A 47-year-old man was admitted to our hospital with melena. Upper gastrointestinal endoscopy revealed a 30-mm wide, circumferential 0-IIc+IIa lesion in the middle thoracic esophagus. A biopsy led to diagnosis of squamous cell carcinoma. Additionally, a bulky submucosal tumor was detected in the gastric fundus during endoscopy. A CT scan showed a 10-cm mass closely adjacent to the diaphragm and the lateral segment of the liver. Based on these findings, thoracic superficial esophageal cancer and a bulky gastric submucosal tumor were diagnosed. The patient underwent thoracoscopic subtotal esophagectomy, two-field lymph node dissection, partial resection of the lateral segment of the liver, and partial resection of the left diaphragm. Gastric tube reconstruction was performed via the retrosternal route. A postoperative histopathological examination revealed that the gastric tumor was an intramural metastasis from the esophageal cancer, infiltrating the liver and diaphragm. As postoperative adjuvant chemotherapy, the patient received two courses of 5-FU+CDDP therapy and one year of oral S-1 monotherapy. He is currently alive with no recurrence 39 months after surgery.

A 43-year-old man experienced epigastric pain for 3 days and visited his family doctor. Blood tests showed inflammation (CRP 19 mg/dl) and mild anemia (Hb 11.7 g/dl). The next day, plain CT revealed a 7-cm mass in the anterior gastric wall and ascites in Douglas’ pouch. The family doctor suspected intra-abdominal hemorrhage and referred the patient to our hospital on the same day. We detected an omental hemorrhage due to omental bleeding on enhanced CT, but vital signs were almost normal and a follow-up examination showed no progression of anemia. Therefore, standby laparoscopic surgery was conducted on the 3rd hospital day. A 10-cm hemorrhage was found and partial omental resection was performed. Omental bleeding is generally defined as a disease in which the arteriovenous system of the omentum fails for some reason and blood accumulates in the abdominal cavity or omentum. Cases of omental bleeding reported in Japan have been treated with surgery or interventional radiology. Our case shows the usefulness of surgery, including standby or laparoscopic surgery, for omental bleeding.

A 35-year-old woman presented with a cystic tumor in the pancreatic tail found on abdominal US during a medical checkup. Abdominal MRI showed a multifocal cystic tumor of approximately 5 cm in size at the pancreatic tail, with no evidence of communication with the main pancreatic duct. Endoscopic US showed a suspected serous cystic neoplasm (SCN) of the macrocystic type. Three months later, CT showed that the tumor had increased to approximately 8 cm in size. The patient underwent laparoscopic distal pancreatectomy. Intraoperative findings showed that the tumor was in close contact with the transverse colon and could not be dissected, so the colon was resected in combination. Histopathological examination revealed a serous cystadenoma. The tumor was not detached from the transverse colon, and the wall of the cyst was contiguous with the muscularis propria via fibrous connective tissue. We report this case as a rare example of SCN extending locally into surrounding tissues, which may necessitate complicated resection of the surrounding organs.

The patient was a 48-year-old male who presented with epigastric pain and bleeding, leading to referral to our department. An examination at our hospital showed mild anemia. An abdominal CT scan revealed a high-density area of 17 mm in the small intestine, which was suspected to be an enterolith. A small bowel contrast study showed a diverticulum in the small intestine with a defect suggestive of a stone inside. Based on these findings, small bowel bleeding due to an enterolith in Meckel’s diverticulum was suspected, and laparoscopic surgery was performed. During the procedure, a bulge suspected to be a Meckel’s diverticulum was observed approximately 60 cm proximal to the terminal ileum. This was withdrawn from the abdominal cavity and partial resection of the small intestine was performed. Macroscopic findings revealed a diverticulum measuring 35 mm in diameter containing an enterolith of 15 mm in diameter. Histopathological examination showed erosion with bleeding at the transition from the oral small intestine to the diverticulum. We report this case as an example of Meckel’s diverticulum with an enterolith diagnosed following bleeding.

