No statistically significant increase in the proportion of patients with anastomotic leak was observed when prescribing nonsteroidal anti-inflammatory drugs for analgesia in the early postoperative period for patients undergoing elective colorectal surgery. Unexpectedly, there was an increased risk of sepsis that warrants further investigation (see video, Supplemental Digital Content 1, http://links.lww.com/DCR/A192, for a synopsis of this study).

A 68-year-old man presented to the emergency department with haematemesis and shock. Upper endoscopy and selective angiography could not identify the source of bleeding. He underwent selective embolisation of the gastroduodenal artery. The patient then had a period of about 24 hours with relative haemodynamic stability before having another episode of massive upper gastrointestinal bleed. A second attempt to embolise the common hepatic artery and distal coeliac axis was unsuccessful. Hence, he was urgently taken to the operating room for exploratory laparotomy. The source of bleeding could not be identified in the operating room. The patient went into cardiac arrest and expired. Autopsy revealed a fistula between proximal jejunum and a previously unknown abdominal aortic aneurysm (AAA). We present an entity that has only been described a few times in the literature while highlighting the importance of having a broad differential with upper gastrointestinal bleeding, especially when the source is not clearly evident.

Dedifferentiated liposarcoma (DDLS) is a high-grade sarcoma that usually arises from a well-differentiated liposarcoma, which most commonly presents as a retroperitoneal mass. DDLS involving the colon is extremely rare, and only a few cases have been reported. We present a case of a DDLS that was found in the cecum and adjacent mesentery. This aggressive sarcoma developed within six months based on computed tomography (CT) findings and initially presented as a perforated colon mass. The patient was taken for emergent exploratory laparotomy including right hemicolectomy with en bloc resection. There was no metastatic disease at time of presentation, but at three-month follow-up, CT scans demonstrated metastatic disease to the liver, lungs, and multiple peritoneal implants. This case highlights a rare form of colon cancer and its aggressive nature of progression.

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