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So far we are obliged to perform colostomy temporarily for rectal stenosis due to Schnitzler metastasis from gastric cancer. This time we were able to manage a case of the disease by placement of an expandable metallic stent (EMS).A 64-year-old woman who had been followed clinical course after the operation for gastric cancer was admitted to the hospital because of abdominal distension and general fatigue. Intestinal obstruction due to rectal stenosis was suspected. Fluoroscopy of the rectum revealed a stenosis at the RS of the rectum. One year and 4 months after the operation, an EMS was placed at the same site. Thereafter gradual symptomatic remission was attained. The patient started to eat and was discharged from the hospital.This EMS method can be easily and safely performed and appears to be very helpful to improve the quality of the patient.

A 59-year-old male developed a cutaneous fistula in the right iliac region. Barium enema and computed tomography revealed that this fistula was originated from a retroperitoneal abscess due to penetration of an advanced cancer of the ascending colon. Extended radical operation comprising of right hemicolectomy with partial resection of the right abdominal wall and reconstruction with recto-abdominal musculo-cutaneous flap was performed. Postoperative clinical course was uneventful, and the patient restored a good QOL (quality of life) and acceptable social activity. In general, colonic cancer is biologically characterized by local growth rather than distant metastasis except in the late stage. There have been many reports which describe a good prognosis on the cases of colonic cancer undergoing the extended resection. Consequently, we should consider to indicate the extended radical operation, for the advanced colonic cancer with invasion to the other organs, if the tumor still remains locally. In this paper, we present a case of advanced colonic cancer with a cutaneous fistula and also discuss the usefulness of the extended radical operation against the advanced colonic cancer with a review of the literature.

A case of gangrenous type ischemic colitis is described. The patient was a 48-year-old woman. There was a previous history of undergoing abdominal surgery three times. After the constipation for 5 days, abdominal pain with rebound tenderness, diarrhea and bloody stool was observed. CT scan revealed a remarkable thickening of the colon, and signs of in flammation continued. Left hemicolectomy was performed. Although the mortality of gangrenous type ischemic colotis is high, the immediate operation successfully saved the life of this patient. In case of gangrenous type of ischemic colitis, early diagnosis and immediate surgery should be performed.

A case of cancer of the colon associated with retrocaval ureter is reported. The case was a 47-year-old male who had a 7 cm colon cancer at the hepatic flexure of the transverse colon. There were inflammatory findings in the right flank caused by secondary infection around the colon cancer. The colon cancer existed near the right pelvic ureter to present with hydronephrosis, accordingly obstruction of ureter due to the cancer was suspected. However, CT-scan revealed a retrocaval segment and retrograde pyelography showed a sigmoid-shaped ureter, and it could be diagnosed preoperatively that hydronephrosis was caused by retrocaval ureter. Right hemicolectomy was carried out for the colon cancer and replacement of urinary tract with nephroplasty, for the retrocaval ureter.