Objective : The safety and effectiveness of endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD) as a bridge to surgery (BTS) were evaluated in patients with acute calculous cholecystitis.

Patients and Methods : The study included 111 patients who underwent cholecystectomy for moderate or severe, acute calculous cholecystitis between April 2016 and December 2021. Of them, 52 underwent BTS [EUS-GBD in 35 ; endoscopic gallbladder stenting (EGBS) in 6 ; and percutaneous transhepatic gallbladder drainage (PTGBD) in 11], and 59 underwent surgery without drainage. The results of the drainage method and of surgical treatment were compared.

Results : EUS-GBD had significantly shorter treatment time than EGBS and significantly longer time to surgery than PTGBD. Only one patient in the EUS-GBD group required conversion to open surgery.

Conclusions : Surgery following EUS-GBD for acute calculous cholecystitis is a safe and effective method of treatment when performed by experienced physicians and surgeons.

An 18-year-old female patient presented with a mass in the upper inner quadrant of the right breast that was accidentally discovered 10 months prior to presentation during self-examination. Ultrasonography revealed a 50 mm hypoechoic mass, and magnetic resonance imaging revealed a regionally concentrated area. Histopathological examination using a core needle biopsy suggested a benign tumor ; however, the histological type could not be determined. The patient was then referred to our hospital for surgery. A lumpectomy was performed, and the histopathological examination revealed proliferation of small glandular ducts with a biphasic pattern of glandular epithelial and myoepithelial cells, leading to a diagnosis of adenomyoepithelioma of the breast. Herein, we report a case of adenomyoepithelioma of the breast in an 18-year-old female along with literature review.

The patient was a 53-year-old woman. Four years previously she was aware of a right breast mass, of which fine needle aspiration cytology (FNAC) revealed bloody discharge, but it was diagnosed as benign. A year before, swelling and pain of the right breast appeared. It was diagnosed as breast abscess and her symptoms improved with puncture and drainage and oral administration of antibiotics at another hospital. Three months before, right bloody milk discharge appeared, for which two times of FNAC at the other hospital revealed the same class II bloody discharge as they gained in the cytology done 4 years previously. As they could not rule out a possibility of malignancy due to an increase of the tumor size and easily bleeding tendency, she was referred to our hospital. She had a 2.4 cm mixed patterned lesion in the right breast, which was Class V on cytology, and squamous cell carcinoma was suspected. Right partial mastectomy and sentinel lymph node biopsy were performed, leading to the histopathological diagnosis of malignant adenomyoepithelioma with metaplastic carcinoma component. As it was triple negative, 4 courses of dose-dense doxorubicin and cyclophosphamide (ddAC), 4 courses of dose-dense paclitaxel (ddPTX) and irradiation to the breast remnant were performed after surgery. As of 2 years after surgery, the patient is alive without recurrence. Due to rarity, we present this case of malignant adenomyoepithelioma of the breast.

We report a case of undifferentiated sarcoma that arose approximately 14 years after partial mastectomy for breast cancer. The patient was a woman 40-years-old who underwent left breast partial mastectomy and sentinel lymph node biopsy for left breast cancer, cT2N0M0 stage IIA. The pathological findings included invasive ductal carcinoma of the breast with a tumor size of 1.8 × 3.0 cm, n0, lymphatic invasion (ly0), venous invasion (v0), and no positive lymph nodes (n (0/4) ). Estrogen receptor (ER) and progesterone receptor (PgR) were positive, HER2 was 1+, nuclear grade was 1, and the Ki-67 index was 3.2%. Surgical margins were negative. Postoperative adjuvant therapy included radiation therapy to the remaining breast and endocrine therapy, and the patient remained free of recurrence. Approximately 14 years after surgery, the patient noticed a lump in the left breast, which was diagnosed as local recurrence of breast cancer. Upon re-excision, the diagnosis was made as radiation-induced soft tissue sarcoma. Due to early detection, the tumor was completely resected through surgery, and the patient is currently without recurrence. Radiation-induced sarcoma is a very rare condition with a poor prognosis, and thus there are no established treatment methods for postoperative care or for advanced cases. It is important to keep this condition in mind during follow-up after breast cancer surgery to ensure early detection.

