Expedient recognition of arterial-enteric fistulas is important in optimizing patient outcomes. The most commonly described aortoenteric fistula is between the abdominal aorta and third portion of the duodenum that overlies it. This has historically been reported as a rare complication of open aortic aneurysm repair but also has been seen in endovascular repairs. Herein described is a case of a 77-year-old male with history of endovascular aortic repair and left hypogastric coiling for aneurysm who presented with a much rarer form of fistula between the residual sigmoid colon, status-post sigmoidectomy for diverticulitis, and the left hypogastric artery.

Background: Carotid body tumors (CBTs) are rare benign tumors that arise from the chemoreceptor tissue located at the carotid bifurcation that require excision if symptomatic. Depending on the size and location of the tumor, the carotid artery may need to be repaired after resection. This study aims to assess whether CBT excision with artery resection had higher rates of 30-day postoperative outcomes compared with CBT excision without artery resection. Methods: This is a retrospective cohort study. Patients were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) registry from 2005 to 2017. They were divided into two groups, based on Current Procedural Terminology (CPT^®) codes: group A had CBT excision without carotid artery excision (CPT code 60600) and group B with carotid artery excision (CPT code 60605). Patient demographic characteristics, co-morbidities, and 30-days postoperative outcomes were compared between the two groups. Categorical data were analyzed using Pearson’s X² or Fisher exact tests and presented as proportions (percentages). Continuous data were analyzed using parametric or non-parametric tests as appropriate. Statistical significance was defined as p < 0.05. Statistical analysis was performed using the SPSS statistical software package. Results: A total of 463 patients were identified, 410 (88.4%) in group A and 53 (11.4%) in group B. Overall, there were 291 (62.9%) women. A higher proportion of women underwent CBT excision only, compared to men (91.1% [265/291] vs. 84.3% [145/172], p < 0.0001). Demographics and comorbidities were similar between groups. There was no significant difference in the 30-day postoperative outcomes. The reoperation rate was higher in group B (3.8% vs. 1.5%, p = 0.334), while the readmission rate was higher in group A (3.2% vs. 0% p = 0.269), and both were not significantly different. Overall morbidity and serious morbidity were higher in group B (7.5% vs. 5.9%, p = 0.626) and lower in group A (5.7% vs. 3.9%, p = 0.544), respectively, but were not significantly different. Operative time (mean, SD) was higher in group B (187 ± 107 vs. 138 ± 66 min, p < 0.001). However, the median (IQR) of hospital length of stay (LOS) was similar (2 [1, 4] vs. 2 [1, 3] days, p = 0.134). Conclusions: Overall, no difference was noted in the 30-day postoperative outcome between the two surgical approaches of CBT. However, operative time was longer when artery resection was performed. Further research to determine the factors predicting the need for carotid artery resection among patient gender is needed.

Mesenteric pseudoaneurysms are uncommon vascular lesions most often resulting from trauma, iatrogenic injury, or local inflammation. Arteriovenous fistula formation following pseudoaneurysm development is a reported but exceedingly rare complication. Herein presented is the case of a 57-year-old male who sustained multiple injuries in a high-speed motor vehicle collision and was found to have a pseudoaneurysm of the superior mesenteric artery, further complicated by arteriovenous fistula formation. This presented clinically as persistent atrial fibrillation with rapid ventricular response, high output heart failure, and hemodynamic instability. This was repaired in an open fashion, resulting in immediate cardiac stabilization and an overall favorable outcome for the patient.