In trauma, blood type O has been found to be associated with an increased risk of exsanguination, while no such association has been reported for the other blood types. Therefore, this study was aimed at investigating the association between the blood type and the prognosis of abdominal trauma (need for emergency blood transfusion). [Subjects and Methods] We retrospectively examined the data of trauma cases with an abdominal AIS of ≥ 3 who presented to our center between 2008 and 2020. The patients who required transfusion of ≥ 1 U of an RBC product within 24 hours were included, and their survival rates and blood transfusion volumes were examined. [Results] Overall, 253 patients were included. Mean age, 62 years; 177 males: 76 females; blunt trauma 93％; ISS 32. The 24-hour mortality rates were 12％ and 13％ in the groups with the O and non-O blood types, respectively, and there was no significant difference in the transfusion volumes of 12 and 9 units, respectively, between the two groups. Further, after excluding head and chest trauma as a cause of death, there was no significant difference in the mortality rate between the two groups. A multivariate analysis did not identify blood type O as being associated with the mortality. [Conclusion] In patients with abdominal trauma requiring blood transfusion, there was no significant difference in the transfusion volume required or prognosis between patients with type O and non-type O blood groups.

The patient was a 42 year-old man who was transported by ambulance to our hospital with melena. He had undergone treatment for esophageal varices secondary to liver cirrhosis, and prior to that, laparoscopic cholecystectomy for gallbladder stones. Laboratory examination revealed mild anemia and CT showed no evidence of extravasation from the varices in the small intestine. Upper gastrointestinal endoscopy revealed no source of bleeding and the patient was admitted to our hospital. However, the melena as well as the anemia worsened on the night of admission; emergency colonoscopy revealed no source of bleeding, which was suspected as being caused by bleeding from small-intestinal varices. Interventional radiology (IVR) was planned, but since the approach to the varices via the right inferior epigastric vein, which drains blood into the right femoral vein, would have been difficult, emergency surgery was performed. Because varices had formed at the site of adhesion of the small intestine to the previous laparoscopic port site, a small laparotomy was performed to avoid injury to the varices, and the affected segment of the small intestine with the varices was resected. In this case, the patient, who had portal hypertension, had developed collateral circulation at the site of adhesion of the small intestine to a previous laparoscopic surgical wound, and rupture of the varices at this site caused melena. Aggressive measures to prevent adhesions, even during laparoscopic surgery, is necessary for patients with portal hypertension undergoing surgery.

The patient was a 23-year-old woman who visited our hospital emergency department complaining of acute epigastric pain. She gave a history of having undergone extrahepatic bile duct resection and biliary jejunostomy for congenital biliary dilatation at the age of three years. Abdominal computed tomography (CT) showed the closed loop near the origin of the Roux-en-Y limb, and decreased blood flow throughout the Roux-en-Y limb. We diagnosed the patient as having strangulated small bowel obstruction in the Roux-en-Y limb and performed emergency surgery. Intraoperative exploration showed a hernia phylum between the mesentery of the Roux-en-Y limb and mesentery of the jejunum near the ligament of Treitz, through which an approximately 20-cm segment of the small intestine had herniated and the Roux-en-Y limb was twisted. Even after the strangulation was released, the color of the Roux-en-Y limb, including the bile duct-jejunal anastomosis did not improve, and no blood flow could be confirmed by ICG fluorescence examination. Due to necrosis of the Roux-en-Y limb, we performed cholangiojejunostomy. We report a rare case of strangulated small bowel obstruction with necrosis of the Roux-en-Y limb after biliary reconstruction.

A 39-year-old man visited his neighborhood hospital with a history of abdominal pain, vomiting, and chills; when his symptoms worsened 6 hours after onset, he was referred to our hospital. Abdominal contrast-enhanced CT revealed distension of the small intestine with a closed loop obstruction posterior to the sigmoid mesocolon. The suspected diagnosis was strangulated ileus secondary to an internal hernia, and emergency laparotomy was performed. Intraoperatively, we observed strangulation of an approximately 6-cm segment of the small intestine that had herniated through a mesenteric defect measuring 1.5 cm in diameter in the right leaf of the sigmoid mesocolon. We diagnosed the patient as having strangulated ileus secondary to an intramesosigmoid hernia. As the incarcerated portion of the small intestine was viable, we did not perform intestinal resection, and completed the surgery by closing the defect in the sigmoid mesocolon. The postoperative course was uneventful and the patient was discharged on the 10th postoperative day. Intramesosigmoid hernia is relatively rare. We discuss the treatment strategy for internal hernias through a defect in the mesentery of the sigmoid colon, with the review of previous case reports in Japan.

