Introduction: The presented case is unique as the patient presented with biopsy-proven papillary thyroid carcinoma (PTC) of the thyroid gland with an incidentally found concurrent thyroglossal duct cyst (TGDC) on computed tomography (CT). The patient was managed with a one-stage procedure. Case Report: A 26-year-old previously healthy female presented with a progressively enlarging neck lump over 6 months. Thyroid ultrasound revealed a 2.6 cm mass of the inferior right thyroid lobe, classified as TIRADS 5. Subsequent fine-needle aspiration of the mass confirmed PTC (Bethesda VI). A neck CT scan revealed a calcified, heterogeneous 2.6 cm mass in the right thyroid lobe along with a cystic lesion at the base of the tongue with likely extension into the floor of the mouth, consistent with a TGDC. The patient underwent simultaneous thyroidectomy and TGDC excision in a single operative session after discussion due to concerns for possible malignancy within the thyroglossal duct as well as possible enlargement of the TGDC leading to dyspnea or even dysphagia. At follow-up, the patient was doing well. Discussion: TGDCs are typically benign which is consistent with the findings in this case. The presence of biopsy-proven glandular thyroid cancer and an incidentally found TGDC present a unique challenge in surgical decision-making. In this case, there were no signs on imaging of malignancy of the TGDC so it was likely a primary glandular PTC. In this case, a one-stage procedure, combining total thyroidectomy and Sistrunk procedure, was selected based on the confirmed diagnosis of PTC with slight potential for synchronous cancer in the TGDC as well as prophylaxis against future aerodigestive tract symptomatology caused by the TGDC.

Introduction and importance: Bouveret syndrome, the rarest variant of gallstone ileus, occurs due to the passage of a gallstone into the gastrointestinal tract via a bilioenteric fistula, leading to gastric outlet obstruction. This condition represents less than 0.1 % of all mechanical bowel obstructions, predominantly affecting elderly females. Its nonspecific symptoms, including nausea, vomiting, and abdominal pain, often result in delayed diagnosis and significant mortality rates ranging from 12 % to 30 %. Historically, management involves a two-stage surgical approach: initial stone removal followed by interval cholecystectomy and fistula repair to prevent recurrence. Case presentation: This report presents two cases of younger patients with Bouveret syndrome managed with a single-stage surgical approach consisting of gallstone removal without subsequent cholecystectomy or fistula repair. Both patients remained symptom-free for two years postoperatively. Clinical discussion: These findings challenge the necessity of routine interval cholecystectomy and fistula closure, particularly in patients without recurrent biliary symptoms. We discuss the implications of a simplified surgical strategy, highlighting the potential for spontaneous fistula closure or adaptation of bile drainage pathways. Conclusion: While current literature supports interval surgery for younger patients to mitigate long-term risks, these cases suggest that selective management may reduce morbidity without compromising outcomes. Further research is needed to refine guidelines for the surgical management of Bouveret syndrome. Highlights:

Deep vein arterialization provides an alternative approach to avoid limb amputations in patients with no other revascularization options. An athletic 28-year-old had an anterior cruciate ligament tear in an on-the-job injury. After an anterior cruciate ligament repair, he was found to have an occluded popliteal artery. An above-knee popliteal artery to posterior tibial vein bypass was performed because of a lack of bypass options. This led to the resolution of his rest pain. This salvage maneuver gave the patient at least 1 more year without amputation, showing that deep vein arterialization can be an option for young patients with trauma.

The term, "Physician-modified endografts (PMEGs)" was first coined by Dr Benjamin Starnes et al at the University of Washington in 2009 to extend endovascular repair to complex aortic anatomy. A literature review was done and included studies written in the last 10 years about PMEG including current guideline statements. PMEGs are used to extend endovascular repair to short-neck infrarenal, juxtarenal, pararenal, and thoracoabdominal aneurysms, including symptomatic or ruptured presentations as well as postdissection pathologies. Overall mortality ranges from 2-16.7% and is highly dependent on the number of rupture cases included in the study. Major adverse events have been noted between 14.6 and 30.3%. At 5 years, overall survival for PMEG patients ranges from 41-69%, likely reflecting the underlying comorbidity burden in the high surgical risk patients. In 2017, the start of PMEG implementation for aortic arch disease occurred using single fenestration for arch branches with debranching as needed. Thirty-day mortality ranged from 1-6%, with a 0-2.5% rate of in-hospital mortality, and no aneurysm-related mortality reported. Thirty-day adverse events included a 2-5% rate of stroke, a 0-1% rate of spinal cord ischemia, a 0-2% rate of retrograde dissection, and a 14-17% rate of access site complication. Modern outcomes of PMEG use demonstrate excellent technical success, durable branch patency, and acceptable long-term survival when performed in experienced centers. Ongoing registry and investigational device exemption data will define durability, standardization, and optimal device selection across aortic segments.