Ehlers-Danlos syndrome (EDS) is a congenital connective tissue disorder that is characterized by skin hyperextensibility, excessive range of joint motion, and tissue fragility. A case of classical-like EDS (clEDS), a rare type of EDS, was seen in a patient with gastrointestinal perforation after uterine evacuation by manual vacuum aspiration. A 34-year-old woman had a history of clEDS associated with repeated joint dislocations. At 10 weeks and 5 days of pregnancy, she was diagnosed with a missed miscarriage and underwent manual vacuum aspiration. Postoperatively, she developed a fever with lower abdominal pain, and contrast-enhanced computed tomography showed small bowel and uterine perforations. Consequently, emergency surgery was performed. A perforation in the anterior wall of the uterine cervix and two perforations in the jejunum were identified, and a small bowel resection and repair of the uterine perforation were performed. Intraoperative findings showed that the intestinal tract and mesentery were extremely fragile and easily damaged by traction, as has been previously reported in the literature. In conclusion, we recommend careful intraoperative manipulation in clEDS patients.

A 62-year-old woman was found to have a 40mm tumor in the small intestine by abdominal contrast-enhanced CT scan during the evaluation of obstructive rectal cancer (cT4aN1bM0, Stage IIIB). We placed a stent in the rectum, but it failed to maintain patency, so we performed laparoscopic ileostomy. At the same time, we performed partial resection of the small intestine to remove the small bowel tumor. Histopathology revealed tumor cells with oval-shaped, enlarged nuclei forming pseudovascular spaces, accompanied by multinucleated giant cells scattered in the stroma. Immunohistochemical staining showed positivity for CD34, bcl-2, and STAT6, and a genetic panel testing identified a NAB2exon6-STAT6exon17 fusion gene, leading to a diagnosis of a solitary fibrous tumor (SFT) of the small intestine.

Small bowel SFTs are rare, and no prior reports exist of laparoscopic resection for such cases. However, for small tumors like in this case, laparoscopic resection can be a minimally invasive and effective option. This case is significant as it represents a rare example of a tumor with atypical histopathological features undergoing genetic testing, providing valuable insights into its genetic characteristics.

An 82-year-old man presented to our hospital with recurrent lower abdominal pain due to an ascending giant colonic diverticular fecal stone after endoscopic coprolite disruption. Abdominal computed tomography (CT) showed a 60 mm long marginal ring-shaped calcified lesion near the ileum, along with luminal trafficking in the ascending colon. The patient had a history of peritonitis after an open gastrectomy. Severe adhesion was expected ; however, laparoscopic ileocecal resection was performed. The patient was discharged 9 days after surgery without any complications. Histopathological examination revealed that the diverticular wall had a defect in the muscular layer, and a pseudodiverticulum was diagnosed. Diverticulosis is generally defined as a diverticulum of > 40 mm in diameter. We report this rare case along with a review of 20 Japanese cases from the literature.

Case 1 involved a 63-year-old man admitted to the hospital for bowel obstruction. The patient had a history of recurrent diverticulitis for seven years. Computed tomography (CT) revealed diverticula and wall thickening of the sigmoid colon, and dilatation of the proximal colon. An enema revealed colonic stenosis and a coloenteric fistula caused by sigmoid diverticulitis. Based on these findings, a sigmoidectomy and partial ileal resection were performed. Case 2 involved a 40-year-old male who presented with exacerbation of diverticulitis, which had repeatedly occurred over the past 10 years. CT revealed diverticula and wall thickening of the sigmoid colon, and suspected fistula formation between the ileum and the sigmoid colon. Although the fistula could not be confirmed with an enema, it was confirmed in a surgical specimen obtained after sigmoidectomy and partial ileal resection. A coloenteric fistulas caused by colorectal diverticulitis are relatively rare ; however, they often co-occur with a colovesical fistula. Although the fistulas in the two presented cases did not involve the bladder, in both patients, the sigmoid colon was adherent to the bladder close to the small bowel fistula. When treating a patient with a colovesical fistula, the possibility of a co-existing coloenteric fistula should be considered.

A 58-year-old man visiting a local hospital for hypertension and mitral regurgitation consulted the same hospital for fatigue and dyspnea, and was diagnosed with chronic heart failure and treated. During the course, he was found to have severe anemia with a Hb level of 3.0 g/dL, and was referred to the department of internal medicine in our hospital. A type 2 tumor was found near the splenic flexure of the descending colon by a colonoscopy, and a biopsy revealed that it was well-differentiated adenocarcinoma. After anemia and heart failure improved, he was referred to our department of surgery. A plain CT scan showed a cyst-like structure on the left side of the pelvis, but a contrast CT scan showed it as dilated and tortuous vessel and continued to the left internal iliac artery and vein, leading to the diagnosis of pelvic arteriovenous malformation (AVM). The tumor was nourished by the left colic artery, and it was thought that dissection would not affect the AVM. So no treatment for the AVM was performed, and a laparoscopic left colectomy was performed. Approximately two years have passed since the surgery, and the patient is under observation without any evidence of colon cancer recurrence, AVM enlargement, or symptoms of heart failure. Here, we report a case in which laparoscopic surgery was performed for descending colon cancer with a coexistent pelvic AVM.

