In Japan, self‑expandable metallic stent（SEMS）for colorectal obstruction, which has been covered by national insurance since January 2012, has become rapidly common as a promising alternative to emergency surgery, as a bridge to surgery（BTS）approach. In this study, we retrospectively reviewed 33 cases of BTS for primary colorectal cancer at our hospital from June 2018 to May 2023. Migration occurred in 2 patients（6.1%）as a stent placement‑related complication. Median time from stent placement to surgery was 15 days（6‑76）, and 19（57.6%）patients were discharged preoperatively. Thirty-two patients（97%）underwent laparoscopic surgery, and 1 patient underwent open conversion due to pancreatic involvement of metastatic lymph nodes. There was no covering stoma created, and a permanent stoma was created in one case（abdominoperineal rectal amputation due to lower rectal cancer）. Postoperative complications included wound infection in 3 patients, paralytic ileus in 3 patients, and urinary tract infection in 1 patient. No anastomotic failure was observed. Median postoperative hospital stay was 12 days（6‑35）. There were few complications related to colonic stenting, bowel decompression was good, and BTS seemed to be a useful strategy, allowing for elective laparoscopic surgery.

［ Aim］ Factors associated with the development of delirium were studied in patients over 65 years of age who underwent abdominal surgery under general anesthesia and were admitted to the HCU postoperatively.

［ Methods］ 91 patients who underwent abdominal surgery under general anesthesia and entered the HCU postoperatively were included in the study. The patients were divided into two groups, one with delirium and one without delirium, and group comparisons were made for each factor using the χ2 independence test. Logistic regression analysis was also performed with each factor as an explanatory variable and the presence of arousal on awakening as the objective variable.

［ Results］ Of the 91 patients, 9 patients developed delirium , with an incidence rate of 9.8% . χ2 independence test results showed that delirium occurred more frequently in patients taking high-risk medications（ p=0.046） and in patients who became hypotensive（ p=0.042）． Multivariate analysis identified two variables as factors associated with postoperative delirium: taking high‑risk medications（ OR=2.87） and hypotension （ OR=6.08）．

［ Conclusion］ We investigated factors associated with postoperative delirium in patients who underwent abdominal surgery under general anesthesia and entered the HCU postoperatively. It is important to collaborate with other professions to identify risk factors and to study their countermeasures.

［ Key words］ delirium, high risk medicine, blood pressure reductions, abdominal surgery

The patient was a 69‑year‑old man who presented to our hospital with a hepatic tumor. He was diagnosed with multiple hepatocellular carcinomas and began chemotherapy. After the beginning of treatment, all lesions, except for hepatic S6, disappeared. Thirty‑six months after the beginning of treatment, the patient presented to our department for surgery due to an enlarged S6 tumor and underwent a partial hepatic resection. Pathological examination revealed acid-fast bacilli in the hepatocellular carcinoma tissue, and a diagnosis of hepatic mycobacterium avium-intracellulare complex（hepatic MAC）was made. The bacteria could not be detected. Eleven months after surgery, intra‑abdominal lymph node enlargement was noted, and an open lymph node biopsy was performed in our department. The clinical diagnosis of pancreatic cancer and disseminated MAC disease was made. Currently, the primary liver cancer has not recurred 21 months after surgery, and the patient is undergoing chemotherapy for pancreatic cancer for 8 months；however, no symptoms associated with MAC disease were observed. We report a rare case of disseminated MAC diagnosed using surgical resection without immunodeficiency or pulmonary involvement.