A retroperitoneal cystic mass compressing the right psoas muscle was found incidentally by ultrasonography in a 67-year-old woman. The radiological findings and a history of costal caries led us to suspect a psoas cold abscess. Ultrasound-guided needle aspiration was done to establish the diagnosis and to drain the content, but only a small amount of sterile fluid was obtained. The patient complained of neuralgia in her right leg at the time of puncture. Under the preoperative diagnosis of a neurogenic tumor, the mass was surgically resected, and found to be filled with old blood. The solid region consisted of a proliferation of fusiform cells, leading to a diagnosis of benign schwannoma. Retroperitoneal schwannoma is often misdiagnosed as an adjacent anatomical structure. Thus, we conclude that both microbiological and cytological examination of an aspiration specimen is important when psoas abscess is considered in a differential diagnosis.

A 68-year-old man, admitted for the treatment of recurrent cholangitis after a pancreatoduodenectomy (PD) performed 3 years previously was diagnosed as having multiple hepaticolithiasis. On laparotomy, the hepatic artery was not recognized. The anastomosed common hepatic duct was obstructed, and a fistula had been formed between the right hepatic duct and the Roux limb of the jejunum. Lithotripsy was performed from this fistula and it was reanastomosed. Angiography was performed postoperatively and it revealed common hepatic artery injury, most likely to have occurred during the previous PD. The patient's postoperative course was uneventful and he has been asymptomatic for 8 months after the operation, indicating that reanastomosis of the fistula can be an effective method. The stricture of the anastomosis was suspected to be mainly due to cholangial ischemia, because no episode of anastomotic leak or retrograde biliary infection had occurred during the PD perioperative period. There are several reports of late stricture of anastomosis 5 or more years after cholangiojejunostomy. This patient, therefore, requires further long-term follow up.

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The patient was a 71-year-old man who underwent low anterior resection for rectal cancer, wherein the reconstruction was performed by forming an anastomotic blind end of the sigmoid colon. There were perioperative complications, including acute renal failure and acute cardiac insufficiency, aspiration pneumonitis, and intra-abdominal abscess formation. At 15 months after the operation, the patient presented to us complaining of a sense of abdominal fullness and subcutaneous emphysema in the region of the closed drain hole in the left lower quadrant of the abdomen. Abdominal computed tomography showed intraperitoneal free air. An abdominal needle aspiration failed to have any favorable effect and gastrointestinal perforation was suspected. Then, lower gastrointestinal tract endoscopy revealed a perforation measuring 2 mm in diameter at the anastomotic blind end, that was closed with clips. Although we did not confirm perfect clip closure, the patient's symptoms improved and the intraperitoneal free air steadily decreased. The patient visits the hospital regularly for follow-up and is in good general condition.