A 75-year-old man underwent thoracoscopic subtotal esophagectomy and reconstruction by cervical esophagogastric tube anastomosis via a retrosternal route for esophageal cancer in 2015. Postoperative anastomotic stenosis developed and endoscopic dilatation was frequently performed. In 2017, the patient presented to our emergency department with hematemesis. He had a left common carotid esophagogastric tube anastomotic fistula and went into cardiopulmonary arrest temporarily, but resuscitation was possible and emergency hemostasis was performed in the emergency room by direct suturing of the bleeding site. On postoperative day (POD) 37, the patient suffered massive bleeding due to rupture of a pseudoaneurysm of the left common carotid artery and underwent emergency surgery. A covered stent graft was placed in the left common carotid artery, and esophageal and gastric tube fistulas were created. The skin defect was large and was filled using a pectoralis major muscle skin valve. Postoperatively, the patient developed a mediastinal abscess, which was treated with percutaneous drainage and antibiotics, and he was discharged from hospital on POD 195. Since then, he has had no recurrence of esophageal cancer and no rebleeding. A free jejunal reconstruction was performed in 2018. The patient is currently under outpatient observation.

Echinococcosis is a parasitic disease that develops after infection with Echinococcus granulosus, but is rare in Japan. A 63-year-old Peruvian man who had immigrated to Japan 30 years ago presented to our hospital with complaints of abdominal pain and distension. CT and MRI revealed two hepatic cysts. The first cyst was a giant lesion that measured 30 cm in diameter, contained several internal septations, and was located in the lateral part of the liver. The second lesion measured 3 cm in diameter and was observed in segment 5 (S5) of the liver. Based on these findings, along with the patient’s residential history, hepatic echinococcosis was suspected, and lateral segmentectomy and S5 subsegmentectomy were performed. Both cysts had a thick fibrous capsule and a cuticular layer with a stratified eosinophilic structure. Echinococcus larvae were observed microscopically in fluid obtained from the cysts, and western blot analysis revealed E. granulosus-specific proteins. The patient was diagnosed with cystic echinococcosis, which is also referred to as hydatid disease. We suspect that the patient was infected with E. granulosus before moving to Japan. Most echinococcosis outbreaks in Japan are reported on the island of Hokkaido, and these cases are most often polycystic echinococcosis. Herein, we report a rare case of cystic echinococcosis in a Peruvian immigrant residing in Japan. An extensive review of the literature on echinococcosis in Japan is also provided.

A 54-year-old man underwent radical cholecystectomy, extrahepatic bile duct resection, lymph node dissection, and choledochojejunostomy for gallbladder cancer associated with pancreaticobiliary maljunction. The histopathological diagnosis was moderately differentiated adenocarcinoma; pT2, pN0, and pStage II. Two years and 10 months after surgery, abdominal US revealed a hypoechoic mass of 11 mm with an irregular shape and a prolonged contrast effect in the pancreatic body. Histological examination using endoscopic ultrasound fine-needle aspiration revealed that the tumor was adenocarcinoma. Distal pancreatectomy was performed under a diagnosis of pancreatic cancer cT3N0M0 cStage IIA. Histopathological examination revealed two lesions in the pancreatic body, both of which were poorly to moderately differentiated adenocarcinoma. Since the morphology of the lesions on HE staining and immunohistochemistry were consistent with the gallbladder cancer, the final diagnosis was pancreatic metastasis from gallbladder cancer. At 18 months after surgery, the patient is alive without recurrence. Most metastatic pancreatic tumors are metastases from renal cell carcinoma, sarcoma, colorectal cancer, or malignant melanoma, whereas pancreatic metastasis from gallbladder cancer is extremely rare. Thus, we report this case as an example of solitary pancreatic metastasis from gallbladder cancer.

A 66-year-old man underwent laparoscopic distal pancreatectomy for a neuroendocrine tumor in the pancreatic tail. On postoperative day (POD) 2, he developed sudden back pain, and enhanced CT revealed a hematoma in the right anterior pararenal space and an anterior inferior pancreaticoduodenal artery aneurysm. Celiac axis stenosis (CAS), which was not observed preoperatively, was also present and was thought to have caused the aneurysm. Selective coil embolization of the anterior pancreaticoduodenal artery was performed via the superior mesenteric artery under abdominal angiography. The patient was discharged on POD 33 without rebleeding. The CAS had disappeared on enhanced CT at 3 months postoperatively. We suspected that the CAS was due to development of acute median arcuate ligament syndrome (AMALS). There have been several reports of AMALS after pancreaticoduodenectomy, but no reports of AMALS after laparoscopic distal pancreatectomy, making this an extremely rare case.

A 37-year-old man with Williams syndrome diagnosed early in childhood and under regular monitoring presented to the urology department of our hospital complaining of bloody pyuria and frequent urination. Abdominal CT revealed a bladder-infiltrating sigmoid colon tumor and the patient was referred to the gastroenterology department of our hospital. A diagnosis of ileo-sigmoid-vesical fistula due to sigmoid colon diverticulitis was made and he was referred to our department. Intraoperative findings showed multiple diverticula of the descending and sigmoid colon. We performed open left hemicolectomy, partial resection of the small intestine, and partial cystectomy. The patient was discharged uneventfully on postoperative day 11. Williams syndrome is caused by microdeletion of genes on chromosome 7q11.23 and has a relatively low incidence. Colon diverticulosis is likely to occur due to elastin abnormality; however, cases of ileo-sigmoid-vesical fistula in patients with Williams syndrome have rarely been reported. The risk of cardiovascular complications due to anesthesia should be carefully considered during perioperative management, given the high incidence of mental retardation and anxiety disorders in patients with Williams syndrome.

A 67-year-old man visited his local doctor with a complaint of bloody stools. He was referred to our hospital because of progressive anemia, and diagnosed with rectal cancer with resectable liver metastasis after a thorough examination. While waiting for surgery, he developed fever and was immediately hospitalized with a diagnosis of sepsis. On the 3rd day of hospitalization, sepsis worsened and the patient developed cardiac and respiratory failure, requiring intensive care with ventilator management. On the 6th day of hospitalization, contrast-enhanced CT revealed multiple liver abscesses of sizes 1–2 cm, and blood cultures revealed Fusobacterium spp. After continued treatment with antimicrobial agents and intensive care, the patient underwent laparoscopic low anterior resection on the 30th day of his illness. Four months later, laparoscopic partial hepatectomy was performed, and the patient is alive without recurrence 3 years and 1 month after hepatic resection. We report this case as an example of preoperative liver abscess caused by Fusobacterium in a patient with liver metastasis of rectal cancer, which required multidisciplinary treatment but was successfully treated with radical surgery.