No abstract

No abstract

A 70-year-old man who had undergone total gastrectomy and Roux-en-Y reconstruction for gastric cancer (M, Less, Type3, 92 × 78 mm, tub2>tub1, pT3N2 (6/78) M0 Stage Ⅲ A) 1 year 6 months prior was admitted to our hospital with abdominal pain, vomiting and diarrhea. Abdominal CT revealed intussusception at the site of the anastomosis. Emergency surgery was performed, and based on the intraoperative findings, the diagnosis of retrograde intussusception of the Roux-en-Y anastomosis towards the ligament of Treitz was made. After replacement by Hutchinson's maneuver, and confirmation of improvement in the ischemic changes and absence of necrotic changes, the operation was completed without intestinal resection. Retrograde intussusception at the Roux-en-Y anastomosis is rare, but should be considered in the differential diagnosis of abdominal pain in patients with a history of gastrectomy.

Laparoscopic wedge resection (LWR) for intraluminal gastrointestinal stromal tumor (GIST) leads to excessive resection of normal gastric wall. We report a case of GIST around the cardia successfully treated with full-thickness partial resection using a hybrid approach of laparoscopic surgery and single-incision intragastric surgery (SIIGS). A 69-year-old woman had a 5 cm intraluminal GIST at the posterior wall around the cardia. Submucosal injection of glycerin and indigo carmine was performed with transoral endoscopy. Circumferential seromuscular incision followed by placement of seromuscular sutures to invert the lesion into the stomach was performed under laparoscopy. By SIIGS, resection of the inverted mucosa and retrieval of the tumor were completed. A hybrid approach consisting of laparoscopic wall-inversion surgery and SIIGS was useful for intraluminal GIST and may expand the indications for laparoscopic wall-inversion surgery by removing size limitations.

No abstract