We report a case of osteonecrosis of the jaw during chemotherapy using bevacizumab in a 69-year-old man with multiple metastases of colorectal cancer. The patient presented with persistent abdominal pain and constipation and was emergently admitted to our hospital. An abdominal CT scan and colonoscopy revealed severe stenosis caused by carcinoma in the cecum, so an ileus tube was placed for decompression. Further general investigations revealed multiple liver, lung and bone metastases. It was difficult to remove the primary lesion and Ileostomy was performed to relieve the obstruction. After the operation, the patient underwent chemotherapy with mFOLFOX6 + bevacizumab because he was positive for RAS mutation. After 11 cycles of the chemotherapy when 5 months had elapsed after the initiation, the patient complained of refractory stomatitis. Osteonecrosis of the jaw was noted by an oral surgeon. The bevacizumab therapy was therefore discontinued and the necrotic tissue was removed by surgical procedures. No recurrent necrosis has occurred after discontinuation of bevacizumab. Osteonecrosis of the jaw might be an adverse event of bevacizumab. There are few case reports on osteonecrosis due to bevacizumab in Japan. However, once osteonecrosis occurs, the present regimen must be reconsidered and it may also lower the patient's quality of life. Careful attention should be paid for patients undergoing chemotherapy including bevacizumab.

A 71-year-old woman visited our ophthalmology department due to left eyelid swelling and was diagnosed with a left orbital tumor on MRI. The patient was diagnosed with IgG4-related disease by tumor biopsy. CT tomography revealed a high-absorption area with a contrast-enhanced effect in the inner upper area of the left mammary gland. Breast ultrasonography revealed a local hypoechoic region at this site. Core needle biopsy revealed advanced plasma cell and lymphocyte infiltration, and IgG4-related mastitis was diagnosed. After the start of steroid treatment, improvement in ocular symptoms and a decrease in blood IgG levels were observed. The breast lesions also reduced over time, and at four years after the start of the observation, no recurrence was observed.

A 66-year-old woman was shown to have a right breast mass on a plain chest CT examination when she was hospitalized in our hospital for a peritonsillar abscess. Five years previously, she was diagnosed with a tubular adenoma of the right breast following tumorectomy elsewhere. She had not undergone further medical examinations since then. At our hospital, a mass with a smooth surface measuring 2 cm in diameter was palpable near the surgical scar. Mammography showed a circumscribed and partially indistinct mass in the right breast (area A). Ultrasonography revealed a clearly defined border and partially indistinct mass measuring 27 mm in the maximum diameter in the same area. Magnetic resonance imaging was significant for a mass with rim enhancement in the right breast. Recurrence of tubular adenoma was suspected based on a core needle biopsy ; however, we could not rule out a possibility of breast cancer considering the image findings and the fact that the mass appeared in such a short period of time. Therefore, we resected the breast mass surgically. The histopathologic diagnosis was local recurrence of tubular adenoma of the breast. We report a case of locally recurred tubular adenoma that developed in postmenopausal 5 years after tumorectomy.

A 58-year-old woman had undergone right mastectomy and axillary lymph node dissection for right invasive lobular carcinoma 16 years previously. The pathological results were invasive lobular carcinoma, pT2N1(2/19)M0, pStage IIB, Estrogen Receptor-positive, Progesteron Receptor-positive, and HER2 score 1. Hormone therapy (anastrozole) was administered as a postoperative adjuvant therapy for four years. Six years after the surgery, her right lower abdominal pain appeared, and when appendicitis was suspected and appendectomy was performed, many disseminated nodules were found in her peritoneum. She was diagnosed with gastric metastasis and peritoneal dissemination of invasive lobular carcinoma and visited our hospital for therapy. She was administered tamoxifen and leuprorelin for nine years and three months, respectively, and anastrozole and palbociclib for seven months. The patient is still receiving treatment. Gastric metastasis and peritoneal dissemination of invasive lobular carcinoma often have a poor prognosis, and we report a rare case of a patient with long-term survival of ten years.

Encapsulated papillary carcinoma (EPC) is a rare malignant papillary lesion newly classified as IB by the World Health Organization in 2012. We report eight cases of EPC experienced at our hospital.

