This case highlights that en bloc resection and vascular reconstruction for colorectal cancer involving major vessels-specifically the right common iliac artery and inferior vena cava-may be performed safely even in super-elderly patients, provided that careful preoperative planning and strict surgical field separation are implemented. Our experience suggests that advanced age alone need not automatically preclude curative-intent surgery when functional status is preserved and the patient strongly wishes to undergo treatment.

A colovesical fistula is a rare complication most often caused by diverticulitis, typically requiring surgical repair due to the pressure gradient in which the intraluminal pressure within the colon exceeds that of the bladder. We report a 49-year-old man with pneumaturia and fecaluria secondary to chronic sigmoid diverticulitis. Imaging demonstrated a colovesical fistula, and cystoscopy confirmed fecal discharge at the bladder dome. Laparoscopic sigmoidectomy with bladder repair was performed after preoperative placement of bilateral near-infrared fluorescent ureteral catheters (NIRFUCs). Intraoperatively, dense adhesions were encountered, but the ureters were instantly and clearly identified with fluorescence prior to and throughout dissection, preventing iatrogenic injury. The fistula was resected, the bladder defect closed, and colorectal anastomosis completed without diversion. Operative time was 360 min with minimal blood loss, and recovery was uneventful. Histopathological examination confirmed diverticulitis without malignancy. This case highlights the feasibility of laparoscopic management of colovesical fistula and demonstrates the usefulness of NIRFUCs in ensuring ureteral safety during challenging pelvic surgery, especially in the era of minimally invasive surgery where fluorescence compensates for the lack of tactile feedback.

Factor XIII deficiency (FXIIID) is a rare coagulation disorder that can cause severe or delayed bleeding and impair wound healing despite normal routine coagulation test results. Congenital FXIIID is caused by homozygous germline pathogenic variants of F13A or F13B. Herein, we report the successful treatment of a patient with FXIIID who underwent surgery for juvenile polyposis syndrome (JPS)-associated early gastric cancer. A 44-year-old woman was admitted to the hospital with anemia secondary to menorrhagia. Gastrointestinal examination revealed polyposis throughout the stomach and type 0-Is early gastric cancer, which was consistent with the histological diagnosis of the biopsy specimens. Investigation into her family history revealed that her mother and maternal aunt had gastric polyposis. Preoperative laboratory tests were almost normal, except for low levels of hemoglobin (6.0 g/dL) and Factor XIII (FXIII) activity (31%). Robot-assisted total gastrectomy with D1-level lymph node dissection, followed by Roux-en-Y reconstruction, was successfully performed, with an operative time of 347 min and estimated blood loss of 26 mL. To prevent surgery-related bleeding, preoperative and postoperative administration of FXIII concentrate (30 IU/kg) was planned. The postoperative course was uneventful, and the patient was discharged on POD 9. Genetic testing identified a germline pathogenic frameshift variant in SMAD4 (c.96delT [p.Ser32fs*13]), which was consistent with the phenotype of JPS, and a heterozygous missense variant of uncertain significance in F13A1 (c.308A>T [p.Glu103Val]). Nine months postoperatively, FXIII activity was re-evaluated and remained low at 59%, although it was higher than the preoperative level. Recognition of FXIIID and appropriate perioperative management may help prevent unexpected bleeding and enable safe gastrectomy in patients with FXIIID.

Endoscopic mini- or less-open sublay (EMILOS) is a minimally invasive extraperitoneal repair technique through a small incision that allows wide mesh placement, which may reduce surgical site infection, postoperative pain, and respiratory compromise. In the present case, we performed umbilical hernia repair using EMILOS in an elderly patient with an impaired pulmonary function, and the procedure was performed safely without major postoperative respiratory complications. An 86-year-old female with asthma using inhaled budesonide-formoterol and mixed ventilatory impairment presented with abdominal pain and a firm umbilical bulge. CT revealed a 38 × 36-mm umbilical hernia with an acutely irreducible small bowel. Elective repair was planned after manual reduction. Given low pulmonary reserve and anticipated airway hyperreactivity, we selected general anesthesia with a supraglottic airway device (SGA) and an EMILOS repair. Through a 3-cm skin incision caudal to the umbilical bulge, the hernia sac was dissected. The retrorectus space was developed, and a 16 × 15-cm monofilament mesh was deployed and secured. Finally, the linea alba and anterior rectus sheath were closed.The postoperative course was generally uneventful. Discharge was delayed for social reasons, and the patient was discharged on day 14. At the 6-month follow-up, there was no evidence of any infection or recurrence. This case suggests that EMILOS may allow curative treatment with relatively low invasiveness in carefully selected elderly patients with impaired pulmonary function. The use of an SGA may be a reasonable option for respiratory management in this context. However, the indication for surgery should be individualized, and conclusions regarding its benefit should be interpreted with caution due to the single-case nature of this report.

