Surgical Case Reports

Immune Thrombocytopenia Successfully Controlled by Dissection of an Enlarged Mediastinal Lymph Node Metastasis from Squamous Cell Carcinoma of Unknown Primary: A Case Report

Yoshihito Iijima. et al

INTRODUCTION: Immune thrombocytopenia (ITP) is an autoimmune hematologic disorder characterized by a reduced platelet count resulting from immune-mediated platelet destruction and/or impaired thrombopoiesis. This condition is often associated with malignant tumors, making perioperative management crucial to maintain hemostasis during and after surgery. Herein, we report a case of ITP successfully controlled following surgical dissection of a large mediastinal lymph node metastasis originating from squamous cell carcinoma of unknown primary.

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Two Cases of Inguinal Hernia after Kidney Transplantation Treated with Transabdominal Preperitoneal

Hitomi Zotani, et al.

INTRODUCTION: The Lichtenstein procedure is often selected for kidney transplantation (KT) recipients due to concerns about the risk of injury to the transplanted organ. However, there have been reports of complications such as ureteral obstruction in cases where the Lichtenstein procedure was performed; therefore, safer techniques and approaches must be selected. We herein report 2 cases of inguinal hernia on the transplant side after KT that were treated with laparoscopic hernia repair (transabdominal preperitoneal [TAPP]) following a careful preoperative assessment.

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A Case of Multiple Metastases in the Gastric Wall Due to Needle Tract Seeding after Endoscopic Ultrasound-Guided Tissue Acquisition for Pancreatic Tail Cancer

Kazuhiro Takami, et al.

INTRODUCTION: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is widely used for the diagnosis of pancreatic cancer, other pancreatic tumors, and autoimmune pancreatitis. Among the adverse events, needle tract seeding (NTS) is the most concerning. NTS is a phenomenon in which tumor cells are observed at the site of biopsy needle passage. We herein report a case of multiple gastric wall recurrences resulting from NTS after laparoscopic distal pancreatectomy for pancreatic tail cancer.

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Conversion Surgery for Advanced Gastric Cancer with Para-Aortic Lymph Node Metastases Following Treatment with Capecitabine, Oxaliplatin, and Pembrolizumab: A Case Report

Takuya Ono, et al.

INTRODUCTION: Immune checkpoint inhibitors (ICIs) have recently emerged as an important treatment option for various cancers. In 2024, pembrolizumab was approved as a first-line treatment for unresectable or recurrent gastric cancer. Conversion surgery following ICI-based chemotherapy has been reported; however, cases involving pembrolizumab-based first-line therapy remain rare. Here, we report a case of conversion surgery after treatment with capecitabine plus oxaliplatin (CAPOX), combined with pembrolizumab for unresectable advanced gastric cancer.

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Successful Conversion Surgery after Zolbetuximab-Based Chemotherapy for Claudin 18.2-Positive Gastric Cancer with Peritoneal Dissemination and Cervical Lymph Node Metastasis: A Case Report

Sadaki Shirao, et al.

INTRODUCTION: Zolbetuximab, a monoclonal antibody targeting claudin (CLDN) 18.2, has been approved as a first-line treatment for patients with human epidermal growth factor receptor 2 (HER2)-negative and CLDN-positive advanced gastric cancer. Conversion surgery following chemotherapy has emerged as a promising strategy for improving outcomes in patients with stage IV gastric cancer. Herein, we report a case of CLDN-positive gastric cancer with peritoneal dissemination and cervical lymph node metastasis that was successfully treated with subtotal gastrectomy (sTG) following zolbetuximab-based chemotherapy.

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Successful Surgical Treatment of Hemosuccus Pancreaticus Caused by Rupture of a Transverse Pancreatic Artery Aneurysm: A Case Report

Ayaka Ogura, et al.

INTRODUCTION: A pancreatic pseudoaneurysm is a rare but potentially life-threatening complication of pancreatitis. Although pseudoaneurysms typically arise from the splenic, gastroduodenal, or pancreaticoduodenal arteries, transverse pancreatic artery involvement is uncommon. Here, we report the case of a pseudoaneurysm in the transverse pancreatic artery that presented with repeated episodes of obscure gastrointestinal bleeding over an extended period, with a clinical course suggestive of pancreatic duct rupture.

