BackgroundMetastatic choroidal carcinomas that originated from the gastrointestinal tract are extremely rare. We report a case of suspected solitary choroidal metastasis from gastric adenocarcinoma.Case presentationThe patient was a 60-year-old man who had undergone laparoscopic distal gastrectomy with D1+ lymphadenecetomy for gastric cancer. The clinical stage was T1bN0M0 (TNM classification), but the pathological stage was T4aN0M0 beyond expectation. Adjuvant chemotherapy with oral Tegafur, Gimeracil, Oteracil potassium (TS-1®) was initiated. But he suddenly complained of decreased visual acuity in his right eye about 8 months later. This was suspected to be caused by choroidal metastasis of gastric adenocarcinoma. Chemotherapy with paclitaxel (PTX) and intensity-modulated radiotherapy (IMRT) achieved complete remission and spared the patient from going blind.ConclusionsThis case demonstrates that we should be aware of the possibility of choroidal metastases, when visual symptoms arise during treatment of gastric cancer.

Background Douche injury is a rare consequence of water recreation activities. Generally, this type of trauma occurs when people fall into the water in a sitting position during high-speed activities such as using a personal watercraft (PWC). Here, we report a rare case of anorectal injury caused by water jets from a PWC during sudden acceleration from rest. Case presentation A 21-year-old male passenger on a PWC fell off backward from the rear seat when the craft suddenly accelerated. He fell into the water in a supine position with his legs open, and the water jets of the PWC struck his perineum directly. Thereafter, bleeding from the anus was seen, and he was transferred to our hospital. On physical examination, there was a deep laceration interrupting the external anal sphincter in the posterior rectal wall. Abdominal computed tomography revealed a full-layer perforation of the posterior rectal wall and leakage of feces into the extraperitoneal space, but intraperitoneal free air was not seen. Laparoscopic sigmoid loop colostomy and primary suturing of the sphincter and mucosa were performed. He did not have any complications and was discharged from our hospital 16 days after the surgery. His anal function was almost perfectly preserved, and his diverting colostomy was closed 4 months later. Conclusion Anorectal injuries related to PWCs can occur not only while traveling at high speeds, but also when suddenly accelerating from rest. A diverting colostomy should be performed for this type of trauma. In these trauma cases, clinicians must suspect complex and life-threatening anorectal injuries early.

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The patient was a 14-year-old girl who had become conscious of the difference between a part of the left nipple and breast cross section since 1.5 years before. She visited a nearby hospital and was suspected to have a tumor mass in the left breast. Thereafter, she was admitted to our hospital. On palpation, we felt an elastic and hard 5 cm mass in her left breast. We observed an apparently circumscribed mass with high density on the mammographic image and an 8-cm mass with a clear margin in the major axis on breast ultrasonography. The image of the tumor mass showed a mixed pattern accompanying a nipple-shaped solid part that protruded into the lumen. We suspected an intracystic tumor or papilloma on preoperative diagnosis. However, because we observed an outgrowth of fibrillary tissue into the cyst wall and both mammary gland tissue and fibrillary interstice in the solid part on histopathologic examination, the patient was given a final diagnosis of juvenile breast fibroadenoma. Upon satisfactory progress, the patient was discharged on the 5th hospital day, and no recurrence has been observed to date, i.e., 7 years after surgery.

A 73-year-old woman was brought into our hospital by ambulance because she had a traffic accident between automobiles. When she arrived, she complained of severe right flank pain. An abdominal CT scan showed a cord like structure connecting to the small bowel from the liver, as well as small bowel obstruction and dilatation of the proximal intestine caused by the cord. She was diagnosed with the intestinal obstruction caused by the cord like structure and we performed a single incision laparoscopic surgery to relieve the obstruction. We confirmed that the inferior margin of the right lobe of liver extended in a shape of a tongue so as to connect to the small bowel, at where intestinal obstruction was present. The tongue-like extended liver was clipped and transected by using the ultrasonic coagulation incision-apparatus to relieve intestinal obstruction. Pathological findings revealed the cord like structure contained liver pareneymal cells and bile duct structures. Accessory liver lobe (Riedel's lobe) was diagnosed. Her postoperative course was uneventful and she was discharged from our hospital on the 7 th postoperative day. Accessory liver lobe is an abnormal morphology and is often detected incidentally. Among accessory liver lobes, one arising from the right lobe of the liver and extending downward in a tongue-like shape is called Riedel's lobe. This paper deals with our experience with a case of intestinal obstruction caused by Riedel's lobe treated by laparoscopic surgery.