A 48-year-old woman was admitted to the hospital because of early gastric cancer (on the lesser curvature of the gastric body, 0-IIc) found at a medical checkup. Preoperative examination also revealed a solid pancreatic head tumor about 5 cm in diameter. Laboratory data were in normal limits except for slight anemia. She was operated on under the diagnosis of early gastric cancer and a solidpeudopapillary tumor of the pancreas. During the operation, the 6×3cm retroperitoneal tumor appeared to be arising from the nerve plexus around the common hepatic artery, with loose adhasions to the pancreas body. The tumor was excised and distal gastrectomy was performed. The retroperitoneal tumor was diagnosed as a schwannoma by intraoperative pathological examination and its gross appearance, so that extended operation was not performed. Retropritoneal schwannoma around the peripancreatic nerve plexus should be considered as a differential diagnosis of the pancreatic tumor.

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We present a case of bilateral Spigelian hernias, extremely rare among primary abdominal wall hernia. A 70-year-old woman who had undergone total hysterectomy for uterine cancer and repair of a right abdominal wall hernia and admitted for abdominal pain was found to have 2 large abdominal wall hernias on both sides of the navel on abdominal CT and was subsequently refered to our hospital with a suspicion of incarceration of the hernias.
We diagnosed these as bilateral Spigelian hernias by CT but the hernias were difficult to recognize by inspection or palpation owing to the woman's obesity. She also had an incisional hernia cystically protruding into the lower abdomen. At surgery, each Spigelian hernia had large hernial orifices of 10×5 cm in diameter and the one at right was diagnosed as recurrent pseudohernia. These three hernias were repaired using polypropylene mesh sheets.
The patient suffered from a cutaneous fistula just after surgery, but has been in good health without signs of recurrence in the 3 years since surgery.

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We report an extremely rare case of obturator hernia with the femoral hernia containing the appendix. A 77-year-old woman admitted for anemia was diagnosed as an incarcerated femoral hernia based on a painful tumor on her right thigh and ileac symptoms appearing during hospitalization. She underwent emergency surgery. The swollen appendix was contained in the hernia sac, to which it adhered. Surgery included appendectomy, excision of the hernia sac, and the McVay, but her ileac symptoms did not improve. On postoperative day (POD) 7, a longtube was inserted and radiological enteroclysis showed obstruction of the small intestine in the right pelvic space. Abdominal CT showed an oval mass with a clear margin between the external and pectineal muscles. She was diagnosed with right obturator hernia on POD 9, and again underwent emergency laparotomy. The small intestine 190 cm from the ileum end was strangulated at the right obturator canal. After partial resection of the small intestine due to partial necrosis, the hernia hilum was closed with direct sutures. She was discharged on POD 35.

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A 77-year-old woman referred for a tumor palpable in the midline of the upper abdomen and having no history of trauma or surgery was found in ultrasonography and computerized tomography to have a protrusion of properitoneal fat and peritoneum through the decussating fibers of the rectal sheath in the midline of the upper abdomen. She was diagnosed with epigastric hernia and underwent hernia repair using Composix Kugel Patch^TM. Epigastric hernias are rare in Japan and no previous report has, to our knowledge, been seen in this approach. We report technical points in the proper placement of this patch.

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Seven cases of acute thromboembolism of the upper limb requiring tromboembolectomy at the hospital from 1989 through 2002 were retrospectively analyzed. Five out of the eight patients were older than 80 years. Affected limb was the right side in five cases and the left side in two cases. Six patients had obstruction at the brachial artery, and one at the ulser artery. Except one iatrogenic case, atrial fibrillation was accompanied. Intervals from the onset of the disease to surgery were within several hours in six cases, and 13 days in the remoining one case. On the basis of ous experiences, certain recommendations and drawn that thromboembolism of the upper limb requires prompt operation against the conventional understanding that the disease is unlikely to be come serious, and that thromboembolectomy alone is not sufficient and anticoagulation is necessary.

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