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Surgical Management of Sigmoid Volvulus: A Retrospective Review of Six Cases with a Focus on the Sharon Operation

Keisuke Inoue, et al

INTRODUCTION: Sigmoid volvulus is a clinically significant cause of large bowel obstruction that occurs particularly in older patients with a reduced physical function. Although endoscopic detorsion is the first-line treatment, volvulus recurrence is common and often requires elective surgery. Despite various reports on the surgical procedures, the optimal approach remains controversial. The Sharon operation, first introduced in 1985, is a minimally invasive technique that avoids mobilization of the sigmoid colon via a small incision in the left lower quadrant. Although it offers several advantages, such as shorter operative time, minimal invasiveness, and favorable clinical outcomes, it remains underutilized, especially in Japan. We evaluated the clinical utility and indications of the Sharon operation in high-risk patients with recurrent sigmoid volvulus

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Successful Primary Closure of Cricotracheostomy Fistula after Cardiac Surgery: Usefulness of Cricotracheostomy in Post-Sternotomy

Mitsunobu Toyosaki, et al.

INTRODUCTION: Patients with complications requiring prolonged mechanical ventilation after cardiac surgery may need a tracheostomy. However, a high rate of sternal wound infection (SWI) after tracheostomy is concerning. Cricotracheostomy is a novel method used to achieve a higher tracheal incision than that using conventional surgical tracheostomy and is often performed by otolaryngologists in patients with anatomical abnormalities. However, it may affect speech and is generally recommended only in cases where tracheal stoma closure is not considered. In addition, its usefulness after cardiac surgery has not been fully verified.

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Tumor Mutational Burden–High Intrahepatic Cholangiocarcinoma Presenting with Solitary Brain Metastasis: A Case of Precision Oncology

Takahiro Maehata, et al.

INTRODUCTION: Brain metastasis from intrahepatic cholangiocarcinoma (ICC) is a rare condition with a poor prognosis, and no standard treatment has been established. This report aims to present a case of solitary ICC brain metastasis successfully treated with a multimodal approach guided by comprehensive genomic profiling (CGP).

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A Case of Pathological Complete Response after “Conversion Surgery” for Initially Unresectable Locally Advanced Intrahepatic Cholangiocarcinoma

Yasunori Shirakawa, et al.

INTRODUCTION: Intrahepatic cholangiocarcinoma (iCCA) is the second most common liver cancer and has a poor prognosis. Given the recent advancements in drug therapy, the topic of so-called “conversion surgery” in biliary tract cancer, including iCCA, is evolving; however, only a few cases have been reported.

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A Case of Pleomorphic-Type Anaplastic Carcinoma of the Pancreas with Rapidly Progressive and Fatal Cardiac Metastasis

Keiichi Shigematsu, et al.

INTRODUCTION: Cardiac metastasis from pancreatic ductal adenocarcinoma (PDAC) is extremely rare. Pleomorphic-type anaplastic carcinoma of the pancreas (PACP) is an uncommon, highly aggressive PDAC variant with lymphatic and hematogenous spread and poor prognosis. We report, to our knowledge, the first PACP case with antemortem diagnosis of cardiac metastasis and a rapidly fatal course.

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Infective Endocarditis due to Esophageal Squamous Cell Carcinoma Invasion of the Left Atrium: A Case Report

Takeru Nakamura, et al.

INTRODUCTION: Esophageal cancer is often diagnosed at an advanced stage and with distant metastases. While cardiac metastases from solid tumors have been reported in 0.2%–6.5% of postmortem cases, solitary cardiac metastases remain exceedingly rare. Infective endocarditis, a life-threatening condition typically associated with valvular involvement and bacteremia, has not been widely associated with cardiac metastases. Here, we present an extremely rare case of esophageal squamous cell carcinoma directly invading the left atrium during chemotherapy, which was further complicated by infective endocarditis.

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