A 59-year-old woman visited our hospital complaining of a cough. A chest computed tomography (CT) examination revealed a 55×30-mm tumor and lymph node swelling (106 recL). Positron emission tomography (PET)-CT studies showed a high uptake of fluorodeoxyglucose (FDG) in the tumor and the 106 recL lymph node. An upper gastrointestinal endoscopy revealed a submucosal tumor located at a point 18-27 cm from the incisors. Endoscopic ultrasonography-guided fine needle aspiration biopsy (EUS-FNA) of the tumor revealed a cluster of spindle-shaped cells. Immunohistochemical staining of the specimen showed a positive reaction for S-100 and negative reactions for CD34, c-kit, and SMA. We diagnosed the tumor as an esophageal schwannoma. We performed tumor enucleation thorough a thoracotomy after intraoperatively confirming the absence of malignant cells in the 106 recL lymph node by frozen section analysis. Immunohistochemical examination of the tumor revealed a positive reaction for S-100 and low levels of Ki-67 expression. Hence, the final diagnosis was benign esophageal schwannoma. Here, we report a case of esophageal schwannoma with lymph node swelling that was diagnosed preoperatively using EUS-FNA and that was removed by enucleation.

A 63-year-old woman with a history of cerebral infarction was taking antiplatelet drugs. We performed an esophagectomy for esophageal cancer. At the time of a preoperative endoscopy and before the operation, the antiplatelet medication was replaced with a heparin infusion. The continuous administration of heparin was resumed three days after the operation. Following the restart of heparin administration, the platelet count decreased and the thoracic drainage volume increased. Computer tomography imaging revealed multiple thrombi in the root of the celiac artery, iliac artery and superior vena cava. She was diagnosed as having heparin-induced thrombocytopenia (HIT) based on her condition and a positive result for HIT antibody. Heparin administration was stopped, and argatroban administration was started. One week after the start of argatroban, her platelet level had returned to a normal level, the chest drainage volume had decreased, and the thrombi tended to have shrunken. Thereafter, the patient began receiving warfarin orally, and she was discharged from hospital 27 days after surgery. Three months after the operation, the multiple thrombi have disappeared, and she is currently free from recurrence and is receiving follow-up care on an outpatient basis.

We report a subtotal gastrectomy complication arising from severe jejunal pouch dysfunction that was treated with a revision surgery. A 79-year-old woman had undergone a subtotal gastrectomy about 45 years earlier and had reported chronic symptoms of postprandial cramping and vomiting since the procedure. She was admitted because of persistent painful upper quadrant cramping and vomiting. Radiological findings revealed a severe dilation of the jejunal pouch suggesting pouch dysfunction. The patient preferred a simple solution, and a revision surgery was suggested. During a laparotomy, the previous reconstruction with jejunal pouch and Roux-en-Y anastomosis was revised through a pouch resection and a new Roux-en-Y anastomosis. On the third post-operative day, the patient resumed dietary intake and did not develop reflux or stasis. The revision surgery was effective for the restoration of gastrointestinal transit, and the patient was satisfied with the results.

A 19-year-old woman presented at our hospital with a right lower abdominal pain. A plain abdominal radiography showed a calculus in the right lower quadrant of the abdomen, and computed tomography imaging showed appendiceal swelling and a calculus in the appendix. She was diagnosed as having acute appendicitis accompanied by an appendiceal calculus and underwent a laparoscopic appendectomy. Inside the resected specimen, we found a calculus with a diameter of 14 mm. The postoperative course was uneventful, and she was discharged two days after the operation. Acute appendicitis accompanied by an appendiceal calculus is rare but has a higher risk of a severe course, resulting in perforated appendicitis. In the present case, the inflammation was mild, but an appendiceal calculus was present; consequently, we performed an emergency operation to prevent a worsening of the patient’s condition. Today, the advancement of antimicrobial treatment has enabled many cases of acute appendicitis to be treated with antibacterial drugs, avoiding surgery. However, when acute appendicitis accompanied by an appendiceal calculus is present, early surgical intervention to prevent a worsening of the patient’s condition should be considered.

During surveillance after surgery for a duodenal adenoma, a 59-year-old woman underwent a thorough examination because of a positive fecal occult blood test and an elevated serum tumor marker level. She was subsequently diagnosed as having an appendix adenocarcinoma (cT4N0M0, cStage Ⅱ) and underwent a planned laparoscopic ileocecal resection and D3 lymphadenectomy. Since the operative findings showed widespread peritoneal dissemination around Douglas’ pouch, we determined that a radical resection was impossible. She underwent a laparoscopic ileocecal resection and D2 lymphadenectomy and was scheduled to receive intensive combined therapy. The pathological findings showed the presence of a goblet cell carcinoid of the appendix (T4a, N1b[2/7], H0, P3, M1b, pStage ⅣB). We feared that the use of bevacizumab could lead to the perforation of the peritoneal disseminated tumor, so systemic chemotherapy with mFOLFOX6 + panitumumab was instead performed. The chemotherapy was continued for about 18 months, but a bowel obstruction caused by peritoneal metastasis and perforation due to a worsening of ileus was observed on postoperative day 620, requiring emergency surgery. Thereafter, the chemotherapy was discontinued, and she died 830 days after her first surgery. One previous report of the use of panitumumab for unresectable GCC has been published in Japan, but the present report is the first case in which panitumumab was used as a first-line treatment.

