Inferior mesenteric arteriovenous fistula

Arteriovenous fistula (AVF) involving the inferior mesenteric artery and vein is very rare with only 33 cases described in the literature and may be of congenital or acquired (iatrogenic or traumatic) or idiopathic etiology. The pathophysiology of AVF that acts as a left-to-right shunt has accounted for clinical signs and symptoms associated with ischemic colitis, portal hypertension, and heart failure. A low incidence and nonspecific clinical signs and symptoms such as abdominal pain, thrill and mass, lower and upper gastrointestinal bleeding make it difficult to establish a diagnosis of inferior mesenteric AVF. Diagnosis of inferior mesenteric AVF is usually established by radiological or intraoperative examination. We report a case of idiopathic inferior mesenteric AVF causing ischemic colitis in a 56-year-old man that was diagnosed preoperatively by multidetector computed tomography and angiography and successfully treated by surgical resection.

Simultaneous Laparoscopic-Assisted Colorectal Resection and Nephrectomy

Simultaneous laparoscopic surgery for colorectal cancer and coexisting abdominal disease is shown to be feasible. However, simultaneous laparoscopic colorectal resection and nephrectomy is rarely documented, and its feasibility is unknown. We report two cases of simultaneous colorectal resection for colorectal cancer and nephrectomy. In the first case, a 71-year-old female underwent laparoscopic right hemicolectomy for an ascending colon cancer and left nephrectomy for a left non-functioning kidney. The second patient was a 77-year-old male with descending colon cancer and left renal cell carcinoma who underwent laparoscopic left hemicolectomy and left nephrectomy. The body mass indexes were 21.73 and 26.78 kg/m², respectively, and operation time was 275 and 395 minutes. Blood loss was 300 and 250 cc, and the postoperative hospital stay was 8 and 10 days. In both cases, there was no postoperative morbidity or mortality. Simultaneous laparoscopic resection for colorectal cancer and nephrectomy is a feasible and safe procedure.