Introduction: The risk factors for postoperative complications after surgery for rectal cancer were compared between late elderly people and non-elderly people.
Materials and Methods: A total of 139 patients who underwent surgery for upper and lower rectal cancer at our department between January 1, 2008 and March 31, 2013 was investigated. These patients were divided into elderly (≥75 years old) and non-elderly (<75 years old) groups, and their clinicopathological factors, surgery-related factors, E-PASS, and PNI were compared.
Results: In the elderly group, 13 of 27 patients (48.1%) developed postoperative complications, and this proportion was significantly greater than in the non-elderly group (27.7%, p=0.0401). In elderly patients, univariate and multivariate analyses showed that E-PASS SSS (p=0.048) and elevated peripheral blood lymphocyte count (p=0.026) were independent risk factors for complications. In the non-elderly group, E-PASS SSS was the independent risk factor for complications (p=0.0398).
Conclusion: E-PASS SSS was found to be a useful index for assessing risks for postoperative complications in both the elderly and non-elderly groups. When performing surgery to treat rectal cancer in elderly people, paying careful attention to the preoperative peripheral blood lymphocyte count and minimizing surgical invasiveness may reduce the development of postoperative complications.

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Purpose and Method: A questionnaire survey was designed to collect data regarding problems in establishing a career and expectations of support from women surgeons who belonged to the Department of Surgery in the University of Tokushima (including six (6) surgeons in the Department of Digestive and Transplant Surgery).
Result: Out study focused on five (5) women who entered our department since 2003. Sixty seven (67%) percent of these women surgeons were married and seventy-five percent (75%) of these were raising children. Eighty percent (80%) of these women felt that their superior and colleagues were understanding of their situations. However, they felt that the backup system was present only fifty percent (50%) of the time and the satisfaction ratings of that system and its accessibility were also only fifty percent (50%). The survey revealed that they thought that their career opportunities were restricted to gaining only clinical experience not achievement, position and studying abroad.
Conclusion: For the career development of woman surgeons, it is imperative to establish a backup system. Furthermore, woman surgeons also need to re-form consciousness.

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Pregnancy and delivery are life events unique to females, and the major burdens of childcare are usually performed by females in Japan. Therefore, those events can obstacles to career development. We administered a questionnaire to female physicians at Nagasaki University Hospital in October 2013 to find out what was needed to improve their career development. A questionnaire was sent to 160 female physicians, 106 of whom responded (response rate: 66%). Forty-four of 50 surgeons responded (88%). Most of the subjects were in their 30s. Female surgeons tended not to have considered delivery and childcare at the time when they were selecting their specialty and tended to expect childcare support, rather than an exemption to be on call for emergency surgery.

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Purpose: Disruption of the local perinatal care system occurred in Japan in the first part of the first decade of the 2000s. Multilateral measures to improve the situation were implemented by supporting increases in female obstetrics and gynecology (Ob/Gyn) doctors.
Methods: We analyzed data on the rates of Ob/Gyn doctors engaging in perinatal medicine by years of experience, trends in numbers of new members for the Japan Society of Obstetrics and Gynecology by fiscal year, questionnaires targeting newly certificated Ob/Gyn doctors and distributions of Ob/Gyn doctors in institutions related to Yokohama City University School of Medicine.
Results: Rates of female Ob/Gyn doctors engaging in perinatal medicine in their 11^th years of experience increased from 46% in 2006 to 66% in 2013. Intentions of female Ob/Gyn doctors to work continuously and develop subspecialties have also increased in recent years, while the trend toward increased numbers of new members for the Japan Society of Obstetrics and Gynecology peaked in 2010 and has since been decreasing.
Conclusion: Situations allowing female Ob/Gyn doctors to work continuously have improved, but issues concerning disparities between regions and institutions remain.

