Purpose: This study aimed to assess whether computed tomography (CT) findings can be used to predict blood flow from the superior mesenteric artery (SMA) to the celiac artery (CA) region in patients with median arcuate ligament syndrome (MALS).

Materials and methods: Two radiologists who reviewed 1,290 conventional SMA angiograms and CT scans identified 36 patients with MALS. MALS was classified by their blood flow angiography findings as type A (CA region not or barely visualized) and type B (CA region clearly visualized). The association between patient age, sex, post-stenotic dilatation ratio of the celiac axis, maximum diameter of the pancreaticoduodenal arcade (PDA), and MALS classification based on SMA angiography was assessed.

Results: Of 36 MALS patients, 17 had MALS type A and 19 had MALS type B. The mean of the maximum diameter of the PDA in MALS type A was 1.6 ± 0.9 mm (SD) and 4.3 ± 1.3 mm in MALS type B. The post-stenotic dilatation ratio of the celiac axis was 2.4 ± 1.2 in MALS type A and 2.2 ± 1.4 in MALS type B. Only maximum diameter of the PDA was a predictor of MALS type B (odds ratio, 15.7; 95% confidence interval, 2.3–108.1).

Conclusion: The maximum diameter of the PDA on CT angiography can be used to predict the blood flow from the SMA to the CA region in patients with MALS.

Herein, we describe a case of a 41-year-old woman with two giant leiomyomas located in the lower thoracic oesophagus and gastric cardia that were treated by minimally invasive thoracoscopic and laparoscopic surgery. We first resected the gastric cardia and laparoscopically prepared a gastric tube, and then we resected the lower thoracic oesophagus and intrathoracically anastomosed the oesophagus and gastric tube using thoracoscopic surgery with the patient in the prone position. Two concurrent giant leiomyomas of the oesophagus and stomach are rare, and the choice of surgical procedure to address the tumour from the mediastinum into the abdominal cavity was particularly challenging. We selected a minimally invasive thoracoscopic approach with the patient in the prone position. This strategy seems effective for resecting these giant tumours in the lower thoracic oesophagus and gastric cardia.

An 82-year-old woman swallowed a fish bone and presented to our hospital 3 days later when she had breathing difficulty and became hypotensive. Chest computed tomography (CT) showed a linear structure with high bone density extending from the oesophagus into the pericardium, along with pericardial effusion, air, and a left pleural effusion. We diagnosed the patient with oesophageal perforation by a foreign body (a fish bone) leading to pericardial penetration, cardiac tamponade, and left empyema. The patient underwent emergency surgery. Pericardial fenestration and drainage of the pericardial and thoracic cavities were performed. Chest CT showed a recurrent abscess cavity in the pericardium on day 6. A pigtail catheter was placed in the recurrent abscess cavity under CT guidance for drainage. The patient gradually improved and was discharged after 5 months.

Introduction: Endometriosis is a rare cause of intussusceptions in adults. Although intestinal endometriosis sometimes arises as a consequence of direct involvement of the pelvic organs with endometrial tissue, there is no report that this type of endometriosis causes ileocecal intussusception.

Case presentation: Computed tomography assessment of a 40-year-old woman who presented with abdominal pain revealed ileocecal intussusceptions. The patient was managed by endoscopic reduction followed by laparoscopic resection. Adhesion between the right uterine adnexa and caecum was identified during surgery; therefore, combined resection of the uterine adnexa and ileocecum was performed. Pathological findings revealed that endometriosis, arising from the uterine tube and directly involving the cecal wall, had caused the intussusceptions.

Conclusion: Although rare, endometriosis should be considered as part of a differential diagnosis of intussusception in adult women who present with abdominal pain. A preoperative diagnosis is sometimes difficult, therefore, surgical resection could be a reasonable strategy to achieve a precise diagnosis.