The median age of the patients was 66.5 years. The main complaint was mass in five cases. Mammography was category 3 or higher in all cases. Ultrasound revealed six cases of mixed mass and two cases of solid mass. Needle biopsies were performed in seven cases, all of which were malignant ; one case was cytologically malignant. Mastectomy and partial mastectomy were performed in four patients each. Pathological findings revealed invasion in four patients and six patients were hormone receptor-positive. All invasive cases were human epidermal growth factor receptor 2-negative, and Ki-67 was > 14% in three invasive cases. Partial resections were treated with radiation : five hormone receptor-positive patients were treated with endocrine therapy and one patient underwent chemotherapy. Patients with EPC reportedly have a tendency to be older ; however, three of our patients were in their 40s. The prognosis of invasive cases was better than those classified as invasive cancers.

Rapid growth and high proliferative activity was noted in patients with invasive EPC ; this suggests the need to carefully monitor the prognosis of such patients.

A 69-year-old woman with previous history of undergoing ascending aortic replacement underwent esophagectomy with a two-stage reconstruction in addition to thoracoabdominal aortic replacement for an aortoesophageal fistula arisen in a descending aortic aneurysm at the inferior mediastinum. In the first-stage operation, we performed thoracoabdominal aortic replacement, subtotal esophagectomy, omental flap transposition, cervical esophagostomy and gastrostomy via thoraco-abdominal approach in the right half side-lying position via left thoracolaparotomy. To create an omental flap, the right gastroepiploic artery and vein was preserved on the stomach side for subsequent use to reconstruct a gastric tube ; and an omental flap with the left gastroepiploic artery and vein as a pedicle was pulled up in the thoracic cavity through the esophageal hiatus. In the second-stage operation, the left gastroepiploic artery and vein which was the pedicle of the omental flap was preserved along the gastric wall not to injure, the gastric tube was then mobilized and pulled up for reconstruction through the antethoracic route. After the operation she developed anastomotic failure that caused a slightly delayed recovery, but she could be discharged home without following a downhill course.

Omental flap creation using the left gastroepiploic artery and vein as the pedicle may be a beneficial method that is able to cope with both omental flap implantation to the posterior mediastinum and esophageal reconstruction with the gastric tube through a two-stage approach.

Complete situs inversus is a rare congenital disease, that occurs with a frequency of 1-2 out of 10,000 persons. There are a few reports of lung cancer with complete situs inversus treated surgically. Recently we have performed right upper lobectomy for lung cancer in a patient with complete situs inversus who had undergone left upper lobectomy for cancer of the left upper lobe more than 10 years previously.

This is an extremely rare case of complete situs inversus, because there are no reports of bilateral lobectomy performed in the same complete situs inversus patient in the past. By confirming cautions that have been reported at intubation for surgery of lung cancer as well as problems in operative procedures and by sharing our experience, we expect to help surgeons who may experience similar cases.

A 74-year-old man with a history of right-sided rib fractures and bloody pneumothorax following a vehicular accident 5 years prior to presentation developed left-sided chest pain after colonoscopy. Computed tomography revealed left diaphragmatic hernia incarceration. We performed emergency laparotomy and released the incarcerated intestine. Furthermore, it was difficult to deploy the surgical field ; therefore, we performed thoracotomy and sutured the diaphragm to repair the hernia.

Diaphragmatic hernia may occur after penetrating or blunt trauma to the diaphragm. However, it may easily be missed because it is often masked by concurrent injuries to other organs. Detection of diaphragmatic hernia warrants urgent repair to avoid the risk of incarceration.

The patient was a 68-year-old man who underwent neoadjuvant chemotherapy, followed by thoracoscopic subtotal esophagectomy and gastric tube reconstruction through the posterior mediastinal route for cancer of the lower thoracic esophagus (cStage III). After the operation, he developed large volumes of left pleural effusion and the triglyceride (TG) level in the effusion was high. Accordingly, the condition was diagnosed as left chylothorax. Conservative therapy was started, but it was unsuccessful. Expecting to gain embolism effect as well as diagnose the leakage site we performed a lymphangiography through an inguinal lymph node puncture. On an enhanced image, a portion from where chyle had leaked was confirmed to be around the superior border of pancreas in the upper quadrant of abdomen. Ligation of abdominal lymphatic vessel was performed under laparotomy. After the reoperation, his pleural effusion decreased in volume and was cured. If conservative therapy is unsuccessful and reoperation is considered, we have to bear a possible leak from the abdominal lymphatic vessel in mind and to consider a use of lymphangiography for correct diagnosis and appropriate therapy.

