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Sample records for mesenteric ischemia non-okklusive

  1. [Chronic mesenteric ischemia revisited].

    PubMed

    do Carmo, Germano; Rosa, António; Ministro, Augusto; Pestana, Cristina

    2013-01-01

    The authors report two clinical cases of rare and complex situations - an aortic dissection and an aortitis -, which had as a common denominator a chronic mesenteric ischemia. They discuss the indications and surgical strategies adopted.

  2. Mesenteric artery ischemia

    MedlinePlus

    ... bowel - mesenteric; Dead gut - mesenteric; Atherosclerosis - mesenteric artery; Hardening of the arteries - mesenteric artery ... the aorta, the main artery from the heart. Hardening of the arteries occurs when fat, cholesterol, and ...

  3. Non-occlusive mesenteric ischemia.

    PubMed

    Lock, G; Schölmerich, J

    1995-07-01

    Non-occlusive disease of the mesentery is still a rather underdiagnosed and underestimated condition. It is associated with circumstances that may compromise circulation or the intake of drugs that may lower mesenteric blood flow. Pathophysiologically, a "low flow syndrome" of mesenteric circulation is followed by vasoconstriction; a reperfusion injury may contribute to the ischemic injury. Histopathological changes vary between superficial localized lesions and transmural gangrene. Diagnosis within the initial 24 hours of the development of symptoms is crucial for prognosis but remains a difficult task. Clinical presentation, laboratory tests and ultrasound lack specificity; the role of duplex ultrasound, tonometry and reflectance spectophotometry is still under evaluation. Mesenteric angiography remains the only reliable diagnostic tool and should be applied early in all patients in whom acute mesenteric ischemia is a real possibility. Therapy is aimed at the rapid correction of predisposing and precipitating factors and an effective treatment of mesenteric vasoconstriction. Treatment of choice is a papaverine infusion into the superior mesenteric artery via an angiography catheter. Patients with peritoneal signs have to be treated surgically.

  4. Acute mesenteric ischemia: current multidisciplinary approach.

    PubMed

    Savlania, Ajay; Tripathi, Ramesh K

    2017-04-01

    The aim of this review was to describe and discuss the mechanisms of acute mesenteric ischemia (AMI) and the rationale and conduct of currently available endovascular and open surgical techniques in its management. We also propose an algorithm to support the current multidisciplinary approach in decision-making for mesenteric revascularization to manage this high-risk entity.

  5. Acute mesenteric ischemia in young adults.

    PubMed

    Ozturk, Gurkan; Aydinli, Bulent; Atamanalp, S Selcuk; Yildirgan, M Ilhan; Ozoğul, Bünyami; Kısaoğlu, Abdullah

    2012-08-01

    Acute mesenteric ischemia is commonly seen in old patients. This study was undertaken to show that mesenteric ischemia might be seen in individuals under 40 years of age and that its diagnosis is challenging. Twenty-six patients with acute mesenteric ischemia under the age of 40 were studied. The main symptom on admission was abdominal pain. Symptom duration varied between 12 h and 5 days. The medical history of the patients revealed that 9 had no previous diseases. Other 17 had predisposing factors in the first evaluation. None of the patients had any history of narcotic or drug abuse. Ten patients presented with signs and symptoms of sepsis and septic shock. Preoperative diagnosis was acute intestinal ischemia only in 6 patients. Preoperatively, all the patients had intestinal or colonic ischemia and necrosis; one had additional ischemia of the liver, stomach, duodenum, and pancreas. Six patients had massive intestinal necrosis. The overall postoperative complication and overall mortality rates were 61.5 and 26.9 %, respectively. Complications and mortality were determined to be associated with previous pulmonary disease, acidosis, presence of septic shock, acute renal failure, extent of the ischemia and extent of resection, second look operations, previous cardiac events, and the kind of affected bowel (colon involvement).

  6. Outcomes after endarterectomy for chronic mesenteric ischemia.

    PubMed

    Mell, Matthew W; Acher, Charles W; Hoch, John R; Tefera, Girma; Turnipseed, William D

    2008-11-01

    A retrospective study was performed to identify optimal factors affecting outcomes after open revascularization for chronic mesenteric ischemia. All patients who underwent open surgery for chronic mesenteric ischemia from 1987 to 2006 were reviewed. Patients with acute mesenteric ischemia or median arcuate ligament syndrome were excluded. Mortality, recurrent stenosis, and symptomatic recurrence were analyzed using logistic regression, and univariate and multivariate analysis. We identified 80 patients (69% women, 31% men). Mean age was 64 years (range, 31-86 years). Acute-on-chronic symptoms were present in 26%. Presenting symptoms included postprandial pain (91%), weight loss (69%), and food fear and diarrhea (25%). Preoperative imaging demonstrated severe (>70%) stenosis of the superior mesenteric artery in 75 patients (24 occluded), the celiac axis in 63 (20 occluded), and the inferior mesenteric artery in 53 (20 occluded). Multivessel disease was present in 72 patients (90%), and 40 (50%) underwent multivessel reconstruction. Revascularization was achieved by endarterectomy in 37 patients, mesenteric bypass in 29, and combined procedures in 14. Concurrent aortic reconstruction was required in 13 patients (16%). Three hospital deaths occurred (3.8%). Mean follow-up was 3.8 years (range, 0-17.2 years). One- and 5-year survival was 92.2% and 64.5%. Mortality was associated with age (P = .019) and renal insufficiency (P = .007), but not by clinical presentation. Symptom-free survival was 89.7% and 82.1% at 1 and 5 years, respectively. Symptoms requiring reintervention occurred in nine patients (11%) at a mean of 29 months (range, 5-127 months). Multivariate analysis showed that freedom from recurrent symptoms correlated with endarterectomy for revascularization (5.2% vs 27.6%; hazard ratio, 0.20; 95% confidence interval, 0.04-0.92; P = .02). For open surgical candidates, endarterectomy appears to provide the most durable long-term symptom relief in patients with

  7. Mesenteric ischemia: the importance of differential diagnosis for the surgeon.

    PubMed

    Reginelli, Alfonso; Iacobellis, Francesca; Berritto, Daniela; Gagliardi, Giuliano; Di Grezia, Graziella; Rossi, Michele; Fonio, Paolo; Grassi, Roberto

    2013-01-01

    Intestinal ischemia is an abdominal emergency that accounts for approximately 2% of gastrointestinal illnesses. It represents a complex of diseases caused by impaired blood perfusion to the small and/or large bowel including acute arterial mesenteric ischemia (AAMI), acute venous mesenteric ischemia (AVMI), non occlusive mesenteric ischemia (NOMI), ischemia/reperfusion injury (I/R), ischemic colitis (IC). In this study different study methods (US, CT) will be correlated in the detection of mesenteric ischemia imaging findings due to various etiologies. Basing on our institutions experience, 163 cases of mesenteric ischemia/infarction from various cases, investigated with CT and undergone surgical treatment were retrospectively evaluated, in particular trought the following findings: presence/absence of arterial/venous obstruction, bowel wall thickness and enhancement, presence/absence of spastic reflex ileus, hypotonic reflex ileus or paralitic ileus, mural and/or portal/mesenteric pneumatosis, abdominal free fluid, parenchymal ischemia/infarction (liver, kidney, spleen). To make an early diagnosis useful to ensure a correct therapeutic approach, it is very important to differentiate between occlusive (arterial, venous) and non occlusive causes (NOMI). The typical findings of each forms of mesenteric ischemia are explained in the text. The radiological findings of mesenteric ischemia have different course in case of different etiology. In venous etiology the progression of damage results faster than arterial even if the symptomatology is less acute; bowel wall thickening is an early finding and easy to detect, simplifying the diagnosis. In arterial etiology the damage progression is slower than in venous ischemia, bowel wall thinning is typical but difficult to recognize so diagnosis may be hard. In the NOMI before/without reperfusion the ischemic damage is similar to AAMI with additional involvement of large bowel parenchymatous organs. In reperfusion after NOMI

  8. Systolically gated 3D phase contrast MRA of mesenteric arteries in suspected mesenteric ischemia

    SciTech Connect

    Wasser, M.N.; Schultze Kool, L.J.; Roos, A. de

    1996-03-01

    Our goal was to assess the value of MRA for detecting stenoses in the celiac (CA) and superior mesenteric (SMA) arteries in patients suspected of having chronic mesenteric ischemia, using an optimized systolically gated 3D phase contrast technique. In an initial study in 24 patients who underwent conventional angiography of the abdominal vessels for different clinical indications, a 3D phase contrast MRA technique (3D-PCA) was evaluated and optimized to image the CAs and SMAs. Subsequently, a prospective study was performed to assess the value of systolically gated 3D-PCA in evaluation of the mesenteric arteries in 10 patients with signs and symptoms of chronic mesenteric ischemia. Intraarterial digital subtraction angiography and surgical findings were used as the reference standard. In the initial study, systolic gating appeared to be essential in imaging the SMA on 3D-PCA. In 10 patients suspected of mesenteric ischemia, systolically gated 3D-PCA identified significant proximal disease in the two mesenteric vessels in 4 patients. These patients underwent successful reconstruction of their stenotic vessels. Cardiac-gated MRA may become a useful tool in selection of patients suspected of having mesenteric ischemia who may benefit from surgery. 16 refs., 6 figs., 4 tabs.

  9. Mesenteric ischemia: the importance of differential diagnosis for the surgeon

    PubMed Central

    2013-01-01

    Background Intestinal ischemia is an abdominal emergency that accounts for approximately 2% of gastrointestinal illnesses. It represents a complex of diseases caused by impaired blood perfusion to the small and/or large bowel including acute arterial mesenteric ischemia (AAMI), acute venous mesenteric ischemia (AVMI), non occlusive mesenteric ischemia (NOMI), ischemia/reperfusion injury (I/R), ischemic colitis (IC). In this study different study methods (US, CT) will be correlated in the detection of mesenteric ischemia imaging findings due to various etiologies. Methods Basing on our institutions experience, 163 cases of mesenteric ischemia/infarction from various cases, investigated with CT and undergone surgical treatment were retrospectively evaluated, in particular trought the following findings: presence/absence of arterial/venous obstruction, bowel wall thickness and enhancement, presence/absence of spastic reflex ileus, hypotonic reflex ileus or paralitic ileus, mural and/or portal/mesenteric pneumatosis, abdominal free fluid, parenchymal ischemia/infarction (liver, kidney, spleen). Results To make an early diagnosis useful to ensure a correct therapeutic approach, it is very important to differentiate between occlusive (arterial, venous) and non occlusive causes (NOMI). The typical findings of each forms of mesenteric ischemia are explained in the text. Conclusion The radiological findings of mesenteric ischemia have different course in case of different etiology. In venous etiology the progression of damage results faster than arterial even if the symptomatology is less acute; bowel wall thickening is an early finding and easy to detect, simplifying the diagnosis. In arterial etiology the damage progression is slower than in venous ischemia, bowel wall thinning is typical but difficult to recognize so diagnosis may be hard. In the NOMI before/without reperfusion the ischemic damage is similar to AAMI with additional involvement of large bowel

  10. Endovascular Treatment of Chronic Mesenteric Ischemia: Report of Five Cases

    SciTech Connect

    Nyman, Ulf; Ivancev, Krasnodar; Lindh, Mats; Uher, Petr

    1998-07-15

    Purpose: To evaluate the midterm results of percutaneous transluminal angioplasty (PTA) and stent placement in stenotic and occluded mesenteric arteries in five consecutive patients with chronic mesenteric ischemia. Methods: Five patients with 70%-100% obliterations of all mesenteric vessels resulting in chronic mesenteric ischemia (n= 4) and as a prophylactic measure prior to abdominal aortic aneurysm repair (n= 1) underwent PTA of celiac and/or superior mesenteric artery (SMA) stenoses (n= 2), primary stenting of ostial celiac occlusions (n= 2), and secondary stenting of a SMA occlusion (n= 1; recoil after initial PTA). All patients underwent duplex ultrasonography (US) (n= 3) and/or angiography (n= 5) during a median follow-up of 21 months (range 8-42 months). Results: Clinical success was obtained in all five patients. Asymptomatic significant late restenoses (n3) were successfully treated with repeat PTA (n= 2) and stenting of an SMA occlusion (n= 1; celiac stent restenosis). Recurrent pain in one patient was interpreted as secondary to postsurgical abdominal adhesions. Two puncture-site complications occurred requiring local surgical treatment. Conclusions: Endovascular techniques may be attempted prior to surgery in cases of stenotic or short occlusive lesions in patients with chronic mesenteric ischemia. Surgery may still be preferred in patients with long occlusions and a low operative risk.

  11. Atherosclerotic inferior mesenteric artery stenosis resulting in large intestinal hypoperfusion: a paradigm shift in the diagnosis and management of symptomatic chronic mesenteric ischemia.

    PubMed

    Lotun, Kapildeo; Shetty, Ranjith; Topaz, On

    2012-11-01

    Symptomatic chronic mesenteric ischemia results from intestinal hypoperfusion and is classically thought to result from involvement of two or more mesenteric arteries. The celiac artery and superior mesenteric artery are most frequently implicated in this disease process, and their involvement usually results in symptoms of small intestinal ischemia. Symptomatic chronic mesenteric ischemia resulting predominantly from inferior mesenteric artery involvement has largely been overlooked but does gives rise to its own, unique clinical presentation with symptoms resulting from large intestinal ischemia. We present four patients with atherosclerotic inferior mesenteric artery stenosis with symptomatic chronic mesenteric ischemia that have unique clinical presentations consistent with large intestinal ischemia that resolved following percutaneous endovascular treatment of the inferior mesenteric artery stenosis. These cases represent a novel approach to the diagnosis and management of this disease process and may warrant a further subclassification of chronic mesenteric ischemia into chronic small intestinal ischemia and chronic large intestinal ischemia.

  12. Noninvasive diagnosis of mesenteric ischemia using a SQUID magnetometer.

    PubMed Central

    Richards, W O; Garrard, C L; Allos, S H; Bradshaw, L A; Staton, D J; Wikswo, J P

    1995-01-01

    OBJECTIVE: The authors assessed the ability of a Superconducting Quantum Interference Device (SQUID) magnetometer to noninvasively detect mesenteric ischemia in a rabbit model. SUMMARY BACKGROUND DATA: Superconducting Quantum Interference Device magnetometers have been used to detect magnetic fields created by the basic electrical rhythm (BER) and to detect changes in BER of exteriorized bowel of anesthetized rabbits during mesenteric ischemia. METHODS: The BER of rabbit ileum was noninvasively measured transabdominally using a SQUID magnetometer and compared with the electrical activity recorded with surgically implanted serosal electrodes before, during, and after snare occlusion of the superior mesenteric artery. RESULTS: Transabdominal SQUID recording of BER frequency was highly correlated to the measurements obtained with electrodes (R = 0.91). Basic electrical rhythm frequency decreased from 16.4 +/- 0.8 to 8.3 +/- 0.3 cpm (p < 0.001) after 25 minutes of ischemia. Reperfusion of ischemic bowel resulted in recovery of BER frequency to 14.3 +/- 0.4 cpm 10 minutes after blood flow was restored. CONCLUSIONS: A SQUID magnetometer is capable of noninvasively detecting mesenteric ischemia reliably and at an early stage by detecting a significant drop in BER frequency. These positive findings have encouraged the authors to continue development of clinically useful, noninvasive, detection of intestinal magnetic fields using SQUID magnetometers. Images Figure 5. PMID:7794074

  13. Prolonged idiopathic gastric dilatation following revascularization for chronic mesenteric ischemia.

    PubMed

    Gauci, Julia L; Stoven, Samantha; Szarka, Lawrence; Papadakis, Konstantinos A

    2014-01-01

    A 71-year-old female presented with nausea, emesis, early satiety, and abdominal distension following revascularization for chronic mesenteric ischemia. Computed tomography angiogram showed gastric dilatation. Esophagogastroduodenoscopy, small bowel follow through, and paraneoplastic panel were negative. Gastric emptying was delayed. Despite conservative management, she required a percutaneous endoscopic jejunostomy. The development of a prolonged gastroparetic state has not been previously described.

  14. Prolonged idiopathic gastric dilatation following revascularization for chronic mesenteric ischemia

    PubMed Central

    Gauci, Julia L.; Stoven, Samantha; Szarka, Lawrence; Papadakis, Konstantinos A.

    2014-01-01

    A 71-year-old female presented with nausea, emesis, early satiety, and abdominal distension following revascularization for chronic mesenteric ischemia. Computed tomography angiogram showed gastric dilatation. Esophagogastroduodenoscopy, small bowel follow through, and paraneoplastic panel were negative. Gastric emptying was delayed. Despite conservative management, she required a percutaneous endoscopic jejunostomy. The development of a prolonged gastroparetic state has not been previously described. PMID:24975870

  15. ACR Appropriateness Criteria(®) Radiologic Management of Mesenteric Ischemia.

    PubMed

    Fidelman, Nicholas; AbuRahma, Ali F; Cash, Brooks D; Kapoor, Baljendra S; Knuttinen, M-Grace; Minocha, Jeet; Rochon, Paul J; Shaw, Colette M; Ray, Charles E; Lorenz, Jonathan M

    2017-05-01

    Mesenteric vascular insufficiency is a serious medical condition that may lead to bowel infarction, morbidity, and mortality that may approach 50%. Recommended therapy for acute mesenteric ischemia includes aspiration embolectomy, transcatheter thrombolysis, and angioplasty with or without stenting for the treatment of underlying arterial stenosis. Nonocclusive mesenteric ischemia may respond to transarterial infusion of vasodilators such as nitroglycerin, papaverine, glucagon, and prostaglandin E1. Recommended therapy for chronic mesenteric ischemia includes angioplasty with or without stent placement and, if an endovascular approach is not possible, surgical bypass or endarterectomy. The diagnosis of median arcuate ligament syndrome is controversial, but surgical release may be appropriate depending on the clinical situation. Venous mesenteric ischemia may respond to systemic anticoagulation alone. Transhepatic or transjugular superior mesenteric vein catheterization and thrombolytic infusion can be offered depending on the severity of symptoms, condition of the patient, and response to systemic anticoagulation. Adjunct transjugular intrahepatic portosystemic shunt creation can be considered for outflow improvement. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College

  16. Diagnostic Value of Procalcitonin Levels in Acute Mesenteric Ischemia

    PubMed Central

    Karaca, Yunus; Gündüz, Abdulkadir; Türkmen, Süha; Menteşe, Ahmet; Türedi, Süleyman; Eryiğit, Umut; Karahan, Süleyman Caner

    2015-01-01

    Background: Acute mesenteric ischemia (AMI) is a potentially fatal disease. Difficulties in diagnosis make it essential to find early biomarkers. Aims: This study investigated the diagnostic value of procalcitonin (PCT) levels in AMI. Study Design: Animal experimentation. Methods: Rats were divided into six groups of six animals each. In the experimental group, an experimental ischemia model was established by clamping the superior mesenteric artery from the aortic outflow tract. Blood and tissue specimens were collected from rats in the experimental mesenteric ischemia model at 30 min and 2 and 6 h, and these were compared with specimens from the respective control groups. PCT levels were compared at 30 min and 2 and 6 h. Results: PCT levels were 185.3 pg/mL in the control group and 219.3 pg/mL in the study group, 199.6 pg/mL in the control group and 243.9 pg/mL in the study group, and 201.9 pg/mL in the control group and 286.9 pg/mL in the study group, respectively, at 30 minute, 2 and 6 hours. Significant differences were determined between 6-h control group and ischemia group PCT levels (p=0.005). Conclusion: The absence of a significant increase in PCT levels in the early period, while a significant difference was detected in the later period (6 h), shows that PCT levels rise late in mesenteric ischemia and can be a marker in the late period. PMID:26185718

  17. Intestinal Injury Currents Associated with Mesenteric Ischemia and Reperfusion

    NASA Astrophysics Data System (ADS)

    Cordova, T.; Bradshaw, L. A.; O'Mahony, G. P.; Gallucci, M. R.; Berch, B.; Richards, W. O.

    2006-09-01

    A non-invasive method of detecting mesenteric ischemia is presented. The aim of this study was to evaluate the effect of arterial reperfusion on these injury currents. The small bowel of New Zealand white rabbits was exteriorized and the mesenteric blood flow interrupted. Experiments were conducted in three groups, control (n = 3), ischemia (n = 6) and reperfusion following ischemia (n = 5). The subject's position was modulated in and out of the biological field detection range of a SQUID magnetometer. The changes in magnetic field amplitude for the experimental groups were 9.3% and 31.0% for the control and the ischemia groups respectively. The reperfusion group first exhibited a decrease of 17.4% from pre-ischemic to the ischemic period followed by an increase of 13.9% of the ischemic value after re-establishing perfusion. It is concluded that injury currents in GI smooth muscle that appear during ischemia are reduced to pre-ischemic levels during reperfusion.

  18. Endovascular Treatment of Chronic Mesenteric Ischemia: Results in 14 Patients

    SciTech Connect

    Chahid, Tamam; Alfidja, Agaicha T.; Biard, Marie; Ravel, Anne; Garcier, Jean Marc; Boyer, L.

    2004-11-15

    We evaluated immediate and long-term results of percutaneous transluminal angioplasty (PTA) and stent placement to treat stenotic and occluded arteries in patients with chronic mesenteric ischemia. Fourteen patients were treated by 3 exclusive celiac artery (CA) PTAs (2 stentings), 3 cases with both Superior Mesenteric Artery (SMA) and CA angioplasties, and 8 exclusive SMA angioplasties (3 stentings). Eleven patients had atheromatous stenoses with one case of an early onset atheroma in an HIV patient with antiphospholipid syndrome. The other etiologies of mesenteric arterial lesions were Takayashu arteritis (2 cases) and a postradiation stenoses (1 case). Technical success was achieved in all cases. Two major complications were observed: one hematoma and one false aneurysm occurring at the brachial puncture site (14.3%). An immediate clinical success was obtained in all patients. During a follow-up of 1-83 months (mean: 29 months), 11 patients were symptom free; 3 patients had recurrent pain; in one patient with inflammatory syndrome, pain relief was obtained with medical treatment; in 2 patients abdominal pain was due to restenosis 36 and 6 months after PTA, respectively. Restenosis was treated by PTA (postirradiation stenosis), and by surgical bypass (atheromatous stenosis). Percutaneous endovascular techniques are safe and accurate. They are an alternative to surgery in patients with chronic mesenteric ischemia due to short and proximal occlusive lesions of SMA and CA.

  19. [Chronic arterial mesenteric ischemia: Doppler color ultrasonography demonstration of collateral flow].

    PubMed

    Danse, E M; Hammer, F; Matondo, H; Dardenne, A N; Geubel, A; Goffette, P

    2001-11-01

    Two cases of atypical mesenteric ischemia where color Doppler US demonstration of the underlying arterial abnormality and collateral supply was possible are presented. Significant stenosis of the celiac axis and thrombosis of the SMA were clearly depicted, along with the presence of collateral arterial supply. Endovascular treatment was successful in both cases. These cases confirm the possibility of detecting collateral flow at Doppler imaging in patients with mesenteric ischemia, both for diagnosis of mesenteric ischemia and endovascular treatment planning.

  20. Endovascular treatment of chronic arterial mesenteric ischemia: a changing perspective?

    PubMed

    Gibbons, C P; Roberts, D E

    2010-03-01

    Endovascular treatment for chronic mesenteric ischemia is growing in popularity because of its lower periprocedural morbidity and mortality than open surgery. It is especially suitable for the high-risk surgical candidate and for those who have a poor nutritional state, although endovascular surgery may not be possible in patients with ostial occlusions or heavily calcified vessels. A positive response to angioplasty is helpful to secure a diagnosis in patients with slightly atypical symptoms. There are little data at present to suggest that primary stenting is better than angioplasty alone, but insertion of a stent may be valuable as a rescue procedure following dissection, vascular recoil, or thrombosis during angioplasty. The superior mesenteric artery is probably the most important vessel to treat but, where this is impossible, celiac or inferior mesenteric artery dilatation may have therapeutic benefit. However, there is some evidence at present favoring multiple, as opposed to single-vessel, angioplasty or stenting. Long-term patency is better after mesenteric bypass, which may be preferred in the younger and fitter patient. Treatment of the celiac artery compression syndrome is primarily surgical, but stent insertion may have a role as a secondary procedure where there is a residual stenosis after median arcuate ligament division.

  1. Retrograde aorto-mesenteric by-pass grafting as treatment option of recurrent chronic mesenteric ischemia after thrombosed superior mesenteric artery stenting. Report of a case.

    PubMed

    Nano, G; Dalainas, I; Bianchi, P; Stegher, S; Casana, R; Malacrida, G; Tealdi, D G

    2006-12-01

    We report a case of early stent failure in a patient with chronic mesenteric ischemia and its treatment with a retrograde aorto-mesenteric by-pass. The patient was initially treated with angioplasty and stenting. Seven months after the procedure complete thrombosis of the stent was achieved. A retrograde aorto-mesenteric by-pass was performed. After two years the patient remains asymptomatic and color Duplex scan confirm the patency of the graft.

  2. Relief of Mesenteric Ischemia by Z-Stent Placement into the Superior Mesenteric Artery Compressed by the False Lumen of an Aortic Dissection

    SciTech Connect

    Yamakado, Koichiro; Takeda, Kan; Nomura, Yoshiyuki; Kato, Noriyuki; Hirano, Tadanori; Matsumura, Kaname; Nakagawa, Tsuyoshi; Yuasa, Hiroshi; Yada, Isao

    1998-01-15

    In a 58-year-old man acute aortic dissection compromised the origin of the superior mesenteric artery (SMA), resulting in mesenteric ischemia. After failed balloon angioplasty a Gianturco Z-stent was placed. The stenosis improved immediately, followed by resolution of the clinical signs of mesenteric ischemia. SMA flow was well preserved 1 year after stenting.

  3. Chronic mesenteric ischemia: Time to remember open revascularization

    PubMed Central

    Keese, Michael; Schmitz-Rixen, Thomas; Schmandra, Thomas

    2013-01-01

    Chronic mesenteric ischemia is caused by stenosis or occlusion of one or more visceral arteries. It represents a therapeutic challenge and diagnosis and treatment require close interdisciplinary cooperation between gastroenterologist, vascular surgeon and radiologist. Although endovascular treatment modalities have been developed, the number of restenoses ultimately resulting in treatment failure is high. In patients fit for open surgery, the visceral arteries should be revascularized conventionally. These patients will then experience long term relief from the symptoms, a better quality of life and a better overall survival. PMID:23539677

  4. Lindnera (Pichia) fabianii blood infection after mesenteric ischemia.

    PubMed

    Gabriel, Frederic; Noel, Thierry; Accoceberry, Isabelle

    2012-04-01

    Lindnera (Pichia) fabianii (teleomorph of Candida fabianii) is a yeast species rarely involved in human infections. This report describes the first known human case of a Lindnera fabianii blood infection after mesenteric ischemia. The 53-year-old patient was hospitalized in the intensive care unit after a suicide attempt and was suffering from a mesenteric ischemia and acute renal failure. Lindnera fabianii was recovered from an oropharyngeal swab, then isolated from stool and urine samples before the diagnosis of the blood infection. Caspofungin intravenous treatment was associated with a successful outcome. Final unequivocal identification of the strain was done by sequencing the internal transcribed spacer (ITS) region, and regions of 18S rDNA gene and of the translation elongation factor-1α gene. Until our work, the genomic databases did not contain the complete ITS region of L. fabianii as a single nucleotide sequence (encompassing ITS1, the 5.8S rDNA and ITS2), and misidentification with other yeast species, e.g., Lindnera (Pichia) mississippiensis, could have occurred. Our work demonstrates that the usual DNA barcoding method based on sequencing of the ITS region may fail to provide the correct identification of some taxa, and that partial sequencing of the EF1α gene may be much more effective for the accurate delineation and molecular identification of new emerging opportunistic yeast pathogens.

  5. Percutaneous Retrograde Recanalization of the Celiac Artery by Way of the Superior Mesenteric Artery for Chronic Mesenteric Ischemia

    SciTech Connect

    Joseph, George Chacko, Sujith Thomas

    2013-02-15

    A 52-year-old man presented with recurrent postprandial abdominal pain, sitophobia, and progressive weight loss. Chronic mesenteric ischemia (CMI) due to subtotal occlusion of the superior mesenteric artery (SMA) and flush occlusion of the celiac artery (CA) was diagnosed. Retrograde recanalization of the CA by way of a collateral channel from the SMA was performed using contemporary recanalization equipment. The CA and SMA were then stented, resulting in sustained resolution of CMI-related symptoms.

  6. Successful Percutaneous Transluminal Angioplasty and Stenting in Acute Mesenteric Ischemia

    SciTech Connect

    Gartenschlaeger, Soeren Bender, Siegfried; Maeurer, Juergen; Schroeder, Ralf J.

    2008-03-15

    Acute mesenteric ischemia (AMI) is a life-threatening emergency. The complications are high by the time of diagnosis in most cases and therefore only few data on primary percutaneous intervention with percutaneous transluminal angioplasty (PTA) and stenting in AMI are available. We present the case of an 84-year-old woman who presented to our emergency department complaining of an acute worsening of pre-existing abdominal periumbilical pain, nausea, vomiting, and diarrhea. She had previously undergone percutaneous transluminal embolectomy for an acute occlusion of the left common femoral artery. Due to suspicion of intestinal infarction, conventional angiography of the aorta and the superior mesenteric artery (SMA) was performed and confirmed a proximal occlusion of the SMA. Percutaneous SMA recanalization with balloon dilation and subsequent stent implantation was carried out successfully. The abdominal symptoms subsided after this procedure. In AMI that is diagnosed early, endovascular stenting should be considered as an alternative treatment to the surgical approach that avoids the need for surgical bowel resection.

  7. Morbidity and mortality after bowel resection for acute mesenteric ischemia.

    PubMed

    Gupta, Prateek K; Natarajan, Bala; Gupta, Himani; Fang, Xiang; Fitzgibbons, Robert J

    2011-10-01

    Patients presenting with acute mesenteric ischemia (AMI) sufficiently advanced to require bowel resection have a high morbidity and mortality. The objective of this study was to analyze these patients to determine if certain pre- or intraoperative variables are predictive of death or complications which could then be used to develop a predictive model to aid in surgical decision-making. Patients undergoing bowel resection for AMI were identified from the American College of Surgeons' National Surgical Quality Improvement Program database (2007-2008). Multiple logistic regression analysis was performed. The 861 patients identified had a median age of 69 years. Thirty-day postoperative morbidity and mortality were 56.6% and 27.9%, respectively. Pre- and intraoperative variables significantly associated with postoperative mortality (C statistic, 0.84) included preoperative do not resuscitate order, open wound, low albumin, dirty vs clean-contaminated case, and poor functional status. Pre- and intraoperative variables significantly associated with postoperative morbidity (C statistic, 0.79) included admission from chronic care facility, recent myocardial infarction, chronic obstructive pulmonary disease, requiring ventilator support, preoperative renal failure, previous cardiac surgery, and prolonged operative time. A predictive risk calculator was developed using these variables. Mortality and morbidity rates after bowel resection for AMI are high. A risk calculator for prediction of postoperative mortality and morbidity has been developed and awaits validation in subsequent studies. Copyright © 2011 Mosby, Inc. All rights reserved.

  8. Nonocclusive Mesenteric Ischemia in a Patient on Maintenance Hemodialysis

    PubMed Central

    Han, Sang Youb; Kwon, Young Joo; Shin, Jin Ho; Pyo, Heui Jung; Kim, Ae Ree

    2000-01-01

    Nonocclusive mesenteric ischemia (NOMI) is known to occupy about 25% to 60% of intestinal infarction. NOMI has been reported to be responsible for 9% of the deaths in the dialysis population and the postulated causes of NOMI include intradialytic hypotension, atherosclerosis and medications, such as diuretics, digitalis and vasopressors. Clinical manifestations, such as fever, diarrhea and leukocytosis, are nonspecific, which makes early diagnosis of NOMI very difficult. Case: A 66-year-old woman on maintenance hemodialysis for 5 years was admitted with syncope, abdominal pain and chilly sensation. Since 7 days prior to admission, blood pressure on the supine position during hemodialysis had frequently fallen to 80/50 mmHg. Four days later, she complained of progressive abdominal pain. Rebound tenderness and leukocytosis (WBC 13900/mm3) with left shift were noted. Stool examination was positive for occult blood. Abdominal CT scan showed a distended gall bladder with sludge. Under the impression of acalculous cholecystitis, she was operated on. Surgical and pathologic findings of colon colon were compatible with NOMI. Because of recurrent intradialytic hypotension, we started midodrine 2.5 mg just before hemodialysis and increased the dose up to 7.5 mg. After midodrine therapy, blood pressure during dialysis became stable and the symptoms associated with hypotension did not recur. Conclusion: As NOMI may occur within several hours or days after an intradialytic hypotensive episode, abdominal pain should be carefully observed and NOMI should be considered as a differential diagnosis. In addition, we suggest that midodrine be considered to prevent intradialytic hypotensive episodes. PMID:10714097

  9. A case of mesenteric ischemia secondary to Fibromuscular Dysplasia (FMD) with a positive outcome after intervention.

    PubMed

    Patel, Neal C; Palmer, William C; Gill, Kanwar R S; Wallace, Michael B

    2012-10-01

    Fibromuscular dysplasia (FMD) is a non-inflammatory, non-atherosclerotic angiopathy, which commonly affects the renal and internal carotid arteries. Although rare, FMD has the potential of involving the mesenteric vasculature. Due its low incidence and relatively little knowledge concerning its risk factors and etiology, actual diagnosis of FMD involving the mesenteric vessels requires a very high degree of suspicion. Upon review of the few reported cases of FMD causing mesenteric ischemia, it is clear that therapeutic interventions are rarely discussed and that positive outcomes are even more uncommon. Herein, we present the case of a 47 year-old female with mesenteric ischemia secondary to FMD, which was diagnosed and treated originally with angioplasty, then repeat angioplasty with stent placement, and finally with a bypass graft. Ultimately, the patient had a positive outcome, including eight month follow-up.

  10. Case Report of Percutaneous Retrograde Transcollateral Recanalization of the Superior Mesenteric Artery via the Celiac Artery for Acute Mesenteric Ischemia

    PubMed Central

    Gupta, Prateek K.; Smith, Brigitte K.; Yamanouchi, Dai

    2015-01-01

    Abstract Revascularization for acute mesenteric ischemia (AMI) can be achieved through a bypass from the aorta or iliac arteries, embolectomy, open exposure of SMA and retrograde recanalization and stent, or percutaneous antegrade stenting. Flush occlusion of the SMA can make antegrade recanalization very challenging and is usually unsuccessful. We present a novel approach for recanalization of superior mesenteric artery (SMA) via the celiac artery for acute mesenteric ischemia. A 69-year-old lady with previous endarterectomy of SMA and extensive small bowel resection presented with severe abdominal pain, emesis, leukocytosis, and imaging finding of new SMA flush occlusion. She refused to consent for a laparotomy. Percutaneous retrograde transcollateral recanalization of SMA was performed via the celiac artery through the pancreaticoduodenal arcade, and the SMA then stented. This resulted in subsequent resolution of patient's symptoms and discharge. SMA revascularization with retrograde transcollateral wiring technique is an important tool in the armamentarium of the vascular care specialist when antegrade percutaneous approach and open exposure via laparotomy are not an option. PMID:26683911

  11. Color Doppler sonography of small bowel wall changes in 21 consecutive cases of acute mesenteric ischemia.

    PubMed

    Danse, E M; Kartheuser, A; Paterson, H M; Laterre, P-F

    2009-01-01

    To describe the small bowel wall changes observed with color Doppler sonography in acute mesenteric ischemia with comparison with its outcome. We reviewed the sonographic findings of 21 patients with a final diagnosis of acute mesenteric ischemia (12 acute arterial forms and 9 acute venous forms). These examinations included identification of non peristaltic thin-walled fluid-filled intestinal loops (with or without pneumatosis), thickened intestinal wall (> 3 mm) (noted as stratified or not), and preserved or absent mural flow assessed with color Doppler. Sonographic findings were compared with the surgical data (n = 16) or with the clinical outcome (n = 5). In acute arterial ischemia, non-peristaltic thin-walled intestinal loops were detected with sonography in five cases, with visualization of pneumatosis in one. Bowel infarction was diagnosed in four of these five patients including one patient with pneumatosis. Thickened bowel loops were sonographically detected in four cases, of which 3 required resection. Conservative therapy was performed in the remaining case having preserved wall stratification and mural flow with color Doppler. In acute venous ischemia, thickened bowel loops were detected with sonography in six cases. Conservative therapy was performed in three cases for whom preserved mural flow was noted. Stratification was present in two of these three cases. In acute arterial ischemia, intestinal resection is frequently required when non-peristaltic, thin-walled, fluid-filled loops are detected with sonography. In arterial and venous ischemia, absence of wall stratification and mural flow are frequently associated with ischemia requiring surgery.

  12. Noninvasive biomagnetic detection of intestinal slow wave dysrhythmias in chronic mesenteric ischemia

    PubMed Central

    Muszynski, N. D.; Cheng, L. K.; Bradshaw, L. A.; Naslund, T. C.; Richards, W. O.

    2015-01-01

    Chronic mesenteric ischemia (CMI) is a challenging clinical problem that is difficult to diagnose noninvasively. Diagnosis early in the disease process would enable life-saving early surgical intervention. Previous studies established that superconducting quantum interference device (SQUID) magnetometers detect the slow wave changes in the magnetoenterogram (MENG) noninvasively following induction of mesenteric ischemia in animal models. The purpose of this study was to assess functional physiological changes in the intestinal slow wave MENG of patients with chronic mesenteric ischemia. Pre- and postoperative studies were conducted on CMI patients using MENG and intraoperative recordings using invasive serosal electromyograms (EMG). Our preoperative MENG recordings showed that patients with CMI exhibited a significant decrease in intestinal slow wave frequency from 8.9 ± 0.3 cpm preprandial to 7.4 ± 0.1 cpm postprandial (P < 0.01) that was not observed in postoperative recordings (9.3 ± 0.2 cpm preprandial and 9.4 ± 0.4 cpm postprandial, P = 0.86). Intraoperative recording detected multiple frequencies from the ischemic portion of jejunum before revascularization, whereas normal serosal intestinal slow wave frequencies were observed after revascularization. The preoperative MENG data also showed signals with multiple frequencies suggestive of uncoupling and intestinal ischemia similar to intraoperative serosal EMG. Our results showed that multichannel MENG can identify intestinal slow wave dysrhythmias in CMI patients. PMID:25930082

  13. Noninvasive biomagnetic detection of intestinal slow wave dysrhythmias in chronic mesenteric ischemia.

    PubMed

    Somarajan, S; Muszynski, N D; Cheng, L K; Bradshaw, L A; Naslund, T C; Richards, W O

    2015-07-01

    Chronic mesenteric ischemia (CMI) is a challenging clinical problem that is difficult to diagnose noninvasively. Diagnosis early in the disease process would enable life-saving early surgical intervention. Previous studies established that superconducting quantum interference device (SQUID) magnetometers detect the slow wave changes in the magnetoenterogram (MENG) noninvasively following induction of mesenteric ischemia in animal models. The purpose of this study was to assess functional physiological changes in the intestinal slow wave MENG of patients with chronic mesenteric ischemia. Pre- and postoperative studies were conducted on CMI patients using MENG and intraoperative recordings using invasive serosal electromyograms (EMG). Our preoperative MENG recordings showed that patients with CMI exhibited a significant decrease in intestinal slow wave frequency from 8.9 ± 0.3 cpm preprandial to 7.4 ± 0.1 cpm postprandial (P < 0.01) that was not observed in postoperative recordings (9.3 ± 0.2 cpm preprandial and 9.4 ± 0.4 cpm postprandial, P = 0.86). Intraoperative recording detected multiple frequencies from the ischemic portion of jejunum before revascularization, whereas normal serosal intestinal slow wave frequencies were observed after revascularization. The preoperative MENG data also showed signals with multiple frequencies suggestive of uncoupling and intestinal ischemia similar to intraoperative serosal EMG. Our results showed that multichannel MENG can identify intestinal slow wave dysrhythmias in CMI patients. Copyright © 2015 the American Physiological Society.

  14. Idiopathic Superior Mesenteric Vein Thrombosis Resulting in Small Bowel Ischemia in a Pregnant Woman

    PubMed Central

    Lin, Hao; Lin, Chih-Che; Huang, Wan-Ting

    2011-01-01

    Background. Small bowel ischemia due to superior mesenteric vein thrombosis (MVT) is rare during pregnancy. However, additional precipitating factors should usually be identified. Case. A 31-year-old woman, pregnant at 34 weeks, was sent to the emergency department because of acute peritonitis. An emergency exploration revealed a segmental gangrene of the small intestine without any mechanical obstruction. Together with the termination of pregnancy, resection of the damaged small bowel was performed, and an end-to-end enterostomy was followed. Based on the operative and pathological findings, small bowel ischemia might be attributed to superior mesenteric vein thrombosis. Conclusion. Hypercoagulation state normally found in pregnant women is believed to lead to this catastrophic condition without other precipitating factors. PMID:22567515

  15. Novel β-carboline-tripeptide conjugates attenuate mesenteric ischemia/reperfusion injury in the rat.

    PubMed

    Bi, Wei; Bi, Yue; Xue, Ping; Zhang, Yanrong; Gao, Xiang; Wang, Zhibo; Li, Meng; Baudy-Floc'h, Michele; Ngerebara, Nathaniel; Li, Xiaoxu; Gibson, K Michael; Bi, Lanrong

    2011-06-01

    We have synthesized a series of new β-carboline-tripeptide conjugates, and examined their anti-inflammatory properties in a mouse model of xylene-induced ear edema. The analgesic capacity of these compounds was further evaluated in a rodent tail flick assay. Our results indicate that β-carboline conjugate 4a manifests potent anti-inflammatory and analgesic activity while exerting a protective effect against mesenteric ischemia/reperfusion (I/R) injury in the rat.

  16. Mesenteric ischemia following the correction of adult spinal deformity: case report.

    PubMed

    Khanna, Krishn; Berven, Sigurd H

    2017-04-01

    Vascular complications are an important adverse event that can be associated with spinal reconstructive surgery. Direct injury of vessels, or indirect traction or compression of vessels, can cause both arterial and venous injury. Indirect compression of the mesenteric vessels is a well-recognized complication of bracing and surgical care of children with spinal deformity (superior mesenteric artery syndrome), but the complication is not common or well recognized in the adult population with spinal deformity. The purpose of this case report is to detail the case of postoperative mesenteric ischemia in a 63-year-old man in whom a posterior approach was used to perform spinal deformity correction. Preoperatively, the patient had had significant lumbar hypolordosis. The reconstructive surgery with the use of posterior-based osteotomies resulted in a shortening of the posterior column of the spine but a relative lengthening of structures anterior to the spine. The significant lordosis achieved by the surgery led to an acute worsening of the mesenteric stenosis suffered by the patient. He required a vascular surgery intervention to restore perfusion to the bowel. Recognition of severe vasculopathy is important in anticipating potential postoperative vascular insufficiency. This case report will inform surgeons and clinicians to have a higher index of suspicion for the exacerbation of vascular insufficiency, including mesenteric pathology, in patients undergoing surgery that involves significant realignment of the spine. Preoperative recognition of vascular insufficiency and treatment of symptomatic disease may limit the occurrence of postoperative vascular complications in spinal reconstructive surgery.

  17. Platelets Orchestrate Remote Tissue Damage After Mesenteric Ischemia-Reperfusion

    DTIC Science & Technology

    2012-02-02

    the inflam- matory response in immune complex disease and ischemia/reperfusion injury. J Immunol 163: 985–994, 1999. 37. Herd CM, Page CP. Pulmonary...Components from both innate and adaptive immunity , including natural immunoglobulin and complement compo- nents, as well as different leukocyte...modifiers of innate and adaptive immune responses to transplants. Curr Opin Organ Transplant 16: 41–46, 2010. 4. Bishop MJ, Giclas PC, Guidotti SM, Su ML

  18. Acute Thrombotic Mesenteric Ischemia: Primary Endovascular Treatment in Eight Patients

    SciTech Connect

    Gagniere, Johan; Favrolt, Gregory; Alfidja, Agaiecha; Kastler, Adrian; Chabrot, Pascal; Cassagnes, Lucie; Buc, Emmanuel; Pezet, Denis; Boyer, Louis

    2011-10-15

    Introduction: The purpose of this study was to evaluate our experience with initial percutaneous transluminal angioplasty (PTA) {+-} stenting as valuable options in the acute setting. Methods: Between 2003 and 2008, eight patients with abdominal angio-MDCT-scan proven thrombotic AMI benefited from initial PTA {+-} stenting. We retrospectively assessed clinical and radiological findings and their management. Seven patients presented thrombosis of the superior mesenteric artery, and in one patient both mesenteric arteries were occluded. All patients underwent initial PTA and stenting, except one who had balloon PTA alone. One patient was treated by additional in situ thrombolysis. Results: Technical success was obtained in all patients. Three patients required subsequent surgery (37.5%), two of whom had severe radiological findings (pneumatosis intestinalis and/or portal venous gas). Two patients (25%) died: both had NIDD, an ASA score {>=}4, and severe radiologic findings. Satisfactory arterial patency was observed after a follow-up of 15 (range, 11-17) months in five patients who did not require subsequent surgery, four of whom had abdominal guarding but no severe CT scan findings. One patient had an ileocecal stenosis 60 days after the procedure. Conclusions: Initial PTA {+-} stenting is a valuable alternative to surgery for patients with thrombotic AMI even for those with clinical peritoneal irritation signs and/or severe radiologic findings. Early surgery is indicated if clinical condition does not improve after PTA. The decision of a subsequent surgery must be lead by early clinical status reevaluation. In case of underlying atherosclerotic lesion, stenting should be performed after initial balloon dilatation.

  19. Novel hematologic inflammatory parameters to predict acute mesenteric ischemia.

    PubMed

    Toptas, Mehmet; Akkoc, İbrahim; Savas, Yildiray; Uzman, Sinan; Toptas, Yasar; Can, Mehmet Mustafa

    2016-03-01

    Acute mesenteric ischaemia (AMI) is an emergency condition that requires urgent diagnosis. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) have been studied as inflammatory biomarkers in atherosclerosis, but data regarding AMI are lacking. The study population included patients with AMI (n = 46) versus age and sex-matched healthy controls (n = 46). Computed multidetector tomographic angiography was performed to diagnose AMI. NLR and PLR were calculated using complete blood count. C-reactive protein (CRP) levels were also analyzed. Neutrophil levels and lymphocytes were significantly higher in patients with AMI than in the control individuals (P < 0.001 and P = 0.43, respectively). NLR levels were significantly higher in patients with AMI compared with that in the control individuals (P < 0.001). Platelet levels did not reach statistical significance between the groups (P = 0.709). However, patients with AMI had significantly higher PLR levels than the control group (P = 0.039). CRP levels on admission were higher in patients with AMI in comparison with control individuals. There was also a positive correlation between NLR and CRP (r = 0.548, P < 0.001), and between PLR and CRP (r = 0.528, P < 0.001). NLR level greater than 4.5, measured on admission, yielded an area under the curve value of 0.790 (95% confidence interval 0.681-0.799, sensitivity 77%, specificity 72%), and PLR level of greater than 157 yielded an area under the curve value of 0.604 (95% confidence interval 0.486-0.722, sensitivity 59%, specificity 65%). Patients with AMI had increased NLR, PLR, and CRP levels compared with controls. Increased NLR and PLR was an independent predictor of AMI.

  20. Bilateral extensive cerebral infarction and mesenteric ischemia associated with segmental arterial mediolysis in two young women.

    PubMed

    Basso, Monique Camila; Flores, Patrícia Carrasco; de Azevedo Marques, Ary; de Souza, Guilherme Leme; D'Elboux Guimarães Brescia, Marília; Campos, Cynthia Resende; de Cleva, Roberto; Saldiva, Paulo Hilario Nascimento; Mauad, Thais

    2005-10-01

    Segmental arterial mediolysis (SAM) is a rare non-atherosclerotic non-inflammatory vascular disease that affects mainly muscular arteries of the splanchnic and cerebral territories. Reported herein are two cases of SAM in young women with fatal outcome. One of the patients had an atypical form of the disease, which primarily affected small intestinal submucosal and subserosal arteries, and resulted in acute mesenteric ischemia. The other had bilateral brain infarction with SAM of internal carotid arteries (ICA). Pathological examination of both cases did not reveal the cause of blood flow disturbance: large mesenteric branches of the former and ICA of the latter were free of either dissection or thrombosis; in addition, small intestinal arteries of the first patient did not show signs of vasculitis. These findings suggest that unusual pathways of arterial occlusion and dissection may occur in the context of SAM.

  1. Idiopathic infantile arterial calcification in a 12-year-old girl presenting as chronic mesenteric ischemia: imaging findings and angioplasty results.

    PubMed

    Zhang, Edwin; Owen, Richard; Bruce, Garth; Wiebe, Sheldon

    2011-11-01

    We report an unusual case of chronic mesenteric ischemia presenting in a 12-year-old girl with idiopathic infantile arterial calcinosis (IIAC). This is the first reported case in the literature of chronic mesenteric ischemia in the setting of IIAC. The girl presented with a classical history of postprandial abdominal pain. Imaging demonstrated significant stenoses of the celiac axis, superior mesenteric artery (SMA) and inferior mesenteric artery (IMA). Angioplasty of the celiac axis and SMA was attempted, with successful dilation of the SMA only. At 3-, 6- and 12-month follow-ups, the child's symptoms had almost resolved. This case report has three important ramifications: chronic mesenteric ischemia is a possible clinical presentation in children with IACC, pre-angioplasty imaging is important in guiding treatment approach, and angioplasty was effective in this case of chronic mesenteric ischemia and offers hope for other similarly affected children.

  2. Infrarenal aorta as the donor site for bypasses to the superior mesenteric artery for chronic mesenteric ischemia: A prospective clinical series of 24 patients.

    PubMed

    Illuminati, Giulio; Pizzardi, Giulia; Calio', Francesco G; Pasqua, Rocco; Masci, Federica; Vietri, Francesco

    2017-08-11

    Treatment of symptomatic, chronic mesenteric ischemia is indicated to relieve symptoms and prevent acute ischemia and death. Current therapeutic options include endovascular and open surgery. The purpose of this prospective study was to evaluate the results of bypasses to the superior mesenteric artery arising from the infrarenal aorta or infrarenal aortic grafts. From January 1999 to December 2016, 24 consecutive patients with a mean age of 61 years underwent a prosthetic bypass to the superior mesenteric artery. Nine patients (37%) presented with an associated clinically important stenosis of the celiac artery and 10 (42%) of the inferior mesenteric artery. Five patients (21%) received preoperative parenteral nutrition. Four patients (17%) underwent dual antiplatelet treatment. The donor site was the infrarenal aorta in 19 patients (79%) and an infrarenal, Dacron graft was used in 5 (21%). The origin of the bypass was from the distal infrarenal aorta or Dacron graft in 19 patients (79%) and from the proximal infrarenal aorta in 5 patients (21%). The graft material consisted of 7 mm polytetrafluoroethylene in 19 cases (79%) and 7 mm Dacron in 5 cases (21%). A concomitant bypass to the inferior mesenteric artery was performed in 4 patients (17%). The primary end points were postoperative mortality, morbidity, graft infection, late survival, primary patency, and symptom-free rate. The secondary end point was postoperative hemorrhagic complications. No postoperative mortality occurred. Postoperative morbidity included a prolonged postoperative ileus in 4 patients (17%), transitory postoperative increases in serum creatinine concentrations in 3 patients (12%), and myocardial ischemia in 2 patients (8%). No postoperative hemorrhagic complications or graft infection were observed. Overall, the cumulative survival rate was 77% at 60 months. The overall late-patency rate and freedom from recurrence of symptoms were both 87% at 60 months. Infrarenal aorta and

  3. The value of combined elevation of D-dimer and neopterin as a predictive parameter for early stage acute mesenteric ischemia: An experimental study.

    PubMed

    Coskun, Ali Kagan; Halici, Zekai; Oral, Akgun; Bayir, Yasin; Deniz, Ferhat; Caycı, Tuncer; Mentes, Oner; Oz, Bilgehan Savas; Harlak, Ali; Yigit, Taner; Kozak, Orhan; Peker, Yusuf

    2017-04-01

    Background The diagnosis of acute mesenteric ischemia is variable. Early diagnosis is important for reducing the mortality and morbidity rates. Aim This experimental study aims to investigate the diagnostic utility of D-dimer and neopterin as a marker for the early stage of acute mesenteric ischemia caused by occlusion of superior mesenteric artery. Methods The levels of D-dimer and neopterin were measured using an animal acute mesenteric ischemia model in 21 male rabbits. Superior mesenteric artery occlusion (Group 1, n = 14) and control (Group 2, n = 7) groups were identified. Blood samples at different times are collected from each rabbits. Blood samples from superior mesenteric artery occlusion group were taken 30 min after anesthesia but before laparotomy, 1, 2, and 3 h after superior mesenteric artery ligation. Blood samples from control group were taken 1 h before, 1 and 3 h after anesthesia and laparotomy. The D-dimer and neopterin levels of each blood sample were measured. Results The probability of acute mesenteric ischemia was found to be 36 times higher when the D-dimer level was over 0.125 ng/L, whereas the probability was 19.2 times higher when the neopterin level was over 1.25 nmol/L. Conclusions In this experimental study, the combined elevation of two significant markers, D-dimer and neopterin, may be helpful for the early diagnosis of acute mesenteric ischemia.

  4. Peritoneal Potassium and pH Measurement in Early Diagnosis of Acute Mesenteric Ischemia in Rats

    PubMed Central

    Hosseinpour, Mehrdad; Khamechian, Tahere; Shahrokh, Soraya

    2014-01-01

    Background: In contemporary practice, acute mesenteric ischemia (AMI) remains a serious cause of morbidity and mortality in abdominal emergencies. Objectives: We report the measurement of peritoneal fluid potassium and pH on a small series of rats that developed extensive AMI following the surgical ligation of superior mesenteric vessels and compare the results with control groups. Materials and Methods: A total of 32 rats were used in our study. They were divided into four groups with eight rats in each one and received following treatments: group I (G-I), 60-minute controls; group II (G-II), 120-minute controls; group III (G-III), 60-minute cases; and group IV (G-IV), 120-minute cases. In case groups, the small bowel mesenteric root was double-ligated and an arrow single-lumen central venous catheter was passed through the skin to the peritoneum. In control groups, the catheter was placed without any intervention. Postoperatively, peritoneal lavage was performed at 60 (G-I, G-III) and 120 minutes (G-II, G-IV). Results: The mean peritoneal potassium values were 1.3 ± 0.3, 1.97 ± 1.06, 2.14 ± 0.89, and 3.28 ± 0.66 mmol/L in G-I, G-II, G-III, and G-IV, respectively. There were significant differences between G-III and G-IV (P = 0.002), between G-I and G-III (P = 0.024), and between G-II and G-IV (P = 0.001). The mean values of peritoneal fluid pH were 7.1 ± 0.26, 6.82 ± 0.22, 6.66 ± 0.16, and 6.78 ± 0.04 in G-I, G-II, G-III, and G-IV, respectively, which indicated significant differences between G-I and G-III (P = 0.001) and between G-II and G-IV (P = 0.018). There was a significant correlation between peritoneal fluid potassium and intestine ischemic grade (F = 4.77, P = 0.048) Conclusions Our findings show that for early detection of bowel ischemia, an evaluation of intraperitoneal potassium and pH was useful and with prolongation of ischemia, potassium changes were more significant. PMID:25599068

  5. Peritoneal Potassium and pH Measurement in Early Diagnosis of Acute Mesenteric Ischemia in Rats.

    PubMed

    Hosseinpour, Mehrdad; Khamechian, Tahere; Shahrokh, Soraya

    2014-09-01

    In contemporary practice, acute mesenteric ischemia (AMI) remains a serious cause of morbidity and mortality in abdominal emergencies. We report the measurement of peritoneal fluid potassium and pH on a small series of rats that developed extensive AMI following the surgical ligation of superior mesenteric vessels and compare the results with control groups. A total of 32 rats were used in our study. They were divided into four groups with eight rats in each one and received following treatments: group I (G-I), 60-minute controls; group II (G-II), 120-minute controls; group III (G-III), 60-minute cases; and group IV (G-IV), 120-minute cases. In case groups, the small bowel mesenteric root was double-ligated and an arrow single-lumen central venous catheter was passed through the skin to the peritoneum. In control groups, the catheter was placed without any intervention. Postoperatively, peritoneal lavage was performed at 60 (G-I, G-III) and 120 minutes (G-II, G-IV). The mean peritoneal potassium values were 1.3 ± 0.3, 1.97 ± 1.06, 2.14 ± 0.89, and 3.28 ± 0.66 mmol/L in G-I, G-II, G-III, and G-IV, respectively. There were significant differences between G-III and G-IV (P = 0.002), between G-I and G-III (P = 0.024), and between G-II and G-IV (P = 0.001). The mean values of peritoneal fluid pH were 7.1 ± 0.26, 6.82 ± 0.22, 6.66 ± 0.16, and 6.78 ± 0.04 in G-I, G-II, G-III, and G-IV, respectively, which indicated significant differences between G-I and G-III (P = 0.001) and between G-II and G-IV (P = 0.018). There was a significant correlation between peritoneal fluid potassium and intestine ischemic grade (F = 4.77, P = 0.048). Our findings show that for early detection of bowel ischemia, an evaluation of intraperitoneal potassium and pH was useful and with prolongation of ischemia, potassium changes were more significant.

  6. Endovascular Therapy as a Primary Revascularization Modality in Acute Mesenteric Ischemia

    SciTech Connect

    Kärkkäinen, Jussi M.; Lehtimäki, Tiina T. Saari, Petri; Hartikainen, Juha; Rantanen, Tuomo Paajanen, Hannu; Manninen, Hannu

    2015-10-15

    PurposeTo evaluate endovascular therapy (EVT) as the primary revascularization method for acute mesenteric ischemia (AMI).MethodsA retrospective review was performed on all consecutive patients treated for AMI during a 5-year period (January 2009 to December 2013). EVT was attempted in all patients referred for emergent revascularization. Surgical revascularization was performed selectively after failure of EVT. Patient characteristics, clinical presentation, and outcomes were studied. Failures and complications of EVT were recorded.ResultsFifty patients, aged 79 ± 9 years (mean ± SD), out of 66 consecutive patients with AMI secondary to embolic or thrombotic obstruction of the superior mesenteric artery were referred for revascularization. The etiology of AMI was embolism in 18 (36 %) and thrombosis in 32 (64 %) patients. EVT was technically successful in 44 (88 %) patients. Mortality after successful or failed EVT was 32 %. The rates of emergency laparotomy, bowel resection, and EVT-related complication were 40, 34, and 10 %, respectively. Three out of six patients with failure of EVT were treated with surgical bypass. EVT failure did not significantly affect survival.ConclusionsEVT is feasible in most cases of AMI, with favorable patient outcome and acceptable complication rate.

  7. Acute mesenteric ischemia and hepatic infarction after treatment of ectopic Cushing's syndrome.

    PubMed

    Takayasu, Shinobu; Murasawa, Shingo; Yamagata, Satoshi; Kageyama, Kazunori; Nigawara, Takeshi; Watanuki, Yutaka; Kimura, Daisuke; Tsushima, Takao; Sakamoto, Yoshiyuki; Hakamada, Kenichi; Terui, Ken; Daimon, Makoto

    2017-01-01

    Patients with Cushing's syndrome and excess exogenous glucocorticoids have an increased risk for venous thromboembolism, as well as arterial thrombi. The patients are at high risk of thromboembolic events, especially during active disease and even in cases of remission and after surgery in Cushing's syndrome and withdrawal state in glucocorticoid users. We present a case of Cushing's syndrome caused by adrenocorticotropic hormone-secreting lung carcinoid tumor. Our patient developed acute mesenteric ischemia after video-assisted thoracoscopic surgery despite administration of sufficient glucocorticoid and thromboprophylaxis in the perioperative period. In addition, our patient developed hepatic infarction after surgical resection of the intestine. Then, the patient was supported by total parenteral nutrition. Our case report highlights the risk of microthrombi, which occurred in our patient after treatment of ectopic Cushing's syndrome. Guidelines on thromboprophylaxis and/or antiplatelet therapy for Cushing's syndrome are acutely needed. The present case showed acute mesenteric thromboembolism and hepatic infarction after treatment of ectopic Cushing's syndrome.Patients with Cushing's syndrome are at increased risk for thromboembolic events and increased morbidity and mortality.An increase in thromboembolic risk has been observed during active disease, even in cases of remission and postoperatively in Cushing's syndrome.Thromboprophylaxis and antiplatelet therapy should be considered in treatment of glucocorticoid excess or glucocorticoid withdrawal.

  8. Acute Mesenteric Ischemia Among Postcardiac Surgery Patients Presenting with Multiple Organ Failure.

    PubMed

    Guillaume, Alexis; Pili-Floury, Sébastien; Chocron, Sidney; Delabrousse, Eric; De Parseval, Bénédicte; Koch, Stephane; Samain, Emmanuel; Capellier, Gilles; Piton, Gaël

    2017-03-01

    Acute mesenteric ischemia (AMI) is a rare but severe complication after cardiac surgery. However, AMI is likely to be more frequent in the subgroup of patients presenting with multiple organ failure after a cardiac surgery. The primary objective of this study was to identify AMI risk factors among patients requiring intensive care unit (ICU) admission after cardiac surgery. Retrospective observational study of all the patients requiring admission to two ICUs in a large university hospital after a cardiac surgery procedure. AMI confirmation was based on abdominal computed tomography scan, digestive endoscopy, laparotomy, or postmortem examination. Univariate and multivariate analyses were done to compare pre- and in-ICU characteristics between patients with or without AMI. Between 2007 and 2013, a cardiac surgery was performed in 4,948 patients, of whom 320 patients (6%) required ICU admission for multiple organ failure. AMI was confirmed in 10% of the patients admitted to the ICU for multiple organ failure (33/320). The prognosis of these patients was extremely poor with 28- and 90-day mortality rates of 64% and 83%, respectively. Nonocclusive mesenteric ischemia (NOMI) was the main mechanism involved in 83% of the patients. Coronary artery bypass graft, need for blood transfusion during cardiopulmonary bypass, aspartate aminotransferase at least 100 UI/L, and Simplified Acute Physiology Score II at least 50 at ICU admission were independently associated with AMI. An AMI risk score based upon these four risk factors was able to identify three classes of risk: low risk (<1%), intermediate risk (9%), and high risk (29%). AMI is a frequent condition among patients presenting with multiple organ failure after cardiac surgery, occurring in 10% of them. The prognosis of AMI is extremely poor. The main mechanism of AMI is NOMI, occurring in approximately 80% of patients. Further progress should be performed on prevention and earlier diagnosis.

  9. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery.

    PubMed

    Bala, Miklosh; Kashuk, Jeffry; Moore, Ernest E; Kluger, Yoram; Biffl, Walter; Gomes, Carlos Augusto; Ben-Ishay, Offir; Rubinstein, Chen; Balogh, Zsolt J; Civil, Ian; Coccolini, Federico; Leppaniemi, Ari; Peitzman, Andrew; Ansaloni, Luca; Sugrue, Michael; Sartelli, Massimo; Di Saverio, Salomone; Fraga, Gustavo P; Catena, Fausto

    2017-01-01

    Acute mesenteric ischemia (AMI) is typically defined as a group of diseases characterized by an interruption of the blood supply to varying portions of the small intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process will eventuate in life threatening intestinal necrosis. The incidence is low, estimated at 0.09-0.2% of all acute surgical admissions. Therefore, although the entity is an uncommon cause of abdominal pain, diligence is always required because if untreated, mortality has consistently been reported in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment and are essential to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques may provide new options. Thus, we believe that a current position paper from World Society of Emergency Surgery (WSES) is warranted, in order to put forth the most recent and practical recommendations for diagnosis and treatment of AMI. This review will address the concepts of AMI with the aim of focusing on specific areas where early diagnosis and management hold the strongest potential for improving outcomes in this disease process. Some of the key points include the prompt use of CT angiography to establish the diagnosis, evaluation of the potential for revascularization to re-establish blood flow to ischemic bowel, resection of necrotic intestine, and use of damage control techniques when appropriate to allow for re-assessment of bowel viability prior to definitive anastomosis and abdominal closure.

