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European Journal of Vascular and... Apr 2017
Review
Topics: Endovascular Procedures; Humans; Mesenteric Arteries; Mesenteric Veins; Predictive Value of Tests; Risk Factors; Splanchnic Circulation; Treatment Outcome; Vascular Diseases; Vascular Surgical Procedures
PubMed: 28359440
DOI: 10.1016/j.ejvs.2017.01.010 -
Scandinavian Journal of Surgery : SJS :... Jun 2021Acute mesenteric venous thrombosis accounts for up to 20% of all patients with acute mesenteric ischemia in high-income countries. Acute mesenteric venous thrombosis is...
BACKGROUND AND AIMS
Acute mesenteric venous thrombosis accounts for up to 20% of all patients with acute mesenteric ischemia in high-income countries. Acute mesenteric venous thrombosis is nowadays relatively more often diagnosed with intravenous contrast-enhanced computed tomography in the portal phase than at explorative laparotomy No high-quality comparative studies between anticoagulation alone, endovascular therapy, or surgery exists. The aim of the present systematic review was to offer a contemporary overview on management.
MATERIALS AND METHODS
Eleven relevant published original studies with series of at least ten patients were retrieved from a Pub Med search between 2015 and 2020 using the Medical Subject Heading term "mesenteric venous thrombosis."
RESULTS
When MVT is diagnosed early, immediate anticoagulation with either unfractionated heparin or subcutaneous low-molecular-weight heparin should commence. Surgeons need to be aware of the importance to scrutinize the computed tomography images themselves for assessment of secondary intestinal abnormalities to mesenteric venous thrombosis and the risk of bowel resection and worse prognosis. Progression toward peritonitis is an indication for explorative laparotomy and assessment of bowel viability. Frank transmural small bowel necrosis should be resected and bowel anastomosis may be delayed for several days until second look. Meanwhile, intravenous full-dose unfractionated heparin should be given at the end of the first operation. Postoperative major intra-abdominal or gastrointestinal bleeding occurs rarely, but the heparin effect can instantaneously be reversed by . Patients who do not improve during conservative therapy with anticoagulation alone but without developing peritonitis may be subjected to endovascular therapy in expert centers. When the patient's intestinal function has recovered, with or without bowel resection, switch from parenteral unfractionated heparin or low-molecular-weight heparin therapy to oral anticoagulation can be performed. There is a trend that direct oral anticoagulants are increasingly used instead of vitamin K antagonists. Up to now, direct oral anticoagulants have been shown to be equally effective with the same rate of bleeding complications. Patients with no strong permanent trigger factor for mesenteric venous thrombosis such as intra-abdominal cancer should undergo blood screening for inherited and acquired thrombophilia.
CONCLUSION
Early diagnosis with emergency computed tomography with intravenous contrast-enhancement and imaging in the portal phase and anticoagulation therapy is necessary to be able to have a succesful non-operative succesful course.
Topics: Anticoagulants; Heparin; Humans; Mesenteric Ischemia; Mesenteric Veins; Venous Thrombosis
PubMed: 33118463
DOI: 10.1177/1457496920969084 -
Journal of Vascular Surgery. Venous and... Oct 2016This review explores the current literature on the natural history, diagnosis, and management of mesenteric venous thrombosis (MVT) in the modern era. (Review)
Review
OBJECTIVE
This review explores the current literature on the natural history, diagnosis, and management of mesenteric venous thrombosis (MVT) in the modern era.
METHODS
A review of the contemporary literature from 1997 to 2016 on MVT and its pathogenesis, diagnosis, and treatment was performed.
RESULTS
MVT is an insidious and lethal disease associated with acute mesenteric ischemia. The prevalence of MVT has increased sharply during the past two decades commensurate with an increase in radiographic imaging for abdominal complaints. The optimal treatment of and approach to MVT is controversial, given the poorly understood natural history of this rare disease. Both endovascular and open surgical strategies in addition to systemic anticoagulation have been used as adjuncts to treat MVT with limited success. Despite advances in treatment, mortality associated with MVT is still high. Furthermore, recent studies have shown that failure to recanalize the portomesenteric venous system leads to an increased risk for development of sequelae of portal hypertension.
