Background: Ileus is quite a common disease, but is associated with various causes. As far as we know, there have only been one case of ileus due to inverted bladder diverticulum, which is extremely rare. Case presentation: The patient was a 53-year-old male. He made an emergency visit to our hospital with a chief complaint of left lower quadrant pain. He underwent right inguinal hernia surgery at 2 years of age with no history of laparotomy. An abdominal enhanced CT revealed inversion of the bladder left side wall where part of enlarged small intestine was found. Ascites were also found between the incarcerated small intestine and the bladder, leading to a diagnosis of strangulation ileus due to internal hernia and subsequent emergency surgery. A laparotomy revealed incarceration of the small intestine in the bladder left wall as a Richter type. The incarceration was rigid. We believed it would be difficult to pull out by extraction. Therefore, we inserted a Nelaton catheter between the incarcerated small intestine and the bladder and carried out the water pressure method to release the ileus. We did not perform an enterectomy since no manifest necrosis or perforation of the small intestine was found. The inverted bladder wall was a partial depression. We interpreted it to be a bladder diverticulum. We made a suture for occlusion with the bladder diverticulum inverted. Ileus arising from inverted bladder diverticulum is a very rare disease state. We hereinafter report on this case along with bibliographical considerations. Conclusions: We experienced a case of small intestine ileus due to inverted bladder diverticulum, which is very rare. In terms of preservation of the bowel, we believed the water pressure method to release the ileus was useful.

The patient was an 82-year-old male who consulted our hospital with a chief complaint of bloody bowel discharge. After hospitalization, a close inspection for the purpose of providing medical treatment showed progressive anemia. We prescribed clopidogrel sulfate based on a diagnosis of angina. The patient s appendix displayed multiple diverticula, and emergency colonoscopy using abdominal ultrasonography was performed as abdominal CT cystography showed extravasation in the appendix. Persistent bleeding from the appendix vermiformis was detected; however, observation did not reveal a clear source of the hemorrhage, and so we attempted the endoscopic hemostasis technique with a clip. The patient s anemia progressed following blood collection after a transfusion, and emergency surgery was required under a diagnosis of bleeding from multiple diverticula. The operative findings showed multiple hematomas in the diverticula, extending from the mesoappendix to the appendiceal wall.We successfully performed an appendectomy, and the patient s postoperative course was uneventful. Reports of appendiceal diverticula bleeding in Japan include only four cases; this condition is extremely rare, including in our experience. However, physicians should consider the possibility of this disorder as a source of hemorrhage in the digestive tract, as it is necessary to provide prompt treatment in such cases.

Background While thrombosis is a well-known complication of coronavirus disease 2019 (COVID-19) infection, reports on intestinal necrosis due to intestinal ischemia caused by thrombosis are extremely rare. We herein report a case of intestinal necrosis due to multiple thrombosis in a COVID-19 patient. Case presentation The patient was a 64-year-old man. He was admitted to hospital after being diagnosed with COVID-19, the severity was classified as moderate II. Nasal High Flow™ management was conducted along with treatment with tocilizumab, remdesivir, and dexamethasone. Heparin was also administered due to high D-dimer values. As abdominal pain appeared from the 6th day of hospitalization, contrast-enhanced CT was performed, which confirmed multiple thrombosis in the aorta. However, no obvious intestinal ischemia was found. On the 10th day of hospitalization, the patient’s abdominal pain was exacerbated. Upon re-evaluation by CT, he was diagnosed with perforative peritonitis due to ileal ischemic necrosis and emergency surgery was performed. Intraoperative examination revealed perforation due to necrosis at multiple sites in the ileum; thus, partial ileectomy was carried out. Pathological findings also revealed discontinuous multiple intestinal necrosis due to the frequent occurrence of thrombosis. Following surgery, the patient recuperated and was discharged after ventilator management and multimodal therapy at the ICU. Conclusions Thrombosis due to COVID-19 complications is rare in the intestinal tract, but also occur. Its initial symptoms might not be captured by CT images, therefore caution is required.

This report presents a case of true enteroliths linked to non-specific multiple ulcers of the small intestine (CNSU). A 53-year-old male presented with abdominal pain and vomiting, and was admitted to our hospital under a diagnosis of ileus. He had anemia and hypoalbuminemia. Abdominal computed tomography showed that several radio-opaque bodies were present in the dilated small intestine. Double-balloon enteroscopy revealed an eccentric stricture accompanying a linear open ulcer. Well defined oblique and branching ulcers were continuous with the stricture. At laparotomy, we observed 18 stenoses of the small intestine from 190 cm to 110 cm proximal to the ileocecal valve. The stenotic and dilated segments were 1.7 ± 0.4 and 5.4 ± 3.0 (mean ± SD) cm in width, respectively. He underwent a resection of the affected small intestine. The macroscopic observation revealed various types of multiple shallow ulcers that were linear or had a tall, triangular configuration, and their alignment was circular or oblique. The ulcers had fused, thus showing a geographic configuration. The microscopic findings showed the maximum depth of the ulcers to be the submucosal layer. The enteroliths were mainly composed of calcium oxalate. As a result, the patient was diagnosed as having true enteroliths linked to CNSU. True enteroliths are a rare complication of CNSU.

A 40-year-old man visited a nearby hospital with the chief complaint of melena. Endoscopy showed an elevated lesion in the rectum, and he was referred to our department with a diagnosis of rectal cancer. The abdomen was flat and soft, and a tumor located 5 cm from the anal verge was palpable on rectal examination. Tumor markers were within normal ranges.Contrast enema showed a crab claw-like filling defect in the rectosigmoid region, and abdominal computed tomography showed a concentric rectal wall. Therefore, intussusception was suspected. Based on these results, he was diagnosed with rectal cancer accompanied by intussusception. Since he had no abdominal symptoms, elective laparoscopic surgery was chosen. Intraoperatively, we tried to reduce the intussusception but it was difficult. Laparoscopic-assisted resection of the rectum was performed with D3 dissection. The pathological diagnosis was Rs, type1, pap>tub2, pT3 (SS), N3, ly1, v1, Stage b. He had a favorable postoperative course and was discharged on hospital day 10. At present, he is continuing to receive adjuvant chemotherapy with XELOX. Rectal cancer with intussusception is extremely rare. We report this case in which elective laparoscopic surgery was possible with a review of the relevant literature.