  10. Ascending Aorta to Hepatic and Mesenteric Artery Bypassing, in Patients with Chronic Mesenteric Ischemia and Extensive Aortic Disease-A Case Report and Review of the Literature.

    PubMed

    Barr, James; Kokotsakis, John; Tsipas, Pantelis; Papapavlou, Prodromos; Velissarios, Konstantinos; Kratimenos, Theodoros; Athanasiou, Thanos

    2017-02-01

    Chronic mesenteric ischemia (CMI) is a rare disorder caused by severe stenosis of the mesenteric arterial supply that results in postprandial pain and weight loss. Treatment options are surgical or endovascular. Surgical bypass can be performed in an antegrade fashion from the supraceliac abdominal aorta (AA) or the distal descending thoracic aorta or in a retrograde fashion from the infrarenal aorta or the common iliac artery. However, in some patients with disease of the descending thoracic aorta or the AA, another site for the proximal anastomosis needs to be found. In this article, we report the case of a 69-year-old man with a thoracoabdominal aortic aneurysm and CMI in whom we performed bypass grafts to the hepatic and superior mesenteric arteries using the ascending aorta as the site for the proximal anastomoses via a median sternolaparotomy. In addition, we performed a literature review of all similar cases and provide an analysis of this technique and an assessment of the success rates.

  11. Acute Mesenteric Ischemia after Cardiac Surgery: An Analysis of 52 Patients

    PubMed Central

    Gucu, Arif; Toktas, Faruk; Erdolu, Burak; Ozyazıcıoglu, Ahmet

    2013-01-01

    Objective. Acute mesenteric ischemia (AMI) is a rare but serious complication after cardiac surgery. The aim of this retrospective study was to evaluate the incidence, outcome, and perioperative risk factors of AMI in the patients undergoing elective cardiac surgery. Methods. From January 2005 to May 2013, all patients who underwent cardiac surgery were screened for participation, and patients with registered gastrointestinal complications were retrospectively reviewed. Univariate analyses were performed. Results. The study included 6013 patients, of which 52 (0.86%) patients suffered from AMI, 35 (67%) of whom died. The control group (150 patients) was randomly chosen from among cases undergoing cardiopulmonary bypass (CPB). Preoperative parameters including age (P = 0.03), renal insufficiency (P = 0.004), peripheral vascular disease (P = 0.04), preoperative inotropic support (P < 0.001), poor left ventricular ejection fraction (P = 0.002), cardiogenic shock (P = 0.003), and preoperative intra-aortic balloon pump (IABP) support (P = 0.05) revealed significantly higher levels in the AMI group. Among intra- and postoperative parameters, CPB time (P < 0.001), dialysis (P = 0.04), inotropic support (P = 0.007), prolonged ventilator time (P < 0.001), and IABP support (P = 0.007) appeared significantly higher in the AMI group than the control group. Conclusions. Prompt diagnosis and early treatment should be initiated as early as possible in any patient suspected of AMI, leading to dramatic reduction in the mortality rate. PMID:24288499

  12. Successful treatment of non-occlusive mesenteric ischemia (NOMI) using the HyperEye Medical System™ for intraoperative visualization of the mesenteric and bowel circulation: report of a case.

    PubMed

    Nitori, Nobuhiro; Deguchi, Tomoaki; Kubota, Keisuke; Yoshida, Masashi; Kato, Ayu; Kojima, Masayuki; Kadomura, Tomohisa; Okada, Akihiro; Okamura, Juri; Kobayashi, Michiya; Sato, Takayuki; Beck, Yoshifumi; Kitagawa, Yuko; Kitajima, Masaki

    2014-02-01

    Non-occlusive mesenteric ischemia (NOMI), leading to intestinal gangrene without a demonstrable occlusion in the mesenteric artery, is a rare condition with extremely high mortality. We report a case of NOMI diagnosed preoperatively by computed tomography and treated successfully with surgery, assisted by indocyanine green (ICG) fluorescence in the HyperEye Medical System (HEMS), a new device that can simultaneously detect color and near-infrared rays under room light. This allowed for precise intraoperative evaluation of the mesenteric and bowel circulation. Although the necrotic bowel wall of the distal ileum and the segmental ischemia of the jejunum were visible, the jejunum was finally preserved because perfusion of ICG fluorescence was confirmed. The patient, an 84-year-old man, had an uneventful postoperative course and is alive without critical illness 8 months after surgery. We report this case to demonstrate the potential effectiveness of HEMS during surgery for NOMI.

  13. DIFFERENT PROTOCOLS OF POSTCONDITIONING DOES NOT ATTENUATE MESENTERIC ISCHEMIA-REPERFUSION INJURY AFTER SHORT-TERM REPERFUSION.

    PubMed

    Brito, Marcus Vinicius Henriques; Yasojima, Edson Yuzur; Machado, Andressa Abnader; Silveira, Matheus Paiva Pacheco Reis; Teixeira, Renan Kleber Costa; Yamaki, Vitor Nagai; Costa, Felipe Lobato da Silva

    2017-01-01

    Mesenteric ischemia is a challenging diagnosis. Delay in diagnosis can lead to extent bowel necrosis and poor outcomes. Ischemia and reperfusion syndrome plays an important role in this scenario. To access effects of different post-conditioning cycles on mesenteric ischemia-reperfusion syndrome. Twenty-five rats were assigned into five groups: Sham, used to establish normal parameters; control group, submitted to mesenteric ischemia for 30 min; in groups GP3, GP1 and GP30, ischemia was followed by post-conditioning protocol, which consisted of 1 cycle of 3 min (GP3), 3 cycles of 1 min (GP1) or 6 cycles of 30 s (GP30), respectively. Ileum samples were harvested after one hour of reperfusion. Intestinal mucosal injury was evaluated through histopathological analysis. The average of mesenteric injury degree was 0 in the sham group, 3.6 in the control group, 3.4 in GP3, 3.2 in GP1, and 3.0 in GP30; villous length average was 161.59 in sham group, 136.27 in control group, 135.89 in GP3, 129.46 in GP1, and 135.18 in GP30. Was found significant difference between sham and other groups (p<0.05); however, there was no difference among post-conditioning groups. Post-conditioning adopted protocols were not able to protect intestinal mucosa integrity after mesenteric ischemia and short term reperfusion. O desfecho satisfatório na abordagem cirúrgica da obesidade deve contemplar, além da perda de peso, alteração significativa nas comorbidades preexistentes e na qualidade de vida dos pacientes. Avaliar a qualidade de vida no pós-operatório tardio de pacientes submetidos à cirurgia de gastrectomia vertical por videolaparoscopia. Foi aplicado o questionário "Bariatric Analysis and Reporting Outcome System" (BAROS) em pacientes submetidos à gastrectomia vertical por videolaparoscopia. Foram avaliados 47 pacientes, entre 21 e 60 anos de idade. O IMC médio antes da operação era 43,06±5,87 kg/m². A média percentual de redução do excesso de peso após foi de 85,46±23

  14. [Extensive mesenteric ischemia related to naratriptan overuse associated with grapefruit juice absorption].

    PubMed

    Gergaud, S; Lermite, E; Butel, F; Soltner, C; Lasocki, S

    2012-05-01

    We reported the case of a 61-year-old woman, who has been hospitalized in ICU because of an extensive mesenteric ischaemia, involving the small bowel, secondary to a naratriptan overuse. This mesenteric ischaemia was complicated by multiple organ failure and was responsible for extensive small bowel resection and left colectomy. A concomitant abundant absorption of grapefruit juice, a well-known P450 inhibitor, may have enhanced this naratriptan toxicity. This case underscore that an abdominal pain occurring in the context of headache treatment may be related to a mesenteric ischaemia.

  15. Can the Preoperative Serum Lactate Level Predict the Extent of Bowel Ischemia in Patients Presenting to the Emergency Department with Acute Mesenteric Ischemia?

    PubMed Central

    Kang, Kai; Papadakis, Marios; Zirngibl, Hubert

    2017-01-01

    Purpose. Early recognition of acute mesenteric ischemia (AMI) can be challenging. Extensive bowel necrosis secondary to AMI is associated with high rates of mortality. The aim of this study was to investigate the association between preoperative serum lactate level and the extent of bowel ischemia in patients with AMI. Methods. Data of patients with abdominal pain and elevated serum lactate undergoing emergency laparotomy for suspected AMI within 24 hours of presentation was retrospectively abstracted. The length of the ischemic bowel segment was compared with the preoperative serum lactate level. Results. 36 female and 39 male patients, with median age 73.1 ± 12.3 years, were included for analysis. The median preoperative lactate was 2.96 ± 2.59 mmol/l in patients with ≤50 cm, 6.86 ± 4.08 mmol/l in patients with 51–100 cm, 4.73 ± 2.76 mmol/l in patients with >100 cm ischemic bowel, and 14.07 ± 4.91 mmol/l in the group with multivisceral ischemia. Conclusion. Although elevated serum lactate might permit an early suspicion and thus influence the clinical decision-making with regard to prioritization of surgery in patients with suspected AMI, a linear relationship between serum lactate and the extent of bowel ischemia could not be established in this study. PMID:28261615

  16. Extra-anatomic iliac to superior mesenteric artery bypass after bridge endovascular treatment for chronic mesenteric ischemia. A case report.

    PubMed

    Bajardi, Guido; Pakeliani, David; Dinoto, Ettore; Bracale, Umberto M; Pecoraro, Felice

    2015-07-03

    Un uomo di 60 anni con ischemia mesenterica cronica (CMI) è stato trattato con una terapia ‘bridge’ verso una terapia di chirurgia open tradizionale, mediante stenting dell’arteria mesenterica superiore (SMA). Al follow-up a 5 mesi lo stent della SMA è andato incontro ad occlusione. Durante questo periodo ‘bridge’ il paziente ha migliorato le sue condizioni generali e il suo indice di massa corporea (BMI) è incrementato da 18 a 22. Il paziente è stato sottoposto successivamente ad intervento chirurgico di bypass iliaco-SMA in configurazione ‘Cloop’. Al follow-up a 6 mesi il bypass è pervio, il paziente non riferisce sintomatologia di CMI ed il suo BMI è di 25. Il trattamento endovascolare non ha precluso una successiva riparazione chirurgica e può essere impiegato in maniera sicura come terapia ‘bridge’. Un miglioramento delle condizioni cliniche, anche durante un limitato periodo ‘bridge’, può migliorare i risultati della terapia chirurgica tradizionale.

  17. [Ascaris lumbricoides in the nasogastric tube after operation on a patient with the diagnosis of acute mesenteric ischemia: case report].

    PubMed

    Çiçek, Ayşegül Çopur; Gündoğdu, Deniz; Direkel, Sahin; Öztürk, Çinar

    2013-01-01

    Ascaris lumbricoides is a comman intestinal helminths in humans. It is a parasite which commonly affects society with a low socioeconomic status, especially in tropical and rural areas. Ascaris lumbricoides infestation can lead to serious complications because of the mobility of the worms. The parasite can cause a variety of complications like intestinal obstruction, perforation, biliary obstruction, pancreatitis, peritonitis, liver abscess, cholangiohepatitis, volvulus, and gangrene, etc. A 59-year-old female patient hospitalized with the diagnosis of mesenteric ischemia was operated on for jejunal resection. On the 6th postoperative day, a worm was noticed emerging through the nasogastric tube. Ascaris lumbricoides was determined as a result of the examination microbiology laboratory. The patient was treated successfully with one dose of albendazole 200 mg 1x2. Our case describes a clinical situation of ascariasis observed after jejunal resection and emphasizes the importance of remaining aware of this rare complication of ascariasis.

  18. Outcome of acute mesenteric ischemia in the intensive care unit: a retrospective, multicenter study of 780 cases.

    PubMed

    Leone, Marc; Bechis, Carole; Baumstarck, Karine; Ouattara, Alexandre; Collange, Olivier; Augustin, Pascal; Annane, Djillali; Arbelot, Charlotte; Asehnoune, Karim; Baldési, Olivier; Bourcier, Simon; Delapierre, Laurence; Demory, Didier; Hengy, Baptiste; Ichai, Carole; Kipnis, Eric; Brasdefer, Etienne; Lasocki, Sigismond; Legrand, Matthieu; Mimoz, Olivier; Rimmelé, Thomas; Aliane, Jugurtha; Bertrand, Pierre-Marie; Bruder, Nicolas; Klasen, Fanny; Friou, Emilie; Lévy, Bruno; Martinez, Oriane; Peytel, Eric; Piton, Alexandra; Richter, Elisa; Toufik, Kamel; Vogler, Marie-Charlotte; Wallet, Florent; Boufi, Mourad; Allaouchiche, Bernard; Constantin, Jean-Michel; Martin, Claude; Jaber, Samir; Lefrant, Jean-Yves

    2015-04-01

    In the intensive care unit (ICU), the outcomes of patients with acute mesenteric ischemia (AMI) are poorly documented. This study aimed to determine the risk factors for death in ICU patients with AMI. A retrospective, observational, non-interventional, multicenter study was conducted in 43 ICUs of 38 public institutions in France. From January 2008 to December 2013, all adult patients with a diagnosis of AMI during their hospitalization in ICU were included in a database. The diagnosis was confirmed by at least one of three procedures (computed tomography scan, gastrointestinal endoscopy, or upon surgery). To determine factors associated with ICU death, we established a logistic regression model. Recursive partitioning analysis was applied to construct a decision tree regarding risk factors and their interactions most critical to determining outcomes. The death rate of the 780 included patients was 58 %. Being older, having a higher sequential organ failure assessment (SOFA) severity score at diagnosis, and a plasma lactate concentration over 2.7 mmol/l at diagnosis were independent risk factors of ICU mortality. In contrast, having a prior history of peripheral vascular disease or an initial surgical treatment were independent protective factors against ICU mortality. Using age and SOFA severity score, we established an ICU mortality score at diagnosis based on the cutoffs provided by recursive partitioning analysis. Probability of survival was statistically different (p < 0.001) between patients with a score from 0 to 2 and those with a score of 3 and 4. Acute mesenteric ischemia in ICU patients was associated with a 58 % ICU death rate. Age and SOFA severity score at diagnosis were risk factors for mortality. Plasma lactate concentration over 2.7 mmol/l was also an independent risk factor, but values in the normal range did not exclude the diagnosis of AMI.

  19. Mesenteric ischemia after capecitabine treatment in rectal cancer and resultant short bowel syndrome is not an absolute contraindication for radical oncological treatment

    PubMed Central

    Perpar, Ana; Brecelj, Erik; Kozjek, Nada Rotovnik; Anderluh, Franc; Oblak, Irena; Vidmar, Marija Skoblar; Velenik, Vaneja

    2015-01-01

    Background. Thrombotic events, arterial or venous in origin, still remain a source of substantial morbidity and mortality in cancer patients. The propensity for their development in oncology patients is partially a consequence of the disease itself and partially a result of our attempts to treat it. One of the rarest and deadliest thromboembolic complications is arterial mesenteric ischemia. The high mortality rate is caused by its rarity and by its non-specific clinical presentation, both of which make early diagnosis and treatment difficult. Hence, most diagnoses and treatments occur late in the course of the disease. The issue survivors of arterial mesenteric ischemia may face is short bowel syndrome, which has become a chronic condition after the introduction of parenteral nutrition at home. Case report. We present a 73-year-old rectal cancer patient who developed acute arterial mesenteric thrombosis at the beginning of the pre-operative radiochemotherapy. Almost the entire length of his small intestine, except for the proximal 50 cm of it, and the ascending colon had to be resected. After multiorgan failure his condition improved, and he was able to successfully complete radical treatment (preoperative radiotherapy and surgery) for the rectal carcinoma, despite developing short bowel syndrome (SBS) and being dependent upon home-based parenteral nutrition to fully cover his nutritional needs. Conclusions. Mesenteric ischemia and resultant short bowel syndrome are not absolute contraindications for radical oncological treatment since such patients can still achieve long-term remission. PMID:26029030

  20. Emergent Treatment of Acute Embolic Superior Mesenteric Ischemia with Combination of Thrombolysis and Angioplasty: Report of Two Cases

    SciTech Connect

    Wakabayashi, H. Shiode, Tsuyoki; Kurose, Michihiro; Moritani, Hiroki; Fujiki, Shigeatsu; Morimoto, Naoki; Kusachi, Shozo

    2004-08-15

    We successfully revascularized the acutely occluded superior mesenteric artery (SMA), caused by a thromboembolus, with a combination of thrombolysis and percutaneous transluminal angioplasty (PTA) in 2 patients. Considerable percent luminal reduction (>90%) was still observed after thrombolysis in both patients. Subsequent adjunctive balloon angioplasty produced sufficient luminal diameter of the SMA (<20% luminal reduction). No serious acute procedural complication occurred. The time from onset to partial reperfusion by thrombolysis was approximately 4.5 and 5.5 hours. Approximately 1 week after the combination therapy, colonoscopy and a small bowel radiocontrast series showed localized mucosal ischemia with mild erosions and ulcerations in the terminal ileum and ascending colon in 1 patient. Subsequent bowel resection was required but the resection was short (<20 cm). The other patient's bowel condition was good and did not require any surgical treatment. The present cases suggest that combination therapy is useful for achieving rapid and sufficient revascularization of acute proximal thromboembolic SMA occlusion, and prevents the considerably broad bowel necrosis that requires surgical bowel resection, resulting in short bowel syndrome.

  1. Tapered self expandable bare stent to treat acute superior mesenteric artery ischemia.

    PubMed

    Martinez Miguez, Marta; Carballo-Fernandez, Coral; Mosquera-Arochena, Nilo

    2012-01-01

    This case demonstrates the use of carotid stents in off-label emergency condition where standard self-expandable stents doesn't fit to native artery and balloon-expandable stents could not be also recommended. 56 years old patient, EVAR therapy performed 2 months before, suffering acute severe abdominal pain; emergency angioCT showed oclusion of superior mesenteric artery (SMA) and no complications related to previous EVAR. A percutaneuos supraselective trombolysis was performed. After 24 hours control DSA showed partial recanalization and tight stenoses in distal SMA with poor run-off to terminal branches. A 6-8 x 40 mm Carotid Stent (Acculink®, Abbot Vascular) was implanted with good inmediate technical result. After 6 months follow up both SMA and branches remain patent and no further treatment was required. tapered self expandable uncovered stents are a good treatment option to achieve better conformability to SMA,and bare metal stents do not compromise side-branches of this artery.

  2. Celiac Artery Stenting in the Treatment of Intestinal Ischemia Due to the Sacrifice of the Dominant Inferior Mesenteric Artery During Endovascular Aortic Repair.

    PubMed

    Su, Zijie; Pan, Tianyue; Lian, Weishuai; Guo, Daqiao; Dong, Zhihui; Fu, Weiguo

    2016-08-01

    A 42-year-old man had intestinal ischemia 7 weeks after endovascular abdominal aortic aneurysm repair due to sacrifice of the inferior mesenteric artery, which had compensated for the intestinal blood supply because of the total occlusion of the superior mesenteric artery (SMA) and severe stenosis of the celiac artery (CA). He was diagnosed in the active phase of Takayasu arteritis, and an emergency endovascular treatment was performed. After the SMA failed to be recanalized, a stent was successfully placed into the CA; this choice was made based on the preexisting collaterals between them. The symptoms were relieved shortly after the operation. The Kirk arcade, the Barkow arcade, and the enlarged pancreaticoduodenal arcade were visualized on the follow-up computed tomography angiography. Based on this case, a short review of celiomesenteric and intermesenteric collateral circulations is presented.

  3. Acute Mesenteric Ischemia

    MedlinePlus

    ... the Professional Version Also of Interest Test your knowledge Clostridium difficile -induced colitis is an inflammation of ... Learn more about our commitment to Global Medical Knowledge . Merck Manuals About Disclaimer Permissions Privacy Contributors Terms ...

  4. Treatment with either obestatin or ghrelin attenuates mesenteric ischemia-reperfusion-induced oxidative injury of the ileum and the remote organ lung.

    PubMed

    Şen, Leyla Semiha; Karakoyun, Berna; Yeğen, Cumhur; Akkiprik, Mustafa; Yüksel, Meral; Ercan, Feriha; Özer, Ayşe; Yeğen, Berrak Ç

    2015-09-01

    To evaluate the effects of exogenous ghrelin or obestatin on intestinal injury and accompanying pulmonary injury, intestinal ischemia-reperfusion (I/R) was induced in rats by obstructing the superior mesenteric artery for 60min, whereas laparotomy was performed in the sham group. At the beginning of the 90-min reperfusion period, the rats were injected with obestatin (100μg/kg), ghrelin (10ng/kg), or saline intravenously (iv). At the end of reperfusion, the blood, ileum, and lung samples were taken for the histological and biochemical assays. In the saline-treated I/R group, the increased serum interleukin (IL)-1β level, high damage scores, and elevated tissue malondialdehyde level and collagen content in both tissues were significantly reduced by obestatin or ghrelin. Increased ileal myeloperoxidase activity of the saline-treated I/R group was reduced by treatment with obestatin or ghrelin, whereas increased pulmonary myeloperoxidase activity was reduced with administration of obestatin. Increased DNA fragmentation in the ileum of the saline-treated I/R group was reduced by both peptides. Elevated luminol-lucigenin chemiluminescence levels and nuclear factor kappa B (NF-κB) messenger RNA (mRNA) expression in the ileum of the saline-treated-I/R group were significantly decreased by obestatin or ghrelin treatment. I/R-induced depletion of the antioxidant glutathione in both ileal and pulmonary tissues was prevented with either obestatin or ghrelin treatment. Administration of either obestatin or ghrelin exerts similar protective effects against I/R-induced ileal and pulmonary injury, thus warranting further investigation for their possible use against ischemic intestinal injury.

  5. Ischemia

    NASA Astrophysics Data System (ADS)

    Byeon, Suk Ho; Kim, Min; Kwon, Oh Woong

    "Ischemia" implies a tissue damage derived from perfusion insufficiency, not just an inadequate blood supply. Mild thickening and increased reflectivity of inner retina and prominent inner part of synaptic portion of outer plexiform layer are "acute retinal ischemic changes" visible on OCT. Over time, retina becomes thinner, especially in the inner portion. Choroidal perfusion supplies the outer portion of retina; thus, choroidal ischemia causes predominant change in the corresponding tissue.

  6. Reperfusion Hemorrhage Following Superior Mesenteric Artery Stenting

    SciTech Connect

    Moore, Michael; McSweeney, Sean; Fulton, Gregory; Buckley, John; Maher, Michael Guiney, Michael

    2008-07-15

    Percutaneous transluminal angioplasty and stent placement is now an established treatment option for chronic mesenteric ischemia and is associated with low mortality and morbidity rates. We present a case of reperfusion hemorrhage complicating endovascular repair of superior mesenteric artery stenosis. Although a recognized complication following repair of carotid stenosis, hemorrhage has not previously been reported following mesenteric endovascular reperfusion. We describe both spontaneous cessation of bleeding and treatment with coil embolization.

  7. Mesenteric Lymphadenitis

    MedlinePlus

    ... results from an intestinal infection. It mainly affects children and teens. This painful condition can mimic the warning signs of appendicitis. Unlike appendicitis, mesenteric lymphadenitis is seldom serious and ...

  8. [A case of spontaneous dissection of the superior mesenteric artery treated by percutaneous stent placement].

    PubMed

    Ko, Geun Jun; Han, Ki Jun; Han, Seo Goo; Hwang, Sang Yon; Choi, Chang Hwan; Gham, Chang Woo; Cho, Hyeon Geun; Song, Soon-Young; Jung, Jin Ho

    2006-02-01

    Acute mesenteric ischemia can result from emboli, arterial and venous thrombi or vasoconstriction secondary to low-flow states. Isolated spontaneous dissection of the superior mesenteric artery is a rare cause of acute mesenteric ischemia. The mortality rates of acute mesenteric ischemia averages 71% with a range of 59-93%. Diagnosis before the occurrence of intestinal infarction is the most important factor in improving survival rate for patients with acute mesenteric ischemia. A 68-year-old female presented with postprandial epigastric pain, and a dissection of the superior mesenteric artery and a gallbladder polyp were shown in abdominal computed tomographic scan. After the percutaneous metalic stent placement and laparoscopic cholecystectomy, her symptoms improved. We report a case of spontaneous dissection of main trunk of the superior mesenteric artery which was successfully treated by percutaneous stent placement with a review of literature.

  9. [Mesenteric cysts].

    PubMed

    Huis, Marijan; Balija, Milivoj; Lez, Cvjetko; Szerda, Ferenc; Stulhofer, Mladen

    2002-01-01

    Mesenteric cysts and cystic mesenteric tumors are very rare abdominal growths. They may be localized all over the mesentery, from duodenum to rectum, however, they are mostly found in the ileum and right colon mesentery. There are several classifications of these formations, among which the one based on histopathologic features including 6 groups has been most commonly used: 1) cysts of lymphatic origin--lymphatic (hilar cysts) and lymphangiomas; 2) cysts of mesothelial origin--benign or malignant mesothelial cysts; 3) enteric cysts; 4) cysts of urogenital origin; 5) dermoid cysts; and 6) pseudocysts--infectious or traumatic etiology. Two adult female patients treated at the Department of Surgery, Zabok General Hospital, are presented. The diagnosis of mesenteric cyst was based on explorative laparotomy indicated for a cystic abdominal growth and characteristic palpatory finding, US and CT findings. In both patients, the cysts were successfully treated by total cystectomy. Pathohistologic findings pointed to lymphatic cysts. Control US finding at 3 months postoperatively was normal in both patients. Cystic lymphangioma mostly occurs in the first decade of life, with a female predominance. It is usually accompanied by acute abdominal symptomatology. Lymphatic cysts occur later in life (1:100,000 in adults and 1:20,000 in children), also show female predominance, and as a rule are asymptomatic. A mesenteric cyst, especially lymphatic, should be suspected in the presence of painless abdominal tumor, with occasionally painful abdominal pressure, normal laboratory findings, and good general condition in a female patient. In symptomatic cases, acute or chronic abdominal pain is the most common feature, whereas other symptomatology depends on the localization, size and consequential abdominal organ compression (intestinal obstruction, hydronephrosis, lower extremity lymphedema). The term of cystic mesenteric tumor is mostly used to refer to cystic lymphangiomas and

  10. Intestinal ischemia in neonates and children.

    PubMed

    Jeican, Ionuţ Isaia; Ichim, Gabriela; Gheban, Dan

    2016-01-01

    The article reviews the intestinal ischemia theme on newborn and children. The intestinal ischemia may be either acute - intestinal infarction (by vascular obstruction or by reduced mesenteric blood flow besides the occlusive mechanism), either chronic. In neonates, acute intestinal ischemia may be caused by aortic thrombosis, volvulus or hypoplastic left heart syndrome. In children, acute intestinal ischemia may be caused by fibromuscular dysplasia, volvulus, abdominal compartment syndrome, Burkitt lymphoma, dermatomyositis (by vascular obstruction) or familial dysautonomia, Addison's disease, situs inversus abdominus (intraoperative), burns, chemotherapy administration (by nonocclusive mesenteric ischemia). Chronic intestinal ischemia is a rare condition in pediatrics and can be seen in abdominal aortic coarctation or hypoplasia, idiopathic infantile arterial calcinosis.

  11. Mesenteric myolipoma.

    PubMed

    Maataoui, Adel; Khan, Fawad M; Vogl, Thomas J; Erler, Alexander

    2013-11-28

    The authors report on a case of benign myolipoma (synonym lipoleiomyoma) which was first described in 1991. The benign soft tissue tumor is composed of smooth muscle and adipose tissue and occurs sporadically in different locations. In the available literature cases were described retroperitoneal, spinal, orbital and subcutaneous and mostly have been discovered in females. Characteristically myolipomas are very large at diagnosis and reach diameters of 7 to 30 cm particularly in peritoneal or retroperitoneal localization. The sometimes enormous size leads to a displacing growth pattern which ultimately leads to the clinical symptoms. The patients often complain of nonspecific, mostly painless abdominal or thoracic pressure. Bordered by an intact capsule the tumors show no signs of malignancy and in the available literature there is no evidence of metastatic seeding. To the best of our knowledge the presented case is the first description of a diffuse mesenteric myolipoma in a male individual. In this article, we present the multidetector computed tomographic image characteristics, macroscopic appearance and histopathological findings.

  12. Inferior Mesenteric Artery Aneurysm Complicated With Occluded Celiac and Superior Mesenteric Artery After Replacement of Thoracoabdominal Aorta for Chronic Dissected Thoracoabdominal Aortic Aneurysm.

    PubMed

    Igarashi, Takashi; Yamamoto, Akihiro; Fujimiya, Tsuyoshi; Takase, Shinya; Satokawa, Hirono; Yokoyama, Hitoshi

    2017-10-01

    We report a case of inferior mesenteric artery aneurysm (IMAA) after the replacement of the thoracoabdominal aorta for a chronic dissected thoracoabdominal aortic aneurysm in which the celiac artery and superior mesenteric artery were occluded. We performed the resection of the IMAA and the revascularization of the superior mesenteric artery, inferior mesenteric artery, and meandering artery. The patient's postoperative course was uneventful, without bowel ischemia. From the findings of intraoperative flow measurement of the visceral arteries, revascularization of the superior mesenteric artery was judged to be appropriate in this situation. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Intestinal Ischemia: US-CT findings correlations

    PubMed Central

    2013-01-01

    Background Intestinal ischemia is an abdominal emergency that accounts for approximately 2% of gastrointestinal illnesses. It represents a complex of diseases caused by impaired blood perfusion to the small and/or large bowel including acute arterial mesenteric ischemia (AAMI), acute venous mesenteric ischemia (AVMI), non occlusive mesenteric ischemia (NOMI), ischemia/reperfusion injury (I/R), ischemic colitis (IC). In this study different study methods (US, CT) will be correlated in the detection of mesenteric ischemia imaging findings due to various etiologies. Methods Basing on experience of our institutions, over 200 cases of mesenteric ischemia/infarction investigated with both US and CT were evaluated considering, in particular, the following findings: presence/absence of arterial/venous obstruction, bowel wall thickness and enhancement, presence/absence of spastic reflex ileus, hypotonic reflex ileus or paralitic ileus, mural and/or portal/mesenteric pneumatosis, abdominal free fluid, parenchymal ischemia/infarction (liver, kidney, spleen). Results To make an early diagnosis useful to ensure a correct therapeutic approach, it is very important to differentiate between occlusive (arterial,venous) and nonocclusive causes (NOMI). The typical findings of each forms of mesenteric ischemia are explained in the text. Conclusion At present, the reference diagnostic modality for intestinal ischaemia is contrast-enhanced CT. However, there are some disadvantages associated with these techniques, such as radiation exposure, potential nephrotoxicity and the risk of an allergic reaction to the contrast agents. Thus, not all patients with suspected bowel ischaemia can be subjected to these examinations. Despite its limitations, US could constitutes a good imaging method as first examination in acute settings of suspected mesenteric ischemia. PMID:23902826

  14. Radiological Evaluation of Bowel Ischemia

    PubMed Central

    Dhatt, Harpreet S.; Behr, Spencer C; Miracle, Aaron; Wang, Zhen Jane; Yeh, Benjamin M.

    2015-01-01

    Intestinal ischemia, which refers to insufficient blood flow to the bowel, is a potentially catastrophic entity that may require emergent intervention or surgery in the acute setting. Although the clinical signs and symptoms of intestinal ischemia are nonspecific, CT findings can be highly suggestive in the correct clinical setting. In this chapter we review the CT diagnosis of arterial, venous, and non-occlusive intestinal ischemia. We discuss the vascular anatomy, pathophysiology of intestinal ischemia, CT techniques for optimal imaging, key and ancillary radiological findings, and differential diagnosis. In the setting of an acute abdomen, rapid evaluation is necessary to identify intraabdominal processes that require emergent surgical intervention (1). While a wide-range of intraabdominal diseases may be present from trauma to inflammation, one of the most feared disorders is mesenteric ischemia, also known as intestinal ischemia, which refers to insufficient blood flow to the bowel (2). Initial imaging evaluation for intestinal ischemia is typically obtained with CT. Close attention to technique and search for key radiologic features with relation to the CT technique is required. Accurate diagnosis depends on understanding the vascular anatomy, epidemiology, and pathophysiology of various forms of mesenteric ischemia and their corresponding radiological findings on MDCT. At imaging, not only is inspection of the bowel itself important, but evaluation of the mesenteric fat, vasculature, and surrounding peritoneal cavity also helps improves accuracy in the diagnosis of bowel ischemia. PMID:26526436

  15. Endovascular Treatment of Totally Occluded Superior Mesenteric Artery by Retrograde Crossing via the Villemin Arcade

    SciTech Connect

    Ferro, Carlo; Rossi, Umberto G. Seitun, Sara; Bovio, Giulio; Fornaro, Rosario

    2013-06-15

    Chronic mesenteric ischemia (CMI) is a rare disorder that is commonly caused by progressive atherosclerotic stenosis or occlusion of one or more mesenteric arteries. Endovascular treatment for symptomatic CMI represents a viable option, especially in high-operative risk patients. We report a case of acute symptomatic CMI with chronic totally occlusion of the superior mesenteric artery (SMA) associated with significant stenosis of celiac trunk (CT) and inferior mesenteric artery (IMA) that underwent endovascular treatment of all the three mesenteric arteries: stenting of CT and IMA stenosis, and recanalization of the SMA occlusion by retrograde crossing via the Villemin arcade.

  16. MR of superior mesenteric artery--renal vein fistula.

    PubMed

    Conces, D J; Kreipke, D L; Tarver, R D

    1986-01-01

    Traumatic arteriovenous fistulas involving the superior mesenteric artery are rare. Diagnosis is most commonly made shortly after the injury. Symptoms, when present, are usually related to intestinal ischemia. Angiography has been the conventional modality used in diagnosing arteriovenous fistulas. We report a patient with a superior mesenteric artery to left renal vein fistula who presented in overt heart failure five years after a gun shot wound. The fistula was evaluated with magnetic resonance imaging.

  17. Mesenteric venous thrombosis: diagnosis and noninvasive imaging.

    PubMed

    Bradbury, Michelle S; Kavanagh, Peter V; Bechtold, Robert E; Chen, Michael Y; Ott, David J; Regan, John D; Weber, Therese M

    2002-01-01

    Mesenteric venous thrombosis is an uncommon but potentially lethal cause of bowel ischemia. Several imaging methods are available for diagnosis, each of which has advantages and disadvantages. Doppler ultrasonography allows direct evaluation of the mesenteric and portal veins, provides semiquantitative flow information, and allows Doppler waveform analysis of the visceral vessels; however, it is operator dependent and is often limited by overlying bowel gas. Conventional contrast material-enhanced computed tomography (CT) allows sensitive detection of venous thrombosis within the central large vessels of the portomesenteric circulation and any associated secondary findings; however, it is limited by respiratory misregistration, motion artifact, and substantially decreased longitudinal spatial resolution. Helical CT and CT angiography, especially when performed with multi-detector row scanners, and magnetic resonance (MR) imaging, particularly gadolinium-enhanced MR angiography, enable volumetric acquisitions in a single breath hold, eliminating motion artifact and suppressing respiratory misregistration. Helical CT angiography and three-dimensional gadolinium-enhanced MR angiography should be considered the primary diagnostic modalities for patients with a high clinical suspicion of mesenteric ischemia. Conventional angiography is reserved for equivocal cases at noninvasive imaging and is also used in conjunction with transcatheter therapeutic techniques in management of symptomatic portal and mesenteric venous thrombosis. Copyright RSNA, 2002

  18. Proteomic Analysis of Human Mesenteric Lymph

    PubMed Central

    Dzieciatkowska, Monika; Wohlauer, Max V.; Moore, Ernest E.; Damle, Sagar; Peltz, Erik; Campsen, Jeffrey; Kelher, Marguerite; Silliman, Christopher; Banerjee, Anirban; Hansen, Kirk C.

    2011-01-01

    Extensive animal work has established mesenteric lymph as the mechanistic link between gut ischemia/reperfusion (I/R) and distant organ injury. Our trauma and transplant services provide a unique opportunity to assess the relevance of our animal data to human mesenteric lymph under conditions that simulate those used in the laboratory. Mesenteric lymph was collected from eleven patients; with lymphatic injuries, during semi-elective spine reconstruction, or immediately before organ donation. The lymph was tested for its ability to activate human neutrophils in vitro, and was analyzed by label-free proteomic analysis. Human mesenteric lymph primed human PMNs in a pattern similar to that observed in previous rodent, swine, and primate studies. A total of 477 proteins were identified from the 11 subject’s lymph samples with greater than 99% confidence. In addition to classical serum proteins, markers of hemolysis, extracellular matrix components, and general tissue damage were identified. Both tissue injury and shock correlate strongly with production of bioactive lymph. Products of red blood cell hemolysis correlate strongly with human lymph bioactivity and immunoglobulins have a negative correlation with the pro-inflammatory lymph. These human data corroborate the current body of research implicating post shock mesenteric lymph in the development of systemic inflammation and multiple organ failure. Further studies will be required to determine if the proteins identified participate in the pathogenesis of multiple organ failure and if they can be used as diagnostic markers. PMID:21192285

  19. Infected mesenteric cyst.

    PubMed

    Reddy, G Ramesh; Gunadal, Shankar; Banda, Vanaja Reddy; Banda, Naveen Reddy

    2013-04-18

    Mesenteric cyst is a rare condition. Presentation with non-typhoid spontaneous infection in an unusual area makes it even more a rare situation with mesenteric cyst. Its diagnosis is mainly based on the imaging modalities. However, there are difficulties in diagnosis when it is present in an uncommon area and rare known complications. Mesenteric cyst can present with few uncommon emergency conditions which pose difficulties in diagnosis as well as treatment options as mentioned in this case.

  20. Infected mesenteric cyst

    PubMed Central

    Reddy, G Ramesh; Gunadal, Shankar; Banda, Vanaja Reddy; Banda, Naveen Reddy

    2013-01-01

    Mesenteric cyst is a rare condition. Presentation with non-typhoid spontaneous infection in an unusual area makes it even more a rare situation with mesenteric cyst. Its diagnosis is mainly based on the imaging modalities. However, there are difficulties in diagnosis when it is present in an uncommon area and rare known complications. Mesenteric cyst can present with few uncommon emergency conditions which pose difficulties in diagnosis as well as treatment options as mentioned in this case. PMID:23605820

  1. Idiopathic myointimal hyperplasia of mesenteric veins and pneumatosis intestinalis: a previously unreported association.

    PubMed

    García-Castellanos, Raquel; López, Raquel; de Vega, Vicente Moreno; Ojanguren, Isabel; Piñol, Marta; Boix, Jaume; Domènech, Eugeni; Cabré, Eduard

    2011-06-01

    Idiopathic myointimal hyperplasia of mesenteric veins is a very rare disease occurring in young male patients, with no more than eight cases reported in the world literature. It causes venous ischemia in the sigmoid colon and rectum that clinically resembles inflammatory bowel disease. Pneumatosis intestinalis is also a rare condition usually associated to a wide range of diseases including bowel ischemia. We herein report on a case of pneumatosis intestinalis associated to idiopathic myointimal hyperplasia of mesenteric veins. To our knowledge, this is the first report of such an association, and the first one of idiopathic myointimal hyperplasia of mesenteric veins occurring in a female patient as well.

  2. Sclerosing Mesenteritis: A Rare Cause of Small Bowel Obstruction.

    PubMed

    Harvin, Glenn; Graham, Adam

    2016-01-01

    Sclerosing mesenteritis falls within a spectrum of primary idiopathic inflammatory and fibrotic processes that affect the mesentery. The exact etiology has not been determined, although the following associations have been noted: abdominal surgery, trauma, autoimmunity, paraneoplastic syndrome, ischemia and infection. Progression of sclerosing mesentritis can lead to bowel obstruction, a rare complication of this uncommon condition. We report a case of a 66-year-old female with abdominal pain who was noted to have a small bowel obstruction requiring laparotomy and a partial small bowel resection. The pathology of the resected tissue was consistent with sclerosing mesenteritis, a rare cause of a small bowel obstruction. Sclerosing mesenteritis has variable rates of progression, and there is no consensus regarding the optimal treatment. Physicians should consider sclerosing mesenteritis in the differential diagnosis of a small bowel obstruction.

  3. Sclerosing Mesenteritis: A Rare Cause of Small Bowel Obstruction

    PubMed Central

    Harvin, Glenn; Graham, Adam

    2016-01-01

    Sclerosing mesenteritis falls within a spectrum of primary idiopathic inflammatory and fibrotic processes that affect the mesentery. The exact etiology has not been determined, although the following associations have been noted: abdominal surgery, trauma, autoimmunity, paraneoplastic syndrome, ischemia and infection. Progression of sclerosing mesentritis can lead to bowel obstruction, a rare complication of this uncommon condition. We report a case of a 66-year-old female with abdominal pain who was noted to have a small bowel obstruction requiring laparotomy and a partial small bowel resection. The pathology of the resected tissue was consistent with sclerosing mesenteritis, a rare cause of a small bowel obstruction. Sclerosing mesenteritis has variable rates of progression, and there is no consensus regarding the optimal treatment. Physicians should consider sclerosing mesenteritis in the differential diagnosis of a small bowel obstruction. PMID:27403104

  4. A Case of Acute Ischemic Duodenal Ulcer Associated with Superior Mesenteric Artery Dissection After Transarterial Chemoembolization for Hepatocellular Carcinoma

    SciTech Connect

    Jang, Eun Sun; Jeong, Sook-Hyang Kim, Jin Wook; Lee, Sang Hyub; Yoon, Chang Jin; Kang, Sung Gwon

    2009-03-15

    We report a case of transarterial chemoembolization (TACE)-related acute ischemic duodenal ulcer that developed in association with dissection of the superior mesenteric artery. We conclude that the acute duodenal ulcer was developed by ischemia related to superior mesenteric artery dissection during TACE. TACE should be conducted carefully with continuous observation of abdominal arteries.

  5. Giant mesenteric cyst

    PubMed Central

    Guraya, Salman Yousuf; Salman, Shaista; Almaramhy, Hamdi H.

    2011-01-01

    Mesenteric cysts are uncommon benign abdominal lesions with no classical clinical features. The preoperative diagnosis requires the common imaging modalities but the final diagnosis is established only during surgery or histological analysis. The treatment of choice is complete surgical excision. We report an 18-year-old female with a non-specific abdominal pain and discomfort since 3 weeks. Her CT scan showed a huge cystic swelling, which necessitated surgical exploration. Preoperatively, a giant cyst was encountered with displacement of bowel loops. The cyst was completely removed and histology report confirmed mesenteric cyst without evidence of malignancy. PMID:24765349

  6. Giant mesenteric cyst.

    PubMed

    Guraya, Salman Yousuf; Salman, Shaista; Almaramhy, Hamdi H

    2011-09-28

    Mesenteric cysts are uncommon benign abdominal lesions with no classical clinical features. The preoperative diagnosis requires the common imaging modalities but the final diagnosis is established only during surgery or histological analysis. The treatment of choice is complete surgical excision. We report an 18-year-old female with a non-specific abdominal pain and discomfort since 3 weeks. Her CT scan showed a huge cystic swelling, which necessitated surgical exploration. Preoperatively, a giant cyst was encountered with displacement of bowel loops. The cyst was completely removed and histology report confirmed mesenteric cyst without evidence of malignancy.

  7. [Chylous mesenteric cyst].

    PubMed

    Skach, J; Gawlik, V

    2014-09-01

    The authors present a case report of a female patient with a recurrent mesenteric cyst. Chylous cyst is one of rare diagnoses of a cyst close to the pancreas in patients with no history of acute pancreatitis. Chylous cysts need to be managed radically; otherwise, given their nature, they are likely to recur.

  8. Isolated inferior mesenteric portal hypertension with giant inferior mesenteric vein and anomalous inferior mesenteric vein insertion

    PubMed Central

    Prasad, G. Raghavendra; Billa, Srikar; Bhandari, Pavaneel; Hussain, Aijaz

    2013-01-01

    Extrahepatic portal hypertension is not an uncommon disease in childhood, but isolated inferior mesenteric portal varices and lower gastrointestinal (GI) bleed have not been reported till date. A 4-year-old girl presented with lower GI bleed. Surgical exploration revealed extrahepatic portal vein obstruction with giant inferior mesenteric vein and colonic varices. Inferior mesenteric vein was joining the superior mesenteric vein. The child was treated successfully with inferior mesenteric – inferior vena caval anastomosis. The child was relieved of GI bleed during the follow-up. PMID:23798814

  9. Arterial Embolization in the Management of Mesenteric Bleeding Secondary to Blunt Abdominal Trauma.

    PubMed

    Ghelfi, Julien; Frandon, Julien; Barbois, Sandrine; Vendrell, Anne; Rodiere, Mathieu; Sengel, Christian; Bricault, Ivan; Arvieux, Catherine; Ferretti, Gilbert; Thony, Frédéric

    2016-05-01

    Mesenteric bleeding is a rare but potentially life-threatening complication of blunt abdominal trauma. It can induce active hemorrhage and a compressive hematoma leading to bowel ischemia. Emergency laparotomy remains the gold standard treatment. We aimed to study the effectiveness and complications of embolization in patients with post-traumatic mesenteric bleeding. The medical records of 7 consecutive patients with active mesenteric bleeding treated by embolization in a level-one trauma center from 2007 to 2014 were retrospectively reviewed. All patients presented with active mesenteric bleeding on CT scans without major signs of intestinal ischemia. We focused on technical success, clinical success, and the complications of embolization. Six endovascular procedures were successful in controlling hemorrhage but 1 patient had surgery to stop associated arterial and venous bleeding. One patient suffered from bowel ischemia, a major complication of embolization, which was confirmed by surgery. No acute renal failure was noted after angiography. For 1 patient we performed combined management as the endovascular approach allowed an easier surgical exploration. In mesenteric trauma with active bleeding, embolization is a valuable alternative to surgery and should be considered, taking into account the risk of bowel ischemia.

  10. Percutaneous mechanical thrombectomy of superior mesenteric artery embolism

    PubMed Central

    Kuhelj, Dimitrij; Kavcic, Pavel; Popovic, Peter

    2013-01-01

    Background The present series present three consecutive cases of successful percutaneous mechanical embolectomy in acute superior mesenteric artery ischemia. Superior mesenteric artery embolism is a rare abdominal emergency that commonly leads to bowel infarction and has a very high mortality rate. Prompt recognition and treatment are crucial for successful outcome. Endovascular therapeutic approach in patients with acute SMA embolism in median portion of its stem is proposed. Case reports. Three male patients had experienced a sudden abdominal pain and acute superior mesenteric artery embolism in median portion of its stem was revealed on computed tomography angiography. No signs of intestinal infarction were present. The decision for endovascular treatment was made in concordance with the surgeons. In one patient 6 French gauge Rotarex® device was used while in others 6 French gauge Aspirex® device were used. All patients experienced sudden relief of pain after the procedure with no signs of intestinal infarction. Minor procedural complication – rupture of a smaller branch of SMA during Aspirex® treatment was successfully managed by coiling while transient paralytic ileus presented in one patient resolved spontaneously. All three patients remained symptom-free with patent superior mesenteric artery during the follow-up period. Conclusions Percutaneous mechanical thrombectomy seems to be a rapid and effective treatment of acute superior mesenteric artery embolism in median portion of its stem in absence of bowel necrosis. Follow-up of our patients showed excellent short- and long-term results. PMID:24133388

  11. Managing mesenteric vasculitis.

    PubMed

    Angle, John Fritz; Nida, Berhanemeskel A; Matsumoto, Alan H

    2015-03-01

    Mesenteric vasculitis is a rare diagnosis, but it comprises a group of disorders that may have devastating manifestations. It is often difficult to diagnose using clinical symptoms and biomarkers. Vascular imaging often provides the best opportunity for the noninvasive diagnosis of vasculitis and obviates the need for performing a biopsy. The medical management of vasculitis involves controlling the inflammatory process with the use of steroids or other immunosuppressants, but medical therapy does not consistently provide regression of the vascular changes (ie, aneurysms or vascular occlusions) seen at the time of the initial diagnosis. Operative management remains the mainstay of therapy for focal occlusive or aneurysms, but the treatment options for multifocal disease remain challenging. Endovascular treatment is increasingly being used as a first line of treatment for symptomatic vasculitis. Interventionalists should be familiar with the indications and outcomes associated with the various therapeutic options for mesenteric vasculitis-associated occlusive disease and aneurysms. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Primary mesenteric hydatid cyst.

    PubMed

    Kushwaha, Jitendra Kumar; Gupta, Rajni; Mohanti, Satyabrot; Kumar, Surender

    2012-07-09

    Hydatid disease mostly caused by Echinococcus granulosus is a common parasitic infestation of the liver. Most common sites are liver (70%) and lungs (25%). Intraperitoneal hydatid cyst is found in 13% and it is usually secondary to rupture of primary hepatic cyst. Primary intraperitoeal hydatid cyst is rare (2%). Primary hydatid cyst in mesentery is very rare. In this article, the author presents a case of primary mesenteric hydatid cyst with chronic pain in lower abdomen.

  13. Primary mesenteric hydatid cyst

    PubMed Central

    Kushwaha, Jitendra Kumar; Gupta, Rajni; Mohanti, Satyabrot; Kumar, Surender

    2012-01-01

    Hydatid disease mostly caused by Echinococcus granulosus is a common parasitic infestation of the liver. Most common sites are liver (70%) and lungs (25%). Intraperitoneal hydatid cyst is found in 13% and it is usually secondary to rupture of primary hepatic cyst. Primary intraperitoeal hydatid cyst is rare (2%). Primary hydatid cyst in mesentery is very rare. In this article, the author presents a case of primary mesenteric hydatid cyst with chronic pain in lower abdomen. PMID:22778458

  14. Mesenteric Artery Insufficiency

    PubMed Central

    Coles, John C.; Walker, John B.; Gergely, N. F.; Buttigliero, Jorge

    1963-01-01

    The syndromes of superior mesenteric artery insufficiency are briefly reviewed. Three cases associated with infarction of bowel which were treated with restoration of arterial flow and resection of residual irretrievable bowel are reported. In two patients an embolectomy and in one patient a bypass graft were used to restore arterial continuity. The importance of the recognition and removal of irretrievable bowel at the time of vascular reconstruction is emphasized. Success is not necessarily predicated by the time factor alone, although the importance of early diagnosis and surgical intervention cannot be denied. PMID:14042788

  15. CT appearance of mesenteric saponification.

    PubMed

    Paris, A; Willing, S J

    1991-01-01

    Although saponification of the pancreas is a frequent finding on computed tomography, saponification of extrapancreatic mesenteric sites has not been previously recognized. A case is presented of acute pancreatitis in which serial scans over a four-year period documented calcifications in old extrapancreatic phlegmons. Saponification from pancreatitis should be considered in the differential diagnosis of mesenteric calcifications.

  16. CT diagnosis of mesenteric adenitis.

    PubMed

    Rao, P M; Rhea, J T; Novelline, R A

    1997-01-01

    To quantify how frequently mesenteric adenitis clinically mimics appendicitis and to determine its appearance at computed tomography (CT). The medical records of 651 consecutive patients with an admission diagnosis of appendicitis were reviewed to determine how often mesenteric adenitis was the discharge diagnosis. The CT scans of a separate group of 18 patients with a discharge diagnosis of mesenteric adenitis were reviewed. These patients were part of a group of 100 consecutive patients prospectively evaluated with CT of the appendix for clinically suspected appendicitis. Fifty of 651 patients (7.7%) with an admission diagnosis of appendicitis had a discharge diagnosis of mesenteric adenitis. Mesenteric adenitis constituted 50 of the 252 (19.8%) discharge diagnoses other than appendicitis. All 18 CT scans of mesenteric adenitis showed three or more nodes that measured at least 5 mm in shortest axis clustered in the right lower quadrant, with a normal appendix identified. Eight patients had associated ileal or ileocecal wall thickening. Mesenteric adenitis is an important clinical mimic of appendicitis. It appears at CT as clustered, enlarged mesenteric lymph nodes with a normal appendix, and there may be associated ileitis or ileocolitis noted.

  17. Celiac Artery Thrombosis and Superior Mesenteric Artery Stenoses with Essential Thrombocythemia: A Case Report

    PubMed Central

    Keskin, Hasan Attila; Yetisir, Fahri; Bayram, Huseyin; Bayraktaroglu, Mehmet Selahattin; Simsek, Erdal; Kilic, Mehmet; Katircioglu, Salih Fehmi

    2012-01-01

    Thrombosis of the celiac artery trunk is a rare cause of acute abdominal pain. Thrombosis of the celiac artery carries a high mortality and morbidity when the diagnoses and treatment are delayed. It is frequently associated with other cardiovascular events. The most common etiology is atherosclerosis. 20–30% of cases may have symptoms of chronic mesenteric ischemia. Main goal of the treatment is to reestablish the diminished or stopped mesenteric blood flow and to avoid end-organ ischemia. Essential thrombocythemia is a chronic myeloproliferative disorder characterized by marked increase in thrombocyte number and clinical presentation may be with thrombotic episodes, hemorrhage, or both. To our knowledge this is the first report of celiac artery thrombosis and superior mesenteric artery stenoses in a patient with essential thrombocythemia. The patient was managed successfully with surgical treatment. PMID:23304160

  18. Superior mesenteric artery syndrome

    PubMed Central

    Giedrius, Bernotavičius; Kęstutis, Saniukas; Irena, Karmonaitė; Rimantas, Zagorskis

    2016-01-01

    Background. An obstruction of the distal part of the duodenum can occur because of the superior mesenteric artery syndrome (SMAS) after a surgical correction of scoliosis. It is essential to evaluate the risk factors and diagnose the SMAS in time because complications of this condition are life-threatening and it is associated with a high rate of morbidity. Diagnostics of the SMAS is challenging, because it is rare and its symptoms are non-specific. Therefore, in order to better understand the essence of this pathology and to make diagnosis easier we present a rare clinical case of the superior mesenteric artery syndrome after a surgical correction of neuromuscular scoliosis. The clinical case. A 12-year-old girl with a specific development disorder, sensory neuropathy and progressive kypho-scoliosis was admitted to Vilnius University Children’s Hospital. The patient had right side 50-degree thoracic scoliosis and an 80-degree thoracic kyphosis. She underwent posterior spinal fusion with hooks and screws from Th1 to L2. On the fourth day after the surgery the patient developed nausea and began to vomit each day 1-2 times per day, especially after meals. The SMAS was suspected and a nasogastric tube was inserted, stomach decompression and the correction of electrolytes disbalance were made. After the treatment, the symptoms did not recur and a satisfactory correction and balance of the spine were made in coronal and sagittal planes. Conclusions. It is extremely important to identify the risk factors of the SMAS and begin preoperative diet supplements before surgical correction of scoliosis for patients with a low body mass index. After the first episode of vomiting following the surgery, we recommend to investigate these patients for a gastrointestinal obstruction as soon as possible. Decompression of the stomach, enteral or parenteral nutrition, and fluid therapy are essential in treating the SMAS. PMID:28356803

  19. Vasculitis of the mesenteric circulation.

    PubMed

    Koster, Matthew J; Warrington, Kenneth J

    2017-02-01

    Vasculitis of the mesenteric circulation is an uncommon but life-threatening manifestation of systemic vasculitis. Initial symptoms are frequently non-specific and therefore patients often present to primary care physicians and gastroenterologists with abdominal pain or gastrointestinal bleeding. Given the severity of the conditions associated with mesenteric vasculitis, it is imperative to appropriately diagnose and initiate treatment of suspected cases. This review will focus on diseases commonly associated with vasculitis of the mesenteric vessels. Imaging characteristics and clinical features assisting in diagnosis as well as initial approaches to treatment are emphasized. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Mesenteric cystic lymphangioma mimicking malignancy.

    PubMed

    Hureibi, Khalid; Sunidar, Osama A

    2014-09-01

    Mesenteric cystic lymphangiomas are benign tumours arising from the mesentery, and have no known aetiology. Patients might be discovered incidentally to have asymptomatic mesenteric cysts, or they can present with symptoms such as pain, nausea and vomiting. A 27-year-old man presented with vague abdominal pain, loss of appetite, postprandial fullness and significant weight loss. There was no lymphadenopathy, and abdominal examination was unremarkable. CT showed a mesenteric mass and a diagnosis of abdominal lymphoma was suggested. There was no evidence of pulmonary tuberculosis on chest X-ray and the purified protein derivative test was negative. On laparotomy, a 5×9×7 cm sessile cyst containing thick white fluid and arising from the ileal mesentery was found and completely removed. Histopathology proved a diagnosis of mesenteric cystic lymphangioma. The patient made uneventful recovery, and was asymptomatic on clinical follow-up after 6 weeks. 2014 BMJ Publishing Group Ltd.

  1. Mesenteric cysts and mesenteric venous thrombosis leading to intestinal necrosis in pregnancy managed with laparotomy: a case report and review of the literature.

    PubMed

    Giannos, Aris; Stavrou, Sofoklis; Goumalatsos, Nikolaos; Fragkoulidis, George; Chra, Eleni; Argiropoulos, Dimitrios; Loutradis, Dimitrios; Drakakis, Peter

    2017-07-07

    Mesenteric cyst is a rare clinical entity especially in pregnancy; therefore, few cases have been reported in the literature. The standard method of their treatment is surgical excision either with laparotomy or laparoscopy. In addition, mesenteric vein thrombosis is a rare and life-threatening condition in pregnancy and needs immediate treatment because it can lead to intestinal necrotic ischemia. This is the first report of the coexistence of mesenteric cysts and mesenteric vein thrombosis during gestation. A 27-year-old Greek woman, gravida 2 para 1, presented at 10 weeks' gestation to the Emergency Unit of our hospital complaining of diffuse abdominal pain which deteriorated the last 3 days, which was localized in her right iliac fossa, along with vomiting. She had undergone open laparotomy and right salpingo-oophorectomy at the age of 23 due to an ovarian cyst. Besides this, her personal and family medical history was unremarkable. She had never received oral contraceptives or any hormone therapy. On arrival, a clinical examination revealed tenderness on palpation of her right iliac fossa, without rebound tenderness or muscle guarding. Within 10 hours of hospitalization, her symptoms deteriorated further with rebound tenderness during the examination, tachycardia, and a drop of 12 units in her hematocrit value. An emergency laparotomy was performed. Two mesenteric cysts and a 60 cm necrotic part of her intestine were revealed intraoperatively. In the postoperative period, she complained of acute abdominal pain, tachycardia, and dyspnea. Computed tomography imaging revealed mesenteric vein thrombosis and pulmonary thromboembolism. She was treated with low molecular weight heparin and she was discharged on the 11th postoperative day. To the best of our knowledge, this is the first report in the literature of a simultaneous mesenteric cyst and mesenteric vein thrombosis in pregnancy. It is known that pregnancy is a state of hypercoagulation and clinicians

  2. Superior Mesenteric Artery Syndrome with Abdominal Compartment Syndrome

    PubMed Central

    Reece, Kevin; Day, Rachel

    2016-01-01

    Superior Mesenteric Artery (SMA) syndrome is a condition in which the duodenum becomes compressed between the SMA and the aorta, resulting in bowel obstruction which subsequently compresses surrounding structures. Pressure on the inferior vena cava (IVC) and aorta decreases cardiac output which compromises distal blood flow, resulting in abdominal compartment syndrome with ischemia and renal failure. A 15-year-old male with SMA syndrome presented with 12 hours of pain, a distended, rigid abdomen, mottled skin below the waist, and decreased motor and sensory function in the lower extremities. Exploratory laparotomy revealed ischemic small bowel and stomach with abdominal compartment syndrome. Despite decompression, the patient arrested from hyperkalemia following reperfusion. PMID:28003918

  3. Celiac artery stent placement for coronary ischemia.

    PubMed

    Madden, Nicholas J; Piccolo, Carmen; Kunasani, Ratna; Mohan, Chittur; Khoobehi, Ali; Sohn, Richard

    2015-08-01

    The use of endovascular technology for mesenteric interventions has become an increasingly accepted treatment modality. We present an unusual case of celiac artery stent placement for coronary ischemia. A 66-year-old male with a history most notable for coronary artery disease and coronary artery bypass grafting (CABG) x 3 utilizing left internal mammary artery to left anterior descending, radial artery to first diagonal and his right gastroepiploic artery (GEA) to posterior descending artery presented with chest pain. His work-up included a cardiac catheterization that revealed a 90% stenosis at the origin of the celiac axis. A subsequent computerized tomography angiogram confirmed this and noted moderate stenosis of his superior mesenteric artery (SMA) as well as severe inferior mesenteric artery (IMA) stenosis. The patient was taken for mesenteric angiography by vascular surgery at which time he underwent balloon-expandable stent placement in the celiac axis. The patient tolerated this procedure well and was noted to have an improvement in his symptoms postoperatively. Use of arterial conduits for CABG have proven to be superior to vein. Long-term viability of the GEA as a conduit is dependent in part on the patency of mesenteric circulation. Our findings demonstrate a viable endovascular treatment option for angina pectoris secondary to mesenteric stenosis in this unique patient population. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Partial abdominal evisceration and intestinal autotransplantation to resect a mesenteric carcinoid tumor

    PubMed Central

    2011-01-01

    Background Midgut carcinoids are neuroendocrine tumors that commonly metastasize to the intestinal mesentery, where they predispose to intestinal obstruction, ischemia and/or congestion. Because of their location, many mesenteric carcinoid tumors are deemed unresectable due to the risk of uncontrollable bleeding and prolonged intestinal ischemia. Case Presentation We report the case of a 60-year-old male with a mesenteric carcinoid tumor obstructing his superior mesenteric vein, resulting in intestinal varices and severe recurrent GI bleeds. While his tumor was thought to be unresectable by conventional techniques, it was successfully resected using intestinal autotransplantation to safely gain access to the tumor. This case is the first described application of this technique to carcinoid tumors. Conclusions Intestinal autotransplantation can be utilized to safely resect mesenteric carcinoid tumors from patients who were not previously thought to be surgical candidates. We review the literature concerning both carcinoid metastases to the intestinal mesentery and the use of intestinal autotransplantation to treat lesions involving the mesenteric root. PMID:21281518

  5. [Mesenteric cysts in children].

    PubMed

    Fernández Ibieta, M; Rojas Ticona, J; Martinez Castaño, I; Reyes Rios, P; Villamil, V; Giron Vallejo, O; Mendez Aguirre, N; Sanchez Morote, J; Aranda Garcia, M J; Guirao Piñera, M J; Zambudio Carmona, G; Ruiz Pruneda, R; Ruiz Jiménez, J I

    2015-01-01

    Mesenteric cysts (MC) are benign cystic tumors that grow within mesentery or omentum tissue. We have reviewed the cases of MC reported and operated on in our centre. Retrospective review of clinical records of MC cases during the period 2002-2012 RESULTS: A total of 7 patients were found. Mean age was 5.3 years (range 3-11). Abdominal ultrasound was the diagnostic tool in all cases, except for one, which was diagnosed during laparotomy. All presented abdominal pain, 5 (71.4%) vomiting, 4 (57%) gross abdominal distension, 3 (42.8%) fever, and none presented complete abdominal obstruction, although 2 patients (28.6%) had slight sub-occlusion symptoms. All MC were pedicled or sesil, except for our last case, which extended into the retroperitoneum. All specimens were reported as Limphatic Malformation. None recurred. MC in children are mostly Lymphatic Malformations of mesentery or omentum origin, and clinical presentation varies from chronic abdominal pain to sudden-onset peritonitis or volvulus. About 50-60% require intestinal resection and anastomosis. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  6. Myocardial Ischemia

    MedlinePlus

    ... pectoris: Chest pain caused by myocardial ischemia. www.uptodate.com/home. Accessed June 1, 2015. Deedwania PC. Silent myocardial ischemia: Epidemiology and pathogenesis. www.uptodate.com/home. Accessed June 1, 2015. Mann DL, ...