CONCLUSIONS
MVT is a challenging disease to treat, given the difficulty in establishing a prompt initial diagnosis and the inability to reliably monitor patients for evidence of impending bowel infarction. Careful selection of patients for endovascular, open, or hybrid approaches is key to achieving improved outcomes. However, the paucity of prospective data and our evolving understanding of the natural history of MVT make consensus treatment strategies difficult to ascertain.
Topics: Acute Disease; Humans; Mesenteric Ischemia; Mesenteric Vascular Occlusion; Mesenteric Veins; Prospective Studies; Venous Thrombosis
PubMed: 27639007
DOI: 10.1016/j.jvsv.2016.04.002 -
Vascular Health and Risk Management 2019Splanchnic vein thrombosis (SVT) including portal, mesenteric, splenic vein thrombosis and the Budd-Chiari syndrome, is a manifestation of unusual site venous... (Review)
Review
Splanchnic vein thrombosis (SVT) including portal, mesenteric, splenic vein thrombosis and the Budd-Chiari syndrome, is a manifestation of unusual site venous thromboembolism. SVT presents with a lower incidence than deep vein thrombosis of the lower limbs and pulmonary embolism, with portal vein thrombosis and Budd-Chiari syndrome being respectively the most and the least common presentations of SVT. SVT is classified as provoked if secondary to a local or systemic risk factor, or unprovoked if the causative trigger cannot be identified. Diagnostic evaluation is often affected by the lack of specificity of clinical manifestations: the presence of one or more risk factors in a patient with a high clinical suspicion may suggest the execution of diagnostic tests. Doppler ultrasonography represents the first line diagnostic tool because of its accuracy and wide availability. Further investigations, such as computed tomography and magnetic resonance angiography, should be executed in case of suspected thrombosis of the mesenteric veins, suspicion of SVT-related complications, or to complete information after Doppler ultrasonography. Once SVT diagnosis is established, a careful patient evaluation should be performed in order to assess the risks and benefits of the anticoagulant therapy and to drive the optimal treatment intensity. Due to the low quality and large heterogeneity of published data, guidance documents and expert opinion could direct therapeutic decision, suggesting which patients to treat, which anticoagulant to use and the duration of treatment.
Topics: Anticoagulants; Humans; Mesenteric Veins; Portal Vein; Predictive Value of Tests; Risk Factors; Splanchnic Circulation; Splenic Vein; Treatment Outcome; Ultrasonography, Doppler; Venous Thrombosis
PubMed: 31695400
DOI: 10.2147/VHRM.S197732 -
Journal of Vascular Surgery Feb 2015
Topics: Adenocarcinoma; Female; Hepatic Artery; Humans; Male; Mesenteric Veins; Pancreatectomy; Pancreatic Neoplasms; Pancreaticoduodenectomy; Portal Vein; Plastic Surgery Procedures; Vascular Surgical Procedures
PubMed: 25619575
DOI: 10.1016/j.jvs.2014.09.004 -
Frontiers in Immunology 2018Many parasitic worms possess complex and intriguing life cycles, and schistosomes are no exception. To exit the human body and progress to their successive snail host,... (Review)
Review
Many parasitic worms possess complex and intriguing life cycles, and schistosomes are no exception. To exit the human body and progress to their successive snail host, eggs must migrate from the mesenteric vessels, across the intestinal wall and into the feces. This process is complex and not always successful. A vast proportion of eggs fail to leave their definite host, instead becoming lodged within intestinal or hepatic tissue, where they can evoke potentially life-threatening pathology. Thus, to maximize the likelihood of successful egg passage whilst minimizing host pathology, intriguing egg exit strategies have evolved. Notably, schistosomes actively exert counter-inflammatory influences on the host immune system, discreetly compromise endothelial and epithelial barriers, and modulate granuloma formation around transiting eggs, which is instrumental to their migration. In this review, we discuss new developments in our understanding of schistosome egg migration, with an emphasis on and the intestine, and outline the host-parasite interactions that are thought to make this process possible. In addition, we explore the potential immune implications of egg penetration and discuss the long-term consequences for the host of unsuccessful egg transit, such as fibrosis, co-infection and cancer development.
