Purpose: Stricture plasty (SP) is well known to be a suitable surgical option for skip lesion of Crohn disease (CD) to avoid risk of extended bowel resection and short bowel syndrome. However, to the best of our knowledge, there are only a few studies on the long-term outcome of SP. The purpose of this study was to evaluate the long-term outcome and patency rate of SP alone and with concomitant bowel resection. Material and Method: We studied 192 CD patients who underwent SP surgery in our institution up till January 2016. Non-patency of the SP group was defined as re-operated cases caused by anastomotic stenosis of SP. In addition, patency of the SP group was defined as cases in which there was no stenosis of the SP anastomotic site at the time of re-operation. Result: Patients’ characteristics: the male/female ratio was 167:33; median age at time of operation was 34 (16–65) years; classification of initial type of disease was 88 jejunoileitis, ileitis and 112 ileocolitis. Procedure of SP was 456 Heineke-Mikulicz, 31 Jaboulay, 15 Finney, and 1 side-to-side method. Post-operative complications: There was no anastomotic leakage at the SP site. The cumulative 5-year SP patency rate was 91.7%. Conclusion: The SP procedure is safe and the cumulative 5-year patency rate is good. SP should be considered when feasible.

A 75-year-old woman visited a family doctor complaining of vomiting and dizziness. Laboratory examination revealed severe anemia. She was referred to our hospital for the further examinations. A CT showed a 59×49 mm tumor at the middle part of the gastric corpus and swollen regional lymph nodes. Esophagogastroduodenoscopy revealed a submucosal tumor with mucosal ulceration at the greater curvature of the middle part of the gastric corpus. Endoscopic ultrasound-guided fine needle aspiration proved this tumor to be a gastric schwannoma. We preoperatively diagnosed a malignant schwannoma with lymph nodes metastases, and performed distal gastrectomy with regional lymph node dissection. Pathologically, the tumor was benign and was composed of proliferation of the spindle cells, which showed S-100 protein positivity by immunohistochemical staining. There were no lymph nodes metastases. Given these findings, we finally diagnosed this tumor as a benign schwannoma. Her postoperative course has been good. A gastric benign schwannoma accompanied by swollen lymph nodes is very rare, therefore we report this case.

A 72-year-old man had undergone total gastrectomy nine years previously, and we diagnosed poorly differentiated adenocarcinoma T2(SS) N1 M0 pStage II according to the Japanese Classification of Gastric Carcinoma, 13th edition. An annual surveillance chest CT revealed a small lesion in the upper lobe of the left lung. Three months later, it grew up to a solid mass of 16×13×11 mm in S3a of the left lung but no swollen lymph nodes were detected. Thoracoscopic partial resection of the left lung was performed and the tumor was intraoperatively diagnosed to be an adenocarcionoma by frozen section. As it was thought to possibly be a primary lung cancer, additional upper lobectomy of the left lung and lymph node dissection was performed. Pathological examination revealed that the tumor was consistent with a metastasis from gastric cancer which was resected nine years previously. Metastatic lung cancer from the stomach is often encountered as lymphangitis carcinomatosa or pleuritis carcinomatosa, but a solitary metastasis is very rare. A metastasis nine years after gastrectomy is even more rare.

A 79-year-old man was found to have an enlarged main pancreatic duct on CT in June 2014. Although pancreatic cancer was suspected from the results of various tests, a definitive diagnosis was not reached. At the patient’s request, he was monitored as an outpatient. An elevated serum carcinoembryonic antigen level was found in a blood sample in April 2016, and additional imaging tests led to a strong suspicion of a tumor. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) was performed and we diagnosed a class V tumor. Based on the above, a diagnosis of cancer of the pancreatic body was made and resection of the pancreatic body and tail were performed. Although surgical findings did not show any dissemination, the tumor in the pancreatic body was firmly adherent to the stomach wall, leading us to suspect infiltration. The resected specimen was a solid light-gray tumor with poorly demarcated borders and a cut surface of 4.3×2.7 cm. Histopathology showed formation of small glandular cavities inside small and large cancer nests and infiltration of the arterial adventitia. Additionally, the endothelial cells of the splenic vein were extensively and discontinuously replaced with cancerous cells accompanied by mucus. There are no published reports of this form of progression to the splenic vein, and we believe it to be rare.

