Strangulated intestinal obstruction is a condition that calls for emergency surgery; however, in patients aged 90 years or over who often have multiple comorbidities and reduced organ function, determining the optimal treatment strategy can be challenging. This study was aimed at investigating the treatment outcomes of patients in this age group presenting with strangulated intestinal obstruction and to identify the associated problems. We retrospectively analyzed the data of 14 patients aged 90 years or over who underwent emergency surgery for strangulated intestinal obstruction between January 2016 and June 2024. Clinical factors and the postoperative outcomes were evaluated. Postoperative complications were observed in 8 patients (57.1%), with pneumonia being the most common (5 cases). In regard to the postoperative outcomes, 6 of the patients (42.9%) could not be discharged home, with a significantly high incidence of dysphagia as the underlying cause in this patient subset (P = 0.015). The high rate of postoperative complications and the inability to discharge patients back to their homes were notable findings in this study. Dysphagia significantly contributed to the poor outcomes after surgery, highlighting the need for early interventions to maintain swallowing and feeding functions postoperatively.

A 78-year-old female patient visited her doctor complaining of lower abdominal pain. She was diagnosed as having ischemic colitis and treated conservatively. However, the symptom failed to improve and she was referred to our hospital for further examination and treatment. Abdominal computed tomography revealed fluid retention in the left adnexa and a fistula formation with the sigmoid diverticulum. We made the diagnosis of tubal abscess secondary to sigmoid diverticulitis and performed sigmoid colectomy, total hysterectomy, and bilateral salpingo-oophorectomy. The patient was discharged on the 16th postoperative day without any complications. Adnexal perforation caused by sigmoid diverticulitis is rare. Conservative treatment alone often fails, so that surgical treatment is considered.

In recent years, while numerous cases of laparoscopic surgery for median arcuate ligament syndrome (MALS) have been reported, awareness about the need to include MALS in the differential diagnosis of abdominal pain is still lacking. Herein, we describe the case of a 52-year-old woman who was diagnosed as having MALS based on the findings of expiratory contrast-enhanced CT performed in the course of detailed examination to identify the cause of abdominal pain. The operation was performed laparoscopically by incising the lesser omentum to approach the median arcuate ligament, and the ligament was divided until the adventitia from the abdominal aorta to the celiac artery was visualized. Postoperatively, the abdominal symptoms improved, and contrast-enhanced CT showed improvement of the celiac artery stenosis. This treatment for MALS is closely related to vascular surgery, and arterial injury is a serious intraoperative complication. Although surgery can be expected to improve symptoms, there remains the need to establish safe surgical techniques and measures to deal with complications, and to raise awareness about the condition itself.

A man in his 50s who had undergone total cystourethrectomy and ileostomy for urethral cancer was admitted to our hospital with the complaint of right lower abdominal pain. Abdominal CT revealed an enlarged appendix and a calcified area at the base of the appendix, which was suspected as an appendiceal diverticulum or a fecal calculus. We diagnosed the patient as having appendiceal diverticulitis and performed laparoscopic appendectomy. As the usual port placement method at our hospital was deemed likely to interfere with the ileal conduit, we modified the port positions accordingly before commencing the operation. Although a perforated diverticulum was identified at the base of the appendix, the laparoscopic surgery was successfully completed. The patient was discharged from the hospital on postoperative day five. Although appendectomy after ileal conduit construction may be difficult because of adhesions or the position of the conduit, laparoscopic surgery can be performed safely if ingenuity is used.

A 57-year-old woman with a ventriculoperitoneal shunt catheter (VPSC) that had been placed for hydrocephalus following a cerebral hemorrhage was admitted to our hospital with right lower abdominal pain and high fever. Abdominal computed tomography revealed localized peritonitis secondary to complicated appendicitis. Given the risk of infection spreading to the VPSC intraoperatively, we planned an interval appendectomy. The patient’s symptoms improved with conservative management over 3 weeks. Interval laparoscopic appendectomy was successfully performed 2 months later. We report a case of interval surgery for acute appendicitis in a patient with a VPSC.

