In D3 sigmoidectomy, the root of the inferior mesenteric artery (IMA) is usually divided. However, this sometimes causes insufficient blood supply at the anastomosis, leading to anastomotic leakage. We perform superior rectal artery (SRA)-preserving laparoscopic sigmoidectomy for proximal sigmoid colon cancer to preserve the blood supply to the anastomotic site. The vascular sheath along the IMA and the SRA were peeled off together with the lymph nodes using bipolar scissors, then the arteries feeding the tumor were divided at the bifurcation from the SRA. Forty patients underwent this operation, and there were no cases of intraoperative morbidity and none required conversion to laparotomy. There were 2 cases of bowel obstruction, 2 of pneumonia, 1 of pulmonary embolism, and 1 of wound infection; however, there were no cases of anastomotic leakage. Laparoscopic D2 or D3 sigmoidectomy with preservation of the SRA can be safely conducted with our technique using bipolar scissors.

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Purpose: We examined clinical features of the small bowel obstruction without abdominal surgery history.
Methods: We retrospectively investigated clinical findings (causes, labo data and CT findings) in 26 patients of the small bowel obstruction without past laparotomy from January 2006 to December 2012, except for hernia which could be diagno sed from body surface.
Results: Among causes of bowel obstruction, obturator hernia accounted for 6 cases, internal hernia 5 cases and volvulus of the small intestine 4 cases. We performed release of small bowel obstruction with ischemic bowel resection in 12 cases, and without bowel resection in 12 cases. In resection group, CRP increased more significantly and ascites accumulated more frequently than in non-resection group.
Conclusion: The small bowel obstruction without past laparotomy had various causes and difficulty of definite diagnosis, so should be treated quickly under refined physical and examination findings.

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Background: Many kinds of energy device (ED) recently are developed. Not much, however, has been done to clarify how the laparoscopic liver resection would be perfomed using with ED frugally, and safely.
Method: We performed 22 laparoscopic minor hepatectomies using with a radiofrequency bipolar coagulation (RFBC) and an ultrasonic dissection (US). Under 10mmH₂O intraabdominal pressure, hepatic parenchyma was coagulated and Glissonʼs sheath was sealed using RFBC via thre/four trocars stabbed. After the coagulation/seal, hepatic parenchyma was cut using US. The coagulation/seal and dissection were operated alternately, and the liver resection was performed. On the viewpoint of the ED used, we analyzed number of ED used, operation time, blood loss, postoperative complication, and days in hospital.
Results: The mean operative time of the present method with RFBC/US was 172 minutes, the mean blood loss was 95cc, and the mean days in hospital were 8.7 days. No patient had postoperative complication. There was no significant difference between the other kinds of combination such as a microwave coagulation (MW)/RFBC, and MW/an ultrasonic surgical aspirator (CUSA).
Conclusion: Apply of two EDs, which is the combination of coagulative sealer and coagulative dissector (e.g., RFBC/US), would contribute to skillful and safe laparoscopic hepatectomy.

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We report the clinicopathological features and genetic alterations of a case with multiple papillary thyroid carcinomas associated with familial adenomatous polyposis (FAP) and Stage Ⅳ colon cancer. A 38-year-old woman underwent a total thyroidectomy for three lesions (20mm, 10mm, and 3mm in diameter) in the thyroid, one (10mm in diameter) of which had been diagnosed preoperatively as a papillary carcinoma based on cytology findings. Twelve months before the thyroidectomy, she had undergone a total colectomy and ileorectal anastomosis for Stage Ⅳ transverse colon cancer, since a complete response to oxaliplatin-based chemotherapy (modified FOLFOX6) for multiple liver metastases had been obtained. A pathological examination revealed that all the tumors were papillary thyroid carcinoma. Genetic analysis of the APC gene from a blood sample and the largest thyroid cancer tissue identified a germ-line mutation (C deletion at codon 1,483) and a somatic mutation (G deletion at codon 295), both of which were considered to form stop codons resulting in truncated products of the APC genes. These results suggest that the inactivation of both alleles of the APC gene might be associated with the development of thyroid cancer in patients with FAP. The patient has remained free from colorectal and thyroid cancer recurrence for 24 months since the thyroidectomy.

