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Case presentation: The patient was a 72-year-old man who consulted with his previous physician for chief complaints of palpitations, fatigue, and blackish feces persisting for 1 month. After confirming the presence of anemia, the patient was referred to our hospital. Blood test findings upon hospital arrival revealed a hemoglobin (Hb) level of 6.0 g/dL. Computed tomography revealed a tumor of 32 mm x 30 mm with a low-density area extending from the bulb to the second part of the duodenum. Magnetic resonance imaging revealed high signal intensity on T1- and T2-weighted imaging and low signal intensity on fat-suppressed T2-weighted imaging, findings consistent with lipoma. Upper gastrointestinal endoscopy revealed a yellowish submucosal tumor that had perforated into the intestinal tract from the external wall extending from the upper corner to the second part of the duodenum. After determining that the tumor was sessile, laparoscopic partial duodenectomy with Roux-en-Y reconstruction was planned and performed. Pathology revealed a yellowish tumor 4 cm x 4 cm in size extending from the pyloric area to the duodenal bulb arising from the tunica muscularis. The present case report details our experience involving a patient who underwent surgical resection for hemorrhagic duodenal lipoma. [ABSTRACT FROM AUTHOR]

Background: Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a non-tumorous benign lesion that originates in the spleen and It is rare., Case Presentation: A 59-year-old man visited his physician for a checkup. Ultrasonography showed a mass in the spleen, and the patient was referred to our hospital. He tested negative for tumor markers and soluble interleukin-2 receptor (sIL-2R). Abdominal computed tomography revealed a 51-mm hypovascular mass that was slowly enhanced from the portal venous to the equilibrium phases, at the inferior extremity of the spleen. Abdominal magnetic resonance imaging showed a spoke-wheel pattern. Fluorodeoxyglucose positron emission tomography indicated a mild tumor accumulation, with a standardized uptake value max of 5.3. These results led to the suspicion of SANT, angioma, and angiosarcoma. Because the onset of malignant diseases could not be excluded, laparoscopic splenectomy was performed. A brown, round mass, without a capsule but with clear boundaries, was macroscopically observed on the cut surface. In addition, white fibrosis was found in the mass. Histopathological examination revealed nodular angioma lesions, and the proliferation of fibrotic interstices and inflammatory cells was observed between the lesions. Immunohistological examination revealed proliferation in the 3 types of narrow capillaries inside angiomatoid nodules;CD31+/CD34+/CD8-, CD31+/CD34-/CD8+, and CD31+/CD34-/CD8- cells; therefore, the patient was diagnosed with SANT., Conclusions: Here, we reported one patient who developed the typical symptoms of SANT. SANT is easily diagnosed by histopathological examination; however, its causes remain unknown. More cases with SANT are required for further analysis.

A 67-year-old woman presented with a chief complaint of umbilical region mass and epigastric pain. Carbohydrate antigen 19-9 (CA19-9) level was 177.5 U/mL; computed tomography (CT) showed a hypovascular mass lesion of 20 mm × 20 mm in the pancreas, infiltration into the superior mesenteric artery and dilation of the main pancreatic duct. Peritoneal dissemination to the omentum and abdominal wall was observed. The patient was diagnosed with T4N0M1, cStage IV unresectable pancreatic body cancer and was started on GEM + nab-PTX therapy. She underwent chemotherapy for 10 months for a total of 10 cycles. The CA19-9 level returned to normal, CT showed reduction in tumor size to 11 mm × 8 mm, and peritoneal dissemination also disappeared. Disappearance of peritoneal dissemination was also observed on Positron emission tomography (PET). Laparoscopic surgery was planned, and rapid pathological examination results of ascites washing cytology and peritoneal mass were negative. Laparoscopic distal pancreatectomy was then performed, which transitioned to hand-assisted laparoscopic surgery; R0 resection was achieved. The patient underwent outpatient postoperative adjuvant chemotherapy with orally administered S-1 and has been recurrence-free for 1 year postoperatively. This case demonstrates that patients with pancreatic body cancer with distant metastasis can undergo R0 resection following GEM + nab-PTX combination therapy.

We present two cases of intestinal obstruction due to intersigmoid hernia that were diagnosed and treated laparoscopically. The first case was a 42-year-old woman with no surgical history. She was treated conservatively with the insertion of an ileus tube. Although the intestinal obstruction improved temporarily, since it subsequently worsened, laparoscopic surgery was performed, which revealed incarceration of the ileum in the intersigmoid fossa. Although there were no signs of necrosis after intestinal release, partial resection of the small bowel was performed before the hernial orifice was closed due to the evidence of serous damage. The second case was a 53-year-old man with no surgical history. An ileus tube was inserted for intestinal decompression, following which laparoscopic surgery was performed. Operative findings revealed incarceration of the ileum in the intersigmoid fossa, and, since there were no signs of necrosis after intestinal release, the hernial orifice was closed without performing intestinal resection. This condition is a good indication for laparoscopic surgery, given that intestinal necrosis is frequently absent and the operation can usually be completed simply by release of the incarcerated intestine and closure of the hernia orifice. Intersigmoid hernia should be suspected in cases of intestinal obstruction with no surgical history.