We report a case of invasive lobular carcinoma (ILC) arising within a fibroadenoma (FA) in a 52-year-old woman with breast cancer. The patient had been diagnosed as having a 17-mm FA in the upper inner quadrant of the left breast by a fine needle aspiration biopsy 12 years earlier. Recently she presented with an uncomfortable feeling in her left breast and was diagnosed with right breast cancer. Increased blood-flow within the known FA albeit with no morphological change on ultrasonography was observed, and needle biopsy confirmed a diagnosis of ILC within the FA. She underwent bilateral partial mastectomy and right axillary lymph node dissection. The pathological examination revealed a 7-mm ILC within the 12-mm FA in her left breast and breast cancer in the right breast (pT1bN1M0 Stage IA). Although breast cancer arising within a benign FA is rare, FA with any unusual imaging findings may require further examination. Here, we discuss the diagnostic strategies of breast cancer arising within a FA, a rare and challenging condition, based on the review of previously reported cases in Japan.

An 88-year-old woman presented to our hospital with a right breast tumor and pain in the D area. The patient was diagnosed with invasive ductal carcinoma upon examination. Partial resection was performed. Histopathological examination revealed that the cancer cells were mainly secretory carcinoma with a microcystic pattern, having a micro-vesicular structure similar to that of thyroid follicles, and a tubular pattern with a luminal-like structure that stored secretions. Secretory carcinoma was initially reported as juvenile breast carcinoma ; however, a few reports found that even older people are diagnosed with secretory carcinoma. No treatment has been developed for this histological type. In this case, treatment was performed according to the breast cancer treatment protocol, and the prognosis was relatively good.

Matrix-producing carcinoma of the breast is a relatively rare histological type of breast cancer and accounts for approximately 0.1% of all breast carcinomas. Most matrix-producing carcinomas are triple-negative breast cancers, which often recur within two-and-a-half years postoperatively. Reportedly, the 5-year survival rate of this malignancy is poorer than that of other types of breast cancer. Few reports in Japan have described neoadjuvant chemotherapy in these cases. We report a case of successful neoadjuvant chemotherapy in a patient with matrix producing carcinoma. A 45-year-old woman developed a right breast mass for which she did not initially seek care. However, the mass gradually increased in size and became painful ; therefore, she visited our department for further evaluation. A 13 cm mass was detected in the CC area of her right breast, and she was diagnosed with a matrix-producing carcinoma based on histopathological evaluation of needle biopsy specimens. Positron emission tomography-computed tomography revealed tracer uptake in a right axillary lymph node without distant metastasis. The tumor shrank following six cycles of fluorouracil, epirubicin, and cyclophosphamide therapy and 12 cycles of paclitaxel as neoadjuvant chemotherapy, and right partial mastectomy and axillary lymphadenectomy were considered feasible in this case. The patient received post-adjuvant radiotherapy to the conserved breast and is currently being followed-up.

A 75-year-old woman was referred to our hospital for a detailed examination of anemia and a mass in the right breast. On examination, breast cancer (4 cm) was revealed in the right C area ; however, no distant metastasis was observed. Bone marrow aspiration was inadequate, and right mastectomy and axillary lymph node dissection were performed. Pathological examination revealed triple-negative invasive lobular carcinoma. Postoperative bone marrow biopsy revealed bone marrow metastasis of breast cancer. The postoperative staging was T2, N1, M1 (MAR), stage IV. Postoperative bone scintigraphy revealed widespread bone marrow metastasis. The patient was treated with epirubicin + endoxan^® → weekly paclitaxel. Bone marrow metastasis is associated with disseminated intravascular coagulation (DIC) and can lead to worsening of the patient's condition. Bone marrow metastasis has a poor prognosis ; thus, immediate therapeutic intervention is crucial. When breast cancer is characterized by anemia or thrombocytopenia, emphasis should be given to the risk of bone marrow metastases. However, no chemotherapy regimen for bone marrow metastases has yet been determined.