Focal nodular hyperplasia (FNH) is a rare benign liver lesion in children, representing approximately 2% of pediatric liver tumors and occurring far less frequently than in adults. Preoperative diagnosis is often challenging because FNH can closely mimic malignant or metastatic liver tumors on imaging, particularly in patients with a history of malignancy. Indocyanine green (ICG) fluorescence imaging has emerged as a useful intraoperative navigation tool in pediatric liver surgery; however, its role in distinguishing FNH from metastatic lesions remains underexplored. A 5-year-old girl with a history of stage IV Wilms tumor-treated with systemic chemotherapy and in complete remission since 3 years of age-underwent routine follow-up imaging. MRI identified a small hepatic lesion in segment 1 (S1) that gradually enlarged on serial examinations. Contrast-enhanced CT demonstrated a 10-mm nodule with arterial phase enhancement and gradual relative washout in the portal and venous phases, raising concern for hepatic metastasis. Given the oncologic history and indeterminate imaging findings, laparoscopic partial hepatectomy of S1 was performed for diagnostic confirmation and treatment. For intraoperative localization, ICG (0.5 mg/kg body weight) was administered intravenously 36 h preoperatively. The lesion was not detectable under conventional white-light laparoscopy; however, near-infrared fluorescence imaging revealed diffuse fluorescence corresponding to the tumor location, enabling precise resection with minimal loss of hepatic parenchyma. Histopathological examination confirmed FNH, characterized by hyperplastic hepatocytes with proliferating bile ductules and small vessels, and a central stellate scar. The postoperative course was uneventful, with no evidence of recurrence at 9-month follow-up. Differentiating pediatric FNH from metastatic liver tumors remains challenging. Intraoperative ICG fluorescence imaging may assist not only with tumor localization but also by providing supplementary information about tumor characteristics, potentially facilitating safe and minimal hepatic resection. In this case, the fluorescence pattern was suggestive of FNH in retrospect. Further case accumulation is needed to clarify the utility of ICG fluorescence patterns for differential diagnosis and surgical planning in pediatric liver lesions.

ABSTRACTINTRODUCTIONJejunogastric intussusception is a rare complication that can occur following gastrectomy or gastric bypass surgery. The occurrence of intestinal intussusception after pancreaticoduodenectomy (Child reconstruction) has been reported in very few cases in the literature.CASE PRESENTATIONHere, we present the case of a 75-year-old patient who developed jejunogastric intussusception following pancreaticoduodenectomy performed for intraductal papillary mucinous neoplasm of the pancreatic head. The diagnosis was confirmed by contrast-enhanced abdominal CT and upper gastrointestinal endoscopy. During the operation, the efferent limb was intussuscepted into the gastric lumen. Manual Hutchinson’s maneuver of the intussusception was successfully performed without incision of the stomach or jejunum. Intestinal blood flow was assessed during surgery using indocyanine green fluorescence imaging and adequate blood flow was confirmed. The surgery was completed without intestinal resection or incision of the stomach or jejunum. The patient’s postoperative course was uneventful, and he was discharged in stable condition on POD 11. He showed no recurrence at follow-up 1 year after the surgery.CONCLUSIONSAlthough jejunogastric intussusception is an uncommon complication following pancreaticoduodenectomy, it can lead to life-threatening outcomes. Delayed diagnosis can necessitate bowel resection. Prompt diagnosis and emergent surgical intervention are essential for effective treatment, highlighting the importance of a rapid clinical response from diagnosis to treatment regarding jejunogastric intussusception.

ABSTRACTINTRODUCTIONNeoadjuvant immunotherapy with nivolumab combined with chemotherapy has become a standard treatment for resectable non-small cell lung cancer (NSCLC), demonstrating improved survival outcomes. However, immune checkpoint inhibitors (ICIs) such as nivolumab are associated with immune-related adverse events, including interstitial lung disease (ILD). While ILD is a recognized complication in advanced NSCLC, its occurrence following neoadjuvant ICI therapy and subsequent surgical resection is rarely reported.CASE PRESENTATIONAn 84-year-old man with stage IIB squamous cell carcinoma of the left lung received three cycles of neoadjuvant chemotherapy with nivolumab, carboplatin, and paclitaxel, followed by left upper lobectomy and mediastinal lymph node dissection. The initial postoperative course was uneventful; however, on POD 7, the patient developed elevated inflammatory markers and radiologic findings suggestive of interstitial changes. Despite the administration of corticosteroids and antibiotics, his condition deteriorated, leading to respiratory failure and death on POD 25. Imaging revealed a diffuse alveolar damage pattern, consistent with severe ILD.CONCLUSIONSThis case highlights the potential risk of fatal ILD following neoadjuvant nivolumab therapy and surgical resection in NSCLC patients. Clinicians should maintain a high index of suspicion for ILD in the perioperative period, even in patients without pre-existing pulmonary disease, and consider early diagnostic imaging and timely corticosteroids therapy when appropriate.

