Background and purpose: This retrospective study was undertaken to clarify the risk of surgical site infection and intrapelvic recurrence in patients with rectal cancer undergoing transabdominal single stapling side-to-end anastomosis (SSSE). Patients and methods: The subjects were consecutive 90 patients with rectal cancer operated on with tansabdominal SSSE, which was performed by single surgical team. Data of clinicopathological factors, surgical site Infection, and type of recturrence were retrieved from the medical charts and analyzed.
Results: The madian age of patients was 64 years (range, 29-90 years) and 56 were male. The primary sits was rectosigmoid (RS) in 49, upper rectum (Ra) in 35, and lowerer rectum (Rb) in 6. Pathological Stage was Stage 0 in 7, I in 28, Ⅱ in 24, Ⅲ in 35, and Ⅳ in 3. Surgical site infection developd in 3 patients (6.7%). With a median radiographic follow-up with CT scan of 839.5 (102-4,509) days (n=78). there was no intrapelvic recurrence. Conclusion: These results suggest that transabdominal SSSE might be safe in terms of surgical infection and oncological point of view.

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A 30-year-old woman presented at our hospital with slurred speech but otherwise normal neurological function. She was referred to an endocrinologist due to concern regarding thyroid disease. Two nodules were found in the left lobe of the thyroid gland by ultrasound examination; first, a 15mm diameter nodule in the upper pole and second, a 40mm nodule caudally adjacent to the first. Cytological examination revealed the upper nodule to be a papillary carcinoma and the other to be an adenomatous goiter. Left thyroid lobectomy and lymph node dissection was performed. Intraoperatively, the papillary carcinoma was found to be contiguous within the thyroid. However, there was no contiguity between the left thyroid lobe and the adenomatous goiter. We concluded the adenomatous goiter may have developed from an ectopic thyroid gland.
In most cases, an ectopic thyroid gland is a congenital disease caused by an abnormal descent of thyroid tissue during embryonic development. Rarely, after the thyroid gland attains its final position, aberrant thyroid tissue develops before the thyroid capsule is formed. In our case, the adenomatous goiter may have developed from aberrant thyroid tissue.

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A 73-year-old man with type 2 gastric cancer of the lower stomach underwent distal gastrectomy followed by Roux-Y reconstruction, D2 lymphadenectomy, and cholecystectomy in June 2007. He was discharged on postoperative day 28. However, he admitted 2 days after discharge because of abdominal distension and sense of fullness. An abdominal paracentesis yielded of milky ascitec fluid and revealed chylous ascites. By conservative treatment with fasting, administration of diuretics, drainage, and IVH, chylous ascites diminished gradually and disappeared in spite of house diet by the 23rd hospital day.
Chylous ascites after radical gastrectomy with D2 lymphadenectomy is quite rare and occured usually before 10 days after gastrectomy. In our case, chylous ascites developed in a month after the operation and he was successfully treated with conservative method within 73 days.

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【Objective】We report 3 cases in which PEG (percutaneous endoscopic gastrostomy) was difficult to perform, and instead performed open gastrostomy by mini-laparotomy using a replaceable button gastrostoma kit.
【Cases】Case 1: 70-year-old male with esophageal cancer accompanying full stenosis following chemoradiation therapy. Case 2: 86-year-old female. Oral feeding was difficult following cerebral infarction, and marked cervical flexure and a hunchback posture were noted. The transverse colon was present in the anterior of the abdomen. Case 3: 80-year-old female with difficulty eating accompanying Alzheimerʼs dementia., and demonstrating ileus with sigma volvulus. The sigmoid colon was present in the anterior of the abdomen. All cases underwent open gastrostomy by mini-laparotomy.
【Technique】Under general anesthesia, a 5-cm minilaparotomy was performed in the upper abdomen. In the anterior wall of the abdomen, from the left side, a replaceable ideal button was inserted along the rectus abdominis muscle. The insertion site in the abdominal wall and gastric wall was reinforced with an absorbable suture.
【Result】Surgery lasted 20-35 minutes. The postoperative course was favorable.
【Summary】This simple technique requires no special instruments. The button also has the benefit of making daily management convenient.

