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Background Acute acalculous cholecystitis (AAC) is a relatively rare disorder of the gallbladder. Breast cancer recurrence more than 10 years after curative surgery is also infrequent. Case presentation Here, we report a case of a 59-year-old woman who presented with right flank pain. Her medical history included a lumpectomy for cancer of the left breast 12 years prior. Laboratory tests showed a severe inflammatory reaction and mild liver function abnormalities. Ultrasonography and computed tomography revealed an enlarged gallbladder and inflammation of the surrounding tissues; however, no gallstone was present. She was diagnosed with AAC. We performed an emergency laparoscopic cholecystectomy, and histopathological examination revealed a poorly differentiated adenocarcinoma in the cystic duct. Both metastatic and primary tumor cells were positive for estrogen and progesterone receptors on immunohistochemistry. The final pathological diagnosis was acute cholecystitis due to breast cancer metastasis to the cystic duct. Conclusion Although AAC secondary to metastatic breast cancer is rare, it should be included in the differential diagnosis for abdominal pain in patients with a previous history of breast cancer.

局所進行大腸癌は解剖学的特性により,腹壁や小腸,膀胱,生殖器など近接他臓器にしばしば浸潤するが,腎に直接浸潤するものは比較的稀である.下行結腸癌が左腎に直接浸潤し,合併切除により治癒を得た.症例は51歳,女性.発熱を主訴に受診し,腹部超音波検査で左腎腫瘍を疑われた.精査にて下行結腸に全周性の進行癌を認め,結腸癌が腎に浸潤したものと考えられた.下行結腸癌は左腎に強固に癒着し,左腎合併切除を含む左半結腸切除(D3郭清)を施行した.病理組織所見では下行結腸癌および左腎腫瘤は共に中分化型腺癌であり,結腸癌の腎直接浸潤と診断した.結腸癌は他臓器浸潤例においても治癒切除例では良好な成績が報告されており,積極的な浸潤臓器の合併切除が予後を改善すると考える.

Internal hernias are not common cause of intestinal obstruction. Among of those hernias, a very rare internal herniation through an abnormal defect in the broad ligament of the uterus is reported. A 54-year-old woman was admitted to the hospital because of abdominal pain and vomiting. She was treated conservatively with a long tube, but no symptomatic remission was obtained except evacuation. As a stenosis of the ileum was detected on a long tube enterogram, an operation was performed on the 11th hospital day. At laparotomy, the ileum, approximately 25cm proximal to the ileocecal valve, was herniated through an abnormal defect in the broad ligament of the uterus. Following a reduction of the incarceration, the hiatus was sutured. This disease presents difficulty in preoperative diagnosis. When we encounter multiparous patient with intestinal obstruction without any previous surgical history, a possibility of this disease must be kept in mind.

Recently colorectal carcinomas have been increasingly reported, multiple carcinomas of the colon and rectum are not rare, and the hereditary factor seems to be involved in the etiology of such multiple occurrence. Thirty-seven cases of multiple colorectal cancers experienced at the department in a recent 14-year period were clinicopathologically studied. Of these 37 patients, seven patients (15 lesions) had a family history of colorectal cancer within the first degree relatives (positive group) and the remaining 30 patients (65 lesions) had no family history (negative group). Patients in the positive group were younger than those in the negative group. Carcinomas of the positive group were located in more prpximal colon than those of the negative group. Histological examination revealed that most of the first lesions in the positive group were moderately differentiated adenocarcinomas while the second lesions were commonly well differentiated adenocarcinomas. Presence of associated adenomatous polyps was more common in the negative group than in the single carcinomas. The cumulative 5-year survival rate was 62.5% in the positive group and 42.0% in the negative group. All patients in the positive group satisfied the diagnosis criteria of HNPCC (hereditary nonpolyposis colorectal cancer), but the negative group may include initiator of HNPCC.

Inflammatory fibroid polyps (IFPs) are rarely found in the gastrointestinal tract. The majority of IFPs are sessile-pedunculated or pedunculated polypoid lesions, whereas a polyp presenting like a Borrmann type II lesion is extremely unusual. This report describes the case of a 74-year-old man with a history of intussusception, in whom a preoperative diagnosis of a cecal tumor of the ileocecal valve was made. A laparotomy subsequently revealed a lesion similar to a Borrmann type II tumor located 15 cm above the ileocecal valve, but not at the valve. The lesion was diagnosed as an IFP which had been caused by repeated colostomy irrigation. The aim of the present report is to draw attention to this entity, which should be included in the differential diagnosis of intussusception and small bowel obstruction.