We studied the long-term outcome of an implantable infusion port in 194 patients from 2004 to 2011. The purpose of infusion was parental nutrition in 89 cases (46%) and chemotherapy in 105 cases (54%). The mean follow-up period was 252 days (1-2,179). The catheter complication was observed in 27 patients (14%:0.55/1,000 catheter days) and the catheter was removd in 26 patients. We assessed and compared the catheter performance and complication with published data.

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We herein report results of central venous catheter (CV) port implantation in 122 patients (69 men, 53 women; mean age, 68 years) with malignant tumors. The number of port implantations was 129, including 7 re-implantations, during an approximately 4.5-year period. CV port implantation took a mean of 29 minutes. The aims of CV port implantation were nutritional management (49 patients, 40％) and chemotherapy (73 patients, 60％). Patient numbers by disease were colorectal cancer, 59; gastric cancer, 22; pancreatic and biliary tract cancer, 10; breast cancer, ８; esophageal cancer, ５; and gynecological cancer, ５. The mean number of days of implantation was 261. The CV ports were removed 18 times in 17 patients due to infection (7 patients), thrombogenesis (4), insufficient drug infusion (2), abnormal tip position (1), torn catheter (1), drug solution leakage (1), and pain (1). We conclude that implantation and proper management of a CV port may be useful for patients with malignant tumors.

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Background: Few reports concerning proper use of Fresh frozen plasma (FFP) in surgical departments have been published.

Patients & Methods: Nineteen cases perioperatively given FFP in our department from April 2007 to March 2008 were analyzed. Examined items were reasons for and quantity of FFP, quantity of combined use of Red cell concentrate (RCC) and Platelet concentrate (PC), Prothrombin time (PT) measured before and after FFP administration, PT values, and prognoses.

Results: Reasons for FFP administration were bleeding (68.4%), disseminated intravascular coagulation (DIC) (26.3%), and hypotension and oliguria (5.3%). Average FFP quantity was 10.9 units. RCC and PC were concomitantly given in 95% and 26% of cases. Total FFP/RCC units used was 0.37. PT was measured before and after the administration of FFP in 79% and 58% of cases. Average PT value measured before FFP administration was 42%.

Conclusions: FFP was given properly in most cases. Improvement of rates of PT measurement before and after FFP administration should be focused on.

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(Objectives) To investigate the efficacy of recombinant human thrombomodulin (rTM) in patients with disseminated intravascular coagulation (DIC) associated with colorectal perforation. (Subjects) Fourteen patients with colorectal perforation complicated by DIC who underwent surgery in our department from January 2011 to December 2011 and were treated with rTM were included as the subjects of this study. (Results) The mean age of the subjects was 77.6±16.6 years; the mean Sequential Organ Failure Assessment (SOFA) score was 7.71±2.63, the mean Simplified Acute Physiology ScoreⅡ(SAPSⅡ) score was 46.8±13.0, and there were 6 cases (42.8%) with septic shock at hospitalization. The mortality was 7.1%, and the mean duration of use of rTM was 6.46±1.27 days. All of the DIC score, SOFA score, fibrin degradation products (FDP), platelet (Plt), C-reactive protein (CRP), prothrombin time-international normalized ratio (PT-INR), Antithrombin Ⅲ (ATⅢ) improved significantly after the start of rTM administration as compared with the values prior to rTM treatment. There were no apparent adverse events associated with the administration of rTM. (Discussion) Our results suggested that rTM may be effective for the treatment of DIC associated with colorectal perforation.

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Recent advances of laparoscopic procedures, the management for small bowel obstruction have been made laparoscopically in many institutions. However, many patients with small bowel obstruction present with histories of various abdominal surgeries in which it was difficult to maintain the operative fields because of dilated bowels. In this paper, we reviewed the clinical outcomes of laparoscopic management of small bowel obstruction in 11 patients (7 men, 4 women; average age, 66 years). The average numbers of trocars used in these procedures was 3.9. Seven patients had a partial resection of the small bowel at small laparotomy. The average operation time and amount of blood loss were 100 min and 10 g, respectively. The length of postoperative hospitalization was 16.8 days. Postoperative bowel obstruction occurred in 2 patients, and these patients were treated conservatively. In conclusion, laparoscopic management of small bowel obstruction offers a safe and effective surgical alternative. However, the identification of the site of obstruction through preoperative imaging diagnosis and sufficient preoperative decompression of the intestine are required.