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A 71-year-old male attended a hospital for examination of anemia. Abdominal CT revealed a large cystic tumor, 26cm in diameter. GIST was diagnosed on the basis of pathological findings. Though imatinib chemotherapy was started, tumor size increased and the patient admitted to our hospital. Abdominal CT revealed a heterogeneously enhanced polycystic tumor, 30×25×18cm, protruding into the stomach, compressing the abdominal wall, pancreas, and transverse colon. Surgery was performed for the large gastric GIST. The tumor adhered strongly to the pancreatic body and transverse colon, but did not infiltrate nearby organs. The tumor was completely resected by wedge resection of the stomach, after which histopathological testing revealed the presence of spindle cells with a long oval nucleus. Immunohistochemical analysis showed that the specimen was positive for KIT and CD34. The patient survives with no recurrence, 18 months after surgery. GIST of the stomach that is more than 30cm in diameter is rare. Therefore, we present this case, which is reported along with appropriate bibliography.

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We underwent open cholecystectomy for an adult patient with gall bladder stone complicated with preduodenal portal vein (PDPV). Splenic vein was merged with inferior mesenteric vein in the left side of abdominal cavity, then merged with superior mesenteric vein and became portal vein, ran towards right side of abdominal cavity and elongated to S-shape at ventral side of 2nd and 3rd portion of duodenum, then ran at ventral side of common bile duct and proper hepatic artery within the hepatoduodenal ligament. This case was not exactly the same as previously reported, so-called PDPV, in which portal vein runs at ventral side of 1st portion of duodenum and causes stenosis of duodenum. But considered in terms of abnormality of embryological development, this case was considered to be caused by the same abnormality of development as so-called PDPV.

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The patient was an 80-year-old man. With a history of chronic heart failure, malnutrition, ventilatory impairment and cerebral infarction, the patient underwent partial resection of the sigmoid colon and Hartmannʼs procedure to relieve symptoms of obstructive sigmoid colon cancer. Ten days postoperatively, he complained of sudden abdominal pain and developed small intestinal prolapse due to parastomal wound dehiscence. Emergent surgery was performed the same day to close the wound. Postoperatively, the patient suffered congestive heart failure and ventricular fibrillation. At the end, he died. In colostomy, when the patient has risk factors as delayed wound healing and deterioration of abdominal wall, tight sutures can avoid such terrible complication. We describe our experience treating this case of small intestinal prolapse caused by parastomal wound dehiscence, with reference to the literature.

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A 62-year-old woman who had undergone left recurrent inguinal hernia repair with a mesh plug nine years prior was admitted to our hospital for left inguinal swelling and pain. Abdominal computed tomography revealed a left inguinal abscess. Percutaneous fistulography results indicated that the abscess had penetrated the small intestine. We diagnosed the causes of the abscess as intestinal penetration by the mesh plug. After adequate percutaneous abscess drainage, we performed simple intestinal closure by the abdominal approach and mesh plug extraction by the anterior approach. Among postoperative complications of inguinal hernia repair by prosthesis, intestinal perforation and penetration are infrequent. Although these complications occurred only infrequently, they can produce severe damage. Therefore, sufficient cares must be taken to prevent complications.

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A woman in her 80s visited our hospital with severe abdominal pain and hematemesis. An emergent gastrofiberscopy was performed, and she was diagnosed with gastroesophageal reflux. However, she continued to have severe abdominal pain, rebound tenderness and muscular defense. An abdominal CT scan was performed and indicated strangulated bowel obstruction. Because of hypovolemic shock and acute renal failure, conservative therapy with fluid replacement and insertion of a long decompression tube was initiated. On the third day of hospitalization, the patientʼs general condition improved and an operation was performed. The operative findings were massive hemorrhagic ascites and intestinal necrosis. The Kugel patch had adhered to the omentum, trapping the small intestine into an adhesive band around the prosthesis. This Kugel patch had been inserted 5 years previously. Recently, several complications involving prostheses have been reported, including infection, ileus and perforation, but there have been few cases of strangulated bowel obstruction caused by adhesion of a direct Kugel patch. Therefore, we chose to report this case along with a review of the literature.

