We report three cases of terminal-stage ovarian cancer where diatrizoate meglumine and diatrizoate sodium solution (Gastrografin) was effective for malignant bowel obstruction due to peritoneal dissemination. All cases had gastrointestinal symptoms such as nausea, vomiting, abdominal pain, and constipation, showed air-fluid levels and dilation of the small intestine on imaging tests. Therefore, all the cases were diagnosed as bowel obstruction. We initiated oral administration of Gastrografin because the patients failed to show a sufficient response to other drugs such as octreotide. Their gastrointestinal symptoms such as nausea and constipation improved after administration of the drug, and they could continue oral intake. In addition, they were diagnosed as having an incomplete bowel obstruction since radiographic examination 24 hours after administration of Gastrografin confirmed its presence in the large intestine. In all the cases, Gastrografin could be used repeatedly without noticeable side effects. This study suggests that Gastrografin might be useful for evaluating bowel obstruction and improving gastrointestinal symptoms in patients with malignant bowel obstruction caused by terminal-stage ovarian cancer.

A 45-year-old man with no history developed pain and paralysis in his left lower extremity. When he visited his previous physician, CT was performed, which showed Stanford type A aortic dissection with an aberrant right subclavian artery and Kommerell's diverticulum and narrowing of the true lumen of the left common iliac artery. He was accompanied by lower limb symptoms. He was then rushed to our hospital for emergency surgery. The operation was planned and performed in two stages. A median sternotomy was conducted, and cardiopulmonary bypass using the right common femoral artery, left axillary artery, and right atrium was initiated. Deep hypothermic circulatory arrest and antegrade selective cerebral perfusion were performed. The tear's entry was located in the distal arch of the aorta. The aortic arch was transected between the left common carotid and left subclavian arteries. We inserted an open stent graft to cover the diverticulated origin of the right subclavian artery. The left subclavian artery was reconstructed using a fenestration technique. The ascending aorta, aortic arch, and right and left common carotid arteries were reconstructed using a 4-branch prosthesis graft. The right subclavian artery was reconstructed through the thoracic cavity. On the day after the surgery, we performed percutaneous embolization of the right subclavian artery distal to the Kommerell's diverticulum. Postoperative CT showed no endoleakage or blood flow to the Kommerell's diverticulum. The patient's postoperative course was uneventful.