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A 70-year-old woman received breast cancer examination. A tumor in her right breast was detected, and she received a thorough examination. Upon further examination were diagnosed bilateral tumors through ultrasound. We performed needle biopsies. And pathological findings showed mucinous carcinomas. She had neither axillary lymph node metastasis, nor distant metastasis, therefore we performed bilateral mastectomies and sentinel lymph node biopsies. From the resected specimens, pathological classification was determined to be luminal-A cancers. The patient has been treated with aromatase inhibitors as adjuvant therapy for approximately 5 years. Here we report a case of synchronous bilateral mucinous carcinoma, which is very rare in the literature.

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We describe a rare case of cervical esophageal adenocarcinoma originating from the esophageal gland. A 63-year-old man underwent endoscopic screening during a medical checkup, during which a type 2 tumor was incidentally detected in the cervical esophagus, which was confirmed as adenocarcinoma on biopsy. Endoscopic ultrasonography indicated that the tumor had invaded the muscularis propria layer. Computed tomography and ¹⁸F-fluorodeoxyglucose positron emission tomography imaging revealed neither lymphadenopathy nor distant metastasis. He was clinically diagnosed with T2N0M0, Stage Ⅱ disease. He preoperatively received 2 courses of chemotherapy consisting of cisplatin (90mg/m²) on day 1 and 5-fluorouracil (900mg/m²) on days 1‒5. Esophagectomy with lymph node dissection was performed. Histopathological diagnosis showed well-differentiated tubular adenocarcinoma that probably originated from the ducts of the esophageal glands. The final diagnosis was T1bN0M0, Stage I disease. The postoperative course was uneventful. He was healthy without any recurrence 27 months after the surgery.

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This report concerns a 76-year-old obese man with postoperative bilateral diaphragmatic paralysis after esophagectomy. The paralysis was successfully managed by respiratory rehabilitation and weight control. The patient was diagnosed with abdominal esophageal cancer accompanied by metastasis of the right supraclavicular lymph node. We performed a lower esophagectomy via a left thoracotomy, as well as resection of the metastatic lymph node together with the right phrenic nerve. After extubation, the patient desaturated and was diagnosed with bilateral diaphragmatic paralysis, which we considered was caused by an incision of the left diaphragm in association with resection of the right phrenic nerve. Conservative management improved pulmonary function and the patient was weaned from mechanical ventilation. When metastatic lymph nodes may invade one-sided of the phrenic nerve, a surgery involving resection of the opposite side of the diaphragm should be avoided to prevent bilateral diaphragmatic paralysis.

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The patient was a 56-year-old male with peritoneal disseminations of advanced gastric cancer. He underwent neoadjuvant chemotherapy with a combination of S-1 120mg/day (2 weeks administration and 2 weeks rest) and paclitaxel (PTX) 90mg/m² (day 1 and 14, intraperitoneally:i.p.). After 2 courses of this regimen, CT revealed no evidence of ascites. Total gasterectomy and D1+lymph node dissection was performed. Cytology of ascites proved negative but peritoneal dissemination remained. The pathological stage was determined as T3 N0 H0 P1 CY0 M0, pStage Ⅳ. Twenty-one days after surgery, S-1+PTX i.p. chemotherapy was provided. We have continued this chemotherapy for seventy-three times. Grade I diarrhea, stomatitis and anorexia were confined throughout the all clinical course.
A condition of no progression has been achieved and maintained for more than five years. PTX i.p. and S-1 chemotherapy may well be one of the effective option for the treatments of gastric cancer with peritoneal disseminations.