A 74-year-old woman was referred to our hospital for evaluation of obstructive jaundice. Contrast-enhanced computed tomography revealed a paraesophageal hernia with duodenal and pancreatic head prolapse. The common bile duct was obstructed secondary to dislocation of the hepatoduodenal ligament. We performed percutaneous transhepatic bile duct drainage to treat jaundice and subsequent elective laparoscopic surgery for paraesophageal hernia repair. The duodenum and pancreatic head were successfully reduced into the abdominal cavity, and the hernial orifice was sutured and reinforced using a non-absorbable mesh. We also added Toupet fundoplication. The patient's postoperative course was uneventful, and she was discharged 6 days postoperatively. She is asymptomatic, and no recurrence has been observed over 3-year follow-up.

A 59-year-old woman was referred to our department for re-examination of abnormal findings of the stomach on a medical checkup. Upper gastrointestinal endoscopy revealed a type 0-IIc lesion, 30 mm in the longest diameter, in the middle third of the stomach. Poorly differentiated adenocarcinoma with signet ring cells was confirmed in biopsy specimens. We performed laparoscopic distal gastrectomy with D1 lymphadenectomy and gastroduodenostomy. During the surgery, we observed that the left portal vein, which was an aberrant left gastric vein, was transected endoscopically near the lateral segment of the liver with lymphadenectomy of the lesser coverture of the stomach. The patient's postoperative course was uneventful and he was discharged 13 days after the surgery. The presence of a left portal vein is a rare anomaly. Although we transected the left portal vein in order to accomplish systematic lymphadenectomy for gastric cancer treatment, there were no postoperative complications, including liver dysfunction. When we encounter a thick vein entering the liver during surgery, we may hesitate to transect it. With a recent increasing use of laparoscopic gastrectomy, our knowledge of the left portal vein is increasingly needed.

A 67-year-old man presented complaining of an upset stomach. On upper gastrointestinal endoscopy, an irregular elevated lesion was seen near the gastric cardia, which was diagnosed by biopsy as poorly differentiated adenocarcinoma. Total gastrectomy and D2 lymph node dissection were performed. Histopathological investigation resulted in a diagnosis of pStage IIb large-cell gastric neuroendocrine carcinoma. Combination carboplatin and irinotecan therapy was given as postoperative adjuvant chemotherapy. Two years postoperatively, a solitary brain metastasis was identified and treated by stereotactic radiotherapy with a CyberKnife. Treatment for this brain metastasis was subsequently performed repeatedly. Around 3 years 10 months postoperatively, the patient also developed normal-pressure hydrocephalus, and a lumboperitoneal shunt procedure was performed. He died of the original cancer at 4 years 2 months postoperatively. No lymph node or other distant metastasis was observed during the clinical course. This extremely rare case of solitary brain metastasis of large-cell gastric neuroendocrine carcinoma is reported along with a short discussion of the literature.

A 76-year-old man, who had undergone distal gastrectomy with Billroth-II reconstruction and Braun anastomosis for gastric ulcer at the age of 23, presented to our hospital because of abdominal pain. Emergency laparotomy performed with the diagnosis of intussusception revealed retrograde intussusception of the jejunum where was distal from the Braun anastomosis. After the intussusception was manually reduced, we confirmed that there were no ischemic findings nor organic diseases such as a tumor in the bowel and terminated the operation. Two years later, he developed intussusception again and underwent emergency operation. Intraoperative findings revealed the same retrograde intussusception as the former operation had demonstrated. Observation of the bowel after manual reduction showed absence of apparent ischemic findings on the bowel and the bowel had developed apparent reverse peristalsis. In order to prevent the recurrence, a reduced segment of jejunum telescoping into the adjacent segment was fixed to the abdominal wall. Thereafter no recurrence has occurred. In a review of the literature, we encountered some cases of post-gastrectomy intussusception, in which mechanical factors such as something wrong in the pacemaker might contribute to jejunal intussusception. Consequently, in the treatment of post-gastrectomy intussusception, we should consider not only simple reduction of intussusception but also additional application of procedure according to factors causing intussusception to prevent recurrence.