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[Objectives] From the viewpoint of the surgical department, we evaluated changes in the treatment of colorectal tumors after the introduction of colorectal endoscopic submucosal dissection (ESD). [Methods] The subjects consisted of patients with colorectal tumors (adenomas or early stage carcinomas) treated during an 8-year period before or after the introduction of ESD. Changes in the number of patients with an adenoma or M/SM carcinomas endoscopic resection and that of patients with an adenoma or M/SM carcinomas without risk factors for lymph node metastasis treated by surgical resection were evaluated. [Results] After the introduction of ESD, all colorectal adenomas were endoscopically resected. Both the number of M/SM carcinomas endoscopically resected and percentage of lesions treated by curative resection increased. The number of patients without risk factors for lymph node metastasis who underwent surgical resection was 27 (4.7％) before ESD introduction, but decreased to 9 (2.8％) during its introduction period, and 6 (1.2％) after its introduction (p<0.01) [Discussion] From the viewpoint of the surgical department, colorectal ESD can reduce the number of adenomas and mucosal carcinomas that cannot be resected by conventional EMR and are resected by surgical operation.

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We report our experience of curative colectomy via a transverse mini-incision for locally advanced colonic cancer, with special reference to its techniques, safety, and minimal invasiveness. The subjects were 24 consecutive patients (12 men) with locally advanced colonic cancer who were operated on using a transverse mini-incision (skin incision, 6-7 cm) between April 2009 and December 2010 (Transverse mini-incision group). Their median body mass index (BMI) was 21.6 (range, 14.2-23.9) kg/m². The pathological stage was stage Ⅰ in 5 patients, stage Ⅱ in 10 patients, and stage Ⅲ in 7 patients. The key points of the surgery included retraction of the rectus abdominis muscle laterally without dissection, adoption of a wound retractor, and a median approach for lymph node dissection. Extension of the wound by 2 cm was needed in one patient and postoperative adhesion ileus requiring relaparotomy developed in one patient. The data of this operative group were compared with the data of 24 patients (control group) who had previously undergone curative colectomy via a longitudinal mini-incision, matched with the patients of the transverse mini-incision group for sex, body mass index ( ± 2kg/m²), tumor location, maximal tumor diameter (±20 mm), histological stage, and level of lymph node dissection. Duration of surgery and blood loss did not significantly differ between the two groups. Postoperative analgesic use was lesser (p < 0.01), passage of flatus was earlier (p = 0.09) and postoperative length of hospital stay was shorter (p = 0.054) in the transverse mini-incision group. These results suggest that curative colectomy via a transverse mini-incision is a safe and minimally invasive procedure for the treatment of locally advanced colonic cancer.

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We report single incision laparoscopic surgery using am E・Z access^®applied on the top of lap-protector^®using in children. We reviewed of 17 patients:Simple Ovarian cyst, 3;acute appendicitis, 7; interval appendectomy, 4;intussuscepation, 2;mesenteric cyst, 1.
2 cases of appendiceal mass and interval appendectomy added 5mm trocers to right upper and left lower abdominal. One of perforation of appendicitis added 5mm trocer to right upper abdominal. All casers did not open surgery.
Postoperative complication in one wound infection due to accidental removal lap protector in acute appendectomy operation, and one transient ileus after operation of appendiceal mass.
Single incision laparoscopic surgery using am E・Z access^®applied to a lap protector^®provided lap protector^®of the wound margin with airtightness and improved stability trocers. E・Z access®was a very useful device for single incision laparoscopic surgery in children.

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Biliary drainage can be achieved by endoscopic or percutaneous drainage (ERBD). Advantages and disadvantages have been reported for each. We have established a new procedure, percutaneous endoscopic trans-gastric biliary drainage (PETGBD). This technique tends not to result in cholangitis, appears associated with fewer critical complications such as bile leakage and peritonitis, and is less painful for patients while providing efficient bile drainage. Tube obstruction is also easily addressed. We performed this procedure on 6 patients. Median total bilirubin (T.Bil) level at first presentation was 6.35 mg/dl. The duration required for T.Bil to decrease to <2 mg/dl was 6 days. No odynophagia, anorexia or tube trouble was recognized. These results suggest that this new method allows stable and continuous biliary drainage, and not only ensures safety, but avoids the discomfort, odynophagia, and loss of appetite associated with use of a nasal tube.

