Gastric outlet obstruction (GOO) frequently occurs as a late complication of advanced pancreato-biliary cancer. Six patients with pancreato-biliary cancer complicated by GOO were treated by self-expandable metallic stents (SEMS) that is commercially available in Japan from April, 2010. In all patients, SEMS were successfully placed in the stenotic sites of the duodenum. After placing the SEMS, appetite loss, nausea or vomiting were disappeared and all patients could take foods. There was no complication during the observation period. Duodenal stenting by SEMS is safe and useful for GOO by pancreato-biliary cancer. It is considered that the procedure provides a relief of symptoms and enhance quality of life.

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An 18-year-old man was referred to the Yamaguchi University Hospital for investigation and treatment of a pancreatic head tumor. Abdominal plane computed tomography (CT) showed a large capsulated lobular tumor with clear boundaries, calcifications and septal walls in the pancreatic head. We suspected a solid-pseudopapillary tumor (SPT) by the findings of endoscopic ultrasonography-fine needle aspiration (EUS-FNA). Thus, we performed duodenum-preserving pancreatic head resection (DPPHR). Histopathological examination revealed many polygonal tumor cells with vascular stromal proliferation and a sheet-like structure. We also noted a pseudopapillary appearance, confirming a diagnosis of SPT. The patient was discharged after an uneventful postoperative course and there has been no evidence of recurrence for a year. We regard SPT as a low grade malignant tumor, so surgery with functional preservation, such as DPPHR, is appropriate.

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A 12-year-old boy's hair on the left side was pulled during a quarrel, after which a hematoma developed over his left cranium. He consulted a doctor at our hospital, wherein he was diagnosed with subgaleal hematoma (SGH) on the basis of computed tomography (CT) findings. We aspirated the hematoma several times and pressed it with an elastic bandage. However, 7 days later, the CT image showed that the hematoma had enlarged again. We thought that he was in danger of developing increased eyeball pressure. Therefore, we performed an emergency surgery. We aspirated the hematoma and inserted a closed drainage system in the SG space and pressed his head more strongly with an elastic bandage. After the surgery, the headache improved, and the SGH disappeared slowly. He was discharged from the hospital 18 days later. SGHs are usually treated conservatively. However, careful observation of SGH is necessary, and if enlargement of hematoma is observed, aspiration with a closed drainage system should be considered. We have provided a literature review on the treatment for such cases.

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