Recurrent Tumor in Colorectal Cancer Requiring Combined Resection of Iliac or Femoral Vessels: Report of Four Cases

Kentaro Abe et al.

INTRODUCTION: Recurrent tumors in colorectal cancer may be removed along with adjacent blood vessels to achieve R0 resection. However, it remains unclear whether to aggressively perform this procedure because it may cause serious intraoperative or postoperative complications.

Laparoscopic Gastrectomy for Heterotopic Pancreas with Concurrent Gastroduodenal Invagination and Gastric Wall Abscess: A Case Report

Fukuda, et al.

INTRODUCTION: Heterotopic pancreas refers to pancreatic tissue located outside its normal position and lacking anatomical or vascular continuity with the pancreas. Gastric heterotopic pancreas (GHP) is generally asymptomatic, but in rare cases large GHP lesions can cause gastric outlet syndrome or gastroduodenal invagination. GHP may also occasionally cause acute pancreatitis and abscess formation in the gastric wall. This report describes a rare case of GHP with concurrent gastroduodenal invagination and gastric wall abscess treated via laparoscopic distal gastrectomy.

Delayed Hemorrhage Following Needle Aspiration for a Mediastinal Cyst: The Significance of Confronting Upside-Down Video-Assisted Thoracic Surgery Under Two-Lung Ventilation

Eri Ueda et al.

INTRODUCTION: Surgical resection remains the gold standard for managing mediastinal cysts, including bronchogenic cysts, whereas needle aspiration serves as an alternative option that can facilitate preoperative volume reduction or, in certain selected cases, serve as a definitive treatment. However, it may lead to rare but potentially life-threatening complications such as mediastinitis; therefore, its indication should be carefully considered. This report details a case of a delayed intracystic hemorrhage 3 days after an endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), requiring emergency surgery with venoarterial extracorporeal membrane oxygenation (V-A ECMO) on standby, which was successfully managed using a confronting upside-down video-assisted thoracoscopic surgery (VATS) approach.

Idiopathic Adult Ileocolic Intussusception Mimicking Cecal Carcinoma: A Case Report and Literature Review

Rina Hashimoto, et al.

INTRODUCTION: Adult intussusception is rare, accounting for approximately 5%–16% of all cases. Unlike pediatric intussusception, which is predominantly idiopathic, most adult cases are associated with organic lesions, nearly half of which are malignant. Idiopathic intussusception without a lead point is uncommon but appears to be increasingly recognized. We report a case of idiopathic adult ileocolic intussusception that mimicked cecal carcinoma in imaging studies.

Successful Deceased Donor Liver Transplantation with Median Sternotomy for Budd–Chiari Syndrome: A Case Report and Review of the Literature

Takahiko Omameuda et al.

INTRODUCTION: When a thrombus extends to the suprahepatic inferior vena cava (IVC) in patients with Budd–Chiari syndrome (BCS) requiring liver transplantation (LT), there is a risk of thrombus migration during hepatectomy that can potentially lead to pulmonary embolism. Intraoperative pulmonary embolism can be life-threatening and may necessitate urgent thrombectomy. However, preventive strategies for pulmonary embolism during LT in BCS cases with IVC thrombosis have seldom been discussed in the literature. We report a case involving a 51-year-old woman with BCS complicated by thrombi extending into the suprahepatic IVC who underwent deceased donor LT (DDLT) for acute liver failure (ALF).

Pneumoperitoneum Caused by a Ruptured Splenic Abscess Mimicking Gastrointestinal Perforation: A Case Report

Naoki Kawahara et al.

INTRODUCTION: Splenic abscess is a rare but potentially life-threatening condition that can rupture, leading to pneumoperitoneum and symptoms that mimic gastrointestinal perforation in rare cases. This can significantly complicate accurate diagnosis and prompt treatment. A splenic abscess can become life-threatening by rupturing, which may cause diffuse peritonitis or sepsis.

Successful Treatment of Locally Advanced Microsatellite Instability-High Ascending Colon Cancer Using an Immune Checkpoint Inhibitor without Extensive Resection: A Case Report

Taiki Nabekura, et al.

INTRODUCTION: Colorectal cancer is a prevalent malignancy that necessitates personalized chemotherapy, especially with the advent of molecular-targeted drugs and immune checkpoint inhibitors. In Japan, immune checkpoint inhibitors have been approved for unresectable advanced and recurrent colorectal cancer; however, their use in preoperative therapy for colorectal cancer has not yet been approved. Globally, neoadjuvant immunotherapy has demonstrated promising outcomes in colorectal cancer cases with high immunogenicity, including microsatellite instability-high and deficient mismatch repair.

Pathological Complete Response after Pembrolizumab Treatment for Unresectable Perihilar Cholangiocarcinoma with High Microsatellite Instability: A Case Report

Yoshikuni Inokawa et al.

INTRODUCTION: Pembrolizumab has been introduced to solid cancers with microsatellite instability (MSI)-high cases; however, its clinical experience for cholangiocarcinoma remains very limited. Here, we present a case who successfully underwent conversion surgery following pembrolizumab treatment for MSI-high perihilar cholangiocarcinoma, which pathologically exhibited complete response.

Post-Esophagectomy Chylothorax with Thoracic Duct Anomaly Successfully Treated with Lymphangiography: A Case Report

Akihiro Kuroda et al.

INTRODUCTION: Chylothorax following esophagectomy is a relatively rare but significant complication, with incidences ranging from 1.1% to 3.8%. It typically arises from damage to the thoracic duct or associated lymphatic vessels during extensive lymph node dissection and thoracic surgery. Initial management usually relies on conservative approaches such as dietary modifications, drainage, and pharmacotherapy. If these methods are ineffective, surgical intervention becomes necessary. However, standardized guidelines for the optimal management of thoracic duct injuries are as yet lacking, with decisions made on a case-by-case basis. We describe a case of chylothorax following esophagectomy where lymphangiography played a crucial role in guiding the surgical approach.

Robotic Distal Pancreatectomy for Adult Pancreatoblastoma with Tumor Extension to the Main Pancreatic Duct: A Case Report

Hiroaki Sugita, et al.

INTRODUCTION: Adult pancreatoblastoma (PB) is an extremely rare malignant pancreatic epithelial tumor. Although no standard treatment strategy has been established, complete resection is recommended for long-term survival. Here, we presented a case of an adult patient with PB who successfully underwent complete resection via robotic surgery. Furthermore, this is the first report of robotic surgery for PB, highlighting its novelty and potential clinical relevance.

A Case of Unresectable Hepatocellular Carcinoma Treated with Spacer Placement Surgery with Bioabsorbable Spacer and Subsequent Proton Beam Therapy

Toru Takahashi, et al.

INTRODUCTION: Hepatocellular carcinoma (HCC) often requires repeated therapy and poses challenges in treatment selection, particularly in patients with impaired liver function. Although hepatic resection, radiofrequency ablation, and liver transplantation are standard local curative therapies, the position of radiotherapy, including proton beam therapy (PBT), remains relatively underexplored. Herein, we report an illustrative case of unresectable HCC treated with spacer placement surgery using a bioabsorbable spacer, followed by PBT.

Renal Artery Stent-Graft Implantation Using the Retrograde Approach in a Patient Who Developed a Renal Artery Aneurysm after Thoracoabdominal Aortic Repair

Yutaka Matsubara, et al.

INTRODUCTION: Herein, we report a patient who underwent stent-graft implantation using the retrograde approach for a renal artery aneurysm.