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A 78-years old man began to suffer from frequent vomiting, since he had eaten a dried persimmon three days ago. He had no abdominal surgery history. He came to vomit many times, so he consulted a nearby doctor. An abdominal X-ray examination showed niveau and ileus was suspected. He was then referred to our hospital. We suspected food induced ileus because CT showed bubbly mass and impaction sign in the ileum, and the intestinal tract remarkably expanded from the oral section up to the obstruction point. We performed emergency surgery on the same day.
We cut open 3cm of umbilical section and performed single incision laparoscopic surgery. When we observed the abdominal cavity, and we confirmed an impaction of firm food ball in the ileum at approximately 50cm oral side from terminal ileum and diagnosed it as food induced ileus. We drew the intestinal tract outside the incision and we tried milking, but since this proved difficult, we cut the intestinal tract open about 3cm and resected an impacted food ball. The food ball that became impacted was a dried persimmon. The postoperative course was uneventful and he was discharged from hospital on the seventh day after the surgery.
By conducting a detailed interview and recognizing the characteristic in a CT image of signs of food induced ileus, if food induced ileus is preoperatively diagnosed, it would be able to choose the minimally invasive operative method.

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Case 1: An 89-year-old man who had been monitored for abdominal aortic aneurysm presented with positive fecal occult blood test. Colonoscopy showed adenocarcinoma 3cm in size on contralateral side to the Bauhin valve.
Case 2: An 81-year-old woman had complained of an abdominal pain and bloody stools. Colonoscopy revealed adenocarcinoma in the vicinity of the Bauhin valve. She had been also followed previously for an abdominal aortic aneurysm, which had been growing gradually.
In both cases, endovascular aortic repair (EVAR) with stent grafting was performed and following this initial operation laparoscopic right hemicolectomy was carried out (7 days and 12 days after EVAR in case 1 and 2, respectively). No postoperative complications were observed. Patients were discharged after 17 and 25 days after EVAR, respectively. In both patients with advanced age and synchronous abdominal aortic aneurysm and ascending colon cancer, minimally invasive two-staged surgery achieved good therapeutic results. Combination of two separated minimally invasive treatments seems to be an effective approach in similar cases.

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Case 1: A 43-year-old man with right lower abdominal pain was diagnosed with acute appendicitis and underwent a simple appendectomy. Intraoperative findings showed appendicitis empyematosa with dirty ascites. Histopathological findings of the surgical specimen revealed goblet cell carcinoid (GCC), and the surgical margins were positive for the tumor. Therefore, we recommended additional resection to the patient. A right colectomy with lymph node dissection (D3) was done in another hospital and no residual tumor or metastatic lymph nodes were pathologically identified in the specimen.
Case 2: A 67-year-old man visited our hospital for right lower abdominal pain. We diagnosed acute appendicitis and performed a laparoscopic appendectomy on the same day. Intraoperative findings showed appendicitis empyematosa. The pathological result was GCC. Based on the malignancy of this tumor, we performed laparoscopic ileocecal resection with lymph node dissection (D3). Histopathologically, no remaining tumor or lymph node metastases were found.
GCC is a rare neoplasm that is considered more malignant than classical carcinoid. More data are required to determine appropriate surgical treatment and chemotherapy for GCC.

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The patient, a 32-year-old man, visited our hospital with the chief complaint of abdominal pain. He was diagnosed as having sigmoid volvulus and underwent an emergency Hartmannʼs operation. The postoperative course was favorable, and the patient was discharged with the advice to present for follow-up at the outpatient service. During the follow-up period, the patient became aware of abdominal distension. On barium enema, the residual portion of the large bowel was diffusely distended, with loss of the haustra from the left transverse colon to the descending colon. Under the diagnosis of chronic idiopathic intestinal pseudo-obstruction, the large bowel segment from the left transverse colon to the descending colon was resected, followed by a right transverse colostomy. The patient had an uneventful course postoperatively without any recurrence of the symptoms, and the right transverse colon was anastomosed with the residual portion of the rectum. The patient has been under regular follow-up checkups at the outpatient service and remains asymptomatic, without any sign of recurrence.

