Laparoscopic Endoscopic Cooperative Surgery for Multiple Gastrointestinal Stromal Tumors Associated with Incomplete Carney Triad: A Case Report

Ryuji Takada, et al.

INTRODUCTION: Gastrointestinal stromal tumor (GIST) associated with Carney triad differs clinically, pathologically, and behaviorally from sporadic GIST. Surgical resection is the main form of treatment.

Neoadjuvant Chemotherapy Followed by Laparoscopic and Endoscopic Cooperative Surgery for Locally Advanced Duodenal Gastrointestinal Stromal Tumor: A Case Report

Kazuya Takabatake et al.

INTRODUCTION: Duodenal gastrointestinal stromal tumors (D-GISTs) are rare neoplasms that pose surgical challenges, particularly when located near critical structures such as the ampulla of Vater or the pancreatic head. Although pancreaticoduodenectomy (PD) is often required in such cases, it is associated with significant morbidity. Neoadjuvant chemotherapy (NAC) with imatinib has emerged as a strategy to downsize tumors, thereby enabling organ-preserving resections. Laparoscopic and endoscopic cooperative surgery (LECS), initially developed for gastric submucosal tumors, has been adapted for duodenal lesions (D-LECS) in selected cases. Here, we present a case in which neoadjuvant imatinib therapy enabled local resection using the D-LECS approach.

Femorocele: A Rare Form of Femoral Hernia

Kimihiko Nakamura and Hisashi Kanoda

INTRODUCTION: Femorocele, also known as a hydrocele of the femoral hernia (FH) sac, is a rare form of FH. Initial misdiagnosis is common not only in FH but is even more frequent in femorocele, due to its rarity and non-distinctive features that make preoperative recognition challenging; in many cases, femorocele is identified only intraoperatively or postoperatively. This report describes a case of femorocele that initially posed a diagnostic challenge and was initially misdiagnosed as a ganglion.

Retro-Appendicular Internal Hernia: A Rare Cause of Small Bowel Obstruction

Jade Heinicke, et al.

INTRODUCTION: Internal hernias are rare causes of small bowel obstruction and are often difficult to diagnose preoperatively. Retro-appendicular internal hernias are exceedingly rare, with very few reports in the literature. This case is noteworthy for involving a patient with no prior history of abdominal surgery, highlighting an unusual presentation of a retro-appendicular internal hernia.

Laparoscopic Sleeve Gastrectomy for an Obese Patient with Retroperitoneal Schwannoma: A Case Report

Yuriko Yamada, et al.

INTRODUCTION: The prevalence of obesity has increased markedly across the globe over the past several decades. In parallel, the number of metabolic surgeries has risen sharply in recent years, resulting in a growing incidence of concomitant surgical procedures. Obese individuals have an elevated risk of malignancy, partly due to the chronic inflammation associated with excess adipose tissue. A key clinical question arises: How should surgeons manage unexpected pathology identified during the preoperative evaluation of patients with morbid obesity?

Trastuzumab Deruxtecan Significantly Reduces Human Epidermal Growth Factor Receptor 2-Positive Pancreatic Metastasis from Advanced Breast Cancer: A Case Report

Rino Tanida, et al.

INTRODUCTION: Pancreatic metastases from breast cancer are rare, with only 61 reported cases. They are often difficult to differentiate from primary pancreatic cancer based on clinical presentation and imaging. The median overall survival after the diagnosis of pancreatic metastases has been reported to be short (17 months).

Seat Belt Injury Diagnosed as Perforation of the 4th Portion of the Duodenum Two Days after a Traffic Accident: A Case Report

Yuichiro Furutani, et al.

INTRODUCTION: Car seat belts are safety devices that protect passengers during collisions in traffic accidents. However, seat belts can cause abdominal injuries during collisions. Many cases of injury to various intraperitoneal organs caused by seat belts have been reported, but reports of duodenal injury are relatively rare. In addition, diagnosing duodenal injury due to blunt trauma is not easy, and it is not uncommon for cases to be diagnosed long after injury. Here, we report a case in which a patient was diagnosed with perforation of the 4th portion of the duodenum 2 days after injury in a traffic accident.

Chest Wall Reconstruction in Ewing Sarcoma Using a Radioprotective Spacer

Hiroko Yoshizawa, et al.

INTRODUCTION: Ewing sarcoma is a rare malignant tumor that primarily affects children and adolescents, and approximately 20% occur in the chest wall, where achieving local control is challenging due to the need for extensive resection and the proximity to vital organs. Adjuvant radiotherapy improves outcomes but carries a risk of severe complications such as radiation pneumonitis. Radioprotective spacers have been used for abdominal and pelvic tumors, but their use in chest wall tumors is rarely reported. We report a chest wall Ewing sarcoma case in which a radioprotective spacer using expanded polytetrafluoroethylene and a water-inflatable expander was placed to reduce radiation-related organ damage.

A Case of Pulmonary Metastasis from Adenoid Cystic Carcinoma of the Hard Palate Exhibiting Ground Glass Nodules

Kanjiro Murakami, et al.

INTRODUCTION: Metastatic lung tumors typically exhibit well-defined, enhanced margins on chest CT. They may rarely present as ground-glass nodules (GGNs), making it challenging to differentiate from primary lung cancers, which can also manifest as progressively enlarging GGNs on CT.

Minimally Invasive Aortic Valve Replacement in Osteogenesis Imperfecta: A Case Report

Noriyuki Takashima, et al.

INTRODUCTION: Cardiac surgery in patients with osteogenesis imperfecta is a high-risk procedure because of tissue fragility, which leads to complications, such as bleeding, fractures, and increased mortality. A less invasive approach, such as right anterior mini-thoracotomy, may help reduce these risks and improve outcomes.

A Case of Ascending Colon Cancer Complicated by Cronkhite-Canada Syndrome Treated with Robot-Assisted Right Hemicolectomy

Shigeyuki Hamanaka, et al.

INTRODUCTION: Cronkhite-Canada syndrome (CCS) is a rare non-hereditary disorder in which multiple non-tumorous polyps occur throughout the digestive tract. Although surgical treatment is sometimes indicated due to the occurrence of gastric and colorectal cancer, in CCS, the polyposis makes it difficult to distinguish from cancer and requires careful follow-up. CCS is characterized by the presence of inflammatory findings, and steroids and immunosuppressants are used as key drugs. So, it is crucial to perform minimally invasive surgeries whenever possible, and in this regard, robotic-assisted surgery might prove to be one of the appropriate approaches.

Safe Laparoscopic Pancreatectomy in a Patient with Rare Superior Mesenteric Artery-Derived Gastroduodenal Artery: A Case Report and Technical Considerations

Takayuki Miura, et al.

INTRODUCTION: Although several studies have highlighted the importance of recognizing gastroduodenal artery (GDA) anomalies during pancreaticoduodenectomy, their relevance during distal pancreatectomy has not been explored. Herein, we describe the safe performance of laparoscopic distal pancreatectomy in a patient with a rare vascular anomaly, specifically a GDA originating from the superior mesenteric artery (SMA).