Aim: The aim of this study was to elucidate the frequency, treatment and outcome for gallstones coexisting with colorectal cancer (CRC).

Method: This was a retrospective study. A total of 590 patients with CRC who underwent surgery between April 2012 and December 2018 were enrolled. Patients were divided into two groups according to existence of gallstones evaluated by preoperative CT. Patients with gallstones who did not undergo cholecystectomy during surgery for CRC were followed up.

Results: There were 86 patients with gallstones evaluated by CT. Three patients underwent cholecystectomy at the same time. Among the remaining 83 patients, 8 patients (9.6%) developed symptoms of gallstones after surgery. One patient underwent emergency surgery and 7 patients recovered by antibiotics or endoscopic treatment.

Conclusion: The frequency of symptoms of gallstones coexisting with CRC might be higher than that in the general population.

A 32-year-old woman visited our hospital complaining of bloody stool. Total colonoscopy revealed an 18-mm Isp tumor in the sigmoid colon, and endoscopic resection was performed. The histopathological findings confirmed a well-differentiated adenocarcinoma that had invaded the submucosal layer, and part of the tumor contained micropapillary carcinoma (MPC). In addition, positive lymphatic invasion into the submucosa was seen, and additional surgery was performed for further resection together with lymph node dissection. Regional lymph node metastasis was positive. MPC is an entity that has been proposed as a variant of breast cancer with high malignancy, and has a poor prognosis because it is associated with a high incidence of lymphatic invasion and lymph node metastasis. Colorectal cancer with MPC is considered to have a higher degree of malignancy than normal colorectal cancer, but diagnosis of MPC is not easy, and diffusion of the MPC concept seems to be a challenge.

We herein report a case of multiple anorectal malignant melanoma. The patient was an 82-year-old male who presented with anal pain. Physical examination revealed a blackish elevated lesion protruding to the skin of the anal region. Lower gastrointestinal endoscopy examination revealed that the main lesion continued from the anus to the upper margin of the anal canal and multiple lesions not continuous with the main lesion were observed in the lower rectum. Abdominal CT scan showed that the intestinal lymph node and the left inguinal lymph node were enlarged. A diagnosis of malignant melanoma was made by biopsy. Laparoscopic abdominoperineal resection was performed. In pathological specimens of the lesions spreading from the anus to the anal canal, a lymphatic invasion lesion spreading in the submucosal layer of the lower rectum was observed, and four other multiple lesions were recognized. Postoperative pulmonary recurrence occurred, but local recurrence was not recognized until 10 months after surgery, and rectal amputation was thought to have a local control effect.

The patient was a 73-year-old male suffering from atrial fibrillation and he was prescribed edoxsaban tosilate hydrate. His chief complaint was bloody bowel discharge. After hospitalization, we performed a colonoscopy and the patient had multiple diverticula in the ascending colon, but observation did not reveal a clear source of the bleeding. However, bloody stool recurred after he took an anticoagulant internally, so an emergency colonoscopy was performed and bleeding from the appendix was found. Immediately after the colonoscopy, abdominal enhanced ultrasound showed contrast-agent bubbles coming from diverticula of the appendix. Based on these findings, we diagnosed the patient as bleeding from diverticula of the appendix.

We performed an appendectomy, and histological examination revealed that the resected appendix contained hemorrhaging. It is rare to be able to diagnose appendiceal diverticula bleeding using enhanced ultrasonography and colonoscopy. In addition to this case, we also review the literature.

An 80-year-old woman was diagnosed with a gastrointestinal stromal tumor (GIST) of the rectum. As she rejected surgical therapy, oral conservative treatment with imatinib mesylate was selected. A dose of 300 mg per day was administered, and the dose of imatinib mesylate was reduced to 100 mg per day because of severe adverse events. However, the lower dose of imatinib mesylate provided good disease control without the adverse events. This case showed the possibility of using a lower dose of imatinib for elderly patients with GIST of the rectum.