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症例は6歳，男児．急性虫垂炎に伴う汎発性腹膜炎と診断して緊急手術を施行したところ，虫垂に炎症所見はなく，回腸末端から15mm口側で小腸の腸間膜付着部が穿孔しており，回盲部切除術を施行した．切除標本を検索すると回腸の腸間膜付着部に径10mm大の嚢胞状病変があり，これが穿孔していた．嚢胞状病変は径2mmの小孔を介して回腸と交通していた．病理組織学的検査所見では，嚢胞状病変の内面は小腸粘膜で覆われ，壁には平滑筋層が存在し，正常の回腸と同様の構造を呈していたため重複腸管症と診断した．重複腸管症は比較的稀な疾患であり，穿孔の本邦報告例は17例のみである．

We experienced a case of advanced gastric cancer with a tumor embolus in the portal vein. A 74-year-old man was seen at another hospital because of abdominal distention and poor appetite. He was diagnosed as having a gastric cancer and referred to the hospital. After admission ultrasonography and computed tomography revealed a gastric cancer with a tumor embolus in the portal vein. Operative procedures included a total gastrectomy with excision of the body and tail of the pancreas and the spleen, embolectomy in the portal vein and cholecystectomy. The postoperative course was good, and the patient was discharged from the hospital on the 30th postoperative day. Gastric cancer with a tumor embolus in the portal vein is rare. Only 29 such cases have been reported in Japan. With a recent progression of imaging diagnosis, cases of the disease have been increasingly seen in the literature, but the majority of them are in an advanced stage with a poor prognosis. However, there is one case that had surfived more than 5 years following resection of the portal vein containing a tumor embolus. The successs of this case as well as our own suggests that prompt and intensive surgery might improve the prognosis of such patients.

We experienced a case of amputation neuroma at the common bild duct where a T-tube was inserted when cholecysectomy and choledochotomy drainage were carried out 3 years before. A 51-year-old man was admitted to the hospital because of general fatigue. On admission jaundice and tenderness at the epigastric region were confirmed. Close examination revealed an annular stricture of the bile duct. After a relief of obstructive janudice with PTCD, biopsy under PTCS disclosed no malignancy. An operation was performed with a diagnosis of benign bile duct stricture. Operative procedures included an excision of hte bile duct and Roux-en Y anastomosis. Histopathological examination of the excised specimen indicated a diagnosis of amputation neuroma. Biliary amputation neiromas are rare and only 45 cases including this case have been reported in Japan. Bile duct stricture due to amputation neuroma presents difficulty in differential diagnosis from cancers only by imagings. Biopsy under PTCS appears useful. All cases reported were operated on, however, non-surgical procedures such as ballon dilatation method and fistulization using a stent should be considered.

We encountered a case of malignant fibrous histiocytoma (MFH) originating in the retroperitoneal region, in which the tumor was surgically resected but pancreatic and pulmonary metastases occurred two years after the first operation, and the metastatic foci were resected. The patient was a 56-year-old woman whose course after retroperitoneal MFH resection had been followed up at the outpatient clinic. The patient began to complain of epigastralgia two years after the operation. Pancreatic and pulmonary metastases were detected on detailed examination, and the metastatic foci were resected simultaneously. The tumor was histopathologically diagnosed as metastatic malignant fibous histiocytoma. MFH originating in the retroperitoneal region is rarely accompanied by subjective symptoms, and is often detected as a huge mass. Accordingly, the incidence of local recurrence and metastasis is higher than MFH originating in other regions, resulting in a worse prognosis. Preferential sites of metastatic foci include the lung, liver and bone. Pancreatic metastasis, as observed in our patient, is extremely rare. Accessory therapies such as radiotherapy and chemotherapy have been performed more frequently, but no established therapy is available. Effects for early detection of the recurrence should be made through careful postoperative follow-up, in order to resect the metastatic foci in the earliest stage possible.

Total pelvic exenteration (TPE) is sometimes necessary for en-bloc resection of colorectal malignant tumors and adjacent organs which are invaded by tumors. We have applied TPE for 16 cases, and 11 cases out of 16 were for the primary site and the other 5 cases for recurrent site. As for the primary cases, more than 5 years survival is expected on condition that lymph node metastasis, invasion to the adjacent organs and remains of cancer are not recognaized histologically. As for the recurrent cases, although its prognosis is worse than the primary cases, relatively long survival is expected when recurrent site is detected more than 3 years after first operation. In the primary cases, distant metastasis often occurs after operation despite of low incidence of local recurrence. On the other hand not only distant metastasis but also local recurrence highly occurs in the recurrent cases.

This paper reports a pediatric case of left sided gallbladder presented with acute acalculous cholecys-titis. The patient was a 11-year-old male complaining of right upper abdominal pain and fever. High values of white blood cell count and CRP were recognized and a mass was palpable on his right upper abdomen. Ultrasonography reveaeld the findings of acute acalculous cholecystitis, and immediately percutaneous transhepatic cholecystodrainage was performed. The common bile duct was imaged at the right side of the fundus of the gallbladder by a drainage tube cholangiography. No abnormalities were found in the common bile duct. The pancreatic duct and gallbladder were invisible by ERCP. Considering of his young age, conservative therapy was started. But as soon as the drainage tube was clamped, abdominal pain and fever occurred. So cholecystectomy was performed. The operative findings indicated gangrenous cholecystitis. The cystic duct was occluded. The liver bed was found in the left to Ligamentum teres hepatis and the gallbladder located on the lateral segment. Generally speaking, the most left sided gallbladders are incidentally found during the operation for another disease. As for this case, the left sided gallbladder itself probably caused the occlusion of the cystic duct because of its unnatural run.