Hip sepsis from retroperitoneal rupture of diverticular disease.

Retroperitoneal perforation of diverticular disease is very uncommon and can be difficult to diagnose because of possible pathways of communication between the retroperitoneal space and the thigh. An iliopsoas abscess from a ruptured diverticulum may drain into the hip joint if the capsule has been violated. Cases of abscesses or gas in the thigh have been reported in which thigh pain was the predominant symptom, overshadowing any abdominal signs. We report a case in which hip sepsis due to a ruptured diverticulum was the presenting feature.

Periampullary carcinoma.

In the majority of instances, periampullary tumors include adenocarcinomas of the pancreatic head, duodenum, ampulla of Vater, and lower bile duct. Diagnosis is based mainly on a history of jaundice or is made by endoscopic duodenoscopy with retrograde pancreatography or by cholangiography or both. The best treatment for these tumors is pancreatoduodenectomy or palliative bypass if the tumor has spread beyond the region encompassed by resection. In experienced hands, resection can be accomplished with a mortality rate of less than 10 per cent and is followed by a 5-year survival rate of 30 to 40 per cent in carcinomas of the ampulla, duodenum, or lower bile duct and of about 10 to 15 per cent in carcinomas of the pancreatic head. Palliative surgical, chemotherapeutic, and radiotherapeutic procedures as yet do not prolong life appreciably.