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A submucosal tumor 30mm in diameter was pointed out in 37-year-old woman as a result of a medical check up. The tumor was pathologically diagnosed as GIST by EUS-FNA. Abdominal CT showed a mass 20mm in diameter near the primary gastric GIST. The mass was suspected of peritoneal or lymph node metastasis as a preoperative diagnosis. Because surgical finding revealed the mass near the primary GIST was likely to be a lymph node metastasis, we performed pick-up lymph node dissection. Then we performed laparoscopic and endoscopic cooperative surgery for the primary gastric GIST.
Histopathological examination showed gastrointestinal tumor which was 30×18×13mm in size. Immunohistochemically, tumor cells were positive for c-kit and CD34; negative for desmin and S-100. The mass near the gastric GIST was diagnosed as lymph node metastasis. Tumor cells were positive for c-kit and CD34 as with primary tumor. MIB-1 index of lymph node metastasis was smaller (4%) than that of primary tumor (6%). Currently, there is no accepted standard treatment with management of GISTs with lymph node metastasis. We presented a case of GIST of the stomach with lymph node metastasis including bibliographic consideration.

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We report it this time because we experienced Gastric Plasmacytoma.

The case is 92 years old woman. The anamnesis is a stomach polyp, prolapsis uteri, a cataract.
With a chief complaint of poor feeding, fatigue, melena from the front for one month, she had been seen in a clinic. It is pointed out a stomach polyp with upper endoscopy, and she had introduced for an excision purpose.
At the first examination, there was not the abdominal symptom. But she became the hospitalization for a complete examination because she had severe anemia (Hb4.6mg/dl) by a blood test. With upper endoscopy, there were two huge polyps (80mm, 40mm) in a stomach. We enforced an operation because the anemia may be worse and her general status was good in spite of advanced age.
In abdominal operation views, two existing tumors infiltrated it to a serosal membrane. We operated partial gastrectomy and, as for the postoperative progress, are good. The results of pathological diagnosis indicated that the tumors were malignant lymphoma of non-Hodgkin type, more specifically, lymphoplasmacytic type, SE, N1 and Stage Ⅲa. Immunostaining showed that CD138 and immunoglobulin light-chain κ were positive.
In Plasmacytoma, Gastric Plasmacytoma is extremely rare. We put report from literatures and consideration together and report the image views that I got for this case.

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The subject was a 66-year-old female who was diagnosed by a local physician with high CEA levels and was referred to our hospital for detailed examination and treatment. An abdominal CT scan revealed an enlarged cystic tumor in the cecum. The tumor was touching the uterine myoma and had a partially indistinct border, which was suggestive of adhesion or infiltration. Surgery was performed by right paramedian incision. The tumor originated from the appendiceal root and the ileal mesentery was firmly adhered to the tumor wall spanning approximately 20cm from Bauhinʼs valve. The possibility of cancer was undeniable and ileocecal resection including approximately 30cm of the terminal ileum was performed. Mucinous cystadenoma of appendix was diagnosed based on histopathological findings. There were no postoperative complications and the subject was discharged from hospital on day 14 in remission. We are reporting a case of mucinous cystadenoma of appendix requiring ileal resection that was firmly adhered to the ileal mesentery, in addition to literary review.

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A 39-year-old man was admitted with abdominal pain, abdominal distension and vomiting without a history of abdominal surgery. The patient underwent conservative therapy using a long tube, because abdominal computed tomography showed dilatation of the small intestine and suspected presence of internal hernia. Although symptomatic remission could be achieved with depression of the intestine, intestinal contrast study through the long tube still showed obstruction of the small intestine. A laparoscopic surgery was carried out with a diagnosis of ileus due to internal hernia. A loop of small intestine was incarcerated in the intersigmoid fossa, so we extracted the small intestine. Bowel resection was not required. The patient was discharged from the hospital on the 10^th day after surgery. We report a rare case of intersigmoid hernia, the incarceration of which was reduced by laparoscopic surgery.

