Purpose: We have performed a diverting ileostomy in the umbilical region to improve the cosmetic appearance after ileostomy closure. We present the medium term results of this procedure. Materials and Methods: The subjects were 104 patients who underwent laparoscopic rectal resection, including robot-assisted surgery, and had a diverting ileostomy in the umbilical region from April 2016 to March 2022. The duration of ileostomy retention, outlet obstruction, presence of incisional hernia after closure, and length of hospital stay after closure were evaluated. Result: The patients included 27 males and the mean age was 68 years. There were 103 cases of rectal neoplasms, including benign and malignant neoplasms. Outlet obstruction was observed in one case (1%). Ileostomy closure was performed in 99 cases. The median duration of ileostomy was 105 days and there were no cases of wound infection requiring treatment after ileostomy closure. There was one case (1%) of incisional hernia at 1 year after closure. Conclusion: Umbilical ileostomy is a technique with excellent cosmetic outcomes that can also reduce the occurrence of outlet obstruction and post-closure incisional hernia, which are adverse events of temporary ileostomy.

A 71-year-old man was diagnosed with swelling of the para-aortic lymph nodes on CT performed for evaluation of disc herniation. Esophagogastroduodenoscopy (EGD) revealed a type 2 tumor in the gastric antrum, and biopsy showed moderately to poorly differentiated adenocarcinoma. The patient was diagnosed with clinical Stage IV gastric cancer with metastases to para-aortic lymph nodes (Nos. 16a2 lat, 16b1 lat). First line nivolumab (Nivo) plus tegafur-gimeracil-oteracil/oxaliplatin (SOX) therapy was administered. After 3 courses of immunochemotherapy, CT revealed shrinkage of almost all of the metastatic lymph nodes. Furthermore, EGD revealed that the primary tumor had become scarred, and biopsy showed non-neoplastic tissue. We judged that curative resection was possible, and distal gastrectomy D2 lymph node dissection, para-aortic lymph node dissection, and Billroth I reconstruction were performed. The patient was discharged 12 days after surgery without complications. The histological effect was complete response. Herein, we describe a patient with gastric cancer who was successfully treated with first line Nivo plus SOX therapy followed by conversion surgery who achieved a pathological complete response.

A 56-year-old female presented to another hospital with a complaint of abdominal distention. She then visited our hospital for further examination and treatment because hemangioma of the liver was found to have increased and ascites had appeared. Abdominal contrast-enhanced CT showed an 11-cm hemangioma in the right lobe of the liver. The portal vein was dilated and strongly contrasted from the arterial phase. Ultrasound color Doppler imaging showed flow between the right branch of the portal vein and the hepatic artery on the hilar side of the tumor. The right branch of the portal vein had distal hepatic blood flow. The left umbilical branch and main trunk had afferent hepatic blood flow. Angiography showed early portal vein contrast and a 10-mm aneurysm of the posterior inferior pancreaticoduodenal artery. We considered that ascites effusion was caused by portal hypertension and the aneurysm was formed by increased demand of hepatic arterial blood flow, and resection of the hepatic hemangioma was planned. Transcatheter arterial embolization of the posterior inferior pancreaticoduodenal artery aneurysm was performed before surgery so that the aneurysm would not rupture due to hemodynamic changes in the perioperative period. Open right hepatic lobectomy was performed and the patient was discharged on the 12th day after a good postoperative course.

The patient was a 57-year-old male who presented with epigastric and back pain. Imaging revealed a 50-mm hypovascular cystic mass in the pancreatic tail containing fat components. Differential diagnoses included lymphoepithelial cyst (LEC), dermoid cyst, and liposarcoma. Over time, the mass increased in size, and laparoscopic distal pancreatectomy was performed. Histopathology showed a benign squamous epithelium with dense lymphocytic infiltration and adipocyte nests without hair follicles, confirming a final diagnosis of pancreatic LEC with sebaceous glands.

We herein present a case of a 65-year-old woman who was referred to our institution for evaluation of a tumor in the head and body of the pancreas. The tumor had been discovered by MRI when glucose tolerance worsened one year after conservative treatment for acute pancreatitis. CT, MRI, and endoscopic ultrasound confirmed that the tumor had invaded the main pancreatic duct. CT showed an enhanced low-density tumor in the head and body of the pancreas in the early phase, leading to diagnosis of acinar cell carcinoma (ACC). Pylorus-preserving pancreatoduodenectomy was started, but an intraoperative examination revealed severe inflammation around the pancreas due to acute and obstructive pancreatitis. Because of difficulty preserving the splenic artery and the small amount of remnant pancreas tissue, total pancreatectomy was finally performed. The pathological diagnosis was ACC. In this report, we discuss our experience with this case of total pancreatectomy for ACC characterized by intraductal spread within one year.

Malignant pleural mesothelioma often presents with direct invasion or intrathoracic lymph node metastasis, but distant metastasis is rare. Herein, we report a case of a malignant pleural mesothelioma that metastasized to the ascending colon. A 73-year-old man presented with the chief complaint of hematemesis. He had a history of a malignant pleural mesothelioma that was diagnosed in 2016 and had been treated with short-term chemotherapy because the patient refused to undergo highly invasive treatment. Subsequently, pleural dissemination and enlargement of the primary tumor were observed, and nivolumab therapy was continued. Follow-up whole-body CT showed a mass shadow in the right colon that was suspicious for intussusception. The patient underwent right hemicolectomy with a diagnosis of intussusception. A pathological examination revealed ascending colon metastasis of malignant pleural mesothelioma. After an uneventful postoperative course, the patient recovered and is currently undergoing chemotherapy 7 months after the surgery. In Japan, the incidence of malignant mesothelioma is expected to peak around 2030, with an increase in the number of cases such as the one described here. This case suggests that intestinal metastasis should be considered in patients with preexisting malignant pleural mesothelioma who present with an intestinal mass.