In recent years, it has been recommended that ileus be distinguished from intestinal obstruction, but this concept has not yet become widely accepted. One of the reasons for this is that there is no name for “intestinal obstruction” in the “ICD10-based Standard Disease Code Master” used for billing medical fees. 【Subjects and Methods】In this study, we conducted a retrospective review of 199 cases hospitalized between January 1, 2014, and December 31, 2018, with “ileus (ICD10 code K567)” or similar names of diseases as to the major disease, and examined the problem with using the term “ileus” by assigning best fitting name to each case. 【Results】A total of 23 names were used to describe 199 cases. Only 15, such as acute enteritis, satisfied the current narrow definition of ileus. 【Conclusion】“Ileus（ICD10 code K567）” and the same kind of diseases are now being used for a variety of conditions beyond the current narrow definition of ileus. We hope that the terms “intestinal obstruction” and “ileus” will be correctly differentiated, which is expected to help in both clinical practice and medical research in the future.

A 72-year-old man under maintenance hemodialysis for diabetic nephropathy had undergone endovascular surgery with stent placement for bilateral common and external iliac artery (EIA) occlusion with critical limb ischemia 10 months prior. The patient was hospitalized for sepsis due to arteriovenous graft infection. Therefore, the graft at anastomosis site of brachial arterial, which was clearly uninfected, was preserved, while the other graft was removed. A blood culture grew methicillin-resistant Staphylococcus aureus (MRSA). On the day of graft removal, the patient developed gradually worsening right inguinal pain. Based on the findings of contrast-enhanced computed tomography (CT), the patient was suspected as having a pseudoaneurysm beyond the stent in the right EIA. A femoro-femoral (FF) bypass was performed and the stent was dissected at the origin of the right EIA. Subsequently, the EIA was removed together with the stent up to the bifurcation of the deep iliac circumflex artery. The postoperative course was uneventful; a repeat CT showed that the infection had not recurred and the bypass was patent. As reported in the literature, surgical revascularization specific to the features in individual patients is recommended in stent infections.

A 53-year-old man was referred to us from another hospital for acute abdomen. The patient had a history of sustaining injury when he hit his right chest against a fence while at work. Contrast-enhanced CT at the previous hospital suggested a hematoma in the ascending colon. A repeat CT performed 3 hours later showed enlargement of the hematoma, and we performed emergency surgery. Gastrointestinal injuries resulting from blunt abdominal trauma frequently include perforation and mesenteric injuries; intramural hematoma is rare and is more commonly seen in the duodenum. Herein, we report a rare case of intramural hematoma occurring in the colon, along with a review of the literature.

A man in his 80s was transferred to our emergency department with the chief complaint of high fever. Abdominal contrast-enhanced CT after admission revealed a 5-cm abscess with a fishbone in the left lateral segment of the liver, so that we diagnosed the patient as having an abscess caused by fishbone perforation. We immediately performed percutaneous transhepatic abscess drainage. The blood pressure declined suddenly seven days later, and CT revealed migration of the fishbone to the pericardial space and pericardial effusion. We made the diagnosis of cardiac tamponade due to fishbone perforation of the pericardium and performed an emergent operation. Intraoperatively, the fishbone was found to be protruding from the gastric wall and penetrating the hepatic surface in the left lateral segment and the subphrenic membrane. We removed the fishbone and drained about 200 mL of old blood from a pinhole made in the subphrenic membrane. We performed left lateral segmentectomy of the liver and pericardial drainage. The patient was discharged 15 days after the operation without any significant complications. Although cardiac tamponade due to fishbone perforation is usually secondary to esophageal injury, a fishbone migrating into the left lateral segment of the liver can also penetrate the subphrenic membrane, causing damage to the pericardial membrane and potentially, cardiac tamponade.