A 39-year-old woman presented with lower abdominal pain. An abdominal contrast-enhanced CT scan showed a 7-cm unilocular cystic lesion in the right lateral abdominal region, with the enhanced cystic wall. We diagnosed the case as cystic tumor arisen in the mesentery. Blood examinations revealed increased levels of CEA and CA19-9. As a possibility of continuity with the intestine could not be ruled out, laparoscopic ileectomy was performed. It revealed that there were no points of contact between the tumor and the uterus/bilateral appendages of uterus. No communication between the cystic wall and the intestine was also demonstrated by pathologic study. The inside of the cystic wall was composed of short monolayer columnar epithelia associated with moderate degree of nuclear atypia. Immunohistology resulted in the tumor cells to be positive for CK7 and CK20 and negative for CDX2. We finally diagnosed the case as mucinous cystadenoma arising in the ileocecal mesentery. Furthermore, CEA and CA19-9 were positive. Her postoperative course was uneventful, her symptoms disappeared, and the tumor marker levels declined within the normal ranges. No recurrence has occurred as of 6 months after the operation. We present this case of mucinous cystadenoma arisen in the mesentery due to its rarity.

A 79-year-old man presented with complaints of abdominal pain and fever. Computed tomography (CT) showed an enlarged appendix and swollen lymph nodes in the ileocecal artery region. He was diagnosed with acute appendicitis and treated with interval appendectomy. Follow-up CT one month later showed no significant changes in the lymphadenopathy and appendiceal enlargement. An appendiceal carcinoma was suspected, and laparoscopic ileocecal resection with D3 dissection was performed. The tumor was diagnosed pathologically as a primary appendiceal mucosa-associated lymphoid tissue (MALT) lymphoma. The patient's postoperative course was uneventful, and he remained alive without recurrence at 19 months post-surgery. MALT lymphoma is a low-grade malignant lymphoma arising from chronic inflammation. In terms of MALT lymphomas originating from digestive organs, there have been numerous reports of primary stomach tumors, but appendiceal MALT lymphomas are rare.

A 72-year-old man visited another hospital with back pain. Since the back pain increased, he was referred to our emergency outpatient department. Contrast-enhanced computed tomography (CT) in the emergency department showed pyogenic spondylitis in the lumbar 4/5 intervertebral spaces, a generalized descending colon cancer, and a chronic dissecting thoracic aortic aneurysm (Stanford type B). In addition, Pseudomonas aeruginosa was detected in the arterial blood culture on the day of admission, which led to the diagnosis of vertebral pyogenic spondylodiscitis (VPSD) due to hematogenous infection from colon cancer. With fasting and bed rest, pain control, proper blood pressure control with antihypertensive agents, and intravenous antibiotics, the patient underwent complete endovascular surgery on the 20^th day of hospitalization and emergency decompression with transanal ileus tube insertion on the 26^th day of hospitalization. The surgery was divided into three phases. The patient progressed well after the 5th operation. Curative resection was performed for the colorectal cancer, and the VPSD was cured by antibiotic treatment without any sequelae. The patient is now living well one year after the last operation.

A rare case of VPSD caused by Pseudomonas aeruginosa with advanced colorectal cancer as a prior infection is reported, along with a discussion of the mechanism of infection by a review of reported cases.

An 81-year-old woman had undergone transanal surgery for rectal prolapse at another hospital five years earlier. She experienced intestinal prolapse during defecation, unusual bleeding, and gradual onset of abdominal pain and vomiting. She visited our hospital Emergency Department with her family. An emergency operation was performed because the small intestine was found to have prolapsed through the anus and ruptured at two points. The prolapsed small intestine was resected, and the oral and anal stumps were returned to the prolapsed rectal lumen. The anus was narrow, and the operation in another hospital seemed to have been the Thiersch method. The rectal prolapse was reduced by making an incision in the perineal region and cutting the sutured anal ring. Laparotomy showed a perforation 3 cm in diameter in the anterior wall of the Rs rectum, and the small intestine was invaded. A functional end-to-end anastomosis was made. The rectum was resected, and an end stoma was created at the oral stump. After the operation, 2 units of RBCs were transfused for anemia. Computed tomography guided drainage was performed for the pelvic abscess, and the patient was discharged on day 40.

A 69-year-old man who had been diagnosed with sigmoid colon cancer underwent laparoscopic sigmoid colectomy, and the resected specimen demonstrated lymph node metastasis of a neuroendocrine tumor (NET). Afterwards, total colonoscopy was performed, and a NET was shown in the rectum. Laparoscopic super-low anterior resection was performed, and 23 NETs were seen in the specimen on histopathology. All tumors were less than 8 mm in diameter, but 11 of 15 harvested lymph nodes were found to be metastatic. The patient is doing well 3 years after surgery with no evidence of tumor recurrence or distant metastasis.

