We report a case of a reconstructed gastric tube ulcer perforation with leakage into the pericardial space after esophagectomy for esophageal cancer. A 64-year-old woman underwent thoracoscopically-assisted esophagectomy and replacement via the retrosternal route, using a gastric tube for advanced esophageal cancer, followed by adjuvant chemoradiotherapy. Ten months after the surgery, she had chest pain, and revisited our hospital. Pericardial effusion, left pleural effusion and mediastinal emphysema were recognized by CT scan, so an upper gastrointestinal series was performed. Contrast medium leaked from the reconstructed gastric tube into the pericardial space. We diagnosed perforation of reconstructed gastric tube and performed emergency surgery. Left posterolateral thoracotomy was performed and the pericardium was incised longitudinally. A large amount of food residue was withdrawn and an 8 mm perforation site of the reconstructed gastric tube ulcer was recognized. After irrigation, we inserted a T-tube into the perforation site and drainage tubes into the pericardium and thoracic cavity respectively. Oral ingestion resumed on POD19 and the patient was discharged on POD 47. Reconstructed gastric tube ulcer perforation with leakage into the pericardial space after esophagectomy for esophageal cancer is rare, but mortality is extremely high using conservative treatment. Rapid surgical intervention is therefore crucial.

This case concerns a 61-year-old woman. Endoscopic imaging and biopsy revealed esophageal carcinosarcoma with superficial hypopharyngeal invasion. Contrast enhanced CT did not show any metastasis and we diagnosed esophageal carcinosarcoma, CePh, cT1b(SM3)N0M0 cStage I. We chose to perform surgery after explaining the possibility of vocal cord loss to the patient. After marking the oral side of the tumor by extending the area with a curved laryngoscope under general anesthesia, we resected the hypopharynx to the oral side of the mark while rotating the larynx to extend the operative field. After confirming that the margin of the intraoperative frozen section was negative for malignancy, we performed a free jejunal graft to complete the larynx-preserving surgery. The final diagnosis was esophageal carcinosarcoma, CePh, fT1b(SM3)N0M0 fStage I. The surgical margin was negative. One year has passed without recurrence or vocal cord paralysis. Among the 9 reported cases of cervical esophageal carcinosarcoma, 8 cases underwent surgery. This is the first reported case of resected esophageal carcinosarcoma with hypopharyngeal invasion in which the larynx could be preserved. The accurate evaluation of the oral side of the tumor to ensure curability and the rotation of the larynx to ensure the operating field are considered essential to preserving the larynx.

The patient was an 82-year-old man with anemia. Upper gastrointestinal endoscopy revealed a type 1 tumor in the middle gastric body. We performed total gastrectomy with Roux-en-Y reconstruction and lymphadenectomy. The tumor specimen measured 80×80 mm, and the pathological diagnosis was T3N2M0 Stage IIIA. The tumor contained histologically epithelial component (30%) and non-epithelial component (70%). The epithelial component consisted mainly of adenocarcinoma, which was partly mixed with squamous cell carcinoma with keratinization. The non-epithelial component was mainly undifferentiated sarcoma, and partially revealed rhabdomyosarcomatous differentiation with eosinophilic cytoplasm. In this case, the non-epithelial component consisted of rhabdo­myosarcoma, and the epithelial component included squamous cell carcinoma in addition to adenocarcinoma. Moreover, metastatic lymph nodes consisted of carcinosarcomatous element. In Japan, 22 cases of true gastric carcinosarcoma have been reported, including this case. Gastric carcinosarcoma with rhabdomyosarcomatous differentiation has been reported in only 12 cases. Furthermore, this is the first case report of gastric carcinosarcoma with a squamous cell carcinoma element, to our knowledge. True gastric carcinosarcoma is very rare, so we reported the present case to add to reports of clinical cases of true gastric carcinosarcoma.

A 73-year-old woman was given a diagnosis of T2 incidental gallbladder cancer, and underwent liver bed wedge resection. However, numerous micronodules were found on the hepatectomy surface, and all were found to be metastatic lesions by postoperative pathological examination. Finally, gall bladder cancer: pT3a (SS), pN1, M1 (liver), pStage IVB was diagnosed. Gemcitabine (GEM)+S-1 therapy was started after surgery, but no target lesion was observed consistently for 6 months from the initiation of chemotherapy. Since we knew that small metastases remained on the hepatectomy surface, we added central lower region (S4a+5) resection as a third operation in order to achieve reliable R0 resection. Pathological examination revealed two metastases in the resected specimen, however, 90% and 50% of necrosis was observed, respectively. GEM+S-1 therapy was performed for 6 months as adjuvant chemotherapy, and now she is alive without recurrence for 2 years and 3 months since the start of treatment. R0 resection was achieved by multidisciplinary treatment including three surgeries and pre- and post-surgical chemotherapies.

An 83-year-old man was referred to our department with a complaint of a right inguinal mass from 1 month previously. Ultrasound examination and abdominal CT scan demonstrated right inguinal hernia containing the appendix, which was penetrated with a fish bone. We observed the case because there were no findings of acute abdomen. Because there were similar findings even after 1 week, we performed elective laparoscopic appendectomy. Although the appendix was adherent to the hernia sac, we removed the appendix by inverting the hernia sac. Because he did not want to treat the inguinal hernia, we made a final examination. Both Amyand hernia and fish bone penetration of the appendix are rare and difficult to diagnose preoperatively. Many such cases of undergo emergency operation by laparotomy. We report a case diagnosed as Amyand hernia and fish bone penetration of the appendix treated by elective laparoscopic appendectomy.

We report a very rare case of internal hernia of the sigmoid colon through a defect in the falciform ligament. A 39-year-old woman who had cerebral palsy was transferred to our hospital with a diagnosis of intestinal obstruction. Abdominal radiography revealed sigmoid colon dilation, suggesting sigmoid colon volvulus. Although endoscopic detorsion was performed, gangrenous bowel was observed near the transition point. Hence, emergency laparotomy was conducted. Intraoperative findings showed incarceration of the sigmoid colon through a small defect in the falciform ligament. She underwent surgery to open the falciform ligament defect and sigmoid colon resection, and no relapse occurred postoperatively. Internal hernia of the sigmoid colon through a defect in the falciform ligament is difficult to distinguish from sigmoid colon volvulus. Once misdiagnosed, it can result in a serious condition. However, recognition of some characteristic images enables definitive diagnosis of this disease. Hence, this rare disease should be included in the probable differential diagnosis of sigmoid colon obstruction.