A 76-year-old man underwent mid-lower esophageal resection and proximal gastrectomy at another hospital, and suffered from weight loss and poor dietary intake for 2 postoperative years without esophageal cancer recurrence. However, the cause could not be detected and he was referred to our hospital, which was closer to his home. On his initial visit, he was found to hardly consume any solid food, which led to emaciation. CT revealed severe dilatation of interposed jejunum, and fluoroscopic-guided upper gastrointestinal endoscopy revealed marked torsion of the interposed jejunum. Enteral feeding was initiated using a jejunum tube, which was inserted from the gastric fistula in the remnant stomach. After 3 months, his dietary condition improved, and therefore reconstruction surgery was performed. Left thoracolaparotomy was performed, and from the interposed jejunum, 3 cm distal to the anal side from the esophagojejunostomy to the jejunalgastrostomy was removed as the blood flow to the remnant interposed jejunum was preserved. In addition, Kocher mobilization was sufficiently performed, and intrathoracic remnant interposed jejunum–remnant stomach anastomosis could be performed. He was able to resume a normal diet and experienced no reflux symptoms postoperatively.

A 62-year-old woman, who had received esophageal stent implantation for esophageal stenosis due to unresectable remnant gastric cancer and received chemotherapy for more than a year, presented with chest and back pain two days after treatment with paclitaxel and ramucirumab. Chest X-ray and CT showed pneumopericardium. In the diagnosis of esophagopericardial fistula, pericardial drainage was performed urgently. There was much air and abscess in the pericardium. Postoperatively, esophagoscopy showed fistula formation near the proximal end of the esophageal stent. A self-expandable metallic stent with cover was implanted to covering the fistula, then she left hospital on the 63rd postoperative day without complications. Esophagopericardial fistula formation in esophageal stent-implanted patient who has been treated with ramucirumab has not been reported previously. Pericardial drainage and esophageal stent implantation were effective for the treatment of esophagopericardial fistula.

A 47-year-old woman underwent distal partial gastrectomy for gastric neuroendocrine tumor (NET) with serosal invasion in 1998. She received a CT scan for examination of eosinophilia in 2014, which revealed four tumors of the transverse mesocolon, right ovary, descending colon, and pelvic wall. The tumor of the transverse mesocolon was resected for diagnosis, and the pathological diagnosis was NET grade 2 (NET G2). We assumed the tumor was recurrence of gastric NET operated 16 years ago. The remaining other 3 tumors were also resected and diagnosed as NET G2. In the following year, CT scan revealed 2 recurrent tumors at the transverse mesocolon and pouch of Douglas. We excised them and diagnosed somatostatin analog for control of peritoneal metastasis. However, CT after 8 administrations of octoreotide acetate showed 2 peritoneal recurrences in the hepatorenal recess and pouch of Douglas. We terminated administration of octoreotide acetate and managed to observe the tumors at regular intervals because the growth rate of the tumors was very slow. We report a case of peritoneal recurrences of gastric NET G2, 16 years after primary operation.

FDG-PET is effective for differential diagnoses of benign and malignant tumors. In recent years FDG-PET has been used to for the diagnosis of recurrence after digestive organ cancer surgery. We report a case of foreign body granuloma which was residual liver after hepatectomy of liver metastasis from colon cancer revealed as a false positive tumor on FDG-PET. A 64-year-old woman underwent left hemicolectomy for descending colon cancer 5 years previously. Partial hepatectomy after preoperative chemotherapy was performed for simultaneous liver metastasis (S5 and S8). Abdominal enhanced CT showed a hypovascular tumor (15 mm) at S8 of the right hepatic lobe after hepatectomy 4 years later. Gd-EOB-DTPA enhanced MRI showed uptake defects in the hepatobiliary phase, and FDG-PET showed strong accumulation at the same site. Therefore residual liver recurrence was suspected. Partial hepatectomy of S8 was performed for a second time. Histopathological examination of the resected specimens showed no malignant findings, foreign body giant cells, lymphocytes, or surgical sutures.

Pancreatic stents are often used in endoscopic treatment for pancreatic duct stenosis due to chronic pancreatitis or pancreatic stone; however, reports of colonic perforation due to migrated pancreatic stents are rare. We report a case of colonic perforation caused by migrated pancreatic stent, and successfully treated by laparoscopic surgery. A 39-year-old woman with a history of alcoholic pancreatitis was admitted to our hospital with abdominal pain. An abdominal CT scan revealed a perforated transverse colon by a migrated pancreatic stent. Emergency laparoscopic surgery was indicated. Pancreatic stent, penetrating the transverse colon wall, was found and the perforated colonic wall was repaired from a umbilical port by direct vision, followed by intraperitoneal washing. Postoperative course was uneventful, and she was discharged on the 10th postoperative day.