A 97-year-old man presented to our hospital with a one-day history of abdominal pain. Based on the findings of abdominal CT and MRI, we diagnosed the patient as having acute cholecystitis. Laparoscopic cholecystectomy was performed on the following day, and Gross type I torsion of the gallbladder was diagnosed intraoperatively. The patient had gangrenous cholecystitis, but there was no perforation, and the postoperative course was favorable. Gallbladder torsion is a relatively rare disease that requires prompt diagnosis. We reviewed the clinical findings of one case reported by us, together with those of the previous 53 cases reported during the last 10 years. We compared the past and current correct preoperative diagnosis rates, and concluded that the characteristic imaging findings of gallbladder torsion are important to make a preoperative diagnosis. However, even in cases of acute cholecystitis with no characteristic imaging findings of gallbladder torsion, the possibility of gallbladder torsion and surgery should be considered.

A 61-year-old woman was referred to our hospital for evaluation of left abdominal pain suspected to be caused by intussusception resulting from a known pedunculated colonic lipoma. Abdominal CT revealed that the known 5-cm tumor mass in the hepatic flexure was incarcerated in the descending colon, causing obstructive enteritis. We initially attempted endoscopic resection, but since that proved difficult, emergency surgery was performed. During the surgery, the incarcerated mass was discovered in the middle of the descending colon. We attempted to move the mass towards the anus, but because the intestinal wall was damaged, we resected the mass from the same site. The surgery involved suturing the intestinal wall and creating a diverting stoma in the ileum to complete the surgery. The histopathological diagnosis of the tumor was lipoma with necrosis. Gastrointestinal masses, such as lipomas, cause intussusception, although sloughing in the large intestine is rare, and incarceration even rarer. It is important to consider less invasive treatments in the early stages, taking into consideration the tumor size and symptoms.

A 47-year-old man was admitted with a history of abdominal pain and recurrent vomiting since childhood. Abdominal CT showed dilatation of the stomach and duodenum, a whirl-like pattern around the superior mesenteric artery, and no evidence of mesenteric ischemia. Based on the findings, we made the diagnosis of bowel obstruction due to midgut volvulus. Laparoscopic repair of the volvulus and the Ladd procedure were performed. The postoperative course of the patient was uneventful, and he was discharged from the hospital on the 6th postoperative day. Although midgut volvulus is rare in adults, preoperative diagnosis can be made if the possibility of this disease is borne in mind. Laparoscopic Ladd procedure is a safe and practical technique for intestinal malrotation with midgut volvulus in adults.

A 75-year-old male patient underwent laparoscopic cholecystectomy for gallbladder stones. The cystic duct and artery had been dissected with a metallic clip. Two months post surgery, the patient presented to the hospital with conjunctival icterus and a history of passing brown-colored urine. Blood tests revealed increased inflammatory markers and elevated bilirubin level. Abdominal computed tomography showed retroperitoneal emphysema in the region of the surgical clip and increased fat attenuation around the first and second parts of the duodenum. Upper gastrointestinal endoscopy revealed a duodenal ulcer and the surgical clip buried in the bed of the ulcer. We diagnosed the patient as having a duodenal ulcer with penetration and extrinsic compression by the surgical clip. We managed the patient conservatively with a proton pump inhibitor and antibiotics, and the patient recovered immediately. Gastrointestinal endoscopy performed after discharge revealed that the surgical clip had fallen into the duodenum, and it was removed endoscopically.

A 71-year-old man with a past medical history of compensated alcohol-related liver cirrhosis who had undergone a subtotal stomach-preserving pancreaticoduodenectomy for chronic pancreatitis presented with asymptomatic refractory ascites postoperatively. Eighteen months after the surgery, the patient developed epigastric pain associated with increased inflammatory marker levels and aggravated ascites. Peritoneal tapping showed white cloudy fluid with elevated neutrophils; however, no bacteria were detected. Based on the status of the liver cirrhosis and the characteristics of the ascitic fluid, we made the diagnosis of spontaneous bacterial peritonitis (SBP). The patient was started on treatment with CTRX and MEPM, and three separate peritoneocenteses were performed. The fifth bacterial culture grew Streptococcus anginosus. Based on the results of microbial sensitivity testing, we switched the antibiotic therapy to SBT/ABPC and SBTPC, and the patient responded well to the peritoneal drainage and antibiotic therapy. Twenty-eight months after discharge, the inflammatory marker levels remain normal. Furthermore, tolvaptan was administered for the entire length of stay of the patient at the hospital, and there has been no recurrence of ascites to date. In conclusion, the possibility of postoperative development of SBP must be borne in mind in patients with compensated liver cirrhosis undergoing surgery.

