-
Annals of the Royal College of Surgeons... May 2024The nutcracker phenomenon, also known as left renal vein entrapment, occurs when there is extrinsic compression of the left renal vein, most often between the abdominal... (Review)
Review
The nutcracker phenomenon, also known as left renal vein entrapment, occurs when there is extrinsic compression of the left renal vein, most often between the abdominal aorta and the superior mesenteric artery. Nutcracker syndrome refers to the constellation of clinical symptoms that may arise from the nutcracker phenomenon, typically inclusive of haematuria, flank/pelvic pain, orthostatic proteinuria and (in male patients) varicocele. We provide a short review of the nutcracker syndrome including various diagnostic and therapeutic modalities. We utilise our own experience with a patient as a case study and highlight the modern management option of endovascular stenting.
Topics: Adult; Humans; Male; Endovascular Procedures; Flank Pain; Hematuria; Renal Nutcracker Syndrome; Renal Veins; Stents
PubMed: 38038139
DOI: 10.1308/rcsann.2023.0090 -
Anticancer Research Dec 2023From an oncological perspective, central ligation of the feeding vessel is an important approach to consider when performing colon cancer surgery. This study aimed to...
BACKGROUND/AIM
From an oncological perspective, central ligation of the feeding vessel is an important approach to consider when performing colon cancer surgery. This study aimed to use three-dimensional computed tomography (3D-CT) to clarify the vascular anatomy for performing central vascular ligation to improve the accuracy of minimally invasive surgery (MIS) performed to treat advanced right-side colon cancer.
PATIENTS AND METHODS
This descriptive study was conducted at one institution and targeted 92 patients with right-side colon cancer whose vascular anatomy was evaluated with 3D-CT before surgery between January 2014 and December 2020 at Tokyo Medical University Hospital.
RESULTS
In 49 patients (53.3%), the ileocolic artery was ventral to the superior mesenteric vein (SMV), whereas in 43 patients (46.7%), it was dorsal to the SMV. The right colic artery was present in 31 patients (33.7%). The middle colic artery was present in all patients (100%). A common duct type was present in 80 patients (87.0%). Branching directly from the superior mesenteric artery without a common duct was observed in 12 patients (13.0%). Twenty-one patients (22.9%) had an accessory superior mesenteric artery.
CONCLUSION
The vascular structure of the right-side colon is highly complex. Conducting 3D-CT evaluations of the vessel anatomy is very useful for surgeons who conduct MIS, and is considered to enable central ligation to be performed safely and improve the quality of surgery, which will benefit patients.
Topics: Humans; Colon; Colonic Neoplasms; Tomography, X-Ray Computed; Mesenteric Artery, Superior; Mesenteric Veins; Laparoscopy
PubMed: 38030207
DOI: 10.21873/anticanres.16765 -
Korean Journal of Radiology Dec 2023
Topics: Humans; Mesenteric Veins; Hyperplasia; Biopsy
PubMed: 38016688
DOI: 10.3348/kjr.2023.0782 -
ANZ Journal of Surgery Mar 2024
Topics: Humans; Mesenteric Veins; Hyperplasia; Colon; Biopsy
PubMed: 38010844
DOI: 10.1111/ans.18788 -
Colorectal Disease : the Official... Jan 2024
Topics: Humans; Mesenteric Veins; Robotic Surgical Procedures; Mesocolon; Colonic Neoplasms; Ligation; Colectomy; Laparoscopy; Lymph Node Excision
PubMed: 38010164
DOI: 10.1111/codi.16806 -
Veterinary Pathology May 2024This study describes the clinical, gross, and histologic findings in 17 cases of aneurysms in bearded dragons (). The clinical presentation ranged from incidental to...
This study describes the clinical, gross, and histologic findings in 17 cases of aneurysms in bearded dragons (). The clinical presentation ranged from incidental to sudden and unexpected death. The affected vasculature was predominantly arterial; however, based on the topographical locations of the lesions, gross structure, and drainage, some veins were likely involved. Magnetic resonance imaging and computerized tomography scans of 1 animal showed a large aneurysm of the internal carotid artery extending from near its aortic origin into the caudal head. Aneurysms were organized in 5 groups based on their anatomical locations: cephalic, cranial coelom (for all near the heart), caudal coelom (for the mesenteric vessels and descending aorta), limbs, and tail. The cranial coelomic region was the most prevalent location. Gross findings were large hematomas or red serosanguineous fluid filling the adjacent area, as most of the aneurysms (94%) were ruptured at the time of the study. The main histological findings were degenerative changes of the vessel walls characterized by moderate to severe disruption of the collagen and elastic fibers of the tunica media and adventitia (100%), followed by thickening of the intima with thrombi formation (54%) and dissecting hematoma of the vessel wall (47%). Vasculitis (29%), mineralization (6%), and lipid deposits (6%) in the vessel wall were observed occasionally. Based on these findings, the vascular dilations and ruptures observed in bearded dragons likely are associated with weakness of the vessel walls caused by degenerative changes in the intimal and medial tunics.