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Mesh plug repair has been one of the common methods for inguinal hernia. We report a case with perforation of sigmoid colon due to mesh plug for the repair of inguinal hernia. The patient presented peritoneal abscess forming colocutaneous and colovesicle fistula. He had previously undergone repair of left inguinal hernia with mesh plug. After diverting colostomy in transverse colon, sigmoidectomy, fistulectomy in bladder as well as removal of the prostheses were carried out. The third surgery of stoma closure finalized these procedures. A little literature described intestinal perforation due to prosthesis including mesh plug, though its incidence is very rare.

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54-year old male was admitted in the Emergency Department at our hospital with a complaint of melena, and rectal cancer was diagnosed on thorough examination. He had suffered a stroke 2 months ago, and then regularly attended to Neurology Department for further investigation and treatment until before the onset of melena. Preoperative CT and PET-CT showed no distant metastasis, and low anterior resection was performed. During the operation, multiple metastatic nodules were observed all over the liver. Pathological diagnosis indicated adeno-endocrine cell carcinoma. After the operation, bleeding gastric ulcer led him into shock. Endoscopic banding and massive transfusion were performed, but his liver gradually went into failure. One month after the operation, he was treated 3 cycles of mFOLFOX6 and associated with such complications as acute cholecystitis. Three months after the operation, he died of liver and renal failure. In this case, we chose the treatment of mFOLFOX6 for colorectal cancer, but treatment for small cell lung cancer is also suggested according to NCCN guideline. The establishment of treatment for adeno-endocrine cell carcinoma is expected in Japan.

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We report a case of a 69-year-old female previously diagnosed with advanced low rectal cancer, who had undergone preoperative chemoradiotherapy followed by laparoscopic ultralow anterior resection, upper D2 lymph node dissection, and ileostomy with double orifices. Approximately 4 months after commencing chemoradiotherapy and 2 months after proctectomy, the patient consulted our hospital with the primary complaints of abdominal pain and fever and bloody diarrhea. Computed tomography on admission revealed an intestinal perforation and emergency surgery was performed. Intraoperative findings revealed an ileal perforation approximately 15cm from the ileostomy. The patient was diagnosed with idiopathic intestinal perforation on the basis of the history of treatment for rectal cancer, preoperative imaging diagnosis, and intraoperative findings. Surgery included closure of the perforation and lavage drainage. Because histopathological examination was not possible, no definitive diagnosis was reached; however, the intestinal perforation may have been due to the delayed effects of chemoradiotherapy. In conclusion, we report an extremely rare case of idiopathic intestinal perforation possibly caused by the delayed effects of chemoradiotherapy along with a short literature review.

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The patient in this case was a 72-year-old woman in whom a recurrence was found after visiting the Department of Gastroenterology for transcatheter arterial embolization (TAE) therapy for cirrhosis and cancer in the liver S6. She was subsequently referred to our department for surgery. Thrombocytopenia had developed; therefore, laparoscopic splenectomy was performed with the aim of improving the platelet count and reducing the amount of bleeding during the subsequent hepatectomy. An increased platelet count was observed soon after surgery, and the patient was discharged from the hospital on day 12 without complications. As the second stage about one month later, a partial hepatectomy was performed via hand-assisted laparoscopic surgery (HALS), and the patient was discharged on day 16. Recent cases in which splenectomy is conducted to control thrombocytopenia in patients with both cirrhosis and liver cancer have been reported. The purpose of this procedure is to control intraoperative bleeding in patients with thrombocytopenia, thus making it possible to perform hepatectomy safely and with reduced blood loss. It is also somewhat better cosmetically, and is thought to be a useful treatment for patients with cirrhosis and liver cancer.

