Purpose: Global lockdowns due to the COVID-19 pandemic (CP) may have resulted in significant intervention delays in abdominal emergencies, including acute appendicitis. In this study, we investigated the impact of CP on intervention delays and perioperative outcomes of emergency appendectomies. Materials and Methods: A retrospective cohort study was conducted for emergency appendectomies performed at our hospital between 12th March, 2018 and 10th March, 2022. Comparative analyses of intervention delays and perioperative outcomes were performed in pre-CP and post-CP, based on declaration of the CP by the World Health Organization on 11th March, 2020. Results: A total of 461 emergency appendectomies (pre-CP 213, post-CP 248) were analyzed. The time from hospital arrival to surgery was significantly longer in post-CP cases (732±426 vs. 651±468 min, P=0.005) and cases of gangrenous appendicitis increased significantly in the post-CP period (66.9% vs. 43.7%, P<0.001). However, there was no significant difference in the length of postoperative hospital stay or in postoperative complications in the two periods. Conclusion: The strict infection control policy at our hospital during the CP may have resulted in delays of surgery and worsening of the severity of appendicitis, but there was no significant clinical impact on postoperative outcomes. Thus, for patients with non-critical appendicitis, the treatment delay due to hospital infection control can be viewed as acceptable.

A 24-year-old man was referred to our hospital for a suspected mediastinal tumor found on chest X-ray in a health check-up. CT showed a tumor with a maximal lateral diameter of 8 cm circumferentially located from the thoracic esophagus to abdominal esophagus. Boring biopsies were performed endoscopically and the pathological diagnosis was esophageal leiomyoma. The patient was suffering from heartburn and dysphagia caused by the tumor compressing and expanding the esophagus. Tumor enucleation was performed using laparoscopy and thoracoscopy. The tumor extended subcircumferentially along the longitudinal esophageal axis and was of length approximately 17 cm. After tumor enucleation, the muscular layer was circumferentially dissected from the middle thoracic esophagus to abdominal esophagus, where the mucosal layer alone was preserved. Anti-reflux fundoplication was also performed to prevent gastroesophageal reflux. The postoperative course was good and the patient was discharged on postoperative day 19. There have been few reports on enucleation of giant esophageal submucosal tumors. We report this case as an example of a giant submucosal esophageal leiomyoma treated by laparoscopic and thoracoscopic enucleation.

A 56-year-old female visited our hospital for treatment of gastric carcinoma. She had a history of type II diabetes mellitus and non-alcoholic fatty liver disease (NAFLD), and she was obese with a body mass index of 34 kg/m². A preoperative blood test showed hyperammonemia and abdominal CT revealed a portosystemic shunt characterized by a marked shunting vessel from the left gastric vein to left renal vein. This vessel had a consistent diameter and ran straight and smoothly without variceal changes. No other features of portal hypertension were observed. Thus, we diagnosed the shunting vessel as a congenital portosystemic shunt. During distal gastrectomy for gastric carcinoma, a clamp test of the vessel was performed. The portal venous pressure was not elevated during the clamp test, and thus, the entire shunting vessel was resected. After the operation, serum ammonia levels immediately decreased to the normal range. The patient was discharged from hospital 16 days after the operation. At 2 years postoperatively, laboratory tests that had indicated abnormalities preoperatively, including liver transaminases, serum ammonia levels, branched-chain amino acids to tyrosine molar ratio, and serum Mac-2 binding protein glycosylation isomer levels, had all returned to normal. Fatty change of the liver was also improved. Thus, liver dysfunction due to a congenital portosystemic shunt with NAFLD was improved by resection of the portosystemic shunting vessel concomitant with distal gastrectomy. The case is reported here with a review of the literature.

There have been few reports on use of molecular-targeted drugs as preoperative therapy for giant hepatocellular carcinoma that is difficult to resect. We report a case in which preoperative administration of lenvatinib in a patient with giant hepatocellular carcinoma resulted in tumor shrinkage and spared the remnant liver volume. The patient was a 78-year-old man with a 19-cm hepatocellular carcinoma protruding from segment (S) 5 and S6 of the liver, and intrahepatic metastasis in S8. The tumor was close to the posterior segmental branch of the portal vein. Extended posterior segmentectomy plus S8 partial resection (31.9% of the whole liver) was assumed to be required for curative resection. Since the ICG retention rate was 28.3% and there was a risk of early postoperative recurrence, we re-evaluated the patient after administration of lenvatinib. After six weeks of this treatment, the main tumor had shrunk in size and intrahepatic metastasis had disappeared. As a result, inferior segmental resection (10.7% of the whole liver) with a sufficient liver volume could be performed. This case suggests that lenvatinib may be a potential preoperative treatment option for giant hepatocellular carcinoma.

A 50-year-old man received chemotherapy for transverse colon cancer with multiple unresectable liver metastases. The patient presented with fever and abdominal distension. CT showed colon and small intestinal dilation on the oral side from the cancer and a thickened terminal ileal wall. Bowel obstruction and obstructive enteritis due to transverse colon cancer were diagnosed preoperatively. Subtotal colectomy and resection of the thickened ileum were performed. Torn colonic taenia and histopathological findings of obstructive colitis were observed in the cecum. The thickened ileum had multiple ulcers, which were deemed to be ischemic changes similar to those in the cecum. Chemotherapy was continued postoperatively, but fever of unknown origin persisted, and thus, the ulcerative lesion of the ileum was reexamined. The ileal submucosa had medium to large atypical lymphocytes that were positive for CD3, CD4 and CD5 and negative for CD8, CD20 and CD56, confirming the diagnosis of primary ileal T-cell lymphoma. In this case, it was difficult to diagnose ileal malignant lymphoma because of obstructive colitis caused by transverse colon cancer. Double cancer of colorectal cancer and ileal malignant lymphoma is rare, but malignant lymphoma should always be considered in differential diagnosis for ileal ulcerative lesions.

A 71-year-old woman was admitted to our hospital for melena and lower abdominal pain. Colonoscopy showed sigmoid colon carcinoma with a histological type of differentiated adenocarcinoma on biopsy. Tumor invasion into a left ovarian cyst was suspected on CT. Laparotomy findings revealed a cyst on the serosal side of the sigmoid colon carcinoma, adjacent to the left ovary. Sigmoidectomy and left adnexectomy were performed assuming the possibility of invasion into the left ovarian cyst. The postoperative course was uneventful and the patient was discharged ten days after the operation. Pathological diagnosis of the tumor was well to moderately differentiated adenocarcinoma, pStage II. The cyst was composed of cancer cells on the subserosal side and was not an ovarian cyst. There were no malignancies in the left ovary and fallopian tube. Cyst formation on the subserosal side by tubular adenocarcinoma of a colorectal lesion is rare, with only three cases reported in the Japanese literature. In our case, it was difficult to differentiate the lesion from cancer invasion in the left adnexa.