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The patient was a 62-year-old woman who after undergoing a right pectoral-muscle-conserving mastectomy at 53 years of age for a diagnosis of right breast cancer (invasive ductal carcinoma, papillotubular carcinoma, pT4bN3aM0, Stage ⅢC, ER (+), PgR (+), HER2 (3+)) received chemotherapy and hormone therapy. During the 5^th year postoperatively she developed right supraclavicular lymph node metastasis, multiple bone metastases, and lung metastasis. The lung metastasis resolved in response to chemotherapy and hormone therapy. Four years later, although there were repeated relapses and remissions of metastatic bone tumors, the drugs were changed one after another, and a long SD (stable disease) state was achieved. Because a metastatic liver tumor (liver metastasis by breast cancer based on a tissue biopsy) and rectal cancer were detected during the 9^th year postoperatively, a Hartmannʼs procedure was performed. Peritoneal dissemination around the site of a primary rectal cancer was observed at surgery, and the histopathological findings revealed that breast cancer was the source of the peritoneal dissemination. Moreover, this was an extremely rare case in which a breast cancer that had peritoneally disseminated on the serosal side of the primary site of the rectal cancer and the rectal cancer had collided.

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A 75-year-old male tested positive for fecal occult blood. Colonoscopy revealed an Ip-type irregular surfaced protruding lesion, measuring 9mm in the rectosigmoid colon. We performed endoscopic mucosal resection (EMR) for this lesion. Histologically, the lesion showed well differentiated adenocarcinoma, invading deeply into submucosal layer without lympatic or venous permeation. The tumor was completely removed and CT showed no signs of metastasis. But We considered the risk of lymph node metastasis and the additional surgery was recommended with lymph node dissection and low anterior resection (D2) was performed. On histopathological examination of the resected specimen, both residual cancer and lymph node metastasis were not recognized. After surgery, CT showed the solid nodule of 5mm in diameter in the apex of the right lung after 1year 10 months. After that, the tumor was enlarged from 5mm to 7mm during 9months and partial resection was performed. Histological findings of resected lung tumor showed the well differentiated adenocarcinoma same as the primary rectal lesion and was diagnosed as lung metastasis. As of 2 years 6 months after partial resection, new metastasis has not occurred. Submucosal colon cancer with metachronous pulmonary metastasis is rare. The resection of lung metastasis is expected good prognosis, therefor it is necessary to accumulate more cases and establish an appropriate surveillance.

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A 73-year-old man underwent a Hartmannʼs operation for an advance rectal cancer and received UFT/UZEL therapy during six months. Nine months after the operation, he developed peritoneal dissemination and was performed bypass surgery. Then, he received mFOLFOX6 therapy. He brought about disturbance of consciousness on treatment day 2. On magnetic resonance imaging (MRI) study, abnormal findings were not detected in the central nervous system. On laboratory data, he was diagnosed as a hyperammonemia induced by a 5-fluorouracil (5-FU). He was treated with branched-chain amino acid solutions and continuous hemodiafiltration. The next day, symptom of encephalopathy was disappeared and level of serum ammonia returned within normal range.
When patients treated with mFOLFOX6 or FOLFIRI present with neurological disorders, the possibility of hyperammonemia induced by 5-FU should be taken into consideration.

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Fournierʼs gangrene is a necrotizing fasciitis of the external genitals and perineum. It rapidly spreads around the affected areas and thus easily becomes fatal. It is rarely caused by rectal carcinoma. However, it is associated with advanced cancer and bad prognosis. We report a 74-year-old male patient diagnosed with Fournierʼs gangrene due to rectal carcinoma who achieved long-term relapse-free survival without undergoing postoperative chemotherapy.
The patient presented to our emergency department because of scrotal pain. He underwent emergency surgery, including penis scrotum extraction, debridement, and cystostomy in the urology department and plastic surgery on the same day.
Rectal vesical fistula was diagnosed at that time, and after thorough examination, it was found to be caused by rectal cancer. The patient underwent total pelvic exenteration, rectal amputation, and ureterocutaneous-fistula on the 16th postoperative day.
The rectal vesical fistula due to the rectal cancer was confirmed during the surgery and was diagnosed as Fournierʼs gangrene. After the surgery, he was doing well and was transferred to the 43rd.
He refused to undergo chemotherapy after the operation. Nevertheless, the patient had no recurrence for 4 years 10 months after the operation and survives up to the time of this writing.

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The patient was a 36-year-old female who had undergone hepatectomy and diaphragm resection for a large primary hepatic yolk sac tumor. Two months later, local recurrence under the diaphragm was found. We therefore performed repeat hepatectomy with a wide range of diaphragm resection as well as repair of the diaphragm with a right fascia lata. The patientʼs postoperative coarse was uneventful, including the status of her respiratory function. Fascia lata is a bio-material that can be conveniently harvested and carries a decreased risk of infection. Considering these advantages, repairing the diaphragm with the fascia lata is a useful method for performing surgery for large hepatic tumors invading the diaphragm.