A 20-year-old man was admitted with a history of sudden abdominal pain and vomiting. Abdominal contrast-enhanced CT revealed a left paraduodenal hernia. Due to the absence of intestinal ischemia, after a short course of non-surgical treatment, we performed laparoscopic repair on the 10th day of hospitalization. The hernia orifice was identified by laparoscopy, and a large loop of the small intestine was reduced into the abdominal cavity. But after the reduction, since it became difficult to secure the operative field, we decided to convert to laparotomy in order to avoid the risk of vascular injury. The patient had a good postoperative course and was discharged on the 8th postoperative day. There was no recurrence at the follow-up examination conducted 2 months after the operation. In this report, we describe a case of left paraduodenal hernia that was initially treated conservatively followed by laparoscopic surgery, but completed safely with laparotomy. In cases of left paraduodenal hernia in which laparoscopic surgery proves difficult, it is important to convert to laparotomy without hesitation in order to complete the operation safely.

We present the case of a 74-year-old man with rectal arteriovenous malformation (AVM) causing left colonic varices, with bleeding from both sites. Initially, the bleeding from the rectal AVM was controlled by IVR, while the left colonic varices continued to bleed after hemostasis was achieved at the site of the rectal AVM. The bleeding from the left colonic varices was so severe that the patient went into shock, and both an endoscopic procedure and IVR were needed for the control of bleeding. Anticoagulant therapy was required because of superior mesenteric venous thrombosis resulting from the surgical hemostasis procedures, which led to recurrent left colonic variceal bleeding; the varices were finally treated by resection. An underlying rectal AVM could cause colonic varices, and while bleeding from the colonic varices could be severe, no therapy has been established yet. In such cases, definitive treatment for the rectal AVM, such as surgery, should be considered to avoid bleeding from left colonic varices.

An 84-year-old man with a medical history of hypertension and duodenal ulcers who was receiving treatment with an H₂-blocker was transferred to our hospital because of tarry stools and impaired consciousness. Abdominal computed tomography showed free air in both the abdominal cavity and retroperitoneal space. Emergent laparotomy showed a perforated lesion measuring 4 × 2 cm in the descending part of the duodenum and a stenotic scar in the oral aspect of the lesion. Simple closure of the perforated lesion was not possible. A transmural duodenotomy was performed from the ulcer to the scar, and side-to-side duodenojejunostomy was performed in a Roux-en-Y fashion. The postoperative course was complicated by a minor anastomotic leak, but the leak healed with conservative treatment. Side-to-side duodenojejunostomy can be performed regardless of the anastomosis size, making it a useful procedure for huge duodenal ulcers that are difficult to treat by simple closure.

The patient was a 57-year-old woman with an inserted ventriculoperitoneal shunt (VPS) after head trauma. She presented with right abdominal pain, and a careful clinical examination led to the suspicion of an infected liver cyst. Percutaneous transhepatic drainage resulted in relief from the pain, but the cyst subsequently relapsed. A single-incision laparoscopic hepatic cyst deroofing was performed. To prevent cerebrospinal fluid infection, the VPS was clamped extracorporeally. Careful attention was paid to prevent intraperitoneal spillage of the cyst fluid, and intraoperative indocyanine green (ICG) examination confirmed the absence of biliary leakage. No intraperitoneal drain was placed. There is no consensus on the surgical approach for and perioperative management of patients with a VPS tube. Minimally invasive surgery by single-incision laparoscopic surgery (SILS) was considered feasible if potential infection-conscious treatment was performed in combination with VPS clamping and intraoperative ICG examination.

A woman in her 80s who had received treatment for pleuritis at a previous hospital was referred to our department with a mass in the left lower abdomen. Abdominal computed tomography (CT) showed an iso-density mass measuring 47 mm in diameter with a linear high-density area inside. We diagnosed the patient as having an intra-abdominal abscess caused by penetration of a fishbone without pan-peritonitis, and performed CT-guided drainage. The patient was discharged after 10 days. Three months later, she was readmitted for a recurrent abscess, and underwent drainage again; this time, she was diagnosed as having a bladder fistula. Finally, we performed laparoscopic removal of the wall of the abscess with the fishbone, located just below the abdominal wall and bladder and adjacent to the sigmoid colon. We ultimately diagnosed the patient as a case of an intra-abdominal abscess caused by fishbone penetration of the sigmoid colon. The patient was discharged four days postoperatively.