A 72-year-old man underwent DDD pacemaker implantation via the subclavian vein. Several years previously he had noticed fatigability and exertional dyspnea, and these now worsened. Echocardiography showed interference by the ventricular lead with the posterior cusp of the tricuspid valve, tricuspid ring dilatation, right ventricular enlargement, and grade IV mitral regurgitation. Severe tricuspid insufficiency due to a ventricular pacemaker lead implanted 23 years previously was diagnosed. Intraoperatively, the ventricular lead was found to have severe adhesions to the posterior cusp of the tricuspid valve and the posterior papillary muscle, greatly restricting the range of motion of the valve. The valve was severely deformed, and valvuloplasty was considered not feasible. Sharp dissection was carried out so as not to damage the lead, and it was performed without cutting the lead during tricuspid valve replacement by moving it to the commissure between the anterior and septal cusps and fixing it outside the artificial valve suture ring. Because patients with no preoperative hepatic congestion or hepatic dysfunction and whose left heart function is maintained should have a good prognosis, it is important to conduct follow-up examinations with regular echocardiography and to perform surgery before it is too late and the patient's condition becomes severe.

The patient was a 71-year-old man who underwent left upper lobectomy for left lung cancer 4.5 years previously. During follow-up period, a shadow in the right upper lobe of lung which enlarged with time appeared and lung carcinoma was suspected. Preoperative contrast-enhanced CT scan revealed partial anomalous pulmonary venous connection (PAPVC) where the V1+2+3 had drained into the superior vena cava. Since his PAPVC was present in the lung lobe to be resected, he was asymptomatic, and the pulmonary blood flow/systemic blood flow ratio (Qp/Qs) was 1.7, we considered the lesion to be within the allowable range for surgery. We thus decided to employ surgical diagnosis and treatment. We performed thoracoscopic right upper lobectomy. The patient required some respiratory rehabilitation after the operation. He was discharged from our hospital on the 13^th postoperative day. Cardiac ultrasonography performed after the operation revealed the decreased Qp/Qs to 1.1, revealing improved right cardiac load-carrying capacity.

We have experienced a resected case of right upper lobe carcinoma associated with PAPVC in the same lobe after left upper lobectomy. Although PAPVC is a comparatively rare congenital anomaly, it can cause right heart failure after surgery if it is present in the non-resected lung lobe. In performing lung resection, we must make preoperative imaging diagnosis by baring a possible existence of PAPVC in mind.

A 54-year-old obese man (Class 2 obesity). Right diaphragmatic eventration was demonstrated on medical examination for five years. The patient visited our hospital with a chief complaint of dyspnea. Thoracoabdominal computed tomography (CT) revealed prolapse of the small intestine, transverse colon, and greater omentum in the right thoracic cavity, and the patient was diagnosed with diaphragmatic hernia. After contrast-enhanced CT examination, the patient developed a cough attack and respiratory failure. During hospitalization, the patient received mechanical ventilation management ; however, his respiratory condition did not improve, and he underwent surgery. Upon thoracotomy, a defect of approximately 10 cm was observed in the center of the right diaphragmatic tendon, and the prolapsed organs were the right lobe of the liver, gallbladder, small intestine, transverse colon, and greater omentum. Since a large number of organs were prolapsed, the volume was reduced by omentectomy and cholecystectomy. The prolapsed organs were then repositioned, and the mesh was fixed over the hernia orifice to complete the surgery. No recurrence was observed for three years after the surgery. Here, we report a surgical case of adult idiopathic diaphragmatic hernia that led to respiratory failure and required mechanical ventilation management.

