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Background Late recurrence of gastric cancer of over 10 years post-gastrectomy is extremely rare, and the mechanism of late recurrence is unclear. We report a case of para-aortic lymph node metastasis that recurred 12 years postoperatively. Case presentation A 44-year-old woman who was pathologically diagnosed with moderately to poorly differentiated adenocarcinoma with T2N2M0 Stage IIIA according to the Japanese Classification of Gastric Carcinoma (the 13th Edition) underwent laparoscopic distal gastrectomy with D1 + lymph node dissection. She received adjuvant chemotherapy with tegafur-uracil (400 mg/day) for 2 years. At postoperative year (POY) 5, a swollen lymph node was detected in the No.16b1lat lymph node station. However, positron emission tomography (PET) revealed normal uptake, and tumor markers were within normal limits; hence, the possibility of metastasis was judged to be low, and the patient was placed under observation. At POY 12, computerized tomography revealed an enlargement of the No.16b1lat lymph node station, and PET revealed abnormal uptake. Endoscopic ultrasound-guided fine-needle aspiration revealed a moderately differentiated adenocarcinoma. Hence, a diagnosis of recurrence of gastric cancer was made. She underwent para-aortic nodal dissection (PAND) of No.16b1lat & int stations. Immunochemical staining was similarly consistent with recurrence of gastric cancer. Meanwhile, CD44 variant 9 (CD44v9), a cancer stem cell marker for gastric adenocarcinoma, was attenuated in the recurrent lesions compared with the primary lesions. Postoperatively, she received chemotherapy with tegafur-gimeracil-oteracil (80 mg/day) for 1 year. At POY 4 after PAND, the patient remained well with no evidence of recurrence and distant metastasis. Conclusions The degree of staining for CD44v9 in the recurrent lesions may be related to the timing of recurrence. Hence, it is important to continue to investigate the role of the expression of CD44v9 in gastric cancer and to clarify the details.

Highlights • Laparoscopic surgery may be safer and less invasive than laparotomy. • Understanding anatomical abnormalities is useful to plan lymph node dissection. • Extracorporeal lymph node dissection is useful in cases of intestinal malrotation., Introduction Intestinal malrotation is a congenital anatomical anomaly resulting from abnormal midgut rotation. Many cases occur during childhood and present with intestinal obstruction and midgut volvulus. Intestinal malrotation rarely occurs in adults and is found incidentally because it is asymptomatic. We herein report a case of intestinal malrotation, and colorectal cancer operated laparoscopically. Presentation of case A 78-year-old man presented to our Department of Surgical Gastroenterology with fecal occult blood. There were no abnormal findings in the physical examination. Colonoscopy revealed a type 3 tumor in the cecum. Contrast-enhanced computed tomography revealed that the tumor was located in the appendix along the midline of the abdomen. The small intestine and colon occupied the right and left sides of the abdominal cavity, respectively. The diagnosis was appendiceal cancer with nonrotation-type intestinal malrotation. A laparoscopy-assisted ileocecal resection was performed. During surgery, the right-side colon was not fixed to the retroperitoneum, and the right-side colon could be extracted out of the abdominal cavity through the umbilical wound with only adhesive dissection, and mesenteric and lymph node dissection can be performed outside the body. The postoperative course was uneventful. Discussion Appendiceal cancer with intestinal malrotation is managed with laparoscopic surgery because this method is safe and minimally invasive. Conclusion The laparoscopic approach may be safer and less invasive than laparotomy, and extracorporeal lymph node dissection is safe and reliable for patients with intestinal malrotation.

Highlights • Adrenal metastasis is usually associated with systemic spread of the disease and is considered to be unsuitable for surgical resection. • Adrenalectomy should be considered in patients who can undergo complete resection. • Adrenalectomy may offer a better long-term prognosis., Introduction Solitary adrenal metastasis derived from colorectal cancer is rare. Adrenal metastasis is usually associated with systemic spread of the disease and is considered to be unsuitable for surgical resection. However, it has been reported that an aggressive surgical resection of adrenal metastasis results in improved overall survival in selected patients. We herein report an extremely rare case of complete resection of rectal cancer with a synchronous solitary adrenal metastasis. Presentation of case A 70-year-old woman who presented with bloody stool was diagnosed with rectal cancer with a synchronous solitary adrenal metastasis and was suspected of having liver invasion. After a total of 2 cycles of chemotherapy with capecitabine and oxaliplatin, an abdominoperineal resection with D2 (proxD3) lymph node dissection and right adrenalectomy was performed and complete resection was possible. According to the TNM classification, the diagnosis was stage IVA (fT3N1bM1a[ADR]). At 18 months after surgery, the patient is alive with no evidence of recurrence and distant metastasis. Discussion Complete resection of adrenal metastasis may have a possibility of leading to a good prognosis in patients with a synchronous solitary adrenal metastasis. Conclusion Adrenalectomy should be considered in patients who can undergo complete resection, as it may offer a good long-term prognosis.

