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Background Colorectal cancer (CRC) is the most malignant complication in patients with Crohn’s disease (CD). We report 6 cases of CD-related CRC treated surgically at our hospital. Case presentation From 2010 to 2016, six CD patients were diagnosed with CRC. All patients were diagnosed with CD at < 25 years old, and the interval from onset of CD to diagnosis of CRC was > 10 years (range, 15–42 years) in all patients. The histological type of cancer was mucinous carcinoma in two cases, well-differentiated tubular adenocarcinoma in two cases, and moderately differentiated tubular adenocarcinoma in two cases. CRC was detected by screening colonoscopy in three cases (50%), and from clinical symptoms in the remaining three cases (50%). Two cases underwent colonoscopy within 2 months after symptom onset, detecting CRC in the relatively early stage. However, one case was diagnosed with advanced-stage CRC by endoscopy 1 year after symptom onset, and experienced poor prognosis. Conclusions Regular surveillance colonoscopy is needed to detect early-stage CRC in CD patients. Clear surveillance methods need to be established based on evidence.

Laparoscopic colectomy for transverse colon cancer (TCC) can be technically demanding due to the anatomical complexity of the region. In Japan, the Endoscopic Surgical Skill Quali cation System (ESSQS) was established to improve the skill of laparoscopic surgeons and further develop surgical teams. We examined the safety and feasibility of laparoscopic colectomy for TCC, and evaluated the effects of the Japanese ESSQS in facilitating this approach. MethodsWe retrospectively reviewed 136 patients who underwent laparoscopic colectomy for TCC between April 2016 and December 2021. Patients were divided into an expert group (surgery performed by an ESSQSquali ed surgeon, n = 52) and a non-expert group (surgery performed by an ESSQS-unquali ed surgeon, n = 84). Clinicopathological and surgical features were compared between groups. ResultsPostoperative complications occurred in 37 patients (27.2%). The proportion of patients who developed postoperative complications was lower in the expert group (8.0%) than in the non-expert group (34.5%; p < 0.017). Multivariate analysis revealed "Operation by ESSQS-quali ed surgeon" (Odds ratio [OR] 0.360, 95% con dence interval [CI] 0.140-0.924; p = 0.033), blood loss (OR 4.146,; p = 0.002) and clinical N status (OR 4.563,; p = 0.001) as factors independently associated with postoperative complications. ConclusionThe present multicenter study con rmed the feasibility and safety of laparoscopic colectomy for TCC and revealed that ESSQS-quali ed surgeons achieved better surgical outcomes.

Schwannoma occurs rarely in the retroperitoneum. The tumors can attain large sizes and cause surgical difficulties. The patient was a 43-year-old male who was incapacitated by a large pelvic tumor, associated with abdominal pain. The neurologic examination was unremarkable. MRI scan showed a 13 x 10 x 8 cm mass with a high signal on T2-weighted images. The stalk of the tumor continued to the left S4/5 intervertebral foramen. The patient underwent surgery with suspicion of schwannoma arising from the retroperitoneum. First, we separated the tumor from the sacral bone and sacral vessels by the transsacral approach in the prone position. Next, the patient was changed to the dorsosacral position. A huge retroperitoneal tumor was seen, however, we could separate the tumor from adjacent tissue with the caudal dissection line as a guide. The tumor was excised intact within its fibrous capsule. HE stain showed Antoni A type with a palisade arrangement of cells. On immunohistochemistry, the tumor was positive for S-100 proteins. Finally, the patient was diagnosed with retroperitoneal schwannoma.

The patient was a 66-year-old woman. PET-CT performed during the treatment of lung cancer showed FDG accumulation in the appendix. Colonoscopy showed submucosal elevation and erythematous orifice of the vermiform appendix, and contrast-enhanced CT showed wall thickening and contrast effect at the same site. The resected specimen showed wall thickening of the appendix. Histologic findings showed fissuring, transmural inflammation, and epithelioid cell granuloma.We diagnosed isolated Crohnʼs disease of the appendix. There has been no recurrence 6 months after surgery. Isolated appendiceal Crohnʼs disease without preceding bowel symptoms is a rare and diagnosis is difficult. We report this of Crohnʼs disease of the appendix with a review of the literature.