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Pathology, Research and Practice Nov 2020Phlebosclerotic colitis (PC) is a rare chronic ischemic colitis caused by venous reflux disorder. It is also called idiopathic mesenteric phlebosclerosis (IMP) due to...
Phlebosclerotic colitis (PC) is a rare chronic ischemic colitis caused by venous reflux disorder. It is also called idiopathic mesenteric phlebosclerosis (IMP) due to unknown etiology. The disease is characterized by sclerosis of mesenteric vein and its branches as well as fibrosis, hyaline degeneration, calcification, thickening of colon wall. CT images show linear calcification in the colon mucosa as well as mesenteric vein and its branches. Endoscopy shows purple-blue mucosa with multiple erosion and ulceration. Microscopically, the colon mucosa shows fibrosis, hyaline degeneration and extensive thickening. The most characteristic lesion is fibrosis and calcification of the vessels especially the veins. Arteries in all layers of colon are also involved, but the injury is significant mild and less. We collected 10 confirmed patients from 2012 to 2019 in our hospital, studied their clinical histories in detail, summarized typical changes of CT images, endoscopic images and pathological sections, and made a detail follow-up. In addition to typical pathological changes, we also found that gardenia or its metabolites may be the pathogenic factor. Probablely, geniposide which is metabolized to genipin by β-glucosidase of colon flora in proximal colon, results in venous sclerosis. PC is occult onset and irreversible without special symptoms in the early stage, but it will also be stable after removing the pathogenic ingredient. Most of patients may be "cured" by appropriate conservative medication and stopping drinking. Contrary, inappropriate surgery may "trigger" the acute ischemia which results in obstruction rapidly. We hope our colleagues pay attention to the unique lesion and make early diagnosis and treatment.
Topics: Adult; Aged; Colitis, Ischemic; Colon; Female; Humans; Intestinal Mucosa; Male; Mesenteric Veins; Middle Aged; Sclerosis
PubMed: 32927306
DOI: 10.1016/j.prp.2020.153193 -
Vascular and Endovascular Surgery Jan 2019Acute mesenteric ischemia is a rare disease entity associated with high morbidity and mortality. Disparate etiologies and nonspecific symptoms make the diagnosis... (Review)
Review
OBJECTIVE:
Acute mesenteric ischemia is a rare disease entity associated with high morbidity and mortality. Disparate etiologies and nonspecific symptoms make the diagnosis challenging and often result in delayed diagnosis and intervention. Open laparotomy with mesenteric revascularization and resection of necrotic bowel has been considered the gold standard of care. With recent advances in percutaneous catheter-directed techniques, multiple retrospective studies have demonstrated the outcomes of endovascular therapy. Herein, we review the etiology, presentation, and diagnosis of acute mesenteric ischemia with contemporary outcomes associated with both open and endovascular treatments.
METHODS:
The PubMed electronic database was queried in the English language using the search words mesenteric, acute ischemia, embolism, thromboembolism, thrombosis, revascularization, and endovascular in various combinations. Abstracts of the relevant titles were examined to confirm their relevance and the full articles then extracted. References from extracted articles were checked for any additional relevant articles. This systematic review encompassed literature for the past 5 years (between 2011 and 2016).
RESULTS:
Early diagnosis and intervention improves acute mesenteric ischemia outcomes. Early restoration of mesenteric flow minimizes morbidity and mortality. In comparison to open laparotomy with mesenteric revascularization and resection of necrotic bowel, several retrospective studies using administrative data and single-center chart reviews demonstrate noninferior outcomes of an endovascular first approach in acute arterial mesenteric occlusion.
CONCLUSIONS:
For acute mesenteric arterial occlusive disease, both endovascular and open revascularization techniques are viable options. Although there is lack of level 1 evidence, single-center retrospective studies and administrative database studies demonstrated that an endovascular first approach may have improved outcomes in the immediate postoperative period. However, selection and other bias in these studies necessitate the need for definitive randomized prospective studies between endovascular and open mesenteric intervention. In contrast, mesenteric venous thrombosis may be treated with systemic anticoagulation without surgical revascularization. Catheter-directed thrombectomy and thrombolysis can be considered at the discretion of the clinician.