Highlights • Case of spontaneous bacterial peritonitis associated with E. tarda infection. • The patient had Child–Pugh A cirrhosis secondary to hepatitis C virus infection. • Surgical findings included redness and thickening of the cecal wall. • Purulent ascites without intestinal contents was observed. • E. tarda infection has a poor prognosis in patients with underlying disease., Introduction Edwardsiella tarda is a member of the Enterobacteriaceae family of gram-negative bacilli isolated from animals. Gastroenteritis is the most common manifestation of E. tarda infection. However, extraintestinal infections can occur in immunocompromised hosts as well as patients with hepatobiliary disease, malignancy, and/or diabetes mellites. The prognosis of sepsis caused by E. tarda is extremely poor, with a mortality rate of 38%. Here we report the occurrence of spontaneous bacterial peritonitis associated with E. tarda infection. Presentation of case An 87-year-old man with Child–Pugh A cirrhosis secondary to hepatitis C virus infection presented with diarrhea and sudden-onset pain in the abdomen. On arrival, guarding and rebound tenderness were observed over the entire abdomen. Computed tomography revealed circumferential thickening of the cecum and a small volume of ascites in the pelvic cavity. A diagnosis of peritonitis was made, and surgery was performed. Surgical findings included redness and thickening of the cecal wall and purulent ascites without intestinal contents. Peritoneal fluid culture revealed E. tarda as the sole pathogen. The abdominal cavity was washed, a drain was placed in the pelvic cavity, and postoperative intravenous antibiotic therapy was initiated. The postoperative course was uneventful. Discussion E. tarda infection in the presence of an underlying disease such as hepatobiliary disease, malignancy, and/or diabetes mellitus has a poor prognosis. Conclusion Although E. tarda infection is extremely rare, it is a life-threatening illness that can cause intestinal and extraintestinal infections. If necessary, early surgical intervention should be considered for cases of extraintestinal infection.

BackgroundGastric carcinosarcoma is most frequently diagnosed at an advanced stage when the tumor is generally large with invasion into other organs, lymph node metastasis, and distant metastasis. Standard chemotherapy has not been established, and surgery is the only curative treatment. Here, we present a case of postoperative recurrence of gastric carcinosarcoma under long-term tumor control with pazopanib.Case presentationA 77-year-old man was referred to our hospital because of nausea and vomiting. Computed tomography and upper gastrointestinal endoscopy revealed a type 1 tumor arising from the gastric antrum and extending into the duodenal bulb. He underwent distal gastrectomy (D2) with Roux-en-Y reconstruction. Histopathologically, the tumor had mixed adenocarcinoma and sarcoma components. According to the tumor–node–metastasis classification, the diagnosis was primary gastric carcinosarcoma pT1bN1M0 stage IB. Liver metastasis was detected 2 months after surgery; multiple lung metastases were detected 17 month after surgery. A genomic profiling test was performed using liver specimens as the patient became refractory to chemotherapy commonly used for gastric cancer, and the test revealedFGFR2amplification along withTP53R209*,AKT3N127D,NOTCH1A2036T, andPOLD1M161I. The patient was treated with pazopanib (800 mg/daily), and the tumor growth was controlled for 11 months.ConclusionsWe report a case of postoperative recurrence of gastric carcinosarcoma under long-term tumor control with pazopanib. This case suggested that pazopanib may be effective in treating gastric carcinosarcoma.

Highlights • Spontaneous esophageal rupture is usually treated surgically. • However, endoscopic interventions can be performed with good outcomes. • Approach is based on degree of infection in the mediastinum and thoracic cavity. • We used an over-the-scope clip for esophageal rupture localized to mediastinum. • The esophageal perforation was closed once the inflammatory response subsided., Introduction and importance Spontaneous esophageal rupture is a life-threatening condition caused by a sudden increase in the intraesophageal pressure. While surgery is the mainstay of management for spontaneous esophageal ruptures, in recent years, an increasing number of patients have been managed with endoscopic interventions. We report a case of spontaneous esophageal rupture managed with endoscopic closure using an over-the-scope clip (Ovesco Endoscopy AG, Tübingen, Germany). Case presentation A 68-year-old female presented with epigastric pain and left-sided back pain following vomiting. A computed tomography scan revealed mediastinal emphysema and an esophagogram showed leakage from the left side of the lower thoracic esophagus into the mediastinum. The patient was diagnosed with spontaneous esophageal rupture localized to the mediastinum and was treated conservatively. However, she had persistent fever and continuing esophageal leakage on the esophagogram. On the 12th day of admission, a gastrointestinal endoscopy was performed, which found a 10-mm full-thickness longitudinal laceration on the left side of the lower esophagus. Endoscopic closure using an over-the-scope clip was performed. The next day, the patient became afebrile. One week later, esophagogram revealed slight residual leakage and an additional endoscopic closure using an over-the-scope clip was performed; the patient subsequently had an uneventful recovery and was discharged on the 44th day of admission. Clinical discussion Endoscopic closure using an over-the-scope clip led to a good outcome in this patient with spontaneous esophageal rupture. Conclusion Endoscopic closure using an over-the-scope clip is an effective and minimally invasive technique for selected patients with spontaneous esophageal rupture.

Catalytic oxidation of styrene and cumene was carried out in the absence of solvent with μ-oxotrinuclear mixed valence and mixed metal carboxylate complexes as catalysts. Main products from styrene are styrene oxide and benzaldehyde. Among these complexes tested, the μ-oxo mixed metal acetate complexes FeIII2ZnII, CoIII2CoII, and CrIII2FeII are superior for both reactivity and epoxide selectivity to monomeric or trinuclear homometal complexes. Moderately high temperatures (80–95°C) and decreased 02 pressure result in increased epoxide selectivity. Cumene was oxidized by all the complexes tested, but the FeIII2MnII complex had no activity for the oxidation of styrene. Electron transfer between metals via a μ-oxo atom is considered to be responsible for the effective catalytic feature.