  7. Bare Stent Implantation in Iatrogenic Dissecting Pseudoaneurysm of the Superior Mesenteric Artery

    SciTech Connect

    Kutlu, Ramazan Ara, Cengiz; Sarac, Kaya

    2007-02-15

    Iatrogenic arterial dissection leading to the development of dissecting pseudoaneurysms of the superior mesenteric artery (SMA) is a rare complication of angiography. Surgical and endovascular treatment options exist for this important condition. We report a case of bare stent implantation in dissecting pseudoaneurysm of the SMA that developed after angiography in a patient with acute mesenteric ischemia. Although it is rarely published, iatrogenic arterial dissection causing pseudoaneurysm can occur after diagnostic and interventional angiography. Bare stent implantation in dissecting pseudoaneurysm of the SMA could be an advantageous endovascular treatment option in selected cases due its to potential preservation of important side branches of the SMA.

  8. Superior Mesenteric Venous Thrombosis after Laparoscopic Exploration for Small Bowel Obstruction

    PubMed Central

    Kunizaki, Shozo; Shimaguchi, Mayu; Yoshinaga, Yasuo; Kanda, Yukihiro; Lefor, Alan T.; Mizokami, Ken

    2013-01-01

    Mesenteric venous thrombosis is a rare cause of intestinal ischemia which is potentially life-threatening because it can lead to intestinal infarction. Mesenteric venous thrombosis rarely develops after abdominal surgery and is usually associated with coagulation disorders. Associated symptoms are generally subtle or nonspecific, often resulting in delayed diagnosis. A 68-year-old woman underwent laparoscopic exploration for small bowel obstruction, secondary to adhesions. During the procedure, an intestinal perforation was identified and repaired. Postoperatively, the abdominal pain persisted and repeat exploration was undertaken. At repeat exploration, a perforation was identified in the small bowel with a surrounding abscess. After the second operation, the abdominal pain improved but anorexia persisted. Contrast enhanced abdominal computed tomography was performed which revealed superior mesenteric venous thrombosis. Anticoagulation therapy with heparin was started immediately and the thrombus resolved over the next 6 days. Although rare, this complication must be considered in patients after abdominal surgery with unexplained abdominal symptoms. PMID:24455391

  9. [Spontaneous isolated dissection of the superior mesenteric artery: an uncommon cause of acute abdomen. A case report].

    PubMed

    Daghfous, A; Bouzaidi, K; Rezgui Marhoul, L

    2015-02-01

    Isolated spontaneous dissection of the superior mesenteric artery is the most common digestive artery dissection. It is a rare cause of acute abdomen. Only a few hundred cases have been reported in the literature. We report a 40-year-old man with a past medical history of high blood pressure who presented abdominal pain that was related to a spontaneous dissection of the superior mesenteric artery. Computed tomography revealed an isolated dissection of superior mesenteric artery. There were no evidence of bowel ischemia. We decided a conservative treatment and the outcome was favorable, without recurrent symptoms or disease progression. Based on this case report, we discuss the etiology of this vascular lesion and the contribution of computed tomography in the diagnosis, the therapeutic strategy and the follow-up of spontaneous dissection of superior mesenteric artery. Copyright © 2014. Published by Elsevier SAS.

  10. Functional adaptation of bovine mesenteric lymphatic vessels to mesenteric venous hypertension.

    PubMed

    Quick, Christopher M; Criscione, John C; Kotiya, Akhilesh; Dongaonkar, Ranjeet M; Hardy, Joanne; Wilson, Emily; Gashev, Anatoliy A; Laine, Glen A; Stewart, Randolph H

    2014-06-15

    Lymph flow is the primary mechanism for returning interstitial fluid to the blood circulation. Currently, the adaptive response of lymphatic vessels to mesenteric venous hypertension is not known. This study sought to determine the functional responses of postnodal mesenteric lymphatic vessels. We surgically occluded bovine mesenteric veins to create mesenteric venous hypertension to elevate mesenteric lymph flow. Three days after surgery, postnodal mesenteric lymphatic vessels from mesenteric venous hypertension (MVH; n = 7) and sham surgery (Sham; n = 6) group animals were evaluated and compared. Contraction frequency (MVH: 2.98 ± 0.75 min(-1); Sham: 5.42 ± 0.81 min(-1)) and fractional pump flow (MVH: 1.14 ± 0.30 min(-1); Sham: 2.39 ± 0.32 min(-1)) were significantly lower in the venous occlusion group. These results indicate that postnodal mesenteric lymphatic vessels adapt to mesenteric venous hypertension by reducing intrinsic contractile activity. Copyright © 2014 the American Physiological Society.

  11. A model of blood flow in the mesenteric arterial system.

    PubMed

    Mabotuwana, Thusitha D S; Cheng, Leo K; Pullan, Andrew J

    2007-05-08

    There are some early clinical indicators of cardiac ischemia, most notably a change in a person's electrocardiogram. Less well understood, but potentially just as dangerous, is ischemia that develops in the gastrointestinal system. Such ischemia is difficult to diagnose without angiography (an invasive and time-consuming procedure) mainly due to the highly unspecific nature of the disease. Understanding how perfusion is affected during ischemic conditions can be a useful clinical tool which can help clinicians during the diagnosis process. As a first step towards this final goal, a computational model of the gastrointestinal system has been developed and used to simulate realistic blood flow during normal conditions. An anatomically and biophysically based model of the major mesenteric arteries has been developed to be used to simulate normal blood flows. The computational mesh used for the simulations has been generated using data from the Visible Human project. The 3D Navier-Stokes equations that govern flow within this mesh have been simplified to an efficient 1D scheme. This scheme, together with a constitutive pressure-radius relationship, has been solved numerically for pressure, vessel radius and velocity for the entire mesenteric arterial network. The computational model developed shows close agreement with physiologically realistic geometries other researchers have recorded in vivo. Using this model as a framework, results were analyzed for the four distinct phases of the cardiac cycle--diastole, isovolumic contraction, ejection and isovolumic relaxation. Profiles showing the temporally varying pressure and velocity for a periodic input varying between 10.2 kPa (77 mmHg) and 14.6 kPa (110 mmHg) at the abdominal aorta are presented. An analytical solution has been developed to model blood flow in tapering vessels and when compared with the numerical solution, showed excellent agreement. An anatomically and physiologically realistic computational model of

  12. Chylous mesenteric cyst: A diagnostic dilemma.

    PubMed

    Lee, Doreen L P; Madhuvrata, Priya; Reed, Malcolm W; Balasubramanian, Saba P

    2016-07-01

    A mesenteric cyst is defined as a cyst that is located in the mesentery of the gastrointestinal tract and may extend from the base of the mesentery into the retroperitoneum. A case report of a patient with mesenteric cyst is presented. In addition, a systematic review was performed of English language literature on chylous mesenteric cysts in adult humans. Of the 18 articles included in the review, there were 19 cases of chylous mesenteric cysts reported. Male to female ratio was 1.4:1 with a median age of 46 years. A preoperative diagnosis of mesenteric cyst was made in four patients based on computed tomography. All patients underwent surgery and there were no reports of recurrence on follow up. Chylous mesenteric cyst is a rare entity that needs to be recognized whenever a preliminary diagnosis of intra-abdominal cystic mass is made. Copyright © 2013. Published by Elsevier Taiwan.

  13. Hepatic ischemia

    MedlinePlus

    ... blood or oxygen, causing injury to liver cells. Causes Low blood pressure from any condition can lead to hepatic ischemia. ... liver's blood vessels Treatment Treatment depends on the cause. Low blood pressure and blood clots must be treated right away. ...

  14. Intestinal Ischemia

    MedlinePlus

    ... and hormone medications, such as estrogen Cocaine or methamphetamine use Vigorous exercise, such as long-distance running ... anti-phospholipid syndrome. Illegal drug use. Cocaine and methamphetamine use have been linked to intestinal ischemia. Complications ...

  15. Silent Ischemia

    MedlinePlus

    ... can be used to diagnose silent ischemia: An exercise stress test can show blood flow through your coronary arteries in response to exercise. Holter monitoring records your heart rate and rhythm ...

  16. Acute small bowel ischemia: CT imaging findings.

    PubMed

    Segatto, Enrica; Mortelé, Koenraad J; Ji, Hoon; Wiesner, Walter; Ros, Pablo R

    2003-10-01

    Small bowel ischemia is a disorder related to a variety of conditions resulting in interruption or reduction of the blood supply of the small intestine. It may present with various clinical and radiologic manifestations, and ranges pathologically from localized transient ischemia to catastrophic necrosis of the intestinal tract. The primary causes of insufficient blood flow to the small intestine are various and include thromboembolism (50% of cases), nonocclusive causes, bowel obstruction, neoplasms, vasculitis, abdominal inflammatory conditions, trauma, chemotherapy, radiation, and corrosive injury. Computed tomography (CT) can demonstrate changes because of ischemic bowel accurately, may be helpful in determining the primary cause of ischemia, and can demonstrate important coexistent findings or complications. However, common CT findings in acute small bowel ischemia are not specific and, therefore, it is often a combination of clinical, laboratory and radiologic signs that may lead to a correct diagnosis. Understanding the pathogenesis of various conditions leading to mesenteric ischemia and being familiar with the spectrum of diagnostic CT signs may help the radiologist recognize ischemic small bowel disease and avoid delayed diagnosis. The aim of this article is to provide a review of the pathogenesis and various causes of acute small bowel ischemia and to demonstrate the contribution of CT in the diagnosis of this complex disease.

  17. Spontaneous Recanalization of Superior Mesenteric Artery Occlusion Following Angioplasty and Stenting of Inferior Mesenteric Artery

    SciTech Connect

    Akpinar, Erhan Cil, Barbaros E.; Arat, Anil; Baykal, Atac; Karaman, Kerem; Balkanci, Ferhun

    2006-02-15

    An 84-year-old woman with a history of hypertension and coronary artery disease was admitted with a progressively worsening diffuse abdominal pain. Computed tomography scan of the abdomen and angiography revealed occlusion of the origin and proximal portion of superior mesenteric artery. Aortography also showed severe origin stenosis of inferior mesenteric artery and that the distal part of the superior mesenteric artery was supplied by a prominent marginal artery of Drummond. Patient was effectively treated with percutaneous transluminal angioplasty and stenting of the inferior mesenteric artery. Follow-up imaging studies demonstrated patency of the stent and spontaneous recanalization of superior mesenteric artery occlusion.

  18. Cocaine-induced mesenteric ischaemia.

    PubMed

    Osorio, J; Farreras, N; Ortiz De Zárate L; Bachs, E

    2000-01-01

    We report a 33-year-old man with distal ileum infarction after intravenous abuse of cocaine. He underwent resection of a gangrenous bowel segment and survived. We review the literature regarding intestinal ischaemia related to cocaine. To date, 19 cases have been published. Like most previously reported cases, our patient was young and had no previous history of arteriosclerosis. He suffered cocaine-induced rhabdomyolysis and acute renal failure. Mesenteric ischaemia should be considered in the differential diagnosis of acute or chronic abdominal pain in cocaine consumers.

  19. Chylous mesenteric cysts in children.

    PubMed

    Chen, Hou-Ping; Liu, Wen-Ying; Tang, Yun-Man; Ma, Bu-Yun; Xu, Bing; Yang, Gang; Wang, Xue-Jun

    2011-03-01

    To evaluate the clinical features, diagnosis, and treatment of chylous mesenteric cysts (CMCs) in children. We analyzed retrospectively the clinical records of 10 children with a CMC, treated in the Department of Pediatric Surgery, West China Hospital of Sichuan University, between 1987 and 2008. This series comprised five girls and five boys. The CMC manifested as abdominal distention (n = 9), acute abdomen (n = 8), or an asymptomatic abdominal mass (n = 1), and included five mesojejunal cysts and five mesoileal cysts. Intestinal volvulus occurred in four patients with mesoileal cysts and acute chylous effusion occurred in two patients with mesojejunal cysts. All ten children were treated surgically. The cystic content was positive for Sudan III staining and the chylous test. Chylous mesenteric cysts manifest as an abdominal mass, abdominal distention, and/or acute abdomen more often in children than in adults. The clinical presentation suggests some association with the localization of the cysts. A good prognosis can be expected with removal of the cyst and the affected intestinal segment.

  20. Hypoxic radioprotection by temporary intestinal ischemia: degradable starch microsphere embolization in the cat

    SciTech Connect

    Lote, K.

    1981-01-01

    Temporary small intestinal ischemia was induced by mesenteric arteriolar embolization of degradable starch microspheres in cats. During ischemia, the small intestine received a surface dose of 7 Gy 200 kV x-ray irradiation. One group of animals also had received 7 Gy to the intact abdomen 72 hr earlier. The risk of thrombosis in small intestinal vessels during or after starch microsphere-induced ischemia combined with irradiation was evaluated by monitoring superior mesenteric arterial blood flow, by determination of blood platelets, fibrinogen, and factor VIII consumed across the mesenteric vascular bed, and by histologic examination of small intestinal vessels. Vascular integrity was inferred from intact response to isoproterenol and vasopressin after the combined trauma of ischemia and irradiation. No signs of thrombosis were detected in small intestinal vessels after temporary ischemia and irradiation. Hypoxic radioprotection of the small intestine in the cat can thus be achieved by mesenteric arterial microembolization of degradable starch spheres without evidence of thrombotic complications of significant vascular damage.

  1. Hypoxic radioprotection by temporary intestinal ischemia: degradable starch microsphere embolization in the cat

    SciTech Connect

    Lote, K.

    1981-11-01

    Temporary small intestinal ischemia was induced by mesenteric arteriolar embolization of degradable starch microspheres in cats. During ischemia, the small intestine received a surface dose of 7 Gy 200 kV x-ray irradiation. One group of animals also had received 7 Gy to the intact abdomen 72 hr earlier. The risk of thrombosis in small intestinal vessels during or after starch microsphere-induced ischemia combined with irradiation was evaluated by monitoring superior mesenteric arterial blood flow, by determination of blood platelets, fibrinogen, and factor VIII consumed across the mesenteric vascular bed, and by histologic examination of small intestinal vessels. Vascular integrity was inferred from intact response to isoproterenol and vasopressin after the combined trauma of ischemia and irradiation. No signs of thrombosis were detected in small intestinal vessels after temporary ischemia and irradiation. Hypoxic radioprotection of the small intestine in the cat can thus be achieved by mesenteric arterial microembolization of degradable starch spheres without evidence of thrombotic complications or significant vascular damage.

  2. A Case of the Inferior Mesenteric Artery Arising from the Superior Mesenteric Artery in a Korean Woman

    PubMed Central

    Yoo, Seung Jin; Ku, Min Jung; Cho, Sa Sun

    2011-01-01

    Anatomical variations of the inferior mesenteric artery are extremely uncommon, since the inferior mesenteric artery is regularly diverged at the level of the third lumbar vertebra. We found a rare case in which the inferior mesenteric artery arose from the superior mesenteric artery. The findings were made during a routine dissection of the cadaver of an 82-yr-old Korean woman. This is the tenth report on this anomaly, the second female and the first Korean. The superior mesenteric artery normally arising from abdominal aorta sent the inferior mesenteric artery as the second branch. The longitudinal anastomosis vessels between the superior mesenteric artery and inferior mesenteric artery survived to form the common mesenteric artery. This anatomical variation concerning the common mesenteric artery is of clinical importance, performing procedures containing the superior mesenteric artery. PMID:22022194

  3. An Autopsy Case of Acute Massive Hematochezia Caused by Superior Mesenteric Vein Thrombosis: A First Report in Forensic Medicine.

    PubMed

    Watanabe, Mayumi; Unuma, Kana; Makino, Yohsuke; Noritake, Kanako; Yamada, Atsushi; Iwase, Hirotaro; Uemura, Koichi

    2016-01-01

    Superior mesenteric vein thrombosis (SMVT) is an uncommon cause of intestinal ischemia and massive gastrointestinal bleeding. This report describes a man with alcoholic liver cirrhosis, who died of massive hematochezia due to SMVT. A medicolegal autopsy disclosed a thrombus at the superior mesenteric vein and hemorrhagic infarction of the bowel wall, an area also within the territory of the superior mesenteric vein. Liver cirrhosis, an enlarged spleen, and esophageal varices without rupture were also observed, but ulcers and variceal bleeding were not. Other organs showed no significant findings. His blood alcohol level was 0.14% w/v. Thus, this man died from severe hematochezia associated with SMVT due to liver cirrhosis and alcohol dehydration, which can lead to coagulopathy and rapid progress of thrombus formation. This is the first report on an alternate cause for massive gastrointestinal hemorrhage with a cirrhotic patient in a forensic autopsy. © 2015 American Academy of Forensic Sciences.

  4. Mesenteric vein thrombosis in a patient heterozygous for factor V Leiden and G20210A prothrombin genotypes.

    PubMed

    Karmacharya, Paras; Aryal, Madan Raj; Donato, Anthony

    2013-11-21

    Mesenteric venous thrombosis (MVT) is a rare but life threatening form of bowel ischemia. It is implicated in 6%-9% of all cases of acute mesenteric ischemia. The proportion of patients with primary (or idiopathic) MVT varies from 0% to 49%, with a decrease in frequency secondary to more recent availability of newer investigations for hypercoagulability. The presence of factor V Leiden (FVL) and prothrombin G20210A mutations (PGM) have been well documented in these cases. However, there have been scarce case reports describing MVT in heterozygotes of both these mutations occurring simultaneously and its implications on long term management. Our case describes acute MVT in a previously asymptomatic young patient with no prior history of venous thromboembolism. The patient was found to be heterozygous for FVL and PGM and treated with lifelong anticoagulation with warfarin (goal international normalized ratio: 2-3) and avoidance of hormonal contraceptives.

  5. Incidental Finding and Management of Mesenteric Fibromatosis

    PubMed Central

    Nicolas, Gregory; Kfoury, Tony; Shimlati, Rasha; Tohme, Maroon; Wakim, Raja

    2016-01-01

    Patient: Male, 45 Final Diagnosis: Mesenteric fibromatosis Symptoms: — Medication: — Clinical Procedure: Surgical removal of the mesenteric fibromatosis Specialty: Surgery Objective: Rare disease Background: Mesenteric fibromatosis, also known as mesenteric desmoids, is part of the clinical-pathologic spectrum of deep fibromatosis, which encompasses a group of benign fibro-proliferative processes that are locally aggressive and have the capacity to infiltrate or recur without metastasis. Case Report: Case of a 45-year-old man, with a history of hypertension and lung fibrosis, presenting for a left abdominal mass, which was found incidentally during his lung fibrosis imaging. He complained of constipation due to pressure upon his bowel leading to difficulty in defecation. Conclusions: Although there are many overlapping criteria between gastrointestinal stromal tumors and mesenteric fibromatosis, making it difficult to discriminate between the two, there are differences that are unique to mesenteric fibromatosis that should be noticed during the diagnosis. In this case, mesenteric fibromatosis was unusual as it is not associated with Gardner’s syndrome, desmoid tumors, nor familial adenomatous polyposis, but was an incidental finding. PMID:27279600

  6. A “clean case” of systemic injury: Mesenteric lymph after hemorrhagic shock elicits a sterile inflammatory response

    PubMed Central

    Yi, Jeniann; Slaughter, Anne; Kotter, Cassandra V.; Moore, Ernest E.; Hauser, Carl J.; Itagaki, Kiyoshi; Wohlauer, Max; Frank, Daniel N.; Silliman, Christopher; Banerjee, Anirban; Peltz, Erik

    2015-01-01

    Post-injury multiple organ failure results from an inappropriate, overwhelming immune response to injury. During trauma and hemorrhagic shock (T/HS), mesenteric ischemia causes gut mucosal breakdown with disruption of the intestinal barrier. It has been proposed that this releases the gut microbiota systemically via post-shock mesenteric lymph, engendering infectious complications. Despite extensive investigation, no clear evidence has been presented for gut bacterial translocation after resuscitation from T/HS. However, such previous studies were limited by available technologies. More sensitive methods, such as quantitative polymerase chain reaction (PCR), have since emerged for detection of bacterial presence and danger-associated molecular patterns (DAMPs). Quantitative PCR was applied to post-shock mesenteric lymph (PSML) derived from a rat model of T/HS. No bacterial presence was detected in a series of 12 samples, whereas multiple lymph samples showed presence of DAMPs after T/HS. Thus, we confirmed that bacterial translocation does not exist in PSML following resuscitation from T/HS-associated mesenteric ischemia. However, T/HS does increase the presence of mitochondrial DAMPs in PSML. These results support our current position that PSML elaborates remote organ injury by multiple inflammatory mechanisms, including lipid-mediated pro-inflammatory stimuli, and by contribution from gut-derived DAMPS. PMID:26196840

  7. Complement Depletion Protects Lupus-prone Mice from Ischemia-reperfusion-initiated Organ Injury

    DTIC Science & Technology

    2012-10-25

    ischemia-reperfusion injury; intestine; complement; systemic lupus erythematosus MESENTERIC ISCHEMIA-REPERFUSION (IR) injury is encountered after...also affect the disease process in patients with autoimmune diseases such as systemic lupus erythematosus (SLE) (1, 36, 47). SLE is characterized by...Bove A, Delgado G, Cervera R, Ingelmo M, Font J. Vasculitis in systemic lupus erythematosus : prevalence and clinical characteristics in 670 patients

  8. Traumatic mesenteric cyst after blunt abdominal trauma

    PubMed Central

    Falidas, Evangelos; Mathioulakis, Stavros; Vlachos, Konstantinos; Pavlakis, Emmanouil; Anyfantakis, Georgios; Villias, Constantinos

    2011-01-01

    Mesenteric cysts are rare abdominal tumors of unclear histologic origin, usually asymptomatic. Post-traumatic mesenteric cyst usually results as a consequence of a mesenteric lymphangitic rupture or a hematoma followed by absorption and cystic degeneration. The preoperative histological and radiological diagnosis is difficult. We present the case of a 45-year-old male patient with sizable, palpable abdominal tumor, the gradual swelling of which the patient himself combined with the blunt abdominal trauma he acquired from an opponent's knee in a football game 5 months ago. PMID:22096714

  9. Nonbacterial Thrombotic Endocarditis in a Patient with Bowel Infarction due to Mesenteric Vein Thrombosis

    PubMed Central

    Kim, Hyue Mee; Lee, Hak Seung; Jung, Ji-Hyun; Kim, Chee Hae; Oh, Sooyeon; Kim, Jung Ho; Zo, Joo-Hee

    2014-01-01

    Ante mortem cases of venous thrombosis in patients with nonbacterial thrombotic endocarditis (NBTE) have not yet been reported. We describe a rare case of NBTE in a patient with mesenteric vein thrombosis. A healthy 37-year-old man with abdominal pain and fever underwent emergency small bowel resection due to bowel ischemia resulting from mesenteric vein thrombosis. Transthoracic echocardiography revealed multiple mobile masses attached to the anterior leaflet of the mitral valves and their chordae tendineae. On suspicion of infective endocarditis, the cardiac masses were excised through open-heart surgery. However, pathologic reviews were compatible with NBTE. The patient was stable after the cardiac surgery and was treated with warfarin. Laboratory and imaging findings regarding his hypercoagulable condition were all negative. PMID:24876861

  10. [The difficulties of diagnosis and treatment of non-occlusive mesenteric circulatory disorders].

    PubMed

    Ermolov, A S; Lebedev, A G; Titova, G P; Yartsev, P A; Selina, I E; Reznitsky, P A; Alekseechkina, O A; Kaloeva, O Kh; Shavrina, H V; Evdokimova, O L; Zhigalkin, R G

    2015-01-01

    To review one of actual problems of emergency surgery - diagnosis and treatment of patients with non-occlusive mesenteric circulatory disorders. The article presents the clinical observations showing the ambiguity of clinical picture, features and challenges of diagnosis, treatment of disease and opportunities for positive outcomes. Diagnostic methods are x-ray, abdominal ultrasonography according to which acute abdominal ischemia may be assumed. However, in all unclear cases diagnostic videolaparoscopy is mandatory to determine further tactics. Unfortunately diagnostic videolaparoscopy is not always interpreted comprehensively and not a definitive method of diagnosis. Wide surgical access is usually necessary for non-occlusal acute violation of mesenteric circulation and volume of surgery varies from segmental to subtotal intestinal and colic resection with obligatory enteral intubation and decompression. Thus, complex pre- and postoperative treatment is required.

  11. Cholinergic innervation of human mesenteric lymphatic vessels.

    PubMed

    D'Andrea, V; Bianchi, E; Taurone, S; Mignini, F; Cavallotti, C; Artico, M

    2013-11-01

    The cholinergic neurotransmission within the human mesenteric lymphatic vessels has been poorly studied. Therefore, our aim is to analyse the cholinergic nerve fibres of lymphatic vessels using the traditional enzymatic techniques of staining, plus the biochemical modifications of acetylcholinesterase (AChE) activity. Specimens obtained from human mesenteric lymphatic vessels were subjected to the following experimental procedures: 1) drawing, cutting and staining of tissues; 2) staining of total nerve fibres; 3) enzymatic staining of cholinergic nerve fibres; 4) homogenisation of tissues; 5) biochemical amount of proteins; 6) biochemical amount of AChE activity; 6) quantitative analysis of images; 7) statistical analysis of data. The mesenteric lymphatic vessels show many AChE positive nerve fibres around their wall with an almost plexiform distribution. The incubation time was performed at 1 h (partial activity) and 6 h (total activity). Moreover, biochemical dosage of the same enzymatic activity confirms the results obtained with morphological methods. The homogenates of the studied tissues contain strong AChE activity. In our study, the lymphatic vessels appeared to contain few cholinergic nerve fibres. Therefore, it is expected that perivascular nerve stimulation stimulates cholinergic nerves innervating the mesenteric arteries to release the neurotransmitter AChE, which activates muscarinic or nicotinic receptors to modulate adrenergic neurotransmission. These results strongly suggest, that perivascular cholinergic nerves have little or no effect on the adrenergic nerve function in mesenteric arteries. The cholinergic nerves innervating mesenteric arteries do not mediate direct vascular responses.

  12. Paraplegia after aortic and superior mesenteric artery stenting for occlusive disease.

    PubMed

    Hans, Sachinder S; Ngo, William; McAllister, Michael

    2014-02-01

    Paraplegia after endovascular therapy for aortic and visceral artery occlusive disease is an extremely uncommon occurrence. Two cases of paraplegia after placement of an aortic covered stent for infrarenal aortic stenosis and a superior mesenteric artery stent for chronic visceral ischemia are presented. In both patients, embolization of the arterial supply to the spinal cord was the presumed cause. One patient had a slight recovery after intense physical therapy and rehabilitation. The second patient did not have any recovery from her paraplegia. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Microballoon Occlusion Test to Predict Colonic Ischemia After Transcatheter Embolization of a Ruptured Aneurysm of the Middle Colic Artery

    SciTech Connect

    Tajima, Tsuyoshi Yoshimitsu, Kengo; Inokuchi, Hiroyuki; Irie, Hiroyuki; Nishie, Akihiro; Hirakawa, Masakazu; Ishigami, Kousei; Ushijima, Yasuhiro; Okamoto, Daisuke; Honda, Hiroshi; Itoh, Hiroyuki; Morita, Masaru; Kakeji, Yoshihiro

    2008-07-15

    A 76-year-old woman presented with sudden massive melena, and superior mesenteric arteriography showed an aneurysm in the middle colic artery (MCA). Because she had a history of right hemicolectomy and ligation of the inferior mesenteric artery (IMA) during open abdominal aortic aneurysm repair, embolization of the MCA aneurysm was considered to pose a risk comparable to that of colonic ischemia. A microballoon occlusion test during occlusion of the MCA confirmed retrograde visualization of the IMA branches through the collateral arteries by way of the left internal iliac artery, and embolization was successfully performed using microcoils. No colonic ischemia or aneurysm rupture occurred after embolization.

  14. Mesenteric lymphatic vessels adapt to mesenteric venous hypertension by becoming weaker pumps

    PubMed Central

    Dongaonkar, R. M.; Nguyen, T. L.; Heaps, C. L.; Hardy, J.; Laine, G. A.; Wilson, E.; Stewart, R. H.

    2014-01-01

    Lymphangions, the segments of lymphatic vessels between two adjacent lymphatic valves, actively pump lymph. Acute changes in transmural pressure and lymph flow have profound effects on lymphatic pump function in vitro. Chronic changes in pressure and flow in vivo have also been reported to lead to significant changes in lymphangion function. Because changes in pressure and flow are both cause and effect of adaptive processes, characterizing adaptation requires a more fundamental analysis of lymphatic muscle properties. Therefore, the purpose of the present work was to use an intact lymphangion isovolumetric preparation to evaluate changes in mesenteric lymphatic muscle mechanical properties and the intracellular Ca2+ in response to sustained mesenteric venous hypertension. Bovine mesenteric veins were surgically occluded to create mesenteric venous hypertension. Postnodal mesenteric lymphatic vessels from mesenteric venous hypertension (MVH; n = 6) and sham surgery (Sham; n = 6) animals were isolated and evaluated 3 days after the surgery. Spontaneously contracting MVH vessels generated end-systolic active tension and end-diastolic active tension lower than the Sham vessels. Furthermore, steady-state active tension and intracellular Ca2+ concentration levels in response to KCl stimulation were also significantly lower in MVH vessels compared with those of the Sham vessels. There was no significant difference in passive tension in lymphatic vessels from the two groups. Taken together, these results suggest that following 3 days of mesenteric venous hypertension, postnodal mesenteric lymphatic vessels adapt to become weaker pumps with decreased cytosolic Ca2+ concentration. PMID:25519727

  15. Mesenteric lymphatic vessels adapt to mesenteric venous hypertension by becoming weaker pumps.

    PubMed

    Dongaonkar, R M; Nguyen, T L; Quick, C M; Heaps, C L; Hardy, J; Laine, G A; Wilson, E; Stewart, R H

    2015-03-01

    Lymphangions, the segments of lymphatic vessels between two adjacent lymphatic valves, actively pump lymph. Acute changes in transmural pressure and lymph flow have profound effects on lymphatic pump function in vitro. Chronic changes in pressure and flow in vivo have also been reported to lead to significant changes in lymphangion function. Because changes in pressure and flow are both cause and effect of adaptive processes, characterizing adaptation requires a more fundamental analysis of lymphatic muscle properties. Therefore, the purpose of the present work was to use an intact lymphangion isovolumetric preparation to evaluate changes in mesenteric lymphatic muscle mechanical properties and the intracellular Ca(2+) in response to sustained mesenteric venous hypertension. Bovine mesenteric veins were surgically occluded to create mesenteric venous hypertension. Postnodal mesenteric lymphatic vessels from mesenteric venous hypertension (MVH; n = 6) and sham surgery (Sham; n = 6) animals were isolated and evaluated 3 days after the surgery. Spontaneously contracting MVH vessels generated end-systolic active tension and end-diastolic active tension lower than the Sham vessels. Furthermore, steady-state active tension and intracellular Ca(2+) concentration levels in response to KCl stimulation were also significantly lower in MVH vessels compared with those of the Sham vessels. There was no significant difference in passive tension in lymphatic vessels from the two groups. Taken together, these results suggest that following 3 days of mesenteric venous hypertension, postnodal mesenteric lymphatic vessels adapt to become weaker pumps with decreased cytosolic Ca(2+) concentration. Copyright © 2015 the American Physiological Society.

  16. Leiomyosarcoma arising from the inferior mesenteric vein

    PubMed Central

    Clemente, Gennaro; Sarno, Gerardo; Barbaro, Brunella; Nuzzo, Gennaro

    2009-01-01

    Leyomiosarcomas arising from the portal/mesenteric venous system are very rare tumours, and only a few cases have been reported in the global literature. As the other leyomiosarcomas of vascular origin, they are associated with a poor prognosis. The present report describes the case of a 66-year-old woman with a leyomiosarcoma of the inferior mesenteric vein, unexpectedly found during a CT scan performed for another indication. A brief review of the literature is also given. The patient underwent radical surgical excision and enjoys a good health, without radiological signs of recurrence, 24 months after surgery. In this case, an early incidental diagnosis determined an early treatment and, probably, a favourable prognosis. This is the second case of leyomiosarcoma of the inferior mesenteric vein reported in the literature. PMID:21686492

  17. Use of T-Stat to predict colonic ischemia during and after endovascular aneurysm repair: a case report.

    PubMed

    Lee, Eugene S; Pevec, William C; Link, Daniel P; Dawson, David L

    2008-03-01

    As surgeons become more aggressive in treating aneurysms with endovascular techniques, traditional surgical principles of preserving internal iliac arteries and the inferior mesenteric artery have been challenged. A case is presented where the T-Stat device (Spectros Corp, Portola Valley, Calif), an optical real-time sensor approved by United States Food and Drug Administration for measuring colon ischemia, was used as an adjunctive measure to assist in the successful endovascular aneurysm repair in a patient at high risk for colon ischemia.

  18. Laparoscopic resection of a jejunal mesenteric pseudocyst: case report

    PubMed Central

    RESTA, G.; TARTARINI, D.; FABBRI, N.; BIANCHINI, E.; ANANIA, G.

    2014-01-01

    Mesenteric cysts are rare and can occur at any age. They can manifest with abdominal pain or compressive mass effect. The exact etiology is unknown. Ultrasonography, computed tomography and laparoscopy are used in diagnosing mesenteric cysts. Laparoscopic excision of a mesenteric cyst is possible and should be considered as the treatment of choice. We present a case of mesenteric pseudocyst of small bowel treated by laparoscopic excision. PMID:25644729

  19. [Autoimmune hemolytic anemia associated with mesenteric teratoma].

    PubMed

    Ntanishyan, K I; Sabirov, K R; Shcherbakova, O V; Vybornykh, D E; Shupletsova, I A; Tsvetaeva, N V

    2017-01-01

    The paper describes a case of autoimmune hemolytic anemia (AIHA) in a 27-year-old woman whose examination revealed mesenteric teratoma. AIHA was characterized by a hypertensive crisis and a temporary response to corticosteroid therapy that was complicated by the development of somatogenic psychosis and discontinued. A relapse of hemolysis developed 6 months later. The patient underwent laparoscopic splenectomy and removal of mesenteric root teratoma. Immediately after surgery, a hematological response was obtained as relief of hemolysis and restoration of a normal hemoglobin level. There is a sustained remission of AIHA for the next 16 months.

  20. [Mesenteric infarct in primary antiphospholipid antibody syndrome].

    PubMed

    Kurz, R; Eder, A; Buck, J; Heinkelein, J

    1997-09-01

    The mesenteric infarction is a rare but life threatening cause of acute abdomen. A 55-year-old woman was referred to the hospital because of acute mesenteric infarction and in the history claudication. In the absence of risk factors (atrial fibrillation, atherosclerosis, nicotin abusus) a postoperative work up was started to identify the cause of the arterial occlusions. A primary antiphospholipid-antibody syndrome was found. The patient is now receiving low-dose aspirin and anticoagulation therapy. The follow-up over now 14 months shows no further events.

  1. Surgical management of peritonitis secondary to acute superior mesenteric artery occlusion

    PubMed Central

    Acosta, Stefan

    2014-01-01

    Diagnosis of acute arterial mesenteric ischemia in the early stages is now possible using modern computed tomography with intravenous contrast enhancement and imaging in the arterial and/or portal phase. Most patients have acute superior mesenteric artery (SMA) occlusion, and a large proportion of these patients will develop peritonitis prior to mesenteric revascularization, and explorative laparotomy will therefore be necessary to evaluate the extent and severity of intestinal ischemia, and to perform bowel resections. The establishment of a hybrid operating room in vascular units in hospitals is most important to be able to perform successful intestinal revascularization. This review outlines current frontline surgical strategies to improve survival and minimize bowel morbidity in patients with peritonitis secondary to acute SMA occlusion. Explorative laparotomy needs to be performed first. Curative treatment is based upon intestinal revascularization followed by bowel resection. If no vascular imaging has been carried out, SMA angiography is performed. In case of embolic occlusion of the SMA, open embolectomy is performed followed by angiography. In case of thrombotic occlusion, the occlusive lesion can be recanalized retrograde from an exposed SMA, the guidewire snared from either the femoral or brachial artery, and stented with standard devices from these access sites. Bowel resections and sometimes gall bladder removal due to transmural infarctions are performed at initial laparotomy, leaving definitive bowel reconstructions to a planned second look laparotomy, according to the principles of damage control surgery. Patients with peritonitis secondary to acute SMA occlusion should be managed by both the general and vascular surgeon, and a hybrid revascularization approach is of utmost importance to improve outcomes. PMID:25110423

  2. Acute thrombosis of the superior mesenteric artery in a 39-year-old woman with protein-S deficiency: a case report

    PubMed Central

    2011-01-01

    Introduction Acute thromboembolic occlusion of the superior mesenteric artery is a condition with an unfavorable prognosis. Treatment of this condition is focused on early diagnosis, surgical or intravascular restoration of blood flow to the ischemic intestine, surgical resection of the necrotic bowel and supportive intensive care. In this report, we describe a case of a 39-year-old woman who developed a small bowel infarct because of an acute thrombotic occlusion of the superior mesenteric artery, also involving the splenic artery. Case presentation A 39-year-old Caucasian woman presented with acute abdominal pain and signs of intestinal occlusion. The patient was given an abdominal computed tomography scan and ultrasonography in association with Doppler ultrasonography, highlighting a thrombosis of the celiac trunk, of the superior mesenteric artery, and of the splenic artery. She immediately underwent an explorative laparotomy, and revascularization was performed by thromboendarterectomy with a Fogarty catheter. In the following postoperative days, she was given a scheduled second and third look, evidencing necrotic jejunal and ileal handles. During all the surgical procedures, we performed intraoperative Doppler ultrasound of the superior mesenteric artery and celiac trunk to control the arterial flow without evidence of a new thrombosis. Conclusion Acute mesenteric ischemia is a rare abdominal emergency that is characterized by a high mortality rate. Generally, acute mesenteric ischemia is due to an impaired blood supply to the intestine caused by thromboembolic phenomena. These phenomena may be associated with a variety of congenital prothrombotic disorders. A prompt diagnosis is a prerequisite for successful treatment. The treatment of choice remains laparotomy and thromboendarterectomy, although some prefer an endovascular approach. A second-look laparotomy could be required to evaluate viable intestinal handles. Some authors support a laparoscopic second

  3. [Anatomicosurgical study of the superior mesenteric vein].

    PubMed

    Dell'Isola, C; Tucci, G F

    1991-01-01

    Results of an autoptic study of the superior mesenteric vein in thirty cadavers are reported. The anatomo-surgical patterns of the venous axis are emphasized. In fact, a better knowledge of this vessel allows an easier and safer surgical approach during pancreatic resections.

  4. Mesenteric calcification following abdominal stab wound

    PubMed Central

    Hicks, Caitlin W.; Velopulos, Catherine G.; Sacks, Justin M.

    2014-01-01

    INTRODUCTION Heterotopic ossification (HO) refers to the formation of bone in non-ossifying tissue. Heterotopic mesenteric ossification is a rare form of HO that is characterized by the formation of an ossifying pseudotumour at the base of the mesentery, usually following abdominal surgery. PRESENTATION OF CASE We describe a case of mesenteric HO in a young male who presented for elective ventral incisional hernia repair following a stab wound to the abdomen requiring exploratory laparotomy 21 months earlier. Preoperative workup was unremarkable, but a hard, bone-like lesion was noted to encircle the base of the mesentery upon entering the abdomen, consistent with HO. The lesion was excised with close margins, and his hernia was repaired without incident. DISCUSSION Traumatic HO describes the ossification of extra-skeletal tissue that specifically follows a traumatic event. It usually occurs adjacent to skeletal tissue, but has been occasionally described in the abdomen as well, usually in patients who suffer abdominal trauma. Overall the prognosis of HO is good, as it is considered a benign lesion with no malignant potential. However, the major morbidity associated with mesenteric HO is bowel obstruction. CONCLUSION The size, location, and symptoms related to our patient's mesenteric HO put him risk for obstruction in the future. As a result, the mass was surgically excised during his ventral hernia repair with good outcomes. PMID:24981165

  5. Chronic mesenteric volvulus in a dog

    PubMed Central

    Spevakow, Andrea B.; Nibblett, Belle Marie D.; Carr, Anthony P.; Linn, Kathleen A.

    2010-01-01

    A chronic, partial mesenteric volvulus was found on laparotomy of an adult Bernese mountain dog with a 4-month history of intermittent vomiting, diarrhea, and weight loss. The dog had elevated cholestatic and hepatocellular leakage enzymes, increased bile acids, azotemia, isosthenuria, and a hypokalemic, hypochloremic, metabolic alkalosis. The dog recovered fully following reduction of the volvulus. PMID:20357947

  6. [Mesenteric cyst--clinical and pathological aspects].

    PubMed

    Santana, Wagner Barreto de; Poderoso, Wendell Luiz Santos; Alves, José Antonio Barreto; Melo, Valdinaldo Aragão de; Barros, Celso de; Fakhouri, Ricardo

    2010-08-01

    To evaluate epidemiologic, clinical, pathologic and therapeutic characteristics of the mesenteric cysts in hospitals of Sergipe, Brazil. Mesenteric cysts were assessed by a non-interventional cross-sectional study from the archives of the Pathology Laboratory of Federal University of Sergipe between 1995 and 2007. The charts of the patients were reviewed in order to find out: gender, age, clinical findings, complementary exams and therapeutic approach. Eighteen cases of mesenteric cysts were found. Females were more affected (72.2%). Mean of age of the patients was 30.46. More frequent symptoms were pain and abdominal mass. Ultrasonography of abdomen, performed in all patients, was not conclusive in half of the cases. CTscan of abdomen with contrast was performed in six cases, being cystic tumor well identified in all of them. Regarding histopathology, 6 lymphangiomas, 8 mesotheliomas, 1 hemorrhagic cyst in organization and 1 mucinous cyst were found. Surgical treatment was performed in all cases. Intracystic bleeding was the main complication in 3 cases. The mesenteric cysts presented clinically with unspecific symptoms. CTscan was more effective than ultrasonography for the diagnosis. Lymphangiomas and mesothelioma had been found in equal ratios. The complete resection of the cyst was the treatment of election. There were no deaths in postoperative period.

  7. Successful Treatment of Acute on Chronic Mesenteric Ischaemia by Common Iliac to Inferior Mesenteric Artery Bypass

    PubMed Central

    Coakley, D. N.; Shaikh, F. M.; Kavanagh, E. G.

    2015-01-01

    Chronic mesenteric ischaemia is a rare and potentially fatal condition most commonly due to atherosclerotic stenosis or occlusion of two or more mesenteric arteries. Multivessel revascularisation of both primary mesenteric vessels, the celiac artery and superior mesenteric artery (SMA), is the current mainstay of treatment; however, in a certain cohort of patients, revascularisation one or both vessels may not be possible. Arteries may be technically unreconstructable or the patient may be surgically unfit for the prolonged aortic cross clamping times required. Here we present a case involving a 72-year-old woman with acute on chronic mesenteric ischaemia. She was a high risk surgical patient with severe unreconstructable stenotic disease of the SMA and celiac arteries. She was successfully treated with single vessel revascularisation of the inferior mesenteric artery (IMA) via a common iliac to IMA reversed vein bypass. At two-year follow-up, the graft remains patent and the patient continues to be symptom-free and is maintaining her weight. PMID:26421207

  8. Mucosal injury induced by ischemia and reperfusion in the piglet intestine: Influences of age and feeding

    SciTech Connect

    Crissinger, K.D.; Granger, D.N. )

    1989-10-01

    The pathogenesis of neonatal necrotizing enterocolitis is unknown, but enteral alimentation, infectious agents, and mesenteric ischemia have been frequently invoked as primary initiators of the disease. To define the vulnerability of the intestinal mucosa to ischemia and reperfusion in the developing piglet, we evaluated changes in mucosal permeability using plasma-to-lumen clearance of chromium 51-labeled ethylenediaminetetraacetic acid in the ileum of anesthetized 1-day-, 3-day-, 2-wk-, and 1-mo-old piglets as a function of (a) duration of intestinal ischemia (20, 40, or 60 min of total superior mesenteric artery occlusion), (b) feeding status (fasted or nursed), and (c) composition of luminal perfusate (balanced salt solution vs. predigested cow milk-based formula). Baseline chromium 51-labeled ethylenediaminetetraacetic acid clearance was not significantly altered by ischemia, irrespective of duration, or feeding in all age groups. However, clearances were significantly elevated during reperfusion after 1 h of total intestinal ischemia in all age groups, whether fasted or fed. Reperfusion-induced increases in clearance did not differ among age groups when the bowel lumen was perfused with a balanced salt solution. However, luminal perfusion with formula resulted in higher clearances in 1-day-old piglets compared with all older animals. Thus, the neonatal intestine appears to be more vulnerable to mucosal injury induced by ischemia and reperfusion in the presence of formula than the intestine of older animals.

  9. In situ intestinal ischemia-reperfusion injury in the pig: a model using the first jejunal artery for flushing.

    PubMed

    Yandza, Thierry; Mekaouche, Mourad; Bréaud, Jean; Oroboscianu, Ioana; Saint-Paul, Marie-Christine; Ramella-Virieux, Silvina; Benchimol, Daniel; Gugenheim, Jean

    2007-09-01

    We describe a new surgical technique of in situ intestinal ischemia-reperfusion injury in the pig, which includes transection of the small bowel, extrinsic autonomic denervation, lymphatic disruption, and finally in-situ cold ischemia of the graft by flushing through the first jejunal artery. Ten female pigs were used for the study. All neural and lymphatic connections to the jejunoileum were transected. The stripped superior mesenteric vessels remained as the only connections. The skeletonized mesenteric vessels were clamped and the superior mesenteric artery was cannulated through the first jejunal artery. The isolated jejunoileum was flushed with cold IGL-1 solution. A small incision on the superior mesenteric vein was made to allow outflow of the effluent. After the flushing process was complete, the small incision in the superior mesenteric vein was closed and the vascular clamps were removed. The proximal 70% of the graft was resected. The mean preoperative weight of the animals was 25.8 +/-7.6 kg. The mean duration of the operation was 242.0 +/- 28.6 min. The mean cold ischemia time was 47.6 +/- 3.9 min. All animals survived the procedure and were sacrificed at day 8. At sacrifice, there were no adhesions. The small bowel appeared normal. On intestinal histology, there were no significant changes between specimens obtained from the animal immediately at the end of cold flushing (T0), 2 h after reperfusion (T1), and at sacrifice (T2). This novel technique for intestinal ischemia-reperfusion injury in the pig provides an extremely useful model for experimental studies of immunological and cold ischemia-reperfusion injury of transplanted small bowels.

  10. Ovarian undifferentiated carcinoma with voluminous mesenteric presentation

    PubMed Central

    Salcedo-Hernández, Rosa Angélica; Lino-Silva, Leonardo Saúl; Cantú de León, David; Pérez-Montiel, María Delia; Luna-Ortiz, Kuauhyama

    2012-01-01

    INTRODUCTION About 5% of ovarian cancers are so poorly differentiated and difficult to classify that they are called undifferentiated carcinomas and usually have disseminated disease at presentation. Extra pelvic debulking it is difficult to complete. PRESENTATION OF CASE We report a case of a rare ovarian tumor presented as a large mesenteric tumor of 14 cm diameter in a 73 years old woman. DISCUSSION Undifferentiated carcinomas are usually large, solid with hemorrhage and necrosis, bilateral and most are difficult to classify histologically. Rarely are pure, generally identified through the extensive sampling of lesions, some other components of surface epithelial carcinoma and usually the predominant element is the latter. Cases with predominantly undifferentiated component are rare. CONCLUSION The treatment and diagnostic approach is the same as for other high-grade epithelial tumors of the ovary, but in this particular case the differential diagnosis and diagnostic approach is that of a mesenteric tumor. PMID:22922357

  11. Cytologic findings of urogenital mesenteric cyst.

    PubMed

    Mokhtari, Maral; Kumar, Perikala Vijayananda

    2013-07-01

    Mesenteric cysts are heterogeneous groups of lesions. Most of them are developmental cysts of lymphatic and enteric origin or cystic neoplasm such as mesothelioma or cystic teratoma. Urogenital cysts are a subcategory of developmental cysts of the mesentery. They are thought to arise from vestigial remnants of urogenital apparatus. These cysts may show evidence of mesonephric or metanephric differentiation. An 11 -year -old boy was presented with undescended testis. During preoperative work- up, an incidental cystic lesion was discovered which was attached to the ileum. Aspiration cytology of the cyst content revealed cuboidal to columnar cells; some of them were ciliated. Histologic examination showed a cyst with fibromuscular wall, lined by Mullerian type ciliated epithelium; so the diagnosis of urogenital mesenteric cyst of Mullerian type was made. Urogenital cysts are rare lesions, but they should be considered in differential diagnosis of any cystic lesion of the mesentery. Cytology could be a useful method for evaluation and revealing the nature of these cysts.

  12. [Laparoscopic resection of a mesenteric cyst].

    PubMed

    Dede, Kristóf; Mersich, Tamás; Faludi, Sándor; Blans, Beáta; Salamon, Ferenc; Jakab, Ferenc

    2010-03-14

    Mesenteric cysts are rare intraabdominal tumors, which cause plain symptoms. Despite the modern imaging techniques, the correct preoperative diagnosis is difficult. The optimal treatment is surgical excision of the cysts with open surgery, laparoscopy, or even retroperitoneoscopy. Surgical excision needs to be considered in case of complaints, growing cyst, or suspicion of malignancy. Indications for urgent surgery treatment are: bleeding, volvulus, torquation or ileus. Most frequently, mesenterial cysts are diagnosed during the operation of an unknown palpable abdominal cystic resistance. We present a case of a 32-year-old female patient with a jejunal mesenteric cyst, treated by laparoscopic resection. Postoperative period was uneventful, and after an early discharge the patient's recovery was free of symptoms. Histopathological examination revealed a benign cyst. We conclude that laparoscopic resection of abdominal cysts with unknown origin is a safe operation and can be recommended.

  13. Mesenteric dermoid cyst in a child.

    PubMed

    Punguyire, Damien; Iserson, Kenneth Victor

    2011-01-01

    If a pediatric abdominal mass is not organomegaly or colonic stool, narrowing the diagnostic possibilities may be difficult, especially in resource-poor areas where ancillary tests and treatment options may be limited. A 2-year-old girl was brought to the rural Kintampo Municipal Hospital in Ghana with a freely moveable, non-tender abdominal mass. A huge mesenteric dermoid cyst was surgically removed. Mesenteric cysts are rare intra-abdominal lesions, most commonly occurring in children <10 years old. Making a preoperative diagnosis is difficult. Dermoid cysts (mature cystic teratoma) rarely occur in the mesentery. Poverty, family circumstances and the rural location led to general physicians doing surgery. As in this case, due to economic, social and transportation issues common throughout Africa, children with abdominal masses may need at least initial surgery in hospitals without dedicated pediatric surgery or even a trained surgeon.

  14. Mesenteric dermoid cyst in a child

    PubMed Central

    Punguyire, Damien; Iserson, Kenneth Victor

    2011-01-01

    If a pediatric abdominal mass is not organomegaly or colonic stool, narrowing the diagnostic possibilities may be difficult, especially in resource-poor areas where ancillary tests and treatment options may be limited. A 2-year-old girl was brought to the rural Kintampo Municipal Hospital in Ghana with a freely moveable, non-tender abdominal mass. A huge mesenteric dermoid cyst was surgically removed. Mesenteric cysts are rare intra-abdominal lesions, most commonly occurring in children <10 years old. Making a preoperative diagnosis is difficult. Dermoid cysts (mature cystic teratoma) rarely occur in the mesentery. Poverty, family circumstances and the rural location led to general physicians doing surgery. As in this case, due to economic, social and transportation issues common throughout Africa, children with abdominal masses may need at least initial surgery in hospitals without dedicated pediatric surgery or even a trained surgeon. PMID:22384287

  15. Chylous mesenteric cysts: a rare surgical challenge

    PubMed Central

    Dioscoridi, Lorenzo; Perri, Giampaolo; Freschi, Giancarlo

    2014-01-01

    A mesenteric cyst is defined as a cyst that is located in the mesentery of the gastrointestinal tract and may extend from the base of the mesentery into the retroperitoneum. It is often asymptomatic and therefore it is usually found as an incidental finding. Preoperative diagnosis may be possible with computed tomography and magnetic resonance imaging. However, the correct diagnosis can only be made with histology. The first-choice therapy is the complete removal of the cyst, which must be accurately planned according to the anatomy of the lesion, its dimensions and its relationships with major abdominal structures. We present two clinical cases: the one of a 30-year-old man with a mesenteric cyst that was removed by laparoscopy and the other of a 61-year-old woman who underwent open excision of a huge retroperitoneal cyst. PMID:24876395

  16. Chylous mesenteric cysts: a rare surgical challenge.

    PubMed

    Dioscoridi, Lorenzo; Perri, Giampaolo; Freschi, Giancarlo

    2014-03-01

    A mesenteric cyst is defined as a cyst that is located in the mesentery of the gastrointestinal tract and may extend from the base of the mesentery into the retroperitoneum. It is often asymptomatic and therefore it is usually found as an incidental finding. Preoperative diagnosis may be possible with computed tomography and magnetic resonance imaging. However, the correct diagnosis can only be made with histology. The first-choice therapy is the complete removal of the cyst, which must be accurately planned according to the anatomy of the lesion, its dimensions and its relationships with major abdominal structures. We present two clinical cases: the one of a 30-year-old man with a mesenteric cyst that was removed by laparoscopy and the other of a 61-year-old woman who underwent open excision of a huge retroperitoneal cyst. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2014.

  17. [Infected jejunal mesenteric pseudocyst: A case report].

    PubMed

    Bolívar-Rodríguez, Martín Adrián; Cazarez-Aguilar, Marcel Antonio; Luna-Madrid, Eduardo Esaú; Morgan-Ortiz, Fred

    2015-01-01

    Mesenteric cysts are very rare abdominal growths, generally asymptomatic, and which are usually detected incidentally while performing a physical examination or an imaging test. Complications such as infections, haemorrhage, torsion, rupture, or bowel obstruction, are seldom found in this pathology, but they can be a cause of acute abdomen. The purpose of this report is to describe the characteristics and the clinical outcome of a male patient with an infected mesenteric pseudocyst of the jejunum. A 49 year-old male was admitted to the emergency department with 6-day onset of abdominal pain, bowel obstruction signs, palpable tumour located in the upper hemi-abdomen, systemic inflammatory response syndrome, 36,100/mm(3) white cells, 4.21 ng/ml procalcitonin, abdominal computed tomography scan with evidence of a mesenteric cystic tumour. An exploratory laparotomy was performed, finding the presence of a mesenteric pseudocyst of the jejunum with infection signs, extirpated and sent for histopathological examination. The clinical progress of the patient was satisfactory with the discharge of the patient 7 days after the surgical intervention. These cysts can debut as an acute abdomen due to haemorrhage, infection, obstruction and/or bowel perforation, complications can be life threatening if not detected and surgically treated at an early stage by performing a resection of the pseudocysts, with or without bowel resection, depending on the location and the size of the cyst. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  18. Fetal and postnatal ovine mesenteric vascular reactivity

    PubMed Central

    Nair, Jayasree; Gugino, Sylvia F.; Nielsen, Lori C.; Caty, Michael G.; Lakshminrusimha, Satyan

    2016-01-01

    BACKGROUND Intestinal circulation and mesenteric arterial (MA) reactivity may play a role in preparing the fetus for enteral nutrition. We hypothesized that MA vasoreactivity changes with gestation and vasodilator pathways predominate in the postnatal period. METHODS Small distal MA rings (0.5-mm diameter) were isolated from fetal (116-d, 128-d, 134-d, and 141-d gestation, term ~ 147 d) and postnatal lambs. Vasoreactivity was evaluated using vasoconstrictors (norepinephrine (NE) after pretreatment with propranolol and endothelin-1(ET-1)) and vasodilators (NO donors A23187 and s-nitrosopenicillamine (SNAP)). Protein and mRNA assays for receptors and enzymes (endothelin receptor A, alpha-adrenergic receptor 1A (ADRA1A), endothelial NO synthase (eNOS), soluble guanylyl cyclase (sGC), and phosphodiesterase5 (PDE5)) were performed in mesenteric arteries. RESULTS MA constriction to NE and ET-1 peaked at 134 d. Relaxation to A23187 and SNAP was maximal after birth. Basal eNOS activity was low at 134 d. ADRA1A mRNA and protein increasedsignificantlyat134danddecreasedpostnatally.sGC and PDE5 protein increased from 134 to 141 d. CONCLUSION Mesenteric vasoconstriction predominates in late-preterm gestation (134 d; the postconceptional age with the highest incidence of necrotizing enterocolitis (NEC)) followed by a conversion to vasodilatory influences near the time of full-term birth. Perturbations in this ontogenic mechanism, including preterm birth, may be a risk factor for NEC. PMID:26672733

  19. Biomechanical analysis of traumatic mesenteric avulsion.

    PubMed

    Bège, Thierry; Ménard, Jérémie; Tremblay, Jaelle; Denis, Ronald; Arnoux, Pierre-Jean; Petit, Yvan

    2015-02-01

    Mesenteric avulsion, corresponding to a tearing of intestine's root, generally results from high deceleration in road accidents. The biomechanical analysis of bowel and mesenteric injuries is a major challenge for injury prevention, particularly because seat belt restraint may paradoxically increase their risk of occurrence. The aim of this study was to identify the biomechanical behavior of mesentery and small bowel (MSB) tissue samples under dynamical loading conditions. A dedicated test bench was designed in order to perform tensile tests on fresh MSB porcine specimens, with quasi-static (1 mm/s) and dynamic (100 mm/s) loading conditions. The mechanical behavior of MSB specimens was investigated and compared to isolated mesenteric and isolated small bowel specimens. The results show a high sensitivity of MSB stiffness (1.0 ± 0.2 and 1.3 ± 0.3 N/mm at 1 and 100 mm/s, p = 0.001) and ultimate force (22 ± 5 and 35 ± 8 N at 1 and 100 mm/s, p = 0.001) to the loading rate but not for the displacement at failure. This leads to postulate on a failure criteria based on strain level regardless of the strain rate. These experimental results could be further used to develop refined finite element models and to further investigate on injury mechanisms associated to seat belt restraints, as well as to evaluate and improve protective devices.

  20. Mesenteric cyst in infancy: presentation and management.

    PubMed

    Belhassen, Samia; Meriem, Braiki; Rachida, Laamiri; Nahla, Kechiche; Saida, Hidouri; Imed, Krichen; Sana, Mosbahi; Amine, Ksiaa; Lassad, Sahnoun; Mongi, Mekki; Mohsen, Belguith; Abdellatif, Nouri

    2017-01-01

    Mesenteric cysts are documented as a rare entity in pediatric population. They are considered as benign intra-abdominal tumors with an unknown etiology. Symptoms are not specific and knowledge of such condition is essential in order to establish a proper management. We report three pediatrics cases of mesenteric cysts managed between 2000 and 2009 in the pediatric surgery Department of Monastir College Hospital. We described the clinical, radiological and operative findings. Two males and a female were managed (age range: 10 days-5years, mean age: 6,3years). Two patients were presented with an intestinal obstruction. A preoperative diagnosis was made basing on imaging. Thus, abdominal ultrasonography was performed in all of our reported cases and showed a cystic mass in all cases. The cystic nature of the mass, its margins and its extension were better described on tomographic images. The mesenteric cyst was completely and successfully removed in all cases. The histopathological report confirmed the diagnosis and showed a multiloculated cyst with columnar mesothelial lining, without any defined muscular layer or cellular atypia and without any evidence of malignancy. The children were evaluated post-operatively with a mean follow-up of 2 years and a half. No recurrence was noted in our patients during the follow-up period. It is known that clinical features are not specific of such anomaly but once the diagnosis is made, the complete surgical removal of the cyst remains the treatment of choice with excellent outcomes.

  1. Mesenteric cyst in infancy: presentation and management

    PubMed Central

    Belhassen, Samia; Meriem, Braiki; Rachida, Laamiri; Nahla, Kechiche; Saida, Hidouri; Imed, Krichen; Sana, Mosbahi; Amine, Ksiaa; Lassad, Sahnoun; Mongi, Mekki; Mohsen, Belguith; Abdellatif, Nouri

    2017-01-01

    Mesenteric cysts are documented as a rare entity in pediatric population. They are considered as benign intra-abdominal tumors with an unknown etiology. Symptoms are not specific and knowledge of such condition is essential in order to establish a proper management. We report three pediatrics cases of mesenteric cysts managed between 2000 and 2009 in the pediatric surgery Department of Monastir College Hospital. We described the clinical, radiological and operative findings. Two males and a female were managed (age range: 10 days-5years, mean age: 6,3years). Two patients were presented with an intestinal obstruction. A preoperative diagnosis was made basing on imaging. Thus, abdominal ultrasonography was performed in all of our reported cases and showed a cystic mass in all cases. The cystic nature of the mass, its margins and its extension were better described on tomographic images. The mesenteric cyst was completely and successfully removed in all cases. The histopathological report confirmed the diagnosis and showed a multiloculated cyst with columnar mesothelial lining, without any defined muscular layer or cellular atypia and without any evidence of malignancy. The children were evaluated post-operatively with a mean follow-up of 2 years and a half. No recurrence was noted in our patients during the follow-up period. It is known that clinical features are not specific of such anomaly but once the diagnosis is made, the complete surgical removal of the cyst remains the treatment of choice with excellent outcomes. PMID:28674584

  2. Mesenteric infarction due to iatrogenic polycythemia.

    PubMed

    Skoog, Katrina; Carmelle-Elie, Marie; Ferguson, Kevin

    2013-01-01

    Polycythemia vera is defined as a chronic myeloproliferative disorder characterized by increased red blood cell count. There have been no reports on mesenteric thrombosis resulting from iatrogenic polycythemia. We present a patient with a history of non-small cell lung cancer undergoing maintenance oral chemotherapy on tarceva and adjunctive use of procrit. The patient presented to our emergency department with an acute abdomen and was found to have ischemic bowel from unmonitored procrit, which lead to hyperviscosity of blood and mesenteric infarction. The patient remained intubated with ventilator support. He refused a tracheostomy. He continued on feeding through the J port of the nasojejunal tube. His white cell count, and hematocrit and creatinine levels remained normal. Procrit use and chemotherapy were not restarted. He was transferred to a subacute nursing facility for further treatment. Procrit and other erythropoiesis stimulating drugs can cause significant morbidity and mortality with an increased risk of cardiovascular events, gastrointestinal bleeding, thromboembolism and stroke. This case report suggests that without closely monitoring hematocrit levels, epoetin may also be associated with an increased risk of mesenteric infarction.