Topics: Acute Disease; Anticoagulants; Clinical Decision-Making; Computed Tomography Angiography; Endovascular Procedures; Humans; Mesenteric Arteries; Mesenteric Ischemia; Mesenteric Vascular Occlusion; Mesenteric Veins; Patient Selection; Phlebography; Risk Factors; Splanchnic Circulation; Thrombolytic Therapy; Treatment Outcome; Vascular Surgical Procedures; Venous Thrombosis
PubMed: 30360689
DOI: 10.1177/1538574418805228 -
Surgery Sep 2023Idiopathic myointimal hyperplasia of the mesenteric veins is an extremely rare non-thrombotic mesenteric veno-occlusive disease. The management of idiopathic myointimal... (Review)
Review
BACKGROUND
Idiopathic myointimal hyperplasia of the mesenteric veins is an extremely rare non-thrombotic mesenteric veno-occlusive disease. The management of idiopathic myointimal hyperplasia of the mesenteric veins is not well-established, and although surgery is the mainstay of treatment, the optimal operation remains unclear. Therefore, we aimed to perform a systematic review to assess the various surgical procedures and associated outcomes for patients with idiopathic myointimal hyperplasia of the mesenteric veins.
METHODS
A systematic search for articles published from 1946 to April 2022 in MEDLINE, EMBASE, Cinahl, Scopus, Web of Science, and Cochrane Library databases is reported. In addition, we report 4 cases of idiopathic myointimal hyperplasia of the mesenteric veins managed at our institution until March 2023.
RESULTS
A total of 53 studies and 88 patients with idiopathic myointimal hyperplasia of the mesenteric veins were included. Most (82%) were male patients, with a mean age of 56.6 years old. The majority (99%) of patients required surgery. Most reports described the involvement of the rectum and sigmoid colon (81%). The most common surgical procedures were Hartmann's procedure (24%) and segmental colectomy (19%); completion proctectomy with ileal pouch-anal anastomosis was performed in 3 (3.4%) cases. In 6 (6.8%) cases, idiopathic myointimal hyperplasia of the mesenteric veins was suspected preoperatively and managed with elective surgery. Four (4.5%) complications were reported. Nearly all (99%) patients achieved remission with surgical intervention.
CONCLUSION
Idiopathic myointimal hyperplasia of the mesenteric veins is a rare pathologic entity infrequently suspected preoperatively and typically diagnosed after surgical resection. Surgical resection with Hartmann's procedure or segmental colectomy was most commonly performed, with completion proctectomy and ileal pouch-anal anastomosis reserved for cases of extensive rectal involvement. Surgical resection was safe and effective, with a low risk of complications and recurrence. Surgical decision-making should be based on the extent of the disease at the time of presentation.
Topics: Humans; Male; Middle Aged; Female; Hyperplasia; Mesenteric Veins; Colon, Sigmoid; Vascular Diseases; Colectomy
PubMed: 37301609
DOI: 10.1016/j.surg.2023.04.014 -
RoFo : Fortschritte Auf Dem Gebiete Der... Mar 2017
Topics: Aged; Colitis, Ischemic; Computed Tomography Angiography; Diagnosis, Differential; Humans; Male; Mesenteric Veins; Radiographic Image Enhancement
PubMed: 28264212
DOI: 10.1055/s-0042-118958 -
Journal of Vascular Surgery Feb 2015
Topics: Adenocarcinoma; Female; Hepatic Artery; Humans; Male; Mesenteric Veins; Pancreatectomy; Pancreatic Neoplasms; Pancreaticoduodenectomy; Portal Vein; Plastic Surgery Procedures; Vascular Surgical Procedures
PubMed: 25619575
DOI: 10.1016/j.jvs.2014.09.004 -
RoFo : Fortschritte Auf Dem Gebiete Der... Sep 2021
Topics: Humans; Mesenteric Ischemia; Mesenteric Veins; Neoplasms; Portal Vein; Thrombosis
PubMed: 33772499
DOI: 10.1055/a-1409-0387 -
Abdominal Radiology (New York) Apr 2019Extrahepatic portal vein obstruction (EHPVO) is the most common cause of upper gastrointestinal bleeding in children. It is defined as thrombosis of the extrahepatic... (Review)
Review
Extrahepatic portal vein obstruction (EHPVO) is the most common cause of upper gastrointestinal bleeding in children. It is defined as thrombosis of the extrahepatic portal vein with or without extension to the intrahepatic portal veins. The Meso-Rex shunt is the gold standard treatment in children with favorable anatomy since it restores physiological portal liver reperfusion. This is achieved by rerouting the splanchnic venous blood through an autologous graft from the superior mesenteric vein (SMV) into the Rex recess of the left portal vein, curing portal hypertension by doing so. General and hepatobiliary radiologists must be familiar with multimodality imaging appearances of EHPVO and with the role of imaging in identifying suitable candidates for Meso-Rex bypass surgery. Imaging might also detect complications of this procedure, some of which might be treated via interventional radiology.