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<Case 1> A female in her 70s visited a hospital with a chief complaint of loss of appetite and discomfort in the upper right abdomen. Imaging examinations showed a simple huge hepatic cyst with a maximum diameter of 160mm in the right hepatic lobe. We performed single incision laparoscopic surgery (SILS) using a SILS Port™ and a Mini Loop Retractor. <Case 2> A female in her 70s visited a hospital with a chief complaint of upper abdominal pain and right shoulder pain. Imaging examinations showed a simple huge hepatic cyst with a maximum diameter of 190mm in the right hepatic lobe. We performed reduced port surgery (RPS) using a GelPoint^®and a 3mm forceps. The postoperative courses of both patients treated using different surgical devices were comparable. In recent years, reduced port laparoscopic surgery has become mainstream for the surgical treatment of huge hepatic cysts.

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A 62-year-old man was found to have rectal tumor at another hospital and he was admitted to our hospital. Computed tomography (CT) showed S5 and S7 tumors were irregular and peripheral enhanced. Fluorodeoxyglucose positron emission tomography (FDG-PET) showed uptake in the S5 tumor, but no uptake in the S7 tumor. Under a diagnosis of rectal cancer with liver metastasis, we performed segmentectomy of the S5 and partial resection of S7 following Milesʼ operation. Histological examination revealed that rectal cancer was moderately differentiated adenocarcinoma and the liver tumors were inflammatory pseudotumor. The patient is alive with no signs of recurrence 6 years after surgery. It is important that differential diagnosis between hepatic inflammatory pseudotumor and liver metastasis when the patient has malignant disease. We report a case of hepatic inflammatory pseudotumor with rectal cancer.

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An examination for FDG-PET is useful for the differentiation of the malignant tumor of biliary tract origin, but may often have a hard time for a diagnosis. A 60-year-old woman admitted to the hospital because of right hypochondralgia and became this course introduction after conservative treatment by a diagnosis of the acute cholecystitis. An abdominal US and CT revealed an irregular wall thickening with the high-speed bloodstream in the gallbladder body and fundus and the swelling of the lymph nodes in a hepatic portal region and paraaorta. FDG-PET showed a high accumulation of FDG in both of them, so we made a diagnosis of gallbladder cancer with lymph node metastasis. Laparotomy was performed, and the lymph node of paraaorta was revealed to be a tuberculous lymphadenitis by intraoperative frozen-section examination. Extended cholecystectomy and extrahepatic bile duct resection had been done, and the histopathologic final diagnosis was given as a result of xanthogranulomatous cholecystitis and tuberculous lymphadenitis. When FDG accumulation in gallbladder and the regional lymph node, I thought about the gallbladder malignancy with lymph node metastases to the first, but it was thought that an inflammatory disease had to take the coexistent possibility into consideration.

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Intra-abdominal lymphangiomas are rear benign neoplasms. It is very rare case that arise from the gallbladder. We experienced a case of a 58-year-old man with palpable tumor at upper abdomen. Preoperative studies, including ultrasonography, computed tomography, and magnetic resonance imaging, showed a tumor with multilocular cystic structure, located around the gallbladder with intact cystic duct and bile duct in the gallbladder. The patient underwent an open cholecystectomy. Macroscopically, the tumor was a multilocular cystic mass, 11×7.5×5cm in size, its spaces were filled with yellowish, serous fluid. The histological findings were consistent with a cysticlymphangioma originated in the gallbladder. Preoperative diagnosis remains difficult owing to its rarity. It is very important for surgical operation, understanding its relation to surrounding organs.

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We consider the risk of impaired ventriculoperitoneal shunt (VPS) derived from increased intra-abdominal pressure and shunt infection, when we perform laparoscopic surgery to the patients who have undergone VPS previously. We performed single-incision laparoscopic cholecystectomy (SPS-LC) on 16-year-old woman with VPS. At first, we examined the subcutaneous and intra-abdominal route of the VPS tube by X-ray and clamped VPS tube with the fistula before CO2 insufflation. We released the clamp of the VPS tube and confirmed the drainage of the cerebrospinal fluid from the tip of the VPS tube, after the resection of the gall bladder and CO₂ disaffiliation. She recovered without any complications such as the sign of increased intracranial pressure, shunt failure and infection after the surgery. This case illustrates that SPS-LC might be able to perform safely in patients with VPS, if we take steps adequately. We describe the clinical experience of the present case and review the relevant medical literatures.