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The number of surgeon is decreasing in Japan. However, the new female members of Japan surgical society is increasing, year by year, and 22% of new members in 2008 were female. Japanese women working rate by age shows M-shaped curve and many of them stop working in their 30s and 40s. This tendency is in the same state.
To have the female doctors continue to work, the supporting committee for female surgeon in Japan Society of Surgery and Japan Association of Women Surgeons performed anquet about specialty of doctors, councillars and male-female perticipation together, and female doctor support for the branch society of Japan Medical Society from June to August in 2011.
As results, many branch societies are trying to support female doctors. However, the rate of female in decision making societies, such as councillars, and committee members, is still low.Having female doctors to participate in all decision making society could accerarate the female participation into the society.

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Current status and issues of Japanese women otorhinolaryngologists are discussed. In Japan, in order to obtain Otorhinolaryngology Board, on average, 4 years of training is required. Moreover, it is necessary to continue academic activity in order to get subspecialty license. The acquisition rate is nearly equal between men and women; however, women spend more time to qualify to take board examination because of child rearing. Also, among women otorhinolaryngologists, 37.3% are private practice, 54% are hospital employee, and of those, 35.4% are part time. It is important to develop effective system for women to enhance their career as otorhinolaryngologists.

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The increase of female dermatologists in Japan has created a variety of problems including the patterns of their employments. The Carrier Supporting Committee of the Japanese Dermatological Association has organized the Mentor & Mentee meeting four times a year for young female doctors. In this meeting young female dermatologists can have chances to meet mentors from different facilities and discuss various worries and concerns regarding their carriers. In the Annual General Assembly, we also have been discussing the meanings of continuing the careers of female doctors. This year we organized for the first time “The Leadership Workshop” to train the future female leaders of dermatology. I herein summarize the recent activities of the Carrier Supporting Committee of the Japanese Dermatological Association.

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Together with my wife, who is also a medical doctor, and my 3 children, I have been working as a neurosurgeon for a total of 33 years. Currently, I am the department chair and board member of the Gender Equity Committee of the Japan Neurosurgical Society. My initial contribution describes my personal history of how my wife and I have conquered difficulties as working parents. I further contributed my analysis of the gap between the minds of young doctors and medical students and the reality of working circumstances for medical doctors in Japan. This includes facing life events, especially having children, which present many difficulties for the an individual or partners, and for partners working together. A substitute doctor for maternity leave is not available automatically in Japan. The proportion of women who are medical students in Japan has been increasing by 33%, however the social infrastructure is not ready for it. We definitely need a more sophisticated social system where medical doctor parents can work more comfortably.

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Purpose: To investigate the effect of postoperative early enteral nutrition in gastric cancer patients who received total gastrectomy. Methods: A retrospective analysis of 201 patients who underwent total gastrectomy was conducted. Postoperative early enteral nutrition was principally given to patients who received aggressive surgery or neoadjuvant chemotherapy, patients whose performance status was poor (PS=2 or 3) and patients aged 80 years or over. Fifty patients received postoperative early enteral nutrition in addition to peripheral infusion, and 147 patients received peripheral infusion only. Backgrounds, surgical indicators, and postoperative complications in the two groups were compared. Results: There were many differences in background data between the two groups, but rates of postoperative complications, including pneumonia, were similar. Among the patients who received neoadjuvant chemotherapy case, the incidence of postoperative pneumonia was significantly lower in patients who received postoperative early enteral nutrition (n=15) than in patients who received peripheral infusion only (n=8). In patients whose performance status was poor and patients aged 80 years or over, there was no efficacy of early postoperative enteral nutrition. Conclusion: Early postoperative enteral nutrition reduces the incidence of postoperative pneumonia without adverse events in patients who have undergone total gastrectomy wiht neoadjuvant chemotherapy case.

