Congenital cystic dilation of the common bile duct (a review of five cases and review of the literature)

Five cases of choledochus cysts have been presented. All were not diagnosed clinically. All were females and relatively very young presenting the classic triad of mass, jaundice and pain except in case 4 and the classic pathologic picture of a cystic mass, an absent lining epithelium and a patent bile duct. (Summary)

Aorta-esophageal fistula: an unusual cause of massive hematemesis and melena

Four fatal cases of aorto-esophageal fistula are presented. The first case is an acute mediastinitis secondary to an ulcerating esophagitis with perforation into the aortic arch; the second and fourth cases are ruptured aortic aneurysms with perforation into the esophagus; and the third is post-irradiation esophagitis with a complicating aorto-esophageal fistula. It is only in case I where an infectious nature is observableThe age range is from 28 years to 63 years. Three out of four cases are males. In all, the immediate cause of death is acute hemorrhage. Fistula, complicating atherosclerotic aneurysms, occurred in cases II and IVIn two of the cases, the fistula is located at the level of the aortic arch, in one case, at the thoraco-abdominal junction, and in the last one, at the level of the right main bronchus. In three out of four cases, there is an abundant amount of fibrous connective tissues surrounding the fistulaDiagnostic aids for the physician include a high degree of suspicion plus the clinical syndrome of unexplainable massive hematemesis and melena together with the ensuing hemorrhage and shock in cases with mediastinal lesionsThese cases should be considered as rarities. (Summary)