Naoki Kataoka

Delayed esophageal perforation occurring with endoscopic submucosal dissection: A report of two cases

We report two cases of delayed esophageal perforation occurring with endoscopic submucosal dissection. Our cases involved delayed perforation after 10 d in case 1 and after 6 d in case 2. Both cases were related to solid food. We performed subtotal esophagectomy with gastric tube reconstruction of the esophagus via the subcutaneous route anterior to the thoracic wall without conservative treatment because both cases involved chest pain and major leakage of food into the mediastinum. Postoperative complications were a local factor (including suture failure and esophageal stricture) in case 1, and we performed endoscopic balloon dilatation five times for esophageal stricture. There was no intrathoracic and mediastinal infection in either case. Surgical treatment for delayed esophageal perforation can be performed safely and surely if diagnosis and assessment are not delayed.

Pancreatectomy and splenectomy for a splenic aneurysm associated with segmental arterial mediolysis

Segmental arterial mediolysis (SAM) is characterized by intra-abdominal, retroperitoneal bleeding or bowel ischemia, and the etiology is unknown. A 44-year-old man complaining of abdominal pain was admitted to our hospital. He had been admitted for a left renal infarction three days earlier and had a past medical history of cerebral aneurysm with spontaneous remission. The ruptured site of the splenic arterial aneurysm was clear via a celiac angiography, and we treated it using trans-arterial embolization. Unfortunately, the aneurysm reruptured after two weeks, and we successfully treated it with distal pancreatomy and splenectomy. We recommended a close follow-up and prompt radiological or surgical intervention because SAM can enlarge rapidly and rupture.

A case report of primary pancreatic leiomyosarcoma requiring six additional resections for recurrences

Highlights • Primary pancreatic leiomyosarcoma is extremely rare, and is considered to be a highly aggressive malignancy.• We performed distal pancreatectomy, splenectomy, and wide resection of the transverse mesocolon.• Due to treat recurrent tumors, six additional resections were needed over a 5-year period.• Even if a primary pancreatic tumor recurs, long-term survival is achievable by repeated resection of recurrent tumors.