The patient was a 77-year-old man who was referred to our hospital for close examination and treatment because a large pelvic mass was incidentally detected on abdominal computed tomography (CT) performed during a visit to his previous doctor for a urinary tract infection. Contrast-enhanced CT and magnetic resonance imaging (MRI) of the abdomen showed a lobulated mass in the midline of the pelvis, which was suspected to be a sigmoid mesenteric tumor, and it was decided to remove the tumor for both diagnosis and treatment. The patient underwent abdominal high-level anterior resection and removal of the mesenteric tumor. The patient was discharged home on the 9th postoperative day without complications. There was no recurrence of the tumor. Histopathologically, immunostaining was positive for S100 protein and negative for CD34, c-kit, and α-SMA, and a diagnosis of schwannoma was made. Sigmoid mesenteric schwannoma is rare, and this case is reported along with some discussion of the literature.

A 72-year-old woman presented to our hospital with hematochezia. After close examinations, she was diagnosed with sigmoid colon cancer cT4aN0M0 cStage IIb, and a surgery was scheduled. On the day before the surgery, mechanical bowel preparation using sodium picosulfate hydrate, magnesium oxide, and anhydrous citric acid was performed. In the morning of the surgery, the patient developed disturbance of consciousness, septic shock due to colitis obliterans, acute renal failure, and hypermagnesemia. Continuous hemodiafiltration dialysis (CHDF) was performed for hypermagnesemia, and her serum Mg level decreased and her consciousness disorder improved. After colorectal stenting and bowel decompression for obstructive colorectal cancer, her general condition improved, and the primary tumor resection was performed as a standby procedure. The patient is now recurrence-free as of 10 months after surgery. The patient had hyperglycemia due to mechanical bowel preparation, but was safely treated with CHDF and colorectal stenting.

A 79-year-old male presented at our hospital with abdominal pain and fever. Contrast-enhanced computed tomography (CT) revealed a ruptured 10 cm liver abscess in the lateral sector (LS) and small abscesses in the right liver lobe. Percutaneous abscess drainage of the LS was performed, followed by antibiotic therapy. However, abscess drainage was inadequate because of the viscosity of the contents, and the patient did not recover from the worsening septic shock. A further CT scan 4 days after admission revealed that the abscess in the LS had increased in size. We decided to surgically remove the detectable abscesses to control the source of the infection. Therefore, the patient underwent lateral sectionectomy. The cut surface of the tissue exhibited a complex gyriform-like structure with mucinous substances. In addition, blood and abscess cultures and string test results suggested that liver abscesses were caused by hypermucoviscous Klebsiella pneumoniae (hmKp). Multiple remnant abscesses continued to increase in size, and wedge resection was performed 4 days later to remove three remnant abscesses. The patient's systemic condition improved, and he was discharged on postoperative day 23. The patient was successfully treated through complete resection of all the hmKp-associated liver abscesses.

The patient was a 67-year-old woman. She presented with pericardial pain and had elevated white blood cell and C-reactive protein levels. Following close examination, cholecystectomy in all layers and sampling of hilar lymph node 12c were performed on suspicion of gallbladder cancer. On postoperative day 8, both white blood cell count and C-reactive protein showed marked improvement. Pre-operative G-CSF activity was abnormally high but normalized post-operatively. The pathology showed an undifferentiated carcinoma-like adenocarcinoma, which was G-CSF-positive on immunostaining, and diagnosis of G-CSF-producing gallbladder cancer was made. Five years after surgery, the patient had no recurrence of G-CSF-producing gallbladder cancer, which has been reported to be a very rare disease with a poor prognosis. The diagnosis of G-CSF-producing tumours is based on a marked increase in white blood cell count, an increase in G-CSF activity, a decrease in white blood cell count and G-CSF activity with treatment and evidence of G-CSF production in tumour cells, all four of which were fulfilled in our case. In the present study, we report a case in which a tumour diagnosed as G-CSF-producing gallbladder cancer was resected and the patient survived for 5 years.

