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The Korean Journal of Gastroenterology... Jul 2023Phlebosclerotic colitis is a rare form of intestinal ischemia. It is caused by calcified peripheral mesenteric veins and a thickened colonic wall. These characteristic... (Review)
Review
Phlebosclerotic colitis is a rare form of intestinal ischemia. It is caused by calcified peripheral mesenteric veins and a thickened colonic wall. These characteristic findings can be identified on CT and colonoscopy. A 37-year-old female with a history of long-term herbal medicine use presented with acute lower abdominal pain and vomiting of sudden onset. Colonoscopic findings showed dark-blue discolored edematous mucosa and multiple ulcers from the ascending colon to the sigmoid colon. Abdominal CT findings showed diffuse thickening of the colonic wall and calcifications of the peripheral mesenteric veins from the ascending colon to the sigmoid colon. Based on these findings, the patient was diagnosed with phlebosclerotic colitis. We report this rare case of phlebosclerotic colitis in a healthy young female patient with a history of long-term herbal medicine use and include a review of the relevant literature.
Topics: Adult; Female; Humans; Colitis; Colitis, Ischemic; Colonoscopy; Plant Extracts; Tomography, X-Ray Computed
PubMed: 37489080
DOI: 10.4166/kjg.2023.058 -
European Journal of Surgical Oncology :... Oct 2023Few studies have evaluated variations of the main trunk of the superior mesenteric vessels. Particularly, the double superior mesenteric vein (DSMV) has not been... (Observational Study)
Observational Study
INTRODUCTION
Few studies have evaluated variations of the main trunk of the superior mesenteric vessels. Particularly, the double superior mesenteric vein (DSMV) has not been described in detail. This study aimed to establish the definition, anatomical characteristics, and underlying clinical significance of the DSMV.
MATERIALS AND METHODS
A total of 115 patients with colorectal cancer were included in this retrospective study between March 2020 and March 2022. The anatomical characteristics were analyzed using computed tomography, three-dimensional image reconstructions, and surgical videos.
RESULTS
Among the patients enrolled, 22 (19.1%) had DSMVs. The median diameters of the right and left superior mesenteric veins were similar. The superior mesenteric artery was sandwiched between the right and the left superior mesenteric veins. The left superior mesenteric vein mainly crossed the ventral side of the superior mesenteric artery (63.6%). In 1 case, the right superior mesenteric vein was mistakenly resected intraoperatively. The DSMV was classified into types I and II based on whether the right and left trunks formed a common trunk; it was further classified into subtypes a and b based on the colonic vein confluence. The proportions of type I-a, I-b, II-a, and II-b were 4.5%, 27.3%, 9.1%, and 59.1%, respectively. The middle colic veins drained into the left superior mesenteric vein in 19 cases (86.4%).
CONCLUSIONS
The DSMV is more common than previously thought. For the first time, the definition and four types of the DSMV were proposed. The presence of a DSMV should be considered during right hemicolectomies.
Topics: Humans; Mesenteric Veins; Colonic Neoplasms; Retrospective Studies; Imaging, Three-Dimensional; Colectomy; Mesenteric Artery, Superior; Tomography
PubMed: 37455181
DOI: 10.1016/j.ejso.2023.06.024 -
DEN Open Apr 2024A 69-year-old woman, a long-term survivor of subtotal stomach-preserving pancreatoduodenectomy with the splenic vein resection for pancreatic cancer, visited our...
A 69-year-old woman, a long-term survivor of subtotal stomach-preserving pancreatoduodenectomy with the splenic vein resection for pancreatic cancer, visited our hospital with a chief complaint of bloody stools. Previously, she was diagnosed with varices in the ascending colon due to left-sided portal hypertension after pancreatoduodenectomy by computed tomography and colonoscopy. After emergency hospitalization, she went into shock, and blood tests showed acute progression of severe anemia. Computed tomography showed a mosaic-like fluid accumulation from the ascending colon to the rectum. She was diagnosed with ruptured varices in the ascending colon. Emergency colonoscopy was performed, and treatment with endoscopic injection sclerotherapy using -butyl-2-cyanoacrylate was successful. Ectopic varices occur at any location other than the esophagus and stomach, and colonic varices are rare among them. They are mostly caused by portal hypertension due to liver cirrhosis. However, with the trend of improving the prognosis for patients with pancreatic cancer, we should occasionally pay attention to the development of ectopic varices including colonic varices in patients who have undergone pancreatoduodenectomy with superior mesenteric and splenic veins resection. Treatment methods for colonic varices varied from case to case, including conservative therapy, interventional radiology, and endoscopic procedure. In this case, endoscopic injection sclerotherapy was successfully performed without any complications. To the best of our knowledge, this is the first study to report successful treatment with endoscopic injection sclerotherapy for varices in the ascending colon caused by left-sided portal hypertension after pancreatoduodenectomy. Colonic varices should be considered in patients with obscure gastrointestinal bleeding after pancreatoduodenectomy.
