Non-occlusive mesenteric ischemia (NOMI), leading to intestinal gangrene without a demonstrable occlusion in the mesenteric artery, is a rare condition with extremely high mortality. We report a case of NOMI diagnosed preoperatively by computed tomography and treated successfully with surgery, assisted by indocyanine green (ICG) fluorescence in the HyperEye Medical System (HEMS), a new device that can simultaneously detect color and near-infrared rays under room light. This allowed for precise intraoperative evaluation of the mesenteric and bowel circulation. Although the necrotic bowel wall of the distal ileum and the segmental ischemia of the jejunum were visible, the jejunum was finally preserved because perfusion of ICG fluorescence was confirmed. The patient, an 84-year-old man, had an uneventful postoperative course and is alive without critical illness 8 months after surgery. We report this case to demonstrate the potential effectiveness of HEMS during surgery for NOMI.

Simple preoperative supplementation significantly improved outcome. Administration of the supplemental diet before esophageal surgery appeared to be an effective strategy in reducing infectious complications, mortality, and hospitalization, and improving short-term survival.

A 67-year-old man was admitted for investigation of bloody stools. The sigmoid colon was found to be intussuscepted into the rectum very close to the anus, making reduction difficult. After dividing the peritoneum, the surgeon inserted his hands below the peritoneal reflection along the rectum and pushed the intussusceptum back from the distal to the proximal rectum using a milking action. The rectum was divided 5 cm from the peritoneal reflection, and the sigmoid colon was divided 10 cm proximally from the intussusception. The proximal end of the sigmoid colon was brought out as a colostomy. The residual rectum and the descending colon were anastomosed 5 months after the first operation. We present a case of adult intussusception of the sigmoid colon caused by a well-differentiated adenocarcinoma, which was successfully treated by manually reducing the intussusception, whereby abdominoperineal resection was avoided.

Although there were limitations in our study using domestic pig, including the small sample size, our results are expected to contribute to a decrease in the incidence of RLN damage during esophageal surgery.

II Altemeier Altemeier's procedure for rectal prolapse Altemeier s procedure for prolapse has been employed for more than 100 years. The operation consists essentially of perineal rectosigmoidectomy and levator plasty. It can be performed under a general, saddle block or even local anesthesia. Therefore, the operation is generally recognized as one of the procedures of choice for elderly debilitated patients who can tolerate the procedure well. In the past the procedure was limited to this category of patient because of the high recurrence rates reported. However, a recent detailed clinical assessment indicates excellent results including a low rate of recurrence, morbidity and improvement of bowel dysfunctions such as incontinence. Therefore, the detailed procedure should be tailored to the pathology of the individual. There are three major theories of the pathology: circumferential intussusceptions, sliding hernia and attribute to mucosal prolapse. Moreover, various other factors are concomitant with the condition, and often need to be balanced against one another. Of course, Altemeier s procedure itself may not be able to solve all the problems. However, as the procedure is so simple, we can modify it to suit the pathology. Altemeier s procedure comes closest to achieving the goals regardless of patient age and associated co-morbidities, providing excellent results and resolving problems in defecation.