Two Cases of Succinate Dehydrogenase-Deficient Juvenile Gastric Gastrointestinal Stromal Tumor

Daisuke Fujimoto, et al.

INTRODUCTION: SDH-deficient GIST is a part of WT GIST that constitutes approximately 10% of gastric GISTs and has no mutation of proto-oncogene receptor tyrosine kinase or PDGFR-α. In this paper, we present 2 cases of juvenile WT gastric GIST with SDH deficiency: a woman who underwent initial surgical treatment in junior high school and subsequently underwent 2 surgical treatments, and a man with lymph node metastasis who underwent distal gastrectomy with lymphadenectomy.

An Adult Case of Bochdalek Hernia with Incarcerated Transverse Colon Successfully Treated by Hand-Assisted Laparoscopic Surgery

Erica Nishimura, et al.

INTRODUCTION: Bochdalek hernia (BH) is a congenital diaphragmatic hernia that is rare among adults. It is difficult to treat especially with an incarcerated abdominal organ. Although surgery via laparotomy or thoracotomy to repair the hernia with or without mesh reinforcement is the gold standard of treatment for BH, conversion to open surgery is performed to obtain a good surgical view and sufficient working space. Herein, we describe a rare case of BH with incarcerated distal transverse colon treated by hand-assisted laparoscopic surgery (HALS).

Obese Patient with Gastric Diverticulum Undergoing Laparoscopic Sleeve Gastrectomy Guided by Preoperative Endoscopic Measurement: A Case Report and Literature Review

Kensuke Hirosuna, et al.

INTRODUCTION: Gastric diverticulum is a rare condition, often asymptomatic and incidentally detected. Laparoscopic sleeve gastrectomy (LSG) is a widely performed bariatric procedure, but a gastric diverticulum complicates surgical planning. In this case, careful preoperative assessment allowed safe execution of LSG despite the diverticulum’s proximity to the esophagogastric junction.

Gallbladder Mixed Neuroendocrine–Non-Neuroendocrine Neoplasm Consisting of Adenocarcinoma and Neuroendocrine Tumor G2 Diagnosed after Surgery for Acute Cholecystitis: A Case Report and Exome Analysis

Takaomi Seki et al.

INTRODUCTION: Among neuroendocrine neoplasms (NENs), non-neuroendocrine and NEN components may rarely coexist, which are referred to as mixed neuroendocrine–non-NENs (MiNENs). Most gallbladder MiNENs are progressive and associated with neuroendocrine carcinoma (NEC), but rarely with neuroendocrine tumor (NET) as a component. To our knowledge, there are 4 reported cases of mixed gallbladder tumors with NET as a component. From the genetic analysis of MiNENs consisting of NEC, MiNEN is believed to have a common origin, as each tumor component shares a common TP53 mutation. Our case is an extremely rare reported case of a mixed gallbladder tumor with a NET component as a MiNEN, and the first reported case of whole-exome analysis performed on a resected specimen.

Idiopathic Myointimal Hyperplasia of the Mesenteric Veins: Diagnosed After Resection due to Insufficient Palliative Surgery

Natsuki Hoshino et al.

INTRODUCTION: Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is a rare, non-thrombotic ischemic bowel disease caused by the proliferation of smooth muscle cells in the venous intima. Most patients are initially diagnosed with typical ischemic colitis or inflammatory bowel disease (IBD) and are treated nonsurgically. There is no established treatment for IMHMV, and surgery is the mainstay of treatment, although the optimal surgical approach remains unclear.

Coexistence of Median Arcuate Ligament Syndrome and Pancreatic Ductal Adenocarcinoma: A Case Report on Pancreaticoduodenectomy with Arterial Reconstruction

Yuta Hiura, et al.

