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ACG Case Reports Journal Sep 2022Splenopneumopexy is an anastomosis performed for patients with portal hypertension secondary to veno-occlusive disease of the portal, splenic, or mesenteric veins. We...
Splenopneumopexy is an anastomosis performed for patients with portal hypertension secondary to veno-occlusive disease of the portal, splenic, or mesenteric veins. We present a case of an adult gentleman who presented with melena and was found to have pseudoaneurysm almost 20 years after his procedure. We also describe the clinical, laboratory, endoscopic, and radiological workup conducted to diagnose and manage gastric bleeding in this rare complication.
PubMed: 36072360
DOI: 10.14309/crj.0000000000000862 -
Diagnostic and Interventional Imaging Nov 2022
Topics: Humans; Mesenteric Veins; Diverticulitis; Colon, Sigmoid; Sigmoid Diseases; Portal Vein
PubMed: 36266193
DOI: 10.1016/j.diii.2022.09.008 -
Updates in Surgery Oct 2022Vascular infiltration may jeopardize resection of the primary tumor and mesenteric metastatic masses in small-intestine neuroendocrine tumors (SI-NETs). However, other...
BACKGROUND
Vascular infiltration may jeopardize resection of the primary tumor and mesenteric metastatic masses in small-intestine neuroendocrine tumors (SI-NETs). However, other factors may play a role in predicting resectability.
METHODS
After computed tomography (CT) scan, three radiological parameters were considered: (1) degree of superior mesenteric artery involvement (SMA) according to a previous classification (2) degree of superior mesenteric venous involvement (SMV) as either absent, peripheral or proximal (3) presence or not of mesenteric fibrosis retraction (MF). Pre-surgical parameters were matched to surgical outcome.
RESULTS
Forty-nine consecutive patients were submitted to laparotomy. Of them, 37 had complete primary tumor and mesenteric masses resection. SMA (p = 0.001), SMV (p = 0.008), metastasis site (p = 0.001) and MF (p < 0.001) were all significantly associated with the likelihood to receive resection at univariate analysis. All the five patients with infiltration of SMV proximal to middle colic vein were unresectable. At multivariable analysis excluding SMA stage, the absence of MF (HR 13.1, I.C. 1.44-119; p = 0.002) was the only factor associated with the likelihood to receive primary tumor and mesentery radical surgery.
CONCLUSIONS
SMA stage 3-up and/or signs of MF, as well as infiltration of SMV proximal to middle colic vein at CT scan are predictive of operative failure in patients with SI-NETs. The assessment of such factors should be always considered in the decision-making process of such patients especially in those with asymptomatic disease with synchronous unresectable liver metastases.
Topics: Colic; Humans; Intestines; Mesenteric Veins; Mesentery; Neuroendocrine Tumors
PubMed: 35224681
DOI: 10.1007/s13304-022-01251-3 -
Revista Espanola de Patologia :... 2021Mesenteric arteriovenous vasculopathy (MAVD/V) is an extremely rare and poorly understood disease and its incidence is probably underestimated. It is an uncommon,...
Mesenteric arteriovenous vasculopathy (MAVD/V) is an extremely rare and poorly understood disease and its incidence is probably underestimated. It is an uncommon, non-inflammatory and non-atherosclerotic form of mesenteric vascular injury, first reported in 2016, with characteristic histopathologic evidence of fibromuscular dysplasia-like vascular changes. We present the case of a chronically ill 84-year-old female with a 5 year history of recurrent small bowel obstruction, who underwent segmental resection of the small bowel. Intraoperative examination showed bowel stricture with fibrosis, intraluminal pill fragments and creeping mesenteric adipose tissue clinically compatible with Crohn's disease. Histological examination showed acute and chronic mucosal injury characterized by crypt distortion, ulcerations with granulation tissue, pseudo-pyloric metaplasia, areas of fibrosis and serosal adhesions. Multiple blood vessels (including both veins and arteries) demonstrated wall hyalinization, elastic degeneration and non-atherosclerotic luminal occlusion. The pattern of the mucosal injury is, in this case, potentially a consequence of acute and chronic ischemic processes secondary to mesenteric arteriovenous vasculopathy.
Topics: Adipose Tissue; Aged, 80 and over; Arteries; Arteriovenous Malformations; Constriction, Pathologic; Crohn Disease; Diagnosis, Differential; Female; Humans; Intestinal Obstruction; Intestine, Small; Mesentery; Tomography, X-Ray Computed; Veins
PubMed: 33455689
DOI: 10.1016/j.patol.2020.05.009 -
Surgery Dec 2020
Topics: Humans; Mesenteric Veins; Pancreatectomy; Pancreatic Neoplasms; Portal Vein
PubMed: 32977974
DOI: 10.1016/j.surg.2020.08.004 -
Journal of Surgical Oncology Mar 2022Portal vein resection and reconstruction in locally advanced pancreatic cancer represents a potentially curative treatment in selected patients without increasing...