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A 53-year-old man with right hypochondriac pain was suspected gallstone and porcelain gallbladder at his local doctor, and he was referred to our hospital. Abdominal ultrasound and Computed Tomography revealed the gallbladder wall was thickened and calcified diffusely without any suspicion of cancer. The patient was diagnosed with porcelain gallbladder and underwent laparoscopic cholecystectomy. Histological examination of the resected gallbladder revealed chronic cholecystitis and no malignancy.
Porcelain gallbladder is frequently accompanied by cancer, especially gallbladder cancer, therefore pre-operative detailed examination is necessary.

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A 61-year-old woman visited to the hospital because of back pain. Abdominal US showed a cystic mass about 45mm in diameter of the pancreas head which was not indicated the previous yearʼs medical examination. Abdominal enhanced CT showed a multilocular cystic lesion 43mm in diameter of the pancreas head with central calcifications and peripheral large and small cysts. MRCP showed a high intensity multilocular cystic lesion 43mm in diameter of the pancreas head on T2 intensity. ERCP showed a slight exclusion by the cyst. Though, the cystic lesion had no communication with the main pancreatic duct. Pylorus-preserving pancreaticoduodenectomy was performed with the diagnosis of serous cystic neoplasm of the pancreas head. Histopathological studies revealed serous cystadenoma of the pancreas with single cuboidal epithelium. Epithelium consisting the cyst showed no atypical cells or abnormal mitosis. However, one part of the epithelium showed back to back–like structures, which suggests malignancy. We report a case of a serous cystadenoma of the pancreas.

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The case pertains to a 73-year-old man, who underwent cholecystectomy for cholecystolithiasis at another institute in June, 1998. Postoperative jaundice was observed and end anastomosis was conducted on the bile duct four days following surgery upon a diagnosis for bile duct injury. Jaundice and hepatic dysfunction appeared from 2001. A bile duct stent was endoscopically placed against stenosis of the biliary anastomosis in October 2001 and was repeatedly replaced thereafter. Cholangitis frequently appeared from 2010, leading to his referral to our department for surgery. An expanded intrahepatic bile duct, biliary anastomosis stenosis, and intrahepatic stone were observed upon imaging. Bile duct resection of the anal side, intrahepatic stone removal, and choledochojejunostomy were conducted in October 2011 upon diagnosis for stricture following bile duct injury. Bile duct amputation neuroma was diagnosed at the postoperative histopathological examination. Bile duct amputation neuroma is a rare disease appearing following biliary tract surgery and takes a long time until postoperative onset. However, an investigation into cases reported in Japan revealed that it frequently appears at an early stage following bile duct surgery compared to other surgeries, so the present case must be kept in mind regarding bile duct strictures generated during the early postoperative period.

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We report two resected cases of pancreatic metastases from renal cell carcinoma (RCC). Case.1: A 76-year-old man who undergoing the left nephrectomy and was diagnosed as left RCC in 2000. Computed tomography (CT) follow-up in 2009 showed pancreatic tail tumor of 47×38mm in diameter. Distal pancreatectomy with splenectomy was performed. Case.2: A 70-year-old woman who undergoing the left nephrectomy and was diagnosed as left RCC in 2003. Computed tomography (CT) follow up in 2010 showed pancreatic body and tail tumor of 100×60mm in diameter and was suspected that the tumor invaded the posterior gastric wall. Distal pancreatectomy with splenectomy and partial gastrectomy was performed. Two resected specimen were diagnosed as pancreatic metastases from RCC (renal cell carcinoma) in histopathological findings. We found aggressive surgery may be effective in pancreatic metastasis from RCC. So we must keep biological characteristics of RCC in mind in case of deciding on treatment and have life-long follow-up.

