Omental torsion is a rare cause of acute abdomen and sometimes requires surgery. Recently, we encountered a case of omental torsion diagnosed as omental infarction preoperatively. An 18-year-old male presented to our emergency room with a chief complaint of lower abdominal pain since previous 2 days. Because of his history of Down syndrome, an abdominal examination was very difficult. Plain abdominal computed tomography (CT) suggested omental hernia adhering to the right paracolic gutters. Two days after hospital admission, symptoms did not improve, and contrast-enhanced abdominal CT suggested omental infarction. We performed an emergency surgery. Upon exploration of the abdominal cavity, the greater omentum was found to be twisted four times and adhered to the right paracolic gutters. We performed a partial omentectomy. He was discharged 9 days after the surgery. There was no cause of omental torsion in the abdominal cavity, and he was diagnosed as having idiopathic omental torsion. In cases wherein the cause of acute abdomen cannot be detected, omental torsion should be considered, and abdominal CT could be helpful for the diagnosis.

To determine the efficacy of postoperative adjuvant chemotherapy with docetaxel + cisplatin + 5-fluorouracil (DCF) in lymph node metastasis-positive esophageal cancer, we retrospectively analyzed 139 patients with stage II/III (non-T4) esophageal cancer with lymph node metastasis (1-6 nodes), who did not receive preoperative treatment and underwent three-field lymph node dissection in the Juntendo University Hospital between December, 2004 and December, 2009. The tumors were histologically diagnossed as squamous cell carcinoma. The patients were divided into two groups, a surgery alone group (S group, 88 patients) and a group that received postoperative DCF therapy (DCF group, 51 patients). The disease-free and overall survival were compared between the groups and a multivariate analysis of prognostic factors was performed. The same analysis was performed for cases classified as N1 and N2, according to the TNM classification. There were no significant differences between the S and DCF groups regarding clinicopathological factors other than intramural metastasis and main tumor location. The presence of intramural metastasis, blood vessel invasion and the number of lymph nodes were identified as prognostic factors. The 5-year disease-free and overall survival were 55.8 and 57.3%, respectively, in the S group and 52.8 and 63.0%, respectively, in the DCF group. These differences were not considered to be statistically significant (P=0.789 and 0.479 for disease-free and overall survival, respectively). Although there were no significant differences in disease-free and overall survival between the S and DCF groups in N1 cases, both disease-free and overall survival were found to be better in the DCF group (54.2 and 61.4%, respectively) compared to the S group (29.6 and 28.8%, respectively) in N2 cases (P=0.029 and 0.020 for disease-free and overall survival, respectively). Therefore, postoperative adjuvant chemotherapy with DCF was shown to improve disease-free and overall survival in moderate lymph node metastasis-positive cases (N2), suggesting that the DCF regimen may be effective as postoperative adjuvant chemotherapy for patients with lymph node metastasis from esophageal cancer.

An extremely rare case of esophageal schwannoma in a 40-year-old woman is reported. She presented with a history of dysphagia persisting for a few years. After close examination the patient underwent surgery under a diagnosis of leiomyoma of the esophagus. The tumor was found in the muscle layers of the esophageal wall, and was enucleated with part of the esophageal mucosa.Histological examination of the tumor demonstrated proliferation of spindle-shaped cells. Immunohistochemically, the tumor cells were diffusely positive for S-100 protein.The pathological diagnosis of this tumor was esophageal schwannoma. To date, only 18 cases of esophageal schwannoma, including our case, have been reported in Japan. This rare case is reported here, together with a review of the literature.

We report a 32-year-old female patient with esophageal stricture thought to have been caused by hyperemesis gravidarum. Eleven months before admission she had been admitted to another hospital, because of hyperemesis gravidarum, at 26 weeks of gestation. Marked and recurrent vomiting occurred and her consciousness gradually worsened. Three weeks later, her baby was delivered by Cesarean section. Postpartum progress was uneventful except that she developed dysphagia 5 months after delivery. Esophagography and upper endoscopy demonstrated severe esophageal stricture. Endoscopic balloon dilatation was performed four times, but was unsuccessful. Blunt dissection of the esophagus was then performed. Histological examination demonstrated marked fibrosis in the submucosal layer and muscular hypertrophy. Esophageal glands were not identified. In this case, esophageal stricture might have been associated with severe esophagitis due to recurrent vomiting and reflux of gastric contents during hyperemesis gravidarum.