Purpose: Obturator hernia is a relatively rare disease that frequently occurs in thin elderly women. Incarcerated obturator hernia often requires emergency surgery. Therefore, clinicians need to understand the tendency of cases to require bowel resection. In this study, obturator hernias operated at our hospital were divided into an intestinal resection and non-resection groups.

Methods: From August 2013 to September 2021, 12 patients undergoing obturator hernia surgery were enrolled. Their preoperative backgrounds and surgical outcomes were compared between the two groups. All data have been presented as median values.

Result: The bowel resection and non-resection groups had four and eight cases, respectively. The bowel resection group had significantly higher serum urea nitrogen (BUN) and C-reactive protein (CRP) levels than the non-resection group preoperatively.

Conclusion: In the bowel resection group, surgical intervention was considered as an early requirement in patients who had an onset beyond 2 days and an elevated BUN and CRP.

We report the case of a late recurrence of breast cancer and an iatrogenic contralateral cancer in a 73-year-old woman. She was first diagnosed with right breast cancer (ER:+, PgR:+, HER2:1+) at the age of 35 years. After right mastectomy, she began tamoxifen therapy but discontinued treatment. At the age of 55 years, she developed a recurrence in the chest wall of the affected side, and at the age of 58 years, she had metastasis to the contralateral left axillary lymph node (ER:+, PgR:+, HER2:1+). She underwent radiotherapy thereafter (clinical complete remission, hereafter cCR). At the age of 65 years, a contralateral left supraclavicular lymph node metastasis was detected, and cyclophosphamide was administered but discontinued. She began exemestane therapy, and the metastatic lesion disappeared after 1 year. At the age of 70 years, she developed left breast cancer (ER:-, PgR:-, HER2:3+). After left mastectomy and axillary lymph node dissection (pT1cN1(1/4) ER-PgR-HER2: 3+), postoperative adjuvant antibody therapy (Pertuzumab+Trastuzumab) was administered for 1 year. At the age of 73 years, two masses were noted at the outer aspect of the left latissimus dorsi. A pathological diagnosis of adenocarcinoma (ER:+, PgR:+, HER2:0) was made. Re-recurrence of a radio-treated site of contralateral axillary metastasis of the right breast cancer and distant metastasis within the latissimus dorsi were diagnosed. Radiotherapy was administered to the lateral border of the latissimus dorsi (40 Gy). Thereafter, she was treated with a CDK4/6 inhibitor and a selective estrogen down regulator.

A 76-year-old man with an elevation in liver transaminase enzymes. liver dysfunction was admitted to our hospital. An enhanced contrast CT and endoscopic retrograde cholangiography showed that hilar cholangiocarcinoma was highly suspected. Further laboratory investigations showed elevated biliary enzyme levels without jaundice. Based on these findings, Bismuth type IIIa was suspected. Therefore, the patient underwent operation after percutaneous transhepatic portal vein embolization. On postoperative day (POD) 6, the patient had a life-threatening shock. The CT and interventional radiological findings showed a raptured aneurysm of posterior superior pancreatoduodenal artery (PSPDA). Thereafter, on POD 17, the patient had an aneurism close to the previous location of the PSPDA. Generally, aneurysms are clinically caused by bile or pancreatic juice leakage. This case served as an important reminder to consider heat arterial damages caused by energy devices when lymph node dissection is performed around the pancreatic head.

In a 74-year-old man, abdominal ultrasonography revealed the presence of a tumor, which was 15 mm in diameter and spanned the body and tail of the pancreas. An abdominal contrast-enhanced CT showed that the tumor was non-enhancing. Endoscopic ultrasound-fine needle aspiration of the tumor revealed a class III tumor. During the procedure, a poorly differentiated adenocarcinoma of the stomach was detected incidentally. In addition, colonoscopy revealed multiple adenomas, and the lesion in the transverse colon was diagnosed as poorly differentiated adenocarcinoma with submucosal invasion 2. The patient was diagnosed with pancreatic, gastric and transverse colon cancers and underwent distal pancreatectomy with splenectomy, distal gastrectomy, and transverse colectomy. The remnant gastric blood flow was evaluated using the intraoperative indocyanine green (ICG) fluorescence method. Pathologically, the pancreatic tumor was diagnosed as an invasive ductal carcinoma. In this report, we discuss a case in which a radical resection was performed for triple cancer of the pancreas, stomach, and transverse colon, preserving the stomach by intraoperative evaluation of remnant gastric blood flow using the ICG fluorescence method.

An 82-year-old man with a splenic tumor was admitted to our hospital. Enhanced contrasted CT and FDG-PET/CT showed a well-defined tumor measuring 13 cm and an FDG-avid spleen. Additionally, laboratory data revealed that the serum IL-2 receptor was elevated. Based on these findings, malignant lymphoma was suspected. Therefore, the patient underwent laparoscopic splenectomy. Histopathologically, the resected specimen was diagnosed with hairy cell leukemia (HCL) due to the presence of immunohistological markers. Generally, HCL clinically presents as pancytopenia and splenomegaly.

This case served as an important reminder to consider HCL in the investigation of all possible causes of splenic tumors.

A 65-year-old man was admitted with a diagnosis of COVID-19. He generally looked well but complained of lower abdominal pain on the 9th day of hospitalization. The abdominal pain persisted, and two days later, signs of peritoneal irritation became apparent. Therefore, he was referred to surgical department. Plain computed tomography (CT) revealed an extensive intramural emphysema in the small intestine, and emergency surgery was indicated for intestinal necrosis. Laparotomy revealed the presence of necrotic tissues in most of the small intestine and poor blood flow to the mesentery in the same region, leading to a diagnosis of superior mesenteric artery occlusion. Extensive small bowel resection was performed, preserving 25 cm from Treitz’s ligament and 15 cm from the terminal ileum, and a jejunal stoma was constructed. The postoperative course was generally favorable, and postoperative abdominal contrast-enhanced CT showed an occlusion of the superior mesenteric artery at the root. The pathology of hypercoagulability due to COVID-19 remains unclear, but COVID-19 is known to increase the risk of thrombosis. Therefore, we suspected a strong relation between the occlusion of the superior mesenteric artery and COVID-19 based on the time of onset.