Bronchogenic cysts (BCs) are congenital foregut malformations and usually asymptomatic, thin-walled, incidentally diagnosed cysts which can be easily resected by a minimal invasive approach at this time point. However, they may develop symptoms such as infection, bleeding or compression of adjacent structures. There is no consensus about the risk of developing complications during a lifetime; however, recent reports suggest a higher incidence than initially believed. Here, we report a case of severe life-threatening mediastinitis emerging from an infected BC requiring complex surgery, which could have been avoided if surgery had been performed at an early, asymptomatic stage.

Perforated diverticulitis is a rare but serious complication associated with a significant mortality rate. Although many cases of conservative treatment have been reported, surgery remains the mainstay for perforated duodenal diverticulitis.We report a rare case of a 55-year-old female who presented with epigastric pain without fever. Computed tomography revealed a 3 cm perforated duodenal diverticulum of the D2 part of the duodenum with a localized abscess. After the failure of conservative treatment, we performed a deriving intestinal patch completed by cholecystectomy and biliary decompression via a transcystic drain, as well as feeding jejunostomy. The patient was discharged on day 32. Removal of the transcystic drainage at eight weeks postoperatively was complicated by the appearance of an iatrogenic bilioperitoneum, which was effectively treated with percutaneous drainage. Surgery remains challenging; our experience suggests that perforation covering with a deriving jejunal patch offers an alternative to direct beach suturing when the latter is deemed precarious. Part of the treatment success lies in local drainage and duodenal exclusion that can be achieved by various surgical approaches.

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