A 53-year-old woman underwent upper-gastrointestinal endoscopy for epigastralgia that reveled a circumferentially growing type 3 tumor, extending from the antrum to duodenal bulb. A biopsy specimen confirmed small-cell neuroendocrine carcinoma. An abdominal computed tomography with contrast showed the thickening of the antrum and duodenal wall which has contact with the liver, and a number of bulky swollen lymph nodes (LNs). From these findings, she was diagnosed with gastric small-cell neuroendocrine carcinoma, T4bN3aM0, cStage III. The patient underwent chemotherapy with cisplatin and irinotecan (IP). After 1 course, gastroduodenal stenosis had occurred. Gastroduodenal stent placement was performed, and passage obstruction improved promptly. After 2 courses, an abdominal CT scan revealed a reduction in size of the primary tumor and LNs which reduced to 49% of the original mass. We performed radical distal gastrectomy with D2 plus no.17 lymph node dissection and Roux-en-Y reconstruction. The histopathological diagnosis was gastric small cell neuroendocrine carcinoma, ypT3(SS), ypN2, ypM0, ypStage IIIA. The efficacy of the chemotherapy was rated Grade 1b. After having received chemotherapy with IP for 6 months, she has no signs of tumor recurrence as of 20 months after the surgery.

We present a rare case of late recurrence to the pleura after gastrectomy for gastric carcinoma and resection of synchronous peritoneal dissemination. A 70-year-old man underwent distal gastrectomy for advanced type 3 gastric cancer, when single small peritoneal metastasis, 1mm in diameter, was identified on the liver surface and resected at the surgery. Histologically it was peritoneal metastasis of gastric cancer. The patient was treated with S-1 chemotherapy for five years without any signs of recurrence and had closely been followed up after cession of the chemotherapy. Eleven years after the surgery, a CT scan revealed nodular deposits on the right diaphragm. We performed a video-assisted pleural biopsy, and pleural metastasis of gastric cancer was confirmed histologically. The number of longer survivors of synchronous peritoneal dissemination has increased, however, late solitary metastasis to the pleura without effusion is very rare.

A 54-year-old male patient receiving high-dose steroid therapy for IgA vasculitis presented with right lower abdominal pain. An abdominal CT scan showed free air and abdominal ascites. Intestinal perforation was diagnosed, and he underwent an emergency operation. During surgery, however, multiple diverticula were found in the terminal ileum, one of which was perforated. Ileocecal resection and ileostomy were performed. The histopathological diagnosis was perforated true diverticulum involving muscularis propria and adventitia. Perforation of ileal diverticula is rare and difficult to diagnose. Patients in whom this condition is suspected should undergo an emergency operation at an early stage. We herein report a case of multiple true diverticula of the small intestine with perforative peritonitis which required emergency operation.

A 76-year-old man was brought into our hospital by an ambulance for abdominal pain and vomiting. Computed tomography (CT) of the abdomen revealed intestinal obstruction by an intraabdominal abscess, and his symptoms were relieved by CT guided abscess drainage. CT performed later suggested intraabdominal abscess by intestinal perforation for a fish bone. He presented to our hospital with abdominal pain and fever 4 months later. We diagnosed the case as recurrence of abdominal abscess by the remained fish bone. We performed laparoscopic surgery for extracting the fish bone and for resecting the perforated intestine. He has been passed without recurrence until now. When we select conservative therapy for intestinal perforation by a fish bone, we have a risk of recurrence by the remained fish bone, therefore we should extract the fish bone as a rule. In this case, we were able to find the small fish bone and perform an operation minutely even on the operative field with severe inflammation by employing laparoscopic surgery.

A 64-year-old man had previously undergone right nephrectomy, partial hepatectomy and right hemicolectomy, left nephrectomy, and surgery for appendicitis. He was examined at our hospital for abdominal pain and constipation and was admitted as an emergency with a diagnosis of postoperative adhesive ileus. After admission, an ileus tube was inserted, and the patient was treated conservatively, but this was ineffective in decompressing the intestine. Since small intestinal contrast injection via the ileus tube showed a barrier to the passage of the contrast agent, surgical treatment was performed on postadmission Day 13. When the abdomen was opened, the ileum exhibited a cicatricial stricture duet to strangulation by a cord-like structure composed of adhesions, and it was torn completely off on the distal side. This was considered to be the origin of the obstruction. There was no exposure of the mucosa of the torn portion and no peritoneal contamination by gastric fluid. The portion from the stenosis site to the torn potion was resected, and the ileum was reconstructed with an ileal-ileal functional end-to-end anastomosis. The patient's postoperative course was uneventful. It is extremely rare for strangulated intestine to cause ileus causing obstruction and tearing without accompanying necrosis and perforation. This case is reported together with a discussion of the literature.

