Nonocclusive mesenteric ischemia (NOMI) is one type of acute mesenteric ischemia. Colonic pseudoobstruction, known as Ogilvie syndrome, is a disorder defined by colonic distension in the absence of mechanical obstruction. A relationship between these diseases has not yet been reported, based on a review of the literature. We report a patient with NOMI secondary to Ogilvie syndrome. An 82-year-old woman reported three days of intermittent abdominal pain. Plain computed tomography scan showed colonic obstruction at the rectosigmoid colon. Colonoscopy was performed that showed a large amount of stool and no evidence of tumor or other physical causes of obstruction. We diagnosed the patient with Ogilvie syndrome and continued nonoperative management. On the third hospital day, she complained of abdominal distension. A repeat CT scan showed pneumatosis intestinalis in the small bowel and ascending colon, with portal venous gas. Emergency laparotomy was performed with diagnosis of mesenteric ischemia. Intraoperatively, there were multiple skip ischemic lesions in the small intestine and cecum. We resected the ischemic bowel and performed a distal jejunostomy. Her residual small bowel measured just 20 cm in length. Postoperatively, her general status gradually improved. She was discharged with total parenteral nutrition and a small amount of enteral nutrition.

BackgroundAlthough gastrointestinal involvement in patients with granulomatosis with polyangiitis is uncommon, it is associated with mild to severe life-threatening complications. We present a case of pneumatosis cystoides intestinalis in a patient with granulomatosis with polyangiitis that was treated successfully with hyperbaric oxygen.Case presentationA 70-year-old Japanese man with a 3-year history of granulomatosis with polyangiitis consulted our hospital with a complaint of severe back pain. Computed tomography showed a large amount of gas located in his bowel wall and mesentery. He underwent urgent exploratory laparotomy, which led to a diagnosis of pneumatosis cystoides intestinalis without intestinal perforation or necrosis. He consequently underwent 13 sessions of hyperbaric oxygen therapy and was discharged from our hospital without complications.ConclusionsSeveral previous reports have supported the efficacy of hyperbaric oxygen for treating pneumatosis cystoides intestinalis. The present case, however, is the first in which pneumatosis cystoides intestinalis in a patient with granulomatosis with polyangiitis was successfully treated with hyperbaric oxygen. We therefore suggest that hyperbaric oxygen therapy could be a candidate treatment for pneumatosis cystoides intestinalis in patients with granulomatosis with polyangiitis.

Introduction and importance The usefulness of laparoscopic surgery in the treatment of Spigelian hernias and the appropriate insufflation pressure remains unclear. Case presentation Case 1 involved an 81-year-old woman presented with a right abdominal protrusion. CT scan demonstrated a defect in the abdominal wall at the lateral edge of the right rectus abdominis muscle. We diagnosed as Spigelian hernia and performed laparoscopic hernia repair. The insufflation pressure was set at 10 cm H 2 O, and the IPOM method was selected as the repair method. Case 2 involved a 74-year-old male presented with a right abdominal painful bulging. Strangulation was released and CT scan demonstrated a defect in the abdominal wall at the lateral edge of the right rectus abdominis muscle. We diagnosed as Spigelian hernia and performed laparoscopic hernia repair. The insufflation pressure was set at 10 cmH 2 O, and the repair was performed by the hybrid method. Clinical discussion In both cases, the positions of the hernia portals marked preoperatively based on the tender areas and confirmed laparoscopically were not accurate. Although Spigelian hernia is a rare disease and various laparoscopic techniques have been reported in recent years, laparoscopic surgery is very useful to obtain an accurate diagnosis and to observe the abdominal wall from inside the abdominal cavity under insufflation, and it is better to decide the repair method according to the situation of each case and institution. Conclusion Laparoscopic surgery is important for accurate diagnosis in surgery of Spiegel's hernia, and insufflation pressure of 10 cmH2O was sufficient.

INTRODUCTIONRetroperitoneal abscess is an unusual presentation of perforated appendicitis. A fistula between the duodenum and an abscess resulting from appendicitis has not been previously reported.PRESENTATION OF CASEA 53-year-old Japanese man with a past medical history of hypertension and iron deficiency anemia presented with a 10-day history of fever and right lower abdominal pain, and was diagnosed with a retroperitoneal abscess secondary to perforated appendicitis. He was then treated with piperacillin and tazobactam after undergoing ultrasound-guided drainage, after which his overall condition improved. Due to iron deficiency anemia, we performed further evaluation for gastrointestinal bleeding and esophagogastroduodenoscopy showed an elevated lesion with granulomatous tissue in the duodenum, without an associated ulcer. At 10 days after abscess drainage, duodenography with contrast showed continuity between the abscess cavity and the duodenum. At 74 days after drainage, we performed laparoscopic appendectomy. Pathological examination showed granulomatous tissue inside the appendix with an inflammatory background and fecaliths infiltrated by macrophages.DISCUSSIONPerforated appendicitis has various presentations and many unusual fistulae have been reported, however, a fistula between a peri-appendiceal abscess and the duodenum has not yet been reported. A retroperitoneal abscess around the duodenum and appendix should be checked to differentiate it from Valentino's syndrome.CONCLUSIONWe present the rare complication of a duodenal fistula during the treatment of perforated appendicitis. The possibility of fistula formation should be considered in patients with complicated appendicitis.

Necrotizing soft tissue infection (NSTI) is a rare but rapidly progressing soft-tissue infection. Few reports of NSTI caused by colon cancer have been published. We present a rare case of NSTI of the thigh associated the retroperitoneal spread of ascending colon cancer. A 64-year-old man had noticed right hip pain since 3 months before admission, he felt pain in the right thigh which was reddening, and he had difficulty in walking. He was referred to Yokosuka general hospital Uwamachi. Anterolateral aspect of his right thigh was reddening and swelling. The patient was diagnosed with a psoas abscess and a NSTI of the right thigh caused by penetration of ascending colon tumor. The patient underwent debridement of severely necrotized tissue in the right thigh, diverting ileostomy and subsequently a right hemicolectomy with reversal of the ileostomy were performed. He was discharged 70 days after the first surgery. Colon cancer can be a cause of retroperitoneal abscess accompanied by NSTI of the thigh. Two-stage surgery was an efficient option in this patient with NSTI of the thigh associated with locally advanced ascending colon cancer.