A case of sepsis presumably caused by bacterial translocation after stoma closure is reported. A 71-year-old man had undergone laparoscopic super-low anterior resection and loop ileostomy for lower rectal cancer. Two months later, he underwent stoma closure and laparoscopic cholecystectomy. He started eating meals three days after surgery. He developed septic shock six days after the operation. The focus of the infection was not identified by several examinations ; therefore, it was thought that the septic shock had occurred due to bacterial translocation. It improved 4 days after the start of administration of intravenous and oral antibiotics and immune globulin and plasma products. Bacterial translocation should be considered when sepsis develops after stoma closure.

The patient was an 80-year-old man who was referred to our hospital because of anal pain with an associated mass in the anus. A 60×25 mm skin mass with induration was found from the anal verge at 12 o'clock to the perineum, and computed tomography (CT) showed a substantial mass with contrast effect. A biopsy showed a collection of histiocytes with Michaelis-Gutmann bodies (MG bodies), and a diagnosis of malakoplakia was made. The margins of the mass were used as the excision line for resection. Seven months after surgery, the patient returned to the hospital with a complaint of a mass in the right inguinal region, and CT showed a substantial mass similar to the previous one in the anorectal region. The mass was found to be self-destructing and draining, and a right inguinal mass excision was performed to confirm the diagnosis and improve the patient's quality of life. Histopathological examination showed numerous MG bodies with positive findings on AB-PAS and iron staining, leading to the diagnosis of recurrent malakoplakia. The occurrence of this disease in the anorectal region itself is rare, and there have been no reports of ectopic recurrence in Japan. A case of anorectal malakoplakia with ectopic recurrence in the inguinal region is reported.

There are several reports about immune thrombocytopenic purpura (ITP) as a rare complication following COVID-19 vaccination.

A 50-year-old woman had received COVID-19 vaccine twice for prevention of infection of severe acute respiratory syndrome corona virus. Two weeks after the second vaccination, she was referred to our hospital for hypermenorrhea with a low platelet count of 1,000/μL. The reticulocyte count increased, and the red blood cell count decreased. Bone-marrow examination revealed slightly increased megakaryocytes without atypia. Helicobacter pylori infection test was negative. Contrast-enhanced computed tomography revealed no obvious splenomegaly or collateral blood flow. The diagnosis was ITP and steroids (pulsed high-dose dexamethasone 40mg/day for four days and prednisolone 25mg/day) were administered. The platelet count was slightly elevated up to 2,000/μL and 5,000/μL after steroids, respectively. The steroids treatments were ineffective, and splenectomy was planned.

Gamma-globulin (20g/day for five days) and thrombopoietin were administered prior to splenectomy. However, the platelet count was 23,000/μL. She underwent laparoscopic splenectomy just after a platelet transfusion. She had an uneventful intra-and post-operative course. Two months later, the platelet count was as stable as 75,000/μL and the splenectomy was considered an effective treatment.

Splenectomy was a good option for ITP as a rare complication following COVID-19 vaccination.

Ultrasonic laparoscopic coagulating shears (LCS) are surgical instruments that can perform coagulation and incision at the same time by ultrasonic vibration and are often used in laparoscopic surgery. Since a large force is applied to the tip of the probe, the probe can break depending on the usage conditions. A 43-year-old woman underwent laparoscopic uterine myomectomy due to uterine fibroids. LCS became an error mode at the time of making a longitudinal incision in the muscularis layer of the posterior wall of the uterus and became unusable. Fracture of the probe tip was confirmed. Although the part of the probe was searched in the surgical field and the extracorporeal area, it could not be found. It was eventually found by using an intraoperative X-ray and could be removed outside the body. Postoperative investigation pointed out a small damage that coincided with the fractured part. It might be the cause of the fracture. We present some precautions for using the LCS and those for collecting the fallen debris, with a review of the literature.