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We report a case of resected hepatic tumors metastasizing from uterine cervical cancer. A 74-year-old woman pointed out two hepatic tumors 5 years after radiation therapy for uterine cervical cancer. Abdominal ultrasonography and computed tomography showed two hepatic tumors in the liver. No other metastatic lesion was found, so conducted a partial hepatectomy. Pathological findings showed squamous cell carcinoma. She survived 2 years after hepatectomy without recurrence.

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We report a case of laparoscopic cholesystectomy (LC) for a left-sided cholecystocholedocolithiasis with a right-sided round ligament. A 65-year-old woman was referred to our hospital because of epigastralgia. Biochemical blood test showed liver function disorders. Abdominal CT and magnetic resonance cholangiopancreatography (MRCP) showed gallbladder wall thickening and stones in gallbladder and common bile duct. Abdominal CT also showed portal anomaly that right portal vein branched independently and the fundus was attached to lateral side of left liver. The stone in common bile duct was removed by endoscopic surgery. Then we performed laparoscopic cholecystectomy using usual four ports. The gallbladder fundus was attached to lateral side of left liver and cystic duct was confluent to the right side of common bile duct. The fundus was first detached from the liver bed, Calotʼs triangle was safely exposed and then gallbladder was removed. To perform LC safely we should take care about LSG and if it is suspected, we also care about the anomaly of the bile duct, artery and portal vein.

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A 65-year-old woman admitted to our hospital suffered severe diarrhea and weight loss. Our examinations revealed hypokalemia and high level of vasoactive intestinal polypeptide. Abdominal imaging demonstrated hypervascular mass measuring 40mm in pancreatic head, and a preoperative diagnosis of pancreatic VIPoma was made. Pylorus-preserving pancreato-duodenectomy was performed and the diagnosis was confirmed by immunohistochemical techniques. Serum VIP levels declined and hypokalemia and diarrhea improved after operation. She has not experienced a reccurence until 3 years and 9 months.

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A 79-year-old woman underwent a total gastrectomy with R-Y reconstruction due to gastric cancer (T1aN0M0fStage ⅠA) in June 2011. Abdominal computed tomography for evaluation of mild liver dysfunction 8 months after surgery revealed a tumor around the duodenal papilla, but no dilatation of the main pancreatic duct. Double-balloon endoscopy, thereafter, revealed a protruding lesion at the descending duodenum, and adenocarcinoma (tub1) cells were found in biopsy samples from that lesion. Pancreaticoduodenectomy was performed under the diagnosis of a primary duodenal cancer. Histopathologically, the tumor was an invasive ductal carcinoma arising from the minor papilla of the pancreatic duct. Herein, we report this rare case of groove pancreatic carcinoma and summarize this disease by literature review.

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A 57-year-old man was referred to our hospital after a mass that was gradually increasing in diameter was found in the spleen. Abdominal computed tomography showed a 50mm, poorly enhanced mass in the spleen. Since the tumor gradually increased in size, and had a high FDG accumulation on FDG-PET, we were not able to rule out malignant disease. Therefore, a laparoscopic splenectomy and distal pancreatectomy were conducted. The pathological diagnosis using immunohistochemistry for CD31, CD34, and CD8 was sclerosing angiomatoid nodular transformation (SANT). Postoperatively, we found a growing pancreatic fistula and treated it with endoscopic transgastric drainage. The patient had no recurrence during the 2-year follow-up period. In this paper, we describe our case as well as other cases in Japan and review the relevant literature.

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Emphysematous cystitis is a rare form of lower urinary tract infection. We report a case of emphysematous cystitis with malnutrition after surgery for gastric cancer. The patient was a 76-year-old woman who presented with complaints of nausea and vomiting. Abdominal computed tomography (CT) showed a gaseous shadow in the bladder wall. The urine culture grew Escherichia coli. These findings were compatible with a diagnosis of emphysematous cystitis. Urethral catheterization and administration of antibiotics improved the clinical course. The gaseous shadow in the bladder wall resolved based on follow-up CT scan.