Schwannomas of the digestive tract are extremely rare, especially in the colon. We report a case of a schwannoma in the ascending colon that was successfully resected by laparoscopic surgery. A woman in her 70s underwent a colonoscopy as a follow-up for ulcerative colitis. The examination revealed a 20-mm submucosal tumor in the ascending colon. A contrast-enhanced abdominal CT study revealed a 20-mm tumor of the ascending colon without any swelling in the lymph node or distant metastasis. We performed a laparoscopic wedge resection of the ascending colon. Intraoperative rapid diagnosis suggested a schwannoma and did not reveal any signs of malignancy. The final histological findings of the resected specimen showed that spindle-shaped cells had proliferated in a palisaded/fascicular manner mainly in the muscularis propria. Immunological staining was positive for S-100 protein and negative for c-kit, CD34 and α-SMA. Based on these findings, the tumor was finally diagnosed as a benign schwannoma. Schwannoma is often difficult to diagnose pathologically prior to surgery. If a definitive preoperative diagnosis cannot be made, surgery with lymph node dissection should be performed because of the possibility of malignancy.

An 84-year-old female with known complete situs inversus from childhood presented at our hospital with fecal occult blood positivity. A colonoscopy revealed a type 2 lesion at the sigmoid-descending colon junction. Abdominal computed tomography confirmed the presence of complete situs inversus and revealed wall thickening of the sigmoid colon. Rule blood vessel of sigmoid colon cancer was sigmoid artery 1st branch by 3D Computed tomography. As the diagnosis was sigmoid colon cancer in a patient with complete situs inversus, we performed a laparoscopic sigmoidectomy with the operator, assistants, nurse, operation instruments, and monitors placed in positions opposite to those used for a standard laparoscopic sigmoidectomy. The presence of adhesions increased the operative time, but the patient’s postoperative progress was good and no complications occurred. A literature search revealed 26 case reports describing laparoscopic operations for colon cancer in patients with complete situs inversus. All the operations were safely performed without excessive extension of the operative time or the occurrence of postoperative complications.

A 71-year-old man had undergone a hernia repair for a left inguinal hernia using a mesh plug 13 years previously. A screening revealed a positive fecal occult blood test, prompting a local doctor to perform a colonoscopy. He visited our hospital because of a suspected type 2 tumor in the upper sigmoid colon. Two colonoscopy examinations were performed at our hospital, but the biopsy results showed granulation tissue only, and no atypical cells were detected. An abdominal computed tomography (CT) examination showed a lesion extending from the abdominal wall of the left groin to the sigmoid colon. Since the patient had a history of surgery for a left inguinal hernia, he was diagnosed as having a sigmoid colon penetration caused by a mesh plug, and a laparoscopic sigmoid resection was performed. The mesh plug was removed. He was discharged on the 11th day after the operation with no complications. Here, we report a rare case of gastrointestinal perforation/penetration caused by a mesh plug after inguinal hernia surgery without infection.

We treated two cases of Sister Mary Joseph’s nodule (umbilical metastatic carcinoma, SMJN). Case 1 was a 33-year-old female who had been admitted to our hospital complaining of an umbilical mass. Contrast CT imaging enabled a diagnosis of umbilical metastasis together with multiple metastases in the liver and para-aortic lymph nodes. Because surgery was not indicated, we used chemotherapy. The patient’s disease stabilized during the first chemotherapy regimen. During the treatment, however, pain caused by the umbilical metastasis prompted the surgical removal of the ascending colon, umbilicus, and ovaries. The patient continued to receive chemotherapy, but she died from cancer one year and seven months after onset. Case 2 is an 83-year-old female who complained of an umbilical mass. Contrast CT imaging showed a locally progressive pancreatic tail cancer with severe liver metastases. Although chemotherapy was applied, she died five months after onset. SMJN has a poor prognosis; hence, when SMJN is found during an examination, the primary disease should always be considered.

A 52-year-old man was referred to our hospital because of inflammation and pus discharge from the umbilicus. A CT examination revealed an ascending colon cancer with liver, lymph node, peritoneal, and umbilical metastases. Chemotherapy was performed; 19 months later, the umbilical tumor had slowly increased in size and a skin disorder appeared around the umbilical tumor. His pain had also worsened. An opioid analgesic was prescribed for the pain. The amount of exudate from the skin disorder, which had a bad smell, had also increased. The smell was improved by the metronidazole ointment. The skin disorder had spread to almost the entire abdominal surface at the time of the patient’s death. Chemotherapy for colorectal cancer is expected to prolong survival. However, the surgical resection of an umbilical metastasis might need to be considered, since the skin damage caused by the umbilical metastasis can cause a significant decrease in quality of life.