BACKGROUND
Portal vein resection and reconstruction in locally advanced pancreatic cancer represents a potentially curative treatment in selected patients without increasing surgical mortality. However, vascular reconstruction after segmental venous resection is challenging. The parietal peritoneum has emerged as a venous substitute but few reports include its use as a tubular graft. We report a retrospective series of portal vein reconstruction using a falciform ligament tubular graft during pancreaticoduodenectomy.
MATERIAL AND METHODS
Technical aspects and short-term morbidity and mortality after pancreaticoduodenectomy with falciform ligament tubular graft interposition were analyzed.
RESULTS
Among 21 patients who used parietal peritoneum for venous substitution between 2015 and 2019, eight underwent pancreaticoduodenectomy with venous resection and reconstruction using interposition of falciform ligament tubular graft. The mean duration of surgery and clamping time were 350 and 27 min, respectively. No perioperative blood transfusion was required. All the grafts were patent the day after surgery. No complication related to venous obstruction was detected during the hospital stay. Two patients had postoperative pancreatic fistula. No further intervention was needed. The 90-day mortality was null.
CONCLUSIONS
The use of interposition of falciform ligament tubular graft for portal venous reconstruction during pancreaticoduodenectomy seems to be a reliable, inexpensive, and safe procedure.
Topics: Aged; Anastomosis, Surgical; Female; Follow-Up Studies; Humans; Ligaments; Male; Mesenteric Veins; Middle Aged; Pancreatic Neoplasms; Pancreaticoduodenectomy; Portal Vein; Prognosis; Plastic Surgery Procedures; Retrospective Studies; Vascular Surgical Procedures
PubMed: 34862611
DOI: 10.1002/jso.26762 -
Journal of Hepato-biliary-pancreatic... Jan 2022The anatomical structure around the pancreatic head is very complex and it is important to understand its precise anatomy and corresponding anatomical approach to safely...
BACKGROUND
The anatomical structure around the pancreatic head is very complex and it is important to understand its precise anatomy and corresponding anatomical approach to safely perform minimally invasive pancreatoduodenectomy (MIPD). This consensus statement aimed to develop recommendations for elucidating the anatomy and surgical approaches to MIPD.
METHODS
Studies identified via a comprehensive literature search were classified using the Scottish Intercollegiate Guidelines Network method. Delphi voting was conducted after experts had drafted recommendations, with a goal of obtaining >75% consensus. Experts discussed the revised recommendations with the validation committee and an international audience of 384 attendees. Finalized recommendations were made after a second round of online Delphi voting.
RESULTS
Three clinical questions were addressed, providing six recommendations. All recommendations reached at least a consensus of 75%. Preoperatively evaluating the presence of anatomical variations and superior mesenteric artery (SMA) and superior mesenteric vein (SMV) branching patterns was recommended. Moreover, it was recommended to fully understand the anatomical approach to SMA and intraoperatively confirm the SMA course based on each anatomical landmark before initiating dissection.
CONCLUSIONS
MIPD experts suggest that surgical trainees perform resection based on precise anatomical landmarks for safe and reliable MIPD.
Topics: Humans; Mesenteric Artery, Superior; Mesenteric Veins; Pancreas; Pancreaticoduodenectomy; Portal Vein
PubMed: 34783176
DOI: 10.1002/jhbp.1081 -
Journal of Parasitic Diseases :... Sep 2022The present study was undertaken to determine the prevalence of infection in domestic ruminants in Krishna district, Andhra Pradesh by coprological and necropsy...
The present study was undertaken to determine the prevalence of infection in domestic ruminants in Krishna district, Andhra Pradesh by coprological and necropsy examination. Examination of 177 buffaloes, 283 sheep and 166 goats faecal samples (n = 626) revealed 2.25, 2.82 and 1.80% of infection, respectively. Necropsy examination of 21 buffaloes, 185 sheep and 217 goats revealed 14.2, 1.08 and 3.68% of infection, respectively. Overall, microscopic examination of faecal smears revealed 2.39% (n = 15) prevalence of . infection in ruminants in the study area, while 3.07% (n = 13) of ruminants were found to be positive for during postmortem examination. Adult worms collected from the mesenteric veins were processed and identified as Grossly, the infected livers were found with petechial haemorrhages, cirrhotic changes and pinpoint granulomas in parenchymatous tissue. Histological sections of livers revealed microgranulomas with infiltration of mononuclears, eosinophils and fibroblast cells surrounding the ova. The intestinal mucosa was thickened, edematous and haemorrhagic with copious mucous exudates. Cut section of infected intestines revealed severe inflammatory reactions in the mucosa and sub mucosa and granulomatous changes surrounding the eggs.