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A 91-years old woman present to our hospital with lower abdominal pain, abdominal distension, fever, and purulent vaginal discharge. She had no abdominal surgery history. She was diagnosed by bowel obstruction and the pyometra, and was hospitalized. Although a nasogastric tube was detained, the symptom was not improved, so she was reffered to our department on the next day. Because she had severe esophageal hiatal hernia, we were not able to detain a long tube. We operated after three days of hospitalization because conservative treatment did not succeed. As laparotomy findings, ileum attached to the uterus base and bent it and presented with bowel obstruction. In operation, the attachment came off easily, and a large quantity of pus began to flow from the uterus. Thus, we diagnosed it with the mechanical ileus obstruction that a perforation department of the pyometra became the obstructing starting point and performed the right adnexectomy and hysterectomy. She developed sepsis postoperatively. Sepsis was improved by an intensive care, but her anamnestic heart failure worsened and she was passed away on the 25^th day of hospitalzation. We review the therapy of pyometra perforation had been reported in Japan and report it.

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A 17-year-old girl presented at our department because of left upper abdominal distention. An elastic-hard mass the size of a childʼs head was palpated in the left upper abdomen, but there were no abnormalities on serum chemical tests, including tumor markers. Computed tomography showed a parenchymal tumor located between the stomach and the transverse colon. Magnetic resonance imaging showed low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. Integrated positron-emission tomography and computed tomography revealed high accumulation of tracer in the tumor. A malignant mesenchymoma was suspected, and surgery was performed. The tumor measured 220mm in longest diameter and was located in the posterior portion of the greater omentum. It partially invaded the splenic flexure of the transverse colon and the diaphragm, and the involved regions were concurrently resected. The resected specimen weighed 2,600g. The cut surface of the tumor was grayish white and parenchymal. The histopathological diagnosis was intra-abdominal desmoid tumor. This disease is extremely rare in young women with no history of open surgery. We report this extremely rare case, along with a discussion of the literature.

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The patient was a 55-year-old female who visited a physician for chief complaints of fever and right upper abdominal pain. A unilocular cyst with a diameter of 10cm was present in the right abdominal region on abdominal CT. On MRI, a cystic lesion with no high-T2 intensity or solid component of the content and unclear continuity with the intestine was present. The patient was referred to our hospital for surgery.
Laparotomic tumorectomy was performed at our hospital. The tumor was observed in the posterior wall of the omental sac, suggesting its location in the transverse mesocolon. It strongly adhered to the stomach and transverse colon, and also adhered to the abdominal wall and gall bladder through the omentum, for which combined partial resection of the stomach and transverse colon walls was performed.
The specimen was an 11-cm unilocular cyst containing viscous yellow liquid including necrotized debris, and no communication with the stomach or transverse colon was observed. Histopathologically, no intestinal structure or intestinal duplication was observed. Inflammatory cell infiltration was noted in the wall structure, showing reactive changes.
Based on the above findings, the lesion was diagnosed as a giant mesenteric cyst induced by infection. We report the case with a literature review.

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A 63-year-old man was admitted to our hospital for treatment of a huge abdominal tumor. Computed tomography and magnetic resonance imaging of the abdomen revealed a 20-cm heterogeneous mass in the retroperitoneum of the right upper quadrant. With a diagnosis of retroperitoneal tumor, the patient underwent laparotomy. Because the tumor invaded or was adherent to the duodenum, pancreas head, colon, right kidney, and inferior vena cava, we performed pancreaticoduodenectomy, right hemicolectomy, right nephrectomy and partial resection of the inferior vena cava for complete resection of the tumor. The tumor was histopathologically diagnosed as retroperitoneal leiomyosarcoma. Because the patient developed local recurrence 17 months after surgery, he received systemic chemotherapy using Doxorubicin and Ifosfamide. However, the patient died 28 months after surgery due to wide-spread recurrence of leiomyosarcoma.

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A 69-year-old male was pointed out to have a 35mm tumor in the left pararenal retroperitoneal region on CT. He had a history of worsening left lumbago. Computed tomography showed the tumor contained dense areas of spotty calcification in the unenhanced phase and strong enhancement in the early to late phases. Magnetic resonance imaging demonstrated low intensity in the T1 phase and slight high intensity in the T2 phase. Abdominal angiography showed that the feeding artery of the tumor was the left lumbar artery; however, no definitive preoperative diagnosis could be made. The mass grew up to 60mm in diameter and the left lumbago worsened over 14 months. Therefore, under the diagnosis of a neurogenic tumor or malignant retroperitoneal tumor, surgical excision was performed. A 60×50×30mm dark yellowish elastic hard mass was extracted; the pathological diagnosis was the hyaline vascular type of Castlemanʼs disease.
We herein report a case of the rapid growth of Castlemanʼs disease in the left pararenal retroperitoneal area.

