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The American Surgeon Dec 2023Nutcracker syndrome (NCS) is the clinical manifestation of unilateral renal venous hypertension. It develops secondary to the nutcracker phenomenon caused by compression...
Nutcracker syndrome (NCS) is the clinical manifestation of unilateral renal venous hypertension. It develops secondary to the nutcracker phenomenon caused by compression of the left renal vein between the superior mesenteric artery and the aorta. We present the case of a 43-year-old female with a history of left flank pain, pelvic congestion, and hematuria secondary to NCS. The patient frequently required high-dose non-steroidal anti-inflammatory medications with minimal relief. She initiated a kidney donor evaluation after electing to undergo a nephrectomy for the possible long-term resolution of NCS symptoms. If diagnosed early, NCS does not generate pathology within the kidney. This finding allows an individual with medically refractory NCS to avoid the morbidity of a complex surgical procedure by instead donating their kidney. Attention to this treatment modality could provide individuals with NCS resolution of symptoms while providing someone with end-stage renal disease with a life-saving organ.
Topics: Female; Humans; Adult; Renal Nutcracker Syndrome; Kidney; Renal Veins; Nephrectomy; Mesenteric Artery, Superior; Hypertension
PubMed: 35856905
DOI: 10.1177/00031348221117043 -
JGH Open : An Open Access Journal of... Jan 2024Idiopathic mesenteric phlebosclerosis (IMP) is characterized by mesenteric vein calcification and ischemic bowel disease. We describe a unique clinical case of IMP in a...
Idiopathic mesenteric phlebosclerosis (IMP) is characterized by mesenteric vein calcification and ischemic bowel disease. We describe a unique clinical case of IMP in a patient with a history of oral administration of various drugs, including traditional Chinese medicines (mainly selfheal), vitamin D, and calcium supplements. The disease was not diagnosed in its early stages and was later detected because of the initial symptoms of chest tightness and difficulties in swallowing. During medical examination, esophageal venous sinuses were found through gastroscopy, and CT revealed thickening and widespread calcification of the colonic wall (esophageal wall calcification). Moreover, typical purple-brown changes in the colonic mucosa were found during colonoscopy. Microscopic examination showed more foam phagocyte, focal lymphocyte aggregation, small-vessel proliferation, and surrounding collagen-like deposition which is a typical finding of IMP. More specifically, the patient's mesenteric veins and colon veins were calcified, and the calcification extended to the esophageal veins. These findings were related to long-term use of traditional Chinese medicines (mainly selfheal). It is possible that excessive intake vitamin D and calcium supplementation may have played a role in the occurrence of vascular calcification, which might have exacerbated the progression of IMP disease.
PubMed: 38268963
DOI: 10.1002/jgh3.13027 -
Journal of Vascular Surgery. Venous and... Jan 2024We evaluated the effect of left renal vein (LRV) compression stenosis on the functional state of the left kidney in patients with pelvic venous disorders (PeVDs).
OBJECTIVE
We evaluated the effect of left renal vein (LRV) compression stenosis on the functional state of the left kidney in patients with pelvic venous disorders (PeVDs).
METHODS
We examined 162 female patients with PeVD and diagnosed LVR compression stenosis using duplex ultrasound (DUS) in 40. Patients with clinical manifestations of PeVD (n = 26) had symptoms and signs of pelvic venous congestion but without pain in the left flank of the abdomen, typical for nutcracker syndrome (NS). The remaining patients were asymptomatic (n = 14). The parameters measured with DUS included the angle of the superior mesenteric artery (SMA) with the aorta, the LRV diameter (D/D) ratio, and LRV velocity (V/V) ratio. All the patients underwent laboratory testing (complete blood count, urinalysis, and biochemical blood testing) and dynamic renal scintigraphy to assess the secretory and evacuation functions of the renal tubular system.
RESULTS
The laboratory tests revealed no abnormalities, including no hematuria or proteinuria, in either group. The D/D and V/V ratios varied from 2.8 to 5.2 and from 2.9 to 8.3, respectively, and did not differ between the symptomatic and asymptomatic patients. All 40 patients with LRV compression stenosis were diagnosed with left gonadal vein reflux with a mean duration of 4.7 ± 0.6 seconds and 2.2 ± 0.6 seconds in the symptomatic and asymptomatic patients, respectively (P = .005). Eight patients had signs of NS on DUS, including five in the symptomatic group (SMA angle, 34.8° ± 2.7°; D/D ratio, 5.2 ± 0.2; and V/V ratio, 5.7 ± 0.4) and three in the asymptomatic group (SMA angle, 35° ± 2.8°; D/D ratio, 5; and V/V ratio, 5 ± 0.5). The groups did not differ significantly in the DUS parameters. Scintigraphy did not reveal any cases of secretory or evacuation dysfunction of the left kidney, including in the patients with DUS signs of NS. The maximum uptake time, elimination half-life, and effective renal plasma flow were within the normal ranges.