PubMed: 37441155
DOI: 10.1002/deo2.255 -
World Journal of Gastroenterology Jun 2023Splenic vein thrombosis is a known complication of pancreatitis. It can lead to increased blood flow through mesenteric collaterals. This segmental hypertension may... (Review)
Review
BACKGROUND
Splenic vein thrombosis is a known complication of pancreatitis. It can lead to increased blood flow through mesenteric collaterals. This segmental hypertension may result in the development of colonic varices (CV) with a high risk of severe gastrointestinal bleeding. While clear guidelines for treatment are lacking, splenectomy or splenic artery embolization are often used to treat bleeding. Splenic vein stenting has been shown to be a safe option.
CASE SUMMARY
A 45-year-old female patient was admitted due to recurrent gastrointestinal bleeding. She was anemic with a hemoglobin of 8.0 g/dL. As a source of bleeding, CV were identified. Computed tomography scans revealed thrombotic occlusion of the splenic vein, presumably as a result of a severe acute pancreatitis 8 years prior. In a selective angiography, a dilated mesenterial collateral leading from the spleen to enlarged vessels in the right colonic flexure and draining into the superior mesenteric vein could be confirmed. The hepatic venous pressure gradient was within normal range. In an interdisciplinary board, transhepatic recanalization of the splenic vein balloon dilatation and consecutive stenting, as well as coiling of the aberrant veins was discussed and successfully performed. Consecutive evaluation revealed complete regression of CV and splenomegaly as well as normalization of the red blood cell count during follow-up.
CONCLUSION
Recanalization and stenting of splenic vein thrombosis might be considered in patients with gastrointestinal bleeding due to CV. However, a multidisciplinary approach with a thorough workup and discussion of individualized therapeutic strategies is crucial in these difficult to treat patients.
Topics: Female; Humans; Middle Aged; Acute Disease; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Pancreatitis; Portal Vein; Splenic Diseases; Splenic Vein; Varicose Veins; Venous Thrombosis; Tomography, X-Ray Computed
PubMed: 37426315
DOI: 10.3748/wjg.v29.i24.3922 -
Annals of Gastroenterological Surgery Jul 2023Most pancreatoduodenectomy (PD) procedures for locally advanced pancreatic head adenocarcinoma (PDAC) require superior mesenteric/portal vein (SMV/PV) axis resection and...
Inverted Y-shaped technique for complex superior mesenteric / portal vein reconstruction in pancreatoduodenectomy for locally advanced pancreatic head ductal adenocarcinoma.
Most pancreatoduodenectomy (PD) procedures for locally advanced pancreatic head adenocarcinoma (PDAC) require superior mesenteric/portal vein (SMV/PV) axis resection and reconstruction. Here we describe the inverted Y-shaped as a new technique for complex SMV/PV reconstruction and aimed at evaluating its safety and effectiveness. Among 287 patients who underwent PD for locally advanced PDAC from April, 2007 to December, 2020 at our hospital, 11 patients (3.8%) who underwent PV/SMV reconstruction with this technique were enrolled. Briefly, two distal veins were slit-wedged, sutured, resulting in one orifice, then reconstruction was completed with ( = 6) or without ( = 5) interposed autologous right external iliac vein (REIV) grafts, respectively. Operation time and blood loss were 649 (502-822) min and 1782 (475-6680) mL, respectively. The median length of resected SMV/PV was 40 (20-70) mm, 50 (50-70) mm for REIV grafts, and the splenic vein was resected in eight patients. No patient developed pancreatic fistula; mild leg edema was observed in the six graft patients and the median hospital stay was 36.0 d. PV patency rate at 2 mo after PD was 91% (10/11) and no 90-d mortality was recorded. R0 resection rate was 91% (10/11). It is feasible to safely reconstruct the SMV/PV using the inverted Y-shaped technique in appropriately selected PDAC patients.