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The complication rate after pancreaticojejunostomy has been reported to correlate with the number of pancreatectomy procedures performed in the hospital. We hypothesize that external stenting is mainly performed in hospitals with few pancreaticoduodenectomy (PD) cases. Thirty-four patients underwent PD in our hospital between April 2006 and March 2012. External stenting was used in 19 patients (stent group) and was not used in 15 patients (non-stent group). In the stent group, Grade A pancreatic fistula occurred in five patients and Grade B fistula in six patients. In the non-stent group, Grade A fistula occurred in two patients and Grade B fistula in three patients. There were no cases of Grade C fistula. This was not a significant difference between the two groups. The median postoperative hospital stay was significantly longer in the stent group (41 days) than in the non-stent group (23 days). Patients with a soft pancreas and pancreatic duct diameter <3mm had similar outcomes to the overall group. Non-stented pancreaticojejunostomy is as an effective treatment option in a hospital with few PD cases, as stenting does not change the rate of pancreatic fistula occurrence and results in a significantly longer postoperative hospital stay.

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A 58-year-old-woman was diagnosed with an esophageal submucosal tumor. The tumor was located on the left side of the lower thoracic esophagus, and no evidence of malignancy was detected on computed tomography or endoscopic ultrasound. We were unable to perform a fine needle biopsy because of technical difficulties. Preoperatively, the patient was diagnosed with a benign esophageal submucosal tumor, and thoracoscopic enucleation was performed under artificial pneumothorax whilst the patient was in the right lateral position. During the operation, the tumor was pushed out through the endoscope using a balloon dilator. Artificial pneumothorax made it easy to maintain the surgical field and prevented oozing. Artificial pneumothorax and the pushing out of the tumor with a balloon dilator facilitate the thoracoscopic enucleation of esophageal submucosal tumors.

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A 75-year-old woman with systemic scleroderma was diagnosed with early gastric cancer StageⅠA (T1aN0M0P0H0), and underwent distal gastrectomy with D1+lymphadenectomy. Complication of hypertension were seen after surgery. This patient noticed blurred vision 10 days after surgery, and immediately visual disturbance after 14 days after surgery. CT and MRI of the brain revealed abnormalities of in the bilateral occipital lobes. We diagnosed her posterior reversible encephalopathy syndrome (PRES), presenting with visual disturbance caused by hypertension. Hypertension is the most commonly cause of PRES, followed by a malignancy, collagen disease, medications and eclampsia. In perioperative period of patients with these risk factors, blood pressure control is vitally important.

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The liver is hard to be generated for infarction, because it receives double blood stream. However, the fatal progress may be traced when the liver infarction occurs extensively. We report a case of hepatic and splenic ischemia after pancreaticoduodenectomy (PD) for pancreatic head cancer with stenosis of celiac trunk. A 75-years-old woman had high amylasemia at the time of periodical blood test. Pancreatic cancer derived from intraductal papillary mucinous neoplasm was diagnosed by imaging. Preoperative angiography revealed stenosis of celiac trunk. We performed sub-stomach preserving PD. The transaminase was severely elevated on post-operative day 2. Abdominal enhanced CT revealed poor contrasted area was extended in the left lobe, caudate lobe of the liver, and the spleen. It indicated that hepatic and splenic ischemia occurred. In addition, poor contrasting area was observed on the mocosa of the left gastric artery domain. We performed an anticoagulant therapy, conservative medical treatment with the prostaglandin. Ischemia was getting improvement. She discharged without any major complication induced by organs infarction.

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A 68-year-old man visited a physician for chief complaints of constipation, abdominal pain, and anorexia. Chest X-ray radiography showed a tumorous shadow in the left lung, and he was referred and admitted to our hospital. On CT, a tumor with a 4.8cm diameter, suspected as primary lung cancer, was seen in the left upper lobe of the lung, and intussusception-associated ileus induced by a tumor of the small intestine was observed as well. A small intestinal tumor was confirmed near the terminal ileum by contrast imaging through the ileus tube. Laparotomy was performed for the release of ileus. Since the tumor at about 40cm oral to the terminal ileum induced intussusception as the advancing region, partial ileectomy was performed. The small intestinal tumor was histopathologically diagnosed as metastasis of pulmonary adenocarcinoma. He was discharged 27days after surgery and received radiotherapy for the left lung tumor. Oral ingestion was possible until death from cancer 98days postsurgery. The prognosis of small intestinal metastasis of lung cancer inducing intussusception is poor, but surgery based on appropriate estimation may bring the improvement of patientʼs quality of life.

