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Carcinoma of unknown primary (CUP) is known to have a poor prognosis with limited treatment options. Here, we report a rare case of a patient who was diagnosed with CUP with perigastric lymph node metastasis. Our patient was a woman in her 60s who was admitted to another hospital with cholangitis. On computed tomography, a solitary swollen lymph node beside the cardia was seen. On follow up after a year and a half, the lymph node seemed to have increased in size, and the patient was referred to our hospital for further scrutiny. Endoscopic ultrasound-guided fine needle aspiration of the lymph node was performed and squamous cell carcinoma was detected histopathologically. Despite further examination, the primary site remained undetectable. Since there was no other metastatic site, a planned laparoscopic dissection of the perigastric metastatic lymph node was carried out successfully. At thirty months after surgery, there was no sign of any recurrence and the primary site still remained unknown.

A 19-year-old woman who had undergone ventriculo-peritoneal (V-P) shunt surgery for Arnold-Chiari malformation type II as a newborn was taken by ambulance to our hospital due to disturbance of consciousness. Bacterial contamination of the cerebrospinal fluid was found, and Computed Tomography (CT) of the abdomen showed that the V-P shunt tube had penetrated the transverse colon and the descending colon. Head CT scan showed hydrocephalus, but it did not get worse than previous CT imaging. An emergency operation was performed and laparoscopic exploration revealed penetration of the peritoneal shunt tube, which was totally covered by fibrous tissue from the fistula, into the transverse colon. No gastrointestinal leakage or contamination of the abdominal space was found, so we removed the peritoneal shunt tube and ligated the fistula in the subcutaneous layer. Colon penetration by a V-P shunt tube is rare, and in this case, laparoscopic procedure was performed safely. This indicates that laparoscopic procedure is one of the useful technique for the treatment of V-P shunt trouble other than open procedure. Furthermore, laparoscopic procedure also reduces risk of accidental organ injury during operation and intra-abdominal adhesion after operation. It is also useful to ligate and dissect the fistula in the subcutaneous layer. Because if the fistula closure is defective, the abscess will occur only in the subcutaneous layer and infectional peritonitis can be avoided.

A 19-year-old woman who had undergone ventriculo-peritoneal (V-P) shunt surgery for Arnold-Chiari malformation type II as a newborn was taken by ambulance to our hospital due to disturbance of consciousness. Bacterial contamination of the cerebrospinal fluid was found, and Computed Tomography (CT) of the abdomen showed that the V-P shunt tube had penetrated the transverse colon and the descending colon. Head CT scan showed hydrocephalus, but it did not get worse than previous CT imaging. An emergency operation was performed and laparoscopic exploration revealed penetration of the peritoneal shunt tube, which was totally covered by fibrous tissue from the fistula, into the transverse colon. No gastrointestinal leakage or contamination of the abdominal space was found, so we removed the peritoneal shunt tube and ligated the fistula in the subcutaneous layer.\nColon penetration by a V-P shunt tube is rare, and in this case, laparoscopic procedure was performed safely. This indicates that laparoscopic procedure is one of the useful technique for the treatment of V-P shunt trouble other than open procedure. Furthermore, laparoscopic procedure also reduces risk of accidental organ injury during operation and intra-abdominal adhesion after operation.\nIt is also useful to ligate and dissect the fistula in the subcutaneous layer. Because if the fistula closure is defective, the abscess will occur only in the subcutaneous layer and infectional peritonitis can be avoided., 論文