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A 79-year-old woman visited our clinic, complaining of a right breast mass. Mammography and ultrasonography revealed an ill-defined mass in the right breast and enlarged right axillary lymph nodes. Core needle biopsy yielded a diagnosis of invasive micropapillary carcinoma (IMPC). The preoperative serum CA15-3 and CEA levels were high and slightly high, at 111.9 U/ml and 7.7 ng/ml, respectively. Muscle-sparing mastectomy with axillary dissection was performed. Histopathological examination of the resected specimen revealed IMPC, pT2, pN2 (17/18), ly (2), ER (+). She received adjuvant chemotherapy (weekly paclitaxel); however, her serum CA15-3 levels increased after five courses of chemotherapy. Therefore, endocrine therapy with letrozole was started 6 months after surgery. Thereafter, the CA15-3 levels rapidly decreased to the normal range 5 months later. The patient has been free of recurrence for the 23 since after surgery, and is currently followed-up with endocrine therapy.

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The patient was a 67-year-old man who suffered from dysphagia since 40 years ago and diagnosed as esophageal achalasia 20 years ago. He visited our hospital because of an abnormal findings on a routine medical check-up in which upper gastrointestinal radiography demonstrated a sigmoid-type achalasia with a maximum diameter of 44 mm. Upper gastrointestinal endoscopy revealed a IIc lesion at 30 cm from incisor which was not stained by iodine. Pathological diagnosis was well differentiated squamous carcinoma. Endoscopic ultrasonography showed a slight thickening of the second layer that indicated T1a-LPM. First, esophageal cancer was treated by endoscopic submucosal dissection. Pathologically, the tumor was T1a-LPM, and was a superficial carcinoma. Because of minimal risk of cancer recurrence, he then underwent laparoscopic Heller-Dor cardioplasty. We herein report such a patient, with a review of the relevant literature.

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Endoscopic submucosal dissection (ESD) for early gastric cancer has been rapidly spread because of its less invasiveness and functional preservation. But gastric perforation is one of the major complications. On the other hand, laparoscopic surgery is widely performed to reduce surgical invasion in the gastrointestinal surgery field. And for further reduction of surgical invasion, single incision laparoscopic surgery (SILS) comes to be performed.
　
In this report, we present a case of late gastric perforation after ESD successfully treated with perforation closure and omental patch under SILS technique. The patient is 60’s male. ESD was performed for early gastric cancer. The operation had been done uneventful. But the next day, the patient complained abdominal pain and he was diagnosed as late gastric perforation. Operation was performed with SILS technique. Post operative course was uneventful and he discharged on the 8th day after operation.

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A 57 years-old man had undergone total gastrectomy with antecolic Roux-en-Y reconstruction for gastric cancer. On the 6th day post operation he had suffered acute abdominal pain and nausea. Abdominal computed tomography showed a severe dilation of afferent loop and the jejunum lifted for esophago-jejunostomy. We performed an emergency operation. According to the operating findings, we diagnosed an internal hernia after total gastrectomy through the space between the mesentery of the Roux-Limb and transverse mesocolon (Petersen’s defect). The herniated intestine was reduced and the hernia orifice was closed. Internal hernia after gastrectomy is rare. But the incidence of internal hernia is expected to increase from now on because a laparoscopic operation for gastric cancer have increased. We report a rare case of internal hernia after total gastrectomy with the relevant literature.

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We report a case of laparoscopic repair for internal hernia at jejuno-jejunostomy mesenteric defect after laparoscopy-assisted total gastrectomy.