Topics: Animals; Lizards; Male; Female; Aneurysm; Magnetic Resonance Imaging; Tomography, X-Ray Computed
PubMed: 38006226
DOI: 10.1177/03009858231214025 -
Pharmaceuticals (Basel, Switzerland) Nov 2023Given in reperfusion, the use of stable gastric pentadecapeptide BPC 157 is an effective therapy in rats. It strongly counteracted, as a whole,...
Given in reperfusion, the use of stable gastric pentadecapeptide BPC 157 is an effective therapy in rats. It strongly counteracted, as a whole, decompression/reperfusion-induced occlusion/occlusion-like syndrome following the worst circumstances of acute abdominal compartment and intra-abdominal hypertension, grade III and grade IV, as well as compression/ischemia-occlusion/occlusion-like syndrome. Before decompression (calvariectomy, laparotomy), rats had long-lasting severe intra-abdominal hypertension, grade III (25 mmHg/60 min) (i) and grade IV (30 mmHg/30 min; 40 mmHg/30 min) (ii/iii), and severe occlusion/occlusion-like syndrome. Further worsening was caused by reperfusion for 60 min (i) or 30 min (ii/iii). Severe vascular and multiorgan failure (brain, heart, liver, kidney, and gastrointestinal lesions), widespread thrombosis (peripherally and centrally) severe arrhythmias, intracranial (superior sagittal sinus) hypertension, portal and caval hypertension, and aortal hypotension were aggravated. Contrarily, BPC 157 therapy (10 µg/kg, 10 ng/kg sc) given at 3 min reperfusion times eliminated/attenuated venous hypertension (intracranial (superior sagittal sinus), portal, and caval) and aortal hypotension and counteracted the increases in organ lesions and malondialdehyde values (blood ˃ heart, lungs, liver, kidney ˃ brain, gastrointestinal tract). Vascular recovery promptly occurred (i.e., congested inferior caval and superior mesenteric veins reversed to the normal vessel presentation, the collapsed azygos vein reversed to a fully functioning state, the inferior caval vein-superior caval vein shunt was recovered, and direct blood delivery returned). BPC 157 therapy almost annihilated thrombosis and hemorrhage (i.e., intracerebral hemorrhage) as proof of the counteracted general stasis and Virchow triad circumstances and reorganized blood flow. In conclusion, decompression/reperfusion-induced occlusion/occlusion-like syndrome counteracted by BPC 157 therapy in rats is likely for translation in patients. It is noteworthy that by rapidly counteracting the reperfusion course, it also reverses previous ischemia-course lesions, thus inducing complete recovery.
PubMed: 38004420
DOI: 10.3390/ph16111554 -
Hamostaseologie Apr 2024Splanchnic or visceral vein thromboses (VVTs) are atypical thrombotic entities and include thrombosis of the portal vein, hepatic veins (Budd-Chiari syndrome),... (Review)
Review
Splanchnic or visceral vein thromboses (VVTs) are atypical thrombotic entities and include thrombosis of the portal vein, hepatic veins (Budd-Chiari syndrome), mesenteric veins, and splenic vein. All VVTs have in common high 30-day mortality up to 20% and it seems to be difficult to diagnose VVT early because of their rarity and their wide spectrum of unspecific symptoms. VVTs are often associated with myeloproliferative neoplasia, thrombophilia, and liver cirrhosis. VVT is primarily diagnosed by sonography and/or computed tomography. In contrast to venous thromboembolism, D-dimer testing is neither established nor helpful. Anticoagulation is the first-line therapy in patients with stable circulation and no evidence of organ complications. Anticoagulation improves significantly recanalization rates and stops the progress of thrombosis. Low-molecular-weight heparin, vitamin K antagonists, as well as direct-acting oral anticoagulants are possible anticoagulants, but it is noteworthy to be aware that all recommendations supporting the off-label use of anticoagulants are based on poor evidence and consist predominantly of case series, observational studies, or studies with small case numbers. When choosing a suitable anticoagulation, the individual risk of bleeding and thrombosis must be weighted very carefully. In cases of bleeding, bowel infarction, or other complications, the optimal therapy should be determined on a case-by-case basis by an experienced multidisciplinary team involving a surgeon. Besides anticoagulation, there are therapeutic options including thrombectomy, balloon angioplasty, stenting, transjugular placement of an intrahepatic portosystemic shunt, liver transplantation, and ischemic bowel resection. This article gives an overview of current diagnostic and therapeutic strategies.
