While there have been numerous reports about colovesical fistulas and ruptured intestinal diverticula, there have been far fewer reports about vesicointestinal fistulas caused by Meckel's diverticula. Most Meckel's diverticula are asymptomatic. Furthermore, they seldom cause vesicointestinal fistulas, and the associated complications are non-specific. Thus, their preoperative diagnosis is difficult. We experienced a case in which a vesicointestinal fistula was caused by a Meckel's diverticulum and was treated with laparoscopic surgery. A 46-year-old male was referred to our hospital after exhibiting hematuria. Cystoscopy revealed a fistula between the small intestine and bladder. Contrast-enhanced computed tomography and magnetic resonance imaging showed a diverticulum in the ileum and a fistula between the ileum and bladder, which passed through the diverticulum. A Meckel's diverticulum was suspected. We conducted a laparoscopic operation. We dissected the Meckel's diverticulum with an automatic suturing device and removed it together with part of the ileum. The patient's postoperative course was good. We experienced a case in which a vesicointestinal fistula was caused by a Meckel's diverticulum and was successfully treated with laparoscopic surgery. In selected cases of Meckel's diverticulum, the dissection of the diverticulum with an automatic suturing device is appropriate.

Patients with spinal cord injury experience changes in the cardiovascular system and a high morbidity associated with peripheral artery disease. We report a case of acute aortic occlusion in a patient with chronic paralysis due to spinal cord injury. A 65-year-old man with chronic paralysis due to spinal cord injury developed mottling of the right extremity. Because of the complete tetraplegia, the patient had no subjective symptoms. Computed tomography revealed occlusion of the infrarenal abdominal aorta. An emergency thromboembolectomy established adequate blood flow, and the postoperative course was uneventful. The loss of muscle mass might be an advantage in avoiding ischemia reperfusion syndrome. Early detection of acute aortic occlusion and immediate reperfusion are primarily important, but patients with chronic paralysis present a risk of delay in detection, diagnosis, and treatment of acute aortic occlusion because of motor or sensory deficits. Although rare, it is necessary to consider acute aortic occlusion in the case of acute limb ischemia in patients with chronic paralysis due to spinal cord injury.