A 32-year-old woman was referred to our hospital because of melena, and ischemic colitis was diagnosed. On abdominal CT, a round-shaped mass of 38 mm in the spleen was incidentally found showing central hypodense and peripheral enhancement in the early phase, and finally enhanced toward its center creating what is called a “spoke wheel-like pattern” in the delayed phase. MRI showed the tumor was gradually heterogeneously enhanced compared with normal splenic parenchyma, and we therefore preoperatively suspected sclerosing angiomatoid nodular transformation of the spleen (SANT) but did not rule out other diagnoses, including malignancy. We performed laparoscopic splenectomy. Microscopically, the tumor was composed of multiple, variably sized nodules separated by α-smooth muscle actin immunopositive myofibroblastic cells, with three types of vascular structure; cord-type capillaries, sinusoid type spaces, and small vessels. These findings yielded a diagnosis of SANT. Spindly and ovoid cells for fibrosclerotic stroma are immunohistochemically positive for IgG4 plasma cells, and especially in the marginal area, the IgG4/IgG ratio in the tumor was increased to over 40%. To the best of our knowledge, this case appears to be extremely rare with SANT meeting the diagnostic criteria for IgG4-related disease.

A 65-year-old man presented with muscle pain and finger swelling, and was given a diagnosis of anti-MDA5 antibody-positive dermatomyositis and interstitial pneumonia. Colonoscopy, as a detailed examination for malignancy detected descending colon cancer (cStage IIIa), and laparoscopic left hemicolectomy was performed. On postoperative day 4, hypoxemia developed and acute exacerbation of the interstitial pneumonia was diagnosed. We started steroid pulse therapy with cyclosporin A and cyclophosphamide. On postoperative day 7, he developed abdominal pain. CT revealed retroperitoneal and intra-abdominal gas. We considered the possibility of anastomotic leakage, nevertheless, there was no tenderness or change in vital signs. We diagnosed this as intra-abdominal gas spreading from mediastinal emphysema and gave conservative treatment with antibiotics. The clinical course was uneventful and the patient was discharged on postoperative day 41. Anti-MDA5 antibody-positive dermatomyositis is often associated with rapidly progressive interstitial lung disease. Surgical cases for malignancy with this disease should be carefully treated.

We report a rare case of gallbladder metastasis from colon cancer. An 82-year-old man complaining of general fatigue was admitted. Blood examination revealed anemia. Colon endoscopy revealed a tumor in the ascending colon which was diagnosed as adenocarcinoma by histopathological examination. Abdominal CT revealed a lesion in the ascending colon and wall thickening in the gallbladder. Abdominal US showed that a part of the border of the gallbladder and liver was unclear. We performed right hemicolectomy and cholecystectomy with resection of the liver bed. The postoperative course was uneventful. Pathological findings revealed that adenocarcinoma cells were limited to the subserosa in the gallbladder. Based on immunostaining results, we diagnosed gallbladder metastasis from colon cancer. Gallbladder metastasis from colorectal cancer is distant metastasis, but long-term survival seem to be possible by resection.

Essential thrombocytosis (ET) is a myeloproliferative disorder characterized by an elevated platelet count. It can lead to thrombosis or bleeding and is a risk factor for patients who require surgery. We report a case of advanced rectal cancer complicated by ET, which required preoperative platelet apheresis. A 46-year-old man with a history of platelet count elevation presented with melena and perianal pain, and was given a diagnosis of advanced rectal cancer with multiple liver metastases. Perianal abscess was also diagnosed, which was treated with incision and drainage. On admission, his platelet count was 1,833×10³/μl and the bone marrow biopsy results were consistent with our diagnosis of ET. We started hydroxyurea therapy of 1,500 mg, which we increased to 2,500 mg due to the marked elevation in platelet count. However, this therapy was ineffective, with the measured platelet count remaining at 1,182×10³/μl. In consideration of the risk of perioperative thrombosis and hemorrhage, we decided on platelet apheresis in order to reduce the platelet count to less than 400×10³/μl. After two cycles, the platelet count decreased to 247×10³/μl, and we performed laparoscopy-assisted low anterior resection of the rectum. The postoperative course was uneventful and he was discharged on postoperative day 16. Platelet apheresis is a rapid and effective treatment for the control of platelet counts in patients requiring urgent surgery with ET whose medical therapy is ineffective.