An adult case of intestinal obstruction caused by a vitelline cyst is reported. A 28-year-old man presented to our hospital because of continuous abdominal pain around the umbilicus. Abdominal enhanced computed tomography showed marked dilatation of the small intestine and a cystic lesion directly under the umbilicus. The cyst was approximately 60 mm in maximal diameter. The preoperative diagnosis was intestinal obstruction caused by a vitelline cyst. intraoperatively, the small intestine was seen to be obstructed by a band-like structure extending from the cyst to the ileum of the oral side, 95 cm from the ileocecum. En bloc resection of the vitelline cyst and the band-like structure was performed. Histological examination of the specimen showed the complete structure of the intestinal wall at the site of the vitelline cyst. Meckel's diverticulum is well known as a form of vitello-intestinal duct remnant, but other forms are rare in adults. This case is presented along with a review of the literature.

A 69-year-old man underwent wide excision of a polymorphic liposarcoma in his left chest wall at another hospital. One year later, he was examined in our hospital for abdominal pain and loss of appetite. Computed tomography showed ileocolic intussusception and a mass in the advanced part. A laparoscopic ileocecal resection was performed without attempting reduction. Histological examination confirmed that the tumor was a metastasis of the liposarcoma. The patient's postoperative course was good. The patient was discharged on the 10th day after the operation. Small intestinal metastasis of liposarcoma is rare and so is its presentation as intussusception. A case that was laparoscopically operable is reported.

A 45-year-old man presented to our hospital complaining of pain in the left lower abdominal quadrant and fever. Laboratory findings and abdominal ultrasound conducted by a local doctor suggested penetration of sigmoid colon cancer and multiple liver metastases. A contrast abdominal CT, a colonoscopic examination and a small bowel series in our hospital made the diagnosis of small intestine tumor with multiple liver metastases. We conducted partial resection of the small intestine. The pathological diagnosis was small intestine gastrointestinal stromal tumor (GIST). We started imatinib mesylate treatment. A CT scan one month after the start of chemotherapy showed that the multiple liver metastases increased in size. We thus added radiofrequency ablation (RFA) to the imatinib mesylate treatment. RFA was used three times for 14 lesions. For two years and six months after the initial RFA, multiple liver metastases kept the reduced states and there were no new recurrences. We performed hepatectomy for liver metastases two, five, seven, and ten years after the primary surgery. After that, there were lung metastases, adrenal metastasis, anterior mediastinal recurrence, retroperitoneal recurrence, pancreatic metastasis and posterior mediastinal recurrence, for which we performed surgical resections. He is free of tumor recurrence and has been on the imatinib treatment, as of 13 years and six months after the primary surgery. Combined therapies including RFA may be an effective treatment for simultaneous unresectable multiple liver metastases of small intestine GIST.

Nonperforated acute appendicitis with disseminated intravascular coagulation (DIC) due to sepsis has rarely been reported. An 82-year-old man presented with nausea and epigastric pain at 3 a.m. and underwent a checkup at another hospital in the evening of the same day. Suspected of having appendicitis, the patient was sent to our department and underwent an abdominal computed tomography scan that revealed swelling of the appendix at 13 mm without calcification. However, the findings did not suggest perforation. However, fever, blood analysis, and biochemical findings led to a diagnosis of nonperforated acute appendicitis with DIC. An emergency operation was performed. The surgical findings and histopathology revealed phlegmonous appendicitis without perforation. Postoperative intensive therapy improved the patient's general condition. The existence of nonperforated acute appendicitis with DIC due to sepsis should be recognized. It could cause the health of an elderly man to deteriorate quickly.

