2 weeks. He presented at our hospital because of intensified abdominal pain. The abdomen was distended, with tenderness and mild rebound pain in the region extending from the right lower abdomen to the upper abdomen. Contrast-enhanced computed tomography showed a circle-like mass with contrast enhancement and the so-called target sign at the lesion margin. Intussusception was thus diagnosed. Because the patient had symptoms of peritoneal irritation, emergency surgery was performed. A slightly hard mass was palpated intraoperatively in the cecum. Because a malignant tumor could not be ruled out, ileocecal resection with lymph-node dissection was performed. Macroscopic examination of the resected specimen showed a pedunculated mass, about 4 cm in diameter, with the characteristics of a submucosal tumor. Histopathological examination revealed mature adipose tissue and capillary proliferation, and an angiolipoma was diagnosed. Angiolipomas arising in the small intestine are extremely rare, but should be considered as a potential cause of small-bowel intussusception.

A 42-year-old man, was hospitalized because of lower abdominal pain. On physical examination, there were sign of fever and left lower abdominal pain. A blood test showed increased inflammatory reaction, and an abdominal CT scan revealed a little gas in the sigmoid mesocolon with inflammation. We suspected colonic perforation. As the symptoms were mild, we judged that there was not an emergency and started conservative treatment with fasting and antibiotics. On the 4th day after admission, he developed a fever again. As repeated CT scans revealed an increase in the abscess, we gave up conservative treatment and performed an emergency operation. During the surgery, a soft mass was palpated in the sigmoid mesocolon, however polluted ascites was absent. We performed resection of the sigmoid colon without perforation of the abscess. Examination of the resected specimen revealed perforation of the colon with diverticular inflammation reaching into the mesentery. The patient was discharged on post-operative day 12, and the postoperative course was uneventful. Intramesenteric penetration of a colon diverticulum is rare. Since the inflammation is relatively localized in the pelvic cavity in these cases, a good prognosis can be expected if early and appropriate surgical treatment is performed.

A 78-year-old male presented to our emergency room with chest pain at rest. Electrocardiogram revealed ST elevation in V1-V4, and we subsequently performed an emergency coronary angiogram. No significant severe stenosis indicating myocardial ischemia was detected. Blood cell count revealed the patient’s hemoglobin count decreased from 10.0g/dL to 7.7g/dL within a period of 5 days, and hemorrhage from an ascending colon tumor was suspected. He was diagnosed as having acute ischemic heart dysfunction induced by reduction of the circulating plasma flow, and an emergency surgery followed by blood transfusion was planned. We performed a right hemi-colectomy and D3 lymph node dissection. No heart attack or abnormal electrocardiogram findings occurred during the laparotomy and after the surgery. The final diagnosis was ascending colon adenocarcinoma with N3 lymph node metastasis. Oral adjuvant chemotherapy was administrated for 6 months, concomitantly with taking oral aspirin to prevent coronary disease. An oncologic emergency is a life-threatening incident and requires immediate treatment. In our patient, the ascending colon adenocarcinoma was bleeding continuously that caused acute ischemic heart dysfunction；therefore an emergency surgery was performed.

Case 1: A 40-year-old female had left flank pain after eating a fish dish. Abdominal CT findings showed a 25 mm linear high-density shadow with an edematous intestine. We diagnosed the problem as localized peritonitis due to a fish bone. Intravenous antibiotics administration and fasting were conducted. CT findings showed that fish bone shadow had disappeared on the 4th day after admission. The patient was discharged at 12 days after hospitalization. Case 2: an 80-year-old male had lower abdominal pain. Abdominal CT findings showed a 32 mm linear high-density shadow with an edematous intestine. We diagnosed it as localized peritonitis due to a fish bone. Intravenous antibiotics administration and fasting were conducted. The fish bone-like shadow disappeared on the 6th day after admission. The patient was discharged on the 12th administrative day. Sequential CT findings of the fish bone were useful for conservative treatments in our cases.

Intussusception in adults is associated with a demonstrable organic cause in more than 90% of all cases. However, only a very few cases of intussusception associated with Crohn’s disease have been reported in the literature. We report herein on a case of intussusception in an adult patient with Crohn’s disease. A 37-year-old woman was admitted to our hospital for the treatment of her abdominal pain, nausea and diarrhea. Abdominal ultrasonography and computed tomography showed a target sign in the ileocecal region, and ileocecal intussusception was suspected. We performed an emergency laparoscopy-assisted ileocecal resection. During the operation, the ileocecal intussusception was confirmed. The resected specimen showed stenosis from the ileum end to Bauhin’s valve. The pathological examination showed numbers of non-caseating granulomas with giant cells and fissuring ulcers, and the diagnosis of Crohn’s disease was confirmed. It was a rare case in which the stenotic area of Crohn’s disease was the lead point of intussusception.

We herein describe a rare case of vaginal evisceration of the ileum. An 84-year-old Japanese woman noticed the sensation of a mass emerging from her vagina, and abdominal pain. Her surgical history included a total cystectomy for bladder cancer together with a hysterectomy four years previously as well as closure of an ileo-vaginal fistula three years previously. The ileum, which exhibited edematous changes, had prolapsed through the vagina so we operated on her. Gynecologists have reported a large number of cases involving the rare condition of vaginal evisceration. However, only one case has been reported by a general surgeon. Multidisciplinary therapy with a gynecologist and general surgeon should be considered for vaginal evisceration of the intestine, especially under contaminated conditions and difficult circumstances.