Topics: Animals; Antigens, Helminth; Disease Models, Animal; Endothelium, Vascular; Feces; Host-Parasite Interactions; Humans; Intestinal Mucosa; Mesenteric Arteries; Mesenteric Veins; Ovum; Peyer's Patches; Schistosoma mansoni
PubMed: 30619372
DOI: 10.3389/fimmu.2018.03042 -
Medicine Oct 2021Idiopathic myointimal hyperplasia of mesenteric veins (IMHMV) is an uncommon cause of ischemic bowel disease resulting from the proliferation of smooth muscles in the...
INTRODUCTION
Idiopathic myointimal hyperplasia of mesenteric veins (IMHMV) is an uncommon cause of ischemic bowel disease resulting from the proliferation of smooth muscles in the venous intima. Delayed diagnosis could only be made following the surgical resection due to lack of imaging data, which may lead to bowel severe bleeding, perforation, necrosis, infection, or shock. In previous reports, few cases have provided the detailed pre-operative radiological characteristics of IMHMV. Herein, we are the first to provide the complete clinical course and comprehensive pre-operative radiological data of a 21-year-old female diagnosed with IMHMV.
PATIENT CONCERNS
A 21-year-old female was admitted to our hospital with bloody diarrhea and abdominal pain. Physical examination revealed tenderness localized to the left lower abdomen. The patient had no prior history of similar symptoms. A computed tomography scan was performed and showed diffuse wall thickening from the rectum to sigmoid colon with poor mural enhancement, multiple ulcers, fat stranding, and free fluid. The arterial phase images demonstrated many tortuous pericolic arteries and submucosal pseudoaneurysm.
INTERVENTION
Conservative treatment including empirical antibiotics, Mesalazine, and methylprednisolone sodium succinate were administrated to relief the symptoms. However, the diarrhea and abdominal pain worsened. An emergency surgery was arranged and total proctocolectomy with ileal pouchanal anastomosis with ileostomy was performed.
DIAGNOSIS
Macroscopic and histopathological examinations of the excised specimen showed ischemic colitis. Elastica van Gieson staining revealed extensive myointimal hyperplasia and confirmed the diagnosis of IMHMV.
OUTCOMES
During the 2-year follow-up period, no additional medical management was needed. The patient was well and surveillance colonoscopy showed normal colon and anastomosis.
CONCLUSION
Pre-operative computed tomography with imaging features including pronounced continuous concentric thickening colonic wall with poor enhancement and enlarged tortuous pericolic arteries could specifically facilitate the speedy diagnosis of IMHMV.
Topics: Colitis, Ischemic; Female; Humans; Hyperplasia; Mesenteric Veins; Vascular Diseases; Young Adult
PubMed: 34678900
DOI: 10.1097/MD.0000000000027574 -
BMC Medical Imaging Mar 2022This study was aimed to explore the clinical application of dual-energy computed tomography (DECT) monoenergetic plus (mono+) imaging to evaluate anatomical variations...
A study on spinal level, length, and branch type of the inferior mesenteric artery and the position relationship between the inferior mesenteric artery, left colic artery, and inferior mesenteric vein.
BACKGROUND
This study was aimed to explore the clinical application of dual-energy computed tomography (DECT) monoenergetic plus (mono+) imaging to evaluate anatomical variations in the inferior mesenteric artery (IMA).