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An-84-year old woman present to a nearby clinic with left lower abdominal pain she had had for two days. Because a rebound tenderness was detected, she was refered to our hospital. CT showed the small intestinal wall thickening, parenteral gas, and rise in density of the circumference fat in proximity to intestinal tract in the left lower quadrant.. Therefore mesenterial abscess of small intestine was suspected. Although the cause was unknown, we diagnosed a mesenterial abscess caused by the small intestine penetration, we performed emergency surgery the same day of hospitalization. As laparotomy findings, we comfirmed a mesenterial abscess of the small intestine in approximately 100cm from the anal side of Treitzʼ ligament. We performed a partial resection of small bowel. Multiple diverticula lay along the mesenterium attachment side when we opened the resected specimen, and one of them penetrated into mesenterium. In the histopathological findings, the diverticulum lack a muscularis propria. Therefore the diverticulum was diagnosed as pseudodiverticulum and pseudodiverticulum penetorated into the mesenterium and formed mesenterial abscess. Pseudodiverticulum occupy most of diverticulum of the small intestine, often occur on the mesenterium attachment side. So when pseudodiverticulum of small intestine perforates it, pseudodiverticulum often penetrate into mesenterium and form mesenterial abscess. When an unidentified mesentery of small intestine abscess is detected, it is necessary to take small intestine penetration of diverticulum into consideration as differential diagnosis.

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We report herein a case of solitary small intestinal recurrence of colorectal cancer. A man in his 70s underwent ileocecal resection with regional lymph node dissection for cecal cancer at Okayama University Hospital in December 2004. The tumor was diagnosed as moderately differentiated adenocarcinoma, and graded as pStage Ⅱ (pT2pN0cM0) according to the Japanese Classification of Colorectal Carcinoma, eighth edition. Thirty-six months after initial surgery, he presented complaining of severe abdominal pain and high fever. Abdominal computed tomography showed localized intra-abdominal abscess. Based on the diagnosis of intestinal penetration, we performed an emergent operation. Intraoperatively, a small intestinal tumor was found to be the cause of the penetration; therefore, both partial resection of the ileum and abscess drainage were performed. Although the patient underwent adjuvant chemotherapy, the tumor recurred in the retroperitoneum in November 2008. He then underwent multimodal therapy, including palliative local resection, radiotherapy, and systemic chemotherapy, to the site of recurrence; however, he died of the cancer about six years after initial recurrence.

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A 50-year-old woman complaining of abdominal pain was diagnosed with tuberculosis of the cecum on colonoscopy. A month later, she was admitted to the hospital with a diagnosis of ileus on abdominal computed tomography (CT). Ileocecal excision was performed. The excised specimen revealed an impacted shiitake mushroom in a stenotic area of the intestinal tuberculosis. When we encounter a patient presenting with tuberculosis of the intestine, the possibility of ileus should be kept in mind in the diagnosis and treatment. Furthermore, dietary counselling appears to benefit the prevention of ileus.

