A 70-year-old male was referred to our hospital with a chief complaint of odynophagia. Esophagogastroduodenoscopy revealed a semicircular type 1 tumor in the middle thoracic esophagus. A biopsy confirmed the diagnosis of esophageal squamous cell carcinoma, but the patient initially declined further evaluation. Nine months later, the patient presented with difficulty in oral intake, and a CT scan identified a large tumor in the upper and middle thoracic esophagus. The patient was diagnosed with esophageal squamous cell carcinoma (UtMt, type 1, cT3br, N1 [No. 106 recR], M0, cStage IIIB, based on the 12th edition of the Japanese Classification of Esophageal Cancer). Following neoadjuvant chemoradiotherapy, surgical resection was planned. The neoadjuvant chemoradiotherapy reduced the tumor size, and the patient subsequently underwent thoracoscopic subtotal esophagectomy with gastric tube reconstruction via the posterior mediastinal route. The final pathological diagnosis was esophageal sarcoma (UtMt, type 1, ypT3, N0, M0, ypStage IIB). We speculate that the squamous cell carcinoma component was eradicated by the preoperative treatment, resulting in a final diagnosis of esophageal carcinosarcoma. We report this case as an example of esophageal carcinosarcoma treated with neoadjuvant chemoradiotherapy.

A 91-year-old man presented with tarry stools and abdominal pain. A CT scan showed a gastric fornix tumor that had moved to the antrum and become incarcerated, leading to a diagnosis of ball valve syndrome (BVS). A gastroduodenal endoscopic examination revealed ulceration on the surface of the tumor. After admission, the patient experienced repeated episodes of incarceration and reduction, eventually leading to hemorrhagic shock, necessitating emergency surgery. The tumor was resected using the combination of laparoscopic and endoscopic approaches to neoplasia with a non-exposure technique (CLEAN-NET). A histopathological examination led to diagnosis of a gastrointestinal stromal tumor. It is rare for a tumor in the gastric fornix to cause BVS. In this case, this occurred due to the fragility of the connective tissue facilitating mucosal stretching. CLEAN-NET, a non-exposure technique, was found to be a simple and effective method for treating lesions with ulceration.

A 75-year-old man was diagnosed with advanced gastric carcinoma in the gastric antrum by upper gastrointestinal endoscopy performed to investigate the cause of anemia. Laparoscopic distal gastrectomy with Billroth I reconstruction (delta-shaped anastomosis) was performed. On postoperative day 3, the patient showed increased levels of inflammatory biomarkers, and contrast-enhanced CT revealed poor enhancement of the gastric wall. These findings led to diagnosis of gastric remnant necrosis, and emergency subtotal gastrectomy with Roux-en-Y reconstruction was performed. During surgery, extensive necrosis was detected from the remnant gastroduodenal anastomosis to the middle gastric body from 5 cm below the terminal branch of the short gastric artery. We report this case as a rare example of gastric remnant necrosis after laparoscopic gastrectomy with Billroth I reconstruction that suggests the causes and precautions required for this condition.

A 50-year-old female was admitted to hospital for abdominal pain. An abdominal CT scan revealed a well-defined 20-cm mass occupying nearly the entire right lobe of the liver. The neoplasm was a complex, mostly cystic lesion that was subdivided into multilocular lesions by septa. Cytological examination of the cystic fluid did not show any malignant cells, although the tumor displayed enhanced mural nodules. Given the diagnosis of suspected biliary cystadenocarcinoma, a right hepatic lobectomy was conducted. A histopathological study showed that the tumor was primarily composed of spindled cells of an epithelioid component. Immunohistochemical staining for HMB-45 and melan-A was positive, leading to diagnosis of hepatic angiomyolipoma (HAML). A 1.5-cm cystic lesion appeared 8 months after surgery, and a CT scan after a further year showed an increase in size of the lesion to 4 cm. A second surgical resection was performed, and histopathological examination revealed recurrence of the tumor. Although most cases of HAML are believed to be benign, there have been reports of malignant behavior, including growth and recurrence following surgical resection. The patient has been monitored for 48 months after the second surgery without any evidence of metastasis or recurrence, but continued careful follow-up is necessary.

