A 33-year-old man was urgently transported to our hospital because he was experiencing acute abdominal pain and vomiting. A contrast-enhanced abdominal CT scan revealed intestinal obstruction and a sac-like appearance of the intestines. The small intestine within the internal hernia showed poor enhancement. The patient was diagnosed with strangulated intestinal obstruction due to a paraduodenal hernia, and emergency surgery was performed. Intraoperatively, we found that almost the entirety of the small intestine had protruded into the hernia sac, and some areas already showed ischemic changes. After the hernia sac was opened, blood flow to the ischemic intestine was immediately restored. On further evaluation of the hernia, we found that the horizontal duodenum was absent, and the cecum until the ascending colon were not fixed to the retroperitoneum. A Meckel's diverticulum, sized 4 cm, was found 60 cm from the end of the ileum. We intraoperatively diagnosed strangulated intestinal obstruction due to a right paraduodenal hernia with associated intestinal malrotation and an asymptomatic Meckel's diverticulum. Thereafter, we resected the Meckel's diverticulum, and performed an appendectomy. Some cases of intestinal malrotation may be associated with other congenital gastrointestinal anomalies ; however, it is difficult to detect these anomalies using preoperative imaging. Therefore, the presence of coexisting congenital anomalies, such as intestinal malformations, should be considered, preoperatively and intraoperatively, in young patients who present with intestinal obstruction without a previous laparotomy.

A 50-year-old man was admitted to our hospital complaining of anorexia, abdominal pain, and fever. A physical examination revealed tenderness in the periumbilical region. Computed tomography showed thickening of the gastric wall from the gastric body to the antrum and enlarged lymph nodes in the abdominal cavity. We suspected gastric cancer or gastric lymphoma and performed an endoscopy. Upper gastrointestinal endoscopy revealed frequent hemorrhagic, irregular ulcerative lesions extending from the gastric body to the antrum of the stomach. Both serologic test for syphilis (STS) and Treponema pallidum hemagglutination test (TPHA) were positive. Gastric biopsies were performed, and a histopathological analysis showed severe inflammatory cell infiltration. Immunohistochemistry showed the presence of T. pallidum in the gastric tissues. A diagnosis of gastric syphilis was made based on a positive syphilis serological reaction and the detection of Treponema pallidum by immunostaining.
He was treated with intramuscular injection of penicillin G, which led to the resolution of his clinical complaints. After 5 weeks of treatment, gastrointestinal endoscopy showed healing of the gastric ulcer.
Syphilis is a contagious infectious disease caused by Treponema pallidum. Gastric syphilis is usually observed after secondary syphilis, but its incidence is extremely low. The endoscopic findings typically reveal mucosal edema, erosion, and superficial ulcers. Recently, the incidence of syphilis has been gradually increasing in Japan, and it is important to be able to recognize the typical endoscopic findings of gastric syphilis.
Here, we report a case of gastric syphilis and review the literature pertaining to this condition.