ABSTRACTINTRODUCTIONTo describe a rare (airway-threatening) cervicothoracic presentation of Madelung disease (multiple symmetric lipomatosis) with upper mediastinal extension and to introduce a reproducible peri-operative strategy in a resource-limited setting.CASE PRESENTATIONWe report a case of a 40-year-old Oromo Ethiopian male who presented with progressive cervicothoracic adipose masses resulting in dyspnea and venous congestion. Awake fiberoptic intubation, staged resection, early extubation, and close airway management were the hallmarks of peri-operative management. Contrast-enhanced CT showed non-encapsulated, diffuse adipose infiltration from the neck into the upper mediastinum with effacement of the trachea. Because extensive bilateral cervical dissection posed a high risk of postoperative airway compromise (edema/hematoma) and prolonged anesthesia, a pre-planned two-stage surgical strategy was chosen. Stage 1 anterior debulking removed 3.5 kg of fatty tissue, and Stage 2 posterolateral debulking removed an additional 2.0 kg (total 5.5 kg). There were no major complications. The patient was discharged one week after the second procedure. At 1 month follow-up, there was significant improvement in breathing and daily functioning with no evidence of early recurrence. Clinical and ultrasound follow-up at 3, 6, and 9 months and 1 year showed no recurrence or complications.CONCLUSIONSGiant cervicothoracic Madelung disease can lead to critical airway compromise. Planned awake fiberoptic intubation and staged debulking resulted in safe care and good outcomes. Reporting detailed airway and surgical strategies for this uncommon presentation may be helpful to teams working in resource-constrained settings. Long-term surveillance remains essential because postoperative recurrence has been reported.

Radiation-induced angiosarcoma of the breast is a rare but aggressive secondary malignancy that develops several years after breast surgery and adjuvant radiation therapy. Because of its poor prognosis and diagnostic challenges, early recognition and complete surgical excision are essential for optimal management. We report a 72-year-old woman who presented with multiple painful, dark purple nodules in her left breast 7 years after breast-conserving surgery and adjuvant radiation therapy for adenoid cystic carcinoma. A core needle biopsy confirmed angiosarcoma. A total mastectomy with wide skin excision, including all overlying breast skin, and split-thickness skin grafting from the left thigh was performed to ensure negative margins, which were pathologically confirmed. Surgical removal of the tumor completely relieved her breast pain. She remains recurrence-free 6 months after surgery. Treatment for radiation-induced angiosarcoma is primarily surgical, with mastectomy and negative margins being the standard approach. Early detection is crucial to achieve complete resection, emphasizing the importance of careful follow-up and close attention to skin changes in patients who have received breast surgery with radiation therapy.

ABSTRACTINTRODUCTIONChronic mesenteric ischemia (CMI) is usually caused by atherosclerotic stenosis of multiple mesenteric arteries. However, aortic stenosis secondary to Takayasu arteritis can rarely cause intestinal ischemia through hemodynamic steal from the mesenteric to lower limb circulation.CASE PRESENTATIONA 67-year-old woman with a history of Takayasu arteritis presented with postprandial and exertional abdominal pain and a 3-kg weight loss over 2 weeks. CTA revealed isolated severe stenosis of the infrarenal aorta with development of the arc of Riolan, and Doppler ultrasonography demonstrated retrograde flow in the inferior mesenteric artery. Based on these findings, a diagnosis of mesenteric steal syndrome secondary to Takayasu arteritis was made. Endovascular stenting of the infrarenal aorta was performed, resulting in improved antegrade aortic flow and reduced collateral circulation. After treatment, the patient’s abdominal pain resolved and her weight recovered.CONCLUSIONSThis rare case demonstrates that Takayasu arteritis can cause mesenteric steal syndrome without mesenteric arterial lesions and highlights that endovascular stenting can effectively restore physiological blood flow and relieve ischemic symptoms.