The patient was an 80-year-old man who was referred to our hospital with suspected intra-abdominal abscess after a visit to a previous hospital for lower abdominal pain. Abdominal CT (computed tomography) showed a 70 x 80 mm low-density area on the right side of the pelvis that was in contact with the end of the ileum, and we decided to perform drainage via a transanal ileocolostomy. The drainage tube was placed under colonoscopic guidance, but the drainage fluid from the fistula was jelly-like, clear, and colorless; upon review of the CT images, we found that the low-density area, which we had thought was suggestive of an intra-abdominal abscess, was, in fact, contiguous with the appendiceal tip; based on this new finding, we considered the diagnosis of an ileocolic fistula formed by penetration of an appendiceal mucinous tumor. We opted for surgical treatment, and performed ileal resection of the affected segment. The histopathological diagnosis was ileal perforation by a low-grade appendiceal mucinous tumor. Initially, we thought that the hypodense area on the right side of the pelvis was an intra-abdominal abscess, but the nature of the draining fluid and review of the CT images led us to revise the diagnosis to an appendiceal mucinous tumor. In addition, drainage treatment of the appendiceal mucinous tumor proved ineffective, and we considered surgical resection as being preferable from an oncological standpoint.

A 77-year-old man presented to our emergency department with acute abdominal pain. He had undergone Frey’s procedure for chronic pancreatitis at another hospital about 10 years ago. Abdominal computed tomography (CT) showed dilated small intestinal loops and the whirl sign. Emergency surgery was performed under the suspicion of strangulated bowel obstruction caused by small bowel volvulus or internal herniation. Intraoperative exploration showed the small bowel incarcerated into a defect of the mesentery. After the incarcerated bowel was released, it was confirmed to be viable. The operation was therefore completed by closure of the mesenteric defect with non-absorbable sutures. The postoperative course was uneventful. Herein, we report a rare case of internal herniation developing after Frey’s operation.

Internal transverse mesocolon hernia is one of the rare internal hernias and is difficult to diagnose preoperatively. We report a patient in whom we diagnosed transverse mesocolon hernia by CT preoperatively. The patient was an 80-year-old man with a previous history of appendectomy who presented to our hospital with abdominal pain. Abdominal contrast-enhanced CT revealed dilated small bowel forming a closed loop and converging near the middle colic artery. Based on these preoperative findings, we made the diagnosis of transverse mesocolon hernia, and performed emergency surgery. Intraoperative exploration showed herniation of a small intestinal loop into a defect of the transverse mesocolon. The herniated bowel was released, and confirmed to show no evidence of necrosis. Therefore, the operation was completed with suture closure of the hernia orifice. The postoperative course was uneventful, and the patient was discharged on the 8th postoperative day. We made the diagnosis of transverse mesocolon hernia preoperatively and performed emergency surgery based on the characteristic findings on abdominal contrast-enhanced CT.

An 84-year-old man visited our hospital complaining of pain in the right inguinal region. Abdominal computed tomography revealed a right inguinal hernia containing a swollen appendix, based on which we made the diagnosis of Amyand’s hernia. Because of evidence of mild appendicitis, we started the patient on antibiotic therapy, with a plan for elective surgery. Laparoscopic surgery was performed one month after the onset. Although the appendix was adherent to the hernia sac, we considered that the inflammation had subsided. Laparoscopic appendectomy and transabdominal pre-peritoneal repair were performed as single operations. The postoperative course was uneventful. It is necessary to consider the timing of surgery, use of a mesh, and the approach method depending on the degree of inflammation of the appendix before surgery. Herein, we report this rare case, along with a review of the pertinent literature.

The patient was a 50-year-old man who presented with orbital pain. Contrast-enhanced CT showed a 4-cm mass in the anterior gastric wall. Abdominal endoscopic ultrasound showed a mass lesion within the anterior gastric wall that was uniformly hypo-echoic, with purulent discharge inside; based on the finding, we made a diagnosis of idiopathic gastric wall abscess. The patient improved with intravenous cefmetazole. On day 9, a blood test showed a decrease in the levels of inflammatory response markers, but CT showed a residual gastric wall abscess, and levofloxacin was added to the treatment. A repeat CT on day 40 showed a reduction in the abscess size. Gastric wall abscess is a rare condition that is important to keep in mind when considering the differential diagnosis of gastric submucosal masses, as it may be difficult to distinguish from a gastric submucosal tumor by CT. Endoscopic ultrasound may be useful for its diagnosis. If diagnosed early and correctly, gastric wall abscesses could be successfully treated by drainage and antibiotics.