The patient was 72-year-old man who underwent laparoscopy-assisted total gastrectomy with D1+ lymphnode dissection and Roux-Y reconstruction for gastric cancer (cT1bN0M0, Stage 1A). Since the intermittent stomachache appeared, the patient consulted our hospital in October, 2011. Only the slight tenderness was observed in the abdomen. No abnormality was detected in the blood test. The computed tomography scan showed whirl sign around the jejuno-jejuno anastomosis. Based on these, the patient was diagnosed with internal hernia after the laparoscopy-assisted total gastrectomy. Conservative treatment was not effective. Because the small intestine did not show dilatation and ischemic change, we selected laparoscopic surgery for the repair of the internal hernia. The laparoscopy indicated that the small intestine was strangulated through the jejuno-jejunostomy mesenteric defect. We reversed the strangulation and closed the jejuno-jejunostomy mesenteric defect under the laparoscopy. The postoperative clinical course was uneventful, and the patient was discharged on the 7th postoperative day. Laparoscopic surgery for internal hernia repair seems feasible and safe if the small intestine did not show dilatation and ischemic change.

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The number of people infected with human immunodeficiency virus (HIV) is increasing in Japan. Since the introduction of highly active antiretroviral therapy (HAART), the mortality of HIV infection has decreased. Consequently, the number of HIV-infected patients with digestive cancer, which is one of the non-AIDS-related malignancies, is expected to increase. We performed surgery for digestive cancer in six patients with HIV infection. Three patients had gastric cancer, two had colorectal cancer, and one had bile duct cancer. No serious postoperative complications were seen among the patients. Two patients who received chemotherapy after the operation showed no opportunistic infections and myelosuppression. One patient having gastric cancer with peritoneal metastasis died of progression of cancer (survival days after operation, 511). Another patient with gastric cancer who rejected therapy for HIV died of AIDS (595 days). A patient having colorectal cancer with paraaortic lymph node metastasis received chemotherapy and was alive in partial response (266 days). The patient with bile duct cancer and one with colorectal cancer and the other patient with gastric cancer underwent curative resections and were alive without recurrence (322 days, 470 days and 47 days). These results suggest that since the best multidisciplinary treatment was able to be administered and safe surgery was able to be performed in HIV-positive patients, their prognosis was similar to that of HIV-negative patients by the virtue of introduction of HAART.

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A 73-year-old woman presented in December 2009 with chief complaints of nausea and heartburn, not relieved by proton pump inhibitors. At our hospital she was diagnosed with ileus by CT of the abdomen and admitted. Decompression of the bowel with ileus tube insertion failed to resolve abdominal distension. Radiography of the ileus tube on hospital day 13 revealed translucency from the ileum anal to the ileus tube tip. Abdominal CT and MRI disclosed a mass with aeration in the small intestinal lumen, suggesting bowel obstruction due to impaction of the small intestine with a gastric bezoar. As the area of translucency remained unmoved in the terminal ileum region on radiography of the ileus tube, ileus due to gastric bezoar was diagnosed and laparoscopic surgery was performed on hospital day 18. The small intestine was partially resected because a white patch was noted on the small intestinal mesentery 20 cm oral to the terminal ileum. She had a favorable course and was discharged on postoperative day 14. The foreign body measuring 6.0×3.0×2.5 cm was estimated to be a persimmon gastric bezoar. Intestinal obstruction by an incarcerated gastric bezoar is relatively rare. This report describes successful laparoscopic resection of the lesion.

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A 60-year-old man with alcoholism had drunk too much during four days, was taken to our hospital because of acute abdomen and shock. Computed Tomography showed severe portal venous gas and pneumatosis intestinalis, and arterial blood gas showed hyperlacticacidemia. Emergent operation was performed under a diagnosis of bowel necrosis from non-occulusive mesenteric ischemia (NOMI), but was resulted investigating laparotomy because of no apparent findings of necrosis. Intensive care was undergone, but postoperative course got worse, second look operation 8 hours after the primary operation revealed intestinal necrosis. Most of small intestine and ascending colon were removed and constructed artificial jejunostomy. After the second operation, general statement was gradually improved. We could avoid the death from NOMI, but we lost him from aspiration pneumonia 71 days after admission. To the best of our knowledge, there have been only one case of NOMI from too much alcohol in Japan. On the case of no fatal sickness, NOMI could be occurred from severe hypotonic statement.

