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Surgical Case Reports Jun 2024Thromboembolic occlusion of the superior mesenteric artery (SMA) is a grave complication in individuals diagnosed with atrial fibrillation (AF). This condition often...
BACKGROUND
Thromboembolic occlusion of the superior mesenteric artery (SMA) is a grave complication in individuals diagnosed with atrial fibrillation (AF). This condition often necessitates extensive bowel resection, culminating in short bowel syndrome, which presents challenges for anticoagulant administration and/or antiarrhythmic therapy.
CASE PRESENTATION
Presented here are findings of two patients, aged 78 and 72 years, respectively, who underwent comprehensive thoracoscopic AF surgery subsequent to extensive small bowel resection following SMA embolization. In each, onset of AF precipitated an embolic event, while the concurrent presence of short bowel syndrome complicated anticoagulation management. Total thoracoscopic AF surgery, comprised stapler-closure of the left atrial appendage (LAA) and bilateral epicardial clamp-isolation of the pulmonary veins, an operative modality aimed at addressing AF rhythm control and mitigating embolic events such as cerebral infarction, led to favorable outcomes in both cases. Additionally, computed tomography (CT) conducted one month post-surgery revealed the absence of residual tissue in the LAA, with the left atrium demonstrating a well-rounded, spherical shape. At the time of writing, the patients have remained asymptomatic following surgery regarding thromboembolic and arrhythmic manifestations for 29 and 10 months, respectively, notwithstanding the absence of anticoagulant or antiarrhythmic pharmacotherapy. Additionally, electrocardiographic surveillance has revealed persistent sinus rhythm.
CONCLUSIONS
The present findings underscore the feasibility and efficacy of a total thoracoscopic AF surgery procedure for patients presented with short bowel syndrome complicating SMA embolization, thus warranting consideration for its broader clinical application.
PubMed: 38861227
DOI: 10.1186/s40792-024-01938-2 -
Clinical Case Reports Jun 2024A whirl sign on contrast-enhanced abdominal CT scan is indicative of intestine twisted around the mesenteric vessels, and is observed in cases of strangulated...
KEY CLINICAL MESSAGE
A whirl sign on contrast-enhanced abdominal CT scan is indicative of intestine twisted around the mesenteric vessels, and is observed in cases of strangulated obstruction, signaling compromised intestinal circulation. In cases of intestinal volvulus, surgery is necessary to untwist the affected bowel, and resection is necessary if necrosis is present.
ABSTRACT
A 31-year-old Japanese man presented with acute lower abdominal pain and vomiting. Contrast-enhanced abdominal computed tomography (CT) revealed a 1440-degree clockwise torsion of superior mesenteric artery and a whirl sign. Intestinal volvulus in adulthood with a background of malrotation is extremely rare. Contrast-enhanced CT is effective for diagnosis.
PubMed: 38855086
DOI: 10.1002/ccr3.9022 -
Annals of Medicine and Surgery (2012) Jun 2024It is common for the liver to be supplied blood by a hepatic artery branching off the coeliac trunk. Occasionally, a replaced common hepatic artery (RCHA), emerges from...
INTRODUCTION
It is common for the liver to be supplied blood by a hepatic artery branching off the coeliac trunk. Occasionally, a replaced common hepatic artery (RCHA), emerges from the superior mesenteric artery (SMA), can supply the liver in 1.5-4.0% of cases. Computed tomography (CT) angiography is a highly accurate method for identifying arterial anomalies, which may remain undetected until the time of surgery, leading to unexpected complications.
CASE PRESENTATION
A 53-year-old male exhibiting symptoms of decreased appetite, weight loss, vomiting, and altered sclera, urine, and stool colour, underwent a contrast-enhanced CT scan revealing biliary tract dilatation and pancreatic abnormalities, leading to a pancreaticoduodenectomy. During the surgery, an uncommon arterial finding-CHA from SMA-was noted. Pancreatic cancer was confirmed. The patient was discharged a week post-surgery without issues, emphasizing perioperative care progress.