  3. Mesenteric infarction due to iatrogenic polycythemia

    PubMed Central

    Skoog, Katrina; Carmelle-Elie, Marie; Ferguson, Kevin

    2013-01-01

    BACKGROUND: Polycythemia vera is defined as a chronic myeloproliferative disorder characterized by increased red blood cell count. There have been no reports on mesenteric thrombosis resulting from iatrogenic polycythemia. METHODS: We present a patient with a history of non-small cell lung cancer undergoing maintenance oral chemotherapy on tarceva and adjunctive use of procrit. The patient presented to our emergency department with an acute abdomen and was found to have ischemic bowel from unmonitored procrit, which lead to hyperviscosity of blood and mesenteric infarction. RESULTS: The patient remained intubated with ventilator support. He refused a tracheostomy. He continued on feeding through the J port of the nasojejunal tube. His white cell count, and hematocrit and creatinine levels remained normal. Procrit use and chemotherapy were not restarted. He was transferred to a subacute nursing facility for further treatment. CONCLUSIONS: Procrit and other erythropoiesis stimulating drugs can cause significant morbidity and mortality with an increased risk of cardiovascular events, gastrointestinal bleeding, thromboembolism and stroke. This case report suggests that without closely monitoring hematocrit levels, epoetin may also be associated with an increased risk of mesenteric infarction. PMID:25215125

  4. Laparoscopic excision of mesenteric cyst of sigmoid mesocolon

    PubMed Central

    Bhandarwar, Ajay H; Tayade, Mukund B; Borisa, Ashok D; Kasat, Gaurav V

    2013-01-01

    Mesenteric cysts are rare abdominal tumours. They are found in the mesentery of small bowel (66%) and mesentery of large intestine (33%), usually in the right colon. Very few cases have been reported of tumours found in mesentery of descending colon, sigmoid or rectum. Mesenteric cysts do not show classical clinical findings and are detected incidentally during imaging due to absent or non-specific clinical presentation or during management of one of their complications. Ultrasonography (USG)/computed tomography (CT)/ magnetic resonance imaging (MRI) are used in diagnosing mesenteric cyst but they cannot determine the origin of cyst. Laparoscopy not only helps in diagnosing the site and origin of the mesenteric cyst but also has a therapeutic role. Laparoscopic treatment of mesenteric cyst is a safe, preferred method of treatment and is a less-invasive surgical technique. Here, we present an unusual case of mesenteric cyst arising from the sigmoid mesocolon treated by laparoscopic excision. PMID:23626420

  5. Laparoscopic excision of mesenteric cyst of sigmoid mesocolon.

    PubMed

    Bhandarwar, Ajay H; Tayade, Mukund B; Borisa, Ashok D; Kasat, Gaurav V

    2013-01-01

    Mesenteric cysts are rare abdominal tumours. They are found in the mesentery of small bowel (66%) and mesentery of large intestine (33%), usually in the right colon. Very few cases have been reported of tumours found in mesentery of descending colon, sigmoid or rectum. Mesenteric cysts do not show classical clinical findings and are detected incidentally during imaging due to absent or non-specific clinical presentation or during management of one of their complications. Ultrasonography (USG)/computed tomography (CT)/ magnetic resonance imaging (MRI) are used in diagnosing mesenteric cyst but they cannot determine the origin of cyst. Laparoscopy not only helps in diagnosing the site and origin of the mesenteric cyst but also has a therapeutic role. Laparoscopic treatment of mesenteric cyst is a safe, preferred method of treatment and is a less-invasive surgical technique. Here, we present an unusual case of mesenteric cyst arising from the sigmoid mesocolon treated by laparoscopic excision.

  6. The treatment of chronic intestinal ischemia.

    PubMed

    Illuminati, G; Caliò, F G; D'Urso, A; Papaspyropoulos, V; Mancini, P; Ceccanei, G; Vietri, F

    2004-01-01

    Due to the rarity of the condition, large and prospective series defining the optimal method of digestive arteries revascularization, for the treatment of chronic intestinal ischemia, are lacking. The aim of this consecutive sample clinical study was to test the hypothesis that flexible application of different revascularization methods, according to individual cases, will yield the best results in the management of chronic intestinal ischemia. Eleven patients, of a mean age of 57 years, underwent revascularization of 11 digestive arteries for symptomatic chronic mesenteric occlusive disease. Eleven superior mesenteric arteries and one celiac axis were revascularized. The revascularization techniques included retrograde bypass grafting in 7 cases, antegrade bypass grafting in 2, percutaneous arterial angioplasty in 1, and arterial reimplantation in one case. The donor axis for either reimplantation or bypass grafting was the infrarenal aorta in 4 cases, an infrarenal Dacron graft in 4, and the celiac aorta in one case. Grafting materials included 5 polytetrafluoroethylene (PTFE) and 3 Dacron grafts. Concomitant procedures included 3 aorto-ilio-femoral grafts and one renal artery revascularization. Mean follow-up length was 31 months. There was no operative mortality. Cumulative survival rate was 88.9% at 36 months (SE 12.1%). Primary patency rate was 90% at 36 months (SE 11.6%). The symptom free rate was 90% at 36 months (SE 11.6%). Direct reimplantation, antegrade and retrograde bypass grafting, all allow good mid-term results: the choice of the optimal method depends on the anatomic and general patients status. Associated infrarenal and renal arterial lesions can be safely treated in the same time of digestive revascularization. Angioplasty alone yields poor results and should be limited to patients at poor risk for surgery.

  7. Right-Side Colon Ischemia: Clinical Features, Large Visceral Artery Occlusion, and Long-Term Follow-Up

    PubMed Central

    Longstreth, George F; Hye, Robert J

    2015-01-01

    Context: Large visceral artery occlusion (LVAO) could underlie right-side colon ischemia (RSCI) but is little known. Objective: To assess patients with RSCI through long-term follow-up, including features and management of LVAO. Main Outcome Measures: Mesenteric ischemia and mortality. Design: Retrospective observational study in an integrated health care system. Results: Of 49 patients (30 women [61.2%]; mean [standard deviation] age, 69.4 [11.9] years), 19 (38.8%) underwent surgery—that is, 5 (83.3%) of 6 who developed RSCI in hospital following surgical procedures and 14 (32.6%) of 43 who had RSCI before hospitalization (p value = 0.03); overall, 5 (10.2%) died. Among 44 survivors with a median (range) follow-up of 5.19 (0.03–14.26) years, 5 (11.4%), including 3 (20.0%) of 15 operated cases, had symptomatic LVAO and underwent angioplasty and stent placement: 2 for abdominal angina that preceded RSCI, 1 for acute mesenteric ischemia 1 week after resection of RSCI, 1 for RSCI 6 weeks after resection of left-side ischemia, and 1 for abdominal angina that began 3 years after spontaneous recovery from RSCI. None had further mesenteric ischemia until death from nonintestinal disease or the end of follow-up (1.6 to 10.2 years later). Kaplan-Meier survival estimates for all 44 survivors at 1, 3, 5, and 10 years were 88.6%, 72.3%, 57.6%, and 25.9%, respectively. Thirty-one patients (70.4%) died during follow-up, 19 (61.3%) of a known cause; the 39 patients not treated for LVAO lacked mesenteric ischemia. Conclusion: Patients with RSCI may have symptomatic LVAO; therefore, we advise they undergo careful query for symptoms of abdominal angina and routine visceral artery imaging. PMID:26263388

  8. Stenting of the Superior Mesenteric Artery as a Preoperative Treatment for Total Pancreatectomy

    SciTech Connect

    Tanigawa, Noboru Kariya, Shuji; Komemushi, Atsushi; Satoi, Sohei; Kamiyama, Yasuo; Sawada, Satoshi; Kojima, Hiroyuki; Sougawa, Mitsuharu; Takai, Yuichirou

    2004-09-15

    The patient was a 58-year-old male with mucinous cyst adenocarcinoma of the pancreas. Prior to total pancreatectomy, preoperative CT and angiography showed a high-grade arteriosclerotic stenosis of about 1.0 cm in length in the ostium of the superior mesenteric artery (SMA), as well as the development of collateral vessels in the area around the head of the pancreas. A stent was placed in the SMA stenosis to preserve the intestinal blood flow in the SMA region after total pancreatectomy, which was performed 25 days after stent placement. The postoperative SMA blood flow was favorable, with no postoperative intestinal ischemia, and the patient had an uneventful postoperative course.

  9. Ischemic Colitis Due to a Mesenteric Arteriovenous Malformation in a Patient with a Connective Tissue Disorder

    PubMed Central

    Poullos, Peter D.; Thompson, Atalie C.; Holz, Grant; Edelman, Lauren A.; Jeffrey, R. Brooke

    2014-01-01

    Ischemic colitis is a rare, life-threatening, consequence of mesenteric arteriovenous malformations. Ischemia ensues from a steal phenomenon through shunting, and may be compounded by the resulting portal hypertension. Computed tomographic angiography is the most common first-line test because it is quick, non-invasive, and allows for accurate anatomic characterization. Also, high-resolution three-dimensional images can be created for treatment planning. Magnetic resonance angiography is similarly sensitive for vascular mapping. Conventional angiography remains the gold standard for diagnosis and also allows for therapeutic endovascular embolization. Our patient underwent testing using all three of these modalities. We present the first reported case of this entity in a patient with a vascular connective tissue disorder. PMID:25926912

  10. Percutaneous treatment of symptomatic superior mesenteric vein stenosis using self-expanding nitinol stents.

    PubMed

    Beyer, L P; Wohlgemuth, W A; Uller, W; Pregler, B; Goessmann, H; Niessen, C; Haimerl, M; Stroszczynski, C; Müller-Wille, R

    2015-10-01

    To evaluate the technical and clinical success of percutaneous superior mesenteric vein (SMV) stenting in symptomatic patients using self-expanding nitinol stents. We retrospectively analyzed the technical and clinical success of percutaneous SMV stenting of 6 symptomatic patients (3 men, mean age 67 years, range 48-81 years). Stenosis of the SMV was caused by postoperative stricture (n=3), pancreas carcinoma (n=1) and pancreatitis (n=2). As a result of the stenosis, 3 patients had symptomatic ascites, 2 patients showed signs of mesenteric ischemia and 1 patient had recurrent gastrointestinal bleeding. Stenting was performed by a percutaneous transhepatic approach using self-expanding nitinol stents. Stenting of the SMV was technically and clinically successful in all patients. No peri-interventional complications occurred. The stent diameters ranged from 6 to 14 mm. During the mean follow-up of 6 months (range, 2-10 months) 1 patient presented early stent occlusion 2 weeks after placement. Stenting of a symptomatic SMV stenosis using self-expanding nitinol stents is feasible and clinically effective. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. Iloprost Use in Patients with Persistent Intestinal Ischemia Unsuitable for Revascularization.

    PubMed

    Nuzzo, Alexandre; Soudan, Damien; Billiauws, Lore; Bataille, Julie; Maggiori, Léon; Ronot, Maxime; Stocco, Jeanick; Bouhnik, Yoram; Castier, Yves; Corcos, Olivier

    2017-07-01

    Persistent or chronic intestinal ischemic injury (i3) can lead to severe malnutrition and acute mesenteric ischemia. Although recommended, revascularization of splanchnic arteries is sometimes unrealizable. We report a case series of iloprost use in consecutive stable patients with persistent i3 unsuitable for revascularization followed in a tertiary care center. The feasibility of revascularization was discussed and ruled out by a multidisciplinary team, and informed consent was obtained prior to consideration of a vasoactive therapy. Therapeutic response was defined at 6 months by a decrease in the use of analgesic and parenteral nutrition, and no need for intestinal resection. Between 2006 and 2015, 6 patients (mean age: 51) were included. Splanchnic vascular insufficiency was due to superior mesenteric artery (SMA) thrombosis (n = 4), dissection of the celiac trunk and SMA (n = 1), or repeated vasospasm resulting in chronic nonocclusive mesenteric ischemia (n = 1). Iloprost was delivered via continuous intravenous perfusion at a maximum dosage of 2 ng/kg/min for 6 hours/day on 4 consecutive days, without severe adverse events. Therapeutic response was observed in 4 patients, 3 of which completely stopped parenteral nutrition and analgesic with no need for intestinal resection. Our results are consistent with findings of a favorable effect of iloprost in patients with persistent splanchnic ischemia that should be confirmed in prospective trials. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Mesenteric Panniculitis Associated With Vibrio cholerae Infection

    PubMed Central

    Roginsky, Grigory; Mazulis, Andrew; Ecanow, Jacob S.

    2015-01-01

    We report the first case of acute Vibrio cholerae infection with computed tomography (CT) changes consistent with mesenteric panniculitis (MP). A 78-year-old Indian man returned from overseas travel with progressively severe nausea, vomiting, abdominal pain, and watery diarrhea. His stool tested positive twice for Vibrio cholerae. CT revealed prominent lymph nodes and a hazy mesentery consistent with MP. Antibiotic treatment resulted in complete resolution of MP on follow-up CT 8 months later. In the setting of Vibrio cholerae infection, the CT finding of MP appears to be the result of a immunologically mediated reactive inflammatory disorder of the mesentery. PMID:26504876

  13. Mesenteric Panniculitis Associated With Vibrio cholerae Infection.

    PubMed

    Roginsky, Grigory; Mazulis, Andrew; Ecanow, Jacob S; Ehrenpreis, Eli D

    2015-10-01

    We report the first case of acute Vibrio cholerae infection with computed tomography (CT) changes consistent with mesenteric panniculitis (MP). A 78-year-old Indian man returned from overseas travel with progressively severe nausea, vomiting, abdominal pain, and watery diarrhea. His stool tested positive twice for Vibrio cholerae. CT revealed prominent lymph nodes and a hazy mesentery consistent with MP. Antibiotic treatment resulted in complete resolution of MP on follow-up CT 8 months later. In the setting of Vibrio cholerae infection, the CT finding of MP appears to be the result of a immunologically mediated reactive inflammatory disorder of the mesentery.

  14. A NON-INVASIVE DIAGNOSIS OF INTESTINAL ISCHEMIA BY EXHALED BREATH ANALYSIS USING GAS CHROMATOGRAPHY AND MASS SPECTROMETRY-PRELIMINARY RESULTS

    EPA Science Inventory

    To explore the potential of exhaled breath analysis by Column Chromatography-Mass Spectrometry (GC-MS) as a non invasive and sensitive approach to evaluate mesenteric ischemia in pigs.

    Domestic pigs (n=3) were anesthetized with Guaifenesin/ Fentanyl/ Ketamine/ Xylazine...

  15. A NON-INVASIVE DIAGNOSIS OF INTESTINAL ISCHEMIA BY EXHALED BREATH ANALYSIS USING GAS CHROMATOGRAPHY AND MASS SPECTROMETRY-PRELIMINARY RESULTS

    EPA Science Inventory

    To explore the potential of exhaled breath analysis by Column Chromatography-Mass Spectrometry (GC-MS) as a non invasive and sensitive approach to evaluate mesenteric ischemia in pigs.

    Domestic pigs (n=3) were anesthetized with Guaifenesin/ Fentanyl/ Ketamine/ Xylazine...

  16. Increased endothelin-1 vasoconstriction in mesenteric resistance arteries after superior mesenteric ischaemia-reperfusion

    PubMed Central

    Martínez-Revelles, S; Caracuel, L; Márquez-Martín, A; Dantas, AP; Oliver, E; D'Ocon, P; Vila, E

    2012-01-01

    BACKGROUND AND PURPOSE Endothelin-1 (ET-1) plays an important role in the maintenance of vascular tone. We aimed to evaluate the influence of superior mesenteric artery (SMA) ischaemia-reperfusion (I/R) on mesenteric resistance artery vasomotor function and the mechanism involved in the changes in vascular responses to ET-1. EXPERIMENTAL APPROACH SMA from male Sprague-Dawley rats was occluded (90 min) and following reperfusion (24 h), mesenteric resistance arteries were dissected. Vascular reactivity was studied using wire myography. Protein and mRNA expression, superoxide anion (O2•−) production and ET-1 plasma concentration were evaluated by immunofluorescence, real-time quantitative PCR, ethidium fluorescence and elisa, respectively. KEY RESULTS I/R increased ET-1 plasma concentration, ET-1-mediated vasoconstriction and ETB mRNA expression, and down-regulated ETA mRNA expression. Immunofluorescence confirmed mRNA results and revealed an increase in ETB receptors in the mesenteric resistance artery media layer after I/R. Therefore, the ETB receptor agonist sarafotoxin-6 induced a contraction that was inhibited by the ETB receptor antagonist BQ788 only in vessels, with and without endothelium, from I/R rats. Furthermore, BQ788 potentiated ET-1 vasoconstriction only in sham rats. Endothelium removal in rings from I/R rats unmasked the inhibition of ET-1 vasoconstriction by BQ788. Endothelium removal, Nω-nitro-L-arginine methyl ester and superoxide dismutase abolished the differences in ET-1 vasoconstriction between sham and I/R rats. We also found that I/R down-regulates endothelial NOS mRNA expression and concomitantly enhanced O2•− production by increasing NADPH oxidase 1 (NOX-1) and p47phox mRNA. CONCLUSIONS AND IMPLICATIONS Mesenteric I/R potentiated the ET-1-mediated vasoconstriction by a mechanism that involves up-regulation of muscular ETB receptors and decrease in NO bioavailability. PMID:21806604

  17. Endovascular Management of Acute Embolic Occlusion of the Superior Mesenteric Artery: A 12-Year Single-Centre Experience

    SciTech Connect

    Raupach, J. Lojik, M. Chovanec, V. Renc, O.; Strýček, M.; Dvořák, P. Hoffmann, P.; Guňka, I. Ferko, A.; Ryška, P.; Omran, N.; Krajina, A. Čabelková, P.; Čermáková, E.; Malý, R.

    2016-02-15

    PurposeRetrospective evaluation of 12-year experience with endovascular management of acute mesenteric ischemia (AMI) due to embolic occlusion of the superior mesenteric artery (SMA).Materials and methodsFrom 2003 to 2014, we analysed the in-hospital mortality of 37 patients with acute mesenteric embolism who underwent primary endovascular therapy with subsequent on-demand laparotomy. Transcatheter embolus aspiration was used in all 37 patients (19 women, 18 men, median age 76 years) with embolic occlusion of the SMA. Adjunctive local thrombolysis (n = 2) and stenting (n = 2) were also utilised.ResultsWe achieved complete recanalization of the SMA stem in 91.9 %. One patient was successfully treated by surgical embolectomy due to a failed endovascular approach. Subsequent exploratory laparotomy was performed in 73.0 % (n = 27), and necrotic bowel resection in 40.5 %. The total in-hospital mortality was 27.0 %.ConclusionPrimary endovascular therapy for acute embolic SMA occlusion with on-demand laparotomy is a recommended algorithm used in our centre to treat SMA occlusion. This combined approach for the treatment of AMI is associated with in-hospital mortality rate of 27.0 %.

  18. Cutaneous sclerosis: a previously undescribed manifestation of sclerosing mesenteritis.

    PubMed

    Hinds, Brian R; Bahrami, Soon; Bernardi, John M; Callen, Jeffrey P

    2010-09-01

    Sclerosing mesenteritis is a rare disease of unknown etiology that is characterized by self-limited, nonspecific inflammation and fibrosis of the mesenteric adipose tissue. Histologic classification characterizes 3 main stages in the evolution of the fibroinflammatory process: mesenteric lipodystrophy (ML), mesenteric panniculitis (MP), and sclerosing (retractile) mesenteritis (SM). A 68-year-old woman with biopsy-proven MP presented with multiple asymptomatic, indurated subcutaneous nodules on both arms, as well as 2 indurated plaques on her abdomen. The cutaneous changes preceded the diagnosis of SM by roughly 3 years. The arm lesions were centrally depressed with a prominent groove and a peau d'orange appearance. Biopsy findings revealed a subcutaneous process with almost total replacement of adipocytes by zones of woody sclerosis and fat necrosis identical to that observed in the mesentery. To our knowledge, this manifestation of sclerosing mesenteritis has not been reported previously. Sclerosing mesenteritis has rarely been associated with extra-abdominal idiopathic fibrosclerotic disorders, but a cutaneous component of SM has never been characterized. The fact that the cutaneous lesions were histopathologically identical to the mesenteric changes and their presence prior to the recognition of intra-abdominal disease suggests that future patients with such lesions might be evaluated for this disorder leading to earlier recognition.

  19. Infected mesenteric ileocaecal dermoid cyst in a child

    PubMed Central

    Upadhyaya, M; Rogers, T; Thyagrajan, MS

    2010-01-01

    Mesenteric dermoid cysts are a rare cause of abdominal pain. Although dermoid cysts occur in many parts of the body there have been only a few case reports involving the bowel mesentery. We present a case of a symptomatic mesenteric dermoid cyst involving the ileocaecal junction in a child. PMID:24945842

  20. Cross-sectional imaging of nontraumatic peritoneal and mesenteric emergencies.

    PubMed

    Patlas, Michael N; Alabousi, Abdullah; Scaglione, Mariano; Romano, Luigia; Soto, Jorge A

    2013-05-01

    Multiple nontraumatic peritoneal and mesenteric emergencies are encountered at imaging of patients in the emergency department. Peritoneal and mesenteric emergencies are usually detected in patients in the emergency department during evaluation of nonspecific abdominal pain. A high index of suspicion is required for the establishment of early diagnosis and aversion of life-threatening complications in cases of peritoneal carcinomatosis, nontraumatic hemoperitoneum, and peritonitis. A correct diagnosis of omental infarction, mesenteric adenitis, and mesenteric panniculitis helps patients primarily by avoiding unnecessary surgery. In this review article, we illustrate the cross-sectional imaging appearance of various nontraumatic peritoneal and mesenteric emergencies by emphasizing the role of the emergency radiologist in detecting and managing these entities.

  1. Hand-Assisted Laparoscopic Surgery for a Mesenteric Teratoma

    PubMed Central

    Koyama, Shinsuke; Shiki, Yasuhiko

    2014-01-01

    Mature cystic teratomas are benign neoplasms of germ cell tumors that occur most frequently in gonadal sites. The tumors usually contain 2 or 3 well-differentiated elements of endodermal, ectodermal, and mesodermal origin. Although relatively uncommon, teratomas can be composed of mature tissue originating from only 1 germ cell layer. This is known as a monodermal teratoma. Extragonadal teratomas, especially mesenteric teratomas, are extremely rare. Currently, only 21 cases of mesenteric teratoma have been described in the English literature. Mesenteric teratomas are rarely diagnosed preoperatively because pathological examination is necessary to make a definitive diagnosis. We herein report a rare case of mesenteric monodermal teratoma and review the literature. To the best of our knowledge, this is the first case of mesenteric teratoma treated with hand-assisted laparoscopic surgery. PMID:24680163

  2. Treatment options for spontaneous and postoperative sclerosing mesenteritis

    PubMed Central

    Klasen, Jennifer; Güller, Ulrich; Muff, Brigitte; Candinas, Daniel; Seiler, Christian A; Fahrner, René

    2016-01-01

    Sclerosing mesenteritis is a rare pathology with only a few described cases in the literature. The etiology is unclear; however, several potential triggers, including abdominal surgery and abdominal trauma, have been discussed. The pathology includes a benign acute or chronic inflammatory process affecting the adipose tissue of the mesenterium. Despite it being a rare disease, sclerosing mesenteritis is an important differential diagnosis in patients after abdominal surgery or patients presenting spontaneously with signs of acute inflammation and abdominal pain. We present here three cases with sclerosing mesenteritis. In two cases, sclerosing mesenteritis occurred postoperatively after abdominal surgery. One patient was treated because of abdominal pain and specific radiological signs revealing spontaneous manifestation of sclerosing mesenteritis. So far there are no distinct treatment algorithms, so the patients were treated differently, including steroids, antibiotics and watchful waiting. In addition, we reviewed the current literature on treatment options for this rare disease. PMID:27933138

  3. GLP-2 and mesenteric blood flow.

    PubMed

    Hansen, Lasse Bremholm

    2013-05-01

    The 33 amino acid peptide hormone GLP-2 is produced by enteroendocrine L-cells, the density of which is highest in the ileum and the colon, in response to the presence of nutrients in the lumen. The biological effect of GLP-2 is mediated by activation of a G-protein-coupled 7-transmembrane receptor. GLP-2 receptors are expressed in the brainstem, lungs, stomach, small intestine and colon, but not in the heart. It has been shown in several animal studies that GLP-2 infusion increases intestinal blood flow and that this increase is confined to the small intestine. The aim of the three studies, on which the thesis is based, was to investigate basic physiological effects of GLP-2, in healthy volunteers and in SBS patients, with focus on the effects on mesenteric blood flow, blood flow at other vascular sites and effects on cardiac parameters. These parameters have been evaluated after both meal stimulation and GLP-2 administration. The studies showed the following results: Blood flow: In all three studies, blood flow changes in the SMA after GLP-2 administration were similar regarding changes over time and degree of change. Blood flow changes were similar to changes seen after a standard meal. Only RI changes were registered in all three studies, but the TAMV changes in study 2 and 3 had similar characteristics. Cardiovascular parameters: In all three studies no significant changes in blood pressure were registered in relation to GLP-2 administration. In study two and three, where cardiac parameters also were registered by impedance cardiography, increases in CO and SV were seen. Plasma GLP-2: There were, as expected, supraphysiological GLP-2 plasma levels after SC administration. All three studies have shown rapid changes in mesenteric blood flow after administration GLP-2. The changes have been the same both in regards to time to maximum changes (increase) and relatively close in regards to maximum extent of change. The changes in the SBS patients were less than in

  4. Adult midgut malrotation presented with acute bowel obstruction and ischemia

    PubMed Central

    Zengin, Akile; Uçar, Bercis İmge; Düzgün, Şükrü Aydın; Bayhan, Zülfü; Zeren, Sezgin; Yaylak, Faik; Şanal, Bekir; Bayhan, Nilüfer Araz

    2016-01-01

    Introduction Intestinal malrotation refers to the partial or complete failure of rotation of midgut around the superior mesenteric vessels in embryonic life. Arrested midgut rotation results due to narrow-based mesentery and increases the risk of twisting midgut and subsequent obstruction and necrosis. Presentation of case 40 years old female patient admitted to emergency service with acute abdomen and computerized tomography scan showed dilated large and small intestine segments with air-fluid levels and twisted mesentery around superior mesenteric artery and vein indicating “whirpool sign”. Discussion Malrotation in adults is a rare cause of midgut volvulus as though it should be considered in differential diagnosis in patients presented with acute abdomen and intestinal ischemia. Even though clinical symptoms are obscure, adult patients usually present with vomiting and recurrent abdominal pain due to chronic partial obstruction. Contrast enhanced radiograph has been shown to be the most accurate method. Typical radiological signs are corkscrew sign, which is caused by the dilatation of various duodenal segments at different levels and the relocation of duodenojejunal junction due to jejunum folding. As malrotation commonly causes intestinal obstruction, patients deserve an elective laparotomy. Conclusion Malrotation should be considered in differential diagnosis in patients presented with acute abdomen and intestinal ischemia. Surgical intervention should be prompt to limit morbidity and mortality. PMID:27015011

  5. GI ischemia in patients with portal vein thrombosis: a prospective cohort study.

    PubMed

    Harki, Jihan; Plompen, Elisabeth P C; van Noord, Désirée; Hoekstra, Jildou; Kuipers, Ernst J; Janssen, Harry L A; Tjwa, Eric T T L

    2016-03-01

    GI ischemia is a concerning adverse event of portal vein thrombosis (PVT). Minimally invasive techniques, such as visible light spectroscopy (VLS), have greatly improved the ability to diagnose GI ischemia. The aim of this study was to assess the clinical presentation and characteristics of GI ischemia in patients with PVT. Patients with noncirrhotic, nonmalignant PVT were included in this prospective cohort study. Clinical symptoms of GI ischemia were assessed by a structured questionnaire, VLS, and radiologic evaluation of the mesenteric vasculature. VLS measurements were compared with those in patients with cirrhosis and with a reference population. We included 15 patients with chronic PVT and 1 patient with acute PVT (median age 46.1 years [interquartile range [IQR], 30.9-53.7]; 44% male). Decreased mucosal oxygenation in at least 1 location of the GI tract was found in 12 patients (75%). Compared with the reference population (median 60.0 [IQR, 56.2-61.7]), VLS measurements were mostly decreased in the descending duodenum in patients with PVT (median 55.5 [IQR, 52.3-58.8]; P = .02) and patients with cirrhosis (median 52.0 [IQR, 46.5-54.0], P = .003). Symptoms typical for GI ischemia, such as postprandial pain and exercise-induced pain, were reported in 10 patients (63%) with PVT. In patients with extension of thrombosis into the superior mesenteric vein and splenic vein and/or presence of hypercoagulability, decreased VLS measurements were observed compared with historical control subjects. In patients with chronic PVT, GI ischemia is frequent. VLS enables objective and quantitative determination of GI mucosal ischemia. Onset of abdominal symptoms such as postprandial pain should prompt the physician to re-evaluate extent, cause, and treatment of PVT. Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  6. Bowel Ischemia in Refractory Status Epilepticus: Report of Two Cases and Review of the Literature.

    PubMed

    Rizek, P; Ikeda, K M; Mele, T; Garcia, B; Gofton, T E

    2016-02-01

    Bowel ischemia is a rare life threatening complication seen in patients with refractory status epilepticus (RSE). The few reported cases of bowel ischemia in this setting have been associated with the use continuous barbiturate infusions. We report two patients with RSE in the absence of barbiturate infusion and without clear structural, infectious, anatomic, vascular, or autoimmune etiology. We review the clinical details of the cases and potential factors involved in the development of non-occlusive bowel ischemia in patients with RSE. The following is a retrospective review of two cases of non-occlusive mesenteric ischemia that occurred during the management of RSE. The clinical data and the details of pathological examination of the infarcted segments of bowel are presented in both cases. In both cases, the bowel ischemia occurred in the absence of barbiturate infusion or evidence of clear thrombosis, infection, or autoimmune etiology. Case 1 had extensive ischemic necrosis of the small bowel with secondary pseudomembrane formation, and case 2 had full thickness infarction of both the large and small bowel. The mechanism of bowel infarction in these cases is likely multifactorial and was not associated with barbiturate use. Likely contributors to ischemia include RSE itself, systemic hypotension, vasopressor use, general anesthesia, and abnormal cardiac function. During the management of RSE, every effort must be made to avoid the secondary complications such as bowel ischemia.

  7. Rectus sheath block for postoperative analgesia in patients with mesenteric vascular occlusion undergoing laparotomy: A randomized single-blinded study

    PubMed Central

    Elbahrawy, Khaled; El-Deeb, Alaa

    2016-01-01

    Background: Acute mesenteric ischemia is a life-threatening vascular emergency that requires early diagnosis, immediate anticoagulation, and intervention to restore mesenteric blood flow adequately. Aims: To investigate the effect of rectus sheath block (RSB) for postoperative analgesia in patients with mesenteric vascular occlusion. Settings and Design: Forty patients with mesenteric vascular occlusion, American Society of Anesthesiologists physical status I or II or III, scheduled for laparotomy were enrolled in this study. Subjects and Methods: Patients were randomized into two groups; control group (C Group) and rectus block group (RB Group). In both groups, general anesthesia was induced fentanyl 1 μg/kg with sleeping dose of propofol and 0.15 mg/kg cisatracurium. Then, anesthesia was maintained with sevoflurane in oxygen 100%. In RB Group, under aseptic condition, RSB guided by ultrasound was performed. Surgery is then continued and intravenous fentanyl patient-controlled analgesia pump started. Postoperative pain, sedation, and opioid side effects were assessed. Statistical Analysis Used: Statistical analysis was done using Statistical Package for Social Sciences (SPSS 19.0, Chicago, IL, USA). Results: Patients in the RB Group consumed statistically significant less opioid in comparison to control group either intraoperatively or postoperatively. Mean pain scores were statistically significant less in RB Group than in the control group at 2, 4, and 6 h postoperatively. Sedation score, incidence of nausea and vomiting were statistically significant less in the RB Group in comparison to control group. More patients’ satisfaction was reported in the RB Group. Conclusions: Ultrasound-guided RSB resulted in postoperative reduction of pain scores and opioid consumption compared with general anesthesia alone. Moreover, RSB was associated with better patient satisfaction and less nausea and vomiting. PMID:27746544

  8. Acute Superior Mesenteric Venous Thrombosis: Transcatheter Thrombolysis and Aspiration Thrombectomy Therapy by Combined Route of Superior Mesenteric Vein and Artery in Eight Patients

    SciTech Connect

    Yang, Shuofei Liu, Baochen Ding, Weiwei He, Changsheng Wu, Xingjiang Li, Jieshou

    2015-02-15

    PurposeTo assess the feasibility, effectiveness, and safety of catheter-directed thrombolysis and aspiration thrombectomy therapy by combined route of superior mesenteric vein and artery (SMV+SMA) for acute superior mesenteric venous thrombosis (ASMVT).MethodsThis retrospective study reviewed eight ASMVT patients with transcatheter direct thrombolysis and aspiration thrombectomy therapy via SMV and indirect thrombolysis via SMA during a period of 14 months. The demographics, etiology, risk factors, therapeutic effect, complications, mortality, and follow-up of the study population were assessed. Anatomic and imaging classification of location and extent of thrombus at diagnosis and degree of thrombus lysis were described.ResultsTechnical success was achieved with substantial improvement in symptoms and thrombus resolution after thrombolytic therapy in all patients. The local urokinase infusion by SMA and SMV was performed for 5–7 (6.13 ± 0.83) and 7–15 (12 ± 2.51) days. Anticoagulation was performed catheter-directed and then orally throughout hospitalization and after discharge. Four patients required delayed localized bowel resection after thrombolytic therapy with no death. Thrombolytic therapy was not interrupted despite minor bleeding at the puncture site in two patients and sepsis in another two postoperatively. Nearly complete removal of thrombus was demonstrated by contrast-enhanced CT scan and portography before discharge. Patients were discharged in 10–27 (19.25 ± 4.89) days after admission. No recurrence developed during the follow-up of 10–13 (12.13 ± 0.99) months.ConclusionsCatheter-directed thrombolytic and aspiration therapy via SMV+SMA is beneficial for ASMVT in avoiding patient death, efficient resolving thrombus, rapid improving symptoms, reversing extensive intestinal ischemia, averting bowel resection, or localizing infarcted bowel segment and preventing short bowel syndrome.

  9. Spontaneous Isolated Superior Mesenteric Artery Dissection

    PubMed Central

    Nath, Anand; Yewale, Sayali; Kousha, Mohammad

    2016-01-01

    A true isolated superior mesenteric artery (SMA) dissection is a rare occurrence. The increasing use of diagnostic imaging studies has resulted in this rare disease being more recognized. A 68-year-old Caucasian female presented with sharp upper abdominal pain. Computed tomography (CT) of the abdomen showed dissection with thrombosis in the proximal SMA. Conservative management with bowel rest, blood pressure control, and anticoagulation relieved her symptoms. Follow-up CT showed stable dissection. Physicians should consider the diagnosis of isolated spontaneous SMA dissection after excluding more common causes. The optimal management pathway has not been firmly established. Conservative management with anticoagulation appears to be a safe first-line therapy in selected patients. PMID:28203123

  10. Scintigraphic demonstration of gastrointestinal bleeding due to mesenteric varices

    SciTech Connect

    Hansen, M.E.; Coleman, R.E. )

    1990-07-01

    Mesenteric varices can appear as massive, acute lower gastrointestinal bleeding. The small bowel or colon may be involved, varices usually developing at sites of previous surgery or inflammation in patients with portal hypertension. Two patients with alcoholic cirrhosis and protal hypertension presented with rectal bleeding. Tc-99m RBC studies demonstrated varices and extravasation into the adjacent bowel. The varices were documented by mesenteric angiography. Characteristic features of Tc-99m labeled RBC studies can identify mesenteric varices as the cause of intestinal bleeding and localize the abnormal vessels.

  11. Superior mesenteric aneurysm and arteriovenous fistula: angiographic and CT features

    SciTech Connect

    Knox, M.; Chuang, V.P.; Stewart, M.T.

    1985-08-01

    Of all splanchnic artery aneurysms, the superior mesenteric aneurysm is the least common type, and most of the reported cases are in the surgical literature. Reports of radiographic findings of superior mesenteric aneurysms and their complications are scarce. The authors present the first case of spontaneous rupture of an atherosclerotic aneurysm of the superior mesenteric artery (SMA) with resultant arteriovenous fistula (AVF). Not only are the angiographic features diagnostic, but the CT scan also shows an interesting and suggestive finding that will be useful for the future diagnosis of similar cases.

  12. Ruptured mesenteric cyst: a rare presentation after trauma.

    PubMed

    Ekçi, Baki; Ayan, Fadil; Gürses, Bengi

    2007-01-01

    Mesenteric cysts are rare intraabdominal benign cystic lesions. These lesions are most commonly located in the ileal mesentery, without any sex predilection. Mesenteric cysts may be totally asymptomatic and discovered incidentally during routine radiologic examinations. Chronic abdominal pain or acute abdomen may be accompanying to these lesions. Ultrasonography, computed tomography and magnetic resonance imaging are valuable in the diagnosis. Rarely, these lesions may be presented with rupture after trauma. We present a patient with a ruptured ileal mesenteric cyst due to a blunt abdominal trauma and diagnosed by emergency laparotomy.

  13. Laparoscopic Excision of a Mesenteric Cyst During Pregnancy

    PubMed Central

    2003-01-01

    Background: Laparoscopic management of mesenteric cysts during pregnancy has not been reported before. Case Report: A young woman with a mesenteric cyst associated with a crossed ectopic kidney, underwent laparoscopic excision of the cyst in the second trimester of pregnancy. The procedure was completed without complications, and the patient was discharged on the third postoperative day. Thereafter, the pregnancy progressed uneventfully, and she delivered a healthy baby at term. Conclusions: Laparoscopic management of mesenteric cysts during pregnancy is feasible, safe, and less invasive than laparotomy when performed in select patients by experienced surgeons. PMID:12723004

  14. Postischemic intestinal motility in rat is inversely correlated to length of ischemia. An in vivo animal model.

    PubMed

    Udassin, R; Eimerl, D; Schiffman, J; Haskel, Y

    1995-05-01

    An inverse correlation between postischemic gastrointestinal motility and the length of intestinal ischemia was found in an animal model. Intestinal ischemia was caused without concurrent laparotomy and for a predetermined time period (ischemia time) by pulling on an external nylon thread that was threaded through a double-lumen catheter. This catheter was passed into the abdominal cavity to encircle the superior mesenteric artery. Gastrointestinal motility was determined by the introduction of a color-marked meal into the animal's stomach and the measurement of the proportionate length of the small bowel filled with it (transit index). This simple and reliable animal model can also be used for the evaluation of techniques and pharmacological manipulations aimed at modulation of the effects of intestinal ischemia on intestinal motility and its consequences.

  15. Ischemia/reperfusion injury in the rat colon.

    PubMed

    Murthy, S; Hui-Qi, Q; Sakai, T; Depace, D E; Fondacaro, J D

    1997-04-01

    This study investigated metabolic and biochemical consequences of colonic ischemia/reperfusion (I/R) in the rat and evaluated whether antioxidants prevent I/R-induced functional damage in the rat colon. The surgical preparation involved a 10 cm segment of the colon and occlusion of the superior mesenteric artery (SMA) to induce I/R. Arterial blood from the aorta and venous blood from the superior mesenteric vein (SMV) was collected to measure blood gases, lactic acid (LA) and arachidonic acid (AA) metabolites. Tissue xanthine oxidase (XO) and thiobarbituric acid (TBA) derivatives were measured before and after reperfusion. In addition, vascular and mucosal permeability, and the effect of MDL 73404 (a water soluble vitamin E analog) and 5-aminosalicylic acid on LA, AA, XO and TBA was measured. After ischemia, the colon displayed a metabolic shift from aerobic to anaerobic course by increasing lactic acid production in the colon (183% increase in SMV lactate level compared 87% in the SMA; p < 0.03). After 10 minutes of reperfusion, circulating 6-keto-prostaglandin F1 alpha increased by 3.85 fold (p < 0.001) and thromboxane B2 increased by 2 to 3 fold. An Ischemia time longer than 60 minutes was required to cause changes in tissue XO levels. Tissue TBA levels showed a good dose response corresponding with I/R time. I/R (60 minutes) caused a three and 16 fold increase (p < 0.01) in vascular and mucosal permeability, respectively. MDL 73404 and 5-aminosalicylic acid significantly inhibited the vascular permeability and decreased LA, AA, XO and TBA. These observations provide the first direct experimental evidence for I/R-induced damage in the colon and some of its effects can be reversed by conventional and novel antioxidants.

  16. Undiagnosed Sjögren's Syndrome Presenting as Mesenteric Panniculitis

    PubMed Central

    Burns, Rebecca L.; Bhavnagri, Sharukh J.

    2016-01-01

    Mesenteric panniculitis is a rare inflammatory and fibrotic process that affects the small intestine mesentery. It may occur following abdominal surgery or in association with a variety of conditions, including malignancy, infection, and certain autoimmune and inflammatory conditions. Herein, an unusual case of mesenteric panniculitis in a patient with primary Sjögren's syndrome will be presented. The patient presented with abdominal pain, weight loss, sicca symptoms, fatigue, and arthralgia. An abdominal CT revealed mesenteric fat stranding and prominent lymph nodes of the small intestine mesentery. She was found on laboratory workup to have positive antinuclear and anti-SSa antibodies. Minor salivary gland lip biopsy revealed focal lymphocytic sialadenitis. The patient's symptoms and CT findings improved with corticosteroids. This case suggests that Sjögren's syndrome should be considered as an underlying disease process in the evaluation of patients with mesenteric panniculitis. PMID:27366340

  17. Computed tomography of mesenteric involvement in fulminant pancreatitis

    SciTech Connect

    Jeffery, R.B.; Federle, M.P.; Laing, F.C.

    1983-04-01

    Although extension into the mesentery has been recognized as a frequent pathway of extrapancreatic spread in acute pancreatitis, it has received relatively little attention in the computed tomography (CT) literature. The medical records and CT scans of 55 patients with severe pancreatitis were reviewed in this study; of these patients, 19 (35%) had mesenteric abnormalities, which in 11 patients (20%) represented the most extensive extrapancreatic site of the most extensive extrapancreatic site of involvement. In fulminant pancreatitis, dissection along the mesentery is an important pathway for spread of pancreatic abscesses or phlegmons. Clinical correlation suggests that a combination of mesenteric with lesser sac and anterior pararenal space involvement is frequently associated with significant morbidity and mortality. Of the 19 patients with mesenteric involvement, two died and 14 (74%) required surgery for abscesses, pseudocysts, or, in one case, a colonic fistula. The CT features of the normal mesentery and CT criteria for diagnosing mesenteric inflammatory lesions are reviewed.

  18. Mesenteric Meckel's diverticulum: an unusual cause of small bowel intussusception.

    PubMed

    Abbas, Syed Hussain; Akbari, Khalid; Mason, John; Booth, Michael

    2016-04-08

    Meckel's diverticulum (MD) is the commonest congenital anomaly of the small intestine, affecting 1-4% of the population. Cardinal features emphasise an antimesenteric location two feet proximal to the ileocaecal valve, with a separate mesenteric blood supply and involvement of all layers of the small intestine. However, reports of MD arising from the mesenteric border of the small intestine are rare in the surgical literature. This report examines the case of a 45-year-old woman presenting with a 6-month history of episodic central abdominal pain and microcytic anaemia who underwent an elective diagnostic laparoscopy as initial CT findings were inconclusive. Intraoperatively, she was found to have small bowel intussusception approximately 40 cm proximal to the ileocaecal valve. Macroscopic examination of the resected small bowel segment revealed a mesenteric outpouching that was confirmed as mesenteric MD on histopathological analysis. Postoperatively, the patient recovered with no surgical complications and full symptom resolution. 2016 BMJ Publishing Group Ltd.

  19. Mesenteric chylous cysts simulating a pelvic disease: a case report.

    PubMed

    Covarelli, Piero; Arena, Saverio; Badolato, Marco; Canonico, Silvia; Rondelli, Fabio; Luzi, Giuseppe; Cristofani, Roberto; Affronti, Giuseppe; Noya, Giuseppe

    2008-01-01

    Mesenteric chylous cysts, also known as retroperitoneal chylomatous cysts, mesenteric lymphangiomas or chyloma of the mesentery, are extremely rare and their aspecific clinical presentation can mimic other diseases. In addition, imaging techniques, which are rarely helpful in the correct diagnosis, can demonstrate aspecific features. The Authors report the case of a 62-year-old woman admitted to the hospital for two incidental abdominal masses diagnosed during a yearly monitoring examination and considered to be large adnexal masses. The abdominal masses were removed at laparotomy. Both frozen section and final histopathological examination showed mesenteric chylous cysts. Mesenteric chylous cysts are usually a benign abdominal pathology. As illustrated by this case, even if they are extremely rare, they should be not underrated. The Authors review the literature, confirming the rarity of the disease and defining its characteristics.

  20. Superior Mesenteric Artery Embolism Treated with Percutaneous Mechanical Thrombectomy

    SciTech Connect

    Popovic, Peter Kuhelj, Dimitrij; Bunc, Matjaz

    2011-02-15

    A case of acute superior mesenteric artery embolism treated with percutaneous thrombus aspiration is described. A 63-year-old man with chronic atrial fibrillation was admitted to the hospital with progressive abdominal pain. Computed tomography angiography revealed an occlusion of the distal part of the superior mesenteric artery. The patient was effectively treated using transaxillary percutaneous mechanical thrombectomy using a 6F Aspirex thrombectomy catheter.

  1. Mesenteric plasmacytoma: an unusual cause of an abdominal mass.

    PubMed

    Rosic, Todor; Ross, Douglas; Nethathe, Gladness Dakalo

    2014-06-06

    Plasmacytoma is a rare plasma cell tumour that arises from plasma cells. The tumour accounts for about 3 - 5% of all plasma cell malignancies and most often affects the head and neck, but may also occur in the gastrointestinal tract. To our knowledge, mesenteric plasmacytoma has not been described previously. We describe the presentation and management of a case of mesenteric plasmacytoma presenting as an abdominal mass in a 69-year-old HIV-positive man.

  2. Mucinous mesenteric cyst of the sigmoid mesocolon: a rare entity.

    PubMed

    Challa, Sreenivas Rao; Senapati, Debadutta; Nulukurthi, Taraka Krishna; Chinamilli, Jaahnavi

    2016-02-23

    Mesenteric cysts are rare and occur in patients of any age. They are asymptomatic and found incidentally or during the management of their complications. They commonly originate from the small bowel mesentery, although a proportion has been found to originate from the mesocolon (24%) and retroperitoneum (14.5%). A mesenteric cyst originating in the sigmoid mesocolon is a very rare finding. 2016 BMJ Publishing Group Ltd.

  3. Critical Limb Ischemia (CLI)

    MedlinePlus

    ... High blood pressure Family history of vascular disease Warning Signs You may have critical limb ischemia if ... blood flow to the limb. Other treatments include laser atherectomy, where small bits of plaque are vaporized ...

  4. Critical Limb Ischemia (CLI)

    MedlinePlus

    ... Get Involved Get Involved Resources Educational Flyers Video Library Types of Vascular Diseases Papers & Presentations News News Items Press Releases Newsletters Events Donate Donate Now Ways to Give Individual Donors Corporate Sponsors Donor Privacy Policy Critical Limb Ischemia (CLI) ...

  5. Multidetector CT of Surgically Proven Blunt Bowel and Mesenteric Injury.

    PubMed

    Bates, David D B; Wasserman, Michael; Malek, Anita; Gorantla, Varun; Anderson, Stephan W; Soto, Jorge A; LeBedis, Christina A

    2017-01-01

    Blunt traumatic injury is one of the leading causes of morbidity and mortality in the United States. Unintentional injury represents the leading cause of death in the United States for all persons between the ages of 1 and 44 years. In the setting of blunt abdominal trauma, the reported rate of occurrence of bowel and mesenteric injuries ranges from 1% to 5%. Despite the relatively low rate of blunt bowel and mesenteric injury in patients with abdominal and pelvic trauma, delays in diagnosis are associated with increased rates of sepsis, a prolonged course in the intensive care unit, and increased mortality. During the past 2 decades, as multidetector computed tomography (CT) has emerged as an essential tool in emergency radiology, several direct and indirect imaging features have been identified that are associated with blunt bowel and mesenteric injury. The imaging findings in cases of blunt bowel and mesenteric injury can be subtle and may be seen in the setting of multiple complex injuries, such as multiple solid-organ injuries and spinal fractures. Familiarity with the various imaging features of blunt bowel and mesenteric injury, as well as an understanding of their clinical importance with regard to the care of the patient, is essential to making a timely diagnosis. Once radiologists are familiar with the spectrum of findings of blunt bowel and mesenteric injury, they will be able to make timely diagnoses that will lead to improved patient outcomes. (©)RSNA, 2017.

  6. Limited systemic sclerosis initially presenting with mesenteric panniculitis

    PubMed Central

    Arroyo-Ávila, Mariangelí; Vilá, Luis M

    2014-01-01

    Mesenteric panniculitis pertains to a group of uncommon disorders named sclerosing mesenteritis that present with different levels of inflammation and fibrosis of the small bowel mesentery. It is associated with abdominal surgeries, trauma, malignancies, infections and connective tissue diseases. To the best of our knowledge, no cases of sclerosing mesenteritis have been reported in patients with systemic sclerosis. We present a case of a 61-year-old woman who had incidental CT findings of mesenteric panniculitis. Diagnosis was confirmed by biopsy that showed fat necrosis. On further review she had a 1-year history of Raynaud's phenomenon. Physical examination showed sclerodactyly. She had elevated anticentromere antibodies and skin biopsy was consistent with scleroderma. She was diagnosed with limited systemic sclerosis and was treated with D-penicillamine. After 6 years of follow-up, the mesenteric panniculitis and systemic sclerosis both remained stable. This case highlights the importance of considering rheumatic diseases in the differential diagnosis of sclerosing mesenteritis. PMID:25326572

  7. Identification of Mouse Mesenteric and Subcutaneous in vitro Adipogenic Cells.

    PubMed

    Miyata, Yugo; Otsuki, Michio; Kita, Shunbun; Shimomura, Iichiro

    2016-02-17

    Fat accumulation and the dysfunction of visceral white adipose tissue (WAT), but not subcutaneous WAT, cause abnormalities in whole body metabolic homeostasis. However, no current drugs specifically target visceral WAT. The primary reason for this is that a practical in vitro culture system for mesenteric adipocytes has not been established. To resolve this issue, we sought to identify in vitro adipogenic cells in mesenteric and subcutaneous WATs. First, we examined the expression pattern of surface antigens in stromal-vascular fraction (SVF) cells from mouse mesenteric and subcutaneous WATs, and found the expression of 30 stem cell-related surface antigens. Then, to evaluate the adipogenic ability of each fraction, we performed in vitro screening, and identified five candidate markers for mesenteric adipogenic cells and one candidate marker for subcutaneous adipogenic cells. To investigate whether in vitro adipogenic ability accurately reflects the conditions in vivo, we performed transplantation experiments, and identified CD9(-) CD201(+) Sca-1(-) cells and CD90(+) cells as mesenteric and subcutaneous in vitro adipogenic cells, respectively. Furthermore, mature adipocytes derived from mesenteric and subcutaneous adipogenic cells maintained each characteristic phenotype in vitro. Thus, our study should contribute to the development of a useful culture system for visceral adipocytes.

  8. Identification of Mouse Mesenteric and Subcutaneous in vitro Adipogenic Cells

    PubMed Central

    Miyata, Yugo; Otsuki, Michio; Kita, Shunbun; Shimomura, Iichiro

    2016-01-01

    Fat accumulation and the dysfunction of visceral white adipose tissue (WAT), but not subcutaneous WAT, cause abnormalities in whole body metabolic homeostasis. However, no current drugs specifically target visceral WAT. The primary reason for this is that a practical in vitro culture system for mesenteric adipocytes has not been established. To resolve this issue, we sought to identify in vitro adipogenic cells in mesenteric and subcutaneous WATs. First, we examined the expression pattern of surface antigens in stromal-vascular fraction (SVF) cells from mouse mesenteric and subcutaneous WATs, and found the expression of 30 stem cell-related surface antigens. Then, to evaluate the adipogenic ability of each fraction, we performed in vitro screening, and identified five candidate markers for mesenteric adipogenic cells and one candidate marker for subcutaneous adipogenic cells. To investigate whether in vitro adipogenic ability accurately reflects the conditions in vivo, we performed transplantation experiments, and identified CD9− CD201+ Sca-1− cells and CD90+ cells as mesenteric and subcutaneous in vitro adipogenic cells, respectively. Furthermore, mature adipocytes derived from mesenteric and subcutaneous adipogenic cells maintained each characteristic phenotype in vitro. Thus, our study should contribute to the development of a useful culture system for visceral adipocytes. PMID:26884347

  9. [Spinal cord ischemia].

    PubMed

    Masson, C; Leys, D; Meder, J F; Dousset, V; Pruvo, J P

    2004-01-01

    Traditional data and recent advances in the field of spinal cord ischemia are reviewed, with special attention to clinical and radiological features, as well as underlying etiology, outcome, and pathophysiology. Acute spinal cord ischemia includes arterial and venous infarction and global ischemia resulting from cardiac arrest or severe hypotension. MRI has become the technique of choice for the imaging diagnosis of spinal cord infarction. Correlation of clinical and MRI data has allowed diagnosis of clinical syndromes due to small infarcts in the central or peripheral arterial territory of the spinal cord. Diffusion-weighted MR imaging may increase the sensitivity and specificity for diagnosis of acute spinal cord infarction. Diagnosis of venous spinal cord infarction remains difficult. As for global ischemia, neuropathological studies demonstrated a great sensitivity of spinal cord to ischemia, with selective vulnerability of lumbosacral neurons. Chronic spinal cord ischemia results in a syndrome of progressive myelopathy. The cause is usually an arteriovenous malformation. Most often, diagnosis may be suspected on MRI, leading to diagnostic, and eventually therapeutic, spinal angiography.

  10. A Case of Hepatic Portal Venous Gas: Hypothesis of a Transient Direct Communication between a Penetrating Antral Gastric Ulcer and Mesenteric Varices

    PubMed Central

    Sheikh, Shamlan M.; Khandelwal, Kanika; Fiore, Joseph; Weinstock, Joel

    2017-01-01

    Hepatic portal venous gas (HPVG) is a rare radiological sign that usually signifies an acute intra-abdominal process, most commonly bowel ischemia and sepsis. Few reports described an association with underlying gastric pathologies. We report a 60-year-old patient who presented with melena and chills and was discovered to have a gastric ulcer that appeared to have penetrated into a mesenteric varix. This, in turn, likely caused development of HPVG associated with fungemia. Treatment with a proton pump inhibitor and bowel rest was sufficient to resolve symptoms and the HPVG. PMID:28331640

  11. Successful Recanalization of Acute Superior Mesenteric Artery Thromboembolic Occlusion by a Combination of Intraarterial Thrombolysis and Mechanical Thrombectomy with a Carotid Filter

    SciTech Connect

    Zelenak, Kamil; Sinak, Igor; Janik, Jan; Mikolajcik, Anton; Mistuna, Dusan

    2013-06-15

    Acute superior mesenteric artery (SMA) occlusion is a life-threatening disease, and acute intestinal ischemia develops from the sudden decrease in perfusion to the intestines. The key to saving the patient's life is early diagnosis, and prompt revascularization of the SMA can prevent intestinal infarction and decrease the risk of bowel segment necrosis. Computed tomographic angiography may be useful for rapid diagnosis. We report recanalization of an SMA occlusion in an 80-year-old man with a combination of intraarterial thrombolysis and mechanical thrombectomy with a carotid filter.

  12. Pylephlebitis and acute mesenteric ischemia in a young man with inherited thrombophilia and suspected foodborne illness.

    PubMed

    Pradka, Sarah P; Trankiem, Christine T; Ricotta, John J

    2012-06-01

    We report on a young man who developed complicated pylephlebitis after foodborne illness. Despite antibiotics and resection of the focus of infectious colitis, he developed extensive small bowel infarction. He was treated with anticoagulation, local thrombolytic infusion, and resection of irreversibly ischemic small bowel. Thrombophilia workup demonstrated heterozygosity for factor V Leiden and the prothrombin G20210A mutation. The complications of pylephlebitis can be minimized by using systemic anticoagulation, thrombectomy, and/or local thrombolytic infusion along with antibiotics and surgical management of the infection. Evaluation for thrombophilic states should be considered, particularly if a patient does not respond to initial therapy. Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  13. Superior Mesenteric Artery Occlusion Models Shock-Induced Gut Ischemia-Reperfusion

    DTIC Science & Technology

    2004-01-01

    and exsanguination were used to achieve euthanasia . All procedures performed were under approved protocols by the Animal Welfare Committee of the... Islam , S., Fueg, A., Rohman, M., and Stahl, W. M. A prospective randomized study of end points of resuscitation after major trauma: Global oxygen

  14. Treatment of mice with cromolyn sodium after reperfusion, but not prior to ischemia, attenuates small intestinal ischemia-reperfusion injury.

    PubMed

    Gan, Xiaoliang; Liu, Dezhao; Ge, Mian; Luo, Chenfang; Gao, Wanling; Hei, Ziqing

    2013-09-01

    Stabilizing mast cells (MCs) can either inhibit or augment inflammation; however, how improved therapeutic benefits against small intestinal ischemia-reperfusion injury (IIRI) can be achieved by stabilizing MCs remains to be elucidated. The present study was designed to evaluate different treatments with cromolyn sodium (CS, an MC stabilizer), which was administrated either prior to ischemia or after reperfusion. Kunming mice were randomized into a sham-operated group (SH), a sole IIR group (M), in which mice were subjected to 30 min superior mesenteric artery occlusion followed by 3 day or 3 h reperfusion, or IIR, treated with CS 15 min prior to ischemia or 15 min after reperfusion in the PreCr and PostCr groups. The survival rate and Chiu's scores were evaluated. The levels of ET-1, histamine, TNF-α and IL-6, and expression of MC protease 7 (MCP7), MC counts and myeloperoxidase (MPO) activity were quantified. IIR resulted in severe injury as demonstrated by significant increases in mortality and injury score. IIR also led to substantial elevations in the levels of ET-1, histamine, TNF-α and IL-6, expression of MCP7, MC counts and MPO activities (P<0.05, M vs. SH groups). All biochemical changes were markedly reduced in the PostCr group (P<0.05, PostCr vs. M groups), whereas pretreatment of IIR mice with CS prior to ischemia exhibited no changes of ET-1 levels, injury score and inflammation (P>0.05, PreCr vs. M groups). In conclusion, administration of CS after reperfusion, but not prior to ischemia, attenuates IIRI by downregulating ET-1 and suppressing sustained MC activation.

  15. Effects of Different Peep Levels on Mesenteric Leukocyte-Endothelial Interactions in Rats During Mechanical Ventilation

    PubMed Central

    Aikawa, Priscila; Farsky, Sandra Helena Poliselli; de Oliveira, Maria Aparecida; Pazetti, Rogério; Mauad, Thaís; Sannomiya, Paulina; Nakagawa, Naomi Kondo

    2009-01-01

    INTRODUCTION: Mechanical ventilation with positive end expiratory pressure (PEEP) improves oxygenation and treats acute pulmonary failure. However, increased intrathoracic pressure may cause regional blood flow alterations that may contribute to mesenteric ischemia and gastrointestinal failure. We investigated the effects of different PEEP levels on mesenteric leukocyte-endothelial interactions. METHODS: Forty-four male Wistar rats were initially anesthetized (Pentobarbital I.P. 50mg/kg) and randomly assigned to one of the following groups: 1) NAIVE (only anesthesia; n=9), 2) PEEP 0 (PEEP of 0 cmH2O, n=13), 3) PEEP 5 (PEEP of 5 cmH2O, n=12), and 4) PEEP 10 (PEEP of 10 cmH2O, n=13). Positive end expiratory pressure groups were tracheostomized and mechanically ventilated with a tidal volume of 10 mL/kg, respiratory rate of 70 rpm, and inspired oxygen fraction of 1. Animals were maintained under isoflurane anesthesia. After two hours, laparotomy was performed, and leukocyte-endothelial interactions were evaluated by intravital microscopy. RESULTS: No significant changes were observed in mean arterial blood pressure among groups during the study. Tracheal peak pressure was smaller in PEEP 5 compared with PEEP 0 and PEEP 10 groups (11, 15, and 16 cmH2O, respectively; p<0.05). After two hours of MV, there were no differences among NAIVE, PEEP 0 and PEEP 5 groups in the number of rollers (118±9,127±14 and 147±26 cells/10minutes, respectively), adherent leukocytes (3±1,3±1 and 4±2 cells/100μm venule length, respectively), and migrated leukocytes (2±1,2±1 and 2±1 cells/5,000μm2, respectively) at the mesentery. However, the PEEP 10 group exhibited an increase in the number of rolling, adherent and migrated leukocytes (188±15 cells / 10 min, 8±1 cells / 100 μm and 12±1 cells / 5,000 μm2, respectively; p<0.05). CONCLUSIONS: High intrathoracic pressure was harmful to mesenteric microcirculation in the experimental model of rats with normal lungs and stable

  16. Deficiency in cold-inducible RNA-binding protein attenuates acute respiratory distress syndrome induced by intestinal ischemia-reperfusion.

    PubMed

    Cen, Cindy; McGinn, Joseph; Aziz, Monowar; Yang, Weng-Lang; Cagliani, Joaquin; Nicastro, Jeffrey M; Coppa, Gene F; Wang, Ping

    2017-10-01

    Intestinal ischemia-reperfusion can occur in shock and mesenteric occlusive diseases, causing significant morbidity and mortality. Aside from local injury, intestinal ischemia-reperfusion can result in remote organ damage, particularly in the lungs. Cold-inducible RNA-binding protein (CIRP) was identified as a novel inflammatory mediator. We hypothesized that a deficiency in CIRP would protect the lungs during intestinal ischemia-reperfusion injury. Intestinal ischemia was induced in adult male C57BL/6 wild-type and CIRP knock-out (CIRP(-/-)) mice via clamping of the superior mesenteric artery for 60 minutes. Reperfusion was allowed for 4 hours or 20 hours, and blood, gut, and lung tissues were harvested for various analyses. After intestinal ischemia-reperfusion, the elevated levels of serum lactate dehydrogenase and inflammatory cytokine interleukin-6 were reduced by 68% and 98%, respectively, at 20 hours after ischemia-reperfusion in CIRP(-/-) mice compared with the wild-type mice. In the gut, mRNA levels of inflammatory cytokine interleukin-6 were reduced by 67% at 4 hours after ischemia-reperfusion in CIRP(-/-) mice. In the lungs, inflammatory cytokine interleukin-6 protein and myeloperoxidase activity were reduced by 78% and 26% at 20 hours and 4 hours after ischemia-reperfusion, respectively, in CIRP(-/-) mice. Finally, the elevated lung caspase-3 was significantly decreased by 55%, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling-positive cells decreased by 91%, and lung injury score decreased by 37% in CIRP(-/-) mice at 20 hours after ischemia-reperfusion. Increased levels of proinflammatory cytokines, myeloperoxidase, and apoptosis are the hallmarks of acute respiratory distress syndrome. We noticed after intestinal ischemia-reperfusion the proinflammatory milieu in lungs was elevated significantly, while the CIRP(-/-) mice had significantly decreased levels of proinflammatory cytokine, myeloperoxidase, and apoptotic cells

  17. Mesenteric Revascularization: Management and Outcomes in the United States 1988–2006

    PubMed Central

    Schermerhorn, Marc L.; Giles, Kristina A.; Hamdan, Allen D.; Wyers, Mark C.; Pomposelli, Frank B.