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This report presents the case of a huge chronic expanding hematoma in the right adrenal gland. A 66-year-old Japanese woman was referred for the evaluation of a huge mass in the middle of her abdomen. Her physical condition was unremarkable except for bilateral edema of the lower extremities. She had undergone hysterectomy and left oophorectomy due to uterine leiomyoma 18 years earlier, but her medical history had included neither anticoagulant therapy nor abdominal trauma. The laboratory data revealed anemia but showed that all tumor markers were within normal range. In the right abdomen, abdominal computed tomography (CT) demonstrated a well-demarcated, 35-cm mass compressing the surrounding organs to the left side. The peripheral region of the mass was slightly enhanced, and the central part was hypovascular, indicating central necrosis or hematoma. No right adrenal gland was identified. Magnetic resonance imaging showed that the inner aspect of the mass appeared to be unequally hyperintense on T1-and T2-weighted images. The rim of the mass was hypointense on the T2-weighted image but hyperintense on diffusion-weighted images. Abdominal CT angiography indicated that the right capsular branches of the right renal artery and right inferior phrenic artery were feeding arteries for the mass. The preoperative diagnosis was a chronic expanding hematoma, but the central necrosis of the tumor was not completely ruled out. Laparotomy revealed that the huge mass was encapsulated. Moreover, no tight adhesion was observed, indicating that the lesion could be easily detached. Histopathological examination of the surgical specimen showed that it was a hematoma, and the rim of the hematoma was composed of the adrenal cortex and medulla, suggesting the hematoma originated in the adrenal gland. Further, a cavernous hemangioma was observed in the periphery of the hematoma, suggesting the hemangioma was the cause of an adrenal hemorrhage and manifested as a chronic expanding hematoma. This report describes the largest adrenal hematoma reported in Japan, which presented as a chronic expanding hematoma of the retroperitoneum.

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A 73-year-old woman had undergone a sigmoidectomy for her sigmoid colon cancer. On day 15 of the operation, postoperative ileus sign with palpable hard mass on her left middle abdomen was appeared, and abdominal CT scan revealed the mesenteric wall thickness around the jejunum. She was diagnosed as postoperative intestinal obstruction and given metoclopramide and erythromycin under nasogastric tube drainage. However, her complaints did not show any improvement and re-diagnosed as mesenteric panniculitis due to increasing of the palpable hard mass. Therefore, dexamethasone (8mg/day) was administered intravenously from on day 24, and showed rapid improvement. Also, she was able to start oral intake from on day 29 and discharged on day 41. As a conclusion, in case of intestinal obstruction relatively soon after operation might be show significant improvement following steroid administration and could avoid unnecessary surgery.

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Thrombosis of superior mesenteric vein is a relatively uncommon disease that is sometimes silent and causes sudden bowel necrosis. The prognosis can be poor depend on the clinical situation. We describe two cases of contrastive course of superior mesenteric vein thrombosis (SMVT), which were diagnosed by abdominal contrast enhanced CT imaging. Case 1 and 2 involved a 63-year-old man and a 58-year-old man. Both two patients arrived at our hospital because of abdominal pain. Abdominal CT scan revealed translucent images in the superior mesenteric vein. Conservative therapy with the continuous infusion was used. In case 1, heparin and urokinase, in case 2, heparin and warfarin were used. In case 1, post treatment abdominal CT demonstrated that the thrombus that had been located in the superior mesenteric vein was no longer present. The patient left our hospital 19 days after admission. In case 2, conservative therapy was not respond. Furthermore, abdominal CT imaging revealed intestinal necrosis. The patient underwent laparotomy. At surgery, the necrosed intestines were removed, and intestinal anastomosis was done. Despite adjunct post-operative therapy, the patient died of sepsis and multiple organ failure.

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