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A 30-year old man with cerebral palsy visited a local clinic complaining of abdominal distention, and was medicated. However, his abdominal symptoms did not improve, and he visited our hospital. Physical examination showed obvious abdominal distention with peritoneal signs in the lower abdomen. Abdominal computed tomography (CT) revealed the whirl sign like appearance of the intestinal mesentery, ascites in the Douglas pouch, and the distended small bowel in the pelvic space.
He was thus diagnosed as torsion of the bowel with strangulation, and underwent emergency laparotomy. Intraoperatively, ileocecal portion was rotated counterclockwise by 360 degree. The rotated bowel was strangulated with extensive ischemic changes. Therefore, the discolored bowel was resected and was anastomosed. His postoperative course was uneventful and oral intake was started on postoperative day 3. He was discharged 20 days after surgery and remains well.
The cecal volvulus often occurs in patients with cerebral palsy and senior persons, and their physical examination may not be pathognomonic, for which early establishment of definite diagnosis and urgent operation are important.

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Goblet cell carcinoid (GCC) of the appendix is rarely diagnosed preoperatively and mostly diagnosed after appendectomy. Although additional resection including lymph node dissection is considered in patients with a potential risk of recurrence, there has been little data about the incidence of lymph node metastases. Here, we present a case report on GCC of the appendix and a review of the published literatures in Japan. An 80-year-old man presented at our hospital with abdominal pain. He was diagnosed with acute appendicitis and underwent emergency laparoscopic appendectomy. Histopathological examination revealed a GCC of the appendix, with subserosal invasion. He underwent ileocecectomy with D3 lymph node dissection following appendectomy because lymph node metastasis was highly suspected. As a result, histopathological findings showed neither residual tumor nor lymph node metastases. The review of the Japanese literatures indicated that the deeper the extent of tumor infiltration, the greater the possibility of lymph node metastases, to be 12.9% in cases with subserosal invasion. Hence, we propose that the depth of tumor infiltration is a novel criteria of additional resection and it would be preferable to add the precise lymph node dissection in patients with subserosal invasion or more.

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A 61-year old man admitted to our hospital, because serum CEA level was high by medical examination. Abdominal computed tomography, barium enema and colonoscopy showed mucocele in the proximal portion of the appendix. Laparoscopic-assisted ileocecal resection with regional lymph nodes dissection was performed because the large tumor was in the proximal portion of the appendix and malignancy could not be denied. The postoperative course was uneventful, and the patient was discharged on postoperative day 14. The histological examination revealed mucinous cystadenoma of the appendix. We concluded that the laparoscopic surgery for the appendiceal mucocele was safe by the protectable technique.

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An 18-year-old male, who was scheduled to undergo bone marrow transplantation for acute myelotic leukemia, complained of abdominal pain on the day of the transplantation. Based on CT images, acute appendicitis was suspected. Myeloablative preparation had already been performed, and bone marrow suppression was expected in a few days; therefore, appendectomy by laparoscopic approach was indicated on the day of the bone marrow transplantation. There were no complications related to the operation, and he was discharged on the 156^th postoperative day. The surgical treatment for leukemia patients should be decided after careful consideration based on their bone marrow suppression status. In this case, immediate diagnosis and treatment for acute appendicitis were essential for a successful bone marrow transplantation.

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We report a case of the stenosis of the colon because of Cronkhite-Canada syndrome (CCS) that was surgically resected. 61-year-old man had diarrhea. He had alopecia of the scalp and skin pigmentation on his legs. His serum albumin was 1.8g/dl. Colonoscopy showed multiple polyps and stenosis of the colon. We diagnosed the case as CCS. He was tried to treat conservatively, however he still had the stenosis and hypoalbuminemia. Extended right hemicolectomy was performed. The post operative course was uneventful. There was no recurrence of CCS and his serum albumin is within a normal range. We concluded that surgical resection is a choice of the treatment in patients who do not respond to conservative therapy.

