Purpose : We performed spleen-preserving distal pancreatectomy (SPDP) for low-grade malignant pancreatic tumors. We recently began performing laparoscopic pancreatectomy in our department, including hand-assisted laparoscopic (HALS) SPDP. Here, we report the indications for, details of the procedure, and results of this operation. Method : Using laparoscopic surgery, we resected two endocrine tumors from the pancreas. The operating time, blood loss, and complications were compared to those of open SPDP. Results : Two HALS SPDP and five open SPDP procedures were performed. The mean operating times were 2 h 58 min for HALS SPDP and 2 h 55 min for open SPDP. Mean blood loss was 97 and 190mL, respectively. Postoperative complications consisted of pancreas juice leakage in one patient in each group. The hospital stay was 10.0 days for HALS SPDP and 13.6 days for open SPDP. No postoperative deaths occurred. Conclusion : HALS SPDP may be applicable to low-grade malignant pancreatic tumors.

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A 61-year-old man with an aneurysm of the common and deep femoral arteries underwent successful vascular reconstruction. The patient presented with localized pain and a rapidly enlarging pulsatile mass in the femoral triangle. A graft was placed from the left common femoral artery to the left superficial and deep femoral arteries. No ischemic symptoms or thrombosis developed postoperatively. Successful reconstruction with a graft is rare in this situation, with less than 30 cases reported in Japan to date. This type of aneurysm is characterized by rapid enlargement and severe atherosclerotic changes. Ischemic complications may occur after surgical treatment of a ruptured deep femoral artery aneurysm. We recommend reconstruction using the saphenous vein or a vascular prosthesis, as there have been some reports of patients requiring leg amputation following ligation of the deep femoral artery.

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Here, we present a rare case of adult Bochdalek hernia in a 15-year-old overweight male (body mass index=35) who was presented to a nearby hospital with the complaints of upper abdominal pain and vomiting. Computed tomography showed a large whole stomach, transverse colon, and greater omentum in the left thoracic cavity. The patient was referred to our hospital and an emergency operation was performed, yielding a diagnosis of incarcerated Bochdalek hernia. Laparoscopic surgery was initiated but it was difficult to proceed with this action because of the patient's morbid obesity ; therefore, we opened the abdomen, repaired the incarceration, and closed hernial opening with direct sutures. The patient's postoperative course was uncomplicated and he was discharged from the hospital on postoperative day 13. No relapse has occurred. In this case, the Bochdalek hernia may have developed due to chronic abdominal pressure related to the patient's obesity. Adult Bochdalek hernia has been considered to be a rare disorder, but the incidence may be higher than reported due to asymptomatic cases. The mortality rate is high when any sudden change occurs in patients with this type of hernia ; thus, early detection and appropriate therapy are important.

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An 89-year-old woman presented with appetite loss, fullness, and abdominal pain. She had undergone a right hemicolectomy and microwave coagulation therapy for liver metastasis due to transverse colon cancer and liver metastasis 22 months earlier. She had not had postoperative chemotherapy. She was diagnosed with ileus and admitted. An ileus tube was inserted. She was ultimately diagnosed with ileal obstruction due to the recurrence of colon cancer, based on computed tomography, contrast radiography via the ileus tube, and colonoscopy. The ileus was treated with a magnetic compression anastomosis using Yamanouchi's method. Using radiography, two magnets were placed in the ileum and transverse colon before and after the obstruction. This method does not require a laparotomy or general anesthesia, making it safe, with a low complication rate. The patient improved once and seemed to be able to leave the hospital, but she suddenly died of aspiration pneumonia.

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A 62-year-old man was transported to the emergency medical center because of blunt chest trauma combined with multiple trauma after a car accident. He complained of severe back pain. Contrast-enhanced computed tomography revealed left hemopneumothorax with multiple left rib fractures, a scapular fracture, lung contusion, liver injury, right renal injury, and acute aortic dissection. Although open surgical repair and endovascular stent grafting were considered, primarily nonoperative management of the thoracic aortic injury under blood pressure control was selected because of the multiple trauma, type B aortic dissection, and oral administration of two antiplatelet drugs. The patient's hemodynamic and respiratory conditions remained stable in the intensive care unit, and the aortic dissection improved. We herein report a rare case of blunt thoracic aortic injury with oral administration of antiplatelet drugs resulting in multiple trauma and acute aortic dissection treated nonoperatively.

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A 59-year-old man consulted a local doctor after 4 days of abdominal pain. The patient had tenderness and a mass in the left umbilical region. The presence of a rectus abdominis muscle abscess was not likely, but the patient was admitted to our hospital. A computed tomographic scan taken at the nearby clinic showed an 8 × 5 cm multilocular cystic mass with a linear area of high density. The abscess cavity and intestinal tract wall were not consecutive, but we thought that the abscess was caused by ingesting a fish bone. Laparotomy revealed that the abscess had damaged the left rectus abdominis muscle sheath and peritoneum, and the abscess cavity commuted with the abdominal cavity. We recognized an approximately 4-cm-long fish bone in the abscess cavity. The greater omentum covered the abscess in the abdominal cavity and adhered to the peritoneum. We examined the small intestine and colon, but found no perforation. We determined postoperatively that the patient had eaten fried salmon several days before the onset of pain. The patient was complicated by a wound infection, but was discharged on postoperative day 21.

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Arsenic is a well-known heavy-metal causing acute intoxication such as nausea, vomiting, abdominal pain, severe diarrhea, polyneuropathy, and encephalopathy. Arsenic trioxide (ATO) monotherapy is effective for the relapsed or refractory acute promyelocytic leukemia (APL). ATO often causes side-effects, but most of them are tolerable with careful management. We report here a Japanese man, who was diagnosed as relapsed APL, fell into deep coma after ATO monotherapy and recovered in 24 hours. In the side-effect reports of ATO, CNS symptom is very rare. In a Japanese post-marketing surveillance study, only four cases demonstrated altered consciousness. However, these cases had other bases for CNS symptoms such as CNS infiltration, brain infarction, panic disturbance and renal failure. As no other reason for coma was detected on examination, and coma did not recur after discontinuance of ATO, ATO was suggested to cause deep coma.

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A 56-year-old man consulted a nearby hospital because of a melena. Colonoscopy showed advanced rectal cancer. Enhanced computed tomography (CT) showed multiple liver tumors. Rectal cancer with multiple liver metastases was diagnosed and a low anterior resection was performed. To treat the liver metastases, he underwent eleven rounds of systemic chemotherapy, plus radiofrequency ablation and partial resection for multiple liver metastases (and subsequent multiple pulmonary metastases). Radiotherapy was performed to alleviate the pain caused by the bone metastases. With these multidisciplinary treatments, he survived for 5 years and 7 months postoperatively.

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