DISCUSSION
The authors' study focused on the detection conditions of the same hepatic artery anomaly in eight cases reported between 2017 and 2023. In two of them the anomaly was discovered in cadaver by routine autopsy. In three cases, this variation was identified before the surgery, but in three other cases it wasn't detected until the surgical procedure. In the authors' case, due to multiple reasons, the anomaly remained undetectable until the surgery.
CONCLUSION
This study underscores the importance of thorough preoperative evaluation to grasp vascular variations for better patient care. Also, a noteworthy observation in our case is that the surgeon identified an expanded hepatic vessel, prompting further investigation into this anomaly.
PubMed: 38846897
DOI: 10.1097/MS9.0000000000002102 -
Annals of Medicine and Surgery (2012) Jun 2024Buerger's disease is an uncommon segmental nonatherosclerotic vasculitis essentially affecting small to medium-sized arteries and veins of upper and lower extremities...
INTRODUCTION AND IMPORTANCE
Buerger's disease is an uncommon segmental nonatherosclerotic vasculitis essentially affecting small to medium-sized arteries and veins of upper and lower extremities and can lead to limb amputation. Visceral vessel involvement is quite rare accounting for 2% of cases presenting with acute abdomen due to mesenteric ischemia. Moreover, isolated visceral involvement is even rare.
CASE PRESENTATION
A 42-year-old gentleman, a chronic smoker, presented with abdominal pain associated with nausea and vomiting and loose stool of 2 months duration. Magnetic resonance enterography revealed segmental circumferential wall thickening with stricture in the mid part of the jejunum with lymphadenopathy features of possible inflammatory bowel disease (Crohn's disease). Furthermore, intraoperative surgical findings were also suggestive of Crohn's disease. However, histologic findings were consistent with thromboangiitis obliterans.
DISCUSSION
Thromboangiitis obliterans can present with inflammatory vascular lesions without necrosis in the early stage to varying degrees of recanalisation, gangrene, and amputation in the late stage. It rarely involves the brain, heart, and abdominal viscera. The visceral involvement may be in the form of intestinal obstruction or mesenteric ischemia or can mimic Crohn's in a background of smoking.
CONCLUSION
This case report will help to learn more about the rarer intestinal presentation of intestinal Buerger's disease. It can present with features of bowel ischemia, obstruction or Crohn's. So, histology would play a pivotal role in differentiating the diagnostic dilemma.
PubMed: 38846871
DOI: 10.1097/MS9.0000000000002111 -
Quantitative Imaging in Medicine and... Jun 2024With the increase of pancreatic tumor patients in recent years, there is an urgent need to find a way to treat pancreatic tumors. Surgery is one of the best methods for...
BACKGROUND
With the increase of pancreatic tumor patients in recent years, there is an urgent need to find a way to treat pancreatic tumors. Surgery is one of the best methods for the treatment of pancreatic tumors, the success of which depends on the evaluation of peripancreatic vessels before surgery. Computed tomography (CT), as a non-invasive, fast, and economical auxiliary examination method, is undoubtedly one of the best means of clinical auxiliary examination. In this study, we investigated the impact of single-energy spectral CT imaging on the image quality of peripancreatic blood vessels and the clinical value of low-keV imaging in enhancing the image quality of peripancreatic arteriovenous vessels.
METHODS
We prospectively enrolled 103 patients who underwent abdominal vascular-enhanced CT examinations at the Affiliated Hospital of Hebei University between December 2022 and May 2023 and who were all scanned with the dual-energy feature on the United Imaging ATLAS scanner. The images were reconstructed at 70 keV, mixed energy, and optimized single energy in the post-processing station of United Imaging Healthcare Technology Co., Ltd. The CT value and contrast-to-noise ratio (CNR) of the superior mesenteric artery (SMA), gastroduodenal artery (GDA), inferior pancreaticoduodenal artery (IPDA), and superior mesenteric vein (SMV) were compared across energy levels, and then the image quality was subjectively evaluated. One-way analysis of variance and rank-sum tests were utilized for the statistical analysis.