Giant colonic diverticula are rare, and only a small percentage of these lesions can be categorized as true diverticula. A 62-year old man visited a local physician with right-sided abdominal pain and was diagnosed with an abdominal mass. He was referred to our hospital for further evaluation and treatment. Abdominal computed tomography showed a mass (5 cm in diameter), which was suspected to be continuous with the ascending colon. Colonoscopy showed a large number of small diverticula in addition to the giant colonic diverticulum. Based on the aforementioned findings, the patient was diagnosed with a giant ascending colon diverticulum, and laparoscopic-assisted right hemicolectomy was performed. Intraoperatively, significant adhesions were identified around the giant diverticulum, which were attributed to inflammation. Histopathological evaluation of the resected specimen showed a muscular layer in the diverticular wall ; therefore, the patient was diagnosed with a true diverticulum, which was accompanied by bacterial infection but no evidence of malignancy.

An 85-year-old woman was referred to the department of plastic surgery of our hospital for detailed examination with a complaint of an enlarged left submandibular lymph node in October 2019. Pathological diagnosis by excisional biopsy showed malignant lymphoma. She was found to have anemia at the time of hospitalization. On further examination, she was suspected to have concomitant descending colon cancer. In November, laparoscope-assisted left hemicolectomy and D3 lymph node dissection were performed. On pathological diagnosis of the resected specimen, the lesions formed a collision tumor of moderately differentiated tubular adenocarcinoma (invasion depth T3) and malignant lymphoma at the subserosal layer. Some of the malignant lymphoma spread surrounding the adenocarcinoma, which is a very rare pathological finding. Although metastasis of adenocarcinoma to the dissected regional lymph nodes was not observed, malignant lymphoma cells were detected in those lymph nodes. Postoperatively, chemotherapy for malignant lymphoma resulted in complete remission. However, a metastatic lesion of the central nervous system appeared in May 2020. Palliative radiation therapy was performed, and symptoms attributable to the metastatic lesion at this site were stable as of August 2020.

A 40-year-old man was referred to our department for surgery as histopathological results following endoscopic mucosal resection performed for early sigmoid colon cancer indicated the need for additional resection. A contrast study of the lower gastrointestinal tract confirmed an inverted cecum. The cecum and appendix were located in the right upper abdomen at the height of superior anterior iliac spine, the blind end of the cecum was directed toward the head, and most of the right colon had moved downward as a whole into the pelvic cavity. An abdominal contrast-enhanced CT examination revealed no intraperitoneal distant metastasis, lymph node enlargement, or SMV rotation sign. Therefore, laparoscopic sigmoidectomy was performed in the usual manner. We hereby report a case of inverted cecum, an extremely rare subtype of intestinal malrotation, which was detected preoperatively, enabling us to perform surgery safely under laparoscopic guidance.

An 81-year-old man presenting with unpleasant sensation of the anus was referred to our hospital with a diagnosis of perianal Paget's disease. Neither recognizable tumor nor ulcer formation was proved in the anal canal and the rectum, but a biopsy with immunological staining resulted in CK20 positive and GCPFD15 negative. We diagnosed the case as pagetoid spread of anorectal cancer and performed abdominoperineal resection. Histopathology confirmed tumor cells to be within the anal gland, and furthermore signet ring cell carcinoma to have progressed from the anal canal epithelium to the surrounding skin. Accordingly, pagetoid spread of anal gland originating anal canal cancer was diagnosed. This case is extremely rare wherein anal gland originating intraepithelial cancer of the anal canal, which did not form any demonstrable tumor in the anal canal, displayed pagetoid spread. We present the case with some bibliographical comments.

