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Journal of Medical Case Reports Jul 2017Mesenteric cyst is a rare clinical entity especially in pregnancy; therefore, few cases have been reported in the literature. The standard method of their treatment is... (Review)
Review
BACKGROUND
Mesenteric cyst is a rare clinical entity especially in pregnancy; therefore, few cases have been reported in the literature. The standard method of their treatment is surgical excision either with laparotomy or laparoscopy. In addition, mesenteric vein thrombosis is a rare and life-threatening condition in pregnancy and needs immediate treatment because it can lead to intestinal necrotic ischemia. This is the first report of the coexistence of mesenteric cysts and mesenteric vein thrombosis during gestation.
CASE PRESENTATION
A 27-year-old Greek woman, gravida 2 para 1, presented at 10 weeks' gestation to the Emergency Unit of our hospital complaining of diffuse abdominal pain which deteriorated the last 3 days, which was localized in her right iliac fossa, along with vomiting. She had undergone open laparotomy and right salpingo-oophorectomy at the age of 23 due to an ovarian cyst. Besides this, her personal and family medical history was unremarkable. She had never received oral contraceptives or any hormone therapy. On arrival, a clinical examination revealed tenderness on palpation of her right iliac fossa, without rebound tenderness or muscle guarding. Within 10 hours of hospitalization, her symptoms deteriorated further with rebound tenderness during the examination, tachycardia, and a drop of 12 units in her hematocrit value. An emergency laparotomy was performed. Two mesenteric cysts and a 60 cm necrotic part of her intestine were revealed intraoperatively. In the postoperative period, she complained of acute abdominal pain, tachycardia, and dyspnea. Computed tomography imaging revealed mesenteric vein thrombosis and pulmonary thromboembolism. She was treated with low molecular weight heparin and she was discharged on the 11th postoperative day.
CONCLUSIONS
To the best of our knowledge, this is the first report in the literature of a simultaneous mesenteric cyst and mesenteric vein thrombosis in pregnancy. It is known that pregnancy is a state of hypercoagulation and clinicians should bear in mind this rare clinical condition in their diagnostic algorithm for acute abdominal pain.
Topics: Abdominal Pain; Abortion, Spontaneous; Adult; Factor Xa Inhibitors; Female; Heparin; Humans; Laparotomy; Mesenteric Cyst; Mesenteric Ischemia; Mesenteric Veins; Pregnancy; Rivaroxaban; Treatment Outcome; Vomiting
PubMed: 28683785
DOI: 10.1186/s13256-017-1320-5 -
Journal of Visceral Surgery Jun 2024
Topics: Humans; Pancreaticoduodenectomy; Portal Vein; Mesenteric Veins; Pancreatic Neoplasms
PubMed: 38653654
DOI: 10.1016/j.jviscsurg.2024.04.003 -
BioMed Research International 2017Nutcracker syndrome (NCS) is the most common term for compression of the left renal vein between the superior mesenteric artery and the abdominal aorta. The development... (Review)
Review
Nutcracker syndrome (NCS) is the most common term for compression of the left renal vein between the superior mesenteric artery and the abdominal aorta. The development of NCS is associated with the formation of the left renal vein (LRV) from the aortic collar during the sixth to eighth week of gestation and abnormal angulation of the superior mesenteric artery from the aorta. Collateralization of venous circulation is the most significant effect of NCS. It includes mainly the left gonadal vein and the communicating lumbar vein. Undiagnosed NCS may affect retroperitoneal surgery and other radiological and vascular procedures. The clinical symptoms of NCS may generally be described as renal presentation when symptoms like haematuria, left flank pain, and proteinuria occur, but urologic presentation is also possible. Radiological methods of confirming NCS include Doppler ultrasonography as a primary test, retrograde venography, which can measure the renocaval pressure gradient, computed tomography angiography, which is faster and less traumatic, intravascular ultrasound, and magnetic resonance angiography. Treatment can be conservative or surgical, depending on the severity of symptoms and degree of LRV occlusion. Nutcracker syndrome is worth considering especially in differential diagnosis of haematuria of unknown origin.
Topics: Anatomists; Aorta, Abdominal; Humans; Renal Nutcracker Syndrome; Renal Veins
PubMed: 29376066
DOI: 10.1155/2017/1746570 -
World Journal of Hepatology May 2024Non-cirrhotic non-malignant portal vein thrombosis (NCPVT) is an uncommon condition characterised by thrombosis of the portal vein, with or without extension into other... (Review)
Review
Non-cirrhotic non-malignant portal vein thrombosis (NCPVT) is an uncommon condition characterised by thrombosis of the portal vein, with or without extension into other mesenteric veins, in the absence of cirrhosis or intra-abdominal malignancy. Complications can include intestinal infarction, variceal bleeding and portal biliopathy. In this article, we address current concepts in the management of NCPVT including identification of risk factors, classification and treatment, and review the latest evidence on medical and interventional management options.
PubMed: 38818283
DOI: 10.4254/wjh.v16.i5.751 -
Journal of Surgical Case Reports Jan 2021Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is caused by proliferation of smooth muscle cells in the wall of small mesenteric veins and venules...
Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is caused by proliferation of smooth muscle cells in the wall of small mesenteric veins and venules with accumulation of a proteoglycan matrix leading to a non-thrombotic, non-inflammatory venous occlusion resulting in venous ischemia. IMHMV is a rare and poorly understood disease, with <20 case reports in the literature. The purpose of this report is to describe the case of a 63-year-old man who presented with this condition that resulted in colonic ischemia necessitating surgical resection. The cause of IMHMV in this patient was attributed to a Chinese herbal supplement used for degenerative osteoarthritis of the knees. A brief review of the literature is provided along with the case report.
PubMed: 33532048
DOI: 10.1093/jscr/rjaa453 -
Innovative Surgical Sciences Mar 2022Pneumatosis intestinalis is a rare condition with subserosal or submucosal gas-filled cysts of the gastrointestinal tract. It is often associated with acute mesenteric...
OBJECTIVES
Pneumatosis intestinalis is a rare condition with subserosal or submucosal gas-filled cysts of the gastrointestinal tract. It is often associated with acute mesenteric ischemia, but also non-ischemic causes are described.
CASE PRESENTATION
A 27-year-old male patient with severe congenital spastic tetraparesis presented to the emergency room with fever and reduced general condition. The patient was hypotonic and tachycardic, had a fever up to 39.7 °C and reduced peripheral oxygen saturation. The laboratory analyses revealed leukocytosis (16.7 G/L) and elevated CRP (162 mg/L).The patient was admitted to the intensive care unit (ICU) for invasive ventilator treatment because of global respiratory insufficiency and antibiotic therapy due to acute pneumonia and severe acute respiratory distress syndrome (ARDS). In addition, he suffered from colonic pseudo-obstruction but with persistent stool passage. After pulmonary recovery, he was transferred to the normal ward of internal medicine, but signs of colonic pseudo-obstruction were still present.Under therapy with diatrizoic acid and neostigmine, the abdomen was less distended, and the patient had regular bowel movements. After four days, the patient developed sudden acute abdominal pain and suffered sudden pulseless electrical activity. Immediate cardiopulmonary resuscitation was provided. After the return of spontaneous circulation, the patient underwent computed tomography (CT) and was re-admitted to the ICU. The CT scan showed massive dilatation of the colon, including pneumatosis coli, extensive gas formation within the mesenteric veins and arteries, including massive portal gas in the liver, the splenic vein, the renal veins, and disruption of abdominal aortic perfusion. The patient was then first presented for surgical evaluation, but due to futile prognosis, treatment was ceased on the ICU.
CONCLUSIONS
In conclusion, colonic pseudo-obstruction might have led to colonic necrosis and consecutive massive gas formation within the mesenteric vessels. Therefore, intestinal passage should be restored as soon as possible to avoid possible mortality.
PubMed: 35974773
DOI: 10.1515/iss-2021-0031 -
Medicine Oct 2021Idiopathic myointimal hyperplasia of mesenteric veins (IMHMV) is an uncommon cause of ischemic bowel disease resulting from the proliferation of smooth muscles in the...
INTRODUCTION
Idiopathic myointimal hyperplasia of mesenteric veins (IMHMV) is an uncommon cause of ischemic bowel disease resulting from the proliferation of smooth muscles in the venous intima. Delayed diagnosis could only be made following the surgical resection due to lack of imaging data, which may lead to bowel severe bleeding, perforation, necrosis, infection, or shock. In previous reports, few cases have provided the detailed pre-operative radiological characteristics of IMHMV. Herein, we are the first to provide the complete clinical course and comprehensive pre-operative radiological data of a 21-year-old female diagnosed with IMHMV.
PATIENT CONCERNS
A 21-year-old female was admitted to our hospital with bloody diarrhea and abdominal pain. Physical examination revealed tenderness localized to the left lower abdomen. The patient had no prior history of similar symptoms. A computed tomography scan was performed and showed diffuse wall thickening from the rectum to sigmoid colon with poor mural enhancement, multiple ulcers, fat stranding, and free fluid. The arterial phase images demonstrated many tortuous pericolic arteries and submucosal pseudoaneurysm.
INTERVENTION
Conservative treatment including empirical antibiotics, Mesalazine, and methylprednisolone sodium succinate were administrated to relief the symptoms. However, the diarrhea and abdominal pain worsened. An emergency surgery was arranged and total proctocolectomy with ileal pouchanal anastomosis with ileostomy was performed.
DIAGNOSIS
Macroscopic and histopathological examinations of the excised specimen showed ischemic colitis. Elastica van Gieson staining revealed extensive myointimal hyperplasia and confirmed the diagnosis of IMHMV.
OUTCOMES
During the 2-year follow-up period, no additional medical management was needed. The patient was well and surveillance colonoscopy showed normal colon and anastomosis.
CONCLUSION
Pre-operative computed tomography with imaging features including pronounced continuous concentric thickening colonic wall with poor enhancement and enlarged tortuous pericolic arteries could specifically facilitate the speedy diagnosis of IMHMV.