RESULTS
The CT values of SMA, GDA, IPDA, and SMV in the optimal single energy group were 358.37±70.24, 323.36±88.23, 300.76±76.27, and 257.74±20.56 Hounsfield unit (HU), respectively, which were superior to those in the mixed energy (241.66±47.69, 235.17±53.71, 207.36±45.17, and 187.39±23.21 HU) and 70 keV groups (260.89±54.27, 252.41±58.87, 223.17±43.65, and 203.18±18.17 HU) (P<0.05). The diagnostic efficacy was greater in the optimal single energy group than in the other 2 groups (4.63±0.50, 3.91±0.57, and 4.23±0.83) (P<0.05).
CONCLUSIONS
The optimal single energy for showing peripancreatic blood vessels is 62±7 keV when utilizing single-energy spectral CT imaging.
PubMed: 38846305
DOI: 10.21037/qims-23-1734 -
Journal of Clinical Imaging Science 2024The great majority of patients admitted to the intensive care unit (ICU) for critical gastrointestinal bleeding (GIB) will have a predictable etiology. Once the site is...
The great majority of patients admitted to the intensive care unit (ICU) for critical gastrointestinal bleeding (GIB) will have a predictable etiology. Once the site is localized to the upper versus the lower gastrointestinal tract, the number of typically encountered etiological possibilities is quite limited. On rare occasions, the cause of GIB requiring ICU care is not one of the standard considerations, potentially leading to diagnostic and therapeutic delays. Within a short time period, three patients were admitted to our institution's medical ICU each with a different unexpected cause of GIB. All three cases generated a variety of instructive images, which are used in the present series to illustrate these conditions and the role of radiology in their evaluation and management.
PubMed: 38841309
DOI: 10.25259/JCIS_96_2023 -
Bio-protocol Mar 2024Understanding protein-protein interactions is crucial for unravelling subcellular protein distribution, contributing to our understanding of cellular organisation....
Understanding protein-protein interactions is crucial for unravelling subcellular protein distribution, contributing to our understanding of cellular organisation. Moreover, interaction studies can reveal insights into the mechanisms that cover protein trafficking within cells. Although various techniques such as Förster resonance energy transfer (FRET), co-immunoprecipitation, and fluorescence microscopy are commonly employed to detect protein interactions, their limitations have led to more advanced techniques such as the in situ proximity ligation assay (PLA) for spatial co-localisation analysis. The PLA technique, specifically employed in fixed cells and tissues, utilises species-specific secondary PLA probes linked to DNA oligonucleotides. When proteins are within 40 nm of each other, the DNA oligonucleotides on the probes interact, facilitating circular DNA formation through ligation. Rolling-circle amplification then produces DNA circles linked to the PLA probe. Fluorescently labelled oligonucleotides hybridise to the circles, generating detectable signals for precise co-localisation analysis. We employed PLA to examine the co-localisation of dynein with the Kv7.4 channel protein in isolated vascular smooth muscle cells from rat mesenteric arteries. This method enabled us to investigate whether Kv7.4 channels interact with dynein, thereby providing evidence of their retrograde transport by the microtubule network. Our findings illustrate that PLA is a valuable tool for studying potential novel protein interactions with dynein, and the quantifiable approach offers insights into whether these interactions are changed in disease.
PubMed: 38841287
DOI: 10.21769/BioProtoc.4961 -
SA Journal of Radiology 2024Immunoglobulin G4 (IgG4)-related disease has the potential to impact any part of the body, including the walls of large- and medium-sized blood vessels and the ureters....
UNLABELLED
Immunoglobulin G4 (IgG4)-related disease has the potential to impact any part of the body, including the walls of large- and medium-sized blood vessels and the ureters. While histopathologic examination is currently the standard method for identifying organ involvement and diagnosing IgG4-related disease (IgG4-RD), obtaining biopsy or surgical samples from vessel or ureteral walls is challenging. Given that patients may display only mild symptoms, non-invasive imaging plays a vital role in both diagnosing and managing IgG4-related diseases. Multidetector CT scans are valuable in establishing the primary diagnosis, identifying anatomical landmarks and assessing their relationships. Involvement of the genitourinary organs, such as the ureter, bladder, urethra, and male and female reproductive organs in IgG4-RD, is infrequent when compared to kidney involvement. The imaging findings may include the presence of a localised mass within or surrounding the affected organ or a generalised enlargement of the organ. This report includes cross-sectional images of five cases of IgG4-RD involving large- and medium-sized blood vessels (the aorta and superior mesenteric artery) and the ureters.