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We describe a patient who developed sigmoid colon penetration after left inguinal hernia repair with a mesh plug. The patient was an 80s man who had undergone repair of a left inguinal hernia 10 years previously. He presented to our hospital because of purulent discharge from the surgical scar in the left inguinal region. CT scans revealed a fistula between the sigmoid colon and the body surface. We diagnosed penetration of the sigmoid colon by the mesh used for hernia repair and performed surgery. At operation, it was found that the mesh plug had penetrated the sigmoid colon, creating a mass with strong adhesion to the scarred abdominal wall in the left inguinal region. We resected the affected part of the sigmoid colon together with the mesh and the fistulous track.
Examination of the resected specimen revealed that the tip of the mesh plug had entered the sigmoid colon, leading to the cutaneous fistula. Postoperatively, he developed surgical site infection, but recovered with conservative treatment. There have only been a few reports of Japanese patients with colon penetration after inguinal hernia repair, so we are reporting this case with discussion of the literature.

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We report a case of Pneumatosis intestinalis (PI) caused by ischemic enteritis, which was cured by conservative treatment. A 80 year old woman developed abdominal distention and was admitted. Tenderness was seen in the left lower quadrant of abdomen, but peritoneal irritation sign was slight and limited. CT scan showed edematous wall thickness from the Transverse colon to the Sigmoid colon, and also emphysema in the subserosal layer which was discontinuous. Slight ascites was seen, but neither free air nor portal venous gas was. Blood examination data showed slight inflammation, but no other abnormal findings. Conservative treatment was chosen from the diagnosis of PI caused by ischemic enteritis. CT scan findings of day 9 after admission, showed no abnormal findings. The patients symptoms and general condition improved and was discharged on day 13 after admission. PI is a rare disease which has many other diseases in the background, and is considered to undergo surgery for suspiciousness of gastrointestinal perforation at times. Treatment plans should be carefully chosen especially in cases like this, which show extensive emphysema in the subserosal layer and ascites.

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Mucosal malignant melanoma has a particularly poor prognosis because there are few subjective symptoms in the early stage, and it easily metastasizes because most of these tumors occur in areas where blood vessels are abundant, such as the gastrointestinal mucosa. We report a case of anorectal malignant melanoma diagnosed after local excision and review the literature. An 84-year-old woman was admitted to our hospital because of anal bleeding. She was diagnosed with anorectal polyp on examination, and a transanal resection was performed. Postoperative histological diagnosis confirmed a malignant melanoma, and a vertical positive margin was suspected. An additional resection was performed, but a positive margin on the oral side of the dentate line was suspected this time. We suggested performing an abdominoperineal rectal resection with radical excision, but she did not give permission for this procedure. Because there was no evidence that chemotherapy would improve her long-term survival, she did not agree to chemotherapy as well. Interferon maintenance therapy was performed considering her older age and the lack of distant metastasis. However, local recurrence was observed 6 months after the primary surgery, and multiple liver metastases were observed 8 months after that. The patientʼs progress in this case reconfirmed that the malignancy of mucosal malignant melanoma is high if aggressive chemotherapy is not performed.

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Metastasis from renal cell carcinoma (RCC) to the pancreas is an uncommon site. We report a surgical case of RCC with synchronous pancreatic metastasis. A 74-year-old woman was admitted to our hospital because of right renal tumor and pancreatic tumors. Abdominal computed tomography showed enhancing tumors in the right kidney, left adrenal gland, pancreatic head and body. Magnetic resonance imaging revealed that right renal tumor, left adrenal tumor and pancreatic tumors were low intensity on T1-weighted image and high intensity on T2-weighted image. Right RCC with left adrenal metastasis and multiple pancreatic metastases was diagnosed, and right nephrectomy, left adrenalectomy and pylorus-preserving pancreaticoduodenectomy were performed. Histopathological examination revealed clear cell carcinoma in the renal tumor, adrenal tumor and pancreatic tumors. The postoperative course was uneventful and she was discharged from the hospital on the 30^th postoperative days. However nephrectomy and pancreatectomy are an invasive, they are safe method for RCC with synchronous pancreatic metastasis.

