An 80-year-old man underwent an exploratory laparotomy for a strangulated bowel obstruction, after a contrast-enhanced abdominal computed tomography (CT) showed fluid highly suggestive of an abscess. Intraoperatively, we observed a perforation, measuring about 5 mm, within the small intestine 70 cm from the anal end of the ligament of Treitz. About 20-cm-long small intestine was resected to include the perforation site. We performed an ileostomy with single orifices. The output of the stoma increased after initiation of feeding; therefore, we collected and administered intestinal fluid directly into the enteric fistula to continue enteral feeding. His nutritional status maintained; therefore, he was discharged without peripheral parenteral nutrition (PPN). Thereafter, he underwent ileostomy closure without any complications. We herein report the case of patient who had a stoma, underwent direct administration of intestinal fluid into the enteric fistula, maintained a good nutritional status, and underwent colostomy closure without PPN while feeding enterally.

A 55-year-old woman presented with a prolapsed mass in the anus and severe pain. The tumor was not manually returned, and CT scan revealed a rectal invagination and a mass with fatty components. An emergency surgery to resect the sigmoid colon was performed. The mass measured 75 mm×55 mm and had smooth margins. The cut surface showed a xanthochromia. Histopathology showed growth of mature adipocytes located in the submucosal and subserosal layers. No lipoblasts and malignancies were observed. Lipoma of the sigmoid colon with prolapse through the anus occurs rarely.

A 72-year-old male patient presented with constipation and bowel distention. Enhanced-contrasted abdominal CT revealed a mass in the sigmoid colon, with multiple liver metastases. Colonoscopy was withheld because of bowel obstruction. We made a tentative diagnosis of sigmoid colon cancer and multiple liver metastases and performed a colostomy. Intraoperative colonoscopy was performed, which confirmed a tumor in the sigmoid colon; biopsy of the tumor revealed the diagnosis of neuroendocrine carcinoma (NEC). Based on the Clinical Practice Guidelines for Gastroenteropancreatic Neuroendocrine Neoplasms, we started the patient on chemotherapy with cisplatin and irinotecan. Despite five courses of therapy, the patient’s condition worsened and he died on day 220 after the first visit. NEC of the colon, which carries a poor prognosis, is rare; no treatment guidelines for NEC of the colon have been published and patients usually receive multidisciplinary treatment. We report a case of primary NEC of the sigmoid colon with multiple liver metastases.

Rectovaginal fistula is a relatively rare complication after rectal cancer surgery. In this study, we report a case of rectovaginal fistula following rectal cancer surgery that was successfully treated with estriol vaginal tablets. A 70-year-old woman underwent laparoscopic low anterior resection and temporary ileocolostomy for rectal cancer (Rb). Following postoperative adjuvant chemotherapy, a rectovaginal fistula was identified during proctography. Moreover, CT scan revealed pulmonary metastasis. We prioritized surgery for the lung metastasis and initiated treatment with estriol vaginal tablets for the rectovaginal fistula. After the pulmonary metastasis surgery, another proctography showed the disappearance of the fistula. Estriol vaginal tablets may facilitate the spontaneous healing of rectovaginal fistula by restoring vaginal self-cleaning post-menopause, enhancing inflammatory resistance via increased blood flow around the uterus and vagina and promoting thickening of the muscle layer.

A 49-year-old woman was referred to our hospital on account of a suspected solid papillary neoplasm (SPN) after presenting at the referring hospital with complaints of abdominal distention and back pain. Contrast-enhanced CT of the abdomen showed a well-defined cystic lesion with peripheral calcification in the pancreatic tail, and T1-weighted MRI showed a heterogeneous low signal within the cystic lesion. A color doppler showed internal blood flow. Based on these findings, an SPN was suspected, and laparoscopic distal pancreatectomy was performed. Histopathology revealed a simple cyst covered with a single layer of squamous epithelia with little atypia, a fibrous cyst wall with calcification, and no pseudopapillary proliferation or ovarian-like stroma. Simple pancreatic cysts with calcifications are relatively rare and difficult to diagnose. However, clarification of the classification of non-neoplastic true cysts among pancreatic cystic diseases and unification of disease names are considered essential for differentiating diseases and clarifying pathophysiology.

We report a case of a simple pancreatic cyst with calcification that was difficult to differentiate from SPN.

In recent years, cases of laparoscopic surgery for hydrocele of the canal of Nuck have been reported. Inguinal incisions are usually used in this type of surgery. By laparoscopic observation, we performed two resections using an inguinal incision. Case 1 is the case of a 47-year-old woman who underwent a CT scan, which showed a cystic lesion in the right inguinal region, suggestive of a hydrocele of the canal of Nuck. Laparoscopy revealed another nodule close to the lesion in the internal inguinal ring. Case 2 is the case of a 37-year-old woman who was diagnosed with a left inguinal hernia after undergoing ultrasonography. Laparoscopy revealed a cyst protruding toward the abdominal cavity in the left internal inguinal ring, which was suggestive of a hydrocele of the canal of Nuck. In each case, the lesions were resected without any complications from the inguinal incision under laparoscopic observation. Due to reports of hydrocele recurrence, endometriosis as a complication, and rare cases of malignancy, hydroceles should be removed without rupturing. Although cases of laparoscopic resection have been reported in literature, a more advanced technique is indicated, and consideration for fertility should be made. Therefore, due to safety concerns, we performed resection using an inguinal incision under laparoscopic observation.

A 59-year-old man presented with a left inguinal protrusion. A CT scan showed the presence of a left direct inguinal hernia. Transabdominal preperitoneal repair was performed to establish a diagnosis of coexisting left external supravesical and left indirect inguinal hernias. A 55-year-old man who had a history of surgery for a right inguinal hernia presented with bilateral inguinal protrusions. Computed tomography (CT) showed a right recurrent direct inguinal hernia and a left indirect inguinal hernia. Transabdominal preperitoneal repair was performed, establishing a diagnosis of coexisting left external supravesical, left indirect inguinal, and right recurrent direct inguinal hernias. Only few cases of external supravesical hernias have been reported in Japan, and the preoperative diagnosis tends to be difficult. Laparoscopic surgery is useful for making an accurate intraoperative diagnosis of coexisting inguinal hernias.

An 89-year-old woman visited our department thrice over an 11-year period with complaints of a mass in the right inguinal region. Based on physical examination and computed tomography (CT) findings, the mass was diagnosed as a right inguinal cyst. She later presented to the emergency room with abdominal pain, vomiting, and nausea lasting over a 4-day period. On physical examination, we found a mass in the right inguinal region, which was later shown by CT to be an incarcerated small intestine in the right femoral canal. A diagnosis of an incarcerated right femoral hernia was made. Emergency single-incision laparoscopic surgery showed an incarcerated small intestine. After reduction, the incarcerated small intestine was found to be necrotic. Therefore, we resected the incarcerated portion of the small intestine. The postoperative course was smooth. Afterwards, a totally extraperitoneal preperitoneal femoral hernia repair was performed as secondary surgery. In the management of an inguinal cyst, a femoral hernia should be considered and ruled out. Additionally, an elective repair should be performed as soon as practicable to prevent possible incarceration.