METHODS
The clinical and imaging data of 212 patients who had undergone total abdominal DECT were retrospectively analyzed. The post-processing mono+ technique was used to obtain 40-keV single-level images in the arterial phase. Three-dimensional reconstruction was performed to evaluate the relationship between the IMA root position and the spinal level, IMA length, and IMA branch type, as well as the position of the left colic artery (LCA) and inferior mesenteric vein (IMV) at the IMA root level.
RESULTS
The IMA root was located at the L3 level in 78.3% of cases and at the L2/L3 level in 3.3%. The highest vertebral level of IMA origin was L2 (4.2%), and the lowest was L4 (7.1%). The distance from the IMA root to the level of the sacral promontory was 99.58 ± 13.07 mm, which increased with the elevation of the IMA root at the spinal level. Of the patients, 53.8% demonstrated Type I IMA, 23.1% Type II, 20.7% Type III, and 2.4% Type IV. The length of the IMA varied from 13.6 to 66.0 mm. 77.3% of the IMAs belonged to Type A, the adjacent type, and 22.7% to Type B, the distant type.
CONCLUSION
DECT mono+ can preoperatively evaluate the anatomical characteristics of the IMA and the positional relationship between the LCA and IMV at the IMA root level, which would help clinicians plan individualized surgery for patients.
Topics: Abdomen; Arteries; Humans; Mesenteric Artery, Inferior; Mesenteric Veins; Retrospective Studies
PubMed: 35260088
DOI: 10.1186/s12880-022-00764-y -
World Journal of Gastroenterology Jun 2021Idiopathic mesenteric phlebosclerosis (IMP) is a rare disease, and its etiology and risk factors remain uncertain.
BACKGROUND
Idiopathic mesenteric phlebosclerosis (IMP) is a rare disease, and its etiology and risk factors remain uncertain.
AIM
To investigate the possible influence of Chinese herbal liquid containing geniposide on IMP.
METHODS
The detailed formula of herbal liquid prescriptions of all patients was studied, and the herbal ingredients were compared to identify the toxic agent as a possible etiological factor. Abdominal computed tomography (CT) and colonoscopy images were reviewed to determine the extent and severity of mesenteric phlebosclerosis and the presence of findings regarding colitis. The disease CT score was determined by the distribution of mesenteric vein calcification and colon wall thickening on CT images. The drinking index of medicinal liquor was calculated from the daily quantity and drinking years of Chinese medicinal liquor. Subsequently, Spearman's correlation analysis was conducted to evaluate the correlation between the drinking index and the CT disease score.
RESULTS
The mean age of the 8 enrolled patients was 75.7 years and male predominance was found (all 8 patients were men). The patients had histories of 5-40 years of oral Chinese herbal liquids containing geniposide and exhibited typical imaging characteristics (., threadlike calcifications along the colonic and mesenteric vessels or associated with a thickened colonic wall in CT images). Calcifications were confined to the right-side mesenteric vein in 6 of the 8 patients (75%) and involved the left-side mesenteric vein of 2 cases (25%) and the calcifications extended to the mesorectum in 1 of them. The thickening of colon wall mainly occurred in the right colon and the transverse colon. The median disease CT score was 4.88 ( = 7) and the median drinking index was 5680 ( = 7). After Spearman's correlation analysis, the median CT score of the disease showed a significant positive correlation with the median drinking index ( = 0.842, < 0.05).
CONCLUSION
Long-term oral intake of Chinese herbal liquid containing geniposide may play a role in the pathogenesis of IMP.
Topics: Aged; Colon; Colonoscopy; Humans; Iridoids; Male; Mesenteric Veins
PubMed: 34168411
DOI: 10.3748/wjg.v27.i22.3097 -
Korean Journal of Radiology Dec 2023
Topics: Humans; Mesenteric Veins; Hyperplasia; Biopsy
PubMed: 38016688
DOI: 10.3348/kjr.2023.0782