Benign duodenocolic fistula as a complication of peptic ulcer disease

A 44-year-old man with upper abdominal pain, diarrhea and 25 kg weight loss since 3 months ago was admitted. He had a history of dyspepsia and peptic ulcer disease 4 months before admission. Gastroduodenal endoscopy and upper gastrointestinal series with barium study were done. Biopsies and CT-scan ruled out malignancies. Endoscopy and radiology studies revealed a duodenocolic fistula. He underwent right hemicolectomy, fistula en bloc excision, and distal gastrectomy surgery with gastrojejunostomy and ileocolic anastomosis. Radiologic modalities are necessary before surgery. Surgery is the only curative treatment in benign cases and reconstruction method is dependent on patient's situation

Outcomes of Levator Resection at Tertiary Eye Care Center in Iran: A 10-Year Experience

PURPOSE: To assess outcomes of levator resection for the surgical correction of congenital and acquired upper lid ptosis in patients with fair to good levator function and evaluation of the relationship between demographic data and success of this operation. METHODS: In a retrospective study, medical records of patients with blepharoptosis who had undergone levator resection over a 10-year period and were followed for at least 3 months were reviewed. RESULTS: Overall, 136 patients including 60 (44.1%) male and 76 (55.9%) female subjects with a mean age of 20 +/- 13.8 years (range, 2 to 80 years) were evaluated, of whom 120 cases (88.2%) had congenital ptosis and the rest had acquired ptosis. The overall success rate after the first operation was 78.7%. The most common complication after the first operation was undercorrection in 26 cases (19.1%), which was more prevalent among young patients (p = 0.06). Lid fissure and margin reflex distance (MRD1) also increased after levator resection (p < 0.001). Age, sex, type of ptosis, amblyopia, levator function, MRD1, lid fissure and spherical equivalent were not predictive of surgical outcomes of levator resection. CONCLUSIONS: Levator resection has a high rate of success and few complications in the surgical treatment of congenital and acquired upper lid ptosis with fair to good levator function. Reoperation can be effective in most cases in which levator resection has been performed.

Recurrent orbital cavernous hemangioma due to overlooked multiple tumors

To report late recurrence of orbital cavernous hemangioma in a patient ten years after complete resection of the primary tumor. A 32-year-old woman with a history of progressive visual loss and proptosis underwent lateral orbitotomy for resection of a large cavernous hemangioma. Ten years later, proptosis recurred and the patient developed progressive ocular deviation. Imaging studies were in favor of a recurrent cavernous hemangioma and the tumor was excised via the previous incision site. Reassessment of previous orbital images suggested the presence of two separate tumors, only one of which had been excised at the time of initial surgery. Recurrent orbital cavernous hemangioma may follow incomplete excision of multiple orbital lesions with gradual growth of unidentified residual tumors. Accordingly, when an encapsulated cavernous hemangioma is removed, exploration is recommended to rule out multiple lesions.