An 82-year-old man developed a fever and a feeling of abdominal fullness. On abdominal CT scan, a foreign body in the small intestine was found ; a large amount of ascites was also noted. Based on the CT findings and an elevated CRP level, the patient had an exploratory laparotomy given a provisional diagnosis of perforated peritonitis caused by a foreign body. During the laparotomy, a large amount of, yellow, clear, ascitic fluid was found in the abdominal cavity ; multiple small nodules were found on the peritoneal surface of small intestine and the mesentery. The intestinal foreign body was easily found and then removed through a jejunotomy. However, the site of perforation was not identified. The intraoperative pathology report noted multiple small granulomatous formations and miliary findings. As a result, the ascites was thought to be related to tuberculous peritonitis. The postoperative pathology report identified Mycobacterium tuberculosis in the small nodules. Given a diagnosis of tuberculous peritonitis antituberculosis treatment was initiated.

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The patient was a 45-year-old man who suddenly developed palpitations and a systolic headache. His blood pressure was extremely elevated and a large mass was found in the right adrenal region on abdominal computed tomography. His serum and urinary catecholamine levels were high. After α-blocker and hydration treatment, surgery was done. The tumor arose from a paraganglion and was diagnosed as a paraganlioma. While the blood pressure was controlled with α-blocker therapy, the inferior vena cava (IVC) was clamped and divided above the renal veins in orger to extend the surgical field. The tumor was extirpated, and the IVC was reconstructed. Postoperatively except for the urinary dopamine level, the serum and urinary catecholamine levels normalized, and his arterial blood pressure could be controlled. The patient was discharged on the 11^th postoperative day. The temporary division and reconstruction of the IVC to extend the surgical field is useful when resecting large retroperitoneal tumors.

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A 58-year-old man visited our emergency clinic because of left abdominal pain, for which prescribed anodyne was effective. Four days later, he was hospitalized to our hospital because he became to have left abdominal pain again and vomiting. Abdominal CT scan showed a mass formed by the small intestine behind the stomach with decreased contrast enhancement of the small intestinal wall. The patient was diagnosed as having strangulated ileus resulting from an internal hernia, and underwent an emergency operation on the sameday. Laparotomy revealed an oval defect about 3cm in diameter in the mesentery of the transverse colon. About 80cm long portion of the small intestine had invaginated through the defect. The invaginated small intestine was manually reduced when no necrosis was seen and the defect was repaired by sutures. The patient followed a favorable postoperative course and was discharged on the postoperative day 7.
We report our experience with a case of this rare condition with a leview of the literature.

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We report two cases of inguinal hernia containing the appendix vermiformis (Amyand' hernia). Case 1 was a 90-year-old woman who was diagnosed as incarcerated right inguinal hernia. Emergency laparotomy was performed. Operative findings disclosed an indirect inguinal hernia that contained the appendix vermiformis and part of the greater omentum. We carried out hernioplasty without artificial mesh after appendectomy and omentectomy. Case 2 was a 81-year-old man who was diagnosed as right inguinal hernia and routine inguinal herniorrhaphy was performed. We found the appendix vermiformis without obvious inflammation in the hernia sac and carried out appendectomy through the hernia sac and hernioplasty by using mesh plug. In case 1, the diagnosis of Amyand' hernia was not made preoperatively. But, in case 2, we diagnosed as Amyand' hernia with a CT scan before operation. It is important to examine the contents of the hernia sac in inguinal hernia by a preoperative CT scan.

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A male in his sixties underwent an emergency operation for diffuse peritonitis caused by idiopathic small-bowel perforation. He complained of pain in the right inguinal region four days after the operation. A mass was palpated in his right inguinal region and it was irreducible. We suspected the incarceration of inguinal hernia and an emergency operation was performed. We found a thumb-head sized elastic hard mass in the spermatic cord which connected to the peritoneum. An abscess was formed in the mass. It was considered that the abscess was formed inside the patent processus vaginalis. It should be suspected that a similar condition as this case could be occurring when a painful mass developes after an operation for peritonitis.

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A 83-year-old man was admitted due to the presence of a soft mass and pain in the left superior lumbar triangle area.
He had a lumbar hernia treated using Petit's procedure 11 years earlier.
On physical examination, a 6×6 cm soft and smooth surfaced mass was found. Abdominal computed tomography (CT) showed a left lumbar muscle defect and retroperitoneal fat herniated through the defect ; a diagnosis of recurrent superior lumbar hernia was made.
The lumbar hernia was repaired with a Bard Composix Mesh^® during laparoscopy. The postoperative course was uneventful, and the patient was discharged on postoperative day 7. For 6 months since the operation there have been no signs of recurrence. Only 6 laparoscopically treated cases, including the present case, have been reported in Japan to date.

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An 85-year-old woman was admitted to the hospital due to low back pain and a mass located at the left lumbar area. The mass was about 8×8 cm in diameter and had a soft elastic consistency. On physical examination, the hernia orifice was found at the left superior lumbar triangle. Computed tomography (CT) showed a defect of the abdominal wall between the left obliquus abdominis internus muscle and the erector muscle of the spine. The descending colon prolapsed to the extraperitoneal fat layer through a left lumbar muscle defect. Given the diagnosis of a left superior lumbar hernia, a herniorrhaphy was performed. The operative repair was done by inserting a Mesh-Plug into the fascial defect and covering the superior lumbar triangle with an onlay patch of a Marlex Mesh. The patient's postoperative course was uneventful ; no recurrence has been observed. A lumbar hernia is rare. It is primarily treated surgically. A hernia repair using the Mesh-Plug method, which was performed in this case, is well known in inguinal hernia surgery. This method is very simple and has few postoperative complications. As shown by this case it is also useful for herniorrhaphy of a lumbar hernia.

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A-73-year-old woman admitted for anal pain was diagnosed as having rectal cancer. A laparoscopic abdominoperineal resection was done. The final, pathological diagnosis was MP, N0, M0, StageI. Wound healing of the perineal area was protracted, and the patient was discharged on the 27th postoperative day. After discharged from hospital, the perineal wound pain continued. Pelvic MRI at 5 postoperative months showed a perineal hernia of the intestine. A herniorrhaphy with artificial mesh was done under laparotomy. The hernia has not recurred. Many patients with perineal hernia have the secondary type of hernia, almost all of which occur postoperatively after abdominoperineal resection or total pelvic exenteration. Secondary perineal hernia after laparoscopic abdominoperineal resection is rare. However, if the incidence of such hernias increases, then an optimal approach for treatment will need to be identified.

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Abstract : We report here a case of Peutz-Jegher's syndrome in a 35-year-old female, in whom thyroid adenocarcinoma with pulmonary metastasis and uterine cervical adenocarcinoma coexisted. The chief complaint of the patient was a tumor in the right neck. An aspiration needle biopsy of the thyroid tumor was not conclusive in diagnosis. A chest X-ray prior to the thyroid operation revealed a 50mm in diameter size mass in the left lung field. Left lower lobectomy was performed first, which confirmed the diagnosis of pulmonary metastasis of thyroid papillary adenocarcinoma. On the other hand, a PET study revealed a concentration of dye in the pelvis and uterine carcinoma was suspected by a MRI study. Therefore, a conical resection of the uterine cervix was performed at the time of total thyroidectomy and the diagnosis of cervical adenocarcinoma of the uterus was made. Later on, an extensive total hysterectomy with bilateral adnexal resection was performed. It is well known that intestinal cancer often arises in PJS, but occasionally cancer arises also out side of the intestinal tract, as in our case. It is, therefore, important to pay attention to the possible coexistence of cancers in other organs.

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