In Western countries, use of a fully covered self-expandable metal stent (SEMS) for closure of anastomotic leakage has been widely reported. However, in Japan, this approach is not covered under the national health insurance system, and there are few reports of it use. We report a case of anastomotic leakage following esophagogastric junctional cancer surgery that was successfully managed with endoscopic placement of a fully covered SEMS. The patient was a 49-year-old man who underwent robot-assisted proximal gastrectomy combined with lower esophagectomy for esophagogastric junction cancer. Anastomotic leakage was detected on postoperative day (POD) 2. On POD 9, thoracoscopic and laparoscopic lavage drainage, direct suture repair, and omental patch covering were performed, but recurrent leakage occurred. As inflammation remained poorly controlled, a fully covered SEMS (HANAROSTENT^®, 18×80 mm) was endoscopically placed on POD 27. This resulted in rapid clinical improvement and fistula reduction. The stent was subsequently removed and the patient was discharged on POD 95. Although fully covered SEMS placement is not reimbursed by insurance in Japan, our experience suggests it may be a minimally invasive and effective treatment option for refractory anastomotic leakage.

Surgical resection of duodenal tumors may require advanced techniques. We report a case in which organ-preserving laparoscopic local resection, assisted by intraoperative endoscopy, was successfully performed for a gastrointestinal stromal tumor (GIST) located at the inferior duodenal flexure. A 65-year-old man was incidentally found to have a mass at the inferior duodenal flexure, adjacent to the pancreatic head, on postoperative CT following resection of a peripheral nerve sheath tumor. Endoscopic examination revealed a submucosal tumor near the ampulla of Vater, which was visualized as a 15-mm hypoechoic mass on endoscopic US. A biopsy confirmed the diagnosis of a duodenal GIST, and the patient subsequently underwent laparoscopic local resection of the duodenum. The postoperative course was uneventful and the patient was discharged on postoperative day 14. Histopathological examination confirmed a low-risk GIST with negative surgical margins. This surgical approach is considered useful, as it allowed for preservation of organ function by avoiding pancreaticoduodenectomy.

Abscess formation due to fallen stone remnants in the abdominal cavity during laparoscopic cholecystectomy (LC) is a noteworthy complication. We report the case of an 81-year-old woman with multiple intra-abdominal abscesses due to remnant stones from LC. Management of the patient was challenging despite open stone removal and drainage, since she had poorly controlled diabetes mellitus. During LC, a small stone fell and was retrieved immediately. Two months after surgery, she returned with a chief complaint of right-sided abdominal pain. Multiple intra-abdominal abscesses with a residual stone were observed on imaging. Initially, the patient underwent conservative treatment, but the condition was refractory to treatment; therefore, laparotomy was performed for stone removal and drainage. However, complete removal of the stones was difficult, and re-drainage was required due to the recurrence of intra-abdominal abscesses. At 8 months after the reoperation, the abscesses had disappeared on imaging, and at 12 months, the patient is under outpatient observation with no recurrence of abscesses.

Biliary hemorrhage is a relatively rare condition for which appropriate management is important. Herein, we report a case of biliary hemorrhage that occurred during chemotherapy for unresectable distal cholangiocarcinoma, in which curative resection was achieved through surgical intervention. The patient was a 77-year-old male diagnosed with unresectable distal cholangiocarcinoma with invasion of the common hepatic artery plexus after examinations for elevated liver enzymes. One year and four months after initiation of chemotherapy, the patient was urgently admitted to hospital due to a diagnosis of biliary hemorrhage. As endoscopic intervention failed to achieve hemostasis, surgical management was considered necessary. Since resectability was unchanged on imaging, we decided to proceed with radical resection if there were no malignant findings in the common hepatic artery plexus. Intraoperative rapid diagnosis revealed no residual cancer in the common hepatic artery plexus, and pancreatoduodenectomy was performed. Radical resection was achieved based on permanent pathological results. This case shows that surgical treatment considering radical resection can be an effective strategy for biliary hemorrhage in a patient with unresectable distal cholangiocarcinoma.

