Purpose: The aim of this study was to evaluate the incidence and treatment course of adult patients with chronic postoperative inguinal pain (CPIP) based on patient-reported outcomes. Patients and Methods: A questionnaire was sent to 592 patients (617 lesions) who underwent inguinal hernia repair between April 2010 and March 2016 at our hospital to assess pain severity at 3 months after surgery using a 6-point numerical rating scale (NRS). We defined CPIP as pain with NRS of 3 or more that lasted for more than 3 months postoperatively. In addition, we directly contacted the patients with CPIP. Results: The questionnaire was returned by 427 patients (72.9%; 450/617 lesions). The incidence of CPIP was 7.6% (34/450 lesions). NRS of 3 or more at 1 week after surgery was significantly associated with the incidence of CPIP. Ten patients, including 9 with CPIP, had treatment for pain. Five patients with CPIP had received pain management since 3 months after surgery. Another 4 patients with CPIP and one without CPIP revisited our hospital to be treated for pain after the questionnaire survey. All patients obtained relief from pain after treatment. Conclusion: CPIP is not an uncommon disease, and this study suggests that early postoperative pain control is important. Patients should be observed for at least 3 months after surgery because early treatment for CPIP is likely to be important.

A 57-year-old woman complained of erythema of the back and limbs, fever, and arthralgia. Blood tests showed neutrophil-dominant leukocytosis and marked increases in serum CRP and ferritin levels, and were negative for antinuclear antibodies, rheumatoid factors, and various infectious-related markers. Although adult-onset Still’s disease (ASD) was suspected, advanced esophageal cancer (cT3N2M0, cStage III) was confirmed by examination, leading to a diagnosis of paraneoplastic syndrome. Surgery was performed without prior preoperative chemotherapy due to a febrile debilitating condition and hypoalbuminemia. No postoperative complications were observed, and improvement of inflammatory findings and fever occurred early after surgery. Erythema disappeared 6 months after the operation and arthralgia had almost disappeared after 1 year. Currently, 2 years after the operation, the patient is alive without recurrence. There are very few reported cases in which ASD-like symptoms manifested as paraneoplastic syndrome and then improved after radical resection of esophageal cancer.

Anastomotic bleeding after gastric cancer surgery is a relatively rare complication with a frequency of about 1%. Bleeding from the remnant stomach other than at the anastomotic site is particularly rare. The patient in our case was a 77-year-old man who was taking dual antiplatelet medications for cardiac coronary artery disease, and was diagnosed with anemia caused by gastric cancer. He underwent distal gastrectomy with D2 dissection for gastric cancer, and unexpectedly vomited massive blood on postoperative day (POD) 14. The hemorrhage point in the remnant stomach could not be detected using upper gastrointestinal endoscopy, and endoscopic hemostasis could not be performed. Contrast-enhanced CT showed an extravasation from the short gastric artery to the inside of stomach free from the anastomotic site or suture site. We performed transcatheter arterial embolization (TAE) and stopped the bleeding on POD 22. Despite secondary ischemia of the remnant stomach caused by TAE, the patient recovered with conservative management, started oral intake on POD 65, and was discharged on POD 89.

A 50-year-old man was admitted to our hospital with a chief complaint of abdominal pain. Abdominal CT showed a 17-mm unilocular cystic lesion in the pancreatic tail and dilation of the main pancreatic duct distal to the lesion. The pancreatic parenchyma was swollen. The fat tissue density around the pancreas was increased and indicative of pancreatitis. There was no communication between the main pancreatic duct and the cystic lesion based on MRCP, and endoscopic ultrasound showed a unilocular cystic lesion with no solid components or septal structure. The patient was diagnosed as having a retention cyst and acute pancreatitis, and received conservative therapy. Because of recurrence of pancreatitis due to stenosis of the main pancreatic duct caused by the cystic lesion, laparoscopic-assisted distal pancreatectomy was performed. The lesion was a bilocular cyst, and histopathologically, ovarian-type stroma was observed in the cystic wall. Thus, the lesion was diagnosed as a mucinous cystic adenoma. Pancreatic mucinous cystic neoplasms in males are less frequent than in females, but if suspicious findings are found on imaging, this disease should be considered in the differential diagnosis.

