An 83-year-old woman who had noticed a bulging at the right inguinal region was seen at our hospital because the right inguinal bulging became larger rapidly and it was difficult to be reduced by hands. There was a previous history of undergoing radical repair for right femoral hernia at the age of 41. When she was first seen, an egg-sized, elastic-soft and painless tumor with the smooth surface was palpated on the caudal aspect of the right inguinal ligament. Maneuver reduction of the tumor was difficult. Abdominal CT scan showed that the right anterior wall of the urinary bladder had projected from the inside of the right femoral vein toward the caudal direction. Accordingly bladder hernia through the femoral ring as the hernia orifice was diagnosed, and radical operation was performed. Operative findings showed the urinary bladder to have prolapsed from the femoral ring. The bladder was reduced to the pelvic side and radical repair for the femoral hernia was performed. The patient's postoperative course was uneventful. She was discharged from our hospital on the 12^th postoperative day. No recurrence has occurred as of one year after the operation.
We report this case of bladder hernia prolapsed from the femoral ring as the hernia orifice.

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Most lipoleiomyomas are malignant tumors generally occurring in the uterus, with peritoneal occurrence being quite rare. We report a case of lipoleiomyoma occurring in the peritoneum with consideration of the relevant literature. The patient was a 65-year-old woman. As an oval tumor was detected on the ventral side of the pelvis by PET-CT following lung cancer surgery, she was referred to our hospital's department of surgery for detailed examination. CT and MRI visualized a solid tumor 65 mm in size suggesting a mixture of lipid components. Although there was no abnormal accumulation of FDG on PET, tumorectomy was performed as the mass was suspected to possibly be malignant. Surgical findings showed a tumor which had apparently arisen in the peritoneum, and there were no abnormalities of intra-abdominal organs. Histopathological examination showed an irregular mixture of a proliferative focus with a population of adipocytes in one part and a bundle-form proliferative focus crossed by smooth muscle cells, consistent with a diagnosis of lipoleiomyoma. According to our PubMed search, 3 cases with lipoleiomyoma occurring in the peritoneum have been reported in the international literature but none in Japan.

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A 70-year-old woman who had undergone abdominal incisional hernia repair with mesh patch 11 years previously was admitted to our hospital for recurrence of the incisional hernia. The mesh patch was infected and computed tomography showed a large incisional hernia (104 mm in diameter). To avoid the use of a mesh, with its high risk of infection, the components separation technique was used for the reconstruction of the abdominal wall after removal of the infected mesh patch. The patient was discharged on postoperative day 8. The components separation technique is a safe and effective procedure for the closure of midline hernias especially in cases with a high risk of mesh infections.

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Perineal hernia is a rare complication developed after abdominoperineal resection or pelvic exentration for rectal cancer. We experienced a case of perineal hernia associated with parastomal hernia developed after laparoscopic abdominoperineal resection and performed laparoscopic hernia repair.
A 59-year-old man underwent laparoscopic abdominoperineal resection with a diagnosis of rectal carcinoma with anal involvement. After the operation he developed parastomal and perineal hernias, so that he was operated on. Laparoscopic repair using Parietex ^TM Parastomal mesh was performed for the parastomal hernia, and at the same time, laparoscopic repair using Parietex ^TM Composite mesh, for the perineal hernia. The patient's postoperative course was uneventful and no signs of recurrence have been seen up to now.

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Now that recurrence of inguinal hernia after surgery has dramatically decreased, it is no exaggeration to say that postoperative chronic pain is the most crucial complication. Particularly postoperative neuropathic pain is intractable and leads to a remarkable decrease in QOL of the patients. Recently we have experienced a case of neuropathic pain after surgery for an inguinal hernia in which neurectomy succeeded in significant relief of the pain. The case involved a woman in her twenties who had severe pain at the right inguinal region which started one month after radical repair for a right inguinal hernia at another hospital. Every kind of analgesic failed to relieve the pain, and she was referred to our hospital nine months after the operation. Since Tinel sign was positive and she strongly wished to undergo surgery, we performed operation. The ilioinguinal nerve was found to have been involved in sutures used for the aponeurosis of external abdominal oblique muscle. We released the involved nerve from the sutures and performed triple neurectomy. Her visual analogue scale (VAS) that was rated as 80 before the operation decreased to five in one month after the operation.

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A 32-year-old man was referred to our hospital with a 1-month history of left leg ulcers that had developed following a blow. Physical examination revealed multiple leg ulcers that appeared associated with varicose veins. Ultrasound examination revealed an enlarged left greater saphenous vein with backflow. He was subsequently diagnosed with Klippel-Trenaunay syndrome because of his larger left foot and nevus, in addition to the varicose veins. As compression and ointment therapy were not effective, stripping of the greater saphenous vein was performed. The skin ulcers healed gradually after surgery. Klippel-Trenaunay syndrome is a congenital vascular anomaly and is known for associated intractable skin ulcers. The first choice of therapy is compression, but surgery for varicose veins is believed to be effective if there is backflow of the superficial veins.

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We report a case of mucoepidermoid carcinoma of the pancreas which is extremely rare. An 82-year-old woman who was pointed out positive faecal occult blood test for colorectal cancer screening was admitted to our hospital. Colonoscopy revealed descending colon cancer. On the inspection prior to operation, Stage II colon cancer and Stage IVa pancreatic tail cancer were detected, and resection of the pancreatic body and tail with splenectomy and partial descending colectomy were performed. Although endoscopic resection was planned for early gastric cancer, the patient did not consens any more treatments since the prognosis of pancreatic cancer was extremely poor. Eighteen months later, multiple liver metastases appeared and she died of liver failure. Postoperative histological diagnosis confirmed mucoepidermoid carcinoma of the pancreas.
Mucoepidermoid carcinoma of the pancreas is extremely rare and is classified into the subtype of pancreatic adenosquamous carcinoma. Pancreatic adenosquamous carcinoma is rare and accounts for about 2 % of all pancreatic cancers. The malignancy carries poor prognosis because it can metastasize in an early stage. The incidence of synchronous multiple cancer involving the pancreas and other organs is reported to be about 3 %, but synchronous multiple cancer of mucoepidermoid carcinoma of the pancreas and other organs like in this case has not been reported in the Japanese literature to our knowledge.

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