[Adenocarcinoma in the Lung Detected Due to the Development of Perforative Peritonitis Caused by Small Intestinal Metastasis-A Case Report].

Previous studies have reported that perforations of the small intestine caused by metastatic tumors prior to the diagnosis of primary lung cancer are very rare. A 79-year-old man was admitted to our hospital with acute lower abdominal pain. Abdominal computed tomography revealed intraperitoneal free air around the bowel wall thickening in the small intestine. The patient was diagnosed with acute peritonitis caused by perforation of the small intestine, and an emergency operation was performed. Laparotomy revealed perforation in the jejunum without any palpable tumor in the abdomen. Partial resection of the jejunum revealed an ulcerating lesion at the perforation site. Histological examination indicated small intestinal metastasis secondary to lung adenocarcinoma. Positron emission tomography performed after discharge showed a small reticular opacity with intense accumulation of FDG in the left lung. The patient was diagnosed with perforation of the small intestine metastasis secondary to lung adenocarcinoma. The postoperative course was uneventful; the patient received chemotherapy, and is alive 6months after the operation.

[A Case of Trousseau Syndrome Complication during Chemotherapy for Advanced Gastric Cancer].

The pathological condition which causes cerebrovascular disease through hypercoagulability associated with malignant tumors is known as Trousseau syndrome. Here, we report the case of a patient with Trousseau syndrome which developed as a complication during chemotherapy for advanced gastric cancer. A 70-year-old woman with multiple lymph node metastases of gastric cancer underwent TS-1 plus CDDP chemotherapy before surgery. She had symptoms of left hemiparesis during the first course of chemotherapy. She was diagnosed with acute cerebralinfarction using brain MRI, and blood tests indicated hypercoagulability. Therefore, it was strongly suspected that she had Trousseau syndrome. A total of 2 courses of chemotherapy were administered, along with anticoagulation therapy with edoxaban. She exhibited improved paralysis and received a totalgastrectomy after chemotherapy. According to recent reports, more than 90% of patients with malignant tumors have hypercoagulability, and more than 50% of them have thromboembolisms. It is therefore essential to obtain early diagnosis and provide anticoagulation therapy for cerebral infarction, and to provide treatment against malignant diseases in patients with Trousseau syndrome.

[A Case That Was Complicated with Pulmonary Artery Thrombosis during Chemotherapy of the Regimen of CapeOX plus Bevacizumab against Recurrence of Colon Cancer].

An 80-year-old woman with peritoneal dissemination after laparoscopic right hemicolectomy for appendicular carcinoma (mucinous adenocarcinoma, pT4aN1M0, stage Ⅲa)underwent CapeOX plus bevacizumab chemotherapy. The patient achieved stable disease over 5 courses of the treatment. Subjective and objective symptoms were not observed; however, chest computed tomography findings revealed a thrombus in the pulmonary artery that was considered to be associated with bevacizumab. Chemotherapy was discontinued, and anticoagulation therapy was initiated with heparin and then switched to apixaban. The thrombus resolved with treatment, but the patient died following an increase in peritoneal dissemination. CapeOX plus bevacizumab is a recommended colon cancer treatment, and even though it is generally considered safe, the side effects of bevacizumab include relatively rare occurrences of gastrointestinal perforation or thrombosis. The frequency of pulmonary embolism associated with bevacizumab is approximately 0.1%, and fatalities have been reported. The possibility of asymptomatic thrombosis warrants regular monitoring of this serious side effect in patients receiving bevacizumab. Early detection and prompt antithrombotic treatment are necessary to ensure patient safety and continued disease management.

[A Case of Orange-Induced Small Bowel Diverticular Obstruction Treated with Laparoscopically-Assisted Surgery].

We report a case of orange-induced small bowel diverticular obstruction treated with laparoscopically-assisted surgery. A 64-year-old man was seen at the hospitalbecause of abdominalpain and vomiting after dinner. Abdominalcomputed tomography( CT)showed a small intestinal ileus. We performed laparoscopically-assisted surgery on the same day for definitive diagnosis and treatment. The postoperative course was uneventful. The pathological diagnosis was orange-induced small boweldiverticul ar obstruction. Food-induced smallbowelobstruction is rare disease, but often requires surgery. Laparoscopic surgery is an effective option for surgery of food-induced smallbowel obstruction.

[A Case of a Laparoscopically Resected Gastrointestinal Stromal Tumor of the Stomach].

During treatment for sigmoid colon diverticulitis, a 72-year-old man underwent abdominal computed tomography, which revealed a gastric tumor that was approximately 40mm in diameter. He then underwent a detailed examination after the remission of diverticulitis. The gastric mucosa was found to be unremarkable on gastrointestinal endoscopy. On ultrasonic endoscopy, however, a hypoechoic mass of approximately 40mm in diameter was detected in the fourth layer of the gastric fornix and was believed to be a gastric submucosal tumor(SMT). The tumor was laparoscopically resected, and histological analysis of the tumor revealed a high-risk gastrointestinal stromal tumor(GIST, modified-Fletcher classification). In many cases, when subgastric SMTs are approximately 2-5 cm in diameter and are without obvious malignant findings on endoscopic or computed tomographic examinations, they are followed-up. However, some recent case reports describing treatments for high- or medium-risk groups of patients with small GISTs have been published. When a small submucosal gastric tumor is suspected to be GIST, we believe that laparoscopic surgery is a minimally invasive and effective method for the diagnosis and treatment of the tumor.

[A Giant Malignant Lymphoma of the Ileocecum Treated with Laparoscopic Surgery].

We experienced a case ofa giant malignant lymphoma ofthe ileocecum treated with laparoscopic surgery. A 78-year-old man presented with right flank pain. Lower endoscopy and abdominal computed tomography revealed a giant tumor in ileocecum. Biopsy results suggested malignant lymphoma or adenocarcinoma. We performed a laparoscopic ileocecal resection for definite diagnosis and treatment. The postoperative course was uneventful. The pathological diagnosis was malignant diffuse large B-cell lymphoma. The patient underwent chemotherapy and is being followed. Laparoscopic surgery can be considered useful to resect gastrointestinal malignant lymphoma.

[A Giant Appendiceal Mucinous Neoplasm Treated with Laparoscopic Surgery].

We encountered a case of giant appendiceal mucinous neoplasm that was treated with laparoscopic surgery. The patient was a 77-year-old man with constipation. Lower endoscopy demonstrated a giant SMT-like tumor in the cecum, and abdominal computed tomography revealed a giant appendiceal mucinous neoplasm and nearby lymph nodes swelling. Hematological examination showed an elevated serum CEA level. We performed laparoscopic ileocecal resection for a definite diagnosis and treatment. The postoperative course was uneventful. The pathological diagnosis was low-grade appendicealmucinous neoplasm(LAMN). Laparoscopic surgery can be considered safe for the resection of appendicealmucinous neoplasm when it is performed with a carefulsurgicalapproach.