We describe a case of squamous cell carcinoma of the lung with invasion of the esophagus treated by radical en bloc resection as salvage surgery. Chest computed tomography showed a 46-mm tumor and a 25-mm subcarinal lymph node invading the esophagus. After three cycles of chemotherapy with cisplatin plus vinorelbine, the bronchoscopic findings revealed that the hemorrhagic tumor had progressed, and hemoptysis, cough and dysphagia were getting worse and proving very bothersome to the patient. To resolve his symptoms, we performed left pneumonectomy with esophageal resection and reconstruction. The esophagus was reconstructed via a posterior mediastinal route to use the greater omentum for coverage of the stump of the left main bronchus and the anastomosis of the reconstructed esophagus. Although he died of metastatic lung and brain tumors 18 months after the surgery, he was doing well more than one year after the operation. In addition, improvement of the respiratory and digestive symptoms was also achieved with complete resection.
A spontaneous, intramural, small-bowel hematoma requiring a surgery is a rare complication of anticoagulant therapy. We present a case of an 82-year-old man who developed abdominal pain in the setting of abnormal coagulation function related to warfarin therapy used as chronic prophylaxis against recurrent pulmonary embolism. Computed tomography (CT) showed wall thickening and luminal narrowing of the jejunum. Dilation of the small bowel proximal to the thickening was also present, indicative of small bowel obstruction. Initially, the patient was treated conservatively, but he later required laparotomy due to worsening of his general condition. A 50cm jejunal segment was resected in order to relieve the intestinal obstruction and to arrest the bleeding. For intramural, small-bowel hematoma, conservative medical management should be the first treatment of choice, but surgical intervention may be indicated if conservative treatment is not successful.
Background: Low-grade appendiceal mucinous neoplasm (LAMN) is rare. Since it can progress to peritoneal pseudomyxoma or mucinous carcinoma, appropriate diagnosis and therapy are needed. Three LAMN cases in various stages that presented within only one year to our hospital are presented.
Case presentation: Case 1 was a 75-year-old woman with right lower quadrant abdominal pain. She was diagnosed with a mucinous mucocele of the appendix and underwent ileocecal resection. Case 2 was a 67-year-old man diagnosed with chronic appendicitis who underwent appendectomy. Case 3 was a 75-year-old man who was found to have a tumor of the appendix on a periodic examination after gastric cancer surgery and underwent ileocecal resection. These three cases were diagnosed with LAMN, and their surgical margins were negative on pathology. None of them have had recurrence.
Conclusion: There are no therapeutic guidelines for LAMN. However, since it has malignant potential, correct diagnosis and optimal surgical therapy are needed. Since LAMN can be seen even in small hospitals, these cases are reported along with a review of the relevant literature.
Synchronous neoplasms of the colorectum and kidney rarely occur. This paper is the second report on synchronous sigmoid colon and renal cancers treated laparoscopically. In this report, we describe synchronous cT4b sigmoid colon and left renal cancers treated laparoscopically simultaneously, along with the summary and review of reported cases.Case presentation
A 45-year-old male presented with high fever and left lower abdominal pain. Computed tomography showed a solid sigmoid colon tumor that was 7cm in diameter and perforated its mesentery. Colon cancer was suspected to infiltrate the adjacent organs including the abdominal wall. In addition, a 5-cm tumor on the left kidney was accidentally discovered, which was suspected to be renal cancer. Colonoscopy showed a circumferential tumor at the sigmoid colon that was 25cm from the anal verge. There was no evidence of distant metastasis. After intravenous antibiotics therapy, we planned laparoscopic left hemicolectomy and nephrectomy. The sigmoid colon cancer adhered to the abdominal wall, small bowel, and appendix; therefore, we performed en bloc resection of the tumor and the adjacent organs. After colectomy, we performed left nephrectomy. Postoperative course was good. The patient was discharged 12 days after the operation.Conclusion
Laparoscopic synchronous resection is a feasible and curable procedure providing several benefits for the patient. Furthermore, left hemicolectomy and radical left nephrectomy can be a good indication of synchronous resection because both include the same procedure such as mobilization of the splenic flexure. For cT4b colon cancer like in our case, en bloc resection without touching the adhesion can be a curable procedure.