A 38-year-old man was admitted to hospital with abdominal distension. An elastic hard mass was palpated in the whole abdomen. An abdominal CT scan showed a large tumor with a diameter of 25 cm. An MRI examination showed a low intensity on T1-weighted images and a high intensity on T2-weighted images. Because invasion of the ileocolic mesentery was found, a combined resection of the ascending colon, cecum, and ileum was performed. The resected specimen weighed 5,800 g. The pathological findings revealed the proliferation of spindle-shaped cells with slight atypia, and the tumor tested positive for β-catenin immunostaining. Based on these findings, the pathologic diagnosis was desmoid fibromatosis. Here, we report a rare case of a large resected mesenteric desmoid fibromatosis.

A 29-year-old man presented in the emergency department with lower abdominal pain. An abdominal computed tomography (CT) examination showed a cyst containing air and a high-density area immediately beneath the umbilicus. No obvious communication between the cyst and other organs was seen. Percutaneous drainage was performed under a diagnosis of urachal remnant. The clinical presentation did not improve, and a follow-up abdominal CT examination revealed several abdominal abscesses. A laparotomy was performed, and a cyst with a fibrous cord extending to Meckel’s diverticulum was found. A histopathological examination revealed intestinal epithelial tissue lining the lumen of the cyst, resulting in a diagnosis of omphalomesenteric duct remnant. Only 11 cases of omphalomesenteric duct remnant have been reported in adults. To the best of our knowledge, the remnant found in the present case (a cyst accompanied by a fibrous cord and diverticulum) has only been described in two previous reports.

A 16-year-old man was referred because of epigastric pain. Contrast-enhanced computed tomography revealed a cystic lesion about 7 cm in diameter, which was in close contact with the head of the pancreas and the duodenum. The patient underwent a laparoscopic-assisted resection, and the lesion was confirmed to be a benign retroperitoneal pseudocyst. He made an uneventful recovery from surgery and was discharged 6 days later. He has remained well without any recurrence for about 5 years since the surgery. Retroperitoneal pseudocysts are rare. Because of the difficulty in establishing a definitive preoperative diagnosis, surgical resection is recommended. We describe a laparoscopic-assisted approach that was successfully used to manage such a patient.

Streptococcal toxic shock-like syndrome (TSLS) is characterized by rapidly progressive shock and organ damage caused by infection with Group A Streptococcus pyogenes (GAS). Reportedly, most of the infected sites are soft tissues, such as the fascia, although a few previous reports of primary peritonitis have been made. Here, we report two cases of TSLS with primary peritonitis.

Case 1 was a 49-year-old woman who was transported to hospital because of sudden abdominal pain. An emergency operation was performed because the patient was in shock upon arrival and showed signs of peritoneal irritation. Intraoperative findings showed no perforation or necrosis, and lavage and drainage were performed. Postoperative disseminated intravascular coagulation and renal dysfunction required intensive treatment. Streptococcus pyogenes was detected in the ascites culture 3 days after surgery, and the patient was diagnosed as having TSLS. The patientʼs general condition gradually improved, and she was discharged 21 days after the operation.

Case 2 was a 53-year-old woman who was admitted to hospital with a chief complaint of abdominal pain and was diagnosed as having infectious gastroenteritis. Streptococcus pyogenes was detected in a blood culture obtained on the 3rd day of hospitalization. The patient continued to take antibiotics. However, on the 5th day, her consciousness deteriorated, and she developed shock; therefore, an emergency operation was performed based on a diagnosis of primary peritonitis and TSLS. No signs of perforation or necrosis were found intraoperatively, and lavage and drainage were performed to complete the surgery. The patient exhibited an immediate postoperative improvement in hemodynamics and was discharged 7 days after the surgery. In both cases, the patientʼs condition was improved by lavage and drainage, and early surgical intervention was important.

The patient was an 87-year-old woman who had been diagnosed as having a ventral hernia by her family physician based on the physical findings. She visited the emergency department of our hospital with a 2-week history of swelling of the median epigastric region and abdominal pain. Although incarceration was suspected, the swelling could be manually reduced. Abdominal CT showed a 1.5×1.5 cm hernia in the midline of the upper abdomen, and we diagnosed linea alba hernia. We planned her operation as a semi-emergency operation, because it could not be mesenteric ischemia. Intraoperatively, a 1.5×1.8 cm fascia defect was found in the abdomen, and the defect was closed with simple sutures. The patient was discharged on day 3 after the operation, and until now, one and a half years since the surgery, she has remained free of recurrence. This was a rare case of an elderly non-obese woman with no past medical history with linea alba hernia. We report this case herein, with a review of 98 previously reported cases of white line hernia.