Angiodysplasia of the gastrointestinal tract is thought to be one of the most common causes of lower gastrointestinal bleeding in the elderly, and, in the majority of cases, lesions are located in the cecum or ascending colon. The authors report an extremely rare case of appendicular angiodysplasia. A 76-yr-old woman was hospitalized with massive recurrent red anal bleeding. Selective superior mesenteric arteriography revealed an extravasation of contrast material from the appendicular artery, and this finding proved to be bleeding from an angiodysplasia of the appendix. An appendectomy was performed, and anal bleeding did not recur postoperatively. A review of the literature revealed this to be an extremely rare case of angiodysplasia.

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Background: Dura mater infiltration is the main growth pattern of meningiomas. Local recurrence may occur in any type of meningioma, but it is more likely so in atypical meningiomas. Therefore, a wide resection of tumor cell-invaded dura mater is necessary to avoid recurrence. DuraGen® (an artificial dural substitute) can be used for dural reconstruction in meningiomas. Here, we report a rare case of a patient with atypical meningioma that invaded into the DuraGen®-derived mature dura mater. Case presentation: A 66-year-old female showed a three-time recurrence of atypical meningioma. Simpson grade I resection (en bloc tumor with autologous dura mater and DuraGen®-derived dura mater resection) was achieved at the 3rd recurrence. Collagen fibers running regularly and transversely were observed in the DuraGen®-derived dura mater resembling the autologous meningeal layer. Meningioma cell invasion, displayed by occasional EMA immunostaining, was observed in the DuraGen®-derived dura mater. Conclusions: This case indicates that meningioma cells may invade and survive in the DuraGen®-derived dura mater. Whether or not DuraGen® is not appropriate as a dural substitute remains unanswered. Further experiences are needed to validate these findings in large sample sizes.

Duodenal diverticula are common in adults, but are usually asymptomatic. Massive hemorrhage is a rare, but potentially lethal, complication that can be difficult to diagnose and treat. A 21‐year‐old woman was referred with duodenal hemorrhage of uncertain origin. Endoscopy revealed a duodenal diverticulum, but a discrete bleeding source was not identified. Transarterial embolization via the posterior pancreaticoduodenal artery decreased bleeding to where endoscopic electrocoagulation could be used effectively to stop all blood loss. Initial management of duodenal diverticular hemorrhage should be endoscopic. If unsuccessful, transarterial embolization should be attempted. When bleeding is slowed, but not arrested completely by embolization, endoscopic coagulation should be attempted again before surgery is undertaken. Advances in endoscopic hemostasis and angiography allow patients with bleeding duodenal diverticula to be managed non‐operatively in some cases.

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