A 66-year-old man underwent laparoscopic right hemicolectomy for ascending colon cancer in March 2020. An enterocutaneous fistula developed postoperatively due to delayed anastomotic leakage, which required anastomotic resection in May 2020. Pathological findings revealed peritoneal dissemination in the vicinity of the fistula, leading to diagnosis of synchronous peritoneal dissemination of ascending colon cancer. In December 2020, the patient underwent distal gastrectomy for gastric cancer. Peritoneal dissemination was observed in the small intestine and mesentery, which were resected at the same time. CT performed in August 2022 revealed a 14-mm nodule near the small intestine, which had increased to 20 mm within two months. FDG-PET/CT showed abnormal accumulation, suggesting recurrent peritoneal dissemination. The patient underwent partial resection of the small intestine, but the tumor found in the small intestine was not peritoneal dissemination histopathologically. The tumor histology was consistent with that of the original ascending colon cancer, leading to diagnosis of isolated small intestinal metastasis. We herein present this case as a rare example of isolated small intestinal metastasis after two resections of peritoneal dissemination of colon cancer.

The patient in this case was a 37-year-old male diagnosed with cerebral venous thrombosis and ulcerative colitis in January 2020. Treatment began with warfarin potassium, mesalazine, and adalimumab. In an examination in our internal medicine department in April of the same year, the patient tested positive for anti-phosphatidylserine-dependent antiprothrombin antibodies, raising suspicion of concurrent antiphospholipid syndrome, but a definitive diagnosis could not be confirmed. In August 2021, he developed lower abdominal pain, and a CT scan suggested necrosis of the sigmoid colon. Emergency surgery was performed on the same day, revealing a dark red, swollen sigmoid colon. This was determined to be due to necrosis caused by congestion from a thrombus in the sigmoid mesenteric vein. Scattered signs of congestion were also observed in the small intestine, and disseminated intravascular coagulation had developed, prompting the decision to forego single-stage resection. Instead, total colectomy and creation of an ileostomy were performed, followed by a secondary transanal mesorectal excision in March 2022. Since the initial surgery, there has been no recurrence of intestinal necrosis, but anticoagulant therapy has been continued due to suspected thrombophilia.

The patient was a 52-year-old male who had undergone laparoscopic distal pancreatectomy for a pancreatic neuroendocrine neoplasm (NEN) one year and a half ago. Follow-up CT revealed a 37-mm retroperitoneal mass adjacent to the pancreatic dissection margin and left adrenal gland. Although somatostatin scintigraphy was negative, the possibility of NEN recurrence could not be ruled out, and we made a decision to perform surgical resection. The tumor was strongly adherent to the pancreas, retroperitoneum and left adrenal gland, and was suspected to be invasive. A histopathological examination of the tumor showed spindle-shaped cell proliferation and immunohistochemical staining showed expression of β-catenin and α-SMA, leading to a diagnosis of desmoid tumor. We report this case as a rare example of a rapidly enlarging retroperitoneal desmoid tumor after resection of the pancreatic tail that was difficult to differentiate from NEN recurrence.

A 79-year-old man presented to our hospital with complaints of abdominal fullness and vomiting. Abdominal CT showed a caliber change of the small intestine. The patient was admitted to hospital for placement of a nasogastric tube for diagnosis of small bowel obstruction. A long intestinal tube was placed on the third hospital day. On the second day after the tube was placed, the patient self-extubated due to severe pharyngeal pain, and the next day, stridor appeared and worsened. Therefore, laryngoscopy was performed, and revealed bilateral paralysis of the vocal cords and laryngeal edema, leading to diagnosis of nasogastric tube syndrome. In addition, there was no improvement in the bowel obstruction. On the same day, an emergency tracheotomy was performed in the operating room for airway management. Intestinal adhesiolysis was also performed. The postoperative course of intestinal obstruction was uneventful. Vocal cord movement improved on the 20th postoperative day, and the patient was transferred to another hospital on the 25th postoperative day. A nasogastric tube is often used in clinical practice, but rarely causes nasogastric tube syndrome, which presents with bilateral paralysis of the vocal cords and laryngeal edema. Nasogastric tube syndrome requires a long time for improvement and often requires tracheotomy.