Inferior mesenteric artery aneurysm in the setting of chronic colonic vascular ectasia.

Colonic vascular ectasia is a condition characterized by dilated submucosal veins, venules, or capillaries found commonly in patients with lower gastrointestinal hemorrhage. We present a case of colorectal ectasia associated with ischemia and an inferior mesenteric artery aneurysm. These pathologic findings may be the result of the vascular ectasia and may add to the natural history of this condition.

Unusual sonographic finding in a patient with late recurrence of a perianal fistula.

We describe a case of late recurrence of a perianal fistula in a 51-year-old man with a 4.5-year history of recurrent perianal fistulas and abscesses. This was the fourth recurrence he had experienced; at each occurrence, he had undergone various examinations, including sigmoidoscopy, anoscopy, barium enema, fistulography, probe exploration, instillation of hydrogen peroxide, and/or sonography, and he had also undergone surgery. At our examination, transperineal sonography with a portable ultrasound scanner revealed an echogenic linear structure within the fistulous tract. Under endoanal sonographic guidance, surgery was performed, and a tan solid cylindrical structure longer than 2 cm was removed. Histopathologic examination revealed stratified squamous epithelium and soft tissue with substantial fibrosis and mild chronic inflammation, findings consistent with the characteristics of a remnant cast from a previous fistulous tract. Our findings suggest that some patients may benefit from relatively inexpensive sonographic examination with appropriate transducers.