A 73-year-old woman presented to the emergency department in our hospital with vomiting and abdominal pain. Abdominal contrast-enhanced CT scan showed a dilated small intestine, an enlarged left ovary, and multiple nodules in the greater omentum peritoneum and mesentery. PET/CT scan showed abnormally high accumulation of FDG in the nodules of the left ovary, peritoneum, and mesentery, but not in the pancreas. Abdominal hysterectomy, adnexectomy, and small bowel resection were performed with the diagnosis of intestinal obstruction due to peritoneal metastasis of left ovarian cancer. Intraoperative findings showed a swollen left ovary and multiple nodules in the omentum, peritoneum, and mesentery. In addition, a 4-cm nodule was found in the mesentery of the jejunum about 1 cm from the ligament of Treitz, and another nodule was found in the serosa of the ileum 20 cm from the ileocecal region. The uterus and bilateral appendages were resected, and the omentum was removed as much as possible. About 10 cm and about 5 cm of the jejunum with a nodule in the mesentery and the ileum with a nodule in the serosa were excised and anastomosed.

The postoperative course was uneventful and she was discharged on the 12th postoperative day.

Histopathology revealed pancreatic tissue-derived adenocarcinoma in all ileum, jejunum, and omentum nodules. In addition, we observed the collision between the dissemination of primary ovarian cancer (mucinous adenocarcinoma) and pancreatic tissue-derived adenocarcinoma in both ovaries. The final diagnosis was double cancer of ectopic pancreatic cancer with peritoneal dissemination and metastasis and primary ovarian cancer. When we searched for the keywords “ectopic pancreatic cancer” and “double cancer” in the central journal of medicine (Ichu-Shi Web), there was only one case of duplication with gastric cancer. We report this case because of its rarity.

Braun tumors are rare inflammatory pseudotumors. We encountered a resected Braun tumor that was preoperatively diagnosed and resected as a solitary peritoneal recurrence.

This patient was a 74-year-old woman. Previously, she had undergone curative surgery for transverse colon cancer with synchronous liver metastasis of segment six. Five months after the surgery, routine FDG-PET/CT imaging identified FDG accumulation on a novel liver tumor in segment four and on a peritoneal nodule with a partially hollowed shape near the transverse colon anastomosis. Both lesions were curatively resected, and a diagnosis of a new recurrence was made. The histopathological findings, however, revealed that the peritoneal nodule was an inflammatory pseudotumor (Braun tumor), in which a silk suture was present as a foreign body in the hollowed area.

FDG-PET/CT imaging can be used to diagnose malignancies in general. However, it is necessary to consider the possibility of an inflammatory pseudotumor, such as a Braun tumor, if the tumor location is near the previous surgical site and if the shape is a partially hollowed nodule.

A 57-year-old woman was transferred to the emergency room for dyspnea. On admission, arterial blood gas showed an oxygen pressure of 46.1 mmHg at room air. Thoraco-abdominal computed tomography (CT) scan showed significant right-sided pleural effusion and giant uterine myoma (GUM). Under the diagnosis of pseudo-Meigs syndrome due to GUM, the patient was admitted for treatment and further detailed examination. This case was corrected as massive pleural effusion due to primary peritoneal carcinoma (PPC) Stage II, based on the laparotomy, total hysterectomy, ascites cell block histology, and the postoperative course. Guideline-directed adjuvant systemic chemotherapy was administered, and alive well in complete remission at 24 months postoperatively.

PPC responds well to systematic chemotherapy, and long-term remission is not uncommon. The diagnosis of stage II PPC is limited by CT imaging alone, and special intraoperative precautions should be taken in cases of GUM coexistence.

A 51-year-old man presented to a local clinic in October 2020 complaining of a right inguinal bulge and pain, and he was referred to our hospital with a suspected right inguinal hernia. Computed tomography in our hospital showed a right external inguinal hernia, with the appendix protruding into the hernial sac, and Amyand's hernia was diagnosed. Laparoscopic appendectomy and transabdominal pre-peritoneal repair (TAPP) were performed under general anesthesia with the patient in the supine position as a single operation. Six months postoperatively, no complications or recurrence of the hernia has been observed.

In Japan, Amyand's hernia is repaired by open inguinal surgery in over 90% of cases, but, recently, cases have been reported that started with a laparoscopic approach for intraperitoneal observation and to determine how to treat the appendix and hernia. To the best of our knowledge, excluding the present patient, only one other case in Japan and one case outside of Japan of simultaneous laparoscopic appendectomy and hernia repair by TAPP have been reported previously. In the present case, laparoscopic appendectomy and TAPP were performed as a single operation to treat Amyand's hernia, with good results, and this rare case is reported along with a short discussion of the literature.