CONCLUSIONS
LRV compression stenosis without hematuria has no significant effects on the functional state of the left kidney, irrespective of the disease severity. In patients with PeVDs, dynamic renal scintigraphy provides an objective assessment of left kidney function.
Topics: Humans; Female; Renal Veins; Constriction, Pathologic; Functional Status; Vascular Diseases; Kidney; Pelvic Pain; Hematuria
PubMed: 37625506
DOI: 10.1016/j.jvsv.2023.08.009 -
Radiology Case Reports Nov 2023Pylephlebitis, a septic thrombophlebitis of the portal vein, is an uncommon but serious complication following an abdominal site of infection, most frequently...
Pylephlebitis, a septic thrombophlebitis of the portal vein, is an uncommon but serious complication following an abdominal site of infection, most frequently diverticulitis or appendicitis. It has a high mortality rate, yet it commonly presents with unspecific abdominal complaints and fever, making diagnosis by clinical and laboratory examinations alone, impossible. This report highlights the extensive computed tomography (CT) findings of pylephlebitis with multiple hepatic abscesses thought to be secondary to diverticulitis, in a patient presenting with septic shock. Radiological characteristics differentiating the liver lesions from malignancy, and showing the ascending pathway of vascular involvement from the inferior mesenteric vein to portal veins is presented, as well as the search for the primary site of infection. Recognizing and understanding the imaging findings in pylephlebitis is crucial for diagnosis and avoiding delay of appropriate treatment for this otherwise often fatal condition.
PubMed: 37663570
DOI: 10.1016/j.radcr.2023.08.054 -
Medicine Mar 2024Idiopathic mesenteric phlebosclerosis (IMP) is a rare gastrointestinal disease with unclear etiology and pathogenesis. IMP occurring in a patient with liver cirrhosis is...
BACKGROUND
Idiopathic mesenteric phlebosclerosis (IMP) is a rare gastrointestinal disease with unclear etiology and pathogenesis. IMP occurring in a patient with liver cirrhosis is more scarcely reported than independent IMP. In this study, we reported a case of IMP occurring in a patient with liver cirrhosis, so as to provide a reference for understanding liver cirrhosis with IMP.
METHOD
A 63-year-old man with liver cirrhosis was admitted in the hospital's department of infectious disease because of fatigue and constipation for 1 month. The patient had an irregular medical history of antivirus drug and Chinese herbal medicine intake because of the hepatitis B virus infection. No other abnormalities were found in the functions of the liver, coagulation, renal, or complete blood count. Fecal occult blood tests were all positive in 5 detections. Contrast-enhanced computed tomography revealed liver cirrhosis and showed thickening of the wall of the right hemicolon and multiple calcifications of the mesenteric veins. Mesenteric vein computed tomography venography displayed diffuse colon mural thickening of the right colon and tortuous linear calcification line in the right colic veins. Colonoscopy revealed a purple-blue, swollen, rough, and vanished vascular texture mucosa. He was finically diagnosed as liver cirrhosis with IMP by a series of examinations during hospitalization.
RESULTS
His symptoms of fatigue and constipation subsided after conservative treatment and withdraw from Chinese herbal medicine. The patient experienced no obvious discomfort during the follow-up period.
CONCLUSION
A comprehensive medical diagnosis is necessary for the discovery of IMP, especially IMP with liver cirrhosis. Liver cirrhosis maybe play a key role in the development of IMP. The regulatory mechanism of liver cirrhosis contributing to IMP needs to be further studied based on more clinical cases.
Topics: Male; Humans; Middle Aged; Drugs, Chinese Herbal; Colon; Colonoscopy; Calcinosis; Liver Cirrhosis; Constipation
PubMed: 38489674
DOI: 10.1097/MD.0000000000037608 -
BMJ Case Reports Dec 2023Colonic self-expanding metal stents (SEMSs) are commonly used to treat large bowel obstruction due to gastrointestinal malignancy with great success. While mortality is...
Colonic self-expanding metal stents (SEMSs) are commonly used to treat large bowel obstruction due to gastrointestinal malignancy with great success. While mortality is negligible, morbidity from both early and late complications can be significant. Stent perforation, erosion and migration are the most feared complications. We present the first reported case of wire-associated colon perforation with placement and migration of an SEMS into the inferior mesenteric vein (IMV). A man in his early 60s presented with a large bowel obstruction due to a colorectal mass. He underwent endoscopic colonic SEMS placement for colonic decompression. The stent was later found to be within the IMV, requiring a colon resection and retrieval of the stent.
