We studied (1) the clinical background of perianal abscesses in our hospital, and (2) the effectiveness of transanal ultrasonography. Results: (1) About 80% of perianal abscesses were of anal gland origin. (2) Transanal ultrasonography was significantly more useful than physical examination for the diagnostic accuracy rate of perianal abscesses before incision and drainage.

The patient was a 77-year-old woman who visited her local clinic in May 2023 to begin treatment for hypertension. A chest X-ray revealed a nodular shadow in the right lung, and she was referred to our hospital in June. As a result of further examination, in addition to ascending colon cancer with metastatic lung cancer, UICC(#8) Stage IVA, right renal cell carcinoma, UICC(#8) Stage I, was diagnosed, indicating multiple cancers. In August, laparoscope-assisted right hemicolectomy and right nephrectomy were performed. The renal cancer was a histological type of clear cell renal cell carcinoma with a maximum diameter of 31 mm. As noted, a metastatic lesion of the ascending colon cancer was found within this clear cell renal cell carcinoma. After systemic chemotherapy for metastatic lung cancer that was derived from the ascending colon cancer, right lower lobectomy under video-assisted thoracoscopic surgery was performed in December. At the time of writing, the patient is uneventful with no evidence of recurrence. Tumor-to-tumor metastasis is a rare phenomenon in which one tumor metastasizes to another tumor in either synchronous or metachronous multiple cancers. Here, we report this case of ascending colon cancer with tumor-to-tumor metastasis to renal cell carcinoma, including a review of the literature.

Anorectal duplication is rare congenital malformation of the gastrointestinal tract. Most patients are generally treated in childhood and only a few patients remain unaware until adulthood. We report the case of a 34-year-old female patient, who underwent surgery for hemorrhoids in another hospital during which a perineal orifice was found at the 6 o'clock position. Magnetic resonance imaging and other examinations showed a short tract behind the native anus. Excision of the tract using the perineal approach was performed and histological findings confirmed a diagnosis of anorectal duplication.

Tension free vaginal mesh operation (TVM) is performed for treatment of pelvic organ prolapse (POP). A 73-year-old woman, who underwent TVM, suffered from complications of defecation and urination with severe pain. We thought that the complications were caused by excessive haulage of its mesharm. Therefore we performed transection of the rectum-vagina mesh laparoscopically. Postoperatively, the defecation disorder has improved and perineal pain has decreased. She was relieved from severe pain and released from a massive amount of purgative medicine. The operation of haulage for pelvic organs and artificial material insertion requires special care.

A 64-year-old female patient underwent construction of a double-barrel colostomy in the transverse colon due to an unresectable advanced sigmoid colon cancer in December 2017. Because she declined aggressive treatment, she was placed under observation without any intervention. In March 2018, she presented to our department with complaints of colostomy prolapse. Upon examination, the distal limb of the colostomy had prolapsed approximately 10 cm, exhibiting marked edema and rupture of the mucosa, with some areas showing necrosis. Laboratory tests at admission showed an inflammatory response. Contrast-enhanced CT of the abdomen revealed that the distal limb of the double-barrel colostomy was inverted and prolapsed. She was diagnosed with colostomy prolapse with incarceration and an emergency surgery was performed. Without laparotomy, the incarcerated necrotic intestine was resected and a single-layer anastomosis was performed. The operation time was 40 minutes, and the blood loss was little. The postoperative course was uneventful.