We experienced a case of acute superior mesenteric venous thrombosis in a 50-year-old male-to-female transsexual suffering from Klinefelter syndrome, who presented with vomiting, bloody feces, and a 1-week history of worsening epigastric pain. The patient also reported receiving intramuscular estrogen injections for gender identity disorder and Klinefelter syndrome over the past 8 years. Plain abdominal CT revealed localized small bowel wall thickening and increased mesenteric adipose tissue. The patient was initially diagnosed with acute enteritis and underwent conservative treatment. On the third day of hospitalization, emergency surgery was required following aspiration of bloody ascitic fluid. Intraoperatively, a 15-cm segment of the jejunum was found to be necrotic and was subsequently excised for histopathological examination, which indicated hemorrhagic bowel infarction associated with superior mesenteric venous thrombosis. Hence, we started anticoagulation therapy on the fourth postoperative day. To date, the patient has survived without relapse. We suggest that in the case presented here, acute superior mesenteric venous thrombosis was caused by two major factors: Klinefelter syndrome and long-term estrogen therapy.

A 70-year-old man went to his family doctor because of right hypochondrial pain. He was diagnosed with cholecystitis by abdominal US. One week later he was referred to our hospital. Abdominal CT showed a 4-cm tumor at the root of the small mesentery, and close to the superior mesenteric artery and inferior mesenteric vein. Teratoma or liposarcoma was suspected because the tumor was mainly fat and partly soft tissue. Tumor resection was planned at the same time as cholecystectomy. Since the mesenteric tumor might have been malignant, it was resected together with surrounding tissue. Hair was found inside the resected spacemen. A pathological examination revealed a mature cystic teratoma. The postoperative course was uneventful and the patient was discharged 8 days after the operation. We report this case as a relatively rare example of a mature cystic teratoma of the mesentery.

The patient was diagnosed with ulcerative colitis (UC) of a left-sided colitis type at age 52. Surveillance colonoscopy at 59 showed a protruded lesion in the anal canal, and endoscopic biopsy revealed squamous cell carcinoma. While chemoradiotherapy is the first line treatment for squamous cell carcinoma of the anal canal, in this case surgery was performed because of the risk of inflammatory exacerbation of the rectal-anal mucosa. Total proctocolectomy and ileal pouch anal anastomosis with ileostomy was performed at age 60. The histopathological diagnosis was pT2N1bM0 Stage IIIA. Twelve cycles of FOLFOX were administered as postoperative adjuvant chemotherapy. There was no recurrence in 8 months after surgery. We report this case as an example of squamous cell carcinoma of the anal canal associated with UC.

A 65-year-old man was referred to our hospital due to a well-circumscribed tumor of 8 cm in diameter on the dorsal side of the pancreatic head that had been found on abdominal CT performed for evaluation of traumatic injuries. Contrast-enhanced CT of the tumor showed heterogeneous ascending contrast enhancement, with a low-density area suggestive of internal degenerative necrosis. Two enlarged lymph nodes were visible in the vicinity of the tumor, but there was no coalescence. Endoscopic US revealed a well-circumscribed, hypoechoic solid lesion that was suspected to be continuous with the duodenal muscularis propria in some regions. Based on these imaging findings, a malignant mesenchymal tumor arising from the duodenal muscularis was diagnosed, and was subsequently treated by pancreaticoduodenectomy. The histopathological diagnosis was diffuse large B-cell lymphoma with necrotic and fibrotic changes inside, and with invasive margins to the pancreatic head nerve plexus. Malignant lymphoma can be distinguished from other diseases by typical imaging findings, such as homogeneous contrast images inside the tumor. However, careful preoperative examinations should be performed while keeping in mind the possibility that the typical imaging patterns may not be seen due to fibrosis and internal necrosis, as in the present case.