A Müllerian cyst arising in the posterior mediastinum was initially reported by Hattori in 2005. We report a 47-year-old woman with a Müllerian cyst in the posterior mediastinum, so-called Hattoriʼs cyst. A mediastinal mass was detected by chest X-ray. She exhibited no clinical symptoms associated with the mass. MRI revealed a cystic lesion between Th4/5. Preoperative diagnosis was a bronchogenic cyst. The lesion was resected thoracoscopically, and histologic and immunohistochemical stainings showed a cyst with ciliated epithelium that was positive for estrogen and progesterone receptors. The resected cyst was pathologically diagnosed as Mül-lerian cyst (Hattoriʼs cyst). Hattoriʼs cyst should be included in the differential diagnosis of posterior mediastinal cysts.

Background Dementia often adversely affects postoperative outcomes in surgical patients. This study evaluated postoperative outcomes among elderly patients with and without dementia undergoing early cholecystectomy for acute cholecystitis (AC). Methods A total of 182 patients over 85 years of age who were diagnosed with AC and treated from January 2005 to March 2018 were reviewed retrospectively; 59 patients who underwent early cholecystectomy were enrolled. The complication rates, length of postoperative hospital stay, and rates of routine discharge (i.e., returning to their preoperative living location) were compared between two groups of patients with and without dementia. Results The overall complication rate after early cholecystectomy for AC in 59 patients was 11.9%, and there was no mortality in this series. The median postoperative hospital stay was 9.0 days, and the routine discharge rate was 89.8%. Of the 59 patients, 22 patients (37.3%) had a history of dementia. Complication rates were comparable between the groups, despite the rate of delirium development being significantly higher in the dementia group. The median length of postoperative hospital stay and routine discharge rates did not significantly differ between groups. Conclusions Early cholecystectomy for patients with AC over 85 years of age was performed safely, and elderly patients with dementia had similar postoperative outcomes as compared with patients without dementia.

Abstract[Purpose] The usefulness of elective surgery after noninvasive manual reduction has been reported for cases of obturator hernia, but there is no consensus regarding indication of manual reduction. Therefore, we examined obturator hernia cases that we experienced in our hospital and evaluated the indication of manual reduction. [Materials and Methods] Thirty-three patients who underwent emergent surgery in the period from January 2003 to May 2013 were divided into a non bowel resection group (group A) and bowel resection group (group B).[Results] The average CRP level in group A was significantly lower than that in group B. The duration of symptoms in group A was significantly shorter than that in group B. The ratio of cases in which the contrast effect of the strangulated intestine on enhanced CT was maintained was higher in group A than in group B.[Conclusion] Noninvasive manual reduction and elective surgery should be considered in the case in which the contrast effect of the strangulated intestine has been maintained within 24 hours after onset and in which CRP level is less than 1.0mg/dl. Key words: obturator hernia, manual reduction, elective surgery IntroductionObturator hernias are mostly found in elderly and Received: December 4, 2013/ Accepted: March 31, 2014 Correspondence to: Yusuke Takahashi Department of Digestive Surgery, Niigata City General Hospital, 463-7 Shumoku Chuo-ku, Niigata, Niigata 950-1197, Japan underweight women, and emergent surgery is often performed in a poor state due to strangulation of the intestine and aspiration pneumonia after vomiting. Recently, the usefulness of elective surgery after noninvasive manual reduction has been reported for cases of obturator hernia, but there is no consensus regarding indication of manual reduction [1][2][3][4] . In the past 10 years, we have performed elective surgery after reduction of the incarcerated organ in two cases of obturator hernia, and we obtained good postoperative results. These two cases are presented here. We also reviewed cases of obturator hernia cases in which emergent surgery was performed in our hospital and evaluated the usefulness of elective surgery for obturator hernia. Case1Patient: 88-year-old woman. Chief complaint: right thigh pain. Past history: Hypertension. Present illness: She visited our hospital with the chief complaint of right thigh pain. Findings: Height ; 138cm, body weight ; 35kg, BMI ; 18.6. Tenderness in the right groin. Positive for Howship-Romberg sign． CT findings: The small intestine was incarcerated in the right obturator foramen on plain CT, and it was released spontaneously on additional contrastenhanced CT (Fig. 1 ). Treatment plan: She had bilateral inguinal hernias and we selected elective surgery. Operation: We performed hernioplasty bilaterally by Kugelʼs method.Her postoperative course was uneventful and she was discharged on the day after the operation. Tenderness in the right groin. CT findings: The small intestine was incarcerated in the right obturator foramen and intestinal obstr...

We evaluated the clinical usefulness of the preoperative risk assessment models in emergency gastrointestinal surgeries in elderly patients: the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), its Portsmouth (P-POSSUM) modification, the estimation of physiologic ability and surgical stress (E-PASS), the systemic inflammatory response syndrome (SIRS) and the quick sepsis-related organ failure assessment (qSOFA) score. Materials and Methods: A total of 107 elderly patients over 90 years of age, who underwent emergency gastrointestinal surgeries in our hospital between April 2013 and March 2018, were enrolled in this retrospective study. The morbidity and mortality risks were assessed using these models. Results: The reasons for emergency surgery in this study were strangulated intestinal obstruction (29.0%), strangulated hernia (17.8%), bowel perforation (16.8%) and acute appendicitis (12.0%). Postoperative complications were observed in 61 patients (57.0%) including 7 (6.5%) in-hospital deaths. Ninety patients (84.1%) returned to the same level of activity after discharge. There were statistically significant differences in the following three scores; the preoperative risk score (P=0.008) and comprehensive risk score (P=0.015) of the E-PASS score, and the SIRS score (P=0.045) between patients who died in the hospital and those who survived. Conclusions: The preoperative risk score and comprehensive risk score of the E-PASS score, and the SIRS score seemed to be useful for preoperative risk assessment of emergency gastrointestinal surgeries in patients over the age of 90.

Acute cholecystitis (AC) is one of the most frequently encountered diagnoses in the emergency room, with its prevalence increasing worldwide. 1-3 The recommended treatment is an early cholecystectomy, which ought to be performed close to the time of the disease onset. 1 A common complication after cholecystectomy for AC is surgical site infection (SSI); its rate has been reported to be almost 10 percent. 4 For the prevention and control of such infection, multimodal strategies and multidisciplinary efforts are needed. The microbiological assessment of gallbladder bile is essential for management in AC patients. 5 Usually, a bacterial culture profile is used for SSI management; however,