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Highlights • Laparoscopy was helpful for the unusual inguinal hernia with cryptorchidism. • The resected ectopic testis in elderly man contained a Leydig cell tumor. • Cryptorchidism may predispose to the development of a Leydig cell tumor. • The resected ectopic testis should be thoroughly examined., Introduction Cryptorchidism is common in children but is rare in the elderly. It often presents with a constellation of signs and symptoms similar to routine inguinal hernias. We present the case of an elderly man with cryptorchidism containing a Leydig cell tumor and provide clinical insights. Presentation of case An-84-year old man was admitted with an incarcerated right lower quadrant hernia. Both testes were absent on palpation of the scrotum. After reduction of the hernia, computed tomography scan revealed a round lesion in the hernia sac, which was suspected to be the ectopic testis. Laparoscopic exploration was performed in combination with an open anterior approach. The hernia orifice was the right internal inguinal ring, and the inguinal canal was obliterated by adhesions because the spermatic cord did not pass through it. The ectopic testis was resected with the hernia sac, and the hernia repaired with a KUGEL™ patch (Bard, USA). Discussion Laparoscopic exploration was useful to delineate the anatomy of this unusual inguinal hernia. The open anterior approach was necessary to dissect the ectopic testis and the hernia sac. Pathological findings revealed tumor cells with clear cytoplasm in the resected testis, diagnosed as a Leydig cell tumor. Conclusion The combination of laparoscopic and anterior approaches facilitated the surgical treatment of an unusual inguinal hernia with cryptorchidism. The resected ectopic testis should undergo thorough histopathologic examination.

A 50-year old male patient chose to have elective surgery for obstructive rectal cancer. Before undergoing surgery, he had a self-expandable metallic stent (SEMS) placed to relieve a colonic obstruction. He was discharged from our hospital after the elective surgery without surgical complications. In our outpatient clinic, he was prescribed UFT/LV for adjuvant chemotherapy. Eight months after surgery, he came back to the hospital complaining of abdominal distension, abdominal pain and constipation. A diagnosis of local recurrence of rectal cancer, peritoneal metastasis and metastatic liver cancer was confirmed. He was admitted to have the bowel obstruction relieved by having a SEMS placed. The procedure was successful in relieving the bowel obstruction and the patient began FOLFIRI plus bevacizumab as chemotherapy. Through this case, we were able to see that SEMS placement can circumvent emergency surgery and prevent the formation of a stoma by relieving a colonic obstruction. A SEMS placement can also lead to positive benefits such as faster treatment and therapy for palliative cases.

Highlights • Endoscopy is necessary for management of gastric volvulus. • Endoscopic reduction is effective as first aid for gastric volvulus. • Endoscopic gastropexy is available for gastric volvulus in elderly patients. • Laparoscopic gastropexy can be an alternative to hernia repair in poor condition., Introduction Gastric volvulus is torsion of the stomach and requires immediate treatment. The optimal treatment strategy for patients with gastric volvulus is not established, because of significant variations in the cause and clinical course of this condition. Presentation of cases We describe our experience with six elderly patients with gastric volvulus caused by different conditions using various approaches. This includes two patients managed with endoscopic reduction, followed by endoscopic or laparoscopic gastropexy. Discussion Endoscopy is a necessary first step to determine the optimal treatment strategy, and endoscopic reduction is often effective. The indications for surgical repair of gastric volvulus depend on the patient’s overall condition, and several options are available. In some elderly patients with severe comorbidities, major surgery may have an unacceptably high risk. We propose a novel treatment strategy for gastric volvulus in the elderly and a review of the literature. Conclusion Early endoscopy is necessary in patients with gastric volvulus. Endoscopic or laparoscopic gastropexy may be adequate therapy in selected elderly patients.