Complicated Diverticulitis and Pelvic Radiation Leading to Colonic Stricture, Colorectal Fistula, and Anal Stenosis.

The purpose of this case is to highlight a rare case of sigmoid colon-to-rectum fistula. A 66-year-old man with a history of pelvic radiation and diverticulosis presented to the emergency department with a 3-week history of abdominal pain and watery diarrhea. Computed tomography (CT) imaging was significant for a sigmoid-to-rectum fistula with sigmoid stricture. The patient underwent a laparoscopic colectomy with end colostomy. Pathology revealed perforated diverticulitis. To date, there have been no cases reported in literature describing sigmoid-to-rectum fistula. In conclusion, it is important to consider the development of complex diverticular disease in patients with history of pelvic radiation.

Readability of Online Patient Material Provided by Reflux Centers in the United States.

The American Medical Association (AMA) and the National Institutes of Health (NIH) suggest patient education materials should not exceed the sixth-grade reading level. Several studies have shown that patient information has been written well above this reading level across multiple specialties. A search was conducted utilizing the Google Chrome browser and the Google search engine. The key words "Reflux Center" and "GERD Center" were used to identify links to programs within the United States. The web site's general description of reflux or gastroesophageal reflux disease was copied and pasted into the Readable.io service, and the readability tests were conducted via the program. Of 52 web sites, none had fulfilled the recommended reading level. Our results reveal that readability related to reflux pathology on center web sites is too difficult for the average patient. In order to improve patient education regarding reflux pathology and treatment, reading materials should be improved.

Management of phlegmasia cerulea dolens caused by a giant leiomyoma.

In the present report, we describe the case of a young woman with a large uterine leiomyoma causing phlegmasia cerulea dolens with thrombosis of the left common and left external iliac veins. She underwent tissue plasminogen activator catheter thrombolysis and mechanical thrombectomy to temporize the condition until she could be evaluated by a gynecologic oncologist to remove the cause of the venous obstruction. Before the hysterectomy, a suprarenal inferior vena cava filter was placed. However, <12 hours after the hysterectomy, she developed recurrent thrombosis involving the left common and external iliac veins. She underwent repeat mechanical thrombectomy with wall stent placement in the left common iliac vein with resolution of her symptoms.

Dual Cystic Duct Found and Confirmed by Intraoperative Cholangiography.

This report presents a case of aberrant gallbladder anatomy. A 75-year-old female presented to the hospital with choledocholithiasis was admitted and underwent an endoscopic retrograde cholangiopancreatography (ERCP) to clear the common bile duct stones; no aberrant anatomy was noted at this time. The following day she was taken to the operating room for cholecystectomy prior to discharge. During the surgical procedure, the patient was found to have aberrant anatomy and an intraoperative cholangiogram was performed. This identified a dual cystic duct, a rare anomaly.