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Recently, we experienced three cases of appendiceal mucocele treated by laparoscopy-assisted ileocecal resection. Ultrasonography and abdominal computed tomography showed mucocele in the appendix. In one of them, the mucocele was intussuscepted into the ascending colon. Laparoscopy-assisted ileocecal resection with regional lymph nodes dissection was performed because the tumor size was large and malignancy could not be denied in all cases. The final pathological diagnosis revealed hyperplasia in one case and mucinouscyst adenoma in two cases. Even though this neoplasm did not appear malignant, it could induce pseudomyxoma peritonei, so the perforation of the mucocele during the operation should be avoided. We concluded that the laparoscopic surgery for the appendiceal mucocele was safe and less invasive by the optimal selection of the procedure and the protectable technique.

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We report a case with metacronous liver metastasis at five years after resection of rectal carcinoma. The patient was an 80-year-old man who received laparoscopic anterior resection with regional lymphadectomy including group 3 lymph nodes in February 2005. Pathological examination revealed well differentiated adenocarcinoma (type2, ss, ly0, v1, n1, ow-, aw-, ew-). He did not hope any adjuvant chemotherapy because of his age. When he had been 75 years old, he had received self-expansion metallic stent detention for the thoracic aortic aneurysm. However, in February 2010, CT revealed a mass in liver segment five. He was diagnosed liver metastasis at his age of 85. In April 2010, He received laparoscopic partial hepatectomy and chorecystectomy using an ultrasonic energy for dissection, cutting and coagulation system (Harmonic^®) and a bipolar tissue sealing system (EnSeal^®) with Micro wave coagulation therapy (MCT). The post-operative course was very well, and he left the hospital on the eighth day after the operation. Regrettably, he died of subarachnoid hemorrage on 9 months after liver resection without recurrence.

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We report the case of a patient with anastomotic leakage that was effectively treated by transanal draining using a decompression tube. A 77-year-old male was diagnosed with rectosigmoid cancer in February 2011 and a laparoscopic low anterior resection was performed. On the postoperative day, he had a high fever and abdominal pain. Following test results, the patient was diagnosed with anastomotic leakage as a postoperative complication. Treatment with a transanal decompression tube as a conservative therapy was selected because the patient’s general condition was good and the leakage space was limited to within the presarcral area.　The condition of the leakage gradually improved and was sufficiently healed after 29 postoperative days. The tube was removed and the digestible diet was started. The patient was discharged a few days later. In conclusion, using a transanal drainage tube can be the optimal method for treating an anastomotic leakage if the patient’s general condition is well and the leakage space is limited.

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A 73-year-old-female consulted dermatologist for continuous anus pain, and 4cm erosion was observed in anal region. Biopsy of the erosion revealed Paget’s disease. After the thorough examinations, she was diagnosed anal canal cancer with pagetoid spread. To decide the excision line, we did mapping biopsy on 2cm distal of the erosion.

No tumor cell was seen in the biopsy. Abdominal perineal resection with partial resection of vagina was performed, and the excision line of skin followed the mapping biopsy.
The histopathological diagnosis was the moderate differentiated adenocarcinoma of anal canal with invasion to posterior wall of vagina and pagetoid spread to erosion of anal skin. Surgical margin was negative for pagetoid spread. For rectal and anal canal cancer with dermatological change around the anus, mapping biopsy was very useful to determine the excision line.

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A 62-year-old man was admitted to our hospital because of epigastric pain. Computed tomography (CT) showed fluid collection around the gallbladder. Because no symptomatic remission was attained with conservative treatment and muscle defence was observed, we conducted an emergency laparotomy under a diagnosis of acute peritonitis. During surgery findings biliary ascites was found and necrotic change from the body to fundus of the gallbladder and leakage of bile juice from the site were noted. Cholecystectomy and abdominal drainage were performed. There were no stones in the gallbladder and culture of the biliary ascites was negative for bacteria. Histologically, localized necrosis was found, and cell infiltration was mild. Finally, we diagnosed idiopathic perforation of the gallbladder. The postoperative course was uneventful and the patient was discharged from the hospital on the 13th postoperative day. Since idiopathic perforation of the gallbladder are rare, we report on this case with some bibliographical comments.

