A 79-year-old woman with distal cholangiocarcinoma underwent subtotal stomach preserving pancreaticoduodenectomy with portal vein resection in May 2020. A postoperative pancreatic fistula developed, but the patient was discharged from hospital 26 days after surgery. Repeated hospitalization was required for postoperative cholangitis and severe anemia requiring transfusion from September 2020. Contrast-enhanced abdominal CT showed extrahepatic portal vein stenosis and development of collateral vessels in the elevated jejunum, which led to a diagnosis of cholangitis associated with bleeding from ectopic varices due to portal vein stenosis. In January 2021, percutaneous transhepatic portal vein stenting and coil embolization of the collateral vessels in the elevated jejunum were performed. The patient did not develop cholangitis after this procedure and is still alive without recurrence one year after surgery. Cholangitis after pancreaticoduodenectomy is a common complication, but it should be noted that cholangitis may occur with a background of portal vein stenosis in a patient undergoing portal vein resection.

A sciatic hernia often coexists with an obturator hernia because both hernias have a similar background. An 89-year-old female visited our hospital with a complaint of vomiting. Abdominal CT revealed an incarcerated right greater sciatic hernia and an incarcerated right obturator hernia. She was diagnosed with ileus due to the hernias. Manual reduction of both hernias provided relief and the patient went home. We subsequently performed elective laparoscopic surgery and repaired the two hernias using a mesh sheet with a slit for the obturator nerve to pass through. The obturator nerve and blood vessels travel around the obturator foramen, and the ureter and sciatic nerve and superior gluteal nerve and blood vessels pass around the greater sciatic foramen. Care was taken not to injure these vessels through treatment of the greater sciatic hernia coexisting with the obturator hernia using a mesh sheet with a slit. There was no evidence of infection or disease. Therefore, we report this case as an example of an approach to hernia repair that is safe and effective.

In the super-aging society in Japan, the number of elderly patients with colorectal cancer is increasing. In recent years, therapeutic developments have produced various treatments for colorectal cancer, and immune checkpoint inhibitors have emerged. in addition to anticancer drugs and molecular-targeted drugs. We report the case of an elderly patient with colorectal cancer in whom FOLFOXIRI+BEV and pembrolizumab therapy were effective. The patient was an 87-year-old woman with ascending colon cancer who underwent laparoscopic right hemicolectomy. At 4 months after surgery, a recurrent lesion was detected in the right abdominal wall. At this time, we decided to administer FOLFOXIRI+BEV as 1st line chemotherapy. After initiation of treatment, the sizes of the tumors diminished. However, after 14 courses of chemotherapy, the main tumor grew and CT showed new lesions on the abdominal wall. At 18 months after surgery, the chemotherapy was changed to immunotherapy with pembrolizumab because MSI-H was diagnosed based on examination of the resected specimen. The tumors then decreased in size. After 27 courses of immunotherapy, the patient presented to our hospital with fatigue, dyspnea, and other symptoms. The cause was considered to be an immune-related adverse event. After their treatment, the symptoms improved and the patient was able to continue immunotherapy. Thereafter, the patient remained in partial response.

The patient was a 75-year-old male who underwent laparoscopy-assisted left hemicolectomy for transverse colon cancer at age 72 years. The pathological diagnosis was pT2N1, tub2, ly1, v2, pStage IIIa. After 6 courses of UFT/UZEL as adjuvant therapy, there was no recurrence. However, 2 years and 11 months after surgery, recurrence of pelvic peritoneal dissemination was diagnosed by CT. After 12 courses of TEGAFIRI+Bev, the disease stabilized and the metastatic nodule was resected. A nodule on the serosal surface of the anterior rectum was found in surgery, and low anterior resection was performed. Histopathologic findings showed peritoneal metastasis of transverse colon cancer to the pararectal node. Two metastatic lymph nodes were found in the No. 251 lymph node, leading to diagnosis of lymphatic metastasis from a peritoneal dissemination nodule. Three courses of XELOX were administered postoperatively as adjuvant therapy and the patient has been recurrence-free for 9 years.

Use of immune checkpoint inhibitors (ICIs) has recently been recommended for treatment of unresectable or recurrent colorectal cancer with a microsatellite instability-high (MSI-H) status. We report a case of recurrent sigmoid colon cancer that was treated with ICIs followed by radical resection. One year after primary resection, the patient was diagnosed with localized peritoneal metastasis invading the left lower abdominal wall. The tumor presented as RAS/BRAF wild-type and was treated with FOLFIRI+panitumumab as 1st line chemotherapy. After shrinkage was observed, the patient was referred to our department for possible resection. Treated with ipilimumab plus nivolumab was used for further disease control of the borderline resectable tumor. However, interim imaging showed a slight increase in tumor size, so radical surgery (abdominal wall tumor resection+lymph node dissection+fascia lata abdominal wall reconstruction) was performed after three courses of ICI treatment. The pathological results showed a complete response, and the patient is now under observation with neither adjuvant therapy nor recurrence.

Parasternal diaphragmatic hernia (PDH) (also known as Morgagni-Larrey hernia) is a relatively rare disease. Here, we report a case of PDH and review 655 published cases of PDH in adults. An 83-year-old woman with kyphosis was admitted to our hospital with vomiting and severe dehydration. She was diagnosed with PDH with incarceration of the distal stomach and duodenum by diagnostic imaging. After reduction, the PDH was surgically repaired using the laparoscopic tension-free method with Ventralight^® mesh. This mesh is flexible and translucent, and therefore, was easy to use. A sac seroma was diagnosed postoperatively by CT; however, this resolved with conservative treatment (observation only). The postoperative course was uneventful and the patient was discharged. Female sex and obesity are predisposing factors for PDH. Historically, in cases in which PDH was misdiagnosed as a thoracic tumor, thoracotomy was chosen as the treatment method. Increased use of CT has improved diagnostic accuracy, and selection of laparoscopic surgery is increasingly common. The primary repair method, reinforcing method, and tension-free method have all been used to repair PDH, but the tension-free method is becoming more common. Using these methods, the rates of postoperative mortality and hernia recurrence are less than 1%, indicating good outcomes.