An 88-year-old man was admitted to our hospital with the chief complaints of abdominal pain and vomiting. Abdominal CT revealed extensive pneumoretroperitoneum on the right side, especially around the right kidney. We performed emergency surgery under the diagnosis of gastrointestinal perforation, but there were no abnormal findings in the gastrointestinal tract, while the fundus of the gallbladder was necrotic and had penetrated into the retroperitoneum. We made the diagnosis of pneumoretroperitoneum caused by emphysematous cholecystitis and performed cholecystectomy with drainage. The patient was admitted to the intensive care unit and treated with broad-spectrum antibiotics, but developed sepsis, disseminated intravascular coagulation and multiple organ failure and died on the 9th postoperative day. Clostridium perfringens was isolated from both the ascitic fluid and blood, and was considered as the causative bacterium for the pathology in this case. Clostridium perfringens exists ubiquitously in nature; it is a known cause of emphysematous cholecystitis which can usually be cured by drainage and surgical treatment, and is rarely associated with fatal complications such as sepsis. We report a rare case of acute emphysematous cholecystitis caused by Clostridium perfringens infection and complicated by extensive pneumoretroperitoneum and sepsis.

The patient was a 52-year-old woman with schizophrenia with a history of repeated self-injury. She was brought to us in a collapsed state after having stabbed herself in the abdomen with a 20-cm-long knife in an attempt at suicide, and having self-extracted the knife. At hospital arrival, she was in hemorrhagic shock, but responded to initial fluid infusion therapy. Abdominal contrast-enhanced CT performed prior to surgery revealed intra-abdominal bleeding, but no evidence of extravasation. Although we could not identify the source of bleeding, we performed emergency surgery to stop the bleeding and repair the injured area. Intraoperative exploration revealed a laceration at the margin of S3 of the liver, and hemostasis was accomplished. Hemorrhage was observed from the hepatoduodenal mesentery, and we explored the region to identify the source. After cholecystectomy, cholangiography confirmed that there was no damage to the bile duct. Intraoperative transfusion of 6 units of RBC and 6 units of FFP was required. On the first postoperative day, abdominal ultrasonography confirmed blood flow in the right and left portal veins, and the patient resumed oral intake on the third day. In this report, we describe a case of acute extrahepatic portal vein injury whose life could be saved.

A 74-year-old man underwent transabdominal preperitoneal repair (TAPP) for bilateral inguinal hernias. He was admitted on postoperative day 4 with vomiting. Contrast-enhanced abdominal CT showed small bowel obstruction and caliber change near the peritoneal atresia area in the left inguinal region. Conservative treatment with an ileus tube failed to afford relief, and laparoscopic operation for the small bowel obstruction was performed on postoperative day 15. A defect in the left inguinal region was detected with herniation and incarceration of the small intestine through the peritoneal defect; the incarcerated bowel was partially adherent to the mesh. The small intestine was returned into the abdominal cavity to release the small bowel obstruction, and the peritoneal defect was re-sutured. Small bowel obstruction after TAPP has different characteristics from that associated with adhesions. Precise peritoneal closure at surgery is essential, and early diagnosis and surgical intervention are critical for the small bowel obstruction.

A 77-year-old woman visited our hospital with a history of upper abdominal pain. She had undergone extended cholecystectomy for gallbladder cancer 36 months earlier, and 28 months after the operation, a gastric metastasis was found and she was initiated on treatment with S-1. Abdominal computed tomography revealed a perforation in the gastric antrum and continuous escape of free air from the same area. We made the diagnosis of perforating peritonitis and performed emergency laparotomy. Because there was a large perforation in the anterior wall of the gastric antrum, we performed distal gastrectomy and B-Ⅱ reconstruction. The postoperative course was uneventful and the patient was discharged on the 17th day. We report a case of gastric metastasis from gallbladder cancer complicated by perforating peritonitis.

A 60-year-old man was transferred to our emergency room with blunt abdominal trauma sustained in a motor vehicle accident. Abdominal contrast-enhanced CT revealed a suspected pseudoaneurysm in the sigmoid mesentery and unstable pelvic fractures, but no intra-abdominal bleeding or hematoma. External fixation of the pelvic fractures was performed in the emergency department. After the procedure (3 hours after the injury), a repeat CT showed no new abnormalities, and the patient was admitted to the hospital for monitoring and supportive care. After admission, the patient went into a shock state, with the systolic blood pressure dropping to 60 mmHg range. The blood pressure failed to stabilize despite blood transfusion. A repeat abdominal CT scan performed 7 hours after the injury showed a large hemoperitoneum and contrast leak near the sigmoid mesentery. The patient was diagnosed as having delayed hemorrhage from the injured mesentery, and emergency laparotomy was performed. When the incision was made, approximately 2,500 mL of blood was found in the abdomen, with active bleeding from the injured mesentery of the sigmoid colon; the bleeding was controlled by ligation and suture. The patient had a satisfactory postoperative course and was transferred to the Department of Orthopedics. In the treatment of patients with abdominal trauma, the possibility of delayed rupture of pseudoaneurysms associated with mesenteric injury should be borne in mind.