INTRODUCTION: The celiac axis (CA) is usually dependent on blood supply from the superior mesenteric artery via the pancreatic arcade, particularly in cases of CA stenosis. During pancreaticoduodenectomy, excision of the gastroduodenal artery poses a significant risk of organ ischemia in the CA territory and may compromise anastomotic integrity. In cases of median arcuate ligament syndrome (MALS), blood flow typically improves after ligament transection. However, if atherosclerosis is present and chronic arterial compression is induced by the median arcuate ligament, stenting or revascularization may be required. Although revascularization is the most definitive technique, it raises concerns about anastomotic disruption due to postoperative pancreatic leakage. Considering these complexities, a thorough preoperative assessment of blood flow and the development of strategies to ensure adequate perfusion after resection are critical. Here, we encountered a patient with pancreatic cancer and MALS complicated by atherosclerosis.

Successful Laparoscopic-Assisted Pancreaticoduodenectomy for a Neuroendocrine Tumor of the Papilla of Vater in Type 1 Portal Annular Pancreas

Hideki Izumi, et al.

INTRODUCTION: Portal annular pancreas (PAP) is a rare anomaly of pancreatic embryology that is classified into three types according to the position of the main pancreatic duct. PAP type 1, in which the main pancreatic duct runs dorsal to the pancreas, is extremely rare. Herein, we describe a case of successful laparoscopic-assisted pancreaticoduodenectomy in a patient with type 1 PAP.

Congenital Pulmonary Airway Malformation with Pulmonary Arteriovenous Malformation in Adulthood: A Case Report

Takehiro Suzuki, et al.

INTRODUCTION: Congenital pulmonary airway malformation (CPAM) is a congenital condition rarely detected in adults because most cases of CPAM are found through prenatal testing or through testing for recurrent pneumonia or lung abscesses in childhood. Pulmonary arteriovenous malformation (PAVM) is an abnormal vascular connection between the pulmonary arteries and veins, which is often related to hereditary hemorrhagic telangiectasia, but can also be induced by infections, trauma, or thoracic surgery. Herein, we report an adult case of coexisting CPAM and PAVM.

Incarceration of the Afferent Loop into the Sutured Closed Mesenteric Defect after Gastrectomy Followed by Billroth-II Reconstruction for Gastric Cancer: Two Case Reports

Kiyotomi Maruyama, et al.

INTRODUCTION: Internal hernia is a critical complication after laparoscopic gastrectomy with Roux-en-Y, Billroth-II or double tract reconstruction. It is recommended that mesenteric defects should be closed to prevent internal hernias. We reported two patients who developed internal hernias, in which the afferent loop of Billroth-II reconstruction became incarcerated into the closed mesenteric defects.

Successful Resection of Leiomyosarcoma Originating from the Inferior Vena Cava with Common Iliac Artery and Vein Reconstruction: A Case Report

Takashi Miyata et al.

INTRODUCTION: Leiomyosarcomas originating from the inferior vena cava are extremely rare. Because they have a strong tendency to invade the surrounding vital structures, cure can only be achieved by R0 resection.

Histiocytic Sarcoma Diagnosed on Repeat Biopsy of Multifocal Extranodal Tumors

Toshinari Ito, et al.

INTRODUCTION: Histiocytic sarcoma (HS) is a rare malignant disease with a poor prognosis and unknown pathogenesis. In addition, this disease is difficult to diagnose due to the wide variety of diseases to be differentiated from it.

Bile Leakage after Liver Transplantation Owing to Stricture of Afferent Jejunal Loop Caused by an Intussusception Valve after Biliary Atresia Surgery: A Case Report

Hironobu Ito et al.

INTRODUCTION: Biliary atresia (BA) is a progressive cholangiopathy in neonates that results in biliary cirrhosis and liver failure without early intervention. Hepatic portoenterostomy (Kasai operation) remains the standard treatment, significantly improving survival rates. However, postoperative cholangitis is a major determinant of prognosis. To prevent cholangitis, various surgical modifications, including anti-reflux procedures such as intussusception anti-reflux valves (IAV), have been introduced. Although IAV has been widely adopted, some reports suggest that long-term survivors may develop afferent jejunal limb stenosis, leading to complications such as cholangitis and intestinal obstruction. Herein, we report a case of afferent jejunal loop stricture caused by IAV, which became symptomatic after liver transplantation (LT).