    2009-01-01

    Background Recent reports have suggested that angioplasty +/− stenting (PTA/S) may have lower perioperative mortality than open surgery for revascularization of acute and chronic mesenteric ischemia (AMI and CMI). It is unclear if there has been nationwide adoption of this methodology or whether there is in fact a mortality benefit. Methods We identified all patients undergoing mesenteric revascularization, either surgical (bypass, endarterectomy, or embolectomy) or PTA/S from the Nationwide Inpatient Sample from 1988–2006. A diagnosis by ICD-9 coding of AMI or CMI was required for inclusion. We evaluated trends in management over this time period and compared in-hospital mortality and complications between surgical bypass and PTA/S for the years 2000–2006. Results From 1988 to 2006 there were 6,342 PTA/S and 16,071 open surgical repairs overall. PTA/S increased steadily over time surpassing all surgery for CMI in 2002. PTA/S for AMI has also increased and surpassed bypass in 2002 but has not surpassed all surgical procedures for AMI even in 2006. Mortality was lower after PTA/S than bypass for both CMI (3.7% vs 13%, P<0.01) and AMI (16% vs 28%, P<0.01). Bowel resection was more common after bypass than PTA/S for CMI (7% vs 3%, P<0.01) and this subgroup showed an increased in-hospital mortality for both repair types (54% and 25%). Conclusion PTA/S in being utilized with increasing frequency for revascularization of both CMI and AMI. Based on lower in-hospital mortality for patients as they are currently being selected, PTA/S is appropriate therapy for selected patients with CMI. Longitudinal data are needed to determine the durability of this benefit. The greater proportion of patients undergoing bowel resection with bypass for AMI suggests a more advanced level of ischemia in this group making comparison with PTA/S difficult. However, PTA/S may be useful in selected patients with AMI and appropriate anatomy. Further data with greater detail regarding

  18. Volvulus of small intestine: rare complication of mesenteric pseudocyst.

    PubMed

    Fan, H-L; Chen, T-W; Hong, Z-J; Hsieh, C-B; Chan, D-C; Chen, C-J; Liu, Y-C; Yu, J-C

    2009-12-01

    Mesenteric cyst is a rare intra-abdominal lesion. Most patients with mesenteric cysts are asymptomatic. Symptomatic mesenteric cysts are associated with cyst size, cyst location, and complications, including infection, rupture, hemorrhage, and intestinal obstruction. Volvulus is a rare complication of mesenteric cyst. We report a 50-year-old woman with colicky epigastric pain for three days. The symptoms exacerbated in the supine position and were relieved in the sitting position. Computed tomography of her abdomen revealed a huge cystic lesion with a whirl sign of mesentery vessels. She had the history of gastro-esophageal reflux disease. Segmental resection of the small intestine with end-to-end anastomosis was performed. Histology indicated a hemorrhagic pseudocyst. The patient recovered well after surgery. Mesenteric pseudocyst rarely results in volvulus of small intestine. Our case is the eleventh case reported in the English literature. Atypical presentation of epigastric pain while lying down may lead to mis-diagnosis. This case reminds the clinicians this rare complication.

  19. [Cerebral ischemia and histamine].

    PubMed

    Adachi, Naoto

    2002-10-01

    Cerebral ischemia induces excess release of glutamate and an increase in the intracellular Ca2+ concentration, which provoke catastrophic enzymatic processes leading to irreversible neuronal injury. Histamine plays the role of neurotransmitter in the central nervous system, and histaminergic fibers are widely distributed in the brain. In cerebral ischemia, release of histamine from nerve endings has been shown to be enhanced by facilitation of its activity. An inhibition of the histaminergic activity in ischemia aggravates the histologic outcome. In contrast, intracerebroventricular administration of histamine improves the aggravation, whereas blockade of histamine H2 receptors aggravates ischemic injury. Furthermore, H2 blockade enhances ischemic release of glutamate and dopamine. These findings suggest that central histamine provides beneficial effects against ischemic neuronal damage by suppressing release of excitatory neurotransmitters. However, histaminergic H2 action facilitates the permeability of the blood-brain barrier and shows deleterious effects on cerebral edema.

  20. Perforation of the mesenteric small bowel: etiologies and CT findings.

    PubMed

    Hines, John; Rosenblat, Juliana; Duncan, Dameon R; Friedman, Barak; Katz, Douglas S

    2013-04-01

    The purpose of this article is to illustrate and discuss the various etiologies of perforation of the mesenteric small bowel and associated findings on abdominal CT. Perforation of the mesenteric small bowel is an uncommon cause of an acute abdomen and can be due to various etiologies. In underdeveloped countries, infection is probably the most common cause, while in industrialized nations, perforation may be due to Crohn disease, diverticulitis, foreign body, trauma, tumor, mechanical obstruction, primary ischemic event, or iatrogenic causes. CT is usually the initial imaging examination in patients with an acute abdomen and is sensitive in diagnosing small bowel perforation. CT findings in the setting of small bowel perforation are often subtle, but when present, may help the radiologist determine a specific cause of perforation. The aims of this pictorial essay are to review the various causes of mesenteric small bowel perforation and to discuss and illustrate the CT findings that can help arrive at the diagnosis.

  1. Superior Mesenteric Vein Thrombosis Following Laparoscopic Nissen Fundoplication

    PubMed Central

    Martin, Matthew J.; Garafalo, Thomas; Ko, Tak-ming; Place, Ronald J.

    2003-01-01

    This report describes the second case of a superior mesenteric and portal vein thrombosis following an uneventful laparoscopic Nissen fundoplication. The patient presented on postoperative day 10 with acute onset of abdominal pain and inability to tolerate oral food. A computed tomography (CT) scan revealed superior mesenteric and portal venous thrombosis with questionable viability of the proximal small bowel. He was heparinized and taken for emergent exploratory laparotomy. At surgery and at a planned re-exploration the following day, the bowel was viable and no resection was needed. Despite continuation on anticoagulation therapy, he developed a pulmonary embolism. A hypercoagulable workup was normal. After continued anticoagulation therapy and supportive care, a duplex ultrasound 2 months after the event showed normal flow in both the superior mesenteric and portal veins. Possible mechanisms are discussed along with a review of the pertinent literature. PMID:12856849

  2. Retractile mesenteritis presenting as protein-losing gastroenteropathy

    PubMed Central

    Rajendran, Bahe; Duerksen, Donald R

    2006-01-01

    Retractile mesenteritis is a rare, idiopathic condition characterized by nonspecific inflammation of the mesenteric adipose tissue. The majority of patients present with abdominal pain and/or a palpable mass. In the present report, a 68-year-old man with peripheral edema and mild hypoalbuminemia is presented. Protein-losing gastroenteropathy was confirmed with an abnormal stool alpha1-antitrypsin clearance test and retractile mesenteritis was diagnosed at laparoscopy. This rare condition may respond to therapy with corticosteroids, azathioprine, cyclophosphamide, colchicine, progesterone, tamoxifen or thalidomide. Gastroenterologists should consider the diagnosis of protein-losing enteropathy in patients who present with unexplained peripheral edema or hypoalbuminemia. The test of choice to confirm this diagnosis is the stool alpha1-antitrypsin clearance test. PMID:17171198

  3. [Mesenteric cyst: case report and review of the literature].

    PubMed

    Casarotto, A; Cerofolini, A; Denitto, F; Invernizzi, L; Chiappetta, A; Di Prima, F; Landoni, L; Rebonato, M

    2010-05-01

    Mesenteric and retroperitoneal cysts are rare intra-abdominal tumours with an incidence of 1/140.000 in surgery departments and 1/20.000 in paediatric departments. There are no pathognomonic signs or symptoms for the cysts. In the differential diagnosis lymphangiomas, sarcomas, adenocarcinomas and intestinal duplications should be considered. Diagnostic includes abdominal computed tomography, ultrasound and MRI. Barium enema examination or intravenous pyelogram may be used in special cases. Surgical treatment is indicated also in asymptomatic patients; laparoscopic approach is the "gold standard". Laparotomic approach should be used in the cases of impossibility of total enucleation or in the cases of malignant degeneration. Complete enucleation is the treatment of choice for retroperitoneal and mesenteric cysts. If this cannot be accomplished, the alternative should be the excision of the cyst or the marsupialization. In this paper we present a case of young man with a mesenteric cyst mimicking acute appendicitis.

  4. [Mesenteric cyst in the descending colon: a case report].

    PubMed

    Ghidirim, Gh; Mişin, I; Ignatenco, S; Sor, E

    2010-01-01

    Mesenteric cysts are rare abdominal findings. The majority are asymptomatic and if found are discovered incidentally during ultrasonography and/or CT scanning. The optimal surgical treatment requires complete excision of the cyst. We report a case of 36-year-old woman with mesenteric cyst in the descending colon. Laboratory tests indicated no abnormality. Abdominal CT revealed a cystic mass in the retropreritneal space measuring 14.0 x 8.3 x 9.4 cm, density 26-29 HU. We found a cystic mass at the mesentery of the descending colon that was removed in toto. The authors discuss the symptoms and complications, classification, and treatment of mesenteric cysts with review of literature.

  5. Mesenteric autotransplantation: an alternative technique for reoperation and bypass of the superior mesenteric artery.

    PubMed

    Carson, John G; Loor, Gabriel; Millis, Micheal J; Testa, Giuliano; Piano, Giancarlo

    2009-01-01

    Superior mesenteric artery (SMA) aneurysms represent a minority of visceral aneurysms but may result in lethal complications if left untreated. Options for treatment include aneurysmorraphy, bypass, ligation, or embolization. Here we present a case of a man with a history of celiac graft thrombosis who presents with a recurrent symptomatic SMA aneurysm. Given his compromised celiac axis, ligation was not an option. His SMA aneurysm was repaired with a PTFE patch. However, to secure longstanding blood flow to the small bowel in the event of graft thrombosis, the distal SMA pedicle was dissected free of the ileocolic vessels and anastomosed to the aorta. Follow-up studies demonstrated an occluded PTFE patch with a patent SMA autotransplant. This case depicts a novel approach to the surgical management of complex recurrent SMA aneurysms.

  6. Total salvianolic acid improves ischemia-reperfusion-induced microcirculatory disturbance in rat mesentery

    PubMed Central

    Wang, Ming-Xia; Liu, Yu-Ying; Hu, Bai-He; Wei, Xiao-Hong; Chang, Xin; Sun, Kai; Fan, Jing-Yu; Liao, Fu-Long; Wang, Chuan-She; Zheng, Jun; Han, Jing-Yan

    2010-01-01

    AIM: To investigate the effect of total salvianolic acid (TSA) on ischemia-reperfusion (I/R)-induced rat mesenteric microcirculatory dysfunctions. METHODS: Male Wistar rats were randomly distributed into 5 groups (n = 6 each): Sham group and I/R group (infused with saline), TSA group, TSA + I/R group and I/R + TSA group (infused with TSA, 5 mg/kg per hour). Mesenteric I/R were conducted by a ligation of the mesenteric artery and vein (10 min) and subsequent release of the occlusion. TSA was continuously infused either starting from 10 min before the ischemia or 10 min after reperfusion. Changes in mesenteric microcirculatory variables, including diameter of venule, velocity of red blood cells in venule, leukocyte adhesion, free radicals released from venule, albumin leakage and mast cell degranulation, were observed through an inverted intravital microscope. Meanwhile, the expression of adhesion molecules CD11b/CD18 on neutrophils was evaluated by flow cytometry. Ultrastructural evidence of mesenteric venules damage was assessed after microcirculation observation. RESULTS: I/R led to multiple responses in mesenteric post-capillary venules, including a significant increase in the adhesion of leukocytes, production of oxygen radicals in the venular wall, albumin efflux and enhanced mast cell degranulation in vivo. All the I/R-induced manifestations were significantly reduced by pre- or post-treatment with TSA, with the exception that the I/R-induced increase in mast cell degranulation was inhibited only by pre-treatment with TSA. Moreover, pre- or post-treatment with TSA significantly attenuated the expression of CD11b/CD18 on neutrophils, reducing the increase in the number of caveolae in the endothelial cells of mesentery post-capillary venules induced by I/R. CONCLUSION: The results demonstrated that TSA protects from and ameliorates the microcirculation disturbance induced by I/R, which was associated with TSA inhibiting the production of oxygen-free radicals in

  7. Mesenteric venous thrombosis precipitated by foodborne gastrointestinal illness.

    PubMed

    Wojciechowski, Amy L; Bajwa, Rajinder Ps; Thatigotla, Bala

    2017-03-01

    Foodborne illnesses are common and are usually considered as part of the differential diagnosis when a patient presents with gastrointestinal symptoms including nausea, vomiting, abdominal pain, diarrhea and fever. The majority of foodborne illness is transient and self-limited, while life threatening complications are rare. Here, we describe a case of a patient presenting with inflammatory diarrhea after consumption of undercooked seafood. She developed mesenteric and portal venous thrombosis and small bowel infarction requiring surgical intervention and resection of gangrenous small bowel. This is a rare presentation and outcome of common food poisoning. The case report is followed by a brief discussion of common foodborne illnesses and mesenteric venous thrombosis.

  8. [Giant mesenteric lipoma in children: A case-report].

    PubMed

    Hida, M; Azahouani, A; Elazzouzi, D

    2017-03-27

    Mesenteric lipoma is an extremely rare disease in children. Fewer than 50 cases have been reported in the literature. Diagnosis is based on clinical examination, ultrasound, and computed tomography (CT). However, only the histological study of the specimen during laparotomy or laparoscopy can confirm the diagnosis. Thus, surgery, be it by laparotomy or laparoscopic, is both a means of exploration and treatment in mesenteric lipoma. We report on a case of giant lipoma of the mesentery in a 7-year-old girl presenting paroxysmal abdominal pain with a subocclusive syndrome lasting 1 week.

  9. Laparoscopic treatment of a huge mesenteric chylous cyst.

    PubMed

    Tebala, Giovanni Domenico; Camperchioli, Ida; Tognoni, Valeria; Noia, Michele; Gaspari, Achille Lucio

    2010-01-01

    Mesenteric chylous cysts are rare pathologic entities that often present with unspecific symptoms. The preoperative diagnosis requires all the common abdominal imaging techniques, but usually the correct diagnosis may be made only at the operation stage or during the histological examination. The treatment of choice is the complete surgical excision that may be safely performed by laparoscopy. A 58-year-old man underwent laparoscopic excision of a huge mesenteric chylous cyst. The technique entails the perfect control of the major abdominal vessels running near the tumor and the complete sealing of the chylous and blood vessels to and from the cyst.

  10. Laparoscopic Treatment of a Huge Mesenteric Chylous Cyst

    PubMed Central

    Camperchioli, Ida; Tognoni, Valeria; Noia, Michele; Gaspari, Achille Lucio

    2010-01-01

    Mesenteric chylous cysts are rare pathologic entities that often present with unspecific symptoms. The preoperative diagnosis requires all the common abdominal imaging techniques, but usually the correct diagnosis may be made only at the operation stage or during the histological examination. The treatment of choice is the complete surgical excision that may be safely performed by laparoscopy. A 58-year-old man underwent laparoscopic excision of a huge mesenteric chylous cyst. The technique entails the perfect control of the major abdominal vessels running near the tumor and the complete sealing of the chylous and blood vessels to and from the cyst. PMID:21333204

  11. Percutaneous transluminal angioplasty and stenting in the management of chronic mesenteric angina: A single center experience

    PubMed Central

    Thomas, Tixon; Kader, Nazar P; Prabhu, Nirmal K; Kannan, Rajesh; Pullara, Sreekumar K; Moorthy, Srikanth

    2016-01-01

    Introduction: The objective of our study was to review the results of percutaneous angioplasty (PTA)/stenting in the treatment of patients who presented with symptoms and angiographic findings of chronic mesenteric ischemia (CMI). Materials and Methods: We performed a retrospective analysis of 13 consecutive patients from a single institution who underwent PTA/stenting for the treatment of symptoms suggestive of CMI. Results: All 13 patients in our study were men, and most common presenting symptoms were weight loss and postprandial pain. Atherosclerosis was the most common cause. PTA and stenting was performed in 9 patients and PTA alone was done in 4 patients. Primary technical success rate was 92% with complete resolution of symptoms within 2 weeks in all patients. No statistical difference was noted in primary clinical success rate based on the number of vessels treated or the method of treatment. However, in patients whom SMA was treated had longer duration of symptom-free survival as compared to other vessels. Conclusion: PTA and stenting are very effective therapeutic options for patients presenting with CMI symptoms. It should be considered as the first-line of management in such patients. PMID:28104938

  12. [Extensive mesenteric venous thrombosis treatment by regional thrombolysis].

    PubMed

    Espeel, B; Gérard, C; Mansvelt, B; Bertrand, C; Vermonden, J

    2005-03-01

    Two cases of mesenteric venous thrombosis with portal extension are reported. The first patient was treated right away by local intra-arterial thrombolysis, the second one benefited from local venous thrombolysis immediately after intestinal resection. No significant complication was observed.

  13. Mesenteric Teratoma in Elderly Female: A Rare Case Report.

    PubMed

    Neeralagi, Chandrasekhar Sharanappa; Surag, K R; Kumar, Yogesh; Lakkanna, S; Raj, Preetham

    2017-01-01

    Dermoid cysts rarely present as mesenteric cysts. Mesenteric cysts are rare pathologic entities, with a reported incidence of approximately 1 of 27 000 to 1 of 100 000 admissions. Mesenteric cyst was first described by Florentine anatomist Benevieni in 1507, while performing an autopsy on an eight-year-old boy. Most commonly, teratoma occurs in the early age group. Mature mesenteric teratoma in adulthood is extremely rare. Teratoma are germ cell tumours commonly composed of multiple cell types derived from one or more of the 3 germ layers. We present the case of a 69-year-old elderly female who presented with abdomen pain for nine months with right lumbar and right iliac fossa mass. Computed Tomography (CT) abdomen revealed bilocular cystic lesion with possibility of mucinous cystadenoma with no definitive organ of origin. She underwent explorative laparotomy and total excision of the cystic mass. Histopathologic examination confirmed diagnosis of mature cystic teratoma of mesentery. This case report highlights the need to maintain high index of suspicion while evaluating abdominal mass.

  14. Ileocolic Arteriovenous Fistula with Superior Mesenteric Vein Aneurism: Endovascular Treatment

    SciTech Connect

    Gregorio, Miguel Angel de; Gimeno, Maria Jose; Medrano, Joaquin; Schoenholz, Caudio; Rodriguez, Juan; D'Agostino, Horacio

    2004-09-15

    We report a case of a venous aneurysm secondary to an acquired ileocolic arteriovenous fistula in a 64-year-old woman with recurrent abdominal pain and history of appendectomy. The aneurysm was diagnosed by ultrasound and computed tomography. Angiography showed an arteriovenous fistula between ileocolic branches of the superior mesenteric artery and vein. This vascular abnormality was successfully treated with coil embolization.

  15. Laparoscopic treatment of mesenteric cysts. Report of two cases.

    PubMed

    Ciulla, Antonio; Tomasello, Giovanni; Castronovo, Gioacchino; Genova, Gaspare; Maiorana, Alfonso Maurizio

    2008-01-01

    Mesenteric cysts are rare intraabdominal tumors. Since the first report by Benevial in 1507, approximately 800 cases of mesenteric cysts have been described in the literature. Clinical presentation is variable and depends on the size and location of the cyst. This lesion are often asymptomatic or can present as an abdominal palpable mass or with abdominal pain, nausea, vomiting, diarrhea or constipation. Laboratory tests are usually helpless. Ultrasonography and CT scan are the best diagnostic tools. In the past the treatment of choice was totally resection performed by open surgery. With the advent of laparoscopic surgery same authors report mesenteric cysts excised laparoscopically. The Authors report two cases of mesenteric cysts that were excised by laparoscopic surgery using. The cysts of both patients were located in the mesenterium of colon. There were no intraoperative of postoperative complications and the postoperative course was uneventful and both patients returned to full activity within a short time. The follow-up period ranged from 6 to 36 months and there were no recurrences. The laparoscopic surgery is a minimally invasive techniques and represent an alternative safe and less invasive operation for these abdominal cysts.

  16. Mesenteric Teratoma in Elderly Female: A Rare Case Report

    PubMed Central

    Surag, KR; Kumar, Yogesh; Lakkanna, S; Raj, Preetham

    2017-01-01

    Dermoid cysts rarely present as mesenteric cysts. Mesenteric cysts are rare pathologic entities, with a reported incidence of approximately 1 of 27 000 to 1 of 100 000 admissions. Mesenteric cyst was first described by Florentine anatomist Benevieni in 1507, while performing an autopsy on an eight-year-old boy. Most commonly, teratoma occurs in the early age group. Mature mesenteric teratoma in adulthood is extremely rare. Teratoma are germ cell tumours commonly composed of multiple cell types derived from one or more of the 3 germ layers. We present the case of a 69-year-old elderly female who presented with abdomen pain for nine months with right lumbar and right iliac fossa mass. Computed Tomography (CT) abdomen revealed bilocular cystic lesion with possibility of mucinous cystadenoma with no definitive organ of origin. She underwent explorative laparotomy and total excision of the cystic mass. Histopathologic examination confirmed diagnosis of mature cystic teratoma of mesentery. This case report highlights the need to maintain high index of suspicion while evaluating abdominal mass. PMID:28274002

  17. A case of atherosclerotic inferior mesenteric artery aneurysm secondary to high flow state.

    PubMed

    Troisi, Nicola; Esposito, Giovanni; Cefalì, Pietro; Setti, Marco

    2011-07-01

    Inferior mesenteric artery aneurysms are very rare and they are among the rarest of visceral artery aneurysms. Sometimes, the distribution of the blood flow due to chronic atherosclerotic occlusion of some arteries can establish an increased flow into a particular supplying district (high flow state). A high flow state in a stenotic inferior mesenteric artery in compensation for a mesenteric occlusive disease can produce a rare form of aneurysm. We report the case of an atherosclerotic inferior mesenteric aneurysm secondary to high flow state (association with occlusion of the celiac trunk and severe stenosis of the superior mesenteric artery), treated by open surgical approach.

  18. Mesenteric artery contraction and relaxation studies using automated wire myography.

    PubMed

    Bridges, Lakeesha E; Williams, Cicely L; Pointer, Mildred A; Awumey, Emmanuel M

    2011-09-22

    Proximal resistance vessels, such as the mesenteric arteries, contribute substantially to the peripheral resistance. These small vessels of between 100-400 μm in diameter function primarily in directing blood flow to various organs according to the overall requirements of the body. The rat mesenteric artery has a diameter greater than 100 μm. The myography technique, first described by Mulvay and Halpern(1), was based on the method proposed by Bevan and Osher(2). The technique provides information about small vessels under isometric conditions, where substantial shortening of the muscle preparation is prevented. Since force production and sensitivity of vessels to different agonists is dependent on the extent of stretch, according to active tension-length relation, it is essential to conduct contraction studies under isometric conditions to prevent compliance of the mounting wires. Stainless steel wires are preferred to tungsten wires because of oxidation of the latter, which affects recorded responses(3).The technique allows for the comparison of agonist-induced contractions of mounted vessels to obtain evidence for normal function of vascular smooth muscle cell receptors. We have shown in several studies that isolated mesenteric arteries that are contracted with phenylyephrine relax upon addition of cumulative concentrations of extracellular calcium (Ca(2+)(e;)). The findings led us to conclude that perivascular sensory nerves, which express the G protein-coupled Ca(2+)-sensing receptor (CaR), mediate this vasorelaxation response. Using an automated wire myography method, we show here that mesenteric arteries from Wistar, Dahl salt-sensitive(DS) and Dahl salt-resistant (DR) rats respond differently to Ca(2+)(e;). Tissues from Wistar rats showed higher Ca(2+)-sensitivity compared to those from DR and DS. Reduced CaR expression in mesenteric arteries from DS rats correlates with reduced Ca(2+)(e;)-induced relaxation of isolated, pre-contracted arteries. The data

  19. Influence of enteral nutrition-induced splanchnic hyperemia on the septic origin of splanchnic ischemia.

    PubMed

    Kazamias, P; Kotzampassi, K; Koufogiannis, D; Eleftheriadis, E

    1998-01-01

    The purpose of this experimental study was to investigate whether enteral nutrition-induced postprandial intestinal hyperemia has a beneficial effect on the splanchnic ischemia due to sepsis. Fourteen dogs, after exposure to Escherichia coli endotoxin via portal vein administration were grouped according to whether they were fed enterally via a jejunostomy or given a placebo. Systemic hemodynamics; portal vein, hepatic, and superior mesenteric artery blood flow; hepatic and intestinal microcirculation; hepatic tissue PO2; intestinal pHi; and hepatic energy charge were assessed before, during, and after endotoxin infusion as well as during and after enteral or placebo feeding. All splanchnic hemodynamic parameters revealed a statistically significant decline (p = 0.001) during the endotoxin shock period relative to the baseline. After enteral feeding all parameters exhibited a statistically significant increase (p = 0.001) relative to the placebo group. The results of this study led us to suggest that enteral nutrition reverses the lipopolysaccharide infusion-induced splanchnic ischemia.

  20. The evolving concept of physiological ischemia training vs. ischemia preconditioning.

    PubMed

    Ni, Jun; Lu, Hongjian; Lu, Xiao; Jiang, Minghui; Peng, Qingyun; Ren, Caili; Xiang, Jie; Mei, Chengyao; Li, Jianan

    2015-11-01

    Ischemic heart diseases are the leading cause of death with increasing numbers of patients worldwide. Despite advances in revascularization techniques, angiogenic therapies remain highly attractive. Physiological ischemia training, which is first proposed in our laboratory, refers to reversible ischemia training of normal skeletal muscles by using a tourniquet or isometric contraction to cause physiologic ischemia for about 4 weeks for the sake of triggering molecular and cellular mechanisms to promote angiogenesis and formation of collateral vessels and protect remote ischemia areas. Physiological ischemia training therapy augments angiogenesis in the ischemic myocardium by inducing differential expression of proteins involved in energy metabolism, cell migration, protein folding, and generation. It upregulates the expressions of vascular endothelial growth factor, and induces angiogenesis, protects the myocardium when infarction occurs by increasing circulating endothelial progenitor cells and enhancing their migration, which is in accordance with physical training in heart disease rehabilitation. These findings may lead to a new approach of therapeutic angiogenesis for patients with ischemic heart diseases. On the basis of the promising results in animal studies, studies were also conducted in patients with coronary artery disease without any adverse effect in vivo, indicating that physiological ischemia training therapy is a safe, effective and non-invasive angiogenic approach for cardiovascular rehabilitation. Preconditioning is considered to be the most protective intervention against myocardial ischemia-reperfusion injury to date. Physiological ischemia training is different from preconditioning. This review summarizes the preclinical and clinical data of physiological ischemia training and its difference from preconditioning.

  1. Mesenteric cyst: report of a case-resulting in pseudomyxoma peritonei.

    PubMed

    Zappa, Luis; Sugarbaker, Paul H

    2010-01-01

    A mesenteric cyst may have an embryonic, traumatic, neoplastic or infectious origin. In rare cases mesenteric cysts may contain neoplastic epithelium. A mesenteric cyst has not previously been recorded as the cause of pseudomyxoma peritonei. A patient who developed widespread mucinous intraperitoneal tumor as a result of a ruptured mesenteric cyst is reported. A literature review of the clinical features, diagnosis, treatment, and prognosis of the mesenteric cyst is presented. This patient was treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy. Her recovery was uneventful and she remains well two years after treatment. Mesenteric cyst is a rare cause of pseudomyxoma peritonei. The definite treatment of a ruptured neoplastic mesenteric cyst can, by analogy, be compared to the treatment for pseudomyxoma peritonei of appendiceal origin. The results of cytoreductive surgery with perioperative intraperitoneal chemotherapy are expected to be good.

  2. Trauma to the Superior Mesenteric Artery and Superior Mesenteric Vein: A Narrative Review of Rare but Lethal Injuries.

    PubMed

    Phillips, B; Reiter, S; Murray, E P; McDonald, D; Turco, L; Cornell, D L; Asensio, J A

    2017-09-05

    Mesenteric vessels, including the superior mesenteric artery (SMA) and vein (SMV), provide and drain the rich blood supply of the midgut and hindgut. SMA and SMV injuries are rare and often lethal. Clinical management of these injuries is not well established, but treatment options include operative, non-operative, and endovascular strategies. A narrative review of the literature was conducted using MEDLINE Complete-EBSCO. Relevant studies, specifically those focusing on diagnosis and management of SMA and SMV injuries, were selected. Only original reports and collected series were selected to prevent duplication of cases. A search of the literature for mesenteric arterial injuries yielded 87 studies. Vessel-specific breakdown of the studies yielded 40 with SMA injuries and 41 with SMV injuries. These searches were winnowed to 26 individual studies, which were included in this collective review. Limitations of this study are similar to all narrative literature reviews: the dependence on previously published research and availability of references as outlined in our methodology. Although historically rare, mesenteric vessel injuries are seen with increasing incidence and continue to present a challenge to trauma surgeons due to their daunting mortality rates. Currently, universal treatment guidelines do not exist, but the various options for their management have been extensively reviewed in the literature.

  3. Impaired Intestinal Mucosal Barrier upon Ischemia-Reperfusion: “Patching Holes in the Shield with a Simple Surgical Method”

    PubMed Central

    Rosero, Olivér; Ónody, Péter; Molnár, Dávid; Lotz, Gábor; Turóczi, Zsolt; Fülöp, András; Garbaisz, Dávid; Harsányi, László; Szijártó, Attila

    2014-01-01

    Mesenteric ischemia-reperfusion (IR) is associated with impairment of the gut barrier function and the initiation of a proinflammatory cascade with life-threatening results. Therefore methods directed to ameliorate IR injury are of great importance. We aimed at describing the effects of postconditioning (PC) on the alterations of the intestinal mucosal function and the inflammatory response upon mesenteric IR. Methods. Male Wistar rats were gavaged with green fluorescent protein-expressing E. coli suspensions. Animals were randomized into three groups (n = 15), sham-operated, IR-, and PC-groups, and underwent 60 minutes of superior mesenteric artery occlusion, followed by 6 hours of reperfusion. Postconditioning was performed at the onset of reperfusion. Blood and tissue samples were taken at the end of reperfusion, for histological, bacteriological, and plasma examinations. Results. The PC-group presented a more favorable claudin-2, claudin-3, claudin-4, and zonula occludens-1 membrane expression profile, and significantly lower rates of bacterial translocation to distant organs and plasma D-lactate levels compared to the IR-group. Histopathological lesions, plasma I-FABP, IL-6, and TNF-α levels were significantly lower in the PC-group compared to the IR-group. Conclusion. The use of postconditioning improved the integrity of the intestinal mucosal barrier upon mesenteric IR, and thus reduced the incidence of bacterial translocation and development of a systemic inflammatory response. PMID:24955347

  4. Vasospastic Limb Ischemia Presenting Acute and Chronic Limb Ischemia

    PubMed Central

    2014-01-01

    Vasospastic limb ischemia might have been underappreciated compared to vasospasm in other territories such as heart and brain. However, an increasing awareness of this vascular disorder can be translated to an improved patients’ care. Herein, we report a case of vasospasm presenting acute and chronic limb ischemia in four extremities. PMID:24995065

  5. Open Abdomen Improves Survival in Patients With Peritonitis Secondary to Acute Superior Mesenteric Artery Occlusion.

    PubMed

    Ding, Weiwei; Wang, Kai; Liu, Baochen; Fan, Xinxin; Wang, Shikai; Cao, Jianmin; Wu, Xingjiang; Li, Jieshou

    2017-10-01

    Damage control surgery and open abdomen (OA) have been extensively used in the severe traumatic patients. However, there was little information when extended to a nontrauma setting. The purpose of this study was to evaluate whether the liberal use of OA as a damage control surgery adjunct improved the clinical outcome in acute superior mesenteric artery occlusion patients. A single-center, retrospective cohort review was performed in a national tertiary surgical referral center. Forty-four patients received OA (OA group) and 65 patients had a primary fascial closure (non-OA group) after diagnosed as peritonitis secondary to acute superior mesenteric artery occlusion from January, 2005 to June, 2016. Revascularization was achieved through endovascular aspiration embolectomy, open embolectomy, or percutaneous stent. No difference of bowel resection length was found between groups in the first emergency surgery. However, more non-OA patients (35.4%) required a second-look enterectomy to remove the residual bowel ischemia than OA patients (13.6%, P<0.05). OA was closed within a median of 7 days (4 to 15 d). There was a mean of 134 cm residual alive bowel in OA, whereas 96 cm in non-OA. More non-OA patients suffered from intra-abdominal sepsis (23.1% vs. 6.8%, P<0.01), intra-abdominal hypertension (31% vs. 0, P<0.01), and acute renal failure (53.8% vs. 31.8%, P<0.05) than OA group after surgery. Short-bowel syndrome occurred infrequently in OA than non-OA patients (9.1% vs. 36.9%, P<0.01). OA significantly decreased the 30-day (27.3% vs. 52.3%, P<0.01) and 1-year mortality rate (31.8 % vs. 61.5%, P<0.01) compared with non-OA group. Liberal use of OA, as a damage control adjunct avoided the development of intra-abdominal hypertension, reduced sepsis-related complication, and improved the clinical outcomes in peritonitis secondary to acute SMA occlusion.

  6. Ischemia causes muscle fatigue

    NASA Technical Reports Server (NTRS)

    Murthy, G.; Hargens, A. R.; Lehman, S.; Rempel, D. M.

    2001-01-01

    The purpose of this investigation was to determine whether ischemia, which reduces oxygenation in the extensor carpi radialis (ECR) muscle, causes a reduction in muscle force production. In eight subjects, muscle oxygenation (TO2) of the right ECR was measured noninvasively and continuously using near infrared spectroscopy (NIRS) while muscle twitch force was elicited by transcutaneous electrical stimulation (1 Hz, 0.1 ms). Baseline measurements of blood volume, muscle oxygenation and twitch force were recorded continuously, then a tourniquet on the upper arm was inflated to one of five different pressure levels: 20, 40, 60 mm Hg (randomized order) and diastolic (69 +/- 9.8 mm Hg) and systolic (106 +/- 12.8 mm Hg) blood pressures. Each pressure level was maintained for 3-5 min, and was followed by a recovery period sufficient to allow measurements to return to baseline. For each respective tourniquet pressure level, mean TO2 decreased from resting baseline (100% TO2) to 99 +/- 1.2% (SEM), 96 +/- 1.9%, 93 +/- 2.8%, 90 +/- 2.5%, and 86 +/- 2.7%, and mean twitch force decreased from resting baseline (100% force) to 99 +/- 0.7% (SEM), 96 +/- 2.7%, 93 +/- 3.1%, 88 +/- 3.2%, and 86 +/- 2.6%. Muscle oxygenation and twitch force at 60 mm Hg tourniquet compression and above were significantly lower (P < 0.05) than baseline value. Reduced twitch force was correlated in a dose-dependent manner with reduced muscle oxygenation (r = 0.78, P < 0.001). Although the correlation does not prove causation, the results indicate that ischemia leading to a 7% or greater reduction in muscle oxygenation causes decreased muscle force production in the forearm extensor muscle. Thus, ischemia associated with a modest decline in TO2 causes muscle fatigue.

  7. Ischemia causes muscle fatigue

    NASA Technical Reports Server (NTRS)

    Murthy, G.; Hargens, A. R.; Lehman, S.; Rempel, D. M.

    2001-01-01

    The purpose of this investigation was to determine whether ischemia, which reduces oxygenation in the extensor carpi radialis (ECR) muscle, causes a reduction in muscle force production. In eight subjects, muscle oxygenation (TO2) of the right ECR was measured noninvasively and continuously using near infrared spectroscopy (NIRS) while muscle twitch force was elicited by transcutaneous electrical stimulation (1 Hz, 0.1 ms). Baseline measurements of blood volume, muscle oxygenation and twitch force were recorded continuously, then a tourniquet on the upper arm was inflated to one of five different pressure levels: 20, 40, 60 mm Hg (randomized order) and diastolic (69 +/- 9.8 mm Hg) and systolic (106 +/- 12.8 mm Hg) blood pressures. Each pressure level was maintained for 3-5 min, and was followed by a recovery period sufficient to allow measurements to return to baseline. For each respective tourniquet pressure level, mean TO2 decreased from resting baseline (100% TO2) to 99 +/- 1.2% (SEM), 96 +/- 1.9%, 93 +/- 2.8%, 90 +/- 2.5%, and 86 +/- 2.7%, and mean twitch force decreased from resting baseline (100% force) to 99 +/- 0.7% (SEM), 96 +/- 2.7%, 93 +/- 3.1%, 88 +/- 3.2%, and 86 +/- 2.6%. Muscle oxygenation and twitch force at 60 mm Hg tourniquet compression and above were significantly lower (P < 0.05) than baseline value. Reduced twitch force was correlated in a dose-dependent manner with reduced muscle oxygenation (r = 0.78, P < 0.001). Although the correlation does not prove causation, the results indicate that ischemia leading to a 7% or greater reduction in muscle oxygenation causes decreased muscle force production in the forearm extensor muscle. Thus, ischemia associated with a modest decline in TO2 causes muscle fatigue.

  8. Bowel and mesenteric injuries from blunt abdominal trauma: a review.

    PubMed

    Iaselli, Francesco; Mazzei, Maria Antonietta; Firetto, Cristina; D'Elia, Domenico; Squitieri, Nevada Cioffi; Biondetti, Pietro Raimondo; Danza, Francesco Maria; Scaglione, Mariano

    2015-01-01

    The bowel and the mesentery represent the third most frequently involved structures in blunt abdominal trauma after the liver and the spleen. Clinical assessment alone in patients with suspected intestinal and/or mesenteric injury from blunt abdominal trauma is associated with unacceptable diagnostic delays. Multi-detector computed tomography, thanks to its high spatial, time and contrast resolutions, allows a prompt identification and proper classification of such conditions. The radiologist, in fact, is asked not only to identify the signs of trauma but also to provide an indication of their clinical significance, suggesting the chance of conservative treatment in the cases of mild and moderate, non-complicated or self-limiting injuries and focusing on life-threatening conditions which may benefit from immediate surgical or interventional procedures. Specific and non-specific CT signs of bowel and mesenteric injuries from blunt abdominal trauma are reviewed in this paper.

  9. [Superior mesenteric artery aneurysm treated with endovascular stentgraft implantation].

    PubMed

    Juszkat, Robert; Zarzecka, Anna; Winckiewicz, Marek; Majewski, Wacław

    2012-01-01

    Aneurysms of the superior mesenteric are very rare and comprises 5.5% of all visceral artery aneurysms. A 60-year-old male was admitted to the General and Vascular Surgery Department due to the superior mesenteric artery (SMA) aneurysm, diagnosed in angio CT. Due to wide neck of the aneurysm and its localization in the mid-die segment of the SMA, a decision to implant a stentgraft was made. After surgical exposure of the right common femoral artery, a stentgraft Viabahn was implanted into the SMA. Control angiography revealed total aneurysm exclusion and patent SMA. Periprocedural course was uneventful. Follow-up CT scan 2 year after the procedure revealed no contrast filling of the aneurysm and patent SMA. A stentgraft implantation is a effective method of treatment of the wide-necked SMA aneurysms.

  10. A rare cause of recurrent gastrointestinal bleeding: mesenteric hemangioma

    PubMed Central

    Kazimi, Mircelal; Ulas, Murat; Ibis, Cem; Unver, Mutlu; Ozsan, Nazan; Yilmaz, Funda; Ersoz, Galip; Zeytunlu, Murat; Kilic, Murat; Coker, Ahmet

    2009-01-01

    Lower gastrointestinal hemorrhage accounts for approximately 20% of gastrointestinal hemorrhage. The most common causes of lower gastrointestinal hemorrhage in adults are diverticular disease, inflammatory bowel disease, benign anorectal diseases, intestinal neoplasias, coagulopathies and arterio-venous malformations. Hemangiomas of gastrointestinal tract are rare. Mesenteric hemangiomas are also extremely rare. We present a 25-year-old female who was admitted to the emergency room with recurrent lower gastrointestinal bleeding. An intraluminal bleeding mass inside the small intestinal segment was detected during explorative laparotomy as the cause of the recurrent lower gastrointestinal bleeding. After partial resection of small bowel segment, the histopathologic examination revealed a cavernous hemagioma of mesenteric origin. Although rare, gastrointestinal hemangioma should be thought in differential diagnosis as a cause of recurrent lower gastrointestinal bleeding. PMID:19178725

  11. Superior mesenteric venous thrombosis treated by direct aspiration thrombectomy.

    PubMed

    Nakayama, Satoshi; Murashima, Naoya; Isobe, Yoshinori

    2008-01-01

    A 69-year-old man, with hepatits C virus-related liver cirrhosis and hemophilia B, developed massive ascites and watery diarrhea after endoscopic injection sclerotherapy for esophageal varices. A multi detector row computed tomography revealed a superior mesenteric venous thrombus without bowel infarction. It was assumed that the thrombus was caused by transient congestion of the portal system after retrograde propagation of the sclerosant agent, in a condition where anticoagulation proteins, such as proteins C and S, had decreased. Because long systemic thrombolytic therapy was hazardous for the patient with hemorrhagic diathesis due to impaired coagulation, a direct thrombolysis was performed with urokinase followed by aspiration thrombectomy, with cannulation of the portal venous system using a transjugular intrahepatic approach. The patient had no complications in this procedure and subsequently diarrhea and refractory ascites were resolved. Direct thrombectomy via the transjugular intrahepatic route may be a useful therapy for mesenteric venous thrombus in the cirrhotic patient.

  12. Mesenteric gastrointestinal stromal tumour presenting as intracranial space occupying lesion

    PubMed Central

    Puri, Tarun; Gunabushanam, Gowthaman; Malik, Monica; Goyal, Shikha; Das, Anup K; Julka, Pramod K; Rath, Goura K

    2006-01-01

    Background Gastrointestinal stromal tumours (GIST) usually present with non-specific gastrointestinal symptoms such as abdominal mass, pain, anorexia and bowel obstruction. Methods We report a case of a 42 year old male who presented with a solitary intracranial space occupying lesion which was established as a metastasis from a mesenteric tumour. Results The patient was initially treated as a metastatic sarcoma, but a lack of response to chemotherapy prompted testing for CD117 which returned positive. A diagnosis of mesenteric GIST presenting as solitary brain metastasis was made, and the patient was treated with imatinib. Conclusion We recommend that all sarcomas with either an intraabdominal or unknown origin be routinely tested for CD117 to rule out GIST. PMID:17105654

  13. Feasibility of laparoscopic resection of mesenteric cysts: two case reports.

    PubMed

    Memmo, L; Belhaj, A; Mehdi, A

    2013-01-01

    Mesenteric cysts (MC) are rare intra-abdominal tumors. The incidence has been estimated to be 1/100000 in the adult population and 1/20000 in children, with a male: female ratio of 1:1. The first successful laparoscopic resection of a MC was reported by MACKENZIE et al. in 1993. The malignant transformation appears in 3% of cases. In our study, we presented the feasibility and results of laparoscopic resection. We report two cases of mesenteric cysts removed by a laparoscopic procedure. Laparoscopic approach in the two cases was successful. No conversion was observed. No complication occurred. The histopathological studies revealed no malignancy. After 18 months of follow-up the 2 patients remained free of disease. In selected cases, safe and complete resection of MC could be achieved by laparoscopic approach. Complete surgical resection of MC is the treatment of choice when the cyst becomes symptomatic or when complications occur.

  14. Oligodendrogenesis after cerebral ischemia

    PubMed Central

    Zhang, Ruilan; Chopp, Michael; Zhang, Zheng Gang

    2013-01-01

    Neural stem cells in the subventricular zone (SVZ) of the lateral ventricle of adult rodent brain generate oligodendrocyte progenitor cells (OPCs) that disperse throughout the corpus callosum and striatum where some of OPCs differentiate into mature oligodendrocytes. Studies in animal models of stroke demonstrate that cerebral ischemia induces oligodendrogenesis during brain repair processes. This article will review evidence of stroke-induced proliferation and differentiation of OPCs that are either resident in white matter or are derived from SVZ neural progenitor cells and of therapies that amplify endogenous oligodendrogenesis in ischemic brain. PMID:24194700

  15. Superior Mesenteric Artery Syndrome in a Young Military Basic Trainee

    DTIC Science & Technology

    2013-03-01

    computed tomography angiogram of the abdomen was an abnormally narrow takeoff angle of the superior mesenteric artery (SMA) from the aorta near the...loss of retroperitoneal fat , resulting in obstruction at the level of the third portion of duodenum as it is distended by food.3 It most commonly occurs...discomfort out of proportion to exam was concerning for intestinal angina. We obtained a computed tomography (CT) angiogram of the abdomen and surgical

  16. Clinical features of mesenteric lymphatic malformation in children.

    PubMed

    Kim, Soo-Hong; Kim, Hyun-Young; Lee, Cheol; Min, Hye Sook; Jung, Sung-Eun

    2016-04-01

    Mesenteric lymphatic malformations (MLs) are a heterogeneous group of benign diseases of the lymphatic system that present with cystic dilated lymphatics of the mesentery. MLs are rare and represent less than 5% of all lymphatic malformations. The aims of this study were to analyze the characteristics of MLs in children and to suggest a modified classification. We investigated 25 patients who underwent ML surgery. The clinical data and pathological findings were reviewed retrospectively. We divided the patients into 4 groups according to the operative findings. Group 1 included patients with MLs involving the intestinal walls. Group 2 included patients with pedicle-type MLs with no relationship to the mesenteric vessels. Group 3 patients presented with MLs located in the mesenteric boundaries near the mesenteric vessels. Group 4 patients had multicentric and diffusely infiltrated MLs. The male-to-female ratio was 11:14, and the median age at diagnosis was 5years of age. The most common symptom was abdominal pain. The jejunal mesentery was the most frequently involved site in this study. Five patients showed the macrocystic type and 20 patients showed the mixed cystic type. With the exception of one patient with a large mixed cystic-type ML who underwent incomplete mass excision, 24 patients underwent complete mass excision. The group 1 patients (n=14) underwent mass excision performed with segmental resection of the bowel. The group 2 patients (n=3) only underwent mass excision surgery. The patients in group 3 (n=7) underwent mass excision with segmental resection of the intestine because ML excision altered the blood supply of the adjacent intestines. The group 4 patients (n=1) presented with MLs involving the entire mesentery and underwent incomplete excision. The relationships between MLs and the neighboring organs determine the surgical strategy, and the size and location of MLs affect the operative methods. The modified classification based on these findings

  17. Postsurgical segmental mesenteric ischemic thrombosis in a horse

    PubMed Central

    Martín-Cuervo, María; Gracia, Luis A.; Vieitez, Verónica; Jiménez, Joquin; Durán, Esther; Ezquerra, Luis J.

    2013-01-01

    A 16-year-old, Lusitanian stallion was admitted to the Veterinary Teaching Hospital with a 12-hour history of signs of abdominal pain. Exploratory celiotomy was performed due to an inguinal hernia, and a second celiotomy was performed in response to the abdominal pain. The horse was euthanized and mesenteric venous thrombosis was diagnosed and considered likely due to peritonitis and systemic inflammatory response syndrome (SIRS). PMID:23814308

  18. Postsurgical segmental mesenteric ischemic thrombosis in a horse.

    PubMed

    Martín-Cuervo, María; Gracia, Luis A; Vieitez, Verónica; Jiménez, Joquin; Durán, Esther; Ezquerra, Luis J

    2013-01-01

    A 16-year-old, Lusitanian stallion was admitted to the Veterinary Teaching Hospital with a 12-hour history of signs of abdominal pain. Exploratory celiotomy was performed due to an inguinal hernia, and a second celiotomy was performed in response to the abdominal pain. The horse was euthanized and mesenteric venous thrombosis was diagnosed and considered likely due to peritonitis and systemic inflammatory response syndrome (SIRS).

  19. [Large mesenteric cyst in a patient suspected of ovarian cyst].

    PubMed

    Czubalski, Andrzej; Barwijuk, Andrzej; Radiukiewicz, Grzegorz

    2004-07-01

    Mesenteric cystic tumors are very rare. They may simulate the ovarian cysts. We report a case of a 38 year-old woman with large cystic tumor suggesting ovarian cyst. The patient was operated on and we found that genital organs were normal. Besides there was a large cyst of small intestine mesentery with 10 liters of clear fluid. The cyst was removed. Histological material showed mucinous cystadenoma.

  20. Benign mesothelial mesenteric cyst: case report and literature review.

    PubMed

    Prudnick, Colton; Turnbull, Jacob; Jarosz, Susan; Hofeldt, Matthew; Richmond, Bryan

    2015-01-01

    A rare case of a benign mesothelial cyst arising from the mesentery of the descending colon is presented. A 73 year old female presented with an asymptomatic mesenteric cyst on CT scan. Colonoscopy revealed extrinsic compression of the descending colon. Surgical resection of the cyst necessitated partial colon resection due to the adherent nature of the cyst to the colon and its mesentery. The details of the case are presented as well as a brief review of the relevant literature.

  1. Rho-kinase inhibitor reduces hypersensitivity to ANG II in human mesenteric arteries retrieved and conserved under the same conditions as transplanted organs.

    PubMed

    Szadujkis-Szadurski, Rafal; Slupski, Maciej; Szadujkis-Szadurska, Katarzyna; Szadujkis-Szadurski, Leszek; Jasinski, Milosz; Grzesk, Grzegorz; Grzesk, Elżbieta; Woderska, Aleksandra; Wlodarczyk, Zbigniew

    2014-08-22

    Rho-kinase and GTP-ase Rho are important regulators of vascular tone and blood pressure. The aim of this study was to investigate the role of Rho-kinase in artery reactions induced by angiotensin II (ANG II) and the effects of ischemia-reperfusion injury as well as the function of intra- and extracellular calcium in these reactions. Experiments were performed on mesenteric superior arteries procured from cadaveric organ donors and conserved under the same conditions as transplanted kidneys. The vascular contraction in reaction to ANG II was measured in the presence of Rho-kinase inhibitor Y-27632, after ischemia and reperfusion, in Ca2+ and Ca2+-free solution. The maximal response to ANG II was reduced after ischemia, while an increase was observed after reperfusion. Vascular contraction induced by ANG II was decreased by Y-27632. Y-27632 reduced vascular contraction after reperfusion, both in Ca2+ and Ca2+-free solution. Reperfusion augments vascular contraction in reaction to ANG II. The Rho-kinase inhibitor Y-27632 reduces the hypersensitivity to ANG II after reperfusion mediated by both intra- and extracellular calcium. These results confirm the role of Rho-kinase in receptor-independent function of ANG II and in reperfusion-induced hypersensitivity.

  2. d-lactate as a marker of venous-induced intestinal ischemia: an experimental study in pigs.

    PubMed

    Nielsen, Casper; Lindholt, Jes S; Erlandsen, Erland J; Mortensen, Frank V

    2011-01-01

    Intestinal ischemia is difficult to diagnose. The search for biomarkers has led to an increased interest in d-lactate. d-lactate measured in higher concentrations arises from bacterial fermentation in the gastrointestinal tract. Permeable intestinal wall is an early consequence of intestinal ischemia, which allows d-lactate to enter the portal circulation. The superior mesenteric vein was clamped in eight pigs for two hours to induce ischemia of the intestine. Eight sham-operated pigs served as controls. Systemic and portal plasma d- and l-lactate, l-LDH and leukocytes were measured. Plasma d-lactate increased significantly and nearly simultaneously in the systemic and portal circulation. After 75 min, samples from the jugular vein showed concentrations of .019 ± .008 mmol/L in the sham group and .042 ± .022 mmol/L in the intervention group (P = .023). A similar significant effect was seen in the portal circulation after 90 min. l-lactate increased five minutes after clamping in the portal circulation, with values of 3.396 ± 1.119 mmol/L in the intervention group compared to 1.696 ± .483 mmol/L in the control group (P = .006). l-LDH increased significantly in the intervention group, while leukocytes were unaffected. l-LDH and l-lactate in plasma led to an overestimation of d-lactate if not handled. Both systemic d- and l-lactate were markers of venous-induced intestinal ischemia. We speculate that d-lactate may be a valuable aid to the clinician in search of the anaerobic focus, because it may be more specific for mesenteric ischemia than l-lactate, in the sense that it is of bacterial origin. Copyright © 2011 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  3. An uncommon cause of abdominal pain: Mesenteric cyst

    PubMed Central

    Ünlüer, Erden Erol; Ünlüer, Seran; Şahı̇n, Yusuf; Kamer, Kemal Erdı̇nç; Karagöz, Arı̇f; Tan, Gözde Canan

    2016-01-01

    Mesenteric cysts are benign cystic lesions. Here, we present the case of a patient with abdominal pain, which was diagnosed as mesenteric cyst. A 28-year-old male patient was admitted to the emergency department (ED) with abdominal pain and distention. Abdominal palpation revealed a smooth-surfaced mass palpable in the left upper quadrant. Ultrasonography depicted a hypoechoic heterogeneous mass-like structure with a size of 15 × 12 cm. Computerized tomography (CT) showed a well-defined cystic structure with a size of 12 × 12.5 cm near to the duodenum and pancreas. The patient was admitted, and the cystic structure was drained with a percutaneous drainage catheter; then, sclerotherapy was performed using ethyl alcohol with the aid of ultrasonography. The material was sent to the pathology lab and revealed negative results for malignant cell and mucin. The patient underwent a control CT with contrast, which revealed the catheter at the site of the operation and no cystic lesion after procedure. He was discharged 1 week after the procedure. Mesenteric cysts are extremely rare benign lesions of the abdomen, and emergency physicians must consider this disease in the differential diagnosis of abdominal pain. The percutaneous drainage technique performed on our patient is a safe technique for the treatment of selected patients. PMID:28250978

  4. An uncommon cause of abdominal pain: Mesenteric cyst.

    PubMed

    Ünlüer, Erden Erol; Ünlüer, Seran; Şahı N, Yusuf; Kamer, Kemal Erdı Nç; Karagöz, Arı F; Tan, Gözde Canan

    2016-03-01

    Mesenteric cysts are benign cystic lesions. Here, we present the case of a patient with abdominal pain, which was diagnosed as mesenteric cyst. A 28-year-old male patient was admitted to the emergency department (ED) with abdominal pain and distention. Abdominal palpation revealed a smooth-surfaced mass palpable in the left upper quadrant. Ultrasonography depicted a hypoechoic heterogeneous mass-like structure with a size of 15 × 12 cm. Computerized tomography (CT) showed a well-defined cystic structure with a size of 12 × 12.5 cm near to the duodenum and pancreas. The patient was admitted, and the cystic structure was drained with a percutaneous drainage catheter; then, sclerotherapy was performed using ethyl alcohol with the aid of ultrasonography. The material was sent to the pathology lab and revealed negative results for malignant cell and mucin. The patient underwent a control CT with contrast, which revealed the catheter at the site of the operation and no cystic lesion after procedure. He was discharged 1 week after the procedure. Mesenteric cysts are extremely rare benign lesions of the abdomen, and emergency physicians must consider this disease in the differential diagnosis of abdominal pain. The percutaneous drainage technique performed on our patient is a safe technique for the treatment of selected patients.

  5. Effect of Clinical Suspicion by Referral Physician and Early Outcomes in Patients with Acute Superior Mesenteric Artery Embolism

    PubMed Central

    Kim, Hyung-Kee; Hwang, Deokbi; Park, Sujin; Huh, Seung; Lee, Jong-Min; Yun, Woo-Sung; Kim, Young-Wook

    2017-01-01

    Purpose To investigate the pattern of referral of patients with superior mesenteric artery embolism (SMAE) and its effect on outcomes, and to evaluate the risk factors for bowel infarction. Materials and Methods This retrospective study included 66 consecutive patients diagnosed with acute SMAE between January 2001 and June 2016. Appropriate diagnosis by the referring physician was defined if the referral letter indicated that acute mesenteric ischemia was suspected or had been diagnosed at the referral center. Surgical delay was defined as the interval between symptom onset and surgery for definitive treatment. Results Among 54 patients transferred from other centers, 26 patients (48.1%) were diagnosed appropriately by the referring physician. The rate of appropriate diagnosis was differed significantly by the use of computed tomography (CT) scan at referral center (25/35 with CT and 1/19 without CT, P=0.00). The surgical delay was significantly longer in patients without appropriate diagnosis compared with the patients with appropriate diagnosis (53.5±52.3 hours vs. 28.8±23.6 hours, P=0.04). Initially, 56 patients received surgical treatment with 31 underwent bowel resection due to infarction, 6 received conservative treatment, and the remaining 4 patients refused any treatment. The surgical delay, abdominal distension, tenderness, rebound tenderness, and level of C-reactive protein were associated with bowel infarction at initial operation. Overall in-hospital mortality was 32%. Conclusion A high index of suspicion with appropriate diagnostic modality, such as CT scan is crucial in patients with SMAE for reducing surgical delay as a risk factor of bowel infarction. PMID:28955699

  6. Successful Treatment of Isolated Spontaneous Superior Mesenteric Artery Dissection with Stent Placement

    SciTech Connect

    Yoon, Young-Won; Choi, Donghoon; Cho, Seung-Yun; Lee, Do Yun

    2003-09-15

    Isolated dissection of superior mesenteric artery is a rare condition and is usually treated surgically. We treated a patient with severe abdominal pain who was angiographically confirmed to have superior mesenteric artery thrombosis associated with isolated spontaneous dissection. He was treated initially by thrombolysis and oral anticoagulation, but recurrent symptoms developed with radiologic evidence of disease progression. We performed superior mesenteric artery stenting and recovery was uneventful.

  7. The curcumin induced vasorelaxation in rat superior mesenteric arteries.

    PubMed

    Zhang, Han; Liu, Huanhuan; Chen, Yulong; Zhang, Yan

    2017-09-21

    Curcumin (Cur) is a natural lipophilic polyphenol compound extracted from the rhizome of turmeric. Recently, protective effect of Cur on cardiovascular system is pay close attention. Some researches demonstrated that Cur could induce vascular relaxation in many arterial beds. However, relaxant effect of Cur on rat superior mesenteric artery is not clear. The present study will investigate the vasorelaxant effect of Cur on rat superior mesenteric arteries and the mechanisms involved. The isometric tension of rat superior mesenteric arterial rings was recorded by a sensitive myograph system in vitro. The vasodilation of Cur at various concentrations ( range from 10(-8)-10(-4)M) on potassium chloride (KCl,60mmol/L) or phenylephrine (PE,10μmol/L)-precontracted arterial rings were observed.We also observed vasorelaxant effect of Cur on KCl (60mM)-preconstricted rat superior mesenteric arterial rings after incubating inhibitors of Endothelial mechanism, the endothelial NO synthase (eNOS) inhibitor L-NAME, the guanylate cyclase inhibitor ODQ and the cyclooxygenase inhibitor Indo, and inhibitors of Potassium ion channel, 4-AP (KV channels blockers), and TEA (KCa channels blockers), and BaCL2 (Kir channels blockers), and Glib (KATP channels blockers), respectively. The effects of Cur are expressed as percentage of relaxation from the pre-contraction induced by KCl (60mmol/L) or PE (10μmol/L). The Emax value refers to the maximum relaxation. The pD2 value refers to the negative logarithmic value of the drug concentration that produces 50% Emax. Cur concentration-dependently relaxed the superior mesenteric artery rings with endothelium pre-contracted by PE (Emax=84.33 ± 1.11%, pD2=5.03 ± 0.02) or KCl (Emax=80.96 ± 2.12%; pD2=4.32 ± 0.01). The vasorelaxant effect of Cur on the superior mesenteric artery rings relied on endothelium partially. Indomethacin (5 μM) significantly inhibited the effect. Hovever, 1H-[1,2,4]Oxadiazolo[4,3-a]quinoxalin-1-one (10 μM) and N

  8. Impaired function of alpha-2 adrenoceptors in smooth muscle of mesenteric arteries from spontaneously hypertensive rats.

    PubMed

    Feres, T; Borges, A C; Silva, E G; Paiva, A C; Paiva, T B

    1998-11-01

    The alpha2-adrenoceptor function in mesenteric arteries of spontaneously hypertensive rats (SHR) was investigated by comparing membrane potential changes in response to adrenergic agonists in preparations from female SHR, Wistar-Kyoto (WKY) and normotensive Wistar rats (NWR). Resting membrane potential was found to be less negative in mesenteric arteries from SHR than in those from NWR and WKY. Apamin induced a decrease in the membrane potential of mesenteric artery rings without endothelium from NWR and WKY, but had no effects in those from SHR. Both UK 14,304 and adrenaline, in the presence of prazosin, induced a hyperpolarization that was significantly lower in de-endothelialized mesenteric rings from SHR than in those from NWR and WKY. In mesenteric rings with endothelium, however, similar hyperpolarization was observed in the three strains. In NWR mesenteric rings with endothelium the hyperpolarization induced by activation of alpha2-adrenoceptors was abolished by apamin, whereas in intact SHR mesenteric rings this hyperpolarization was slightly reduced by apamin and more efficiently reduced by Nomega-nitro-L-arginine. It is concluded that the activity of potassium channels coupled to alpha2-adrenoceptors is altered in the smooth muscle cells of SHR mesenteric arteries, contributing to their less negative membrane potential. On the other hand, the endothelial alpha2-receptors are functioning in mesenteric vessels from SHR and their stimulation induces a hyperpolarization mainly through the release of nitric oxide.

  9. Extensive Sclerosing Mesenteritis of the Rectosigmoid Colon Associated with Erosive Colitis

    PubMed Central

    Nobili, C.; Degrate, L.; Caprotti, R.; Franciosi, C.; Leone, B. E.; Romano, F.; Dinelli, M.; Uggeri, Fr.

    2009-01-01

    Sclerosing mesenteritis is a rare, idiopatic, usually benign, inflammatory process of the mesenteric adipose tissue. The most common site of involvement is the small bowel mesentery. We present a case of sclerosing mesenteritis of the rectosigmoid colon as a cause of severe abdominal pain, abdominal obstruction, and ischemic colic mucosal lesions. Contrast enema, colonoscopy, angiography, and CT were the imaging modalities used. A 20 cm diameter, fibrotic mass causing extensive compression of rectosigmoid colon was found at laparotomy. Histological examination showed extended fibrosis, inflammatory cells infiltration, lipophages, and granulomas within the mesenteric adipose tissue associated with erosive colitis. Clinical presentation and treatment are discussed. PMID:19365585

  10. Mast cells drive mesenteric afferent signalling during acute intestinal ischaemia.

    PubMed

    Jiang, Wen; Kirkup, Anthony J; Grundy, David

    2011-08-01

    Acute intestinal ischaemia stimulates visceral afferent nerves but the mechanisms responsible for this excitation are not fully understood. Mast cells may participate in this process as they are known to signal to mesenteric afferents during intestinal anaphylaxis and contribute to early inflammation and neuronal damage in response to cerebral ischaemia. We therefore hypothesised that mast cells are early responders to acute intestinal ischaemia and their activation initiates rapid signalling to the CNS via the excitation of mesenteric afferents. Primary afferent firing was recorded from a mesenteric nerve bundle supplying a segment of jejunum in anaesthetized adult rats. Acute focal ischaemia was produced by clamping theme senteric vessels for 8 min, and reperfusion followed removal of the vessel clip. Two episodes of ischaemia–reperfusion (I–R) separated by a 30 min interval were performed. Drugs or their vehicles were administered 10 min before the 2nd I–R episode. Ischaemia caused a reproducible, intense and biphasic afferent firing that was temporally dissociated from the concomitantly triggered complex pattern of intestinal motor activity. The L-type calcium channel blocker, nifedipine, significantly attenuated this afferent firing by a mechanism independent of its action on intestinal tone. Ischaemia-induced afferent firing was also abrogated by the mast cell stabilizer, doxantrazole, and the H1 histamine receptor antagonist, pyrilamine. In contrast, the nicotinic receptor antagonist, hexamethonium, and the N-type calcium channel toxin, ω-conotoxin GVIA, each reduced the ischaemia-evoked motor inhibition but not the concurrent afferent discharge. Similarly, the cyclooxygenase inhibitor, naproxen, had no effect on the ischaemic afferent response but reduced the intestinal tone shortly from the onset of ischaemia to the early period of reperfusion. These data support a critical role for mast cell-derived histamine in the direct chemoexcitation of

  11. Superior Mesenteric Artery Dissection after Extracorporeal Shockwave Lithotripsy

    PubMed Central

    Bakoyiannis, Christos; Anastasiou, Ioannis; Koutsoumpelis, Andreas; Fragiadis, Evangelos; Felesaki, Eleni; Kafeza, Marina; Georgopoulos, Sotirios; Tsigris, Christos

    2012-01-01

    The use of shockwave lithotripsy is currently the mainstay of treatment in renal calculosis. Several complications including vessel injuries have been implied to extracorporeal shockwave lithotripsy. We report an isolated dissection of the superior mesenteric artery in a 60-year-old male presenting with abdominal pain which occurred three days after extracorporeal shockwave lithotripsy. The patient was treated conservatively and the abdominal pain subsided 24 hours later. The patient's history, the course of his disease, and the timing may suggest a correlation between the dissection and the ESWL. PMID:23304627

  12. Current Understandings of Spontaneous Isolated Superior Mesenteric Artery Dissection

    PubMed Central

    Kim, Young-Wook

    2016-01-01

    Spontaneous isolated superior mesenteric artery dissection (SISMAD) has been known as a rare vascular disease. However it is increasingly reported in these days with the development of advanced imaging technology. Underlying etiology, natural course or an optimal management strategy of SISMAD is not exactly known at the moment. During the past 10 years, we have had an interest in this rare vascular disease and collected clinical and image data in 100 or more patients with SISMAD. In this review article, I would like to describe my current understanding of SISMAD on the base of our recent publications in the major vascular surgery journals. PMID:27386450

  13. Use of bovine mesenteric vein in rescue vascular access surgery.

    PubMed

    Benedetto, Filippo; Carella, Giuseppe; Lentini, Salvatore; Barillà, David; Stilo, Francesco; De Caridi, Giovanni; Spinelli, Francesco

    2010-01-01

    We describe a technique for rescue surgery of autologous arterovenous fistula (AVF), using bovine mesenteric vein (BMV), which may be used in patients with autologous AVF malfunction caused by steno-occlusion on the arterial side or by fibrosis of the first portion of the vein. To preserve the autologous AVF, we replaced the diseased portion of the artery, or the first centimeters of the vein, by a segment of BMV, with the aim of saving the patency and functionality of the access. We used this technique in 16 cases. All patients underwent hemodialysis treatment immediately after the procedure. Infection or aneurismal dilatation of the graft in implanted BMV was never observed.