Topics: Colitis, Ischemic; Female; Humans; Hyperplasia; Mesenteric Veins; Vascular Diseases; Young Adult
PubMed: 34678900
DOI: 10.1097/MD.0000000000027574 -
Journal of Animal Science Apr 2018Prior work using a contractility bioassay determined that the serotonin (5-HT) receptor subtype 5-HT2A is present in bovine lateral saphenous veins and plays a role in...
Prior work using a contractility bioassay determined that the serotonin (5-HT) receptor subtype 5-HT2A is present in bovine lateral saphenous veins and plays a role in ergot alkaloid (EA)-induced vascular contraction in steers grazing endophyte-infected (Epichloë coenophiala) tall fescue (Lolium arundinaceum). Ergot alkaloids have also been shown to be vasoactive in bovine gut vasculature. To determine what 5-HT receptors are involved in vasoconstriction of gut vasculature, contractility of ruminal and mesenteric arteries and veins collected from cattle was evaluated in the presence of agonists selective for 5-HT1B (CP 93129), 5-HT1D (L-694, 247), 5-HT2A (TCB-2), 5-HT2B (BW 723C86), 5-HT4 (BIMU-8), and 5-HT7 (LP 44) receptors. Segments of ruminal and mesenteric veins and arteries were collected and suspended in a multimyograph containing continuously oxygenated Krebs-Henseleit buffer. Blood vessels were exposed to increasing concentrations of 5-HT agonists every 15 min and contractile response data were normalized as a percentage of the maximum contractile response induced by 120 mM KCl. Analysis of variance was evaluated using mixed models procedure of SAS for effects of agonist concentration for each vessel type. Receptor agonists for 5-HT2B, 5-HT1D, and 5-HT7 did not induce a contractile response for ruminal or mesenteric vasculature (P > 0.05). However, when exposed to agonists for 5-HT2B or 5-HT1D, mesenteric veins relaxed below zero (P < 0.05). Exposure of all 4 blood vessel types to 5-HT2A agonist induced contractile responses (P < 0.05). The findings of this study indicate that 5-HT1D and 5-HT2B are present in mesenteric veins and may play a role in vasorelaxation. Further, 5-HT2A is present in ruminal and mesenteric vasculature, plays a role in vasoconstriction of these vessels, and could be influenced by EA exposure as has been demonstrated in peripheral blood vessels.
Topics: Animals; Cattle; Endophytes; Epichloe; Ergot Alkaloids; Festuca; Male; Mesenteric Arteries; Mesenteric Veins; Receptors, Serotonin; Saphenous Vein; Serotonin; Vasoconstriction; Vasodilation
PubMed: 29471490
DOI: 10.1093/jas/sky038 -
BMC Medical Imaging Aug 2021Estimating the prognosis of patients with pneumatosis intestinalis (PI) and porto-mesenteric venous gas (PMVG) can be challenging. The purpose of this study was to...
BACKGROUND
Estimating the prognosis of patients with pneumatosis intestinalis (PI) and porto-mesenteric venous gas (PMVG) can be challenging. The purpose of this study was to refine prognostication to improve decision making in daily clinical routine.
METHODS
A total of 290 patients with confirmed PI were included in the final analysis. The presence of PMVG and mortality (90d follow-up) were evaluated with regard to the influence of possible risk factors. Furthermore, a linear estimation model was devised combining significant parameters to calculate accuracies for predicting death in patients undergoing surgery by means of a defined operation point (ROC-analysis).
RESULTS
Overall, 90d mortality was 55.2% (160/290). In patients with PI only, mortality was 46.5% (78/168) and increased significantly to 67.2% (82/122) in combination with PMVG (median survival: PI: 58d vs. PI and PMVG: 41d; p < 0.001). In the entire patient group, 53.5% (155/290) were treated surgically with a 90d mortality of 58.8% (91/155) in this latter group, while 90d mortality was 51.1% (69/135) in patients treated conservatively. In the patients who survived > 90d treated conservatively (24.9% of the entire collective; 72/290) PMVG/PI was defined as "benign"/reversible. PMVG, COPD, sepsis and a low platelet count were found to correlate with a worse prognosis helping to identify patients who might not profit from surgery, in this context our calculation model reaches accuracies of 97% specificity, 20% sensitivity, 90% PPV and 45% NPV.
CONCLUSION
Although PI is associated with high morbidity and mortality, "benign causes" are common. However, in concomitant PMVG, mortality rates increase significantly. Our mathematical model could serve as a decision support tool to identify patients who are least likely to benefit from surgery, and to potentially reduce overtreatment in this subset of patients.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Decision Support Techniques; Embolism, Air; Female; Humans; Male; Mesenteric Veins; Middle Aged; Overtreatment; Pneumatosis Cystoides Intestinalis; Prognosis; Proportional Hazards Models; Regression Analysis; Retrospective Studies; Risk Factors; Sensitivity and Specificity
PubMed: 34429069
DOI: 10.1186/s12880-021-00651-y