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An 83-year-old man, underwent trans-hiatal esophagectomy, and with retrosternal gastric tube reconstruction for esophageal cancer. Five days after the surgery, intestinal gas was shown in the left thoracic cavity by X-ray. A diaphragmatic hernia was observed on an abdominal computed tomography scan. Emergency surgery was performed. The esophageal hiatus was expanded, and the transverse colon was prolapsed into the left thoracic cavity. First, the transverse colon was returned into the abdominal cavity. Then, the soft tissues of the left triangular ligament of the liver and fatty tissues were placed over the esophageal hiatus. Although a diaphragmatic hernia following esophageal cancer surgery is rare, it is a grave complication.

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A 59-year-old man with a 2-year history of an expanding groin swelling that had been present since early childhood presented to our hospital. He was diagnosed with a right inguinal hernia and hernioplasty was performed via the anterior approach. Intraoperative findings showed a right inguinal hernia (I-2). Adherence of the appendix to the hernial sac was noted on exposure of the sac. Ligature was performed peripheral and superior to the adherent appendix that crossed the hernial sac, followed by Lichtenstein repair. The peripheral hernial sac was resected up to the tip. We describe this rare case of Amyandʼs hernia and provide a discussion in relation to the 35 previously reported cases in Japan.

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A 79-year-old woman was transferred to our hospital because of a diagnosis of gastric GIST and a rectal carcinoid. We performed a laparoscopy-assisted gastric wedge resection and a super-low anterior resection of the rectum, with an ileostomy. The operative duration was 4 hours, 47 minutes, and the total blood loss was 15mL. An immunohistochemical study of the gastric tumor showed positive staining for CD34, c-kit, and a Ki labeling index of 1%-3%. We diagnosed the tumor as a GIST of intermediate risk (modified-Fletcher classification). An immunohistochemical study of the rectal tumor showed positive staining for synaptophysin, chromogranin,and CD56. We diagnosed the tumor as a rectal carcinoid. We performed a laparoscopy-assisted concurrent surgery for synchronous gastric GIST and a rectal carcinoid, using novel port placement and a minilaparotomy.

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A 73-year-old male complaining of bloody stool was diagnosed with double cancer of the stomach and the rectum. Laboratory data showed a high level of serum alpha-fetoprotein [AFP (4633.4→13,623ng/mL)]. A computed tomography (CT) scan showed multiple liver metastases. CapeOX therapy was administered and was remarkably effective. The serum AFP level normalized, and a follow-up CT scan showed a remarkable reduction in liver metastases. We performed distal gastrectomy and low anterior resection of the rectum as well as partial resection of the liver. The patient is currently alive and shows no recurrence 3 years and 3 months after the operation without adjuvant chemotherapy.
Here we report a case of long-term survival without recurrence in a patient with double cancer (AFP-producing gastric cancer and rectal cancer) and synchronous liver metastases who was successfully treated with systemic chemotherapy and operation.

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The patient was a 70-year-old female who was examined due to bloody stools, diagnosed with sigmoid colon cancer, and underwent sigmoidectomy and D2 lymphadenectomy at another hospital. The pathological diagnosis was SS, N0, M0, Stage Ⅱ moderately differentiated adenocarcinoma. After 1 year, an elevation of CEA was noted, and as she was diagnosed by PET-CT with right lung and left adrenal gland metastases, she was referred to our department. PR was achieved by chemotherapy using mFOLFOX6+Bevacizumab, and as no new lesions appeared, thoracoscopic right upper lobectomy was performed 2 years after the initial surgery with laparoscopic left adrenalectomy after 1 month. Both the lung and adrenal lesions were histologically diagnosed as metastases of the sigmoid colon cancer. Postoperative adjuvant chemotherapy using uracil-tegafur/leucovorin was performed, and the patient is still under observation. There have been few reports of resection of adrenal metastasis of colon cancer. This case, in which metachronous lung and adrenal metastases detected after surgery for sigmoid colon cancer could be laparoscopically resected, is presented with a review of the literature.

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