Inferior mesenteric arteriovenous fistula is rare and may be congenital or acquired. Affected patients present with abdominal pain, mass, or manifestations of portal hypertension and bowel ischemia. Until now, inferior mesenteric arteriovenous fistula due to trauma has not been reported. Herein, we report a case of a 53-year-old woman who had inferior mesenteric arteriovenous fistula considered to have originated from remote blunt trauma that was successfully treated by surgical resection of only the arteriovenous fistula without colectomy. To our knowledge, this is the first case of traumatic inferior mesenteric arteriovenous fistula.
Arteriovenous Fistula/*diagnosis/pathology/surgery ; Colonoscopy ; Female ; Humans ; Mesenteric Artery, Inferior/radiography ; Middle Aged ; Tomography, X-Ray Computed ; Treatment Outcome

The authors dissected and examined a horseshoe kidney from the cadaver of a 54-year-old Korean female. The results were as follows. Other congenital anomalies or complications were not found, and no renal stones showed on plain radiography of the horseshoe kidney. The horseshoe kidney was located in the area between the 12 th thoracic vertebra and the 4th lumbar vertebra, with the superior extremity of the left kidney 10mm more inferior than that of the right. The isthmus connecting the bilateral kidneys was located at the level of the 3rd lumbar vertebra. The size of the kidney was 102mm × 52mm × 44mm (right) and 108mm × 62mm × 34mm (left), and the superoinferior and anteroposterior lengths of isthmus were 22mm and 10mm, respectively. The abdominal aorta and inferior vena cava passed posteriorly to the isthmus, with the inferior mesenteric artery and lumbar splanchnic nerve passing anteriorly. Some grooves were found on the anterior surface of the bilateral kidney. The hilum of the right kidney faced the anteromedial direction and that of the left kidney faced the anterolateral direction. At the hilar plane, the right renal arteries and veins passed anteriorly and posteriorly to the renal pelvis ; the left renal arteries passed posteriorly to the renal pelvis, with the left renal veins passing anteriorly and posteriorly. Three branches of the right renal arteries passed renal hilum, while two branches did not, and two branches of the left renal arteries passed renal hilum, while six branches did not. The two arteries arising from the aortic bifurcation were distributed to the isthmus. The number of renal veins passing the renal hilum were three in the right, and two in the left. The right and left ovarian veins drained to the renal veins. There were 12 minor calyces distributed normally in the right kidney, 13 minor calyces distributed radially in the left kidney, and 3 minor calyces in the isthmus, composed of parenchyme. The left portion of the horseshoe kidney was concluded to have developed poorly, on the basis of incomplete ascension and abnormal rotation during development, the imperfect configuration of the renal shape, and the abnormal distribution of the renal vessels and renal calyces.
Aorta, Abdominal ; Arteries ; Cadaver ; Extremities ; Female ; Fused Kidney* ; Humans ; Kidney ; Kidney Pelvis ; Mesenteric Artery, Inferior ; Middle Aged ; Radiography ; Renal Artery ; Renal Veins ; Spine ; Splanchnic Nerves ; Veins ; Vena Cava, Inferior

A Dieulafoy lesion in the rectum is a very rare and it can cause massive lower gastrointestinal bleeding. An 83-year-old man visited our hospital. He had chronic constipation and had taken aspirin for about 10 years because of a previous brain infarction. He was admitted because of a recent brain stroke. On the third hospital day, he had massive hematochezia and suddenly developed hypovolemic shock. Abdominal computed tomography showed active arterial bleeding on the left side of the mid-rectum. Emergency sigmoidoscopy showed an exposed vessel with blood spurting from the rectal wall. The active bleeding was controlled successfully by an injection of epinephrine and two hemoclippings. On the fourth day after the procedure, he had massive recurrent hematochezia, and his vital signs were unstable. Doppler-guided hemorrhoidal artery band ligation was performed urgently at two sites. However, he rebled on the third postoperative day. Selective inferior mesenteric angiography revealed an arterial pseudoaneurysm in a branch of the superior rectal artery, as the cause of rectal bleeding, and this was embolized successfully. We report a rare case of life-threatening rectal bleeding caused by a Dieulafoy lesion combined with pseudoaneurysm of the superior rectal artery which was treated successfully with embolization.
Aged, 80 and over ; Aneurysm/radiography ; Angiography ; Aspirin/therapeutic use ; Brain Infarction/drug therapy/prevention & control ; Embolization, Therapeutic ; Gastrointestinal Hemorrhage/*diagnosis/etiology/therapy ; Hemorrhoids/*complications ; Humans ; Male ; Mesenteric Artery, Inferior/radiography ; Platelet Aggregation Inhibitors/therapeutic use ; Rectal Diseases/complications/diagnosis/therapy ; Rectum/blood supply ; Sigmoidoscopy ; Tomography, X-Ray Computed

A Dieulafoy lesion in the rectum is a very rare and it can cause massive lower gastrointestinal bleeding. An 83-year-old man visited our hospital. He had chronic constipation and had taken aspirin for about 10 years because of a previous brain infarction. He was admitted because of a recent brain stroke. On the third hospital day, he had massive hematochezia and suddenly developed hypovolemic shock. Abdominal computed tomography showed active arterial bleeding on the left side of the mid-rectum. Emergency sigmoidoscopy showed an exposed vessel with blood spurting from the rectal wall. The active bleeding was controlled successfully by an injection of epinephrine and two hemoclippings. On the fourth day after the procedure, he had massive recurrent hematochezia, and his vital signs were unstable. Doppler-guided hemorrhoidal artery band ligation was performed urgently at two sites. However, he rebled on the third postoperative day. Selective inferior mesenteric angiography revealed an arterial pseudoaneurysm in a branch of the superior rectal artery, as the cause of rectal bleeding, and this was embolized successfully. We report a rare case of life-threatening rectal bleeding caused by a Dieulafoy lesion combined with pseudoaneurysm of the superior rectal artery which was treated successfully with embolization.
Aged, 80 and over ; Aneurysm/radiography ; Angiography ; Aspirin/therapeutic use ; Brain Infarction/drug therapy/prevention & control ; Embolization, Therapeutic ; Gastrointestinal Hemorrhage/*diagnosis/etiology/therapy ; Hemorrhoids/*complications ; Humans ; Male ; Mesenteric Artery, Inferior/radiography ; Platelet Aggregation Inhibitors/therapeutic use ; Rectal Diseases/complications/diagnosis/therapy ; Rectum/blood supply ; Sigmoidoscopy ; Tomography, X-Ray Computed