Unusual case of massive hemorrhage of a gastric duplication cyst in a very advanced age.

PURPOSE: The objective of this study was to report an unusual case of gastric duplication in an 82-year-old female patient. MATERIALS AND METHODS: The patient was treated immediately by Billroth I partial gastrectomy due to massive hematemesis. The surgical specimen was histopathologically examined. RESULTS: The histopathologic report confirmed the operative diagnosis of a gastric duplication cyst. Gastric duplication cysts are rare congenital abnormalities occurring mainly in the pediatric population and rarely in adults. They account for 2% to 7% of all gastrointestinal duplications, having a male to female ratio of 2:1 (Agha et al., AJR Am J Roentgenol 137:406-407, 1981; Macpherson, Radiographics 13:1063-1080, 1993). CONCLUSIONS: Gastric duplication cysts present with a variety of symptoms and complications including hematemesis. The massive upper gastrointestinal hemorrhage in our octogenarian patient indicates that there is no age limit in clinical manifestations of this rather common in the pediatric population, congenital malformation of the stomach.

Empyema resulting from a true colopleural fistula complicating a perforated sigmoid diverticulum.

Empyemas developing after traumatic rupture of intraabdominal organs have been previously reported. We report a case of a true nontraumatic colopleural fistula following surgery for spontaneous rupture of a sigmoid diverticulum. The diagnosis was suspected by the presence of an air-containing tract seen in a computerized tomogram of chest and abdomen and was established with a contrast study. The empyema cavity was initially drained, followed by a laparotomy and fistulectomy with primary large bowel anastomosis and loop ileostomy. Although rare, colopleural fistulas present a diagnostic challenge and delayed management can lead to increased morbidity.