A 46-year-old woman underwent total colorectal resection and ileoanal anastomosis at the age of 17 years due to familial adenomatous polyposis (FAP). She also underwent resection for a desmoid tumor at the age of 23, and transanal and endoscopic resections of ileal-pouch polyps at the ages of 32, 36, and 37. At the age of 45 years, she underwent endoscopic submucosal dissection for duodenal lesions of a laterally spreading tumor, which led to the diagnosis of adenocarcinoma (tub1, pTis). Six months later, a 12-mm lesion suspicious for early-stage cancer of type 0-IIa was found on follow-up. The patient was referred to our department for surgical intervention and underwent a pancreas-sparing total duodenectomy (PSTD). Duodenal adenoma is reported to occur in 30-90% of patients with FAP and may become cancerous. Consequently, duodenal adenoma is considered to be the second most important prognostic factor after colorectal cancer. Surgery is considered for duodenal adenomas with Stage IV or higher disease according to the modified Spigelman classification, but there is a lack of evidence and room for debate regarding the choice of surgical technique including PSTD. A review of the literature is presented.

An urgent omentoplasty was performed for perforation of duodenal ulcers in a 54-year-old woman who was undergoing maintenance dialysis for chronic renal failure. However, bleeding from multiple ulcers and refractory diarrhea persisted. Proton pump inhibitor therapy was problematic because it caused pancytopenia in this patient. Contrast-enhanced computed tomography showed multiple nodules around the duodenum, and a selective arterial secretagogue injection test demonstrated a gastrinoma in the gastroduodenal artery area. Therefore, octreotide administration was started, and tumor reduction and bleeding control were achieved. A subtotal stomach-preserving pancreaticoduodenectomy was performed. The resected specimen showed a 4.5-mm, duodenal gastrinoma and a metastatic lymph node. After the procedure, the patient developed peritonitis due to leakage of the gastrojejunal anastomosis, but she recovered with intensive care. Duodenal gastrinomas are extremely rare in dialysis patients. Octreotide was effective in its perioperative management.

A 72-year-old man had previously undergone distal pancreatectomy and splenectomy for a G2 pancreatic neuroendocrine tumor (pNET). Eleven years after surgery, follow-up computed tomography showed a mass lesion, 3.8 cm in diameter, in S8 of the liver, which was suspected to be recurrence of hepatic metastases from pNET. Laparoscopic hepatic S8 segmentectomy was performed for the lesion. The patient was discharged without any postoperative complications on the 8^th postoperative day. The pathological examination showed NET G2 that was almost identical to that of the previous pancreatic surgery. Hematological recurrence of pNETs is well known even after curable resection. However, it has been reported that such recurrences commonly occurred less than 10 years after surgery. A rare case with a late hepatic recurrence of pNET that was successfully resected by laparoscopic surgery is reported.

A 91-year-old male developed bowel obstruction four days after TAPP surgery for a left external inguinal hernia. Computed tomography (CT) showed the tapering and obstruction of the small intestine around the TAPP surgical site. The patient experienced abdominal distention and repeated vomiting. Therefore, laparoscopic surgery was performed after decompression using a long intestinal tube. Peritoneal suture dehiscence and small intestinal incarceration in the preperitoneal space were observed intraoperatively. Furthermore, the small intestine was perforated. We flushed the abdominal cavity with a large volume of physiological saline solution after the resection of the small intestine, and repaired the peritoneal hiatus using a prosthetic mesh. Reports describing intestinal obstruction due to peritoneal suture dehiscence after TAPP surgery are limited and cases complicated by bowel perforation are rare. Herein, we report a rare case in a literature review.

A 60-year-old man presented with right inguinal swelling. The patient was diagnosed with an Amyand hernia classified as JHS L3 (Losanoff Type 1) and underwent laparoscopic transabdominal preperitoneal (TAPP) hernia repair. The patient developed redness, swelling, and localized heat in the right inguinal region on postoperative day 25. A CT scan revealed fluid collection with septation, leading to the diagnosis of a preperitoneal abscess following TAPP. Abscess drainage and mesh removal were then performed. Intestinal fluid leakage from the abscess drainage site was observed postoperatively, and a CT scan showed that the drain had migrated into the cecal lumen. Consequently, a fistulectomy and ileocecal resection were performed, and the patient was discharged on postoperative day 21. The presence of enteric bacteria in the abscess culture and intraoperative findings of strong adhesions between the ileocecal region and fistula site, with the appendix being unidentifiable, suggested that mechanical stimuli during TAPP, such as traction and thermal injury from electrocautery, induced inflammation in the appendix and surrounding tissues. This led to preperitoneal abscess formation. Initial appendectomy followed by staged hernia repair could be a safer and more effective approach to prevent such complications in Amyand hernia repair.