A 63-year-old woman was admitted with complaints of discomfort and tenderness at the neck, suspecting thyroid cancer in the left lobe by US findings. Further examinations concluded the diagnosis of Killian Jamieson diverticulum and an adenomatous goiter. At the time of diagnosis, however, symptoms disappeared, and the patient was followed up. A couple of months later, the patient suffered from cervical pain again. Diverticulectomy, cricopharyngeal muscle incision, and partial thyroidectomy were planned and performed. During the surgical treatment of Killian Jamieson diverticulum, the anatomical identification and preservation of the recurrent laryngeal nerve is essential. In cases of adhesion due to repeated diverticulitis or complicated thyroid disease, the recurrent laryngeal nerves possibly could not be identified easily. In the present case, therefore, intraoperative neural monitoring was available safely to identify and preserve the recurrent laryngeal nerve.

Patients with myotonic dystrophy (MD) are susceptible to respiratory complications under general anesthesia. A 51-year-old woman who had been treated for MD developed appetite loss and visited a local clinic. Blood tests revealed anemia (Hb 8.0 g/dl), and respiratory function tests confirmed restrictive ventilation disorder (VC 0.93 l, %VC 37.8). We diagnosed Stage IIIA gastric cancer, and planned surgical treatment because of the anemia and appetite loss. The patient underwent total gastrectomy under total intravenous anesthesia combined with epidural anesthesia. Propofol was used for induction, and a muscle relaxant was used only once at induction. The patient was extubated at the end of surgery. On postoperative day (POD) 3, she started enteral nutrition, and on POD 5 she started to eat. The patient was discharged from hospital on POD 16. We presented a rare case of MD with concomitant gastric cancer requiring surgery under general anesthesia.

Secondary aortoduodenal fistula (sADF) is a rare but very serious cause of gastrointestinal hemorrhage, difficult to diagnose, and a potentially fatal disease. We report 3 patients with aortic prostheses who were hospitalized for gastrointestinal bleeding due to sADF, and discuss their clinical diagnosis, treatment, and final results. All of them underwent surgical interventions and were successfully rescued once, but two of them succumbed due to postoperative infectious complications. In cases of gastrointestinal hemorrhage after aortic prostheses, clinical suspicion of sADF and an early diagnostic abdominal CT scan with anticipation of its high sensitivity and specificity for sADF are crucial. Early surgical intervention with removal of prosthetic aortic graft should be considered to control systemic infections and survival.

A tumor was detected by fluorine-18 (F18) fluorodeoxyglucose positron emission tomography (18FDG-PET) in a medical check-up of a 33-year-old man. The tumor showed uptake of 18FDG (SUV max of 10.4). He had no remarkable past medical history. His liver function and the tumor markers AFP, CEA, and CA19-9 were within normal limits. Hepatitis B surface antigen and hepatitis C antibody were negative. US showed a hyperechoic tumor, 4 cm in diameter, in the liver. CT showed a low density tumor in the arterial phase and a low density tumor in the portal phase. Gadoxetic acid disodium-enhanced magnetic resonance imaging (EOB-MRI) showed high intensity on T1-weighted in-phase images and low intensity on T1-weighted out-of-phase images. Furthermore, this tumor showed hypointensity in the hepatobiliary phase. He underwent partial resection of segment 4 because the tumor was suspected to be hepatocellular carcinoma. Pathological examination revealed that the tumor consisted of hepatocytes without cellular atypia with apparent fatty change. The tumor was diagnosed as HNF1α-inactivated hepatocellular adenoma (HCA) because the tumor cells were negative for L-FABP.

A 70-year-old woman was admitted to our department for examination of a gallbladder tumor detected by ultrasound screening. Abdominal US examination revealed a well-circumscribed echogenic mass with submucosal tumor-like morphology in the body of the gallbladder. MRI study showed a mass lesion 15 mm in diameter with stronger high-signal intensity than the kidney on T2-weighted images. Dynamic MRI showed a gradually increasing contrast enhancement of the outer edge and inside of the tumor. MRI findings suggested a solid tumor with abundant mucus stroma. We diagnosed mucinous adenocarcinoma of the gallbladder preoperatively and performed cholecystectomy with partial resection of the gallbladder bed, bile duct resection, and regional lymph node dissection. The histopathological diagnosis was a mucinous adenocarcinoma of the gallbladder. For the diagnosis of mucinous adenocarcinoma, detection of mucinous stroma is an important factor. Dynamic MRI is useful for diagnosis of mucinous adenocarcinoma of the gallbladder because it is able to evaluate not only tumor morphology and contrast effect but also qualitative assessment of the interstitium of the tumor concurrently.

A 33-year-old woman visited a nearby orthopedic clinic because of back pain in the left side. An abdominal X-ray showed eggshell-like calcification in the left side of the abdomen. A 46×48 mm tumor with calcification was detected in the pancreatic tail, which was in contact with the left side of Gerota’s fascia, hilum of the spleen, and the splenic vein on CT. MRI showed a high-intensity signal in the T1 weighted image, and a mixture of high and low signals in the T2 weighted image. Solid-pseudopapillary neoplasm (SPN) was diagnosed based on the image findings, and laparoscopic distal pancreatectomy was performed. Histopathologically, the main tumor and one of the No. 11d lymph nodes were diagnosed as SPN. The postoperative course was good. No recurrence has occurred for 9 months after the surgery.

A 72-year-old man visited a local physician with complaints of left upper quadrant abdominal pain and back pain in the left side. Abdominal US revealed a suspected splenic tumor, and the patient was referred to our hospital. Abdominal contrast-enhanced CT revealed hematoma around the spleen and spleen parenchyma of reduced density which was thought to be a splenic contusion. CT, performed while the patient was under observation, revealed enlargement of a soft tissue shadow around the splenic hilum region. PET/CT revealed increased uptake around the spleen. As malignant splenic tumor or pancreatic cancer could not be ruled out, we proceeded with surgery. The spleen was hard and swollen to a size larger than an adult’s fist, and adhered tightly to the stomach, transverse colon, and diaphragm. Splenectomy, distal pancreatectomy, partial resection of the stomach and transverse colon, and combined resection of the diaphragm were performed. A diagnosis of perisplenic retroperitoneal IgG4-related disease was made based on histopathological findings. The present case is among a group of diseases that manifest as enlargement and hypertrophy of organs throughout the body, high IgG4 levels in blood, and histologically prominent IgG4-positive plasma cell infiltration. This disease group occurs predominantly in the pancreas and retroperitoneum, but is rarely diagnosed based on findings of splenorrhagia.

A 69-year-old woman visited our hospital because of hematemesis. Hemorrhage with shock was uncontrolled by upper gastrointestinal endoscopy, and we performed emergency interventional radiology (IVR). A celiac angiogram showed a proper hepatic aneurysm, but we could not embolize the proper hepatic artery because of the narrowing vessel lumen. A superior mesenteric angiogram showed the right hepatic artery was visualized by the back flow through the pancreaticoduodenal arcades. We embolized the common hepatic artery and gastroduodenal artery, so there was almost no blood flow to the aneurysm. An enhanced CT after TAE showed hepatic artery aneurysm had blood flow from the proper hepatic artery and right gastric artery. We performed urgent surgery to avoid re-rupture. We detached the right gastric artery, right hepatic artery and left hepatic artery, so there was no blood flow to the aneurysm. The postoperative course was uneventful, and she was discharged on postoperative day 15. A postoperative CT showed the hepatic artery aneurysm to be cured. The left hepatic artery had blood flow through the communicating arcade from the right hepatic artery.