A 42-year-old woman with systemic lupus erythematosus (SLE) on regular follow-up presented to our emergency department with abdominal pain. She was admitted with a diagnosis of infectious enteritis and received conservative treatment. However, her abdominal pain worsened two days later. CT suggested the possibility of intestinal necrosis, and diagnostic laparoscopy was performed. Intraoperatively, extensive necrosis was observed from the jejunum to the entire colon, necessitating resection of the small intestine and colon, along with construction of a jejunostomy. The postoperative course was favorable, and the patient was discharged on postoperative day 59. Histopathological examination of the resected specimen confirmed a diagnosis of lupus enteritis. Intestinal necrosis and gastrointestinal perforation due to lupus enteritis are associated with high mortality, as abdominal symptoms may be masked by steroid use and patients are often in an immunosuppressed state. This case highlights the importance of early diagnosis and timely therapeutic intervention in patients with SLE presenting with worsening abdominal symptoms, given the possibility of intestinal necrosis or perforation secondary to lupus enteritis.

Intussusception of the transverse colon is rare, and cases accompanied by gastric invagination are even more uncommon. A 68-year-old man was brought to our hospital by ambulance with a one-day history of progressive abdominal pain, distension, and vomiting. He was febrile, and physical examination revealed a board-like rigid abdomen. Contrast-enhanced abdominal CT showed intussusception of the left colon with a mass lesion at the lead point, without evidence of pneumoperitoneum. Additionally, the greater curvature of the stomach was invaginated into the intussuscepted segment, causing gastric outlet obstruction. Emergency surgery was performed. Intraoperative findings confirmed intussusception extending from the splenic flexure of the transverse colon to the rectum, with part of the greater curvature of the stomach and greater omentum entrapped within the intussuscepted bowel. As the lead point mass was suspicious for advanced colon cancer, left hemicolectomy with D2 lymph node dissection was performed following manual reduction of the invaginated stomach and colon. Histopathological examination of the resected tumor revealed leiomyosarcoma.

A 79-year-old man who had undergone open low anterior resection for rectal cancer 12 years prior and had remained free of recurrence since the surgery presented to our hospital with a one-week history of difficulty with defecation. Contrast-enhanced abdominal CT revealed colonic volvulus involving the residual sigmoid colon. Endoscopic detorsion was attempted, but this was unsuccessful and surgical intervention was deemed necessary. Laparotomy revealed that the volvulus was caused by adhesions at the site of left colonic mobilization, and lymph node dissection was performed during the initial surgery. Because the anastomosis from the previous low anterior resection was located close to the anus, additional bowel resection and reconstruction were thought to carry a high risk of complications. Therefore, we performed adhesiolysis of the causative adhesions and applied an anti-adhesion barrier without performing bowel resection. The patient was followed-up for 16 months postoperatively without volvulus recurrence. In reconstruction after left-sided colorectal cancer surgery, prevention of postoperative volvulus should be considered through use of measures such as retroperitoneal fixation of the residual colon segments. Furthermore, when managing colonic volvulus after left-sided colorectal surgery, an appropriate surgical strategy should be selected based on a careful assessment of invasiveness and safety, as bowel resection is not always necessary.

A 53-year-old woman with colonic obstruction secondary to sigmoid colon cancer was transferred to our hospital. Despite being concurrently diagnosed with coronavirus disease (COVID-19), urgent bowel decompression was necessary, and sigmoid colostomy was performed on the day of admission. On postoperative day (POD) 2, erythema was noted around the stoma, which progressed to a black discoloration by POD 4, raising concerns of necrotizing fasciitis. On POD 5, the necrotic abdominal wall, including the stoma site, was extensively resected. This was followed by reconstruction with an ileostomy, a sigmoid mucosal fistula, and abdominal wall repair using a musculocutaneous flap. Histopathological examination revealed extensive necrosis of the skin and subcutaneous tissues. In the postoperative period, progressive purpura developed around the reconstructed abdominal walls. However, no further necrosis was observed after administration of fresh frozen plasma and heparin. The patient’s condition gradually improved, and she was discharged in a stable condition on POD 40. Peristomal infections following colostomy have been reported in 0.9–8% of cases, but rapid progression to necrotizing soft tissue infection is rare. In this case, the COVID-19-associated hypercoagulable state may have contributed to the pathogenesis.