The patient is a 51-year-old woman who was diagnosed with Turner syndrome in her childhood. She came to our hospital because of abdominal pain and vomiting; CT showed obstruction of the ileum by a mass lesion. When we performed the surgery, we found a stenosis caused by a neoplastic lesion in the ileum, about 10 cm from the ileocecal valve, which had invaded the tip of the appendix and the right uterine tube. Based on the patient’s history, it was considered to be a primary tumor of the gastrointestinal tract rather than a tumor of the uterine appendage. Therefore, we performed a combined ileocecal resection with resection of the invaded organs and lymph node dissection. Histopathological examination rendered a diagnosis of mucinous carcinoma of the appendix. We believe that a good outcome can be achieved by suspecting a primary tumor of the gastrointestinal tract and performing a radical resection.

Although appendicitis is a common disease, appendicitis complicated by formation of an abdominal wall abscess is rare. The patient was a 79-year-old woman who had undergone laparoscopic cholecystectomy and developed an umbilical port site hernia. She visited our hospital complaining of fever and anorexia, and also gave a 2-month history of right lower quadrant abdominal pain and 2-week history of abdominal induration in the right lower quadrant. Contrast-enhanced CT showed a right lower abdominal wall abscess and an enlarged appendix just below the abscess. Percutaneous abscess drainage was performed. Nine days later, a contrastography showed shrinkage of the abscess and formation of a fistula between the appendix and the abscess. The imaging findings confirmed the diagnosis of right lower abdominal wall abscess caused by a perforated appendix and umbilical port site hernia, and we performed appendectomy and port site hernia repair on the 14th day of admission.

A75-year-old man was admitted to our hospital with the chief complaint of right lower abdominal pain. Abdominal CT revealed a cystic lesion measuring 120×80×65 mm in size that was contiguous with the appendix. He was diagnosed as having an appendiceal mucocele with impending rupture, considering his abdominal symptoms; therefore, we performed urgent surgery. At laparotomy, the appendix was found to be swollen, and twisted at the appendix side. Laparoscopic appendectomy was performed with as a minimally invasive surgery. Histopathology showed low-grade appendiceal mucinous neoplasm (LAMN). Laparoscopic appendectomy for torsion of LAMN is rare. We present the case and a review of the literature.

A 72-year-old man visited our emergency department complaining of chest discomfort. While at the outpatient emergency, he had massive hematemesis and went into a state of shock. Abdominal contrast-enhanced CT showed a splenic artery aneurysm measuring 12 mm in diameter in the body/tail of the pancreas with extravasation of contrast medium into the stomach. The patient was diagnosed as having a splenic artery aneurysm that had ruptured into the stomach and treated by emergency transcatheter arterial embolization of the splenic artery. On the third day of hospitalization, abdominal dynamic CT showed a tumor in the body/tail of the pancreas that showed enhancement in the late phase. Upper gastrointestinal endoscopy showed an ulcerative lesion on the posterior wall of the body of the stomach, and biopsy of the lesion revealed adenocarcinoma. Thus, we made the diagnosis of carcinoma of the body and tail of the pancreas with infiltration of the stomach. Artery aneurysm is contributed to portal hypertension, pregnancy and infection. Our proposed mechanism to explain the pathophysiology in this case is as follows: The pancreatic tail cancer was associated with the formation of a splenic artery aneurysm; as the cancer infiltrated the stomach wall, the splenic artery aneurysm was exposed to digestive fluids and ruptured into the stomach. The patient was discharged on the 15th hospital day after resumption of oral intake, without any rebleeding.