PubMed: 36091293
DOI: 10.1007/s12639-022-01504-3 -
Journal of Vascular Surgery. Venous and... Sep 2020Superior mesenteric venous thrombosis (MVT) is a poorly understood clinical entity, and as such, outcomes are poorly described. This study aimed to identify predictors... (Comparative Study)
Comparative Study
OBJECTIVE
Superior mesenteric venous thrombosis (MVT) is a poorly understood clinical entity, and as such, outcomes are poorly described. This study aimed to identify predictors of bowel ischemia after MVT and to compare outcomes for patients treated medically (group 1) with those for patients treated with bowel resection (group 2).
METHODS
This was a retrospective, single-institution study capturing all patients diagnosed with symptomatic acute MVT on computed tomography imaging from 2008 to 2018. Demographics, comorbidities, imaging, laboratory values, and treatment were included. Predictors of bowel resection were analyzed by univariate and multivariate statistics. Outcomes including mortality, readmissions for abdominal pain, and chronic mesenteric venous congestion were compared using χ test.
RESULTS
There were 121 patients included in the study; 98 patients were treated medically (group 1), 19 patients were treated with bowel resection (group 2), and 4 patients were treated with endovascular recanalization (group 3). Group 1 and group 2 were compared directly. Patients requiring bowel resection tended to have higher body mass index (P = .051) and a hypercoagulable disorder (P = .003). Patients who required bowel resection were more likely to present with lactic acidosis (P < .001) and leukocytosis (P < .001) with bowel wall thickening on scan (P < .001). On multivariable analysis, a genetic thrombophilia was a strong predictor of bowel ischemia (odds ratio, 3.81; 95% confidence interval, 1.12-12.37). One-year mortality and readmission rates did not differ between groups. However, readmission rates for abdominal pain were high for both groups (group 1, 44.90%; group 2, 57.89%; P = .317), and a significant proportion of patients exhibited chronic mesenteric venous congestion on repeated scan (group 1, 42.86%; group 2, 47.37%; P = .104).
CONCLUSIONS
A genetic hypercoagulable disorder is a predictor of bowel ischemia due to MVT. Regardless of treatment, outcomes after MVT are morbid, with high rates of readmission for abdominal pain. An alternative approach to treat these patients is needed, given the poor outcomes with current strategies.
Topics: Abdominal Pain; Acute Disease; Adult; Aged; Anticoagulants; Digestive System Surgical Procedures; Endovascular Procedures; Female; Humans; Male; Mesenteric Ischemia; Mesenteric Vascular Occlusion; Mesenteric Veins; Middle Aged; Patient Readmission; Retrospective Studies; Risk Assessment; Risk Factors; Splanchnic Circulation; Thrombophilia; Time Factors; Treatment Outcome; Venous Thrombosis
PubMed: 32139329
DOI: 10.1016/j.jvsv.2020.01.007 -
Insights Into Imaging Jan 2022Phlebosclerotic colitis (PC) is a rare form of nonthrombotic colonic ischemia. This retrospective study analyzed the clinical findings and temporal CT changes in 29 PC...
BACKGROUND
Phlebosclerotic colitis (PC) is a rare form of nonthrombotic colonic ischemia. This retrospective study analyzed the clinical findings and temporal CT changes in 29 PC patients with long-term follow-up.
METHODS
Twenty-nine patients with characteristic CT features of PC collected between 1997 and 2020 were stratified into the acute abdomen group (AA-group) (n = 10), chronic-progressive group (CP-group) (n = 14) and chronic-stable group (CS-group) (n = 5). Clinical and CT changes during follow-up, comorbidities and final outcomes were compared.
RESULTS
The AA-group exhibited a significantly thicker colonic wall and more involved segments and pericolic inflammation than the CP-group and CS-group on initial CT (p = < 0.001-0.031). Seven patients in the AA-group who underwent right hemicolectomy had no recurrence during follow-up (mean ± SD, 7.1 ± 3.3 years), and the remaining three patients with renal or hepatic comorbidities who underwent conservative treatment died within 14 days. The CP-group showed significantly higher frequencies of chronic renal failure, urinary tract malignancies and liver cirrhosis than the AA-group (p = 0.005-0.008). In addition, CT follow-up (7.9 ± 4.3 years) showed significant increases in mesenteric venous calcifications, colonic wall thickening and involved colonic segments (p = 0.001-0.008) but conservative treatments were effective. The CS-group remained unchanged for years (8.2 ± 3.9 years).
CONCLUSIONS
Early surgery offered excellent prognosis in PC-related acute abdomen denoted by marked right colonic wall thickening and pericolic inflammation on CT. Conservative treatments with a wait-and-watch strategy were appropriate for CP-PC and CS-PC, albeit CP-PC harbored significant increases in calcifications, colonic wall thickening and affected segments in long-term CT follow-up.
PubMed: 35092508
DOI: 10.1186/s13244-022-01159-x