A 61-year-old man who had undergone total gastrectomy and distal pancreatectomy for a pancreatic tumor 30 years ago had sudden appetite loss and weight loss for two years. Esophagogastroduodenoscopy performed at a nearby clinic showed no particular findings, and the patient was referred to our hospital for further examination and treatment. Upper gastrointestinal X-ray revealed that the cecum (the blind end of the esophageal jejunal anastomosis) was extended and barium was retained in the cecum. Thus, the patient was diagnosed with blind pouch syndrome (BPS). ρ anastomosis and cholecystectomy were performed because the patient also had cholelithiasis. He resumed eating on postoperative day (POD) 10 and was discharged on POD 14. ρ anastomosis is a reconstruction technique used as a subtype of Roux-Y anastomosis after total gastrectomy. ρ anastomosis is expected to increase storage capacity and food intake, and conversion to ρ anastomosis was particularly effective in this case. We report the case as an example of a patient with BPS with improvement of nutritional status due to increased food intake after ρ anastomosis.

The patient was a 64-year-old man in whom upper endoscopy revealed a 2-cm gastric submucosal tumor. Endoscopic US suggested a gastrointestinal stromal tumor derived from the fourth layer, but fine-needle aspiration failed to diagnose the tumor, so laparoscopic resection was performed for diagnostic treatment. The tumor was pedunculated and extragastric, and was resected using an autosuture device. Histopathological examination showed that the tumor was continuous with the muscularis propria and subserosa. Spindle-shaped cells with hyalinized collagen fibers proliferated, and calcification and inflammatory cell infiltration were present. Immunohistochemical staining of the spindle cells was positive for vimentin, but negative for CD34, c-kit, α-smooth muscle actin, desmin, and S-100, and the tumor was diagnosed as a calcifying fibrous tumor. One year after the operation, there has been no recurrence. We report this case as a rare example of a calcifying fibrous tumor originating from the gastric wall.

A 68-year-old man had no past medical history; however, he was a heavy drinker. He had visited a previous hospital for stomach ache and was diagnosed with chronic pancreatitis and pancreatic pseudocyst hemorrhage. He underwent conservative treatment. Since the same symptoms recurred twice after discharge, he was referred to our hospital. CT showed a cystic lesion at the pancreatic head, which was strongly enhanced during the late phase, and no aneurysm. Angiography also failed to identify a bleeding etiology. Despite conservative treatment, abdominal pain and anemia progression continued. Therefore, we decided to perform pancreaticoduodenectomy. Intraoperative and macroscopic findings showed no intracystic hemorrhage, and a bleeding etiology could not be identified; however, microscopic findings suggested chronic bleeding from the cystic wall. There is no clear consensus on treatment of pancreatic pseudocyst hemorrhage with an angiographically unidentified bleeding etiology. Based on the present case and a review of the literature, we suggest that conservative treatment is not clearly effective for pancreatic pseudocyst hemorrhage, and that surgical treatment, including combined resection of other organs, should be selected.

A 62-year-old woman was referred to our hospital for a detailed examination and treatment of obstructive jaundice. The results led to diagnosis of resectable pancreatic head carcinoma, and neoadjuvant chemotherapy was initiated. CT performed at the initial visit revealed severe stenosis of the superior mesenteric artery and a markedly dilated pancreatic arcade, which posed a concern of intestinal hypoperfusion during radical resection. Thus, angiography was additionally performed to embolize the pancreatic arcade during the neoadjuvant chemotherapy. Two weeks after embolization, we confirmed development of a collateral pathway from the inferior mesenteric artery, which compensated the main blood supply to the intestinal tract. Subsequently, subtotal stomach-preserving pancreaticoduodenectomy was safely performed without delay. While neoadjuvant chemotherapy is becoming a standard treatment for resectable pancreatic cancer, it is crucial to focus on early detection of abnormalities of the major abdominal blood vessels and vascular bifurcations, with development of multidisciplinary treatment strategies.

Purpose: The purpose of this study is to examine gender equality in training facilities for board certification designated by the Japanese Society of Gastroenterological Surgery at the time when the Gender Equality Working Group (now the Committee) was established, and to provide a benchmark for evaluating the effectiveness of the Working Group’s subsequent activities. Methods: Letters were mailed to supervisors and administrative staff at 899 facilities certified by the Japanese Society of Gastroenterological Surgery as requests to respond to a web-based questionnaire from June 30 to September 14, 2021. Administrative staff were asked about hospital policies on gender equality and the working environment. Gastroenterological surgeons were asked about the current situation regarding gender equality. Results: 32.0% of supervisors and 68.6% of administrative staff reported policies to ensure that physicians do not work more than eight hours per day, and 26.5% of supervisors and 27.9% of office managers gave physicians the day off following a night shift. A system of multiple attending physicians was reported by 64.9% of supervisors, and gastroenterological surgeons took 5–10 days of paid leave per year, with a median of six days. Among facilities, 22.6% and 11.9% reported that female and male surgeons, respectively, had taken childcare leave. Among female surgeons, 45.9% of those who had taken childcare leave had taken between one and six months, and 33.8% had taken between six and 12 months, while 71.8% of male surgeons who had taken childcare leave had taken less than one month. Conclusion: The current situation remains inadequate, although facilities are trying to improve gender equality and the working environment. The Committee will continue to promote gender equality in all facilities affiliated with the Japanese Society of Gastroenterological Surgery.