An 11-year-old girl with fever, right lower abdominal pain, and vomiting was referred to our hospital. Blood examination revealed mildly elevated inflammatory markers, and computed tomography revealed a small amount of ascites in the pelvic cavity. The appendix was slightly enlarged, and the lumen was found to contain retained fecal matter. Diagnostic laparoscopy revealed three small pedunculated and paraovarian cysts in the right fallopian tube. A pedunculated and subpedunculated cyst, along with part of the fallopian tube, were intertwined and compressed. However, no fallopian tube torsion was present. The compression was relieved, and the cysts were resected by laparoscopic surgery. Similar cysts were also present in the left fallopian tube, which were cauterized and the contents aspirated and removed. The appendix showed no signs of inflammation and was therefore not resected. Acute abdominal pain due to gynecological disorders such as large paraovarian cysts with tubal torsion is relatively common, however, cases involving multiple small entangled and compressed paraovarian cysts without tubal torsion are extremely rare.

A 26-year-old man with severe motor and intellectual disabilities and advanced scoliosis underwent emergency surgery for postoperative intussusception after being diagnosed as having adhesive small bowel obstruction. After the operation, he developed tachycardia triggered by repositioning. Six hours postoperatively, he progressed from tachycardia to cardiac arrest. Despite resuscitative efforts, he was pronounced dead. Although a rapid drop in hemoglobin to 4.1 g/dL indicated massive bleeding, there were no external findings or changes in the drain output to suggest hemorrhage. Autopsy revealed an abdominal wall injury and intraperitoneal hematoma in the left abdominal region. It was presumed that the injury occurred during left lateral repositioning, due to compression from the severely deformed spine. Patients with severe motor and intellectual disabilities differ from healthy individuals in terms of their physiological reserve, general condition, and risk of perioperative complications due to the complex underlying disorders. Surgeons should collaborate closely with pediatricians and remain vigilant for unexpected postoperative events.

Superior mesenteric artery embolism (SMA embolism) is often missed in the early stages of the disease due to the lack of specific findings. We report a case in which the intestinal tract was successfully preserved by hybrid surgery, even though about 24 hours had passed since the onset of the disease. The patient was a 72-year-old man who had been off anticoagulants after orthopedic surgery. On day X-1, he complained of sudden abdominal pain, but there were no remarkable findings and he was kept under observation. On day X, bloody stools were observed, SMA embolism was diagnosed based on the results of imaging examinations, and hybrid surgery was performed. Angiography showed that intestinal blood flow was maintained via the marginal artery, intraperitoneal observation revealed that total necrosis had not yet occurred, and the SMA obstruction was released by retrieval of the thrombus. Following thrombus retrieval, the color of the intestinal tract gradually improved, indicating the restoration of perfusion, and bowel resection was deemed unnecessary. Hybrid surgery enables real-time assessment of the intestinal viability, facilitating appropriate intraoperative decision-making and potentially improving the patient outcomes.

Superior mesenteric venous thrombosis (SMVT) is a rare disease that can cause intestinal congestion and necrosis and may follow a serious course. A 56-year-old man presented to our hospital with the chief complaint of abdominal pain. Abdominal contrast-enhanced computed tomography (CT) revealed evidence of acute appendicitis and ileocolic and superior mesenteric vein thrombosis, and based on the findings, we diagnosed the patient as having acute appendicitis accompanied by SMVT. As the patient’s condition was stable, we selected conservative treatment and initiated the patient on antibiotic and anticoagulant therapy. The clinical course was satisfactory, and contrast-enhanced CT confirmed that the SMVT had disappeared. Considering the possibility of SMVT recurrence due to appendicitis, we performed an interval appendectomy and subsequently completed the anticoagulant therapy. In cases of acute appendicitis accompanied by SMVT, our experience suggests that in the absence of intestinal congestion or necrosis, the patient can receive the usual treatment for acute appendicitis with the addition of anticoagulant therapy.

The patient was a man in his 70s who underwent pancreaticoduodenectomy with portal vein resection for pancreatic head cancer. Initially, the plan was to perform portal vein reconstruction by end-to-end anastomosis. However, during the procedure, the portal vein ruptured, making the anastomosis difficult. To prevent intestinal blood flow stagnation due to prolonged portal vein blood flow obstruction, we created a temporary shunt between the superior mesenteric vein and the inferior vena cava and performed portal vein reconstruction using a right superficial femoral vein graft. On the fifth postoperative day, portal vein thrombosis was detected, and on the thirteenth day, the graft became completely occluded, necessitating emergency thrombectomy and re-reconstruction of the portal vein. This report includes a discussion of portal vein reconstruction using a graft and early postoperative portal vein thrombosis, along with a review of the relevant literature.