[A Case of Immediately-Treated Internal Hernia Occurring during Chemotherapy for Liver Metastasis after Gastric GIST Resection].

A 71-year-old man underwent total gastrectomy with Roux-en-Y reconstruction for gastric GIST in October 2017. Liver metastasis was identified in June 2019, and chemotherapy with imatinib was started in July. In December, the patient presented with acute upper abdominal pain and back pain. Abdominal contrast-enhanced CT showed that the jejunum extending from the duodenal stump was dilated. In addition, part of the jejunum had a poor wall contrast effect, with ascites also found surrounding it. We suspected a strangulated ileus and immediately performed emergency surgery. We found an internal hernia with incarceration of the afferent loop at the Petersen's defect. The time from the onset of symptoms to the surgery was relatively short, and the surgery was completed with hernial repair and closure of the hernial orifice without the development of bowel necrosis; the patient's postoperative course was good. Although the frequency of internal hernia after gastrectomy is relatively low, there is a risk that it may be severe if it occurs. Therefore, care should be taken to not cause internal hernias during surgery, and an internal hernia should be considered in the event of sudden abdominal pain after gastric surgery.

[Long-Term Complete Response by Chemotherapy for Distant Lymph Node Metastases after Curative Surgery for Ascending Colon Cancer-A Case Report].

A 74-year-old woman underwent right hemicolectomy for ascending colon cancer in March 2013, after which she received adjuvant chemotherapy(UFT plus UZEL)for 6 months. In October 2014, left supraclavicular lymphadenopathy appeared, and it was diagnosed as adenocarcinoma metastasis through fine-needle aspiration cytology. CT revealed swelling of left supraclavicular lymph nodes and para-aortic lymph nodes but no metastases to other organs. Exclusion diagnosis was performed, and they were diagnosed as multiple distant lymph node metastases. Chemotherapy(mFOLFOX6 plus bevacizumab) was started in December 2014, and all swollen lymph nodes shrank and disappeared on CT in July 2015. Furthermore, there was no swelling of lymph nodes or appearance of new lesions on CT in December 2015, as the response to treatment was judged to be complete. In addition, the regimen was changed to FOLFIRI plus bevacizumab because side effects such as peripheral neuropathy were worsening. Although chemotherapy was discontinued in November 2016, there has been no recurrence and a long-term complete response has been sustained.

[A Case of Mesenteric Fibromatosis after Robot-Assisted Total Gastrectomy for Gastric Cancer].

The patient underwent robot-assisted total gastrectomy for an early gastric cancer. Thirty-four months later, he was admitted to another hospital because of abdominal discomfort. Computed tomography scans showed a giant solid mass approximately 13 cm in diameter in the lower abdomen. We performed a resection of the tumor; operative findings showed a giant solid tumor, without adhesion, in the mesentery of the jejunum. The tumor did not involve other parts of the small intestine. The resected tumor had a smooth surface with an elastic hard consistency. Pathological examination revealed that the tumor was immunohistochemically positive for a-SMA and b-catenin and negative for S-100, CD34, and c-kit. The tumor was diagnosed as a mesenteric fibromatosis. The patient did not show any incidence of recurrence for five months after resection. Mesenteric fibromatosis is a very rare condition and has been reported in association with Gardner's syndrome, abdominal traumas such as surgery and injury, and with pregnancy. This report describes a case of mesenteric fibromatosis after robotassisted laparoscopic surgery.