[A Case of Internal Hernia into a Reconstructed Pelvic Floor and Torsion of Jejunum near the Treitz Ligament after Laparoscopic Abdominoperineal Resection].

A 50s women underwent laparoscopic abdominoperineal resection(APR)for rectal cancer. Laparotomy was performed on the 8th postoperative day because of intestinal obstruction. An internal hernia was observed at the pelvic floor and the hernia orifice was found at the retroperitoneum that was sutured in the initial operation. On the other hand, the jejunum near the Treitz ligament was twisted, resulting in ischemic necrosis. The reason of the internal hernia is considered that a suction drain placed during the initial operation may have caused the rupture of the fragile part of the sutured peritoneum. Furthermore, increase of intra-abdominal pressure due to the internal hernia may have exacerbated the torsion of the jejunum near the Treitz ligament. This is probably due to the failure to the adequate reposition of the small intestine at the end of the initial operation. There is no consensus of the need for retroperitoneal sutures for APR. Currently, we only spray anti-adhesion agents on the pelvic floor without retroperitoneal reconstruction. Although the mobilization of small intestine is important to provide a good operative view in laparoscopic colorectal surgery, it is also important to confirm the reposition of the small intestine at the end of surgery.

[Long-Term Disease-Free Survival after Chemoradiotherapy for Postoperative Local Recurrence of Rectal Cancer-A Case Report].

We report a case of a 63-year-old man with a perirectal abscess due to rectal cancer referred to us from another clinic. We performed 3 courses of preoperative chemotherapy using mFOLFOX6 and then performed a Miles operation plus D3 dissection followed by reconstruction of an artificial anus using the ileum. The pathological diagnosis was tub2, pAI(prostate), pN0 (0/12), ND(v+), and fStage Ⅲa. Dehiscence of the perineum wound area occurred 4 months after surgery, for which drainage was required. Local recurrence was then discovered by cytology. We administered mild 40 Gy radiation and chemotherapy using Bmab combined with mFOLFOX6. CT scans showed a significant reduction in the tumor and the tumor marker levels returned to within normal ranges. We then converted to Pmab plus FOLFIRI, which has been administered bimonthly for 3 years to date. The overall chemoradiotherapy duration has been about 5 years. Follow-up imaging findings continue to show sustained remission.

[Two Cases of Surgery Combined with Intraoperative Radiofrequency Ablation for Colorectal Cancer and Synchronous Liver Metastases].

The therapeutic management of simultaneous liver metastasis of colorectal cancer(SCRLM)remains controversial. Although hepatic metastasectomy is the first choice for resectable liver metastasis of colorectal cancer, radiofrequency ablation (RFA)is one of the least invasive application for patients who refuse more invasive treatment such as hepatectomy and longterm systemic chemotherapy or for whom such treatment is not suitable. We report 2 cases of SCRLM treated by surgery combined with intraoperative RFA and adjuvant chemotherapy, raising the possibility of local control in the liver for selected patients.