PubMed: 37416737
DOI: 10.1002/ags3.12666 -
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 -
Radiology Case Reports Sep 2023Abernethy malformation (congenital extrahepatic portosystemic shunt [CEPS]) is rare and is characterized by an aberrant connection between the portal and systemic veins,...
Abernethy malformation (congenital extrahepatic portosystemic shunt [CEPS]) is rare and is characterized by an aberrant connection between the portal and systemic veins, bypassing the liver. It can have varying presentations and can lead to severe complications if left untreated. It is usually diagnosed incidentally on abdominal imaging. Occlusion venography and measurement of portal pressures (pre- and postocclusion) is an important step in management. Complete occlusion of the malformation in cases where the portal veins in the liver are very small and the gradient is more than 10 mm Hg, can potentially lead to acute portal hypertensive complications, such as porto-mesenteric thrombosis. We report a case of Abernethy malformation diagnosed on an abdominal computed tomography scan that presented with neurological symptoms and was successfully managed by interventional radiology via endovascular closure through placement and sequential occlusion of 2 metal stents.
PubMed: 37388532
DOI: 10.1016/j.radcr.2023.06.019 -
Frontiers in Medicine 2023To discuss the clinical value of hepatic and portal vein Doppler ultrasounds in assessing liver inflammation and fibrosis in patients with chronic hepatitis B virus...
AIMS
To discuss the clinical value of hepatic and portal vein Doppler ultrasounds in assessing liver inflammation and fibrosis in patients with chronic hepatitis B virus (HBV) infection, and a normal alanine transaminase (ALT) level.
METHODS
94 patients with chronic HBV infections who had undergone ultrasound-guided liver biopsies were enrolled and grouped by the liver tissue pathological results. Analyzed the differences and correlation between parameters of the hepatic and portal vein Doppler ultrasounds are discussed across different degrees of liver inflammation and fibrosis.
RESULTS
There were 27 patients with no significant liver damage and 67 patients with significant liver damage, there were significant differences in the parameters of the hepatic and portal vein Doppler ultrasounds between them ( < 0.05). As liver inflammation was aggravated, the inner diameter of the portal vein increased, and the blood flow velocities of the portal and superior mesenteric veins decreased ( < 0.05). When liver fibrosis became more severe, the inner diameter of the portal vein increased, while the blood flow velocities of the portal, superior mesenteric, and splenic veins decreased, and the Doppler waveforms of hepatic veins became unidirectional or flat ( < 0.05). The receiver operating characteristic (ROC) curve showed the assessment efficacy of hepatic and portal vein Doppler ultrasounds was superior to abdominal Doppler ultrasound alone in assessing liver fibrosis, and the combination of the two examination techniques outperformed any technique used alone.
CONCLUSION
The hepatic and portal vein Doppler ultrasounds have important clinical value for assessing liver fibrosis in patients with chronic HBV infection, to aid improve the diagnosis of liver fibrosis.
PubMed: 37305137
DOI: 10.3389/fmed.2023.1178944 -
International Journal of Surgery Case... Jun 2023An arteriovenous malformation (AVM) in the inferior mesenteric artery is a rare vascular pathology that accounts for 6 % of the causes of gastrointestinal bleeding....
INTRODUCTION AND IMPORTANCE
An arteriovenous malformation (AVM) in the inferior mesenteric artery is a rare vascular pathology that accounts for 6 % of the causes of gastrointestinal bleeding. AVMs are typically classified as congenital persisting embryonic vasculature that link both systems and do not develop into arteries or veins [3], but they may also develop later in life. The majority of documented cases are iatrogenic after colon surgery.
CASE PRESENTATION
Herein we describe a 56-year-old man who presented complaining of fresh blood per rectum with passage of clots not related to defecation with no previous similar episodes, he was found to have extensive inferior mesenteric branches AVM invading the colonic splenic flexure via Computed Tomography (CT) angiography following three non-revealing upper and lower endoscopies which was later managed surgically with left hemicolectomy with primary end to end colo-colic anastomosis.
CLINICAL DISCUSSION
Although AVMs seldom manifest in multiple sites through the gastrointestinal tract, it is more prevalent in the stomach, small intestine, and ascending colon, and very unusual to affect the Inferior mesenteric artery and vein and to extend to the splenic flexure colonic wall.
CONCLUSION
Even if rare, inferior mesenteric AVMs should be suspected in a patient presenting with GI Bleeding with unrevealing endoscopies, where CT Angiography is to be considered.
PubMed: 37244107
DOI: 10.1016/j.ijscr.2023.108322