  14. Successful nutritional therapy for superior mesenteric artery syndrome.

    PubMed

    Chan, Dedrick Kok Hong; Mak, Kenneth Seck Wai; Cheah, Yee Lee

    2012-11-01

    Superior mesenteric artery (SMA) syndrome is an uncommon cause of duodenal outlet obstruction. Symptoms and signs suggestive of this condition are nonspecific, and a high index of suspicion coupled with appropriate imaging studies are necessary for diagnosis. We present the case of a 70-year-old man who developed SMA syndrome following prolonged hospitalisation for a surgically treated bleeding duodenal ulcer. His SMA syndrome resolved after successful nonoperative management based on accepted guidelines for nutritional therapy, thus avoiding the need for reoperation and its attendant risks in a malnourished patient.

  15. Superior Mesenteric Artery Syndrome Treated with Percutaneous Radiologic Gastrojejunostomy.

    PubMed

    Choi, Jeong Woo; Lee, Ju Young; Cho, Hyeon Geun

    2016-06-25

    Superior mesenteric artery (SMA) syndrome is a rare condition that must be differentiated from other gastrointestinal diseases manifesting as upper abdominal pain, nausea, or vomiting. The description of SMA syndrome is compression of the third portion of the duodenum by the SMA and the abdominal aorta. SMA syndrome is managed with nasoenteral nutrition or surgical strategies such as laparoscopic duodenojejunostomy. However, SMA syndrome treated using enteral nutrition by percuta-neous radiologic gastrojejunostomy has not been reported. Here, we report our experience of successfully managing a case of SMA syndrome with percutaneous radiologic gastrojejunostomy.

  16. Farnesoid X Receptor Activation Attenuates Intestinal Ischemia Reperfusion Injury in Rats

    PubMed Central

    Decuypere, Jean-Paul; Farré, Ricard; De Hertogh, Gert; Lenaerts, Kaatje; Jochmans, Ina; Monbaliu, Diethard; Nevens, Frederik; Tack, Jan; Laleman, Wim; Pirenne, Jacques

    2017-01-01

    Introduction The farnesoid X receptor (FXR) is abundantly expressed in the ileum, where it exerts an enteroprotective role as a key regulator of intestinal innate immunity and homeostasis, as shown in pre-clinical models of inflammatory bowel disease. Since intestinal ischemia reperfusion injury (IRI) is characterized by hyperpermeability, bacterial translocation and inflammation, we aimed to investigate, for the first time, if the FXR-agonist obeticholic acid (OCA) could attenuate intestinal ischemia reperfusion injury. Material and Methods In a validated rat model of intestinal IRI (laparotomy + temporary mesenteric artery clamping), 3 conditions were tested (n = 16/group): laparotomy only (sham group); ischemia 60min+ reperfusion 60min + vehicle pretreatment (IR group); ischemia 60min + reperfusion 60min + OCA pretreatment (IR+OCA group). Vehicle or OCA (INT-747, 2*30mg/kg) was administered by gavage 24h and 4h prior to IRI. The following end-points were analyzed: 7-day survival; biomarkers of enterocyte viability (L-lactate, I-FABP); histology (morphologic injury to villi/crypts and villus length); intestinal permeability (Ussing chamber); endotoxin translocation (Lipopolysaccharide assay); cytokines (IL-6, IL-1-β, TNFα, IFN-γ IL-10, IL-13); apoptosis (cleaved caspase-3); and autophagy (LC3, p62). Results It was found that intestinal IRI was associated with high mortality (90%); loss of intestinal integrity (structurally and functionally); increased endotoxin translocation and pro-inflammatory cytokine production; and inhibition of autophagy. Conversely, OCA-pretreatment improved 7-day survival up to 50% which was associated with prevention of epithelial injury, preserved intestinal architecture and permeability. Additionally, FXR-agonism led to decreased pro-inflammatory cytokine release and alleviated autophagy inhibition. Conclusion Pretreatment with OCA, an FXR-agonist, improves survival in a rodent model of intestinal IRI, preserves the gut barrier

  17. Acute thromboembolic occlusion of the superior mesenteric artery following covered stent occlusion in the superior mesenteric artery: endovascular therapy using mechanical rotational thrombectomy.

    PubMed

    Goltz, Jan P; Petritsch, Bernhard; Spor, Leo; Hahn, Dietbert; Kickuth, Ralph

    2012-09-01

    Acute thromboembolic occlusion of the superior mesenteric artery is a rare and often fatal condition in which surgery represents the golden standard in therapy. We present a case in which a patient was treated with covered stent implantation for acute bleeding from the superior mesenteric artery following pancreatic resection, radiation, and embolization of a hepatic artery pseudoaneurysm. Some weeks later clinical signs were suggestive of acute thromboembolic occlusion of the superior mesenteric artery and digital subtraction angiography showed occlusion of the previously implanted covered stents. The patient was successfully treated transfemorally with percutaneous mechanical instent thrombectomy using a 6F Rotarex® catheter. We conclude that in selected cases percutaneous mechanical thrombectomy may represent a minimally-invasive alternative to open surgical thrombectomy for treatment of acute thromboembolic occlusion of the superior mesenteric artery.

  18. Intestinal ischemia and reperfusion injury in growing rats: hypothermia and N-acetylcysteine modulation.

    PubMed

    Montero, Edna F S; Abrahão, Marcos S; Koike, Márcia K; Manna, Mônica C B; Ramalho, Carlos E B

    2003-01-01

    Our objective was to evaluate intestinal ischemia-reperfusion injury in growing rats, modulated by hypothermia (I/RH) and N-acetylcysteine (NAC). We used 30 EPM-1 Wistar male rats, aged around 35 days, weighing 90 g. Rats were randomized into 5 groups with 6 animals in each: I/RH group, intestinal ischemia under hypothermia for 40 min and reperfusion for 30 min; I/RH-NAC group, same procedure but adding NAC (150 mg x kg(-1)), previously with ischemia; S-H group, topic hypothermia for 40 min, and observation for 30 min; I/R H-Ve group; and S-NAC group, NAC administration and observation for 70 min. All animals were heparinized and anesthetized with ketamine (60 mg kg(-1)) and xylazine (10 mg kg(-1)) intramuscularly. Surgical procedures were done under microsurgical technique (augmentation, 10x). After laparotomy, the superior mesenteric artery was dissected and clamped to promote ischemia. Topic hypothermia was obtained by using plastic bags at 4 degrees C, changed every 10 min. Rats were sacrificed by exsanguination, and blood samples were utilized to measure D(-)lactate. Intestinal fragments were removed for morphological study. Statistical analysis was done with nonparametric tests (P ischemia and reperfusion were associated to hypothermia (I/RH = 36 mg/dl). NAC decreased ischemia-reperfusion injury (I/RH-NAC = 19 mg/dl). Morphologic tissue injuries, evaluated by hematoxylin-eosin staining, showed grades 4 and 5 for the I/RH and I/RH-Ve groups, respectively, in contrast with other groups (I/RH-NAC = 2, S-H = 1, and S-NAC = 1). Based on our data, we conclude that intestinal ischemia reperfusion injury occurred morphologically as well as functionally, even under hypothermia. However, NAC showed a protective effect on the small bowel from ischemia-reperfusion injury.

  19. TRPM8 Channel Activation Induced by Monoterpenoid Rotundifolone Underlies Mesenteric Artery Relaxation

    PubMed Central

    Silva, Darizy Flavia; de Almeida, Monica Moura; Chaves, Cinthia Guedes; Braz, Ana Letícia; Gomes, Maria Aparecida; Pinho-da-Silva, Leidiane; Pesquero, Jorge Luiz; Andrade, Viviane Aguiar; Leite, Maria de Fátima; de Albuquerque, José George Ferreira; Araujo, Islania Giselia Albuquerque; Nunes, Xirley Pereira; Barbosa-Filho, José Maria; Cruz, Jader dos Santos; Correia, Nadja de Azevedo; de Medeiros, Isac Almeida

    2015-01-01

    In this study, our aims were to investigate transient receptor potential melastatin-8 channels (TRPM8) involvement in rotundifolone induced relaxation in the mesenteric artery and to increase the understanding of the role of these thermosensitive TRP channels in vascular tissue. Thus, message and protein levels of TRPM8 were measured by semi-quantitative PCR and western blotting in superior mesenteric arteries from 12 week-old Spague-Dawley (SD) rats. Isometric tension recordings evaluated the relaxant response in mesenteric rings were also performed. Additionally, the intracellular Ca2+ changes in mesenteric artery myocytes were measured using confocal microscopy. Using PCR and western blotting, both TRPM8 channel mRNA and protein expression was measured in SD rat mesenteric artery. Rotundifolone and menthol induced relaxation in the isolated superior mesenteric artery from SD rats and improved the relaxant response induced by cool temperatures. Also, this monoterpene induced an increase in transient intracellular Ca2+. These responses were significantly attenuated by pretreatment with capsazepine or BCTC, both TRPM8 channels blockers. The response induced by rotundifolone was not significantly attenuated by ruthenium red, a non-selective TRP channels blocker, or following capsaicin-mediated desensitization of TRPV1. Our findings suggest that rotundifolone induces relaxation by activating TRPM8 channels in rat superior mesenteric artery, more selectively than menthol, the classic TRPM8 agonist, and TRPM8 channels participates in vasodilatory pathways in isolated rat mesenteric arteries. PMID:26599698

  20. TRPM8 Channel Activation Induced by Monoterpenoid Rotundifolone Underlies Mesenteric Artery Relaxation.

    PubMed

    Silva, Darizy Flavia; de Almeida, Monica Moura; Chaves, Cinthia Guedes; Braz, Ana Letícia; Gomes, Maria Aparecida; Pinho-da-Silva, Leidiane; Pesquero, Jorge Luiz; Andrade, Viviane Aguiar; Leite, Maria de Fátima; de Albuquerque, José George Ferreira; Araujo, Islania Giselia Albuquerque; Nunes, Xirley Pereira; Barbosa-Filho, José Maria; Cruz, Jader dos Santos; Correia, Nadja de Azevedo; de Medeiros, Isac Almeida

    2015-01-01

    In this study, our aims were to investigate transient receptor potential melastatin-8 channels (TRPM8) involvement in rotundifolone induced relaxation in the mesenteric artery and to increase the understanding of the role of these thermosensitive TRP channels in vascular tissue. Thus, message and protein levels of TRPM8 were measured by semi-quantitative PCR and western blotting in superior mesenteric arteries from 12 week-old Spague-Dawley (SD) rats. Isometric tension recordings evaluated the relaxant response in mesenteric rings were also performed. Additionally, the intracellular Ca2+ changes in mesenteric artery myocytes were measured using confocal microscopy. Using PCR and western blotting, both TRPM8 channel mRNA and protein expression was measured in SD rat mesenteric artery. Rotundifolone and menthol induced relaxation in the isolated superior mesenteric artery from SD rats and improved the relaxant response induced by cool temperatures. Also, this monoterpene induced an increase in transient intracellular Ca2+. These responses were significantly attenuated by pretreatment with capsazepine or BCTC, both TRPM8 channels blockers. The response induced by rotundifolone was not significantly attenuated by ruthenium red, a non-selective TRP channels blocker, or following capsaicin-mediated desensitization of TRPV1. Our findings suggest that rotundifolone induces relaxation by activating TRPM8 channels in rat superior mesenteric artery, more selectively than menthol, the classic TRPM8 agonist, and TRPM8 channels participates in vasodilatory pathways in isolated rat mesenteric arteries.

  1. Successful Treatment of Mesenteric Varices After Living Donor Liver Transplantation with Retrograde Transvenous Obliteration Via an Abdominal Wall Vein

    SciTech Connect

    Ikeda, Osamu Tamura, Yoshitaka; Nakasone, Yutaka; Yamashita, Yasuyuki; Okajima, Hideaki; Asonuma, Katsuhiro; Inomata, Yukihiro

    2010-06-15

    Balloon-occluded retrograde transvenous obliteration is an established treatment for gastric varices; it has been used more rarely to treat mesenteric varices. We report a 12-year-old girl who had received a living donor liver transplant and suffered melena due to ruptured mesenteric varices. We addressed treatment of the mesenteric varices by retrograde transvenous obliteration of an abdominal wall collateral vein detected by superior mesenteric arteriography.

  2. Sclerosing Mesenteritis: Multidisciplinary Collaboration Is Essential for Diagnosis and Treatment.

    PubMed

    He, Huan; Zhi, Min; Zhang, Min; Su, Mingli; Chen, Huangwei; Kang, Liang; Huang, Yan; Zhou, Zhiyang; Gao, Xiang; Wang, Jianping; Hu, Pinjin

    2017-02-01

    Sclerosing mesenteritis (SM) is an extremely rare disease characterized by chronic non-specific inflammation, fat necrosis and fibrosis of the mesentery. We presented a 77-year-old man with progressive dyschezia, abdominal pain and mass in left lower quadrant. Computed tomography (CT) exhibited a thickened mesentery, enlarged lymph nodes and strand-like densities around the mesenteric vessels. However, laboratory investigation, colonoscopy and positron emission tomography did not provide any specific results for diagnosis. Because of the exacerbating abdominal pain, partial colectomy was performed and SM was diagnosed based on the pathological changes of mesentery including fat necrosis, multifocal lipid-filled macrophages, lymphocytes and multifocal fibrosis. Although SM is difficult to diagnose and often found by incident, progressive deterioration of abdominal symptoms and general status alteration are indicators of SM. Some typical imaging and pathologic manifestations are also helpful to SM diagnosis. There is no standard treatment for SM. Operation is preferred in those at the stage of fibrosis and particularly combined with intestinal obstruction. Therefore, a multidisciplinary collaboration is essential to diagnose and manage this rare disease, with combined approaches in gastroenterology, colorectal surgery, pathology and radiology.

  3. Crohn's disease mistaken for long-standing idiopathic mesenteric panniculitis

    PubMed Central

    Nuzzo, Alexandre; Zappa, Magaly; Cazals-Hatem, Dominique; Bouhnik, Yoram

    2016-01-01

    Abstract Background: Mesenteric panniculitis (MP) is mostly an associated sign of an intra-abdominal or systemic inflammatory primary disease. Nevertheless, etiological and differential diagnosis of idiopathic MP can be challenging when an associate primary cause is not in the foreground. Methods: We report here the case of an isolated small bowel Crohn's disease, long time considered as idiopathic MP. Results: This patient presented to our department with a 10-year history of acute abdominal symptoms evolving with flare-up and remission. A diagnosis of idiopathic MP was made based on compatible CT-scan features along with normal laboratory tests and upper and lower bowel endoscopies. As symptoms recurred, a steroid course was proposed which dramatically improved his condition for years. Finally, an explorative laparoscopy was performed because of concern of malignancy when he returned to our unit with a steroid refractory flare-up and weight loss, along with MP nodes growing up to 10 mm. Crohn's disease was eventually diagnosed, based on histopathological middle-gut bowel resection and numerous granulomas in mesenteric nodes without necrosis. Conclusion: This case emphasizes the importance of excluding inflammatory intestinal lesions before making the diagnosis of idiopathic MP (fecal calprotectin, magnetic resonance enterography, wireless capsule endoscopy). PMID:27684882

  4. Phlegmonous gastritis secondary to superior mesenteric artery syndrome.

    PubMed

    Nomura, Kosuke; Iizuka, Toshiro; Yamashita, Satoshi; Kuribayashi, Yasutaka; Toba, Takahito; Yamada, Akihiro; Furuhata, Tsukasa; Kikuchi, Daisuke; Matsui, Akira; Mitani, Toshifumi; Ogawa, Osamu; Hoteya, Shu; Inoshita, Naoko; Kaise, Mitsuru

    2015-01-01

    We herein report a case of phlegmonous gastritis secondary to superior mesenteric artery syndrome. An 80-year-old woman visited the hospital emergency department with the chief complaints of epigastric pain and vomiting. She was hospitalized urgently following the diagnosis of superior mesenteric artery syndrome based on abdominal computed tomography findings. Conservative therapy was not effective, and phlegmonous gastritis was diagnosed based on the findings of upper gastrointestinal endoscopy and biopsy performed on the 12th day of the disease. Undernutrition and reduced physical activity were observed on hospital admission, and proactive nutritional therapy with enteral nutrition was started. An upper gastrointestinal series, performed approximately 1 month later, confirmed the persistence of strictures and impaired gastric emptying. Because conservative therapy was unlikely to improve oral food intake, open total gastrectomy was performed on the 94th day of the disease. Examination of surgically resected specimens revealed marked inflammation and fibrosis, especially in the body of the stomach. Following a good postoperative recovery, the patient was able to commence oral intake and left our hospital on foot approximately 1 month after surgery.

  5. Sclerosing Mesenteritis: Multidisciplinary Collaboration Is Essential for Diagnosis and Treatment

    PubMed Central

    He, Huan; Zhi, Min; Zhang, Min; Su, Mingli; Chen, Huangwei; Kang, Liang; Huang, Yan; Zhou, Zhiyang; Gao, Xiang; Wang, Jianping; Hu, Pinjin

    2017-01-01

    Sclerosing mesenteritis (SM) is an extremely rare disease characterized by chronic non-specific inflammation, fat necrosis and fibrosis of the mesentery. We presented a 77-year-old man with progressive dyschezia, abdominal pain and mass in left lower quadrant. Computed tomography (CT) exhibited a thickened mesentery, enlarged lymph nodes and strand-like densities around the mesenteric vessels. However, laboratory investigation, colonoscopy and positron emission tomography did not provide any specific results for diagnosis. Because of the exacerbating abdominal pain, partial colectomy was performed and SM was diagnosed based on the pathological changes of mesentery including fat necrosis, multifocal lipid-filled macrophages, lymphocytes and multifocal fibrosis. Although SM is difficult to diagnose and often found by incident, progressive deterioration of abdominal symptoms and general status alteration are indicators of SM. Some typical imaging and pathologic manifestations are also helpful to SM diagnosis. There is no standard treatment for SM. Operation is preferred in those at the stage of fibrosis and particularly combined with intestinal obstruction. Therefore, a multidisciplinary collaboration is essential to diagnose and manage this rare disease, with combined approaches in gastroenterology, colorectal surgery, pathology and radiology. PMID:28270878

  6. Mesenteric Neovascularization with Distraction-Induced Intestinal Growth: Enterogenesis

    PubMed Central

    Ralls, Matthew W.; Sueyoshi, Ryo; Herman, Richard S.; Utter, Brent; Czarnocki, Isabel; Si, Nancy; Luntz, Jonathan; Brei, Diann; Teitelbaum, Daniel H.

    2012-01-01

    Background Distraction-induced enterogenesis, whereby the intestine lengthens with application of linear forces, is an emerging area which may provide a unique treatment for short bowel syndrome (SBS). With an increase in overall tissue mass, there is an increase in oxygen and nutrient demand. We hypothesized that a neovascularization within the mesentery is necessary to support the growing small bowel. Methods A curvilinear hydraulic device was used to induce growth within the small bowel of Yorkshire pigs, and the intestine was harvested after 14 days. High-resolution, gross pictures were recorded of the mesentery at implantation and at harvest, and CT imaging of the bowel and mesentery was performed at harvest after dye injection. Results After 2 weeks of distraction, an average of 72.5% (8.7cm) bowel lengthening was achieved. Gross images of the mesentery between major vessels showed a blossoming of the microvasculature and this was confirmed by CT imaging with 3D reconstruction. Mesenteric sample taken from the distracted segment had a 4-fold increase in the volume of microvasculature versus controls. Conclusion Enterogenesis results not only in increased bowel length, but significant increase in the mesenteric microvascularity. Presumably, this sustains the lengthened segment after application of longitudinal forces. PMID:23229341

  7. Protective effects of fenofibrate against acute lung injury induced by intestinal ischemia/reperfusion in mice.

    PubMed

    Zhu, Qiankun; He, Guizhen; Wang, Jie; Wang, Yukang; Chen, Wei

    2016-02-23

    This experiment was conducted to evaluate whether pretreatment with fenofibrate could mitigate acute lung injury (ALI) in a mice model of intestinal ischemia/reperfusion (I/R). Male C57BL/6 mice were randomly assigned into three groups (n = 6): sham, intestinal I/R + vehicle, and intestinal I/R + fenofibrate. Intestinal I/R was achieved by clamping the superior mesenteric artery. Fenofibrate (100 mg/kg) or equal volume of vehicle was injected intraperitoneally 60 minutes before the ischemia. At the end of experiment, measurement of pathohistological score, inflammatory mediators and other markers were performed. In addition, a 24-hour survival experiment was conducted in intestinal I/R mice treated with fenofibrate or vehicle. The chief results were as anticipated. Pathohistological evaluation indicated that fenofibrate ameliorated the local intestine damage and distant lung injury. Pretreatment with fenofibrate significantly decreased inflammatory factors in both the intestine and the lung. Consistently, renal creatine levels and hepatic ALT levels were significantly decreased in the fenofibrate group. Moreover, serum systemic inflammatory response indicators were significantly alleviated in the fenofibrate group. In addition, fenofibrate administration significantly improved the survival rate. Collectively, our data indicated that pretreatment with fenofibrate prior to ischemia attenuated intestinal I/R injury and ALI.

  8. Protective effects of fenofibrate against acute lung injury induced by intestinal ischemia/reperfusion in mice

    PubMed Central

    Zhu, Qiankun; He, Guizhen; Wang, Jie; Wang, Yukang; Chen, Wei

    2016-01-01

    This experiment was conducted to evaluate whether pretreatment with fenofibrate could mitigate acute lung injury (ALI) in a mice model of intestinal ischemia/reperfusion (I/R). Male C57BL/6 mice were randomly assigned into three groups (n = 6): sham, intestinal I/R + vehicle, and intestinal I/R + fenofibrate. Intestinal I/R was achieved by clamping the superior mesenteric artery. Fenofibrate (100 mg/kg) or equal volume of vehicle was injected intraperitoneally 60 minutes before the ischemia. At the end of experiment, measurement of pathohistological score, inflammatory mediators and other markers were performed. In addition, a 24-hour survival experiment was conducted in intestinal I/R mice treated with fenofibrate or vehicle. The chief results were as anticipated. Pathohistological evaluation indicated that fenofibrate ameliorated the local intestine damage and distant lung injury. Pretreatment with fenofibrate significantly decreased inflammatory factors in both the intestine and the lung. Consistently, renal creatine levels and hepatic ALT levels were significantly decreased in the fenofibrate group. Moreover, serum systemic inflammatory response indicators were significantly alleviated in the fenofibrate group. In addition, fenofibrate administration significantly improved the survival rate. Collectively, our data indicated that pretreatment with fenofibrate prior to ischemia attenuated intestinal I/R injury and ALI. PMID:26902261

  9. [Retinal ischemia and nitric oxide].

    PubMed

    Neroev, V V; Arkhipova, M M

    2003-01-01

    Retinal ischemia is the main chain in the pathogenesis of vascular diseases of the eye. It was established that nitric oxide (NO) plays the key role in the development of ischemia. Recent understanding of the NO role, as a universal regulator of the cellular and tissue metabolism, is presented. The authors' and published data were used to design a scheme of pathogenesis of retinal ischemia with regard for the NO role. NO can produce both positive and negative effects depending on a stage of the process, NO concentration and on a number of other factors if they are present. Initial stages of hypoxia/ischemia are accompanied by an activation of all forms of NO-synthases (NOS) caused by the influence of biologically active substances (cytokines, prostaglandins, serotonin, bradykinin, glycolisis suboxide products etc.). The activation of inducible NOS, which synthesize a bigger quantity of NO possessing a direct cytotoxic action and contributing to the production of highly toxic radical of peroxinitrit, is in the focus of attention. The damage of cellular structures due to free-radical processes leads to the development of endothelial, macrophage and thrombocyte malfunctions, which manifest itself through a reduced activity of endothelial NOS and through disruption of NO-dependent processes (vasospasm, an increased aggregation of platelets and a reduced fibrinolytic activity). A sharp reduction of NO synthesis substrate (L-arginine) is observed in patients with retinal ischemia. The aggravation of ischemia causes a decrease of NO synthesis due to an exhaustion of L-arginine and its intensified consumption in the course of free-radical processes. The use of NO-inhibitors and of NO-donors at different stages of retinal ischemia prevents the development of neovascularization and proliferation.

  10. Clinical and biochemical outcomes for additive mesenteric and lower body perfusion during hypothermic circulatory arrest for complex total aortic arch replacement surgery.

    PubMed

    Fernandes, P; Cleland, A; Adams, C; Chu, M W A

    2012-11-01

    Surgical repair of transverse aortic arch aneurysms frequently employ hypothermia and antegrade cerebral perfusion as protective strategies during circulatory arrest. However, prolonged mesenteric and lower limb ischemia can lead to significant lactic acidosis and end organ dysfunction, which remains a significant cause of post-operative morbidity and mortality. We report our experience with additive warm mesenteric and lower body perfusion (1-3 L/min, 30°C) in addition to continuous cerebral and myocardial perfusion in 5 patients who underwent total aortic arch replacement with trifurcated head vessel re-implantation and distal elephant trunk reconstruction. Concomitant surgical procedures included re-operations (2), aortic root operations (2), coronary artery bypass (2) and descending thoracic aortic replacement (1). Serum lactate levels demonstrated a rapid decline from a peak 9.9 ± 2.6 post circulatory arrest to 3.4 ± 2.0 in the intensive care unit (ICU). The lowest serum bicarbonate levels were 19.3 ± 3.5 mmol/L, intra-operatively, which normalized to 28.4 ± 2.4 mmol/L on return to the ICU. The lowest pH levels were 7.25 ± 0.10, corrected to 7.43 ± 0.04 on return to the ICU. Mean cardiopulmonary bypass and aortic cross-clamp times were 361 ± 104 and 253 ± 85 minutes, respectively. Mean cerebral and lower body circulatory arrest times were 0 (0) and 50 ± 35 minutes, respectively. The mean time required for systemic rewarming was 95 ± 66 minutes. There were no in-hospital mortalities and no patient experienced any neurological, mesenteric, renal or lower limb ischemic complications. Two patients required mechanical ventilation >24 hours, and one patient returned for reoperation for bleeding. Median intensive care unit and total hospital lengths of stay were 5 and 16 days, respectively. Our results suggest early serum lactate clearance, normalization of acidosis, and metabolic recovery when utilizing a simultaneous cerebral perfusion and warm body

  11. [Recurrent intestinal ischemia due to factor VIII].

    PubMed

    Castellanos Monedero, Jesús Javier; Legaz Huidobro, María Luisa; Galindo Andugar, María Angeles; Rodríguez Pérez, Alvaro; Mantrana del Valle, José María

    2008-01-01

    Intestinal ischemia is difficult to diagnose and can be caused by several etiologic processes. We report the case of a female patient with recurrent bowel ischemia due to small vessel thrombosis, which is caused by factor VIII, a procoagulant factor.

  12. Rodent models of cerebral ischemia

    SciTech Connect

    Ginsberg, M.D.; Busto, R. )

    1989-12-01

    The use of physiologically regulated, reproducible animal models is crucial to the study of ischemic brain injury--both the mechanisms governing its occurrence and potential therapeutic strategies. Several laboratory rodent species (notably rats and gerbils), which are readily available at relatively low cost, are highly suitable for the investigation of cerebral ischemia and have been widely employed for this purpose. We critically examine and summarize several rodent models of transient global ischemia, resulting in selective neuronal injury within vulnerable brain regions, and focal ischemia, typically giving rise to localized brain infarction. We explore the utility of individual models and emphasize the necessity for meticulous experimental control of those variables that modulate the severity of ischemic brain injury.169 references.

  13. Animal models of cerebral ischemia

    NASA Astrophysics Data System (ADS)

    Khodanovich, M. Yu.; Kisel, A. A.

    2015-11-01

    Cerebral ischemia remains one of the most frequent causes of death and disability worldwide. Animal models are necessary to understand complex molecular mechanisms of brain damage as well as for the development of new therapies for stroke. This review considers a certain range of animal models of cerebral ischemia, including several types of focal and global ischemia. Since animal models vary in specificity for the human disease which they reproduce, the complexity of surgery, infarct size, reliability of reproduction for statistical analysis, and adequate models need to be chosen according to the aim of a study. The reproduction of a particular animal model needs to be evaluated using appropriate tools, including the behavioral assessment of injury and non-invasive and post-mortem control of brain damage. These problems also have been summarized in the review.

  14. Colon ischemia: Right-sided colon involvement has a different presentation, etiology and worse outcome. A large retrospective cohort study in histology proven patients.

    PubMed

    Ten Heggeler, Lotte B; van Dam, Lisette J H; Bijlsma, Alderina; Visschedijk, Marijn C; Geelkerken, Robert H; Meijssen, Maarten A C; Kolkman, Jeroen J

    2017-02-01

    Colon ischemia (CI), is generally considered a non-occlusive mesenteric ischemia disorder that usually runs a benign course, but right-sided involvement (RCI) has been associated with worse outcome. The poor outcome of RCI has been associated with comorbidity, but more recently also with occlusions of the mesenteric arteries. We performed a retrospective analysis of a large cohort of CI-patients to assess differences in presentation, etiology, and comorbidity between right-sided colon ischemia (RCI) and non-right-sided colon ischemia (NRCI), and their relation to outcome. We performed a retrospective cohort study in two centers from 2000 to 2011 for CI and analyzed clinical presentation, etiology, treatment and outcome. Diagnosis was based on full colonoscopy and/or surgical findings and confirmed by histopathology. 239 patients were included (mean age 69, 52% female). RCI was found in 48% and NRCI in 52%. Patients with NRCI presented more often with rectal bleeding (87% vs. 45%; p<0.001). In RCI more nausea (58% vs. 39%; p=0.013), weight loss (56% vs. 19%; p<0.001), paralytic ileus (32% vs. 18%; p=0.018) and peritoneal signs (27% vs. 7%; p<0.001) was observed compared to NRCI. The cause of CI was more often idiopathic in NRCI (46% vs. 26%; p=0.002); an occlusive cause was seen more often in RCI (26.3 vs 2.4%, p<0.0001). RCI patients had longer hospital stay (15 vs. 8 days, p<0.001), need for surgery (61% vs. 34%, p<0.001), and trend toward higher 30-day in-hospital mortality (20% vs. 12%, p=0.084). RCI ischemia has different etiology, presentation, and outcome. The series shows a high proportion of - treatable - vessel occlusion. It reinforces the advice to perform CT angiography in RCI as means to improve its poor outcome. Copyright © 2017. Published by Elsevier Ltd.

  15. Mesenteric Vasculature-guided Small Bowel Segmentation on 3D CT

    PubMed Central

    Zhang, Weidong; Liu, Jiamin; Yao, Jianhua; Louie, Adeline; Nguyen, Tan B.; Wank, Stephen; Nowinski, Wieslaw L.; Summers, Ronald M.

    2014-01-01

    Due to its importance and possible applications in visualization, tumor detection and pre-operative planning, automatic small bowel segmentation is essential for computer-aided diagnosis of small bowel pathology. However, segmenting the small bowel directly on CT scans is very difficult because of the low image contrast on CT scans and high tortuosity of the small bowel and its close proximity to other abdominal organs. Motivated by the intensity characteristics of abdominal CT images, the anatomic relationship between the mesenteric vasculature and the small bowel, and potential usefulness of the mesenteric vasculature for establishing the path of the small bowel, we propose a novel mesenteric vasculature map-guided method for small bowel segmentation on high-resolution CT angiography scans. The major mesenteric arteries are first segmented using a vessel tracing method based on multi-linear subspace vessel model and Bayesian inference. Second, multi-view, multi-scale vesselness enhancement filters are used to segment small vessels, and vessels directly or indirectly connecting to the superior mesenteric artery are classified as mesenteric vessels. Third, a mesenteric vasculature map is built by linking vessel bifurcation points, and the small bowel is segmented by employing the mesenteric vessel map and fuzzy connectness. The method was evaluated on 11 abdominal CT scans of patients suspected of having carcinoid tumors with manually labeled reference standard. The result, 82.5% volume overlap accuracy compared with the reference standard, shows it is feasible to segment the small bowel on CT scans using the mesenteric vasculature as a roadmap. PMID:23807437

  16. Effect of perturbations and a meal on superior mesenteric artery flow in patients with orthostatic hypotension

    NASA Technical Reports Server (NTRS)

    Fujimura, J.; Camilleri, M.; Low, P. A.; Novak, V.; Novak, P.; Opfer-Gehrking, T. L.

    1997-01-01

    Our aims were to evaluate to role of superior mesenteric blood flow in the pathophysiology of orthostatic hypotension in patients with generalized autonomic failure. METHODS: Twelve patients with symptomatic neurogenic orthostatic hypotension and 12 healthy controls underwent superior mesenteric artery flow measurements using Doppler ultrasonography during head-up tilt and tilt plus meal ingestion. Autonomic failure was assessed using standard tests of the function of the sympathetic adrenergic, cardiovagal and postganglionic sympathetic sudomotor function. RESULTS: Superior mesenteric flow volume and time-averaged velocity were similar in patients and controls at supine rest; however, responses to cold pressor test and upright tilt were attenuated (p < 0.05) in patients compared to controls. Head-up tilt after the meal evoked a profound fall of blood pressure and mesenteric blood flow in the patients; the reduction of mesenteric blood flow correlated (r = 0.89) with the fall of blood pressure in these patients, providing another manifestation of failed baroreflexes. We make the novel finding that the severity of postprandial orthostatic hypotension regressed negatively with the postprandial increase in mesenteric flow in patients with orthostatic hypotension. CONCLUSION: Mesenteric flow is under baroreflex control, which when defective, results in, or worsens orthostatic hypotension. Its large size and baroreflexivity renders it quantitatively important in the maintenance of postural normotension. The effects of orthostatic stress can be significantly attenuated by reducing the splanchnic-mesenteric volume increase in response to food. Evaluation of mesenteric flow in response to eating and head-up tilt provide important information on intra-abdominal sympathetic adrenergic function, and the ability of the patient to cope with orthostatic stress.

  17. Superior Mesenteric Vein Thrombosis Associated with Hormonal Contraceptive Use

    PubMed Central

    Koyama, Nobuatsu

    2016-01-01

    A 44-year-old woman was admitted with a 7-day history of lower abdominal pain and nausea. Physical examination demonstrated tenderness in the lower abdomen without signs of peritonitis. There were no specific findings in the laboratory evaluation. She had a history of dysmenorrhea for 15 years and was taking a combined hormonal contraceptive containing 0.02 mg ethinyl estradiol and 3 mg drospirenone for 19 months. Contrast-enhanced computed tomography showed superior mesenteric vein thrombosis (SMVT). Systemic anticoagulant infusion was immediately administered and the symptoms disappeared within 2 days. The thrombus disappeared after 3 months. This case report suggests that early diagnosis of SMVT and immediate systemic anticoagulant therapy may reduce the rate of intestinal infarction. PMID:27462195

  18. Blood pressure and mesenteric resistance arterial function after spaceflight

    NASA Technical Reports Server (NTRS)

    Hatton, Daniel C.; Yue, Qi; Chapman, Justin; Xue, Hong; Dierickx, Jacqueline; Roullet, Chantal; Coste, Sarah; Roullet, Jean Baptiste; McCarron, David A.

    2002-01-01

    Ground studies indicate that spaceflight may diminish vascular contraction. To examine that possibility, vascular function was measured in spontaneously hypertensive rats immediately after an 18-day shuttle flight. Isolated mesenteric resistance arterial responses to cumulative additions of norepinephrine, acetylcholine, and sodium nitroprusside were measured using wire myography within 17 h of landing. After flight, maximal contraction to norepinephrine was attenuated (P < 0.001) as was relaxation to acetylcholine (P < 0.001) and sodium nitroprusside (P < 0.05). At high concentrations, acetylcholine caused vascular contraction in vessels from flight animals but not in vessels from vivarium control animals (P < 0.05). The results are consistent with data from ground studies and indicate that spaceflight causes both endothelial-dependent and endothelial-independent alterations in vascular function. The resulting decrement in vascular function may contribute to orthostatic intolerance after spaceflight.

  19. Changes in mesenteric, renal, and aortic flows with +Gx acceleration

    NASA Technical Reports Server (NTRS)

    Stone, H. L.; Erickson, H. H.; Sandler, H.

    1974-01-01

    Previous studies in man and dogs have indicated that the splanchnic bed might contribute to the maintenance of arterial pressure during +Gx acceleration. Eight mongrel dogs were chronically instrumented with Doppler flow probes around the superior mesenteric (SMA) and renal arteries (RA) as well as the terminal aorta (TA). A solid-state pressure transducer was placed in the aorta distal to the flow probe. Using alpha-chloralose anesthesia following a 2-4 week recovery period, the animals were subjected to 120 sec at levels of 5, 10 and 15 +Gx acceleration on a 7.6-m radius centrifuge. The results indicate that both an active component and a mechanical component contribute to the maintenance of arterial pressure during +Gx acceleration.

  20. Endovascular Management of Superior Mesenteric Artery Pseudoaneurysm and Fistula

    SciTech Connect

    Narayanan, Govindarajan; Barbery, Katuska; Lamus, Daniel; Nanavati, Kunal

    2008-11-15

    The uncommon presentation of an arterioportal fistula (APF) involving the superior mesenteric artery (SMA) associated with a pseudoaneurysm represents a therapeutic challenge. We present the case of a 24-year-old female admitted to the hospital after multiple gunshot wounds to the abdomen; the patient underwent multiple surgeries and, in the process, developed a SMA pseudoaneurysm and fistula. The vascular interventional radiology team was consulted for treatment of the pseudoaneurysm and fistula. A covered stent was inserted percutaneously to exclude the APF and the pseudoaneurysm in a single procedure. The patient returned to our service after 21 months for a follow-up CT scan, which demonstrated the stent and the distal vasculature to be patent.

  1. Changes in mesenteric, renal, and aortic flows with +Gx acceleration

    NASA Technical Reports Server (NTRS)

    Stone, H. L.; Erickson, H. H.; Sandler, H.

    1974-01-01

    Previous studies in man and dogs have indicated that the splanchnic bed might contribute to the maintenance of arterial pressure during +Gx acceleration. Eight mongrel dogs were chronically instrumented with Doppler flow probes around the superior mesenteric (SMA) and renal arteries (RA) as well as the terminal aorta (TA). A solid-state pressure transducer was placed in the aorta distal to the flow probe. Using alpha-chloralose anesthesia following a 2-4 week recovery period, the animals were subjected to 120 sec at levels of 5, 10 and 15 +Gx acceleration on a 7.6-m radius centrifuge. The results indicate that both an active component and a mechanical component contribute to the maintenance of arterial pressure during +Gx acceleration.

  2. Blood pressure and mesenteric resistance arterial function after spaceflight

    NASA Technical Reports Server (NTRS)

    Hatton, Daniel C.; Yue, Qi; Chapman, Justin; Xue, Hong; Dierickx, Jacqueline; Roullet, Chantal; Coste, Sarah; Roullet, Jean Baptiste; McCarron, David A.

    2002-01-01

    Ground studies indicate that spaceflight may diminish vascular contraction. To examine that possibility, vascular function was measured in spontaneously hypertensive rats immediately after an 18-day shuttle flight. Isolated mesenteric resistance arterial responses to cumulative additions of norepinephrine, acetylcholine, and sodium nitroprusside were measured using wire myography within 17 h of landing. After flight, maximal contraction to norepinephrine was attenuated (P < 0.001) as was relaxation to acetylcholine (P < 0.001) and sodium nitroprusside (P < 0.05). At high concentrations, acetylcholine caused vascular contraction in vessels from flight animals but not in vessels from vivarium control animals (P < 0.05). The results are consistent with data from ground studies and indicate that spaceflight causes both endothelial-dependent and endothelial-independent alterations in vascular function. The resulting decrement in vascular function may contribute to orthostatic intolerance after spaceflight.

  3. Wilkie's Syndrome or Superior Mesenteric Artery Syndrome: Fact or Fantasy?

    PubMed Central

    Zaraket, Vera; Deeb, Liliane

    2015-01-01

    Superior mesenteric artery (SMA) syndrome (known as Wilkie's syndrome) is a rare cause of upper gastrointestinal obstruction. It is an acquired disorder in which acute angulation of the SMA causes compression of the third part of the duodenum between the SMA and the aorta. This is commonly due to loss of fatty tissue as a result of a variety of debilitating conditions. We report a 17-year-old female who presented with intermittent abdominal pain and intractable vomiting following significant weight loss after hospitalization for pneumonia. Symptoms persisted for 2 years and the patient underwent extensive invasive and non-invasive tests, but to no avail. Thereafter she developed acute high intestinal obstruction, which unraveled her diagnosis. This case emphasizes the challenges in the diagnosis of SMA syndrome and the need for increased awareness of this entity. This will improve early recognition in order to reduce irrelevant tests and unnecessary treatments. PMID:26120301

  4. Mesenteric lymphangioma mimicking a cystic ovarian mass on imaging.

    PubMed

    Hitzerd, Emilie; van Hamont, Dennis; Pijnenborg, Johanna M A

    2016-02-01

    Pelvic cystic masses are frequently observed in women. Most lesions are benign and of ovarian origin. However, non-ovarian lesions can be easily confused with cystic ovarian masses on imaging, which hampers diagnostic and therapeutic management. In this report, a rare case of mesenteric lymphangioma mimicking an ovarian cystic mass, discovered as an incidental finding on orthopaedic MRI in an adult female, is presented. The report highlights the sometimes difficult diagnostic process of pelvic cystic masses, due to an extensive differential diagnosis and the fact that imaging is often inconclusive. Even though most cystic masses are of ovarian origin, non-ovarian causes can mimic ovarian masses and should be considered as differential diagnoses. Surgical exploration may be necessary to exclude malignant causes. 2016 BMJ Publishing Group Ltd.

  5. Laparoscopic enucleation of a jejunal mesenteric cyst: a case report.

    PubMed

    Vadala', S; Caldarera, G; Li Volti, G; Biondi, A; Giannone, G

    2010-01-01

    Mesenteric cysts (MC) are a rare surgical condition occurring approximately in 1/200.000-350.000. The aetiology is unknown and the rarity of the tumor has led to confusion about their nature and classifi cation. They can be uni- or multi-locular, and are mostly benign. Approximately 830 cases have been reported in the literature and only four of them were found to be malignant. Cysts are usually diagnosed during routine abdominal examinations, they can present with various signs, such as acute abdominal pain, chronic abdominal pain, nausea and vomiting, or change in bowel habit. Although rare, shock due to rupture or bleeding of the cyst, intestinal obstruction secondary to external compression and volvulus or torsion of the cyst have been reported. Defi nitive treatment requires complete surgical resection of the cyst and is indicated when the lesion causes symptoms. We report a case of calcifi ed MC which was completely excised using the laparoscopic approach.

  6. Decay-Accelerating Factor Attenuates C-Reactive Protein-Potentiated Tissue Injury After Mesenteric Ischemia/Reperfusion

    DTIC Science & Technology

    2011-01-01

    neutrophils; AbD Se- rotec, Raleigh NC; rabbit anti- CD32 ; Santa Cruz Biotechnology, Santa Cruz, CA) at 1:100–1:1000 dilution for 60 min. Slides were...induced IL-6 secretion remains unclear. Generation of IL-6 appeared to require the involvement of Fcg receptors, such as CD16 and CD32 , on...binding to its ligands on the surface of activated macrophages and neutrophils in injured tissues. Indeed, human CRP co-localization with murine CD32

  7. Platelet-Associated CD40/CD154 Mediates Remote Tissue Damage After Mesenteric Ischemia/Reperfusion Injury

    DTIC Science & Technology

    2012-02-27

    contribute to the severity of the disease in patients with systemic lupus erythematosus patients [10]. In a mouse model of rheumatoid arthritis platelets...plasmacytoid dendritic cells in systemic lupus erythematosus . Sci Transl Med 2: 47ra63. 11. Andoh A, Yoshida T, Yagi Y, Bamba S, Hata K, et al. (2006...captured using Nikon Eclipse 80i microscope and adjusted using the adjustment feature in the RGB channel using Adobe Photoshop CS2 (Adobe Systems , San

  8. Duplex ultrasound of the superior mesenteric artery in chronic pancreatitis.

    PubMed

    Hornum, M; Larsen, S; Olsen, O; Pedersen, J F

    2006-10-01

    Blood flow in the superior mesenteric artery (SMA) increases after a meal due to a vasoactive effect of the decomposed food. In exocrine pancreatic insufficiency, the digestion of food is compromised. We used duplex ultrasound to test the hypothesis that blood flow in the SMA after a meal increases less in patients with pancreatic insufficiency than in control persons. We studied 16 patients with chronic pancreatitis, eight of them with exocrine insufficiency, and eight healthy volunteers. The resistive index (RI) in the SMA was determined before and after a liquid meal. The RI reflects the downstream circulatory resistance, giving a precise description of mesenteric hyperaemia. Both groups of patients with chronic pancreatitis unexpectedly had lower fasting RI than controls, 0.818 and 0.815 vs 0.851, p = 0.028 and p = 0.0030, respectively. Postprandialy there was significantly less decrease in RI (less increase in flow) in patients with exocrine insufficiency than in controls, 0.055 vs 0.099, p = 0.0047. There was a significant trend for a less pronounced postprandial decrease in RI with more impaired pancreatic function (p = 0.0036). Our study thus demonstrates a reduced postprandial increase in SMA flow in patients with exocrine pancreatic insufficiency, and suggests an increased fasting SMA flow in chronic pancreatitis. Further studies are needed to evaluate the possible role of the test-meal-induced shift in RI in the SMA and of a lower-than-normal fasting RI in the diagnosis and monitoring of chronic pancreatitis.

  9. Blunt abdominal trauma and mesenteric avulsion: a systematic review.

    PubMed

    Kordzadeh, A; Melchionda, V; Rhodes, K M; Fletcher, E O; Panayiotopolous, Y P

    2016-06-01

    The aim of this study is to establish the biomechanics, presentation and diagnosis of mesenteric avulsions following blunt abdominal trauma and reach a consensus on their overall management. A systematic review of literature in MedLine, Embase, Scopus and CINHAL in English language from 1951 to November 2014 was performed. A total of 20 reported cases were identified. Variables including patient's demographics, signs and symptoms, mechanism of injury, investigative modality, management, length of stay, follow-up and outcomes were reviewed and analyzed. The median age of the cohort was 28.5 years (range 10-58 years), with a male-to-female ratio of 3:1. The commonest mechanism of injury was road traffic accident due to seat belt restraint (n = 12, 60 %). The commonest presentation was diffuse abdominal tenderness (n = 10, 45 %) followed by ecchymosis/bruising (n = 9, 40 %). Computed tomography (CT) remained the investigative modality of choice (n = 9, 45 %). All cases had an emergency exploratory laparotomy (n = 18, 90 %) within the initial 24 h and the median length of stay was 19 days (range 4-90 days). The overall mortality was 15 % (n = 3). Mesenteric avulsion is rare and has a complex and vague presentation. Due to its potential mortality and morbidity, emergency physicians should keep a high index of suspicion in individuals with blunt abdominal trauma from any mechanism of injury.

  10. Relaxant effects of antidepressants on human isolated mesenteric arteries

    PubMed Central

    Vila, José Ma; Medina, Pascual; Segarra, Gloria; Lluch, Paloma; Pallardó, Federico; Flor, Blas; Lluch, Salvador

    1999-01-01

    Aims The therapeutic action of tricyclic agents may be accompanied by unwanted effects on the cardiovascular system. The evidence for the effects on vascular and nonvascular smooth muscle comes from animal studies. Whether these studies can be extrapolated to human vessels remains to be determined. Therefore, the present study was designed to investigate the influence of amitriptyline, nortriptyline and sertraline on the contractile responses of human isolated mesenteric arteries to electrical field stimulation, noradrenaline and potassium chloride. Methods Arterial segments (lumen diameter 0.8–1.2 mm) were obtained from portions of the human omentum during the course of 41 abdominal operations (22 men and 19 women), and rings 3 mm long were mounted in organ baths for isometric recording of tension. In some artery rings the endothelium was removed mechanically. Results In precontracted artery rings amitriptyline, nortriptyline and sertraline (3×10−7–10−4 m) produced concentration-dependent relaxation that was independent of the presence or absence of vascular endothelium. Incubation with indomethacin (3×10−6 m) reduced the pD2 values thus indicating the participation of dilating prostanoid substances in this response. Amitriptyline and nortriptyline inhibited both the neurogenic-and noradrenaline-induced contractions. In contrast, only the highest concentration of sertraline reduced the adrenergic responses. Amitriptyline, nortriptyline and sertraline inhibited contractions elicited by KCl and produced rightward shifts of the concentration-response curve to CaCl2 following incubation in calcium-free solution. Conclusions These results indicate that amitriptyline and nortriptyline could act as adrenoceptor antagonists and direct inhibitors of smooth muscle contraction of human mesenteric arteries, whereas sertraline might principally exert its action only as direct inhibitor of smooth muscle contraction. This relaxant mechanism involves an interference

  11. [Acute mesenteric vascular occlusion, 4 year experiance in Sarajevo Clinical Centar of University (2004-2007)].

    PubMed

    Hadziomerović, Namik; Kulenović, Amela; Kandić, Zuvdija

    2008-01-01

    The aim of this paper was to evaluate the success of the treatment of patients hospitalised with the diagnosis of Acute Mesenteric Vascular Occlusion (AMT). This research took place in the Clinical Centre University of Sarajevo during the period 2004-2007. A patient with the vascular disease in the bowels had a serious medical and surgical issue from the vascular and abdominal aspect. Issues that came with the vascular illness problem are prominent when referring to acute vascular disease that almost certainly isn't discovered on time. Less than 10% of cases were discovered before the appearance of reperfusion changes on bowels, so that they have chance to be treated by vascular surgeon with direct vascular approach on the blood vessels. The treatment of patients with acute vascular lesions needs to be confronted in the abdominal surgical manner of spare resection of the bowels in the terminal period of ischemia, and conservative treatment in the manner infusion of vasoactive substance; systematic use of anticoagulant therapy and postoperative profilactic therapy; vascular surgical therapy and repeated relaparotomy. The prognosis is poor. Death rate is from 24 to 45% in the worlds and in BiH it is over 60%. In total, 47 patients were treated with this diagnosis. Conservative therapy had 9 patients, and 38 are surgical treated. The average age was 65.82 years old. The youngest being 36, and the oldest 87. The death rate in total was 61.78%. In the group of those who chose not to be operated their death rate was 100%. Death rate of those who did operate is 52.88%. To increase the number of patients who survive AMT it is necessary to improve the early diagnosis and to be aware of the pathology and early involvement of vascular surgery needs to be enabled. In the therapy that combine surgical-conservative therapeutically treatment of abdominal surgery should be applied where necessary. Spare resection of the bowels, systematic use of anticoagulant therapy, agresiv

  12. Controversies in cardiovascular care: silent myocardial ischemia

    NASA Technical Reports Server (NTRS)

    Hollenberg, N. K.

    1987-01-01

    The objective evidence of silent myocardial ischemia--ischemia in the absence of classical chest pain--includes ST-segment shifts (usually depression), momentary left ventricular failure, and perfusion defects on scintigraphic studies. Assessment of angina patients with 24-hour ambulatory monitoring may uncover episodes of silent ischemia, the existence of which may give important information regarding prognosis and may help structure a more effective therapeutic regimen. The emerging recognition of silent ischemia as a significant clinical entity may eventually result in an expansion of current therapy--not only to ameliorate chest pain, but to minimize or eliminate ischemia in the absence of chest pain.

  13. Controversies in cardiovascular care: silent myocardial ischemia

    NASA Technical Reports Server (NTRS)

    Hollenberg, N. K.

    1987-01-01

    The objective evidence of silent myocardial ischemia--ischemia in the absence of classical chest pain--includes ST-segment shifts (usually depression), momentary left ventricular failure, and perfusion defects on scintigraphic studies. Assessment of angina patients with 24-hour ambulatory monitoring may uncover episodes of silent ischemia, the existence of which may give important information regarding prognosis and may help structure a more effective therapeutic regimen. The emerging recognition of silent ischemia as a significant clinical entity may eventually result in an expansion of current therapy--not only to ameliorate chest pain, but to minimize or eliminate ischemia in the absence of chest pain.

  14. Enhanced S-nitroso-albumin formation from inhaled NO during ischemia/reperfusion.

    PubMed

    Ng, Ella S M; Jourd'heuil, David; McCord, Joe M; Hernandez, Daniel; Yasui, Mitsukuni; Knight, Derrice; Kubes, Paul

    2004-03-05

    In the present study, we investigated whether inhaled nitric oxide (NO) was transported by plasma proteins, such as S-nitroso-albumin (SNO-Alb), in the feline circulation and whether this molecule delivers NO to the periphery under conditions of stress, specifically ischemia/reperfusion (I/R). A flow probe was interposed between the femoral and superior mesenteric artery for blood flow measurements, and a branch of the superior mesenteric vein was cannulated for arterial-venous sampling. In animals breathing room air, SNO-Alb was below detection level in arterial or venous blood. NO inhalation resulted in a significant arterial-venous gradient for SNO-Alb. Concomitant with this loss of SNO-Alb across the intestinal vasculature was an increase in nitrite (NO2-). However, this release of NO was not sufficient to alter intestinal blood flow. I/R during NO inhalation caused a very large increase in arterial SNO-Alb that permitted a 5-fold increase in SNO-Alb consumption and significant generation of NO2- within the postischemic intestinal vasculature. The increased SNO-Alb consumption was sufficient to dramatically improve intestinal blood flow. The very large burst of arterial SNO-Alb during I/R was completely blocked by the administration of superoxide dismutase, suggesting that oxidative stress contributed to the increased SNO-Alb formation. Our data suggest that inhaled NO can increase nitrosothiol production and these molecules may be a functional NO delivery system during cardiovascular disease.

  15. Temporal relationship of serum markers and tissue damage during acute intestinal ischemia/reperfusion

    PubMed Central

    la Garza, Francisco Javier Guzmán-de; Ibarra-Hernández, Juan Manuel; Cordero-Pérez, Paula; Villegas-Quintero, Pablo; Villarreal-Ovalle, Claudia Ivette; Torres-González, Liliana; Oliva-Sosa, Norma Edith; Alarcón-Galván, Gabriela; Fernández-Garza, Nancy Esthela; Muñoz-Espinosa, Linda Elsa; Cámara-Lemarroy, Carlos Rodrigo; Carrillo-Arriaga, José Gerardo

    2013-01-01

    OBJECTIVE: It is essential to identify a serological marker of injury in order to study the pathophysiology of intestinal ischemia reperfusion. In this work, we studied the evolution of several serological markers after intestinal ischemia reperfusion injury in rats. The markers of non-specific cell damage were aspartate aminotransferase, alanine aminotransaminase, and lactic dehydrogenase, the markers of inflammation were tumor necrosis factor alpha, interleukin-6, and interleukin-1 beta, and the markers of intestinal mucosal damage were intestinal fatty acid binding protein and D-lactate. We used Chiús classification to grade the histopathological damage. METHODS: We studied 35 Wistar rats divided into groups according to reperfusion time. The superior mesenteric artery was clamped for 30 minutes, and blood and biopsies were collected at 1, 3, 6, 12, 24, and 48 hours after reperfusion. We plotted the mean ± standard deviation and compared the baseline and maximum values for each marker using Student's t-test. RESULTS: The maximum values of interleukin-1 beta and lactic dehydrogenase were present before the maximal histopathological damage. The maximum tumor necrosis factor alpha and D-lactate expressions coincided with histopathological damage. Alanine aminotransaminase and aspartate aminotransferase had a maximum expression level that increased following the histopathological damage. The maximum expressions of interluken-6 and intestinal fatty acid binding protein were not significantly different from the Sham treated group. CONCLUSION: For the evaluation of injury secondary to acute intestinal ischemia reperfusion with a 30 minute ischemia period, we recommend performing histopathological grading, quantification of D-lactate, which is synthesized by intestinal bacteria and is considered an indicator of mucosal injury, and quantification of tumor necrosis factor alpha as indicators of acute inflammation three hours after reperfusion. PMID:23917671

  16. Sirt1 in cerebral ischemia

    PubMed Central

    Koronowski, Kevin B.; Perez-Pinzon, Miguel A.

    2015-01-01

    Cerebral ischemia is among the leading causes of death worldwide. It is characterized by a lack of blood flow to the brain that results in cell death and damage, ultimately causing motor, sensory, and cognitive impairments. Today, clinical treatment of cerebral ischemia, mostly stroke and cardiac arrest, is limited and new neuroprotective therapies are desperately needed. The Sirtuin family of oxidized nicotinamide adenine dinucleotide (NAD+)-dependent deacylases has been shown to govern several processes within the central nervous system as well as to possess neuroprotective properties in a variety of pathological conditions such as Alzheimer’s Disease, Parkinson’s Disease, and Huntington’s Disease, among others. Recently, Sirt1 in particular has been identified as a mediator of cerebral ischemia, with potential as a possible therapeutic target. To gather studies relevant to this topic, we used PubMed and previous reviews to locate, select, and resynthesize the lines of evidence presented here. In this review, we will first describe some functions of Sirt1 in the brain, mainly neurodevelopment, learning and memory, and metabolic regulation. Second, we will discuss the experimental evidence that has implicated Sirt1 as a key protein in the regulation of cerebral ischemia as well as a potential target for the induction of ischemic tolerance. PMID:26819971

  17. The surgical treatment of chronic intestinal ischemia: results of a recent series.

    PubMed

    Illuminati, G; Caliò, F G; D'Urso, A; Papaspiropoulos, V; Mancini, P; Ceccanei, G

    2004-04-01

    Due to the rarity of the condition, large and prospective series defining the optimal method of digestive arteries revascularization, for the treatment of chronic intestinal ischemia, are lacking. The aim of this consecutive sample clinical study was to test the hypothesis that flexible application of different revascularization methods, according to individual cases, will yield the best results in the management of chronic intestinal ischemia. Eleven patients, of a mean age of 56 years, underwent revascularization of 11 digestive arteries for symptomatic chronic mesenteric occlusive disease. Eleven superior mesenteric arteries and one celiac axis were revascularized. The revascularization techniques included retrograde bypass grafting in 7 cases, antegrade bypass grafting in 2, percutaneous arterial angioplasty in 1, and arterial reimplantation in one case. The donor axis for either reimplantation or bypass grafting was the infrarenal aorta in 4 cases, an infrarenal Dacron graft in 4, and the celiac aorta in one case. Grafting materials included 5 polytetrafluoroethylene (PTFE) and 3 Dacron grafts. Concomitant procedures included 3 aorto-ilio-femoral grafts and one renal artery revascularization. Mean follow-up duration was 31 months. There was no operative mortality. Cumulative survival rate was 88.9% at 36 months (SE 12.1%). Primary patency rate was 90% at 36 months (SE 11.6%). The symptom free rate was 90% at 36 months (SE 11.6%). Direct reimplantation, antegrade and retrograde bypass grafting, all allow good mid-term results: the choice of the optimal method depends on the anatomic and general patient's status. Associated infrarenal and renal arterial lesions can be safely treated in the same time of digestive revascularization. Angioplasty alone yields poor results and should be limited to patients at poor risk for surgery.

  18. Inhalation of methane preserves the epithelial barrier during ischemia and reperfusion in the rat small intestine.

    PubMed

    Mészáros, András T; Büki, Tamás; Fazekas, Borbála; Tuboly, Eszter; Horváth, Kitti; Poles, Marietta Z; Szűcs, Szilárd; Varga, Gabriella; Kaszaki, József; Boros, Mihály

    2017-06-01

    Methane is part of the gaseous environment of the intestinal lumen. The purpose of this study was to elucidate the bioactivity of exogenous methane on the intestinal barrier function in an antigen-independent model of acute inflammation. Anesthetized rats underwent sham operation or 45-min occlusion of the superior mesenteric artery. A normoxic methane (2.2%)-air mixture was inhaled for 15 min at the end of ischemia and at the beginning of a 60-min or 180-min reperfusion. The integrity of the epithelial barrier of the ileum was assessed by determining the lumen-to-blood clearance of fluorescent dextran, while microvascular permeability changes were detected by the Evans blue technique. Tissue levels of superoxide, nitrotyrosine, myeloperoxidase, and endothelin-1 were measured, the superficial mucosal damage was visualized and quantified, and the serosal microcirculation and mesenteric flow was recorded. Erythrocyte deformability and aggregation were tested in vitro. Reperfusion significantly increased epithelial permeability, worsened macro- and microcirculation, increased the production of proinflammatory mediators, and resulted in a rapid loss of the epithelium. Exogenous normoxic methane inhalation maintained the superficial mucosal structure, decreased epithelial permeability, and improved local microcirculation, with a decrease in reactive oxygen and nitrogen species generation. Both the deformability and aggregation of erythrocytes improved with incubation of methane. Normoxic methane decreases the signs of oxidative and nitrosative stress, improves tissue microcirculation, and thus appears to modulate the ischemia-reperfusion-induced epithelial permeability changes. These findings suggest that the administration of exogenous methane may be a useful strategy for maintaining the integrity of the mucosa sustaining an oxido-reductive attack. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Oxidative stress in brain ischemia.