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Castleman’s disease localized around the pancreas is rare, and only 26 cases have been reported till date. We report two cases having different clinical and histological types of Castleman’s disease localized around the pancreas and discuss the relevant previous literature. Case 1 was that of a 67-year-old woman with Castleman’s disease that was clinically and histologically classified as the plasma cell type. Case 2 was that of a 56-year-old man with Castleman’s disease that was clinically classified as the unicentric type and histologically classified as the hyaline vascular type. In both cases, a preoperative definitive diagnosis could not be obtained and the disease was only diagnosed during laparotomy. Preoperative diagnosis of Castleman’s disease is difficult because the lesions have different clinical and histological features; in addition, the diagnosis rate of biopsy is low. Differential diagnoses include pancreatic neuroendocrine tumors and malignant lymphomas. Therapy and prognosis vary with clinical and histological types ; therefore, making an accurate diagnosis is important. Physicians should consider Castleman’s disease in patients presenting with pancreatic masses and consider performing biopsy as well as diagnostic laparotomy to rule out the various possibilities and establish an accurate diagnosis.

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A 42-year-old woman was refered to our hospital for tumor in the tail of the pancreas, splenic hilum.

Abdominal computed tomography (CT) showed a low-density, well-circumscribed cystic mass about 5cm in diameter at the pancreas tail and its inside appeared homogenous.

Endoscopic retrograde pancreatography (ERP) showed normal findings in the main pancreatic duct and no drainage duct into the tumor.

Endoscopic ultrasonogram (EUS) demonstrated cystic mass, 4.9×4.3cm in size, with thickwalled capsula in the pancreas tail.

We then performed an operation under the preoperative diagnosis of pancreatic tumor including of mucinous cystic tumor.

The tumor was elastic soft, about 6cm in diameter, at the pancreas tail, so we performed a distal pancreatectomy and splenectomy.

The resected material was a tumor, a size of 6.5×5.5×4.0 cm, with capsula between the tail of the pancreas and splenic hilum.

The pathological diagnosis was benign neurilemoma, having mixed formation of Antoni type A and B with cyst and hemorrhage in the center of the tumor.

Immunohistochemically, the tumor cells were positive for S-100 protein, but they were negative for c-kit, CD34, desmin and SMA.

The final diagnosis was the neurilemoma arising from peripheral nerve around pancreas.

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A 32-year-old female was diagnosed as having hereditary spherocytosis, when her second child was born. She was admitted to our hospital for splenectomy, because of icterus and anemia attack. Laparoscopic splenectomy was performed. The splenic hilum was divided by using an Endo-GIA suturing devise after dissection of attachment around the spleen. Because her spleen was too large to put it into a standard laparoscopic harvesting bag, an intestinal bag (Isolation Bag^TM) was used to successful collection of the spleen from the small incision. The spleen was the biggest one weighing 1,240g, among those in previously reported cases with laparoscopic splenectomy for hereditary spherocytosis in Japanese literature. Isolation Bag^TM was very useful to harvest the large spleen preventing splenosis which may cause diseae recurrence.

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We experienced a case of a CA19-9 producing splenic cyst, which is comparatively rare, in which laparoscopic dome resection was successfully performed. A 43-year-old woman was admitted to our hospital with the complaint of left upper abdominal pain. Abdominal CT revealed a 14.7×13.5cm cyst lesion in the spleen, and serum CA19-9 value showed high level of 775U/ml. No apparent findings of malignancy were identified by imaging, so that CA19-9 producing splenic cyst was diagnosed and laparoscopic dome resection was performed. At first, ３ ports were inserted into her abdomen and a double balloon catheter was used for suction of the intracystic fluid. The cystic fluid was brown, and CA19-9 in the cystic fluid was as high as 550,200U/ml. The proximal region transitional to the parencymal spleen was resected. A cyst wall consisted of fibrous connective tissue with calcification. Histopathology revealed it to be an epidermoid cyst. The elevated CA19-9 level was normalized to be 30 U/ml after the operation. Laparoscopic dome resection for splenic cyst is a safe and useful procedure for the preservation of splenic function.