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A 64-year-old women admitted to a nearby hospital because of abdominal pain, diarrhea and thirst. On laboratory testing, increased serum pancreatic enzymes and HbA1c, she was referred to our hospital on suspicion of chronic pancreatitis. An abdominal enhanced CT showed a mass measuring 25mm in diameter located in the head of the pancreas, and pancreatic cancer was suspected. Endoscopic ultrasound guided fine needle aspiration biopsy (EUS-FNAB) was done from the mass of pancreas, cytological diagnosis of anaplastic carcinoma with osteoclast-like giant cell type of the pancreas. After careful examination, she was diagnosed synchronous triple cancer including right breast cancer and papillary thyroid cancer. Progression of right breast cancer and papillary thyroid cancer is slowly, pancreatic cancer is determined to be prognostic factor. She underwent subtotal stomach preserving pancreaticoduodenectomy. Anaplastic pancreatic carcinoma is rare and is associated with poor prognosis. Synchronous triple cancer including anaplastic carcinoma is very rare, and only 1 cases, have been reportes in Japan. We reported this patient and review the literature.

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A 60-year old man was pointed-out a cystic lesion in the pancreatic body by screening of CT scan. After 1year, the cystic lesion was increased slightly by followed up CT. Serum CA19-9 level was remarkably elevated. ERCP showed that the cystic lesion had no communication between main pancreatic duct and cystic lesion. As a tendency to increase with high serum tumor marker level, the cystic lesion was diagnosed as cystic tumor of the pancreas not to deny possibility of malignant potential. Considering a possibility of malignancy, distal pancreatectomy with lynphadenectomy and splenectomy was performed subsequently. Pathologically, the cyst wall was lined by stratified squamous epithelium with lymphatic follicle in places. So the cystic lesion was diagnosed as pancreatic lymphoepithelial cyst (LEC). The immunostaining findings showed positive in CA19-9 at squamous epithelium.Three months after the operation, serum CA19-9 level was normalized to 18U/ml. We should considered that the possibility of LEC when we need differential diagnosis of the pancreatic cystic lesions.

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A 39-year-old man was referred to our department because of gastric submucosal tumor during a health screening. Abdominal enhanced computed tomography revealed two well-defined and hyper-vascular tumors dorsal to the duodenal bulb, and they did not have the continuity to the stomach and the duodenum. Magnetic resonance imaging confirmed both tumors were isointense to spleen on the T1-weighted image, and were slightly hyperintense to the spleen on the T2-weighted image. We suspected Castlemanʼs disease, gastrointestinal stromal tumor, neuroendocrine tumor, or malignant lymphoma. Since we could not rule out the possibility of malignancies, laparoscopic surgery was performed to obtain a definite diagnosis and perform adequate treatment. These tumors were located in the gastrocolic ligament near the duodenal bulb, and were resected safely with ultrasonically activated coagulating shears. The histopathological diagnosis was unicentric Castleman’s disease of hyaline vascular type. Castleman’s disease is difficult to differentiate accurately from other solid tumors, because it does not have specific clinical signs and imaging findings. In the intra-abdominal tumor which does not exhibit an obvious malignancy like this disease, laparoscopic surgery is useful for diagnostic treatment because of its minimal invasiveness.

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An 83 year-old female who had no previous surgeries had sudden abdominal pain and visited our hospital. Abdominal CT scan showed dilation of the small intestine and left obturator hernia. Therefore, she was diagnosed with ileus due to incarcerated obturator hernia and underwent an emergency operation. Laparoscopic surgery revealed left obturator defect, but the cause of ileus was a defect of the mesentery of the transverse colon. Small intestine incarcerated through the defect. The incarcerated small intestine was not necrotic, so it needed no repair. The patient followed a good postoperative course, so we discharged her on postoperative day 8. Transmesocolic hernia is an infrequent disease and it made the diagnosis difficult. Our case had an obturator hernia which we were not able diagnose before surgery. However, we were able to search all of the abdominal cavity by the use of laparoscopy and find that the cause was ileus. Thus, we found that laparoscopy is a good approach to search for the cause of idiopathic ileus.

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