Topics: Humans; Anticoagulants; Venous Thrombosis; Practice Guidelines as Topic; Viscera; Budd-Chiari Syndrome; Portal Vein
PubMed: 37992729
DOI: 10.1055/a-2178-6670 -
Surgical Case Reports Nov 2023Left-sided portal hypertension including gastric venous congestion may be caused by ligating the splenic vein during pancreaticoduodenectomy with portal vein resection...
Reconstruction with the right gastroepiploic vein during pancreaticoduodenectomy and total pancreatectomy to prevent left-sided portal hypertension: a report of two cases.
BACKGROUND
Left-sided portal hypertension including gastric venous congestion may be caused by ligating the splenic vein during pancreaticoduodenectomy with portal vein resection or total pancreatectomy. The usefulness of reconstruction with the splenic vein has been reported in such cases. However, depending on the site of the tumor and other factors, it may be impossible to leave sufficient length of the splenic vein, making anastomosis difficult. We report two patterns of reconstruction with the right gastroepiploic vein during pancreaticoduodenectomy and total pancreatectomy to prevent left-sided portal hypertension.
CASE PRESENTATION
The first patient was a 79-year-old man who underwent pancreaticoduodenectomy for pancreatic cancer. The root of the splenic vein was infiltrated by the tumor, and we resected this vein at the confluence of the portal vein. Closure of the portal vein was performed without reconstruction of the splenic vein. To prevent left-sided portal hypertension, we anastomosed the right gastroepiploic vein to the middle colic vein. Postoperatively, there was no suggestion of left-sided portal hypertension, such as splenomegaly, varices, and thrombocytosis. The second case was a 63-year-old woman who underwent total pancreatectomy for pancreatic cancer. The splenic vein-superior mesenteric vein confluence was infiltrated by the tumor, and we resected the portal vein, including the confluence. End-to-end anastomosis was performed without reconstruction of the splenic vein. We also divided the left gastric vein, left gastroepiploic vein, right gastroepiploic vein, and right gastric vein, which resulted in a lack of drainage veins from the stomach and severe gastric vein congestion. We anastomosed the right gastroepiploic vein to the left renal vein, which improved the gastric vein congestion. Postoperatively, imaging confirmed short-term patency of the anastomosis site. Although the patient died because of tumor progression 8 months after the surgery, no findings suggested left-sided portal hypertension, such as varices. Reconstruction with the right gastroepiploic vein during pancreaticoduodenectomy and total pancreatectomy is useful to prevent left-sided portal hypertension.
PubMed: 37982916
DOI: 10.1186/s40792-023-01773-x -
Transplantation Feb 2024This study examines the vascular and biliary variations in 3035 liver donors. We propose a novel classification of hepatic arteries, portal veins, and bile ducts and...
BACKGROUND
This study examines the vascular and biliary variations in 3035 liver donors. We propose a novel classification of hepatic arteries, portal veins, and bile ducts and clinically relevant donor classification.
METHODS
Preoperative imaging and operative details of 3035 donors from 2005 to 2020 were reviewed. Hilar anatomical variations were identified and grouped on the basis of incidence and clinical relevance.
RESULTS
Hilar structures are classified according to the numbers supplying or draining the graft: for the hepatic artery, right (R) and left (L), RA1/LA1 (1 artery), RA2/LA2 (2 arteries), and RA3/LA3 (3 arteries), respectively, further defined on the basis of the inflow trunk into C (for common hepatic artery), S (for superior mesenteric artery), and L (for left gastric artery); for the portal vein, RP1 (1 vein) and RP2 (2 veins) for the right lobe; and for the hepatic duct, RB1/LB1 (1 duct), RB2/LB2 (2 ducts), RB3 (3 right ducts), and RB4 (4 right ducts). Donors were classified on the basis of anatomical variations into 3 groups: class 1 and class 2 donors, who can donate liver with acceptable risks, and class 3 donors, who are high-risk donors because they are anatomically unacceptable ( Figures S1 to S4, SDC , http://links.lww.com/TP/C918 ).
CONCLUSIONS
Defining hilar anatomical variations and donor grouping into anatomy-based clinical classes helps in operative planning of donors, hepatobiliary surgeries, and interventional procedures.
Topics: Humans; Liver; Liver Transplantation; Hepatic Artery; Bile Ducts; Living Donors; Portal Vein; Hepatic Veins; Hepatectomy
PubMed: 37953482
DOI: 10.1097/TP.0000000000004807