A solitary necrotic nodule is a rare benign lesion, and multiple such nodules may be present. A 71-year-old woman was referred to our hospital for follow-up after partial mastectomy for breast cancer that she underwent 12 years earlier. She had no recurrence after radiation therapy, chemotherapy, and endocrine therapy. Computed tomography (CT) showed hepatic lesions with a maximum diameter of 10 mm located in segments II, III, V, VI, and VIII. Ultrasound examination showed hypoechoic regions with distinct borders. PET-CT showed no FDG uptake in these regions, and they all had a similar morphology. A percutaneous liver biopsy showed only coagulative necrosis. Since the possibility of metastatic liver cancer could not be ruled out, laparoscopic partial hepatectomy was performed. Histopathological examination showed a solitary necrotic nodule in the liver. All intrahepatic lesions had the same morphology and were diagnosed as multiple liver necrotic nodules. There has been no sign of enlargement of the other lesions to date, four months after the surgery. In cases of multiple hepatic solitary necrotic nodules, differentiation from metastasis is extremely difficult. Laparoscopic hepatectomy was useful for the definitive diagnosis of multiple intrahepatic space occupying lesions.

A 68-year-old woman was found to have a 24-cm-diameter hepatic hemangioma in the left liver lobe and ventral side of the anterior segment. Laboratory examination showed a coagulation abnormality, and hepatic hemangioma complicated by Kasabach-Merritt syndrome (KMS) was diagnosed. The patient was referred to our department for liver resection. Hyperfibrinolytic type disseminated intravascular coagulation was diagnosed based on a prolonged bleeding time and increased concentrations of thrombin-antithrombin complex and plasmin-α2 plasmin inhibitor complex. Therefore, a continuous infusion of nafamostat mesylate was given as antifibrinolytic therapy in the perioperative period. Extended left hemi-hepatectomy under good bleeding control was performed compared with previously reported cases of hepatic hemangiomas in patients with KMS. No bleeding or thrombotic complications occurred postoperatively, and the patient was discharged from the hospital in good clinical condition. Therapeutic selection taking into account the disseminated intravascular coagulation classification based on the patient's fibrinolytic condition may be a new approach to reducing the bleeding risk in patients undergoing liver resection for hepatic hemangiomas complicated by KMS.

A 72-year-old woman was referred to our hospital for the treatment of hepatocellular carcinoma detected by screening. Abdominal dynamic computed tomography showed a hepatocellular carcinoma, 60 mm in diameter, located in the S1 Spiegel lobe of the liver in the vicinity of the inferior vena cava ligament, compressing the vena cava from the dorsal side. She had good liver functional reserve and underwent Spiegel lobectomy with left hemi-hepatectomy using the anterior transhepatic approach. Pathologically, the tumor was a simple nodular type of moderately differentiated hepatocellular carcinoma without vascular invasion, with a resection margin of 0 mm without tumor exposure. Two years and one month after the operation, she is alive without recurrence. A rare case of hepatocellular carcinoma on the dorsal side of the inferior vena cava is reported.

A 56-year-old man presented to our hospital complaining of right upper quadrant pain. An abdominal dynamic CT scan revealed a tumor in the right liver lobe measuring 84 mm in diameter and right portal vein branch thrombosis. AFP and PIVKA-II levels were also high, and the patient was diagnosed with hepatocellular carcinoma. Sorafenib treatment was started because Vp3 portal vein tumor thrombosis was associated. CT scan conducted 5 months after the initiation of sorafenib treatment showed that the tumor markedly shrank to 50 mm in diameter with no arterial enhancement, and portal vein thrombosis also shrank. Due to severe diarrhea, it became difficult to continue administration of sorafenib, and the patient was scheduled to receive right liver lobectomy and removal of the portal vein thrombosis. Intraoperative findings disclosed absence of the thrombosis so that only right liver lobectomy was performed. Pathological findings showed that the tumor cells in the main tumor and the peripheral portal vein were necrotic, and no viable tumor cells were observed. The patient is currently alive without recurrence as of 27 months after the surgery.

