Cholecystocolonic fistula: two different presentations of this rare complication of gallstones.

Cholecystocolonic fistulas (CCF) are a rare but significant complication of biliary disease, frequently presenting as gallstone ileus. Although there is no one agreed-upon procedure, enterolithotomy appears to be the initial treatment of choice; with a subsequent cholecystectomy performed ~4-8 weeks later. Alternatively, a patient may undergo a single-stage procedure, at which time an enterolithotomy, cholecystectomy and fistula closure are performed. Herein, we describe two patients with chronic cholecystitis and subsequent development of CCF with differing presentations. We report the clinical, radiographic and intraoperative findings and discuss the surgical treatment options for each patient, respectively.

Duodenal perforation in the pediatric population: two rare cases at a small community hospital.

Duodenal ulcer perforation is very uncommon in the pediatric population; hence, it is usually not considered in the differential diagnosis of acute abdomen in this age group. In our small community hospital, we had two rare cases of perforated peptic ulcer in the pediatric population within a short span of time. A 14-year-old male and a 13-year-old female child presented to the emergency room with acute abdominal pain. No other symptoms were reported and neither had any history of peptic ulcer disease. Abdominal CT showed pneumoperitoneum consistent with perforated hollow viscus. Subsequent exploratory laparotomy indicated perforated duodenal ulcer in both children. These cases illustrate that perforated peptic ulcers should be considered in children presenting with acute abdomen.

The effect of hormones on an uncommon breast disorder pseudoangiomatous stromal hyperplasia: a case report and literature review.

Pseudoangiomatous stromal hyperplasia (PASH) is a benign proliferation of the breast, with few cases reported to date. While the etiology of the disease is uncertain, a prevailing theory is that PASH is hormonally responsive, especially in the presence of progesterone. Literature review shows a correlation between PASH development and oral contraceptive pill (OCP) use. We report a case of a 28-year-old autistic female who underwent excision of palpable bilateral breast masses where the histology of the left breast mass identified as PASH. Our patient had a history of multiple medications including OCPs and cytochrome p450 inhibitors that could lead to an increase in progesterone levels. Thus, supporting a theory that medications, in addition to OCPs, may lead to an increased occurrence of PASH in pre-menopausal women.