Internal hernia after laparoscopic right hemicolectomy, report of a case.

Mesenteric defects are often not closed in laparoscopic colectomy. We herein report a case of an internal hernia projecting through a mesenteric defect following laparoscopy-assisted right hemicolectomy. A 74-year-old woman was hospitalized for the surgical treatment of double colon cancer. Preoperative colonoscopy demonstrated the presence of ascending colon and transverse colon cancers. A laparoscopic-assisted right hemicolectomy was performed. The mesenteric defect resulting from the colectomy was not closed. Three months after the surgery, the patient developed a bowel obstruction. Under a diagnosis of strangulated bowel obstruction, we performed a laparotomy, and found a necrotic small bowel, which had passed into the bursa omentalis through the mesenteric defect. We removed the necrotic small bowel and closed the mesenteric defect by suturing. The patient's postoperative course was uneventful. An internal hernia projecting through a mesenteric defect following laparoscopy-assisted right hemicolectomy developed a severe strangulated bowel obstruction.

Significance of lymphadenectomy with splenectomy in radical surgery for advanced (pT3/pT4) remnant gastric cancer.

BACKGROUND: To date, the optimal surgical strategy for remnant gastric cancer has not been determined. The purpose of this study was to clarify the significance of lymphadenectomy with splenectomy in remnant gastric cancer surgery. METHODS: This retrospective cohort study was conducted at the Kumamoto Regional Medical Center. The primary endpoint was overall survival after surgery. We retrospectively analyzed the clinicopathologic features, surgical treatments, and long-term prognosis of remnant gastric cancer patients treated with total gastrectomy. RESULTS: A total of 80 patients with gastric cancer in the remnant stomach after distal gastrectomy and who underwent total gastrectomy were enrolled in the study. Splenectomy was performed in 38 patients. Lymph node metastasis in the splenic hilum was not observed in the patients with pT1/pT2 tumors, whereas nodal metastasis at the splenic hilum was detected in 30.4% of the patients with pT3/pT4 tumors. The survival rate of the patients with pT3/pT4 tumors who underwent splenectomy was significantly higher than that of the patients who did not undergo splenectomy, although there was no difference in the patients with pT1/pT2 tumors. Among the patients classified as R0, the survival rate of the patients with pT3/pT4 tumors who underwent splenectomy was significantly higher than that of the patients who did not undergo splenectomy. CONCLUSION: Lymphadenectomy with splenectomy in radical surgery is beneficial for patients with advanced (pT3/pT4) remnant gastric cancer.

A case of mesh plug migration into the bladder 5 years after hernia repair.

The mesh plug technique is one of the most popular procedures for inguinal hernia repair in Japan. This procedure is quick, easy, and low cost with a low recurrence rate. However, some complications associated with the mesh plug have been reported recently. We hereby present a case of an 80-year-old female admitted to our hospital with swelling and pain in the right lower abdomen 5 years after hernia repair with the PerFix plug. Discharge of urine through the route of exploratory needle puncture demonstrated the fistula of skin and the bladder. Computed tomography (CT), magnetic resonance imaging (MRI), abdominal US, and cystoscope examination revealed that the mesh plug had penetrated into the bladder. As far as we know, this is the first report that a mesh plug has migrated into the bladder.

Reactive fibroinflammatory pseudotumor of the pancreas: report of three cases.

Reactive fibroinflammatory pseudotumor located in the pancreas is a rare condition. However, we experienced three cases of reactive fibroinflammatory pseudotumor of the pancreas over the previous 2 years. Immunohistochemical staining of immunoglobulin G4 (IgG4) confirmed that Cases 1 and 3 involved IgG4-related disease and that Case 2 did not. In Cases 1 and 3, the masses were formed through autoimmune reaction and were diagnosed as autoimmune pancreatitis (AIP). In Case 2, because only a few IgG4-positive cells were found, it was difficult to diagnose AIP or IgG4-related disease. Reactive fibroinflammatory pseudotumors can develop without the involvement of any autoimmune mechanisms. There seems to be partial overlap between reactive fibroinflammatory pseudotumors and AIP.

Trichoblastic carcinoma arising from colostomy.

Trichoblastic carcinoma is a rare skin cancer originating from hair germ cells. We report a case of an 84-year-old man who presented with a tumor on the stoma of the descending colon, which was preoperatively diagnosed as colon cancer. He underwent colectomy with adjacent skin, and the tumor was diagnosed as trichoblastic carcinoma by postoperative pathological examination. We are not aware of any similar cases published in the English literature. Therefore, we report this case because it is quite a rare condition.

Acute afferent loop necrosis after Roux-en-Y cholangiojejunostomy.

Afferent loop necrosis after Roux-en-Y cholangiojejunostomy biliary reconstruction is rare. We present the case of a 36-year-old woman with acute necrotic afferent loop obstruction. The peripheral area of the Roux-en-Y limb, including the cholangiojejunostomy portion, was twisted just proximal to the cholangiojejunostomy. Cholangiojejunostomy was completely separated due to necrosis of the Roux-en-Y jejunum. In addition to the case report, we discuss features of cholangiojejunostomy that require special attention.