Is colorectal neoplasia more aggressive in the young? A look at shifting guidelines.

BACKGROUND: This study aimed to compare factors associated with CRC in patients younger than 50 and in those 50 and older, that required surgical resection due to malignancy or premalignant conditions. METHODS: A retrospective chart review was conducted looking at patients who had bowel resection due to CRC or advanced polyps; individuals found to have hereditary tumors and inflammatory bowel disease were excluded. Data was analyzed with chi square test of association comparing proportions of patients in the two age groups. RESULTS: A significantly higher proportion of the younger population had advanced stages of CRC. Data from this and other studies suggests that the colorectal tumors seen in patients under 50 have a higher virulence, and perhaps this is due to different tumor biology. CONCLUSION: These findings illustrate how changes in screening guidelines reinforced by proper support from insurance providers/payors and a widespread aggressive educational campaign for patients and providers can benefit this increasingly vulnerable population.

Successful Coil Embolization Treatment of a Large Arterioportal Fistula: A Rare Cause of Mesenteric Ischemia.

Superior mesenteric arteriovenous fistulae (SMAVF) are a rare complication from trauma or iatrogenic surgical intervention. There are less than 50 cases reported in the literature and no clear guidelines as to the best practices for diagnosis and treatment. SMAVF are often asymptomatic but can present with nonspecific abdominal symptoms ranging from nausea and vomiting to gastrointestinal bleeding and mesenteric ischemia. Symptom onset, when present, is often delayed years after the inciting event, further complicating the diagnosis. We present a case of a 71-year-old man presenting with mesenteric ischemic symptoms secondary to a large SMAVF that was successfully treated with coil embolization. We describe our approach to treatment and describe the classical imaging findings. We, then, review the current literature and management recommendations.