[A Case of Repeated Bowel Obstruction Due to Diaphragmatic Hernia after Surgery for Esophagogastric Junction Cancer].

The patient was a 79-year-old man who underwent robot-assisted gastrectomy for esophagogastric junction cancer. pT4aN1M0, pStage ⅢA. Nine months after surgery, he had emergency visit to the hospital due to abdominal pain and vomiting, and contrast CT scan showed a small intestine with poor contrast effect above the left diaphragm. He was diagnosed as a diaphragmatic hernia with small intestinal strangulation and underwent emergency surgery. Under laparotomy, 2 fb hernia orifice were observed on the ventral side of the esophageal hiatus, and a 50 cm jejunum was incarcerated and became necrotic. A partial jejunectomy was performed, and the esophageal hiatus was closed by suturing the stomach with 3-0 absorbable suture. He was discharged from the hospital with good postoperative course. But one month after the operation, the patient was seen in the hospital again with abdominal pain. Under laparotomy, it was found that one suture was dropped off the esophageal hiatus at the previous surgery, and a 100 cm jejunum was incarcerated, which was not necrotic. The hiatal hernia was closed by suturing the stomach and the hiatal hernia with 3-0 non-absorbable suture. Diaphragmatic hernia is a rare late complication of esophagogastric junction cancer.

[A Resected Case of Gallbladder Neuroendocrine Cancer Found as a Liver Mass].

Our patient was a 72-year-old man in whom a liver mass was identified on abdominal ultrasonography at the examination for which he was referred to our hospital. Contrast-enhanced CT showed that the liver mass was a hemangioma with a surrounding AP shunt. Gallbladder wall thickening could not be ruled out as gallbladder cancer; however, a high possibility of adenomyomatosis was considered. EOB-MRI determined that the gallbladder wall thickening was adenomyomatosis and liver mass was a metastatic malignant tumor of unknown primary origin. Our policy was to resect gallbladder adenomyomatosis and the liver tumor for diagnostic purposes. Cholecystectomy plus hepatic S4a subsegmental resection and hepatoduodenal mesenteric lymph node dissection were performed. The histopathological diagnosis was neuroendocrine cancer of the gallbladder. A similar histology of the liver mass suggested continuity from the gallbladder tumor and was considered direct infiltration. Fifteen months after the operation, no recurrence was observed.

[A Case of Rapidly Progressing Colon NEC Treated with Laparoscopic Colectomy and Completely Cured].

We experienced a case of rapidly progressing transverse colon NEC that was treated with laparoscopic right hemispherectomy. A 72-year-old man underwent a follow-up lower gastrointestinal endoscopy at another hospital after a polyp resection. The examination showed a surrounding mass with stenosis of the intestinal tract of the transverse colon. A biopsy led to a diagnosis of poorly differentiated adenocarcinoma. A laparoscopic right hemicolectomy was performed of the transverse colon tumor. He was discharged on postoperative day 13 without complications, and NEC was diagnosed. We decided to administer postoperative adjuvant chemotherapy, starting with cisplatin plus etoposide. Four courses of postoperative adjuvant chemotherapy were completed. Approximately 1 year has passed since the operation, and progress has been observed in the outpatient department without recurrence.

Fever of unknown origin following parathyroidectomy prior to onset of typical polymyalgia rheumatica symptoms: a case report.

Polymyalgia rheumatica (PMR) is a disease commonly seen in elderly individuals, however, the etiology has not been reported. Typical clinical features include bilateral shoulder pain and morning stiffness, while serologic autoantibody test findings are negative. Approximately 40%-50% of affected patients present with low-grade fever, fatigue, and appetite loss, which we often experience in the field of general medicine, and thus, the condition should not be given low priority. However, knowledge regarding such constitutional manifestations is also limited. We encountered an elderly woman with a fever of unknown origin that developed following a parathyroidectomy for a single parathyroid adenoma, after which severe shoulder pain and morning stiffness emerged, leading to a diagnosis of PMR. The fever developed several days prior to appearance of severe pain, which is an uncommon presentation in PMR cases. Our patient had low-grade inflammation without pyrexia prior to the surgery, which might have been an important reason for the accelerated immoderate immune activation leading to PMR induced by surgery in this case. Furthermore, she was infected with the influenza A virus 3 weeks before coming to us. Some reports have suggested a relationship between the influenza virus or vaccine and PMR. It is difficult to conclude regarding the definite trigger in our patient, though the details of this case should be helpful for a better understanding of the disease.