Topics: Humans; Male; Colonic Diseases; Colorectal Neoplasms; Intestinal Obstruction; Mesenteric Veins; Palliative Care; Retrospective Studies; Stents; Treatment Outcome; Middle Aged
PubMed: 38123323
DOI: 10.1136/bcr-2023-256786 -
Cureus Aug 2023Nutcracker syndrome (NCS) is an uncommon condition that predominantly affects the left renal vein (LRV) because of its entrapment between the aorta and superior...
Nutcracker syndrome (NCS) is an uncommon condition that predominantly affects the left renal vein (LRV) because of its entrapment between the aorta and superior mesenteric vein. It can result in pain in the left flank or back, hematuria, and proteinuria. May-Thurner syndrome (MTS) is described as a condition in which the left common iliac vein is compressed by the right common iliac artery, causing swelling, fullness, venous ulcers, or varicose veins in the leg. We present a case of a 77-year-old female who had these symptoms for over a decade, until she was diagnosed in 2017. Initially, she experienced swelling and pain in her left leg, which began in 2005; however, treatment did not begin until she had her left ovarian vein embolized in 2017. Her symptoms returned the following year, leading to the diagnosis of bilateral MTS. Owing to recurring symptoms in 2022, a repeat venogram revealed bilateral external iliac vein constriction, requiring intervention. She presented to our clinic in 2023 after being referred by her cardiologist because of persistent back pain and venous congestion. This led to the findings and diagnosis of NCS with bilateral MTS.
PubMed: 37746485
DOI: 10.7759/cureus.43996 -
The American Journal of Case Reports Jul 2023BACKGROUND Patients cured of Hodgkin lymphoma (HL) are at increased risk of second malignancies, such as lung, breast, and colon cancer. Isolated metastasis of these...
BACKGROUND Patients cured of Hodgkin lymphoma (HL) are at increased risk of second malignancies, such as lung, breast, and colon cancer. Isolated metastasis of these malignancies to the vasculature is rare. We present a unique case of a patient cured of HL who developed colon cancer and later presented with an isolated metastases of colon cancer to the superior mesenteric vein. The patient is now in complete remission 5 years after surgical excision of the superior mesenteric vein metastases followed by chemotherapy. CASE REPORT A 56-year-old woman presented with a past medical history notable for stage III HL diagnosed at age 13 years that was treated by splenectomy, chemotherapy, and mantle with inverted Y radiation. She underwent a right nephrectomy at age 51 years for renal cell carcinoma. At age 56, an 8-cm mass in the transverse colon was found during surveillance imaging. She underwent right hemicolectomy for pathological stage IIA (T3N0M0) adenocarcinoma. A liver adenoma was identified a year later. Two years after hemicolectomy, an abdominal recurrence was identified, and she underwent a resection of a superior mesenteric vein mass with porto-mesenteric reconstruction. Pathology revealed metastatic colonic adenocarcinoma, 1 of 7 lymph nodes positive for cancer, and clear margins. She received 6 months of fluorouracil chemotherapy and remained free of recurrences for 5 years. CONCLUSIONS Isolated vascular recurrences of colon cancer can be cured with resection and systemic chemotherapy. Diagnosis and treatment of venous recurrences remains challenging owing to the lack or percutaneous access for biopsy and the difficulty of venous reconstruction.
Topics: Female; Humans; Adolescent; Middle Aged; Mesenteric Veins; Neoplasm Recurrence, Local; Colonic Neoplasms; Adenocarcinoma; Thrombosis
PubMed: 37403331
DOI: 10.12659/AJCR.939156 -
Internal Medicine (Tokyo, Japan) Oct 2023
Topics: Humans; Mesenteric Ischemia; Protein C Deficiency; Mesenteric Veins; Tomography, X-Ray Computed; Portal Vein
PubMed: 36889707
DOI: 10.2169/internalmedicine.1420-22 -
IJU Case Reports Nov 2023Venous hemorrhage from ectopic varices is potentially fatal. This report describes a rare case in which bleeding from mesenteric varices in an ileal conduit was treated...
INTRODUCTION
Venous hemorrhage from ectopic varices is potentially fatal. This report describes a rare case in which bleeding from mesenteric varices in an ileal conduit was treated successfully by embolization therapy.
CASE PRESENTATION
The patient was an 82-year-old man who had previously undergone total pelvic exenteration for colon cancer with creation of an ileal conduit for urinary diversion. He subsequently developed liver cirrhosis and underwent partial hepatectomy for hepatocellular carcinoma. 9 years after his colon surgery, he was admitted with gross hematuria. Computed tomography revealed subcutaneous mesenteric varices in the ileal conduit and hemorrhage as a result of rupture of the varices. The bleeding continued despite repeated manual compression but was eventually stopped by embolization therapy.
CONCLUSION
Embolization therapy may be helpful for hemostasis in the event of intractable bleeding from mesenteric varices in an ileal conduit.
PubMed: 37928295
DOI: 10.1002/iju5.12644