Surgical Case Reports

Pancreatoduodenectomy for Pancreatic Cancer after Prior Modified Puestow Procedure: A Case Report

Yuiko Nagasawa, et al.

INTRODUCTION: Chronic pancreatitis is a known risk factor for pancreatic cancer and may develop over the course of long-term disease management. When a pancreatectomy is required following pancreatic duct decompression surgery, careful consideration of the surgical approach is necessary due to altered anatomy. This study reports a case of pancreatoduodenectomy for intraductal papillary mucinous carcinoma after the modified Puestow procedure.

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Real-Time Full-Color Overlay Indocyanine Green Navigation for Laparoscopic Deroofing of Liver Cysts

Koya Yoshida, et al.

INTRODUCTION: Laparoscopic deroofing is the standard treatment for symptomatic liver cysts. Indocyanine green (ICG) fluorescence imaging has been effectively used to delineate the boundary between cysts and liver parenchyma; however, intermittent switching between fluorescence and normal light modes is time-consuming and requires memorizing the cutting lines along a curved surface, which can be burdensome during surgery.

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Successful Sphincter-Preserving Resection of a Giant Rectal Schwannoma Using Transanal Total Mesorectal Excision: A Case Report

Mamoru Miyasaka, et al.

INTRODUCTION: Rectal schwannomas are rare, accounting for less than 10% of all gastrointestinal schwannomas. When they are large and located in the lower rectum, achieving complete resection while preserving sphincter function can be technically challenging. Transanal total mesorectal excision (TaTME) provides an enhanced view of the deep pelvis and facilitates precise dissection around the anorectal junction. We report a case of a giant rectal schwannoma that was successfully resected with anal preservation using TaTME.

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Ascitic Fluid Cytology Provides Diagnostic Clues in a Case of Gastric Metastasis from Invasive Lobular Carcinoma of the Breast

Takashi Matsutani, et al.

INTRODUCTION: Breast cancer metastasis to the gastrointestinal tract is rare, and invasive lobular carcinoma (ILC) shows a higher propensity for dissemination than invasive ductal carcinoma. Accurate diagnosis is often challenging because of nonspecific clinical and pathological findings.

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Catastrophic Esophageal Tumor Perforation within One Week after First-Line Chemo-Immunotherapy for Advanced Esophageal Squamous Cell Carcinoma: A Case Report

Takeshi Matsubara, et al.

INTRODUCTION: Esophageal perforation secondary to advanced esophageal squamous cell carcinoma (ESCC) is a life-threatening oncologic emergency that can rapidly progress to mediastinitis, empyema, and septic shock. With the increasing use of first-line chemo-immunotherapy, early tumor necrosis—particularly in ulcerated or deeply invasive lesions—may precipitate catastrophic perforation.

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A Case of Epstein-Barr Virus–Associated Transplanted Kidney Post-Transplant Lymphoproliferative Disorder Complicated by Hemophagocytic Lymphohistiocytosis, Six Years after Transplantation

Takato Waseda, et al.

INTRODUCTION: We present a case of acute kidney failure due to post-transplant lymphoproliferative disorder (PTLD) in the transplanted kidney 6 years after transplantation. Epstein–Barr virus (EBV) infection was identified as the likely trigger, and reducing immunosuppression was sufficient to resolve both inflammation and renal failure.

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Improvement of Steroid-Dependent Encephalopathy Clinically Diagnosed as Paraneoplastic Neurological Syndrome in Onconeural Antibody-Negative Sigmoid Colon Cancer after Laparoscopic Tumor Resection

Susumu Inamoto, et al.

INTRODUCTION: Paraneoplastic neurological syndrome (PNS) is a rare complication of malignancy caused by immune-mediated mechanisms. Although characteristic onconeural antibodies are useful for the diagnosis of PNS, 30%–40% of cases are seronegative, which makes recognition difficult. We present a case of sigmoid colon cancer complicated by onconeural autoantibody-negative PNS which caused impaired consciousness. The patient’s symptoms recurred with steroid tapering but improved after resection of the primary tumor and radiofrequency ablation (RFA) of the metastasis. This case highlights the importance of considering PNS, even when onconeural antibodies are negative.

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Small Bowel Obstruction Caused by Meckel’s Diverticulum Entrapped behind Transperitoneal Sigmoid Colostomy: A Case Report

Hidenobu Nakagama, et al.

INTRODUCTION: Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract, often asymptomatic but occasionally causing inflammation, bleeding, or intestinal obstruction. Permanent colostomy after abdominoperineal resection (APR) is typically created via either a transperitoneal or extraperitoneal route. Although small bowel obstruction (SBO) is a known complication of transperitoneal colostomy, SBO caused by Meckel’s diverticulum entrapped behind the stoma has not previously been reported. We describe an extremely rare case of SBO caused by adhesion between Meckel’s diverticulum and the sigmoid colon at the stoma site.

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Complete Resection of a Giant Hypervascular Pelvic Floor Solitary Fibrous Tumor Using Intraoperative Balloon Occlusion and Staged Open Abdomen Management: A Case Report

Masahiro Hashimoto, et al.

INTRODUCTION: Solitary fibrous tumors (SFTs) are rare fibroblastic neoplasms that can occur at various anatomical sites, including the pleura, retroperitoneum, and pelvis. Although surgical resection remains the mainstay of curative treatment, pelvic SFTs often present as giant hypervascular tumors, making intraoperative bleeding control particularly challenging.

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Bimanual Use of Articulating Laparoscopic Instruments (ArtiSential) in Pediatric Surgery: A Report of Three Cases

Yushi Kaisyakuji, et al.

INTRODUCTION: Articulating laparoscopic instruments such as ArtiSential have been developed to overcome the limited range of motion associated with conventional straight instruments, particularly in narrow operative fields. While robot-assisted surgery provides highly precise manipulation, its introduction in pediatric surgery remains limited due to high cost and restricted insurance coverage. We introduced bimanual use of ArtiSential in pediatric minimally invasive surgery as a potential alternative to robotic assistance and evaluated its feasibility and technical advantages.

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A Case of Acquired Hemophilia A Following Robot-Assisted Minimally Invasive Esophagectomy

Shota Eguchi, et al.

INTRODUCTION: Acquired hemophilia A (AHA) is a rare but potentially fatal bleeding disorder that arises suddenly in individuals without a prior history of bleeding tendency. It is often associated with malignant disease and can present with severe hemorrhagic complications. Reports of AHA occurring in the postoperative course of esophageal cancer surgery are extremely limited, and the safety of immune checkpoint inhibitors (ICIs) in patients with a history of AHA remains uncertain. This case highlights both the diagnostic and therapeutic challenges of AHA and provides novel insight into the safe administration of ICIs in a patient with recurrent esophageal cancer following remission of AHA.

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A Rare Case of Mucinous Carcinoma Arising in Association with an Intraductal Papilloma

Haruka Yamasaki, et al.

INTRODUCTION: Intraductal papilloma (IDP) is a benign breast lesion that accounts for 3%–6% of core biopsy diagnoses. It is considered a high-risk precursor due to its association with atypia, ductal carcinoma in situ, and invasive carcinoma. Although IDP-NOS (not otherwise specified) rarely progresses to invasive cancer, IDP with atypia carries a higher risk of malignant transformation.

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