Purpose:Gastrointestinal cancer surgery is often complicated by adhesive small bowel obstruction (ASBO) and paralytic ileus (PI), managed with a long intestinal tube (LIT), surgery, or hyperbaric oxygen therapy (HBOT). LIT insertion is challenging for both patients and medical staff, whereas HBOT requires only bed rest. However, HBOT has not been reported in clinical practice. Therefore, this study aimed to investigate its use for postoperative ASBO in patients with gastrointestinal cancer. Methods:This single-center, retrospective study included gastrointestinal cancer patients with postoperative ASBO between January 2012 and March 2023. A total of 126 patients (mean age 77.3 years) diagnosed with ASBO or PI at our hospital were assigned to either HBOT (96 patients) or LIT (30 patients). The primary outcome was the fasting period. Responders were defined as cases that resolved with a single treatment. Results:The fasting periods did not differ significantly between the HBOT group (median [IQR], 5 [4-7] days) and the LIT group (5 [4-7.8] days;p=0.574). Among responders, the fasting period was also not significantly longer in the HBOT group (5 [3-7] days) than in the LIT group 5 [4-7.3] days;p=0.181). HBOT non-responders were significantly more emetic (94% vs 63%, p=0.018) and older (mean 82.0 vs 75.1 years;p=0.023) than HBOT responders. Conclusion:HBOT appears no less effective than LIT for patients with ASBO or PI and offers greater comfort. It may be preferable for patients with mild vomiting, improvement after nasogastric tube placement, age <77 years, lower CRP, moderate intestinal dilatation, and within 24 hours of onset.

The patient was an 86-year-old man admitted to the neurology department with inclusion body myositis. Owing to dysphagia, a gastric tube was placed on 2nd hospital day 2, and steroid pulse therapy was initiated on day 7. On day 14, contrast-enhanced computed tomography (CT) performed for elevated D-dimer level revealed intra-mural gastric gas and intra-abdominal free air. He was referred to our department, where conservative treatment was initiated, as abdominal symptoms and ischemic findings were absent. Follow-up contrast-enhanced CT on day 8 after the onset showed resolution of both intra-mural gas and intra-abdominal free air. An esophagogastroduodenoscopy on day 9 revealed erosive gastritis in the gastric body, without necrosis or ulceration. The patient had an uneventful course. We report a case of gastric emphysema with intra-abdominal free air successfully managed conservatively, along with a literature review.

A 71-year-old woman with abnormal liver function was referred to another hospital. During follow-up, she developed refractory leg edema and ascites and was subsequently referred to our institute. Despite multiple imaging studies, including dynamic computed tomography (CT), Gd-EOB-DTPA magnetic resonance imaging (MRI), angiographic CT, and perflubutane-enhanced ultrasound, a definitive diagnosis could not be established. Liver biopsies from three sites with different imaging findings revealed adenocarcinoma of bile duct origin, and the patient was diagnosed with unresectable intrahepatic cholangiocarcinoma involving nearly the entire liver. She received gemcitabine/cisplatin, but treatment was discontinued early due to severe anorexia. Palliative care was provided, but she died approximately six months after diagnosis. This case highlights the diagnostic difficulty of imaging alone and underscores the value of liver biopsy when imaging findings are inconclusive.

A man in his 60s presented to our hospital with decreased appetite and approximately 10-kg weight loss over the past year. He was found to have chronic liver dysfunction and jaundice, prompting a thorough evaluation, including hepatitis virus markers. Three weeks after the initial visit, he was hospitalized with acute exacerbation of liver injury and persistent nausea. Given his personal and family history of photosensitivity, porphyria was suspected. Blood testing revealed markedly elevated protoporphyrin level at 4923μg/dL RBC (normal 30-86). Ferrochelatase gene testing identified a heterozygous deletion mutation and a low-expression allele, IVS3-48C/C, in both alleles, suggesting erythropoietic protoporphyria (EPP). Liver biopsy revealed deposits with birefringence under polarized light, confirming EPP-related hepatopathy. The patient's symptoms improved temporarily with hemin therapy, and he was discharged from the hospital, but liver injury worsened after relapse. Despite multidisciplinary management-including repeat hemin, phlebotomy, and plasma exchange-he died just over two weeks later. An autopsy performed with the family's consent revealed a markedly cirrhotic liver with a smooth black surface. Microscopy revealed dark-brown matrix deposits with birefringence under polarized light, along with perivascular deposits of acidophilic, PAS-positive substrates in the papillary dermis, consistent with EPP pathology. Comparison of the liver biopsy and autopsy specimens showed marked fibrosis progression. This was a severe case of EPP-related liver failure with no established treatment, although temporary benefit was achieved with hemin therapy.