CONTRIBUTION
This case series provides insight into the various imaging appearances of IgG4-related retroperitoneal organ involvement and helps differentiate it radiologically from retroperitoneal fibrosis.
PubMed: 38840828
DOI: 10.4102/sajr.v28i1.2830 -
Journal of Cardiology Cases Jun 2024Coronavirus disease 2019 (COVID-19) is associated with an increased risk of thromboembolic events. However, there are few reports on multiple thromboembolic events in...
UNLABELLED
Coronavirus disease 2019 (COVID-19) is associated with an increased risk of thromboembolic events. However, there are few reports on multiple thromboembolic events in young patients with COVID-19. Herein, we report a case of multiple visceral arterial embolisms secondary to acute myocardial infarction in a young patient with COVID-19. A 36-year-old male developed sudden chest pain after being diagnosed with COVID-19. Emergency coronary angiography revealed total occlusion of the right coronary artery, and the patient underwent a subsequent emergency percutaneous coronary intervention (PCI) which achieved successful recanalization. The patient was administered a loading dose and a subsequent maintenance dose of aspirin and prasugrel and a continuous intravenous infusion of unfractionated heparin at 10,000 units per day. Echocardiography detected a left ventricular apical thrombus 3 days after PCI; a loading dose of warfarin was administered and promptly reached the therapeutic range. However, the patient developed superior mesenteric artery embolism and renal infarction on the 12th day after PCI. COVID-19 was considered to play a role in the thromboembolic events observed in this patient. This case highlights the need for individualized antithrombotic regimens when managing patients with COVID-19 who develop acute myocardial infarction.
LEARNING OBJECTIVE
Reportedly, coronavirus disease 2019 (COVID-19) is associated with an increased risk of venous and arterial thromboembolic events. However, few reports have described multiple thromboembolic events in younger patients with COVID-19. This case report describes arterial thromboembolism secondary to acute myocardial infection (AMI) in a patient with COVID-19. It highlights the need for individualized antithrombotic regimens when managing patients with COVID-19 who develop AMI.
PubMed: 38826765
DOI: 10.1016/j.jccase.2024.02.012 -
Cureus Apr 2024Abdominal paracentesis is a commonly performed bedside procedure. It serves as a therapeutic and diagnostic tool for a variety of conditions. It is regarded as a safe...
Abdominal paracentesis is a commonly performed bedside procedure. It serves as a therapeutic and diagnostic tool for a variety of conditions. It is regarded as a safe procedure with a low risk of complications. Rarely, iatrogenic complications such as peritonitis, haemorrhage, and bowel perforation may occur. Intraperitoneal haemorrhage is rare and usually occurs due to bleeding from the intraabdominal venous collateral vessels or mesenteric varices. However, intraperitoneal haemorrhage secondary to injury to the abdominal wall arteries, such as the inferior epigastric artery or deep circumflex iliac artery (DCIA), is very uncommon. We report on a 64-year-old man with decompensated cardiac failure who underwent paracentesis due to gross ascites. Twenty-four hours post-procedure, he became progressively hypotensive and lethargic. An ecchymosis measuring 3 cm × 2 cm was seen over the puncture site. An urgent CT angiography of the abdomen showed a large left-sided intraperitoneal haematoma with active contrast extravasation from the left DCIA. We performed a successful angioembolisation of the left DCIA. It is important to note that intraperitoneal haemorrhages secondary to DCIA injury may present as occult intraperitoneal haemorrhage. Angioembolisation is a useful tool in the management of uncontrolled intraperitoneal haemorrhage. The recommended puncture site is in the left lower quadrant, 2-4 cm superior and medial to the anterior superior iliac spine (ASIS). This case report serves to emphasise the rare but potentially lethal complication of a commonly performed procedure. A high index of suspicion of intraperitoneal haemorrhage is required for patients with unexplained hypotension post-paracentesis, even if overt abdominal signs are absent. The use of ultrasound guidance will aid in reducing the risk of severe complications and increasing the overall success rate.
PubMed: 38826601
DOI: 10.7759/cureus.59428