Sclerosing angiomatoid nodular transformations (SANT) are rare neoplasms of the spleen. The patient in this case was a 47-year-old male with SANT of the spleen mimicking another solid splenic neoplasm who was admitted to our hospital for further examination of the splenic tumor. The tumor was diagnosed as an inflammatory pseudotumor or inflammatory myofibroblastic tumor, and hand-assisted laparoscopic splenectomy was performed. A histopathological examination showed that the solid tumor was a SANT of the spleen. Since Martel et al. first described SANT in 2004, 39 patients with SANT of the spleen have been reported in the Japanese literature. SANT of the spleen is a benign tumor, but preoperative diagnosis of SANT remains difficult. Puncture biopsy is likely to be useful, but our case shows that laparoscopic splenectomy is a treatment option in cases in which puncture is difficult.

Intestinal bleeding due to post-transplant lymphoproliferative disorder (PTLD) is a rare condition, with only six reported cases to our knowledge. The patient was a 35-year-old woman who had received living donor kidney transplants from her parents at ages 16 and 23 for renal failure, and was on immunosuppressants. In December 2020, she was diagnosed with PTLD in upper gastrointestinal endoscopy performed for anemia and was referred to our hematology department. FDG-PET showed multiple small bowel lesions. In March 2021, she was admitted to hospital and received medical therapy. From day 14 after administration, she showed hematochezia, and emergency surgery was performed on day 17 because conservative treatment did not improve her condition. Laparotomy revealed a hematoma throughout the small intestine and five nodular lesions in the small intestine. We made a small incision in the small intestine and inserted an endoscope. Endoscopy revealed the bleeding point and ulcer activities. Partial intestinal resections, including the bleeding point and active ulcers, were performed. One month after surgery, she resumed medical therapy and this resulted in complete remission.

The patient was an 80-year-old male who had experienced right lower abdominal pain since the previous day and visited our hospital. The patient had tenderness in the right lower abdomen and peritoneal irritation was observed. Images showed an abscess formation due to a perforated appendix, and our department was consulted. Examination of the images showed a foreign body that appeared to be an endoscopic clip in the center of the abscess. Because it was doubted that conservative treatment would improve the condition caused by the foreign body, surgery was performed. Due to abscess formation, there was significant inflammatory thickening around the ileocecal area. Ileocecal resection was performed and endoscopic clips were identified in the appendix in the resected specimen. Investigation of the patient’s past endoscopic examination history suggested that the clips had migrated into the appendix and may have remained asymptomatic for five years. A literature search revealed only four reported cases of appendicitis caused by a migrated endoscopic clip. We herein report this case as a rare example of this condition.

A 68-year-old man had been diagnosed with sigmoid colon cancer at age 65, but ceased medical attention on his own initiative. Two years later, he was hospitalized for colonic ileus. Abdominal CT showed no distant metastasis, but indicated massive tumor invasion into the bladder. Chemotherapy was started after transverse colostomy. The therapy caused the tumor and infiltrating lesion to shrink, and laparoscopic sigmoidectomy and partial resection of the bladder were performed. The bowel was reconstructed using a double stapling technique with an automated anastomosis device, and there were no postoperative complications. Six months of adjuvant chemotherapy was added due to the pathological diagnosis of ypStage IIa. Without any recurrence or metastasis, colostomy closure was scheduled, but a preoperative examination showed complete obstruction at the anastomosis. Although the ring shape of the anastomosis was preserved, mucosa had developed in the lumen, resulting in a membranous obstruction. The center of the obstruction was cauterized and balloon dilation was performed under endoscopic observation from both sides of the anus and the colostomy. Two days later, colostomy closure was performed. We report this case as a rare example of complete membranous obstruction of an anastomosis.

We present two cases of laparoscopic surgery for colorectal cancer complicated by decompensated liver cirrhosis. As well known, both cases developed collateral vessels due to portal hypertension that resulting in minor bleeding during surgery. Both also exhibited marked thickening and sclerosis of the peritoneum and subperitoneal loose connective tissue, making it difficult to identify dissection planes during mesentery mobilization. Similar changes were also observed in the loose connective tissue surrounding the vessels, causing significant risks to arise during vessel identification and dissection, and ultimately rendering adequate lymph node dissection unfeasible. These changes were thought to have resulted from chronic peritonitis induced by continuous absorption of ascites from the peritoneum and subperitoneal tissue in patients with cirrhosis. In surgery for such patients, it is important to pay attention to risks of intraoperative bleeding, postoperative liver failure, and anastomotic leakage due to delayed wound healing, and to potential challenges in mesentery mobilization and lymph node dissection caused by thickening and sclerosis of the peritoneal and subperitoneal connective tissues.