Duodenal diverticulum (DD) is a common incidental finding, which rarely causes complications. Perforation is one of the most feared and the least common complications. Surgery is the mainstay for complicated duodenal diverticulum, but with the advancement of medical treatment and intensive care, nonoperative management has been reported. We present a rare case of perforated DD that failed medical management and subsequently underwent surgical intervention.A 77-year-old, healthy female presented with right-sided abdominal pain with low-grade fever and leukocytosis. Computed tomography (CT) of the abdomen showed retroperitoneal fluid collection around the second part of the duodenum, which was not amenable to percutaneous drainage. Contrast studies showed no evidence of perforation or leak of the stomach or duodenum. The diagnosis was made via an upper endoscopy that showed a large periampullary duodenal diverticulum with purulent drainage and normal-looking ampulla. After failed conservative management with broad-spectrum antibiotics and worsening symptoms, she underwent excision and primary repair of the diverticulum with a jejunal serosal patch and exploration of the common bile duct (CBD). She had an uncomplicated postoperative course and was discharged home on postoperative day four.Although rare, the duodenal diverticular perforation can be a life-threatening complication. Combined subjective, clinical, and radiological assessment of the patient is crucial in deciding whether to operate or not.

Highlights Colonic perforation after colonoscopy could be intraperitoneal, extraperitoneal or a combination of both. Majority of the perforations are intraperitoneal. Risk factors include advance age, female sex, diverticulosis, previous abdominal surgery and colonic strictures. Extraperitoneal perforations can manifest as pneumoretroperitoneum, pneumomediastinum, pneumothorax and/or subcutaneous emphysema. Non operative management in isolated retroperitoneum while surgery required in majority of peritoneal perforation.

Currently, there is a worldwide obesity pandemic with an incidence that has increased progressively over the last few decades. Obesity is considered a global health hazard and is associated with a significant economic impact on the healthcare system. It has been linked to several serious medical conditions, including heart disease, hypertension, stroke, diabetes mellitus, and cancer. Obesity is also related to social and psychological problems such as anxiety and depression. Several factors predispose the population to obesity, including decreased physical activity and non-healthy dietary habits. Sugar is the most important key contributor to the pandemic of obesity, and implementing a sugar-free workplace policy will provide a promising strategy for fighting obesity.

Giant basal cell carcinoma (GBCC) is a rare skin cancer characterized by an aggressive biological behavior with extensive local invasion, frequent metastasis, and associated poor prognosis. Wide local excision with sentinel lymph node biopsy is often warranted for this condition, and reconstruction by local rotational flap is one of the best surgical techniques for repairing similar skin cancers with a relatively large skin defect. A 59-year-old man who was a former construction worker with a significant smoking history presented with a single giant suspicious chronic ulcerating skin lesion measuring 9 x 7 cm that proved to be a basal cell carcinoma (BCC) on his left shoulder. The patient was negative for enlarged or palpable lymph nodes and underwent a wide local excision and primary repair with a local flap. Despite negative margins, his follow-up visits at six, nine, and 10 months revealed numerous suspicious lesions that further required multiple local wide excisions that showed new basal cell carcinoma and recurrence to the left axilla. Given the invasiveness of his skin cancer, he was referred to oncology and later treated by chemoradiation. Patients with multiple risk factors are associated with a higher incidence of more invasive skin cancer due to possible cumulative effects. The therapeutic approach for GBCC should involve multidisciplinary teams, with wide local resection of the tumor with possible sentinel lymph node biopsy, local rotational flap for reconstruction of the wide defect, and adjuvant chemoradiotherapy if necessary.

Chronic lymphedema (CL) due to failure of lymphatic drainage harbors an immunologically vulnerable environment for the development of various neoplasms. Independently, either melanoma or basal cell carcinoma (BCC) arising from CL has only been reported, but synchronous melanoma and BCC originating from CL is never reported. We report a very rare case of synchronous melanoma and BCC arising from the lymphedematous upper extremity developed secondary to axillary lymphadenectomy for breast cancer. Additionally, a literature review reporting either melanoma or BCC in the lymphedematous area was performed using Medline and PubMed databases.