A 91-year-old woman presented to our hospital with difficulty moving and loss of consciousness. Although she did not complain of abdominal pain, laboratory tests indicated an ongoing inflammatory response with increased lactate levels. An enhanced abdominal computed tomography scan revealed an enlarged gallbladder that was incarcerated into the foramen of Morgagni. The diagnosis was gangrenous cholecystitis with incarceration into the foramen of Morgagni and an emergency open laparotomy was performed. During the operation, incarceration of the gallbladder into the foramen of Morgagni was observed. Surprisingly, the gallbladder was twisted at the neck and the serosal surface showed black discoloration. The gallbladder was removed and a cholecystectomy was performed. The hernial orifice was closed by suturing the foramen of Morgagni. The postoperative course was uneventful, and the patient was transferred to another hospital on postoperative day 21. Morgagni hernia is a relatively rare type of hernia, accounting for only 3% of diaphragmatic hernias. Incarceration of the gallbladder into the foramen of Morgagni is even more rare. We report a case of an elderly woman with a Morgagni hernia complicated by gallbladder torsion.

A 74-year-old man underwent subtotal stomach-preserving pancreaticoduodenectomy for extra-hepatic cholangiocarcinoma at our hospital. After surgery, the patient experienced vomiting and had a nasogastric tube inserted. Contrast-enhanced computed tomography revealed stenosis at the efferent loop (anal side) of the Braun anastomosis and the ileus in this area. Upper gastrointestinal endoscopy confirmed stenosis at the efferent loop (anal side) of the Braun anastomosis. We diagnosed an obstructed ileus via constriction at the Braun anastomosis, so the area underwent reoperation. Operative findings revealed an internal hernia in the efferent loop of the Braun anastomosis penetrating the mesenteric gap between the gastrojejunostomy and the Braun anastomosis. We released the jejunal loop from the mesenteric gap and sutured the gap closed. The patient was discharged 16 days after surgery with no postoperative complications. Six months after surgery, the patient had no abdominal symptoms and had a good appetite. Internal hernia in the mesenteric gap between a gastrojejunostomy and a Braun anastomosis after pancreaticoduodenectomy is rare. We present a case report and literature review.

A 73-year-old woman presented to our hospital with a perineal hernia that developed after laparoscopic abdominoperineal resection for rectal cancer. Abdominal computed tomography revealed a protrusion of the small intestine into the perineum. The patient underwent laparoscopic hernia repair using mesh. The hernial orifice was 8 cm × 5 cm. The mesh was sutured to the pelvic cavity in a fully circumferential fashion and tacked dorsally to the sacrum. It was then fixed with sutures via the transperineal approach. The hernia had not recurred at 22 months after repair.

A 55-year-old woman, who had undergone distal pancreatectomy and splenectomy through a Mercedes-type incision, presented to our department complaining of abdominal bulging 6 months after the operation. Computed tomography revealed an incisional hernia with a 5-cm fascial defect. Because the incisional hernia had grown 7 cm 1 year after surgery, the patient underwent posterior component separation with transversus abdominis muscle release and sublay synthetic mesh reinforcement. The patient had an uneventful postoperative course and was discharged on postoperative day 5. Posterior component separation seems safe and effective for repairing a complicative incisional hernia from a Mercedes-type incision.

A popliteal venous aneurysm is rare, but when found is often associated with pulmonary thromboembolism. The case of a 77-year-old man who was admitted to our hospital because of chest discomfort is presented. Echocardiography showed right heart overload, and contrast-enhanced computed tomography showed pulmonary thromboembolism and a right popliteal venous saccular aneurysm. A thrombus, approximately 30 mm in diameter, was also detected and appeared to be the cause of the pulmonary thromboembolism. After insertion of a temporary inferior vena cava filter, the patient underwent tangential aneurysmectomy with lateral venorrhaphy. On postoperative day 1, the popliteal vein was repaired with contralateral saphenous vein patches because of bleeding from the suture line. Today, 1 year after the operation, there has been no recurrence of either the pulmonary thromboembolism or the popliteal venous aneurysm. Because two-thirds of the popliteal venous aneurysms reported are saccular, tangential aneurysmectomy with lateral venorrhaphy is currently the most commonly performed procedure. In cases where it is difficult to complete resection of the diseased popliteal vein or to avoid venous constriction, vein patching should be used flexibly as an alternative reconstructive surgical procedure.