Enterocele is a herniation of the peritoneal sac between the anterior rectal wall and the posterior vaginal wall with the small bowel mainly in its contents. It occurs typically in elderly women after hysterectomy and is frequently associated with other anatomical abnormalities including rectal intussusception, rectocele, rectal prolapse, and perineal descent. The specific symptoms of enterocele include pelvic pressure, feeling of prolapse, false urge to defecate, and lower abdominal pain. Emptying difficulties also frequently occur, which may be caused by the anatomical abnormalities associated with enterocele. Diagnosis is confirmed by imaging such as defecography. Surgical treatment is considered when the specific symptoms of enterocele may have an adverse effect on patients' quality of life. A laparoscopic approach is advisable as the choice of surgical procedure. Specifically, laparoscopic ventral rectopexy may be reasonable, since it allows enterocele and frequently associated rectal prolapse, rectal intussusception, and rectocele to be repaired at the same time.

Objective: We assessed the optimal regions for central lymph node dissection while evaluating the safety of our standardized surgical procedure. The procedure involved dorsal mesenteric mobilization from the outside of the duodenojejunal flexure in patients with splenic flexure colon cancer.

Methods: Fifty patients with splenic flexure colon cancer, who received surgical treatment between 2008 and 2020, were assessed. The individual distribution of feeding arteries and lymph nodes was compared according to tumor localization. Surgical outcomes were compared before (n＝32) and after (n＝18) standardization of the surgical procedure.

Results: Tumors of the transverse colon had a wide variety of feeding arteries: 26.3% of tumors were fed by the left branch of the middle colic artery, 15.8% by the left colon artery (LCA), and 54.1% were fed by two or more vessels. The LCA alone fed 69% of the tumors in the descending colon. After standardizing procedures, surgical duration was significantly shortened (345 vs. 277 min; P＝0.03). There was no difference in post-operative complications between the two groups.

Conclusion: Our extensive anatomical knowledge on central lymph node dissection aided our standardized procedure, which was deemed a safe surgical treatment for splenic flexure colon cancer.

An 81-year-old man visited our hospital complaining of abdominal pain. An enhanced CT scan revealed a suspected 3-cm-large aneurysm with contrast enhancement in the early phase in the right mesentery. Transcatheter arterial embolization was performed and the patient was discharged after follow-up. Six months later, the patient visited the emergency room due to abdominal pain, and enhanced CT revealed a 5-cm-large mass with partial contrast effect in the right mesentery.

Suspecting re-rupture of the aneurysm, an ileocecal resection was performed. Operative findings revealed a tumor in the right mesentery, so the tumor was resected. Pathological examination revealed that the tumor was mesenteric malignant lymphoma. We report this case of malignant lymphoma mimicking a ruptured ileocolonic aneurysm.

The patient was a 66-year-old woman. PET-CT performed during the treatment of lung cancer showed FDG accumulation in the appendix. Colonoscopy showed submucosal elevation and erythematous orifice of the vermiform appendix, and contrast-enhanced CT showed wall thickening and contrast effect at the same site. The resected specimen showed wall thickening of the appendix. Histologic findings showed fissuring, transmural inflammation, and epithelioid cell granuloma. We diagnosed isolated Crohn's disease of the appendix. There has been no recurrence 6 months after surgery.

Isolated appendiceal Crohn's disease without preceding bowel symptoms is a rare phenomenon and diagnosis is difficult. We report this case of Crohn's disease of the appendix with a review of the literature.

The case was a 46-year-old woman. She was diagnosed with perforated appendicitis and intraperitoneal abscess, and 52 days later underwent a standby laparoscopic appendicectomy. She was pathologically diagnosed with appendiceal goblet cell carcinoid (GCC). In some areas, the tumor may have been exposed on the serous or surgically resected surfaces, and the proximal margins may have been positive. Twenty-seven days after the initial operation, a laparoscopic ileocecal resection was performed. Peritoneal nodules were present in the pelvic cavity and right subdiaphragmatic region. We resected the one in the lesser pelvic cavity. Postoperative pathology revealed GCC in the remnant appendix and the peritoneal nodules.

Appendiceal GCC is often diagnosed by appendectomy. The criteria for additional resections and effective chemotherapy have not yet been determined; more case reports are needed.

The case was a 78-year-old male. He had a medical history of hypertension, type II diabetes mellitus, hyperlipidemia, and cerebral infarction. He had previously visited a clinic to investigate bloody stool. Colonoscopy showed colon cancer in the rectosigmoid. Preoperative computed tomography (CT) showed obstruction of the abdominal aorta, therefore he was diagnosed with Leriche syndrome. The patient came to our hospital for investigation and surgery. Preoperative 3D-CT angiography showed blood flow to the pelvic organs and lower limbs through the collateral pathway of the abdominal wall and trunk, called the systemic-systemic pathway and visceral-visceral pathway. If these collateral pathways were injured during surgery, serious complications might have occurred postoperatively such as ischemia of the intestine and the lower limbs. In the present case, we were able to perform laparoscopic Hartmann's operation safely by preoperative or perioperative evaluation of blood vessels.

The patient was an 80-year-old man. He visited our hospital because elevated tumor marker levels were noted during a physical examination. Lower gastrointestinal endoscopy showed a type 0-IIa lesion in the ascending colon, and a biopsy indicated the presence of adenocarcinoma (por/sig). A computed tomography scan showed many enlarged lymph nodes in the ileocecum. Therefore, he was diagnosed as having a cT1bN2bM0-stage ascending colon carcinoma. On performing laparoscopic ileocecal resection, a 20-mm-large mass was detected in the subserosa of the resected tissue. It was identified as a lymph node that had enlarged due to metastasis of the mucinous carcinoma. On performing additional resection, a signet-ring cell carcinoma lesion was detected in the ascending colon near the metastatic site. Therefore, the patient was diagnosed as having a pT3 (Ly) N2bM0-stage ascending colon carcinoma. After adjuvant chemotherapy with CAPOX, paratracheal lymph node metastasis and peritoneal dissemination recurrence were confirmed. However, after switching to FTD/TPI, the peritoneal dissemination reduced and tumor marker levels normalized. Although signet-ring cell carcinoma of the colon is rare and often difficult to treat, we experienced a patient who was successfully treated after recurrence. Thus, we report this case, with a review of the literature.