Mantle cell lymphoma (MCL) has a poor prognosis, and it may recur after complete remission and cause intussusception. The patient was an 83-year-old man, who had been diagnosed with MCL 2 years and 5 months before and followed up after a complete remission had been induced by combination chemotherapy consisting of bendamustine and rituximab. This time he presented with vomiting. Computer tomography and colonoscopy revealed numerous submucosal tumors in the small intestine and large intestine, ileocecal intussusception caused by these tumors, and multiple lymphadenopathies. After decompression of the intestinal tract with a Miller-Abbott tube, a laparoscopic ileocecal resection was performed to relieve the symptoms produced by the intussusception. Histopathological examination confirmed the diagnosis of recurrent MCL. The postoperative course was uneventful. Combination chemotherapy with bendamustine and rituximab was restarted on postoperative day 17, and a complete remission was achieved after a total of 5 courses. Laparoscopic surgery is an effective surgical treatment option for intussusception caused by MCL, because it is minimally invasive and enables early institution of chemotherapy.

An 80-year-old woman with a ventriculoperitoneal shunt (VPS) was admitted to our hospital for right lower quadrant pain, and we made a diagnosis of acute appendicitis with abscess. Since the patient was elderly, on chemotherapy for cancer, and at high risk for surgery, and the risk of retrograde CNS infection was considered low because the abscess and the tip of the VPS catheter were far apart, she was treated by conservative antibiotic therapy and percutaneous abscess drainage in order to delay performing an appendectomy. However, three days later the inflammation and pain became worse due to the development of a new abscess, and the VPS catheter had become displaced to the vicinity of the abscess. Emergency appendectomy was performed and the VPS catheter was removed, because nonoperative therapy was unsuccessful and the risk of retrograde CNS infection had increased. This is the first report of a case in which percutaneous abscess drainage was selected to treat a patient with ruptured appendix who had a VPS. Strict follow-up of a VPS catheter is important, because the tip of a catheter can migrate.

A 72-year-old man was admitted to our hospital’s emergency department complaining of right inguinal pain. He had previously been diagnosed with a right inguinal hernia, but he had reduced it himself. Physical examination on admission revealed right inguinal swelling and tenderness. Contrast CT showed prolapse of the small intestine into the hernia, and a diagnosis of incarcerated right inguinal hernia was made. Since we were able to reduce the incarceration of the small intestine, we performed surgery the next day. The operation began by making an inguinal incision under general anesthesia. When the hernia sac was opened, a testis was found within it, and a diagnosis of cryptorchidism was made. Because of the possibility of canceration, orchiectomy was performed under the guidance of a urologist, and hernia repair was performed by the direct Kugel patch method. Histopathological examination of the resected specimen confirmed that it was nonmalignant. The postoperative course was uneventful, and the patient was discharged from the hospital the day after the operation. Cryptorchidism is usually diagnosed in young persons. Cases of inguinal hernia associated with cryptorchidism in an adult, as in our patient, are very rare. We report a case of inguinal hernia in which the diagnosis of cryptorchidism was made intraoperatively, and we include a discussion based on the literature.

An 87-year-old woman was referred to our hospital due to dyspnea on exertion, and computed tomography (CT) indicated a mass lesion measuring 13 cm in diameter extending from the spleen to the stomach. Upper gastrointestinal tract endoscopy showed a large submucosal tumor at the greater curvature in the middle-third of the stomach. Biopsy of the lesion revealed diffuse large B-cell lymphoma. Chemotherapy was started, which resulted in shrinkage of the tumor, but the patient vomited blood on day 51 after the start of chemotherapy, and developed hemorrhagic shock. Findings of abdominal CT led to the suspicion of gastrointestinal bleeding due to rupture of malignant lymphoma into the stomach. Endoscopic hemostasis was attempted, but failed because the gastrosplenic fistula was too large. Therefore, emergency laparotomy was performed. Intraoperatively, the stomach was found to be filled with clotting blood, but no intraabdominal bleeding was observed. After cutting the splenic hilum to control the bleeding, the infiltrated stomach was partially resected and the specimen was removed. The postoperative course was satisfactory. Histopathology showed that the tumors of the spleen and stomach wall were completely necrotic, suggesting that the chemotherapy was effective.