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A 25-year-old woman presented to the hospital with omphalitis. A physical examination revealed a poorly defined mass 3 cm in diameter without tenderness under her umbilicus. A contrast-enhanced computed tomography scan revealed an abscess cavity under the anterior abdominal wall and umbilicus. After conservative treatment with antibiotics and drainage, we performed laparoscopic resection of umbilical urachal remnant including some of the indurated surrounding tissues under pneumoperitoneum using a 3-port method. Histological examination revealed an urachal remnant with inflammation. The patient was discharged on postoperative day 7 without any complications.
　In this case, the patient was successfully treated with laparoscopic resection of the umbilical urachal remnant, and no evidence of local recurrence was observed during the follow-up period.

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We experienced two cases of ectopic endometriosis. Case 1 was a 45-year-old woman who was referred to our hospital from a nearby gynecology clinic for a mass in the umbilical region accompanied by pain that was noticed 2 years previously. At presentation, an abdominal mass of 3 cm in size was noted with tenderness. MRI imaging revealed a mass in the umbilical region and surgery was performed. Pathology of the surgical specimen showed insular endometrial glands and endometrial stromata of various sizes within fibrous tissues. A pathological diagnosis of endometriosis was made. Case 2 was a 23-year-old woman who visited our hospital for a painful mass that developed in the left inguinal region 1 year previously. At presentation, an inguinal mass of 1 cm in size was noted with tenderness. The mass was confirmed in the left inguinal region on MRI and increased in accordance with the menstrual cycle. In surgical resection, the tumor was found arising from the round ligament. A diagnosis of endometriosis was confirmed by pathological findings. In the case of ectopic endometriosis, differentiation from other masses occurring on the body surface is important. The mass border is often indistinct in surgical removal and therefore the surgeon should consider excision with an adequate margin of healthy tissue to avoid disease recurrence.

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A 71-year-old woman visited our institution complaining of a tumor as big as a quail egg in her abdomen at an incisional scar. She had undergone surgery for advanced appendiceal carcinoma (pT4N0M0) one year prior.

Althogh her serum CA19-9 and CEA levels were 7.2 U/ml and 1.5 ng/ml, respectively, and the maximum standardized uptake value of 18F-fluorodeoxyglucose positron emission/computed tomography was 1.9, the tumor was suspected to be a solitary metastasis from the appendiceal carcinoma.

We resected the tumor. It was a 22×17×22 mm solid tumor that had developed in the abdominal wall. We diagnosed it histologically as an abdominal desmoids tumor.

Our case had a rare abdominal desmoids tumor that developed in the abdomen at ac incisional scar after surgery for appendiceal carcinoma. Both benign abdominal desmoid tumors and solitary metastatic tumors from appendiceal carcinoma are rare. It is important to distinguish these disease to determine the appropriate therapeutic strategy.

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We report a case with long-term imatinib therapy followed by surgical resection for peritoneal recurrence of GIST. A 72-year-old man had undergone the resection of small intestinal tumor 7 cm in size and histopathologically diagnosed as a leiomyosarcoma 17 years before. In an emergency with abdominal pain 10 years after surgery, abdominal computed tomography scan showed peritoneal tumor with 4.6×4.5 cm in size. A biopsy was performed, and immunohistochemistry of the tumor showed positive staining for c-kit and CD34. Immunohistological examination of the specimen 10 years before was again performed, and it was positive for both c-kit and CD34, so we diagnosed the peritoneal tumor as local recurrence of GIST. Imatinib therapy was started. After the response as stable disease continued for 54 months, surgical resection for recurrent lesions had been undergone. Imatinib therapy has been continued after surgical intervention, and there is no evidence of recurrence 36 months after the surgical intervention.

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A 79-year-old woman admitted to our hospital for hernia repair of giant midline incisional hernia 1 year after abdomino-perineal resection of rectum for Bowen disease complicated with surgical site infection of midline and perineal incision. On physical findings, a midline incisional hernia measuring 16×9 cm in diameters was found without parastomal hernia. Hernia repair was performed using Composix EX (25cm×20cm) under general anesthesia. After separation of Retziusʼ cavity, mesh was fixed in an os pubis facies posterior, Cooperʼs ligament, and rectus abdominis muscle as circumference, and hernia orifice as internal circumference. Operation time was 220 minutes, and blood loss was 40 g. The patient made a satisfactory recovery and was discharged on nine post-operative day 9. The patient remains well with no evidence of recurrence of hernia 1 year after operation.

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