Topics: Diagnostic Imaging; Humans; Mesenteric Veins; Multimodal Imaging; Portal Vein; Portasystemic Shunt, Surgical; Venous Thrombosis
PubMed: 30467724
DOI: 10.1007/s00261-018-1836-1 -
World Journal of Surgery Mar 2018Mesenteric vessels, including the superior mesenteric artery (SMA) and vein (SMV), provide and drain the rich blood supply of the midgut and hindgut. SMA and SMV... (Review)
Review
Mesenteric vessels, including the superior mesenteric artery (SMA) and vein (SMV), provide and drain the rich blood supply of the midgut and hindgut. SMA and SMV injuries are rare and often lethal. Clinical management of these injuries is not well established, but treatment options include operative, non-operative, and endovascular strategies. A narrative review of the literature was conducted using MEDLINE Complete-EBSCO. Relevant studies, specifically those focusing on diagnosis and management of SMA and SMV injuries, were selected. Only original reports and collected series were selected to prevent duplication of cases. A search of the literature for mesenteric arterial injuries yielded 87 studies. Vessel-specific breakdown of the studies yielded 40 with SMA injuries and 41 with SMV injuries. These searches were winnowed to 26 individual studies, which were included in this collective review. Limitations of this study are similar to all narrative literature reviews: the dependence on previously published research and availability of references as outlined in our methodology. Although historically rare, mesenteric vessel injuries are seen with increasing incidence and continue to present a challenge to trauma surgeons due to their daunting mortality rates. Currently, universal treatment guidelines do not exist, but the various options for their management have been extensively reviewed in the literature.
Topics: Endovascular Procedures; Humans; Ligation; Mesenteric Artery, Superior; Mesenteric Veins; Traumatology; Vascular System Injuries
PubMed: 28875279
DOI: 10.1007/s00268-017-4212-3 -
BMJ Case Reports Dec 2022A man in his 40s presented with a 7-day history of fever and abdominal pain after polypectomy of the sigmoid colon. On physical examination, he had mild tenderness on...
A man in his 40s presented with a 7-day history of fever and abdominal pain after polypectomy of the sigmoid colon. On physical examination, he had mild tenderness on deep palpation of the left lower abdominal quadrants without guarding, rigidity or rebound tenderness. Contrast-enhanced CT revealed the thrombosis of the inferior mesenteric vein and the portal vein. Blood cultures were positive for We diagnosed him with pylephlebitis after colonic polypectomy, as a rare complication. He was started on cefmetazole and heparin. Antibiotic and anticoagulation therapy were initiated. He had a complete recovery within 17 days. The patient had no evidence of underlying hypercoagulable condition, and no signs of recurrence at a 3-month follow-up. Pylephlebitis after colonic polypectomy is extremely rare. Although bacteraemia after colonoscopy was a rare complication, phlebitis should be considered in the differential diagnosis of patients who present with persisted fever and abdominal pain after polypectomy.
Topics: Male; Humans; Colon, Sigmoid; Phlebitis; Mesenteric Veins; Portal Vein; Abdominal Pain
PubMed: 36524262
DOI: 10.1136/bcr-2022-253095 -
Frontiers in Immunology 2018Many parasitic worms possess complex and intriguing life cycles, and schistosomes are no exception. To exit the human body and progress to their successive snail host,... (Review)
Review
Many parasitic worms possess complex and intriguing life cycles, and schistosomes are no exception. To exit the human body and progress to their successive snail host, eggs must migrate from the mesenteric vessels, across the intestinal wall and into the feces. This process is complex and not always successful. A vast proportion of eggs fail to leave their definite host, instead becoming lodged within intestinal or hepatic tissue, where they can evoke potentially life-threatening pathology. Thus, to maximize the likelihood of successful egg passage whilst minimizing host pathology, intriguing egg exit strategies have evolved. Notably, schistosomes actively exert counter-inflammatory influences on the host immune system, discreetly compromise endothelial and epithelial barriers, and modulate granuloma formation around transiting eggs, which is instrumental to their migration. In this review, we discuss new developments in our understanding of schistosome egg migration, with an emphasis on and the intestine, and outline the host-parasite interactions that are thought to make this process possible. In addition, we explore the potential immune implications of egg penetration and discuss the long-term consequences for the host of unsuccessful egg transit, such as fibrosis, co-infection and cancer development.
Topics: Animals; Antigens, Helminth; Disease Models, Animal; Endothelium, Vascular; Feces; Host-Parasite Interactions; Humans; Intestinal Mucosa; Mesenteric Arteries; Mesenteric Veins; Ovum; Peyer's Patches; Schistosoma mansoni
PubMed: 30619372
DOI: 10.3389/fimmu.2018.03042