Ectopic pancreatic tissue within a duodenal diverticulum has not been previously described in the English-language literature, to our knowledge. We report a case of a 52-year-old woman who presented with a perforated duodenal diverticulum after upper endoscopy. Operative resection and repair of the perforated diverticulum was performed, and, on microscopic examination, ectopic pancreatic tissue was found within the diverticulum.

Chimney endovascular aneurysm repair provides an endovascular treatment for complex aortic aneurysms. However, type I gutter endoleaks can complicate this approach and prevent full aneurysm exclusion. Treatment of these leaks can be challenging. We report successful embolization of a type I gutter endoleak after (chimney endovascular aneurysm repair) via a transcaval approach.

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Objectives: Perioperative myocardial infarction (MI) has been shown to increase early and late mortality after vascular surgical (VS) procedures. We evaluated the frequency and timing of MI after VS and its impact on survival across a heterogeneous cohort of VS patients.Methods: All patients undergoing a spectrum of VS (open aortic resection, endovascular aneurysm repair/thoracic endovascular aortic repair, carotid endarterectomy/carotid angioplasty and stenting, or lower extremity bypass) from July 2007 to May 2012 were included. MI was diagnosed by electrocardiogram changes, elevated troponin, or diagnosis by a cardiologist. Patients were identified by Current Procedural Terminology code using an institutional patient data research registry consisting of administrative/clinical data and stratified according to the temporal relationship of the MI to the indexed procedure (early: #30 days; intermediate: 1 month to 1 year; late: >1 year). Univariate and multivariate methods were used to identify predictors of MI and its impact on survival. Results: We identified 2984 patients who underwent VS during the study interval. Early MI was observed in 110 (3.7%), intermediate MI in 66 (2.2%), and late MI in 136 (4.5%). Patient age per year (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.0002-1.05; P ¼ .03) and history of coronary artery disease (CAD; OR, 4.6; 95% CI, 2.8-7.5; P < .01) independently predicted risk of early MI. Intermediate MI was predicted by history of CAD (OR, 3.2; 95% CI, 1.9-5.3; P < .01) and diabetes (OR, 1.7; 95% CI, 1.1-2.7; P ¼ .02). Procedure type was not predictive of perioperative or delayed MI. Patients who had an MI within the first year had a lower (logrank P < .001) survival at 1 year (77% 6 3% vs 92% 6 1%) and 5 years (61% 6 5% vs 71% 6 2%; Fig). Risk-adjusted (age, gender, CAD, race, hypertension) Cox regression modeling showed that early MI (HR, 1.5; 95% CI, 1.01-2.2; P ¼ .04) and, more importantly, intermediate MI (HR, 2.2; 95% CI, 1.5-3.2; P < .01) independently predicted increase in late mortality, whereas late MI had no impact (HR, 1.03; 95% CI, 0.7-1.6; P ¼ .9).Conclusions: The incidence of MI within the first year after major vascular procedures remains low yet is predicted by a history of CAD and diabetes. Readily identifiable high-risk patients should have focused intensive medical therapy before and after VS.

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