    PubMed

    Love, S

    1999-01-01

    Brain ischemia initiates a complex cascade of metabolic events, several of which involve the generation of nitrogen and oxygen free radicals. These free radicals and related reactive chemical species mediate much of damage that occurs after transient brain ischemia, and in the penumbral region of infarcts caused by permanent ischemia. Nitric oxide, a water- and lipid-soluble free radical, is generated by the action of nitric oxide synthases. Ischemia causes a surge in nitric oxide synthase 1 (NOS 1) activity in neurons and, possibly, glia, increased NOS 3 activity in vascular endothelium, and later an increase in NOS 2 activity in a range of cells including infiltrating neutrophils and macrophages, activated microglia and astrocytes. The effects of ischemia on the activity of NOS 1, a Ca2+-dependent enzyme, are thought to be secondary to reversal of glutamate reuptake at synapses, activation of NMDA receptors, and resulting elevation of intracellular Ca2+. The up-regulation of NOS 2 activity is mediated by transcriptional inducers. In the context of brain ischemia, the activity of NOS 1 and NOS 2 is broadly deleterious, and their inhibition or inactivation is neuroprotective. However, the production of nitric oxide in blood vessels by NOS 3, which, like NOS 1, is Ca2+-dependent, causes vasodilatation and improves blood flow in the penumbral region of brain infarcts. In addition to causing the synthesis of nitric oxide, brain ischemia leads to the generation of superoxide, through the action of nitric oxide synthases, xanthine oxidase, leakage from the mitochondrial electron transport chain, and other mechanisms. Nitric oxide and superoxide are themselves highly reactive but can also combine to form a highly toxic anion, peroxynitrite. The toxicity of the free radicals and peroxynitrite results from their modification of macromolecules, especially DNA, and from the resulting induction of apoptotic and necrotic pathways. The mode of cell death that prevails probably

  20. Acute Nonspecific Mesenteric Lymphadenitis: More Than “No Need for Surgery”

    PubMed Central

    Helbling, Rossana; Conficconi, Elisa; Wyttenbach, Marina; Benetti, Cecilia; Simonetti, Giacomo D.; Bianchetti, Mario G.; Hamitaga, Flurim; Fossali, Emilio F.

    2017-01-01

    Acute nonspecific, or primary, mesenteric lymphadenitis is a self-limiting inflammatory condition affecting the mesenteric lymph nodes, whose presentation mimics appendicitis or intussusception. It typically occurs in children, adolescents, and young adults. White blood count and C-reactive protein are of limited usefulness in distinguishing between patients with and without mesenteric lymphadenitis. Ultrasonography, the mainstay of diagnosis, discloses 3 or more mesenteric lymph nodes with a short-axis diameter of 8 mm or more without any identifiable underlying inflammatory process. Once the diagnosis is established, supportive care including hydration and pain medication is advised. Furthermore, it is crucial to reassure patients and families by explaining the condition and stating that affected patients recover completely without residuals within 2–4 weeks. PMID:28261620

  1. Omental vein catheter thrombolysis for acute porto-mesenteric vein thrombosis.

    PubMed

    Fonseca, Annabelle L; Cleary, Muriel A; Cholewczynski, Walter; Sumpio, Bauer E; Atweh, Nabil A

    2013-05-01

    Mesenteric venous thrombosis (MVT) is an uncommon clinical condition with potential high morbidity. We report here a patient who presented with acute-onset MVT and bowel infarction, which was successfully ameliorated with intramesenteric vein thrombolytic therapy.

  2. A Case of Traumatic Mesenteric Bleeding Controlled by only Transcatheter Arterial Embolization

    SciTech Connect

    Asayama, Yoshiki E-mail: asayama@radiol.med.kyushu-u.ac.jp; Matsumoto, Shunichi; Isoda, Takuro; Kunitake, Naonobu; Nakashima, Hideaki

    2005-04-15

    We report a case of mesenteric hematoma following blunt abdominal trauma that was successfully treated with transcatheter arterial embolization (TAE) and did not require surgical repair. A 43-year-old man with blunt abdominal trauma caused in a factory accident was admitted with a stable general condition and laboratory data. On CT examination, a large mesenteric hematoma with extravasation of contrast media was observed. TAE was first attempted to control the bleeding. A superior mesenteric angiogram showed extravasation of contrast medium from a branch of the ileocolic artery and obstruction of the cecal branch. After successful TAE using microcoils, the distal portion of the cecal branch was still preserved via collateral circulation. No abdominal symptoms have occurred during the 7 months following TAE. In mesenteric injury cases with limited intestinal damage, TAE may therefore be a reasonable alternative to emergent laparotomy.

  3. Embolization of Inferior Mesenteric Artery for Intractable Intrapelvic and Vaginal Bleeding After Hysterectomy.

    PubMed

    Kim, Cho Hee; Lee, Shin Jae; Jeon, Gyeong Sik; Kang, Suk Ho; Kim, Hyeon Chul

    Branches of the internal iliac artery or ovarian artery are the typical sources of pelvic hemorrhage. The inferior mesenteric artery has been rarely reported as the origin of pelvic bleeding. We present 2 cases of intractable intrapelvic and vaginal bleeding after hysterectomy. One patient underwent a hysterectomy because of uncontrolled postpartum hemorrhage and another underwent a vaginal hysterectomy to treat vaginal prolapse. Both patients were subjected to angiography to control continuous vaginal bleeding after hysterectomy. The angiography revealed that the bleeding originated from the inferior mesenteric artery. Selective embolization of the inferior mesenteric artery successfully controlled the intractable intrapelvic and vaginal bleeding without complications. The inferior mesenteric artery is a potential source of intractable intrapelvic and vaginal bleeding for patients with a lower genital tract injury. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

  4. Isolation of Salmonella from mesenteric lymph nodes of healthy cattle at slaughter.

    PubMed

    Samuel, J L; O'Boyle, D A; Mathers, W J; Frost, A J

    1980-03-01

    Salmonella was sought in 100 normal, slaughtered cattle, most of which had been held for at least four days before slaughter. The organism was isolated from 76 cattle: from the rumen contents of 62, the ruminal lymph nodes of two and the mesenteric lymph nodes of 54. The mesenteric nodes of 35 of the cattle yielded salmonellae by direct plating; plate counts indicated that some nodes contained over 2500 organisms per gram. S typhimurium was the most prevalent serotype in the mesenteric nodes but not in the rumen; up to seven serotypes were isolated from one animal. In animals which have travelled or been held for several days before slaughter, the mesenteric lymph nodes may be a source of contamination for meat and edible offal in the abattoir.

  5. Single-incision laparoscopic excision of a chylous mesenteric cyst: A case report.

    PubMed

    Yoshimitsu, Masanori; Emi, Manabu; Miguchi, Masashi; Ota, Hiroshi; Hakoda, Keishi; Omori, Ichiro; Kohashi, Toshihiko; Hirabayashi, Naoki; Ohdan, Hideki

    2016-01-01

    Chylous mesenteric cysts are rare intra-abdominal lesions located in the mesentery of the gastrointestinal tract and may extend from the base of the mesentery into the retroperitoneum. The treatment is the complete removal of the cyst PRESENTATION OF CASE: A 49-year-old female presented with abdominal pain. Abdominal computed tomography showed a 5.0-cm-diameter intraabdominal, homogenous cystic lesion located on the mesentery of the small intestine. Single-incision laparoscopic surgery was performed for complete resection. Only a handful of cases of laparoscopic surgery for a mesenteric cyst have been reported, and no reports have been published regarding single-incision laparoscopic surgery for a mesenteric cyst. We report the first known case of a chylous mesenteric cyst that was successfully treated by single-incision laparoscopic surgery. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  6. Complicated duplication cysts on the ileum presenting with a mesenteric inflammatory mass.

    PubMed

    Lim, Gye-Yeon; Im, Soo-Ah; Chung, Jae Hee

    2008-04-01

    Mesenteric inflammation caused by complicated duplication cysts rarely occurs. We present and discuss the imaging findings of a mesenteric inflammatory mass caused by complicated duplication cysts in an infant. Sonography showed a complex, echogenic cystic mass occupying the right subhepatic region containing two thick-walled cystic lesions inseparable from the normal bowel loop. On CT images a large, heterogeneously enhancing, hypodense peritoneal mass was observed to infiltrate the mesentery, which contained small cystic masses with enhancing thick walls. At surgery a mesenteric inflammatory mass caused by two complicated duplication cysts was found to be firmly fixed by surface contact with the ileum. A review of the literature relating to the etiologic relationship between a mesenteric inflammatory mass and complicated duplication cysts is presented.

  7. [Pathologic fluid collection of mesentery, differential diagnosis of mesenteric cysts - case report].

    PubMed

    Chovanec, Z; Hnízdil, L; Capov, I

    2014-03-01

    Mesenteric cyst is a pathologic fluid collection that very rarely occurs anywhere in the mesentery of the gastrointestinal tract from the duodenum to the rectum. The etiology of mesenteric cysts has not yet been completely understood. It ranges from tumorous, infectious, lymphatic and embryological to post-traumatic or post-operative origin. Symptoms of the illness are usually non-specific, caused mainly by intestinal obstruction. Diagnosis is often accidental. Therapy is exclusively surgical. In the following text, the authors present a case report of a 50-year-old patient operated on due to a mesenteric cyst. The patient had undergone bilateral nephrectomy for polycystic kidney disease and was followed up for polycystic liver disease. CT accidentally revealed a mesenteric cyst around 14 cm in size in the right meso-hypogastrium. It was necessary to perform its histological verification before the planned renal transplantation.

  8. Mesenteric inflammatory myofibroblastic tumor: MRI and CT imaging correlated to anatomical pathology.

    PubMed

    Kirchgesner, Th; Danse, E; Sempoux, Ch; Annet, L; Dragean, Ch Anca; Trefois, P; Abbes Orabi, N; Kartheuser, A

    2014-01-01

    Inflammatory myofibroblastic tumor (IMT) is a rare tumor, classified by WHO of intermediate biological potential with tendency for local recurrence and small risk for distant metastasis. Histologically IMT is a mixture of inflamma- tory cells and myofibroblastic spindle cells proliferation. To our knowledge there is no MRI description of mesenteric IMT in the literature. We would like to emphasize the correlation between medical imaging and anatomical pathology based on our experience of a mesenteric IMT in a 28-year-old patient.

  9. Percutaneous Ablation of a Mesenteric Cyst Using Ethanol: Is It Feasible?

    SciTech Connect

    Irie, Toshiyuki Kuramochi, Masashi; Takahashi, Nobuyuki; Kamoshida, Toshirou

    2010-06-15

    A huge mesenteric cyst in a 61-year-old female was treated by percutaneous ablation using ethanol. Marked shrinkage was achieved and regrowth was not seen 16 months after ablation. Resection is the standard therapy for mesenteric cysts, but it may be valuable to discuss the feasibility of percutaneous ablation before resection if the lesion wall is smooth and thin, and if solid nodules are not depicted on imaging.

  10. Acute Abdominal Pain Caused by an Infected Mesenteric Cyst in a 24-Year-Old Female

    PubMed Central

    Ponten, Joep B.; Zijta, Frank M.

    2016-01-01

    A mesenteric cyst is a rare cause for abdominal pain. This umbrella term includes cystic entities which reside in the mesentery. We present a case of an infected false mesenteric cyst in a 24-year-old female patient without prior surgery or known trauma. Mainstay of treatment involves surgical resection, although less invasive treatments have been described. Prognosis depends on the origin of the cyst. PMID:27190668

  11. Mesenteric cysts associated with recurrent small-bowel volvulus: cause or effect?

    PubMed

    Prabhu, Shailesh M; Anand, Rama; Narula, Mahender K; Shetty, Gurucharan S; Udiya, Alok K; Chauhan, Udit; Shukla, Shailaja; Grover, Jitendra Kumar

    2012-12-01

    Recurrent small-bowel volvulus is a state of recurrent intermittent or long-standing persistent twisting of small-bowel loops around its mesentery. The association of mesenteric cysts with recurrent small-bowel volvulus as the cause or effect is a much debated issue in the literature. We report two cases of mesenteric lymphangioma and one case of enteric duplication cyst seen in association with recurrent small-bowel volvulus of long duration in absence of malrotation.

  12. [Mesenteric cyst is a rare origin for abdominal pain in children].

    PubMed

    Dawar, Mirwais; Madsen, Mogens Rørbæk

    2015-02-16

    A ten-year-old boy with known episodes of moderate abdominal pain during 18 months suddenly developed severe abdominal pain, and a CT scan showed a 25 × 15 cm cystic process. The patient was operated and a mesenteric cyst was removed along with 15 cm of small bowel. Post-operative course was uneventful. Mesenteric cysts are rare, but should be considered as an origin for abdominal pain in children, particularly after exclusion of more common diagnoses.

  13. Percutaneous ablation of a mesenteric cyst using ethanol: is it feasible?

    PubMed

    Irie, Toshiyuki; Kuramochi, Masashi; Takahashi, Nobuyuki; Kamoshida, Toshirou

    2010-06-01

    A huge mesenteric cyst in a 61-year-old female was treated by percutaneous ablation using ethanol. Marked shrinkage was achieved and regrowth was not seen 16 months after ablation. Resection is the standard therapy for mesenteric cysts, but it may be valuable to discuss the feasibility of percutaneous ablation before resection if the lesion wall is smooth and thin, and if solid nodules are not depicted on imaging.

  14. Simultaneous Occurrence of a Rare Pancreatic Lymphoepithelial Cyst and Duodenal Mesenteric Castleman's Disease: a Case Report.

    PubMed

    Mei, Yong; Peng, Ci-Jun; Shu, De-Jun; Zhu, Hong-Jiang; Li, Xiong-Xiong; Li, Wei-Nan

    2015-04-01

    Pancreatic lymphoepithelial cyst is a rare pancreatic lesion of undetermined pathogenesis, which is a true pancreatic cyst. Castleman's disease is a rare lymphoproliferative disorder, and a mesenteric location is unusual. The simultaneous occurrence of the two diseases are rarer than metachronous ones and has not been reported to date. We present a case report of a patient with simultaneous occurrence of pancreatic lymphoepithelial cyst and duodenal mesenteric Castleman's disease.

  15. Acute Abdominal Pain Caused by an Infected Mesenteric Cyst in a 24-Year-Old Female.

    PubMed

    Sudiono, Davy R; Ponten, Joep B; Zijta, Frank M

    2016-01-01

    A mesenteric cyst is a rare cause for abdominal pain. This umbrella term includes cystic entities which reside in the mesentery. We present a case of an infected false mesenteric cyst in a 24-year-old female patient without prior surgery or known trauma. Mainstay of treatment involves surgical resection, although less invasive treatments have been described. Prognosis depends on the origin of the cyst.

  16. Mesenteric fat as a source of C reactive protein and as a target for bacterial translocation in Crohn's disease

    PubMed Central

    Peyrin-Biroulet, Laurent; Gonzalez, Florent; Dubuquoy, Laurent; Rousseaux, Christel; Dubuquoy, Caroline; Decourcelle, Cécilia; Saudemont, Alain; Tachon, Mickael; Béclin, Elodie; Odou, Marie-Françoise; Neut, Christel; Colombel, Jean-Frédéric

    2011-01-01

    Objective Mesenteric fat hyperplasia is a hallmark of Crohn's disease (CD), and C reactive protein (CRP) is correlated with disease activity. The authors investigated whether mesenteric adipocytes may be a source of CRP in CD and whether inflammatory and bacterial triggers may stimulate its production by adipocytes. Design CRP expression in the mesenteric and subcutaneous fats of patients with CD and the correlation between CRP plasma concentrations and mesenteric messenger RNA (mRNA) levels were assessed. The impact of inflammatory and bacterial challenges on CRP synthesis was tested using an adipocyte cell line. Bacterial translocation to mesenteric fat was studied in experimental models of colitis and ileitis and in patients with CD. Results CRP expression was increased in the mesenteric fat of patients with CD, with mRNA levels being 80±40 (p<0.05) and 140±65 (p=0.04) times higher than in the mesenteric fat of patients with ulcerative colitis and in the subcutaneous fat of the same CD subjects, respectively, and correlated with plasma levels. Escherichia coli (1230±175-fold, p<0.01), lipopolysaccharide (26±0.5-fold, p<0.01), tumour necrosis factor α (15±0.3-fold, p<0.01) and interleukin-6 (10±0.7-fold, p<0.05) increased CRP mRNA levels in adipocyte 3T3-L1 cells. Bacterial translocation to mesenteric fat occurred in 13% and 27% of healthy and CD subjects, respectively, and was increased in experimental colitis and ileitis. Human mesenteric adipocytes constitutively expressed mRNA for TLR2, TLR4, NOD1 and NOD2. Conclusion Mesenteric fat is an important source of CRP in CD. CRP production by mesenteric adipocytes may be triggered by local inflammation and bacterial translocation to mesenteric fat, providing a mechanism whereby mesenteric fat hyperplasia may contribute to inflammatory response in CD. PMID:21940721

  17. The effects of insulin on mesenteric blood flow in anaesthetized pigs.

    PubMed

    Grossini, E; Battaglia, A; Bona, G; Mary, D A S G; Molinari, C; Vacca, G

    2004-07-01

    Infusion of insulin in anaesthetized pigs has been shown to cause an increase in renal blood flow and a decrease in coronary blood flow, which were the net result of a vasoconstriction involving sympathetic alpha-adrenoceptor-mediated mechanisms and of a local vasodilatation involving the endothelial release of nitric oxide. In the present study, the effect of insulin on superior mesenteric blood flow was examined in pentobarbitone-anaesthetized pigs at constant heart rate, aortic blood pressure, left ventricular contractility and blood levels of glucose and potassium. In 10 pigs, infusion of 0.004 IU kg(-1) min(-1) of insulin increased mesenteric flow. In five of these pigs, intravenous phentolamine enhanced the increase in mesenteric flow elicited by insulin, a response which was abolished by the subsequent injection of N(omega)-nitro-L-arginine methyl ester (L-NAME) into the mesenteric artery. In the remaining five pigs, infusion of insulin after intramesenteric injection of L-NAME caused a decrease in mesenteric flow. This response was abolished by the subsequent intravenous administration of phentolamine. The present study showed that infusion of insulin in anaesthetized pigs primarily caused a mesenteric vasodilatation, which was the net result of two opposite effects, namely a predominant vasodilatation mediated by the endothelial release of nitric oxide and a sympathetic vasoconstrictor mechanism mediated by alpha-adrenoceptors.

  18. Review article: diagnosis and management of mesenteric ischaemia with an emphasis on pharmacotherapy.

    PubMed

    Kozuch, P L; Brandt, L J

    2005-02-01

    Mesenteric ischaemia results from decreased blood flow to the bowel, causing cellular injury from lack of oxygen and nutrients. Acute mesenteric ischaemia (AMI) is an uncommon disorder with high morbidity and mortality, but outcomes are improved with prompt recognition and aggressive treatment. Five subgroups of AMI have been identified, with superior mesenteric artery embolism (SMAE) the most common. Older age and cardiovascular disease are common risk factors for AMI, excepting acute mesenteric venous thrombosis (AMVT), which affects younger patients with hypercoaguable states. AMI is characterized by sudden onset of abdominal pain; a benign abdominal exam may be observed prior to bowel infarction. Conventional angiography and more recently, computed tomography angiography, are the cornerstones of diagnosis. Correction of predisposing conditions, volume resuscitation and antibiotic treatment are standard treatments for AMI, and surgery is mandated in the setting of peritoneal signs. Intra-arterial vasodilators are used routinely in the treatment of non-occlusive mesenteric ischaemia (NOMI) and also are advocated in the treatment of occlusive AMI to decrease associated vasospasm. Thrombolytics have been used on a limited basis to treat occlusive AMI. A variety of agents have been studied in animal models to treat reperfusion injury, which sometimes can be more harmful than ischaemic injury. Chronic mesenteric ischaemia (CMI) usually is caused by severe obstructive atherosclerotic disease of two or more splanchnic vessels, presents with post-prandial pain and weight loss, and is treated by either surgical revascularization or percutaneous angioplasty and stenting.

  19. Binding protein for vitamin D and its metabolites in rat mesenteric lymph

    SciTech Connect

    Dueland, S.; Bouillon, R.; Van Baelen, H.; Pedersen, J.I.; Helgerud, P.; Drevon, C.A.

    1985-07-01

    A protein with high affinity for vitamin D3 and 25-hydroxyvitamin D3 in rat mesenteric lymph has been studied. Mesenteric lymph was collected after duodenal instillation of radiolabeled vitamin D3 and 25-hydroxyvitamin D3. As previously described, approximately 10% of vitamin D3 and 95% of 25-hydroxyvitamin D3 recovered in mesenteric lymph were associated with the alpha-globulin fractions. The radioactive vitamin D3 recovered in the lymph fraction with d greater than 1.006 (free of chylomicrons) coeluted with purified rat serum binding protein for vitamin D and its metabolites (DBP) from an antirat DBP column. The results obtained by immunoblotting after sodium dodecyl sulfate polyacrylamide gel electrophoresis showed that this protein in mesenteric lymph had molecular weight and immunological properties identical with purified serum DBP. Purified serum DBP labeled with /sup 125/I was injected intravenously and mesenteric lymph was collected. results suggesting that DBP may be transferred from blood to mesenteric lymph and that plasma and lymph DBP may have a similar origin.

  20. Bardoxolone Methyl Prevents Mesenteric Fat Deposition and Inflammation in High-Fat Diet Mice

    PubMed Central

    Dinh, Chi H. L.; Szabo, Alexander; Yu, Yinghua; Camer, Danielle; Wang, Hongqin; Huang, Xu-Feng

    2015-01-01

    Mesenteric fat belongs to visceral fat. An increased deposition of mesenteric fat contributes to obesity associated complications such as type 2 diabetes and cardiovascular diseases. We have investigated the therapeutic effects of bardoxolone methyl (BARD) on mesenteric adipose tissue of mice fed a high-fat diet (HFD). Male C57BL/6J mice were administered oral BARD during HFD feeding (HFD/BARD), only fed a high-fat diet (HFD), or fed low-fat diet (LFD) for 21 weeks. Histology and immunohistochemistry were used to analyse mesenteric morphology and macrophages, while Western blot was used to assess the expression of inflammatory, oxidative stress, and energy expenditure proteins. Supplementation of drinking water with BARD prevented mesenteric fat deposition, as determined by a reduction in large adipocytes. BARD prevented inflammation as there were fewer inflammatory macrophages and reduced proinflammatory cytokines (interleukin-1 beta and tumour necrosis factor alpha). BARD reduced the activation of extracellular signal-regulated kinase (ERK) and Akt, suggesting an antioxidative stress effect. BARD upregulates energy expenditure proteins, judged by the increased activity of tyrosine hydroxylase (TH) and AMP-activated protein kinase (AMPK) and increased peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α), and uncoupling protein 2 (UCP2) proteins. Overall, BARD induces preventive effect in HFD mice through regulation of mesenteric adipose tissue. PMID:26618193

  1. Early management of mesenteric cyst prevents catastrophes: a single centre analysis of 17 cases.

    PubMed

    Prakash, Advait; Agrawal, Amit; Gupta, Rahul K; Sanghvi, Beejal; Parelkar, Sandesh

    2010-01-01

    Mesenteric cysts are rare intra-abdominal masses in the paediatric age group with varied presentation, ranging from an asymptomatic mass to acute abdomen. This study reviews our experience in the diagnosis and treatment of 17 mesenteric cysts in our centre, with especial reference to acute abdominal symptoms. Seventeen patients (age less than 10 years) with mesenteric cysts were managed in our hospital. The age ranged from 15 days to 10 years. Patients were admitted with acute or chronic symptoms. They were evaluated with complete history, clinical examination, blood investigations and radiological investigations (x-ray abdomen erect, ultrasound abdomen (USG) and computed tomography (CT) scan in selected cases) to reach a provisional diagnosis. The diagnosis was proven on laparotomy and histologically confirmed. The main presenting symptoms were abdominal pain or lump. The most common mode of presentation was acute small intestinal obstruction. USG was not conclusive in all. Abdominal CT scan with intravenous contrast was diagnostic in nine patients. Five patients had volvulus on exploration. Cysts were located in small intestinal mesentery in 14 cases and three were in the sigmoid mesentery. Seven patients had complete excision, intestinal resection was required in four and marsupialisation with cauterisation of margins was done in six patients. Histologically, all were lymphangiomatous mesenteric cysts. The diagnosis of mesenteric cysts should be kept in mind in any patient presenting with acute abdominal symptoms. Small bowel volvulus with mesenteric cyst constituted a significant number in children with acute abdominal symptoms. Early diagnosis and treatment yields excellent outcome.

  2. Acute Abdomen Caused by an Infected Mesenteric Cyst in the Ascending Colon: A Case Report

    PubMed Central

    Kim, Eun-Ji; Ahn, Byung-Kwon; Baek, Sung-Uhn

    2011-01-01

    Mesenteric cysts are rare intra-abdominal tumors. Mesenteric cysts are usually asymptomatic and are incidentally detected during physical or radiological examination. Although uncommon, complications such as infection, bleeding, torsion, rupture and intestinal obstruction cause an acute abdomen. Spontaneous infection is a very rare complication. We present a case of infected mesenteric cysts in the ascending colon, which caused an acute abdomen. A 26-year-old woman was admitted to our hospital with acute abdominal pain. She had a painful mass in the right abdomen on physical examination. Abdominal computed tomography showed a hypodense cystic mass with septation at the mesenteric region of the ascending colon. A laparotomy revealed two cystic tumors at the mesenteric region of the ascending colon. She underwent a right hemicolectomy. The two cysts were filled with a yellowish turbid fluid. The walls of both two cysts were lined with a thin fibrotic membrane without any epithelial cell. They were diagnosed as psuedocysts with E. coli infection. Mesenferic cysts may cause life-threatening complications. Mesenteric cyst, even if it is asymptomatic and was diagnosed incidentally, should be removed completely. PMID:21829771

  3. Acute abdomen caused by an infected mesenteric cyst in the ascending colon: a case report.

    PubMed

    Kim, Eun-Ji; Lee, Seung-Hyun; Ahn, Byung-Kwon; Baek, Sung-Uhn

    2011-06-01

    Mesenteric cysts are rare intra-abdominal tumors. Mesenteric cysts are usually asymptomatic and are incidentally detected during physical or radiological examination. Although uncommon, complications such as infection, bleeding, torsion, rupture and intestinal obstruction cause an acute abdomen. Spontaneous infection is a very rare complication. We present a case of infected mesenteric cysts in the ascending colon, which caused an acute abdomen. A 26-year-old woman was admitted to our hospital with acute abdominal pain. She had a painful mass in the right abdomen on physical examination. Abdominal computed tomography showed a hypodense cystic mass with septation at the mesenteric region of the ascending colon. A laparotomy revealed two cystic tumors at the mesenteric region of the ascending colon. She underwent a right hemicolectomy. The two cysts were filled with a yellowish turbid fluid. The walls of both two cysts were lined with a thin fibrotic membrane without any epithelial cell. They were diagnosed as psuedocysts with E. coli infection. Mesenferic cysts may cause life-threatening complications. Mesenteric cyst, even if it is asymptomatic and was diagnosed incidentally, should be removed completely.

  4. Ischemia/Reperfusion Injury Alters Sphingolipid Metabolism in the Gut.

    PubMed

    Hoehn, Richard S; Seitz, Aaron P; Jernigan, Peter L; Gulbins, Erich; Edwards, Michael J

    2016-01-01

    Intestinal ischemia/reperfusion injury (I/R) is a significant cause of morbidity and mortality in surgical patients. Ceramide is a mediator of apoptosis and has been implicated as increasing bacterial infection susceptibility. The metabolite of ceramide, sphingosine, was recently shown to play an important role in the cell-autonomous, innate immune response of the upper respiratory tract by killing bacterial pathogens. The role of ceramide and/or sphingosine after mesenteric I/R is unknown. We investigated the specific effects of intestinal I/R on tissue ceramide and sphingosine concentration and resulting susceptibility to bacterial invasion. To simulate intestinal I/R, C57BL/6 mice underwent 30 minutes of vascular clamp-induced occlusion of the superior mesenteric artery followed by variable reperfusion times. Jejunum segments and intraluminal contents were analyzed for ceramide, sphingosine and bacteria using immunohistochemistry. Jejunum samples were also homogenized and cultured to quantify bacterial presence in the proximal intestine. We hypothesized that I/R induces an increase of ceramide in the intestine resulting in increased permeability, while a concomitant decrease of sphingosine may permit bacterial overgrowth. Control mice had no measurable bacteria in their proximal jejunum as measured by tissue culture and immunohistochemistry. After I/R, bacterial counts in the jejunum increased in a time-dependent manner, reaching a peak at 12 hours after reperfusion. Immunohistochemical analysis revealed a marked increase in ceramide in the vasculature of jejunal villi. In contrast, while ceramide concentrations in the epithelial cells decreased after I/R, sphingosine levels appeared to remain unchanged. Surprisingly, bacteria present in the jejunal lumen following I/R contained a ceramide coat. These data indicate that intestinal I/R leads to small intestine bacterial overgrowth as well as ceramide formation in the jejunal vasculature, which may contribute to

  5. Protective effects of dexmedetomidine on intestinal ischemia-reperfusion injury

    PubMed Central

    SUN, YONG; GAO, QIANG; WU, NAN; LI, SHENG-DE; YAO, JING-XIN; FAN, WEN-JIE

    2015-01-01

    Dexmedetomidine (DEX) has been hypothesized to possess anti-oxidative properties that may mitigate the damage caused by ischemia-reperfusion (IR) injury. The aim of the present study was to examine the effects of DEX on intestinal contractile activity, inflammation and apoptosis following intestinal IR injury. Intestinal IR injury was induced in rats by complete occlusion of the superior mesenteric artery for 60 min, followed by a 60-min reperfusion period. Rats received an intraperitoneal injection of 25 µg/kg DEX at 30 min prior to the mesenteric IR injury. Following reperfusion, segments of the terminal ileum were rapidly extracted and transferred into an isolated organ bath. The contractile responses to receptor-mediated acetylcholine (Ach) and non-receptor-mediated potassium chloride (KCl) were subsequently examined. Nitric oxide (NO) levels were determined and the expression levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, Bax and Bcl-2 were measured using an enzyme-linked immunosorbent assay. The levels of telomerase and caspase-3 were determined using reverse transcription-quantitative polymerase chain reaction. The results indicated that DEX treatment produced a significant reduction in the IR-induced contractile response to Ach and KCl in the intestinal tissue. Furthermore, DEX appeared to significantly ameliorate intestinal IR injury, in addition to reducing the production of NO. Similar reductions were observed in the intestinal expression levels of TNF-α and IL-6. In addition, DEX treatment resulted in a reduction in the expression levels of Bax in the intestinal tissues, while increasing those of Bcl-2, in addition to significantly increasing the mRNA levels of telomerase and caspase-3. Therefore, the present study indicated that NO, TNF-α and IL-6 may partially contribute to the pathogenesis of intestinal IR injury in addition to the increased expression levels of Bax, Bcl-2, telomerase and caspase-3. These findings suggest that DEX

  6. Rho Kinase Enhances Contractions of Rat Mesenteric Collecting Lymphatics

    PubMed Central

    Kurtz, Kristine H.; Souza-Smith, Flavia M.; Moor, Andrea N.; Breslin, Jerome W.

    2014-01-01

    The mechanisms that control phasic and tonic contractions of lymphatic vessels are poorly understood. We hypothesized that rho kinase ROCK, previously shown to increase calcium (Ca2+) sensitivity in vascular smooth muscle, enhances lymphatic contractile activity in a similar fashion. Contractions of isolated rat mesenteric lymphatic vessels were observed at a luminal pressure of 2 cm H2O in a 37°C bath. The expression of ROCK in isolated rat mesenteric lymphatic vessels was assessed by Western blotting and confocal microscopy. The role of ROCK in contractile function was tested using two specific yet structurally distinct inhibitors: H1152 (0.1–10 μM) and Y-27632 (0.5–50 μM). In addition, lymphatics were transfected with constitutively active (ca)-ROCK protein (2 μg/ml) to assess gain of contractile function. Vessel diameter and the concentration of intracellular free Ca2+ ([Ca2+]i) were simultaneously measured in a subset of isolated lymphatics loaded with the Ca2+-sensing dye fura-2. The results show expression of both the ROCK1 and ROCK2 isoforms in lymphatic vessels. Inhibition of ROCK increased lymphatic end diastolic diameter and end systolic diameter in a concentration-dependent manner. Significant reductions in lymphatic tone and contraction amplitude were observed after treatment 1–10 μM H1152 or 25–50 μM Y-27632. H1152 (10 μM) also significantly reduced contraction frequency. Transient increases in [Ca2+]i preceded each phasic contraction, however this pattern was disrupted by either 10 μM H1152 or 50 μM Y-27632 in the majority of lymphatics studied. The significant decrease in tone caused by H1152 or Y-27632 was not associated with a significant change in the basal [Ca2+]i between transients. Transfection with ca-ROCK protein enhanced lymphatic tone, but was not associated with a significant change in basal [Ca2+]i. Our data suggest that ROCK mediates normal tonic constriction and influences phasic contractions in lymphatics. We propose

  7. [Prothrombotic states and cerebral ischemia].

    PubMed

    Barinagarrementeria, F; González-Duarte, A; Cantú-Brito, C

    1998-01-01

    Hematological disorders per se represent unusual causes of cerebral ischemia, explaining in young people 4% of strokes. Hematological disorders that induce a thrombotic tendency contribute to overall ischemic stroke risk and may directly cause cerebral ischemia in patients without other risk factors. The frequency of cerebral infarctions caused by prothrombotic states is not known. This review will focus on disorders such as prothrombotic coagulopaties, including resistance to activated protein C and antiphospholipid syndrome as cause of cerebral infarction. Cerebral venous thrombosis and cerebral infarction from arterial origin are the most common form of neurological involvement. Pathophysiological mechanism of stroke in these patients are multiple and can include as in antiphospholipid syndrome embolism from valves abnormalities related to hematological disturbance, as well as thrombosis of extracranial or intracranial vessels. Is clear, however, that prothrombotic states could explains a high percentage of cases of those so called cryptogenic cerebral infarction in young people.

  8. Experimental myocardial ischemia. Pt. 2

    SciTech Connect

    Serur, J.R.; Als, A.V.; Paulin, S.

    1982-01-01

    The comparative effects of meglumine sodium diatrizoate (MSD), sodium meglumine calcium metrizoate (SMCM), and metrizamide (M) were studied in an isolated canine heart preparation. The parameters observed were coronary blood flow (CBF), myocardial contractile force (MCF), positive and negative dF/dt, and perfusion pressure during normal and ischemic perfusion conditions. MSD had an initial negative inotropic effect but baseline MCF returned in 1 min during normal perfusion and 2 min under ischemic conditions. SMCM and M had only a positive inotropic effect under normal perfusion. However, during ischemia, the positive effect of SMCM was followed by a decrease in contractile force. M showed only a positive effect on force during ischemia. Our results indicate that calcium additive may increase the risk of coronary arteriography in patients with severe coronary artery disease.

  9. [Clinical research progress of mesenteric internal hernia after Roux-en-Y reconstruction].

    PubMed

    Xu, Zhengrong; Guo, Wenjun

    2017-03-25

    Postoperative internal hernia is a rare clinical complication which often occurs after digestive tract reconstruction. Roux-en-Y anastomosis is a common type of digestive tract reconstruction. Internal hernia after Roux-en-Y reconstruction, which occurs mainly in the mesenteric defect caused by incomplete closure of mesenteric gaps in the process of digestive tract reconstruction, is systematically called, in our research, as mesenteric internal hernia after Roux-en-Y reconstruction. Such internal hernia can be divided, according to the different structures of mesentric defect, into 3 types: the type of mesenteric defect at the jejunojejunostomy (J type), the type of Petersen's defect (P type), and the type of mesenteric defect in the transverse mesocolon (M type). Because of huge differences in the number of cases and follow-up time among existing research reports, the morbidity of internal hernia after LRYGB fluctuates wildly between 0.2% and 9.0%. Delayed diagnosis and treatment of mesenteric internal hernia after Roux- en-Y reconstruction may result in disastrous consequences such as intestinal necrosis. Clinical manifestations of internal hernia vary from person to person: some, in mild cases, may have no symptoms at all while others in severe cases may experience acute intestinal obstruction. Despite the difference, one common manifestation of internal hernia is abdominal pain. Surgical treatment should be recommended for those diagnosed as internal hernia. A safer and more feasible way to conduct the manual reduction of the incarcerated hernia is to start from the distal normal empty bowel and trace back to the hernia ring mouth, enabling a faster identification of hernia ring and its track. The prevention of mesenteric internal hernia after Roux-en-Y reconstruction is related to the initial surgical approach and the technique of mesenteric closure. Significant controversy remains on whether or not the mesenteric defect should be closed in laparoscopic Roux

  10. Plasma citrulline measurement in the diagnosis of acute mesenteric ischaemia.

    PubMed

    Kulu, Rıdvan; Akyildiz, Hizir; Akcan, Alper; Oztürk, Ahmet; Sozuer, Erdogan

    2017-09-01

    The differential diagnosis in acute mesenteric ischaemia (AMI) is essential and sometimes life-saving. A marker for early diagnosis is lacking. Citrulline is an amino acid mainly synthesized by small bowel enterocytes from glutamine. In this study, we aimed to evaluate the diagnostic and prognostic values of citrulline with those of the D-dimer in patients with AMI. The patients were divided into two groups; group 1: patients with acute abdominal findings which were attributed preoperatively to AMI, and group 2: patients with acute abdominal findings which were attributed preoperatively to causes other than AMI. All patients underwent surgical exploration. Blood samples were taken before surgery. The demographic features, laboratory examinations, citrulline concentration, D-dimer level and surgical findings were evaluated. Overall, 48 patients were enrolled in the study. AMI was diagnosed in 23 of the 48 patients. There was no significant difference between the groups with regard to gender, leucocyte count and creatinine levels but group 1 was significantly older than group 2. Citrulline, D-dimer and lactate levels were also significantly higher in group 1. Age, lactate, D-dimer and citrulline levels were statistically significant for mortality. The most significant factor was increased lactate level at admission. Plasma citrulline level may be helpful in the diagnosis of patients with AMI. © 2016 Royal Australasian College of Surgeons.

  11. Non-occlusive mesenteric ischaemia of a free jejunal flap.

    PubMed

    Onoda, Satoshi; Kimata, Yoshihiro; Yamada, Kiyoshi; Koshimune, Seijiro; Onoda, Tomoo; Shirakawa, Yasuhiro

    2013-05-01

    Free jejunal transfer using microsurgery after oesophageal or pharyngeal cancer resection is a useful operative approach. However, the disadvantage of free tissue transfer is the risk of necrosis of the transferred tissue due to impaired blood supply. In addition, jejunal flaps are more prone to blood-flow disorders such as ischaemia and congestion compared with other types of flaps. The causes of local blood supply disorders after microsurgery are divided broadly into two classes: one is thrombosis of an artery and/or vein in the anastomotic region and the other consists of local physical factors such as compressive pressure derived from haematoma formation and the effect of infection of the vascular pedicle. In this report, two rare cases of blood-flow disorder of the transferred free jejunum are described. In both cases, no signs of significant infection or occlusion of the vascular pedicles were present and late necrosis progressed gradually. The patients showed remarkable weight loss and a poor nutritional state due to inadequate preoperative nutritional intake. The necrosis was considered to be a result of non-occlusive mesenteric ischaemia of a free jejunal flap, and the factors contributing to free jejunal necrosis were reviewed.

  12. Characteristics of plasmalemma alkaline phosphatase of rat mesenteric artery.

    PubMed

    Kwan, C Y

    1983-01-01

    General characteristics of alkaline phosphatase activity of the plasma membrane-enriched fraction isolated from rat mesenteric arteries were investigated. The vascular smooth muscle plasmalemma alkaline phosphatase is a metalloenzyme which is strongly inhibited by chelating agents and this inhibition can be completely overcome by addition of Mg2+ or Ca2+. Zn2+ only partially reactivates the enzyme in the presence of low concentrations of EDTA. The enzymatic hydrolysis of p-nitrophenyl phosphate, beta-glycerophosphate, alpha-glycerophosphate, or 3'-adenosine monophosphate showed an optimal activity in the alkaline region between pH 9 and 11. The alkaline phosphatase activity is distinctly different from the plasmalemma ATPase and 5'-nucleotidase activities with respect to their pH dependence, influence by added divalent metal ions and stability against heat inactivation. Vanadate ion, being structurally similar to the transition state analog of the phosphoryl group, potently inhibits alkaline phosphatase with an apparent Ki of 1.5 microM. The altered alkaline phosphatase activity of vascular smooth muscle in relation to its possible physiological function and pathophysiological manifestation associated with hypertensive disease are discussed.

  13. Superior mesenteric artery syndrome in the modern trauma patient.

    PubMed

    Adams, John B; Hawkins, Michael L; Ferdinand, Coville H; Medeiros, Regina S

    2007-08-01

    In 1861, von Rokitansky described obstruction of the third part of the duodenum by external compression of the duodenum by the superior mesenteric artery (SMA). In 1926, this entity was furthermore described by Wilke in his presentation of 75 patients with "chronic duodenal compression". In 1968, Mansberger used angiography to define anatomical measurements as the diagnostic criteria for this condition. Current modalities of diagnosis of SMA syndrome include esophagogastroduodenoscopy, computerized tomography angiogram, fluoroscopy, transabdominal ultrasound, and endoscopic ultrasound. The SMA syndrome has been associated with prolonged confinement in the supine position, loss of weight, loss of abdominal wall muscle tone, application of a body cast, and severe burns. With current surgical techniques allowing early ambulation, patients are able to avoid prolonged bed rest. The use of parenteral and enteral nutritional support has limited the loss of weight associated with trauma and burn patients, making this syndrome uncommon in this patient population. Recent reports of SMA syndrome focus on the association with corrective surgical procedures for scoliosis and obesity.

  14. The superior mesenteric artery syndrome in patients with spinal deformity.

    PubMed

    Altiok, Haluk; Lubicky, John P; DeWald, Christopher J; Herman, Jean E

    2005-10-01

    A retrospective review. To determine the incidence of the superior mesenteric artery syndrome (SMAS) after surgical correction for scoliosis and if it is influenced by newer derotation/translation surgical systems. The SMAS is a known complication after surgery. Of 2939 charts reviewed, 17 patients between 1960 and 2002 matched inclusion criteria. Our incidence of the SMAS was 0.5%. Onset of symptoms was 7.2 days. Several scoliosis diagnoses were included in the study group. Instrumentation that was used included: nondistraction systems (n = 14), Harrington rod with body cast (n = 1), Luque rod with sublaminar wires (n = 1), and casted in situ posterior spinal fusion (n = 1). Before surgery, 10 of 17 patients weighed less than the 50th percentile. Mean preoperative BMI was 18.6 kg/cm/cm. Postoperative height gain averaged 3.175 cm, and weight loss at onset of symptoms averaged 4.5 kg. There were 14 patients who required nasogastric suction for an average duration of 10.2 days, 11 required hyperalimentation, and 5 concurrently received hyperalimentation with enteric feeding. The SMAS recurred in 2 patients. Postoperative weight loss appears to be more important for the development of the SMAS than asthenic body type. Newer derotation/translation corrective techniques have not eliminated the SMAS. Gastrointestinal imaging is indicated when nausea and vomiting occur 6-12 days after surgery, associated with early satiety and normal bowel sounds. Decompression and nutritional support remain the mainstays of treatment.

  15. Hypothalamic germinoma masquerading as superior mesenteric artery (SMA) syndrome.

    PubMed

    Vethakkan, Shireene R; Venugopal, Yogeswari; Tan, Alexander T B; Paramasivam, Sharmila S; Ratnasingam, Jeyakantha; Razak, Rohaya A; Alias, Azmi; Kassim, Fauziah; Choong, Karen

    2013-01-01

    To report a case of superior mesenteric artery (SMA) syndrome secondary to hypothalamic germinoma. We describe the clinical presentation, diagnostic work-up, management, and clinical course of a patient admitted with SMA syndrome who was subsequently found to have a hypothalamic germinoma. An adolescent boy was admitted to the surgical ward with progressive weight loss over a 2 year period and postprandial vomiting. He was diagnosed with SMA syndrome based on evidence of proximal duodenal dilatation, extrinsic compression of the distal duodenum, and a narrowed aortomesenteric angle (16°). Investigations performed to exclude thyrotoxicosis unexpectedly revealed secondary hypothyroidism and further evaluation demonstrated evidence of pan-hypopituitarism. Psychiatric evaluation excluded anorexia nervosa and bulimia. Magnetic resonance imaging (MRI) of the brain revealed a heterogeneously enhancing hypothalamic lesion, but a normal pituitary gland. Hormone replacement with hydrocortisone, desmopressin, testosterone, and thyroxine resulted in weight gain and resolution of gastrointestinal symptoms. A transventricular endoscopic biopsy subsequently confirmed a hypothalamic germinoma and he was referred to an oncologist. SMA syndrome secondary to severe weight loss is an uncommon cause of upper gastrointestinal obstruction. While there have been reports of poorly controlled diabetes mellitus and thyrotoxicosis manifesting as SMA syndrome, there are no published reports to date of SMA syndrome secondary to hypothalamic/pituitary disease. Management of SMA syndrome is conservative, as symptoms of intestinal obstruction resolve with weight gain following treatment of the underlying cause. Awareness of this uncommon presentation of endocrine cachexia/hypothalamic disease will prevent unnecessary laparotomies and a misdiagnosis of an eating disorder.

  16. Intracellular Signalling in Retinal Ischemia

    DTIC Science & Technology

    1990-07-01

    36) However, vascularization of the RPE is not known to occur in human diseases of photoreceptor degeneration, such as retinitis pigmentosa ...A.C. (1986) Retinitis pigmentosa and retinal neovascularization. Ophthalmology 91, 1599- 1603. Figure la: Control rat retina, 8 weeks of age, central...TITLE (Include Security Classification) Intracellular Signalling in Retinal Ischemia 12. PERSONAL AUTHOR(S) Burns, Margaret Sue; Bellhorn, Roy William

  17. Functional tests for myocardial ischemia

    SciTech Connect

    Levinson, J.R.; Guiney, T.E.; Boucher, C.A. )

    1991-01-01

    Functional tests for myocardial ischemia are numerous. Most depend upon a combination of either exercise or pharmacologic intervention with analysis of the electrocardiogram, of regional perfusion with radionuclide imaging, or of regional wall motion with radionuclide imaging or echocardiography. While each test has unique features, especially at the research level, they are generally quite similar in clinical practice, so the clinician is advised to concentrate on one or two in which local expertise is high.22 references.

  18. Predictive Modeling of Cardiac Ischemia

    NASA Technical Reports Server (NTRS)

    Anderson, Gary T.

    1996-01-01

    The goal of the Contextual Alarms Management System (CALMS) project is to develop sophisticated models to predict the onset of clinical cardiac ischemia before it occurs. The system will continuously monitor cardiac patients and set off an alarm when they appear about to suffer an ischemic episode. The models take as inputs information from patient history and combine it with continuously updated information extracted from blood pressure, oxygen saturation and ECG lines. Expert system, statistical, neural network and rough set methodologies are then used to forecast the onset of clinical ischemia before it transpires, thus allowing early intervention aimed at preventing morbid complications from occurring. The models will differ from previous attempts by including combinations of continuous and discrete inputs. A commercial medical instrumentation and software company has invested funds in the project with a goal of commercialization of the technology. The end product will be a system that analyzes physiologic parameters and produces an alarm when myocardial ischemia is present. If proven feasible, a CALMS-based system will be added to existing heart monitoring hardware.

  19. Severe Hypokalemia Masquerading Myocardial Ischemia

    PubMed Central

    Petrov, Daniel Bogdanov; Sardovski, Svetlozar Ivanov; Milanova, Maria Hristova

    2012-01-01

    An advanced degree of body potassium deficit may produce striking changes in the electrocardiogram (ECG). These changes can result in incidental findings on the 12-lead ECG or precipitate potentially life-threatening dysrhythmias. Although usually readily recognized, at times these abnormalities may be confused with myocardial ischemia. The object was to report a case of severe hypokalemia mimicking myocardial ischemia. A 33-year-old, previously healthy man, presented to the Emergency Department (ED) with a progressive weakness and chest discomfort. The electrocardiogram showed a marked ST-segment depression in leads II, III, aVF, V1-V6. The initial diagnosis was non ST-elevation myocardial infarction. Echocardiography was normal and troponin levels were within normal limits. A more detailed history revealed that the patient had an episode of acute gastroenteritis with diarrhea and vomiting. Serum chemistries were notable for a potassium concentration of 1,8 mmol per liter. With aggressive electrolyte correction, the ECG abnormalities reverted as potassium levels normalized. Hypokalemia induced ST-segment depression may simulate myocardial ischemia. The differential diagnosis might be difficult, especially in the cases when ST changes are accompanied with chest discomfort.

  20. Chronic Gastric Ischemia Leading to Gastric Perforation

    PubMed Central

    Lundsmith, Emma; Zheng, Matthew; McCue, Peter

    2016-01-01

    A 69-year-old man with diabetes, peripheral vascular disease, and hypertension presented with 3 months of diffuse abdominal pain that worsened with meals, weight loss, and dysphagia. Esophagogastroduodenoscopy and computed tomography revealed findings consistent with chronic gastric ischemia secondary to atherosclerosis. Gastric ischemia eventually led to perforation. We discuss causes, symptoms, diagnosis, and management of gastric ischemia, an underdiagnosed and potentially fatal condition that requires urgent diagnosis and treatment. PMID:28119945

  1. Effect of Meconium on the Contractility of the Superior Mesenteric Artery: A Clue to Intestinal Damage in Gastroschisis.

    PubMed

    Karakuş, Osman Z; Solmaz, Bora; Ateş, Oğuz; Ateş, Mehmet; Hakgüder, Gülce; Olguner, Mustafa; Akgür, Feza M

    2015-08-01

    Intestinal damage has been shown to occur when intra-amniotic meconium concentration exceeds threshold level. However, the mechanism of the meconium-induced intestinal damage is still unclear. Intestinal ischemia can cause intestinal damage in gastroschisis. This study was aimed to determine the effects of intra-amniotic meconium on the contractility of superior mesenteric artery (SMA). Eighteen-day-old fertilized chick embryos (Gallus Domesticus) were extirpated and intestines were harvested. The SMA specimens were prepared as 4 mm segments in the organ bath with Krebs-Henseleit buffer. The isometric contraction responses of the SMA specimens were evaluated with norepinephrine, different meconium concentrations, and clear amniotic fluid. Maximum isometric contractions responses (MICR) of the SMA specimens were recorded with an amplifier system on a computer. In the norepinephrine group, MICR was found as 2.92 ± 0.57 mN. While MICR of the 1/100 meconium group (highest meconium concentration) was found as 1.56 ± 0.40 mN, MICR of the clear amniotic fluid group was 0.41 ± 0.07 mN. The MICR of the norepinephrine group was significantly increased compared with the 1/100 meconium and clear amniotic fluid groups. MICR of the 1/100 meconium group was also found to be significantly increased compared with clear amniotic fluid group. No statistically significant difference was found among the meconium subgroups. Intra-amniotic meconium in fetuses with gastroschisis might cause ischemic intestinal damage by reducing the intestinal blood flow. Further studies are needed to show the outcomes of the vasoactive effect of meconium on the SMA blood flow. Georg Thieme Verlag KG Stuttgart · New York.

  2. Gradual Colonic Impaction of a Chicken Bone Associated with Inflammatory Pseudotumor Formation and Nonocclusive Colon Ischemia

    PubMed Central

    Fosi, Stefania; Bindi, Alessio; De Sanctis, Flavio; Ricciardi, Edoardo; Rossi, Piero; Petrella, Giuseppe; Simonetti, Giovanni

    2014-01-01

    Foreign body (FB) ingestion is a common clinical problem and most FBs pass through the gastrointestinal tract without the need for intervention. A wide spectrum of clinical presentations may be possible and these can be either acute or chronic. We present a case of an 83-year-old woman featuring insidious abdominal discomfort who was hospitalized in our institution due to worsening symptoms. She underwent contrast-enhanced computed tomography (CT) evaluation which showed the presence of a significant parietal thickening of the transverse and descending colon, a mesenteric loose tissue imbibition, venous engorgement, and no filling defect of visceral arteries, suggesting a condition of nonocclusive colon ischemia. A hyperdense FB was identified in the sigma and was associated with a small pseudotumoral mass. The patient underwent surgical exploration which confirmed the hypoperfusional state of the colon, showing the presence of a chicken bone perforating the sigma and lying in the context of a pseudotumoral mass. Our experience shows how contrast-enhanced CT is feasible and can be strongly recommended as a first-line imaging tool on suspicion of colon ischemia and also how it can easily identify the underlying cause, in our case a FB sealed perforation of the sigma with pseudotumoral mass formation. PMID:24707425

  3. Diagnosis of intestinal ischemia in the rat using magnetic resonance imaging.

    PubMed

    Park, A; Towner, R A; Langer, J C

    1993-01-01

    Noninvasive diagnosis of persistent ischemia after intestinal revascularization has remained an elusive goal. Because magnetic resonance imaging (MRI) can detect changes in tissue water, we studied its efficacy in differentiating ischemic from perfused intestine in an animal model. Six-week-old rats were subjected to (1) 30-min superior mesenteric artery (SMA) occlusion and reperfusion, (2) permanent SMA ligation, or (3) sham operation, and were then imaged for 90 min using a small-animal MRI scanner with T1 weighting (TR = 1000 msec, TE = 25 msec). In an additional group of rats, the experiment was repeated using a new contrast technique consisting of oral ferrite to decrease luminal signal and intravenous gadolinium to increase bowel wall signal. Mean abdominal intensity over the scanning period was calculated for each animal (n = 5 rats per experimental group). Definition of individual bowel loops was subjectively improved in animals scanned with intravenous and oral contrast. Mean abdominal intensity was significantly lower in ligated vs sham rats (43.90 +/- 8 vs 59.63 +/- 6 and 46.19 +/- 6 vs 54.26 +/- 6, with and without contrast, respectively). There was no significant difference in intensity between reperfused and sham animals. MRI differentiated persistently ischemic bowel from viable bowel in this model, both with and without the use of contrast. These data suggest that MRI may have a potential role in the noninvasive diagnosis of persistent intestinal ischemia.

  4. Purkinje fibers after myocardial ischemia-reperfusion.

    PubMed

    García Gómez-Heras, Soledad; Álvarez-Ayuso, Lourdes; Torralba Arranz, Amalia; Fernández-García, Héctor

    2015-07-01

    The purpose of this study was to evaluate the effects of ischemia-reperfusion on Purkinje fibers, comparing them with the adjacent cardiomyocytes. In a model of heterotopic heart transplantation in pigs, the donor heart was subjected to 2 hours of ischemia (n=9), preserved in cold saline, and subjected to 24 hours of ischemia with preservation in Wisconsin solution, alone (n=6), or with an additive consisting of calcium (n=4), Nicorandil (n=6) or Trolox (n=7). After 2 hours of reperfusion, we evaluated the recovery of cardiac electrical activity and took samples of ventricular myocardium for morphological study. The prolonged ischemia significantly affected atrial automaticity and A-V conduction in all the groups subjected to 24 hours of ischemia, as compared to 2 hours. There were no significant differences among the groups that underwent prolonged ischemia. Changes in the electrical activity did not correlate with the morphological changes. In the Purkinje fibers, ischemia-reperfusion produced a marked decrease in the glycogen content in all the groups. In the gap junctions the immunolabeling of connexin-43 decreased significantly, adopting a dispersed distribution, and staining the sarcolemma adjacent to the connective tissue. These changes were less marked in the group preserved exclusively with Wisconsin solution, despite the prolonged ischemia. The addition of other substances did not improve the altered morphology. In all the groups, the injury appeared to be more prominent in the Purkinje fibers than in the neighboring cardiomyocytes, indicating the greater susceptibility of the former to ischemia-reperfusion injury.

  5. Mesenteric findings of CT enterography are well correlated with the endoscopic severity of Crohn's disease.

    PubMed

    Sakurai, Takehiro; Katsuno, Tatsuro; Saito, Keiko; Yoshihama, Sayuri; Nakagawa, Tomoo; Koseki, Hirotaka; Taida, Takashi; Ishigami, Hideaki; Okimoto, Ken-Ichiro; Maruoka, Daisuke; Matsumura, Tomoaki; Arai, Makoto; Yokosuka, Osamu

    2017-04-01

    Maintenance of mucosal healing is a primary goal when treating Crohn's disease (CD). Endoscopy is the most precise method for the assessment of mucosal healing, but is considered overly invasive for patients with CD. In contrast, CT enterography (CTE) is less invasive, but little is known about the correlation between mucosal status and CTE parameters. We recruited CD patients who underwent CTE and double balloon endoscopy (DBE) on the same day at our hospital between 2012 and 2014. CTE parameters evaluated included bowel-wall thickening, mural hyperenhancement, mural stratification (target sign), submucosal fat deposition, mesenteric hypervascularity (comb sign), increased fat density, mesenteric fibrofatty proliferation, enlarged mesenteric lymph nodes, and stenosis/sacculation. Endoscopic findings were evaluated using the Simple Endoscopic Score for Crohn's Disease (SES-CD). CTE parameters that were predictive of higher values in the SES-CD were extracted statistically. Forty-one patients were recruited, from which 191 intestinal segments were evaluated. Spearman's rank correlation coefficients showed that the majority of CTE values exhibited mild to moderate correlations with SES-CD values. Notably, multiple ordinal logistic regression analysis demonstrated that CTE findings obtained from the mesenteric area, such as mesenteric hypervascularity (comb sign) and enlarged mesenteric lymph nodes, were more critical predictors of endoscopic mucosal ulceration than those obtained from the bowel wall. This study was the first of its kind to assess correlations between CTE values and SES-CD values. Mesenteric findings of CTE, rather than mural findings, were highly correlated with the endoscopically evaluated severity of ulceration. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Raised tone reveals ATP as a sympathetic neurotransmitter in the porcine mesenteric arterial bed.

    PubMed

    Shatarat, Amjad; Dunn, William R; Ralevic, Vera

    2014-12-01

    The relative importance of ATP as a functional sympathetic neurotransmitter in blood vessels has been shown to be increased when the level of preexisting vascular tone or pressure is increased, in studies carried out in rat mesenteric arteries. The aim of the present study was to determine whether tone influences the involvement of ATP as a sympathetic cotransmitter with noradrenaline in another species. We used the porcine perfused mesenteric arterial bed and porcine mesenteric large, medium and small arteries mounted for isometric tension recording, because purinergic cotransmission can vary depending on the size of the blood vessel. In the perfused mesenteric bed at basal tone, sympathetic neurogenic vasocontractile responses were abolished by prazosin, an α1-adrenoceptor antagonist, but there was no significant effect of α,β-methylene ATP, a P2X receptor-desensitizing agent. Submaximal precontraction of the mesenteric arterial bed with U46619, a thromboxane A2 mimetic, augmented the sympathetic neurogenic vasocontractile responses; under these conditions, both α,β-methylene ATP and prazosin attenuated the neurogenic responses. In the mesenteric large, medium and small arteries, prazosin attenuated the sympathetic neurogenic contractile responses under conditions of both basal and U46619-raised tone. α,β-Methylene ATP was effective in all of these arteries only under conditions of U46619-induced tone, causing a similar inhibition in all arteries, but had no significant effect on sympathetic neurogenic contractions at basal tone. These data show that ATP is a cotransmitter with noradrenaline in porcine mesenteric arteries; the purinergic component was revealed under conditions of partial precontraction, which is more relevant to physiological conditions.

  7. Vasodilator activity of hydrogen sulfide (H2S) in human mesenteric arteries.

    PubMed

    Materazzi, Serena; Zagli, Giovanni; Nassini, Romina; Bartolini, Ilenia; Romagnoli, Stefano; Chelazzi, Cosimo; Benemei, Silvia; Coratti, Andrea; De Gaudio, Angelo Raffaele; Patacchini, Riccardo

    2017-01-01

    The role of endogenous H2S has been highlighted as a gaseous transmitter. The vascular smooth muscle inhibitory effects of H2S have been characterized in isolated aorta and mesenteric arteries in rats and mice. Our study was aimed at investigating the vascular effects of H2S on human isolated mesenteric arteries and examining the underlying mechanisms involved. All experiments were performed on rings (4-8mm long) of human mesenteric arteries obtained from patients undergoing abdominal surgery. Ethical approval was obtained from the Ethics Committee of the University Hospital of the University of Florence (app. N. 2015/0024947). The effect of NaHS, an H2S donor, was determined using noradrenaline pre-contracted human isolated mesenteric rings. NaHS evoked a concentration-dependent relaxation (EC50 57μM). In contrast, homocysteine, an endogenous precursor of H2S, failed to affect human isolated mesenteric rings. Vasorelaxant response to NaHS was reduced by endothelium removal, application of the nitric oxide synthase inhibitor L-NAME and ODQ inhibitor of cyclic GMP. SQ 22536, an adenylate-cyclase inhibitor, failed to block NaHS-induced vasorelaxation. Inhibition of endogenous prostanoid production by indomethacin significantly reduced NaHS induced vasorelaxation. The role of potassium channels was also examined: blockers of the Ca(2+)-dependent potassium channel, charybdotoxin and apamin, failed to have any influence on the relaxant response to NaHS on this vascular tissue. In summary, H2S induced relaxation of isolated rings of human mesenteric arteries. Endothelium-dependent related mechanisms with the stimulation of ATP-sensitive potassium channels represents important cellular mechanisms for H2S effect on human mesenteric arteries. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. [Capillary blood flow as an index of the therapeutic effect of folinic acid in ischemia-reperfusion syndrome].

    PubMed

    San Cristóbal, J; Cearra, I; Otero, B; Martínez-Astorquiza, T; Marín, H; García-Alonso, I

    2007-01-01

    An intestinal reperfusion study with two aims: a) to assess the usefulness of intestinal capillary blood flow measurement by laser-Doppler for intestinal reperfusion studies; and b) to compare the effects of racemic and levo forms of folinic acid in treating the syndrome. A murine model of intestinal ischemia by completely clamping the superior mesenteric artery for 90 minutes. A comparison was made of three treatment groups: saline, folinic acid, and levo-folinic acid. The following factors were analyzed: changes in biochemical parameters (levels of creatine kinase, lactic dehydrogenase, and alkaline phosphatase at 60 minutes, and at two and seven days after restoring blood flow), capillary flow in the jejunum and ileum by laser-Doppler (during ischemia and after the first hour of reperfusion), intestinal mucosa injury, and survival curve. Laser-Doppler provided reliable data on how the different treatments affected capillary flow during intestinal reperfusion. Levo-folinic acid improved capillary flow in the ileum after 25 minutes of reperfusion, and also reduced mucosal injury in the same stretch of intestine by the seventh day post-reperfusion (p<0.05). On the other hand, it produced an initial increase in serum enzymes during reperfusion, and did not modify survival. The changes observed in intestinal capillary blood flow measurement by laser-Doppler have similarities with the effects of drugs on pathological mucosal changes. We could not prove that the levo form of folinic acid has a stronger protective effect versus racemic folinic acid in intestinal ischemia-reperfusion syndrome.

  9. Antiinflammatory effects of soluble complement receptor type 1 promote rapid recovery of ischemia/reperfusion injury in rat small intestine.

    PubMed

    Eror, A T; Stojadinovic, A; Starnes, B W; Makrides, S C; Tsokos, G C; Shea-Donohue, T

    1999-02-01

    We examined the effect of soluble complement receptor type 1 (sCR1) on mucosal injury and inflammation in a rat model of ischemia/reperfusion. Groups of vehicle- and sCR1-treated rats underwent 30 min of mesenteric ischemia followed by 60 or 120 min of reperfusion. When compared to vehicle-treated rats, treatment with sCR1 (12 mg/kg) prior to 120 min of reperfusion significantly reduced mucosal injury, neutrophil infiltration, leukotriene B4 production, and restored villus height to control levels. The protective effect of sCR1 evident at 120 min of reperfusion was not observed at 60 min of reperfusion despite rapid inactivation of complement. These data suggest that complement inhibition minimized mucosal disruption by facilitating mucosal restitution or interrupting the inflammatory process. Delayed administration of sCR1 for 30 or 60 min into the reperfusion period progressively reduced the protection. sCR1-mediated rapid recovery of rat intestine after ischemia/reperfusion underscores the fundamental role of complement activation in neutrophil-mediated tissue injury.

  10. Endovascular Therapeutic Approaches for Acute Superior Mesenteric Artery Occlusion

    SciTech Connect

    Acosta, S. Sonesson, B.; Resch, T.

    2009-09-15

    The purpose of this study was to characterize the outcome of attempted endovascular intervention in patients with acute embolic or thrombotic superior mesenteric artery (SMA) occlusion. The records of 21 patients during a 3-year period between 2005 and 2008 were retrieved from the in-hospital registry. The first group included 10 patients (6 women and 4 men; median age 78 years) with acute embolic occlusion of the SMA. The median duration of symptoms from symptom onset to angiography was 30 hours (range 6 to 120). Synchronous emboli (n = 12) occurred in 6 patients. Embolus aspiration was performed in 9 patients, and 7 of these had satisfactory results. Complementary local thrombolysis was successful in 2 of 3 patients. Residual emboli were present at completion angiography in all 7 patients who underwent successful aspiration embolectomy, and bowel resection was necessary in only 1 of these patients. One serious complication occurred because of a long SMA dissection. The in-hospital survival rate was 90% (9 of 10 patients). The second group included 11 patients (10 women and 1 man; median age 68 years) with atherosclerotic acute SMA occlusions. The median time of symptom duration before intervention was 97 hours (range 17 to 384). The brachial, femoral, and SMA routes were used in 6, 7, and 5 patients, respectively. SMA stenting was performed through an antegrade (n = 7) or retrograde (n = 3) approach. Bowel resection was necessary in 4 patients. No major complications occurred. The in-hospital survival rate was 82% (9 of 11 patients). Endovascular therapy of acute SMA occlusion provides a good alternative to open surgery.

  11. Impaired myogenic tone in mesenteric arteries from overweight rats.

    PubMed

    Sweazea, Karen L; Walker, Benjimen R

    2012-03-16

    Rats fed high fat (HFD) or high sucrose (HSD) diets develop increased adiposity as well as impaired vasodilatory responsiveness stemming from oxidative stress. Moreover, HFD rats become hypertensive compared to either control (Chow) or HSD fed rats, suggesting elevated vascular tone. We hypothesized that rats with increased adiposity and oxidative stress demonstrate augmented pressure-induced vasoconstriction (i.e. myogenic tone) that could account for the hypertensive state. Male Sprague-Dawley rats were fed Chow, HFD or HSD for 6 weeks. The effects of oxidative stress and endogenous nitric oxide on myogenic responses were examined in small mesenteric arteries by exposing the arteries to incremental intraluminal pressure steps in the presence of antioxidants or an inhibitor of nitric oxide synthase, LNNA (100 μM). Contrary to the hypothesis, rats fed either HSD or HFD had significantly impaired myogenic responses despite similar vascular morphology and passive diameter responses to increasing pressures. Vascular smooth muscle (VSM) calcium levels were normal in HFD arteries suggesting that diminished calcium sensitivity was responsible for the impaired myogenic response. In contrast, VSM calcium levels were reduced in HSD arteries but were increased with pre-exposure of arteries to the antioxidants tiron (10 mM) and catalase (1200 U/mL), also resulting in enhanced myogenic tone. These findings show that oxidative stress impairs myogenic tone in arteries from HSD rats by decreasing VSM calcium. Similarly, VSM calcium responses were increased in arteries from HFD rats following treatment with tiron and catalase, but this did not result in improved myogenic tone. Nitric oxide is involved in the impaired myogenic response in HFD, but not HSD, rats since inhibition with LNNA resulted in maximal myogenic responses at lower intraluminal pressures and VSM calcium levels, further implicating reduced calcium sensitivity in the impaired response. The impaired myogenic

  12. Superior mesenteric artery outcomes after fenestrated endovascular aortic aneurysm repair.

    PubMed

    Lala, Salim; Knowles, Martyn; Timaran, David; Baig, Mirza Shadman; Valentine, James; Timaran, Carlos

    2016-09-01

    The Zenith (Cook Medical, Bloomington, Ind) fenestrated endovascular graft may be designed with single-wide scallops or large fenestrations to address the superior mesenteric artery (SMA). Misalignment of the SMA with an unstented scallop or a large fenestration is possible. This study assessed SMA outcomes after fenestrated endovascular aortic aneurysm repair (FEVAR). During an 18-month period, 47 FEVARs were performed at a single institution. For analysis, patients were grouped according to unstented (n = 23) vs stented (n = 24) SMA scallops/fenestrations. The Institutional Review Board approved this single-institution observational study. Because this was a retrospective review of the data, patient consent was unnecessary for the study. Technical success for FEVAR was 100%. The median follow-up period was 7.7 months (range, 1-16 months). Nine of 21 patients (43%) in the unstented group had some degree of misalignment of the SMA (range, 9%-71%). Among these, four patients (44%) developed complications: three SMA stenoses and one occlusion. The mean peak systolic velocity in patients with and without SMA misalignment was 317.8 cm/s vs 188.4 cm/s (P < .08), respectively. No misalignment occurred in the stented group, and only one of 19 patients (5%) developed an SMA stenosis that required angioplasty. Overall, patients with unstented SMAs had significantly more adverse events directly attributable to SMA misalignment than the stented group (44% vs 5%, respectively; P < .05). Misalignment of the SMA with the use of unstented unreinforced scallops or fenestrations occurs frequently. Routine stenting of single-wide and large fenestrations, when feasible, may be a safer option for patients undergoing FEVAR. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  13. Gastrin attenuates ischemia-reperfusion-induced intestinal injury in rats

    PubMed Central

    Liu, Zhihao; Luo, Yongli; Cheng, Yunjiu; Zou, Dezhi; Zeng, Aihong; Yang, Chunhua

    2016-01-01

    Intestinal ischemia-reperfusion (I/R) injury is a devastating complication when the blood supply is reflowed in ischemic organs. Gastrin has critical function in regulating acid secretion, proliferation, and differentiation in the gastric mucosa. We aimed to determine whether gastrin has an effect on intestinal I/R damage. Intestinal I/R injury was induced by 60-min occlusion of the superior mesenteric artery followed by 60-min reperfusion, and the rats were induced to be hypergastrinemic by pretreated with omeprazole or directly injected with gastrin. Some hypergastrinemic rats were injected with cholecystokinin-2 (CCK-2) receptor antagonist prior to I/R operation. After the animal surgery, the intestine was collected for histological analysis. Isolated intestinal epithelial cells or crypts were harvested for RNA and protein analysis. CCK-2 receptor expression, intestinal mucosal damage, cell apoptosis, and apoptotic protein caspase-3 activity were measured. We found that high gastrin in serum significantly reduced intestinal hemorrhage, alleviated extensive epithelial disruption, decreased disintegration of lamina propria, downregulated myeloperoxidase activity, tumor necrosis factor-α, and caspase-3 activity, and lead to low mortality in response to I/R injury. On the contrary, CCK-2 receptor antagonist L365260 could markedly impair intestinal protection by gastrin on intestinal I/R. Severe edema of mucosal villi with severe intestinal crypt injury and numerous intestinal villi disintegrated were observed again in the hypergastrinemic rats with L365260. The survival in the hypergastrinemic rats after intestinal I/R injury was shortened by L365260. Finally, gastrin could remarkably upregulated intestinal CCK-2 receptor expression. Our data suggest that gastrin by omeprazole remarkably attenuated I/R induced intestinal injury by enhancing CCK-2 receptor expression and gastrin could be a potential mitigator for intestinal I/R damage in the clinical setting. PMID

  14. Mesenteric lymph drainage alleviates acute kidney injury induced by hemorrhagic shock without resuscitation.

    PubMed

    Zhao, Zi-Gang; Zhu, Hong-Xia; Zhang, Li-Min; Zhang, Yu-Ping; Niu, Chun-Yu

    2014-01-01

    This study aimed to investigate the effect of mesenteric lymph drainage on the acute kidney injury induced by hemorrhagic shock without resuscitation. Eighteen male Wistar rats were randomly divided into sham, shock, and drainage groups. The hemorrhagic shock model (40 mmHg, 3 h) was established in shock and drainage groups; mesenteric lymph drainage was performed from 1 h to 3 h of hypotension in the drainage group. The results showed that renal tissue damage occurred; the levels of urea, creatinine, and trypsin in the plasma as well as intercellular adhesion molecule-1 (ICAM-1), receptor of advanced glycation end-products (RAGE), tumor necrosis factor-α (TNF-α), malondialdehyde (MDA), lactic acid (LA), and 2,3-DPG in the renal tissue were increased in the shock group after 3 h of hypotension. Mesenteric lymph drainage lessened the following: renal tissue damage; urea and trypsin concentrations in the plasma; ICAM-1, RAGE, TNF-α, MDA, and LA levels in the renal tissue. By contrast, mesenteric lymph drainage increased the 2,3-DPG level in the renal tissue. These findings indicated that mesenteric lymph drainage could relieve kidney injury caused by sustained hypotension, and its mechanisms involve the decrease in trypsin activity, suppression of inflammation, alleviation of free radical injury, and improvement of energy metabolism.

  15. The role of radiology in the diagnosis and treatment of mesenteric ischaemia.

    PubMed

    Upponi, Sara; Harvey, John Julian; Uberoi, Raman; Ganeshan, Arul

    2013-03-01

    Clinicians working in any acute medical/surgical unit need an understanding of mesenteric ischaemia. Acute mesenteric ischaemia is a life-threatening vascular emergency associated with high morbidity and mortality. However, prompt diagnosis with the use of contrast-enhanced CT, more specifically CT angiography, has replaced catheter angiography as the new standard and is readily available in many emergency departments. Similarly, new hybrid open surgery endovascular treatment can minimise the surgical insult to these often critically ill elderly patients. Together, these changes can change the previously grim prognosis associated with this condition. By contrast, chronic mesenteric ischaemia (CMI) is an insidious disease and often a diagnosis of exclusion. However, it can cause a significant reduction in a patient's quality of life, due to 'mesenteric angina' and food avoidance, yet can potentially be treated simply and effectively. Recognition of the typical clinical history and imaging findings is key to making the diagnosis in a timely fashion. Radiology plays a significant role in the diagnosis and increasingly in the treatment of mesenteric ischaemia. Other clinicians should have a basic understanding of what radiology can and cannot offer. The advantages and limitations of commonly used imaging modalities-plain films, CT, MRI and ultrasound, are examined. The significance of findings, such as pneumatosis coli and portal gas are explained. Finally, the different endovascular management of both acute and CMI is discussed, which have emerged as minimally invasive options to complement open revascularisation surgery.

  16. Mesenteric Resistance Arteries in Type 2 Diabetic db/db Mice Undergo Outward Remodeling

    PubMed Central

    Souza-Smith, Flavia M.; Katz, Paige S.; Trask, Aaron J.; Stewart, James A.; Lord, Kevin C.; Varner, Kurt J.; Vassallo, Dalton V.; Lucchesi, Pamela A.

    2011-01-01

    Objective Resistance vessel remodeling is controlled by myriad of hemodynamic and neurohormonal factors. This study characterized structural and molecular remodeling in mesenteric resistance arteries (MRAs) in diabetic (db/db) and control (Db/db) mice. Methods Structural properties were assessed in isolated MRAs from 12 and 16 wk-old db/db and Db/db mice by pressure myography. Matrix regulatory proteins were measured by Western blot analysis. Mean arterial pressure and superior mesenteric blood flow were measured in 12 wk-old mice by telemetry and a Doppler flow nanoprobe, respectively. Results Blood pressure was similar between groups. Lumen diameter and medial cross-sectional area were significantly increased in 16 wk-old db/db MRA compared to control, indicating outward hypertrophic remodeling. Moreover, wall stress and cross-sectional compliance were significantly larger in diabetic arteries. These remodeling indices were associated with increased expression of matrix regulatory proteins matrix metalloproteinase (MMP)-9, MMP-12, tissue inhibitors of matrix metalloproteinase (TIMP)-1, TIMP-2, and plasminogen activator inhibitor-1 (PAI-1) in db/db arteries. Finally, superior mesenteric artery blood flow was increased by 46% in 12 wk-old db/db mice, a finding that preceded mesenteric resistance artery remodeling. Conclusions These data suggest that flow-induced hemodynamic changes may supersede the local neurohormonal and metabolic milieu to culminate in hypertrophic outward remodeling of type 2 DM mesenteric resistance arteries. PMID:21829729

  17. Inverse regulation of basal lipolysis in perigonadal and mesenteric fat depots in mice.

    PubMed

    Wueest, Stephan; Yang, Xingyuan; Liu, Jun; Schoenle, Eugen J; Konrad, Daniel

    2012-01-01

    Given the strong link between visceral adiposity and (hepatic) insulin resistance as well as liver steatosis, it is crucial to characterize obesity-associated alterations in adipocyte function, particularly in fat depots drained to the liver. Yet these adipose tissues are not easily accessible in humans, and the most frequently studied depot in rodents is the perigonadal, which is drained systemically. In the present study, we aimed to study alterations in lipolysis between mesenteric and perigonadal adipocytes in mice. Basal free fatty acid and glycerol release was significantly lower in perigonadal compared with mesenteric adipocytes isolated from chow-fed C57BL/6J mice. However, this difference completely vanished in high-fat diet-fed mice. Consistently, protein levels of the G(0)/G(1) switch gene 2 (G0S2), which were previously found to be inversely related to basal lipolysis, were significantly lower in mesenteric compared with perigonadal fat of chow-fed mice. Similarly, perilipin was differently expressed between the two depots. In addition, adipocyte-specific overexpression of G0S2 led to significantly decreased basal lipolysis in mesenteric adipose tissue of chow-fed mice. In conclusion, lipolysis is differently regulated between perigonadal and mesenteric adipocytes, and these depot-specific differences might be explained by altered regulation of G0S2 and/or perilipin.

  18. Guanylyl cyclase C and guanylin reduce fat droplet accumulation in cattle mesenteric adipose tissue.

    PubMed

    Yasuda, Masahiro; Kawabata, Jyunya; Akieda-Asai, Sayaka; Nasu, Tetsuo; Date, Yukari

    2017-09-30

    Guanylyl cyclase C (GC-C) is a member of a family of enzymes that metabolize GTP to cGMP and was first identified as a receptor for heat-stable enterotoxin. Guanylin (GNY) has since been identified as an endogenous ligand for GC-C in the intestine of several mammalian species. The GNY/GC-C system regulates ion transportation and pH in the mucosa. Recently, it was reported that GC-C and GNY are involved in lipid metabolism in rat mesenteric adipose tissue macrophages. To examine the role of GC-C and GNY in lipid metabolism in cattle, we used a bovine mesenteric adipocyte primary culture system and a coculture system for bovine adipocytes and GNY-/GC-C-expressing macrophages. Fat droplets were observed to accumulate in bovine mesenteric adipocytes cultured alone, whereas few fat droplets accumulated in adipocytes indirectly cocultured with macrophages. We also observed that GC-C was present in bovine mesenteric adipose tissue, and that fat droplet accumulation decreased after in vitro GNY administration. Expressions of mRNAs encoding lipogenic factors decreased significantly in adipocytes after either coculture or GNY administration. These results suggest that the GNY/GC-C system is part of the control system for lipid accumulation in bovine mesenteric adipose tissue.

  19. Case Report of Four Different Primary Mesenteric Neoplasms and Review of Literature

    PubMed Central

    Yagmur, Yusuf; Akbulut, Sami; Gumus, Serdar; Babur, Mehmet; Can, Mehmet Ali

    2016-01-01

    Introduction It is rare for primary tumors to arise from the mesentery. Lymphangiomas appear as congenital malformations of the lymphatic system or benign neoplasms as a large, thin-walled, often multilocular cyst. Mesenteric infiltration is common and during surgical treatment, adjustment of structures such as the bowel and resection of the spleen may be required. Cystic mesotheliomas are rare, benign tumors that originate from the peritoneal mesothelium and are more common in women. Mesenteric cysts are mostly benign and rare intra-abdominal tumors, and can be seen as occupying a large cyst. Malignant fibrous histiocytoma is a rare pleomorphic sarcoma that is more commonly encountered in men. After the extremities, the second most common areas to be affected are the retroperitoneum and peritoneal cavity. Case Presentation We encountered four cases of different primary mesenteric neoplasms that were operated at the Gazi Yasargil teaching and research hospital, department of general surgery, Diyarbakir, Turkey, between 2013 and 2014. We reviewed these primary mesenteric neoplasms and compared them with previous literature. Conclusions Primary mesenteric tumors are rare and mostly benign tumors. Complete surgical excision is necessary for all tumors and follow-up is necessary after surgery for malignant fibrous histiocytoma due to recurrence. PMID:28180018

  20. Case Report of Four Different Primary Mesenteric Neoplasms and Review of Literature.

    PubMed

    Yagmur, Yusuf; Akbulut, Sami; Gumus, Serdar; Babur, Mehmet; Can, Mehmet Ali

    2016-10-01

    It is rare for primary tumors to arise from the mesentery. Lymphangiomas appear as congenital malformations of the lymphatic system or benign neoplasms as a large, thin-walled, often multilocular cyst. Mesenteric infiltration is common and during surgical treatment, adjustment of structures such as the bowel and resection of the spleen may be required. Cystic mesotheliomas are rare, benign tumors that originate from the peritoneal mesothelium and are more common in women. Mesenteric cysts are mostly benign and rare intra-abdominal tumors, and can be seen as occupying a large cyst. Malignant fibrous histiocytoma is a rare pleomorphic sarcoma that is more commonly encountered in men. After the extremities, the second most common areas to be affected are the retroperitoneum and peritoneal cavity. We encountered four cases of different primary mesenteric neoplasms that were operated at the Gazi Yasargil teaching and research hospital, department of general surgery, Diyarbakir, Turkey, between 2013 and 2014. We reviewed these primary mesenteric neoplasms and compared them with previous literature. Primary mesenteric tumors are rare and mostly benign tumors. Complete surgical excision is necessary for all tumors and follow-up is necessary after surgery for malignant fibrous histiocytoma due to recurrence.

  1. Protective effect of the traditional Chinese medicine xuesaitong on intestinal ischemia-reperfusion injury in rats

    PubMed Central

    Xu, Xuan; Li, Dengxiao; Gao, Hong; Gao, Yuejin; Zhang, Long; Du, Yuling; Wu, Jian; Gao, Pengfei

    2015-01-01

    Objective: We investigated the effect of xuesaitong on intestinal barrier dysfunction and related mechanisms in a rat model for intestinal ischemia-reperfusion. Methods: Rats were divided into sham-operated, disease-model and Xuesaitong-treated groups. In the disease-model and Xuesaitong-treated rats an intestinal ischemia-reperfusion injury (IRI) model was introduced, which was created by a temporary obstruction of the superior mesenteric artery (SMA). The xuesaitong group was pre-treated with injections into the abdominal cavity prior to the generation of the IRI model. Tissue changes were evaluated using H&E staining and electron microscopy. Samples were analyzed at 0, 3 and 24 h post IRI. Ascites volumes as well as small intestinal mucosa bleeding, injury scores, wet to dry weight ratios, and propulsions were evaluated. Apoptotic rates were determined with TUNNEL assays. Blood serum tumor necrosis factor-α (TNF-α) levels were measured using ELISA, and Bcl-2 and caspase-3 expression in small intestinal mucosa measured using immunohistochemistry. Results: We determined a significant increase of pathological damage to small intestinal tissues, intestinal wet to dry ratios, ascites volume, TNF-α levels, apoptosis rates of small intestinal mucosa, and expression of Bcl-2 and caspase-3 proteins in the disease-model group compared to the sham-operated group (P < 0.001), and intestinal motility was significantly decreased (P < 0.001). However, comparisons between disease-model and xuesaitong pre-treated animals revealed, that in the treatment group these changes occurred in significant less severities. Conclusions: Xuesaitong can effectively alleviate intestinal barrier dysfunction caused by ischemia-reperfusion injury by reducing TNF-α, up-regulating Bcl-2 and down-regulating caspase-3 expression, in addition to increasing peristalsis. PMID:25932105

  2. Consequences of pneumoperitoneum on liver ischemia during laparoscopic portal triad clamping in a swine model.

    PubMed

    Nsadi, Berthier; Gilson, Nathalie; Pire, Emilie; Cheramy, Jean-Paul; Pincemail, Joel; Scagnol, Irène; Meurisse, Michel; Defraigne, Jean-Olivier; Detry, Olivier

    2011-03-01

    Portal triad clamping (PTC) may be required during laparoscopic liver resection to limit blood loss. The aim of this study was to test in a swine model the hypothesis that during laparoscopic PTC, increased intraperitoneal pressure may alter hepatic vein reverse circulation, inducing a more severe hepatic ischemia compared with PTC performed in laparotomy. Fifteen pigs were randomized into three groups: laparoscopy (1 h of pneumoperitoneum at 15 mmHg and 3 h of surveillance), open PTC (1 h PTC through laparotomy and 3 h of reperfusion), and laparoscopic PTC (1 h PTC with 15 mmHg pneumoperitoneum and 3 h of reperfusion). PTC was performed under mesenteric decompression using a veno-venous splenofemoral bypass. Hepatic partial oxygen tension and microcirculatory flow were continuously measured using a Clarke-type electrode and a laser Doppler flow probe, respectively. Liver consequences of PTC was assessed by right atrium serum determination of transaminases, creatinine, bilirubin, INR, and several ischemia/reperfusion parameters, drawn before PTC (T0), before unclamping (T60), and 1 (T120) and 3 h after reperfusion (T240). Histology was performed on T240 liver biopsies. Compared with open PTC, laparoscopic PTC produced a more rapid and more severe decrease in hepatic oxygen tension, indicating a more severe tissular hypoxia, and a more severe decrease in hepatic microcirculatory flow, indicating a decrease in hepatic backflow. At T240, the laparoscopic PTC livers suffered from a higher degree of hepatocellular damage, shown by higher transaminases and increased necrotic index at pathology. These results indicate that in this pig model, laparoscopic PTC induces a more severe liver ischemia, related to decreased hepatic oxygen content and decreased hepatic backflow. If confirmed by clinical studies, these results may indicate that caution is necessary when performing prolonged PTC during laparoscopic hepatic resection, particularly in cirrhotic or steatotic livers

  3. Effects of Ukrain on intestinal apoptosis caused by ischemia-reperfusion injury in rats

    PubMed Central

    Akcılar, Raziye; Akcılar, Aydın; Koçak, Cengiz; Koçak, Fatma Emel; Bayat, Zeynep; Şimşek, Hasan; Şahin, Server; Savran, Bircan

    2015-01-01

    Background: To investigate the antiapoptotic effect of Ukrain on intestinal lesion induced by mesenteric ischemia-reperfusion (I/R) injury. Methods: Male Sprague-Dawley rats were divided into three groups: laparotomy (L), I/R, and Ukrain and I/R (U + I/R). In the U + I/R group, Ukrain (7 mg/kg) was given by intraperitoneal at the beginning of the study. 1 h after ukrain application, ischemia was induced for 30 minutes, and reperfusion was subsequently allowed for 120 minutes in the I/R and U + I/R groups. Rats were sacrificed at the end of reperfusion and intestinal tissues were collected for biochemical and molecular examination. Intestinal tissues caspase 3 protein were assayed. Serum Bcl-xL and iNOS were measured. The expression level of caspase-3, Bcl-xL and iNOS in intestinal tissue of rats were detected by reverse transcription-polymerase chain reaction (RT-PCR). Results: Levels of serum iNOS and mRNA expression were increased in the I/R and decreased in the U + I/R group. In addition, levels of the proapoptotic gene caspase-3 protein and mRNA expression were increased in the I/R and decreased in the U + I/R group. Levels of the antiapoptotic gene Bcl-xL serum and mRNA expression were increased in the U + I/R group. Conclusions: Ukrain can reduce the ischemia-reperfusion injury in the intestinal tissue by inhibiting the cell apoptosis. The mechanism may be correlated with increased Bcl-xL mRNA expressions and decreased mRNA expressions of Caspase-3 and iNOS. PMID:26885190

  4. Effects of Ukrain on intestinal apoptosis caused by ischemia-reperfusion injury in rats.

    PubMed

    Akcılar, Raziye; Akcılar, Aydın; Koçak, Cengiz; Koçak, Fatma Emel; Bayat, Zeynep; Şimşek, Hasan; Şahin, Server; Savran, Bircan

    2015-01-01

    To investigate the antiapoptotic effect of Ukrain on intestinal lesion induced by mesenteric ischemia-reperfusion (I/R) injury. Male Sprague-Dawley rats were divided into three groups: laparotomy (L), I/R, and Ukrain and I/R (U + I/R). In the U + I/R group, Ukrain (7 mg/kg) was given by intraperitoneal at the beginning of the study. 1 h after ukrain application, ischemia was induced for 30 minutes, and reperfusion was subsequently allowed for 120 minutes in the I/R and U + I/R groups. Rats were sacrificed at the end of reperfusion and intestinal tissues were collected for biochemical and molecular examination. Intestinal tissues caspase 3 protein were assayed. Serum Bcl-xL and iNOS were measured. The expression level of caspase-3, Bcl-xL and iNOS in intestinal tissue of rats were detected by reverse transcription-polymerase chain reaction (RT-PCR). Levels of serum iNOS and mRNA expression were increased in the I/R and decreased in the U + I/R group. In addition, levels of the proapoptotic gene caspase-3 protein and mRNA expression were increased in the I/R and decreased in the U + I/R group. Levels of the antiapoptotic gene Bcl-xL serum and mRNA expression were increased in the U + I/R group. Ukrain can reduce the ischemia-reperfusion injury in the intestinal tissue by inhibiting the cell apoptosis. The mechanism may be correlated with increased Bcl-xL mRNA expressions and decreased mRNA expressions of Caspase-3 and iNOS.

  5. Neuroprotective evaluation of Tilia americana and Annona diversifolia in the neuronal damage induced by intestinal ischemia.

    PubMed

    Angeles-López, Guadalupe E; González-Trujano, María Eva; Déciga-Campos, Myrna; Ventura-Martínez, Rosa

    2013-08-01

    Tilia americana and Annona diversifolia are plants widely distributed in Mexico and sold in markets for their medicinal properties on the central nervous system (CNS) including possible neuroprotection. Pharmacological studies have corroborated CNS activities due to flavonoid constituents, but evidence of their neuroprotector effects are lacking. This study was conducted to test aqueous and organic extracts of these two plants for neuroprotective effects in a novel experimental model of intestinal ischemia in situ. T. americana and A. diversifolia aqueous and organic extracts were administrated to guinea pigs at an oral dose of 100 and 300 mg/kg for 15 days. Twenty four hours after the last administration, the animals were anesthetized and intestinal ischemia in situ was induced by clamping for 80 min selected branches of the superior mesenteric artery. Ischemic segments placed in an in vitro organ bath were stimulated electrically (0.3 Hz frequency, 3.0 ms duration, 14 V intensity) and chemically (ACh; 1 × 10(-9) to 1×10(-5) M). Neuroprotection was considered present when the depressed contractile response of the ischemic tissue to electrical stimulation was normalized in the treated animals. Results showed that pretreatment with the T. americana hexane and aqueous extracts, but not with those from A. diversifolia, significantly improved responses of the ischemic tissue. These results suggest that T. americana possesses neuroprotective effects against neuronal damage induced by ischemia, and that flavonoids as well as non-polar constituents are involved. Our study supports the use of this plant in folk medicine and suggests its possible effectiveness for stroke prevention.

  6. Recipient twin limb ischemia with postnatal onset.

    PubMed

    Broadbent, Roland Spencer

    2007-02-01

    After the occurrence of 3 local cases of limb ischemia in newborn twins, we reviewed the literature to investigate this combination systematically. This review reveals a distinct condition: postnatal onset limb ischemia affecting recipient twins in twin-twin transfusion syndrome.

  7. Chick Embryo Partial Ischemia Model: A New Approach to Study Ischemia Ex Vivo

    PubMed Central

    Majumder, Syamantak; Ilayaraja, M.; Seerapu, Himabindu Reddy; Sinha, Swaraj; Siamwala, Jamila H.; Chatterjee, Suvro

    2010-01-01

    Background Ischemia is a pathophysiological condition due to blockade in blood supply to a specific tissue thus damaging the physiological activity of the tissue. Different in vivo models are presently available to study ischemia in heart and other tissues. However, no ex vivo ischemia model has been available to date for routine ischemia research and for faster screening of anti-ischemia drugs. In the present study, we took the opportunity to develop an ex vivo model of partial ischemia using the vascular bed of 4th day incubated chick embryo. Methodology/Principal Findings Ischemia was created in chick embryo by ligating the right vitelline artery using sterile surgical suture. Hypoxia inducible factor- 1 alpha (HIF-1α), creatine phospho kinase-MB and reactive oxygen species in animal tissues and cells were measured to confirm ischemia in chick embryo. Additionally, ranolazine, N-acetyl cysteine and trimetazidine were administered as an anti-ischemic drug to validate the present model. Results from the present study depicted that blocking blood flow elevates HIF-1α, lipid peroxidation, peroxynitrite level in ischemic vessels while ranolazine administration partially attenuates ischemia driven HIF-1α expression. Endothelial cell incubated on ischemic blood vessels elucidated a higher level of HIF-1α expression with time while ranolazine treatment reduced HIF-1α in ischemic cells. Incubation of caprine heart strip on chick embryo ischemia model depicted an elevated creatine phospho kinase-MB activity under ischemic condition while histology of the treated heart sections evoked edema and disruption of myofibril structures. Conclusions/Significance The present study concluded that chick embryo partial ischemia model can be used as a novel ex vivo model of ischemia. Therefore, the present model can be used parallel with the known in vivo ischemia models in understanding the mechanistic insight of ischemia development and in evaluating the activity of anti

  8. [Ischemia-reperfusion injury after lung transplantation].

    PubMed

    Gennai, Stéphane; Pison, Christophe; Briot, Raphaël

    2014-09-01

    Lung ischemia-reperfusion is characterized by diffuse alveolar damage arising from the first hours after transplantation. The first etiology of the primary graft dysfunction in lung is ischemia-reperfusion. It is burdened by an important morbi-mortality. Lung ischemia-reperfusion increases the oxidative stress, inactivates the sodium pump, increases the intracellular calcium, leads to cellular death and the liberation of pro-inflammatory mediators. Researches relative to the reduction of the lung ischemia-reperfusion injuries are numerous but few of them found a place in common clinical practice, because of an insufficient level of proofs. Ex vivolung evaluation is a suitable technique in order to evaluate therapeutics supposed to limit lung ischemia-reperfusion injuries.

  9. Wandering spleen as a cause of mesenteric and portal varices: a new etiology?

    PubMed

    Zarroug, Abdalla E; Hashim, Yassar; El-Youssef, Mounif; Zeidan, Moiz M; Moir, Christopher R

    2013-03-01

    Wandering spleen is a rare clinical entity characterized by spleen hypermobility due to lack or weakness of one or more splenic ligaments. We report two patients with the diagnosis of wandering spleen with portal and mesenteric varices. A 16 year-old girl presented with abdominal pain, an abdominal mass and pancytopenia. A 12 year-old girl presented with an abdominal mass only. Imaging studies revealed both patients had a viable but torsed wandering spleen in association with portal, splenic and mesenteric varices. Both were treated with splenectomy and had resolution of their symptoms. Imaging confirmed complete resolution of all varices at 30 month and 11 year follow up respectively. These cases represent the first report of a wandering spleen causing portal and mesenteric venous partial obstruction leading to varices; splenectomy resolved these findings post-operatively.

  10. A Rare Cause of Childhood Ileus: Giant Mesenteric Lipoma and a Review of the Literature

    PubMed Central

    Turk, Erdal; Edirne, Yesim; Karaca, Fahri; Memetoglu, Mehmet Erdal; Unal, Emel; Ermumcu, Ozgur

    2013-01-01

    Mesenteric lipomas are benign tumors of mature fat cells. They are usually asymptomatic and create a clinical picture that depends on the localization and size of the lipoma. Although rare, unusually large mesenteric giant lipomas can cause partial or complete bowel obstruction. Lipomas resulting in partial bowel obstruction can present with symptoms such as intermittent abdominal pain and abdominal distention. With complete obstruction, a child can present with an acute abdomen. Treatment is the excision of the mass along with the affected portion of bowel. In this case study, a 2-year-old female presented with a bowel obstruction due to the presence of a giant mesenteric lipoma. Clinical features of 16 cases published in the English literature to date are presented. PMID:25610284

  11. Mesenteric vein thrombosis caused by secondary polycythaemia from AndroGel.

    PubMed

    Katz, Heather; Popov, Eugene; Bray, Natasha; Berman, Barry

    2014-10-21

    Mesenteric vein thrombosis is a rare but potentially lethal cause of abdominal pain. It is usually caused by prothrombotic states that can either be hereditary or acquired. Testosterone supplementation causes an acquired prothrombotic state by promoting erythropoeisis thus causing a secondary polycythaemia. We report a case of a 59-year-old man with a history of chronic obstructive pulmonary disease (COPD) stage III, who presented with abdominal pain. Evaluation revealed an elevated haemoglobin and haematocrit, a superior mesenteric vein thrombosis on CT and a negative Janus kinase 2 mutation. The patient is currently being treated with 6 months of anticoagulation with rivaroxiban. Although a well-known side effect of testosterone is thrombosis, the present case is used to document in the literature the first case of mesenteric vein thrombosis due to secondary polycythaemia from Androgel in the setting of COPD.

  12. Effects of exercise and excitement on mesenteric and renal dynamics in conscious, unrestrained baboons

    NASA Technical Reports Server (NTRS)

    Vatner, S. F.

    1978-01-01

    Radiotelemetry was used to measure arterial pressure and mesenteric and renal blood flows from nine unrestrained, conscious baboons during periods of rest, moderate exercise, and extreme excitement. A description of the experiments hardware is presented, including artificial depressants phenylcyclidine hydrochloride, 0.5-1.0 mg/kg, and pentobarbital sodium, 15 mg/kg, and an ultrasonic telemetry flow meter. Results showed rising heart rate and arterial pressure coupled with a reduction of mesenteric and renal flows as the level of exercise was increased. These findings are compared with mesenteric and renal flows somewhat above control level, but relatively stable heart rate and arterial pressure, postprandially. Attention is given to a quantitative analysis of the experimental results.

  13. Laparoscopic Toupet fundoplication with duodenojejunostomy for the management of superior mesenteric artery syndrome with reflux symptoms

    PubMed Central

    Yan, Chao; Hu, Zhi-Wei; Wu, Ji-Min; Zhang, Chao; Yan, Liang; Wang, Zhong-Gao

    2017-01-01

    Abstract Rationale: The patient had symptoms of GERD and the reflux even caused the symptom of cough. Gaining weight is a risk factor for the treatment of reflux as it could exacerbated symptoms of reflux and the drug treatment is not effective. Surgical intervention becomes necessary when there is failure following conservative medical therapy or the patient. Patient concerns: The patient was not satisfied with the drug treatment. Diagnoses: Superior mesenteric artery syndrome, gastroesophageal reflux disease. Interventions: Laparoscopic Toupet fundoplication with duodenojejunostomy. Outcomes: The patient discharged from hospital 10 days after surgery without any postoperative complication. The patient achieved complete relief of symptoms and discontinuation of drug. Lessons subsections: Superior mesenteric artery (SMA) syndrome may manifest the symptoms of GERD such as heartburn, acid reflux and cough. It is necessary to complete examination to exclude superior mesenteric artery syndrome for these patients. Laparoscopic fundoplication with duodenojejunostomy provided an effective treatment for patients who failed drug treatment. PMID:28099334

  14. Proteomic profiling of the mesenteric lymph after hemorrhagic shock: Differential gel electrophoresis and mass spectrometry analysis

    PubMed Central

    2011-01-01

    Experiments show that upon traumatic injury the composition of mesenteric lymph changes such that it initiates an immune response that can ultimately result in multiple organ dysfunction syndrome (MODS). To identify candidate protein mediators of this process we carried out a quantitative proteomic study on mesenteric lymph from a well characterized rat shock model. We analyzed three animals using analytical 2D differential gel electrophoresis. Intra-animal variation for the majority of protein spots was minor. Functional clustering of proteins revealed changes arising from several global classes that give novel insight into fundamental mechanisms of MODS. Mass spectrometry based proteomic analysis of proteins in mesenteric lymph can effectively be used to identify candidate mediators and loss of protective agents in shock models. PMID:21906351

  15. [A rare case of suppurative mesenteric adenitis associated with intussusception in a child: a clinical case].

    PubMed

    Mujinga, Didier Tshibangu; Katombe, François Tshilombo

    2016-01-01

    Some cases of suppurative mesenteric adenitis have already been described in the literature but not associated with intussusception. We describe the case of a 3-year-old boy presenting to the department of surgery at the University Hospital of Lubumbashi with bowel obstruction. He was visited elsewhere, in the previous 12 days, for diarrhea, vomiting, fever, coma and treated for cerebral malaria and blackwater fever. Surgery revealed an ileal intussusception and a suppurative mesenteric adenitis whose pyoculture revealed the presence of Enterobacter cloacae, sensitive to norfloxacin. We performed desinvagination, sucked the pus out into a syringe and excized completely the site of suppurative adenitis. The evolution of patient was good. The clinician must know that the association between suppurative mesenteric adenitis and intussusceptions exists. The diagnosis is not easy and there is the risk of developing acute peritonitis due to its fistulation in the abdominal cavity.

  16. Effects of exercise and excitement on mesenteric and renal dynamics in conscious, unrestrained baboons

    NASA Technical Reports Server (NTRS)

    Vatner, S. F.

    1978-01-01

    Radiotelemetry was used to measure arterial pressure and mesenteric and renal blood flows from nine unrestrained, conscious baboons during periods of rest, moderate exercise, and extreme excitement. A description of the experiments hardware is presented, including artificial depressants phenylcyclidine hydrochloride, 0.5-1.0 mg/kg, and pentobarbital sodium, 15 mg/kg, and an ultrasonic telemetry flow meter. Results showed rising heart rate and arterial pressure coupled with a reduction of mesenteric and renal flows as the level of exercise was increased. These findings are compared with mesenteric and renal flows somewhat above control level, but relatively stable heart rate and arterial pressure, postprandially. Attention is given to a quantitative analysis of the experimental results.

  17. In vivo identification of parasinus macrophages in the mesenteric lymph node.

    PubMed

    Nagata, H; Hokari, R; Suzuki, H; Miura, S; Sekizuka, E; Ishii, H

    2000-01-01

    Macrophages beneath the marginal sinus in the lymph nodes may play a role in defense against microorganism. The purpose of this study was to directly visualize the parasinus macrophages in the mesenteric lymph node. Fluorescent latex particles were injected into the appendix submucosa of rats. The mesenteric lymph node was epi-illuminated and observed with a fluorescent microscope. Fluorescent particles entered the marginal sinus of the mesenteric lymph node through the afferent lymphatic vessels, and distributed diffusely all over the marginal sinus. The particles became aggregated and interspersed 3 hr after injection, suggesting that particles were incorporated by phagocytes. The number of these particle-laden phagocytes increased up to 12 hr after injection, and then declined. Some phagocytes migrated rapidly within the marginal sinus. Morphology of these phagocytes in cell suspension was consistent with macrophages. In conclusion, we successfully visualized parasinus macrophages in vivo, which incorporated foreign bodies and migrated within the marginal sinus.

  18. Mesothelial mesenteric cyst in patient with ascending colon cancer. Case report.

    PubMed

    Ioannidis, O; Cheva, A; Kakoutis, E; Chatzichristou, A; Chatzopoulos, S; Konstantara, A; Papadimitriou, N; Paraskevas, G; Makrantonakis, A

    2011-03-01

    Mesenteric cysts are rare cystic malformations of the mesentery. They are usually located at the iliac mesentery. Clinically most mesenteric cysts are asymptomatic, but sometimes they present with non-specific abdominal symptoms. Diagnosis can be aided using US, CT and MRI but careful interpretation of the images and high index of suspicion of this rare condition is essential for the correct diagnosis, which cannot always be preoperatively established. The therapeutic method of choice is complete surgical excision of the cyst which minimizes the possibility of recurrence. Histopathologically they are classified in six group. We present a case of a mesothelial mesenteric cyst in patient with colon cancer. The cyst was misdiagnosed as urinary bladder diverticulum in the preoperative CT scan.

  19. Ultrasound-guided mesenteric lymph node iohexol injection for thoracic duct computed tomographic lymphography in cats.

    PubMed

    Kim, Mieun; Lee, Hyeyeon; Lee, Namsoon; Choi, Mihyeon; Kim, Junyoung; Chang, Dongwoo; Choi, Mincheol; Yoon, Junghee

    2011-01-01

    Computed tomographic (CT) lymphography was performed in cats using percutaneous ultrasound-guided injection of contrast medium into a mesenteric lymph node. The thoracic duct and its branches were clearly delineated in CT images of seven cats studied. The thoracic duct was characterized by anatomic variation and appeared as single or multiple branches. The thoracic duct and the cisterna chyli were identified along the ventral or left ventral aspect of the vertebrae from the level of the cranial lumbar to the caudal cervical vertebrae. The thoracic duct was identified in the central caudal mediastinum, deviated to the left in the cranial mediastinum, and finally moved toward the venous system. Small volumes of extranodal contrast medium leakage were identified in all cats. After injection, the mesenteric lymph nodes were cytologically normal. Ultrasound-guided CT lymphography via percutaneous mesenteric lymph node injection appears safe and effective in cats.

  20. Contribution of Mesenteric Lymph Nodes and GALT to the Intestinal Foxp3+ Regulatory T-Cell Compartment.

    PubMed

    Geem, Duke; Ngo, Vu; Harusato, Akihito; Chassaing, Benoit; Gewirtz, Andrew T; Newberry, Rodney D; Denning, Timothy L

    2016-05-01

    This study showed that the absence of CCR7 or mesenteric lymph nodes/gut-associated lymphoid tissue did not appreciably impact total intestinal Foxp3+ regulatory T cell representation in the steady-state. However, mesenteric lymph nodes/GALT are required for normal peripherally induced Foxp3+ regulatory T cell differentiation in the small intestine, but not in the large intestine.

  1. Relationships between the genes expressed in the mesenteric adipose tissue of beef cattle and feed intake and gain

    USDA-ARS?s Scientific Manuscript database

    Mesenteric fat, a depot within the visceral fat, accumulates in cattle during maturation and finishing and may be a potential source of production inefficiency. The aim of this study was to determine whether the genes expressed in the mesenteric fat of steers were associated with body weight gain an...

  2. A Case of a 4-Year-Old Boy with a Mesenteric Chylous Cyst Infected with Histoplasma capsulatum.

    PubMed

    Kweyamba, Vianney; Apiyo, Mirraim; Olika, Biratu; Kituuka, Olivia

    2016-01-01

    Mesenteric cysts are uncommon entities and chyle- (lymph-) containing cysts are the rarest of this group. This is a case report of a 4-year-old boy with a mesenteric chylous cyst who was later found to have Histoplasma capsulatum infection.

  3. Alosetron, cilansetron and tegaserod modify mesenteric but not colonic blood flow in rats.

    PubMed

    Painsipp, Evelin; Shahbazian, Anaid; Holzer, Peter

    2009-11-01

    As the use of the 5-HT(3) receptor antagonist alosetron (GlaxoSmithKline) and the 5-HT(4) receptor agonist tegaserod (Novartis) in patients with irritable bowel syndrome has been associated with cases of ischaemic colitis, the effects of alosetron, cilansetron (Solvay) and tegaserod on the rat splanchnic circulation were evaluated. Phenobarbital-anaesthetised rats were instrumented to record blood flow in the superior mesenteric artery and transverse colon and to calculate mesenteric and colonic vascular conductance. Intravenous alosetron (0.03-0.3 mg.kg(-1)) did not alter blood pressure or heart rate but reduced mesenteric blood flow and vascular conductance by 15-20%. This activity profile was also seen after intraduodenal alosetron and shared by the 5-HT(3) receptor antagonist cilansetron. In contrast, blood flow, vascular conductance and intraluminal pressure in the colon were not modified by alosetron and cilansetron. Intravenous or intraduodenal tegaserod (0.3-1.0 mg.kg(-1)) had no inhibitory effect on mesenteric and colonic blood flow. Peroral treatment of rats with alosetron or tegaserod for 7 days did not modify mesenteric haemodynamics at baseline and after blockade of nitric oxide synthesis. Mild inflammation induced by dextran sulphate sodium failed to provoke a vasoconstrictor effect of cilansetron in the colon. Alosetron and cilansetron, not tegaserod, caused a small and transient constriction of the rat mesenteric vascular bed, whereas blood flow in the colon remained unaltered. The relevance of these findings to the treatment-associated occurrence of ischaemic colitis in patients with irritable bowel syndrome remains open.

  4. The Mesenteric Lymph Duct Cannulated Rat Model: Application to the Assessment of Intestinal Lymphatic Drug Transport

    PubMed Central

    Trevaskis, Natalie L.; Hu, Luojuan; Caliph, Suzanne M.; Han, Sifei; Porter, Christopher J.H.

    2015-01-01

    The intestinal lymphatic system plays key roles in fluid transport, lipid absorption and immune function. Lymph flows directly from the small intestine via a series of lymphatic vessels and nodes that converge at the superior mesenteric lymph duct. Cannulation of the mesenteric lymph duct thus enables the collection of mesenteric lymph flowing from the intestine. Mesenteric lymph consists of a cellular fraction of immune cells (99% lymphocytes), aqueous fraction (fluid, peptides and proteins such as cytokines and gut hormones) and lipoprotein fraction (lipids, lipophilic molecules and apo-proteins). The mesenteric lymph duct cannulation model can therefore be used to measure the concentration and rate of transport of a range of factors from the intestine via the lymphatic system. Changes to these factors in response to different challenges (e.g., diets, antigens, drugs) and in disease (e.g., inflammatory bowel disease, HIV, diabetes) can also be determined. An area of expanding interest is the role of lymphatic transport in the absorption of orally administered lipophilic drugs and prodrugs that associate with intestinal lipid absorption pathways. Here we describe, in detail, a mesenteric lymph duct cannulated rat model which enables evaluation of the rate and extent of lipid and drug transport via the lymphatic system for several hours following intestinal delivery. The method is easily adaptable to the measurement of other parameters in lymph. We provide detailed descriptions of the difficulties that may be encountered when establishing this complex surgical method, as well as representative data from failed and successful experiments to provide instruction on how to confirm experimental success and interpret the data obtained. PMID:25866901

  5. Endothelium-dependent and-independent relaxation induced by resveratrol in rat superior mesenteric arteries

    PubMed Central

    Chen, Yulong; Xu, Cangbao; Wei, Yahui; Zhang, Yaping; Cao, Ailan

    2016-01-01

    Resveratrol (Res) is a specific agonist of sirtuin 1, and has many cardioprotective effects. Although Res is able to relax various vascular beds, its pharmacological properties in rat superior mesenteric arteries and the underlying mechanism are not well clarified. The aim of present study was to investigate the vasorelaxant effects of Res on rat superior mesenteric arteries and the mechanisms involved. The isometric tension of rat superior mesenteric arterial rings was recorded in vitro using myography. It was found that Res concentration-dependently relaxed endothelium-intact superior mesenteric artery rings pre-contracted by phenylephrine hydrochloride (Emax, 97.66±0.79%; pD2, 4.30±0.14) or KCl (Emax, 101.3±0.6%; pD2, 4.12±0.03). The vasorelaxant effect of Res on the superior mesenteric artery rings was partially endothelium-dependent. NG-nitro-L-arginine methyl ester (100 µM) significantly inhibited the Res-induced vasorelaxant effect. However, 1H-[1,2,4]oxadiazolo[4,3-a] quinoxalin-1-one (10 µM) and indomethacin (5 µM) each had no effect on the Res-induced vasorelaxation. In artery rings without endothelium, the vasorelaxation induced by Res was attenuated by 4-aminopyridine (100 µM) and glibenclamide (10 µM). However, barium chloride dehydrate (10 µM) and tetraethylammonium chloride (1 mM) did not affect the vasorelaxation induced by Res. Moreover, Res also inhibited the contraction induced by an increase in external calcium concentration in Ca2+-free medium plus KCl (60 mM). These results suggest that Res induces relaxation in superior mesenteric arterial rings through an endothelium-dependent pathway, involving nitric oxide release, and also through an endothelium-independent pathway, with opening of voltage-dependent K+ channels and ATP-sensitive K+ channels and blockade of extracellular Ca2+ influx. PMID:27698719

  6. Traumatic lumbar hernias: do patient or hernia characteristics predict bowel or mesenteric injury?

    PubMed

    Mellnick, Vincent M; Raptis, Constantine; Lonsford, Chad; Lin, Michael; Schuerer, Douglas

    2014-06-01

    Traumatic lumbar hernias are rare but important injuries to diagnose in blunt abdominal trauma, both because of delayed complications of the hernia itself and because of well-documented association with bowel and mesenteric injuries. No study to our knowledge has determined whether specific features of the hernia-size of the wall defect, inferior or superior location, or the side of the hernia-bear any predictive value on the presence of underlying bowel and mesenteric injury. A retrospective query of the radiology information system yielded 21 patients with lumbar hernias which were diagnosed on CT. These were reviewed by three radiologists to confirm the presence of an acute lumbar hernia and to determine the size and location of the hernia. The patients' medical records were reviewed to determine the presence of operatively confirmed bowel and/or mesenteric injuries, which occurred in 52 % of patients. A significant (p < 0.001) difference was found in the frequency of bowel and/or mesenteric injury with hernia defects greater than 4.0 cm (100 %) and those less than 4.0 cm (17 %). Larger hernias also resulted in more procedures (p = 0.042) and a trend towards longer ICU stay, but no difference in injury severity score (ISS) or overall hospital stay. No significant difference was seen in the frequency of bowel and/or mesenteric injuries based on side or location of the hernia, though distal colonic injuries were more commonly seen with left-sided hernias (50 %) compared to right-sided hernias (18 %). Although based on a small patient population, these results suggest that larger traumatic lumbar hernias warrant particularly close evaluation for an underlying bowel and/or mesenteric injury.

  7. Inflammatory Cytokine Gene Expression in Mesenteric Adipose Tissue during Acute Experimental Colitis

    PubMed Central

    Mustain, W. Conan; Starr, Marlene E.; Valentino, Joseph D.; Cohen, Donald A.; Okamura, Daiki; Wang, Chi; Evers, B. Mark; Saito, Hiroshi

    2013-01-01

    Background Production of inflammatory cytokines by mesenteric adipose tissue (MAT) has been implicated in the pathogenesis of inflammatory bowel disease (IBD). Animal models of colitis have demonstrated inflammatory changes within MAT, but it is unclear if these changes occur in isolation or as part of a systemic adipose tissue response. It is also unknown what cell types are responsible for cytokine production within MAT. The present study was designed to determine whether cytokine production by MAT during experimental colitis is depot-specific, and also to identify the source of cytokine production within MAT. Methods Experimental colitis was induced in 6-month-old C57BL/6 mice by administration of dextran sulfate sodium (2% in drinking water) for up to 5 days. The induction of cytokine mRNA within various adipose tissues, including mesenteric, epididymal, and subcutaneous, was analyzed by qRT-PCR. These adipose tissues were also examined for histological evidence of inflammation. The level of cytokine mRNA during acute colitis was compared between mature mesenteric adipocytes, mesenteric stromal vascular fraction (SVF), and mesenteric lymph nodes. Results During acute colitis, MAT exhibited an increased presence of infiltrating mononuclear cells and fibrotic structures, as well as decreased adipocyte size. The mRNA levels of TNF-α, IL-1β, and IL-6 were significantly increased in MAT but not other adipose tissue depots. Within the MAT, induction of these cytokines was observed mainly in the SVF. Conclusions Acute experimental colitis causes a strong site-specific inflammatory response within MAT, which is mediated by cells of the SVF, rather than mature adipocytes or mesenteric lymph nodes. PMID:24386254

  8. No benefit of extended mesenteric resection with central vascular ligation in right-sided colon cancer.

    PubMed

    Olofsson, F; Buchwald, P; Elmståhl, S; Syk, I

    2016-08-01

    The optimal extent of mesenteric resection in colon cancer surgery is not known. We have previously shown an increased mortality associated with wider mesenteric resection in right hemicolectomy. This study compares the short- and long-term outcome in three variations of right hemicolectomy based on the position of the vascular ligature in the mesentery. In all, 2084 cases of cancer in the caecum or ascending colon were identified in the Swedish Colorectal Cancer Registry and categorized according to the position of the vascular ligature: central ligation of ileocolic vessels (ICVs) ± right colic vessels (n = 390), central ligation of ICVs + right branch of middle colic vessels (MCVs) (n = 1360) and central ligation of ICVs + central ligation of MCVs (n = 334). Neither 3-year overall survival, 3-year disease-free survival nor local recurrence rate differed between the groups (P = 0.604; P = 0.247; P = 0.237). There was still no difference after multivariate analysis adjusted for age, sex, American Society of Anesthesiologists classification, TNM stage and adjuvant therapy. An increased peri-operative mortality, however, was observed in extended mesenteric resections, increasing from 0.8% in non-extended to 3.6% in more extended resection, P = 0.025. The study showed no survival benefit by more extended mesenteric resection, indicating that there is no need to extend the mesenteric resection to involve the MCVs in cancer of the caecum or ascending colon. On the contrary, increased peri-operative mortality by more extensive mesenteric resection was noted suggesting that a more conservative approach may be favourable. Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.

  9. Metabolic Adaptation to Muscle Ischemia

    NASA Technical Reports Server (NTRS)

    Cabrera, Marco E.; Coon, Jennifer E.; Kalhan, Satish C.; Radhakrishnan, Krishnan; Saidel, Gerald M.; Stanley, William C.

    2000-01-01

    Although all tissues in the body can adapt to varying physiological/pathological conditions, muscle is the most adaptable. To understand the significance of cellular events and their role in controlling metabolic adaptations in complex physiological systems, it is necessary to link cellular and system levels by means of mechanistic computational models. The main objective of this work is to improve understanding of the regulation of energy metabolism during skeletal/cardiac muscle ischemia by combining in vivo experiments and quantitative models of metabolism. Our main focus is to investigate factors affecting lactate metabolism (e.g., NADH/NAD) and the inter-regulation between carbohydrate and fatty acid metabolism during a reduction in regional blood flow. A mechanistic mathematical model of energy metabolism has been developed to link cellular metabolic processes and their control mechanisms to tissue (skeletal muscle) and organ (heart) physiological responses. We applied this model to simulate the relationship between tissue oxygenation, redox state, and lactate metabolism in skeletal muscle. The model was validated using human data from published occlusion studies. Currently, we are investigating the difference in the responses to sudden vs. gradual onset ischemia in swine by combining in vivo experimental studies with computational models of myocardial energy metabolism during normal and ischemic conditions.

  10. [Tonic pupil caused by ischemia].

    PubMed

    Wilhelm, H

    1989-01-01

    Tonic pupil is usually an idiopathic condition. In some cases, the cause of the ciliary ganglion lesion leading to tonic pupils is obvious. Rarely ischemia causes a lesion of the ciliary ganglion or the short ciliary nerves due to the good blood supply of the ciliary ganglion. Only two cases of tonic pupils in the course of giant cell arteritis are mentioned in the literature, but tonic pupils are probably much more common with this disease. Five cases are demonstrated here. All had associated ischemic optic neuropathy, and stagnation of the blood flow in the supratrochlear artery could be demonstrated in two cases by Doppler sonography. Tonic pupils may also occur when an oclusion of the internal carotid artery resolves, probably because of transient stasis of the orbital blood flow. In another case, tonic pupils were associated with choroidal ischemia (proved by video fluorescent angiography) of unknown origin. The diagnosis of tonic pupils was made by pharmacological testing for cholinergic hypersensitivity with 0.1% pilocarpine.

  11. Inflammatory Responses in Brain Ischemia

    PubMed Central

    Kawabori, Masahito; Yenari, Midori A.

    2017-01-01

    Brain infarction causes tissue death by ischemia due to occlusion of the cerebral vessels and recent work has shown that post stroke inflammation contributes significantly to the development of ischemic pathology. Because secondary damage by brain inflammation may have a longer therapeutic time window compared to the rescue of primary damage following arterial occlusion, controlling inflammation would be an obvious therapeutic target. A substantial amount of experimentall progress in this area has been made in recent years. However, it is difficult to elucidate the precise mechanisms of the inflammatory responses following ischemic stroke because inflammation is a complex series of interactions between inflammatory cells and molecules, all of which could be either detrimental or beneficial. We review recent advances in neuroinflammation and the modulation of inflammatory signaling pathways in brain ischemia. Potential targets for treatment of ischemic stroke will also be covered. The roles of the immune system and brain damage versus repair will help to clarify how immune modulation may treat stroke. PMID:25666795

  12. Metabolic Adaptation to Muscle Ischemia

    NASA Technical Reports Server (NTRS)

    Cabrera, Marco E.; Coon, Jennifer E.; Kalhan, Satish C.; Radhakrishnan, Krishnan; Saidel, Gerald M.; Stanley, William C.

    2000-01-01

    Although all tissues in the body can adapt to varying physiological/pathological conditions, muscle is the most adaptable. To understand the significance of cellular events and their role in controlling metabolic adaptations in complex physiological systems, it is necessary to link cellular and system levels by means of mechanistic computational models. The main objective of this work is to improve understanding of the regulation of energy metabolism during skeletal/cardiac muscle ischemia by combining in vivo experiments and quantitative models of metabolism. Our main focus is to investigate factors affecting lactate metabolism (e.g., NADH/NAD) and the inter-regulation between carbohydrate and fatty acid metabolism during a reduction in regional blood flow. A mechanistic mathematical model of energy metabolism has been developed to link cellular metabolic processes and their control mechanisms to tissue (skeletal muscle) and organ (heart) physiological responses. We applied this model to simulate the relationship between tissue oxygenation, redox state, and lactate metabolism in skeletal muscle. The model was validated using human data from published occlusion studies. Currently, we are investigating the difference in the responses to sudden vs. gradual onset ischemia in swine by combining in vivo experimental studies with computational models of myocardial energy metabolism during normal and ischemic conditions.

  13. Giant primary synchronously bilateral mesenteric dedifferentiated liposarcoma with hyperparathyroidism, hyperthyroidism, type-2 diabetes mellitus and hypertension.

    PubMed

    Korukluoglu, Birol; Ergul, Emre; Sisman, Ibrahim Cagatay; Yalcin, Samet; Kusdemir, Ahmet

    2009-08-01

    Liposarcomas represent the single most common type of soft tissue sarcoma, occurring most commonly in the extremities and retroperitoneum. There is no relation between liposarcomas and multiple endocrine syndromes. We presented a 61-year old woman with giant primary synchronously bilateral mesenteric dedifferentiated liposarcoma with hyperparathyroidism, hyperthyroidism, Type-2 diabetes mellitus (T2DM) and hypertension. The mesenteric liposarcoma was reported neither synchronously bilateral nor with endocrine disorders. We must note if the patients' presentation was a co-incidence or an undescribed syndrome, waiting to be discovered.

  14. Superior Mesenteric Artery Syndrome: A Case Report of Two Surgical Options, Duodenal Derotation and Duodenojejunostomy

    PubMed Central

    2016-01-01

    Superior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction and its management is usually conservative with nasojejunal feeding. The pathophysiology entails the loss of the fat pad between the superior mesenteric artery and the abdominal aorta. This reduces the angle between the two vessels to less than 20 degrees with the resultant compression of the third part of the duodenum. The surgical management is usually a laparoscopic duodenojejunostomy. The two cases in our series had two different surgical procedures with good outcomes in both patients. The surgical management of each patient should be determined on its own merits irrespective of the standard of care. PMID:28101395

  15. Superior Mesenteric Artery Syndrome: A Case Report of Two Surgical Options, Duodenal Derotation and Duodenojejunostomy.

    PubMed

    Pillay, Yagan

    2016-01-01

    Superior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction and its management is usually conservative with nasojejunal feeding. The pathophysiology entails the loss of the fat pad between the superior mesenteric artery and the abdominal aorta. This reduces the angle between the two vessels to less than 20 degrees with the resultant compression of the third part of the duodenum. The surgical management is usually a laparoscopic duodenojejunostomy. The two cases in our series had two different surgical procedures with good outcomes in both patients. The surgical management of each patient should be determined on its own merits irrespective of the standard of care.

  16. Giant mesenteric fibromatosis: Report of a case and review of the literature.

    PubMed

    Gari, Mohammed Khalid Mirza; Guraya, Salman Yousuf; Hussein, Amir Mounir; Hego, Moustafa Mahmoud Nafady

    2012-03-27

    Mesenteric fibromatosis poses a diagnostic and therapeutic challenge. This paper presents a 35-year-old female complaining of vague abdominal pain of 2 mo duration. Her computed tomography scan and magnetic resonance imaging revealed a pelvi-abdominal heterogenous mass with significant displacement of the small bowel and urinary bladder. She underwent surgical excision of the mass with resection and anastomosis of the involved loop of the small intestine. Histological examination confirmed mesenteric fibromatosis without infiltration of the bowel. The patient remained well during the 6 mo follow-up.

  17. Giant mesenteric fibromatosis: Report of a case and review of the literature

    PubMed Central

    Gari, Mohammed Khalid Mirza; Guraya, Salman Yousuf; Hussein, Amir Mounir; Hego, Moustafa Mahmoud Nafady

    2012-01-01

    Mesenteric fibromatosis poses a diagnostic and therapeutic challenge. This paper presents a 35-year-old female complaining of vague abdominal pain of 2 mo duration. Her computed tomography scan and magnetic resonance imaging revealed a pelvi-abdominal heterogenous mass with significant displacement of the small bowel and urinary bladder. She underwent surgical excision of the mass with resection and anastomosis of the involved loop of the small intestine. Histological examination confirmed mesenteric fibromatosis without infiltration of the bowel. The patient remained well during the 6 mo follow-up. PMID:22530082

  18. Mesenteric cystic masses: a series of 21 pediatric cases and review of the literature.

    PubMed

    Chang, Tiffany S; Ricketts, Richard; Abramowsky, Carlos R; Abramowksy, Carlos R; Cotter, Breandan D; Steelman, Charlotte K; Husain, Aliya; Shehata, Bahig M

    2011-01-01

    Mesenteric cysts, seen in all age groups, represent a rare cause of benign abdominal masses in children. We reviewed 21 patients with mesenteric/omental cysts. Gross and radiologic images, along with histologic sections, were reviewed to categorize the structures and determine the relationship to the mesentery and intestines. The cysts were composed of multi-loculated dilated channels at the serosal surface consistent with lymphangioma. Most treatment was simple excision, infrequently with intestinal resection. Nineteen patients did well after surgery. One patient developed short-gut syndrome after massive bowel resection, and one patient died immediately after birth due to massive fetal hydrops and heart failure.

  19. Thrombosis of a Superior Mesenteric Vein Aneurysm: Transarterial Thrombolysis and Transhepatic Aspiration Thrombectomy

    SciTech Connect

    Hechelhammer, L.; Crook, D.W.; Widmer, U.; Wildermuth, S.; Pfammatter, T.

    2004-09-15

    We report the case of a 31-year-old woman presenting with abdominal pain due to acute thrombosis of a superior and inferior mesenteric vein aneurysm, which was treated by a combination of arterial thrombolysis and transhepatic thrombus aspiration. At the last follow-up CT, 21 months following this procedure, there was no evidence of rethrombosis, and the patient continues to do well under oral anticoagulation. The literature regarding these uncommon mesenteric vein aneurysms without portal vein involvement, as well as their treatment options, is reviewed.

  20. Superior Mesenteric Artery Pseudoaneurysm Associated with Celiac Axis Occlusion Treated Using Endovascular Techniques

    SciTech Connect

    Ray, Biswajit; Kuhan, Ganesh; Johnson, Brian; Nicholson, Anthony A.; Ettles, Duncan F.

    2006-10-15

    The case of a 30-year-old woman with a post-traumatic pseudoaneurysm of the superior mesenteric artery and associated celiac axis occlusion is presented. The patient was successfully treated with celiac artery recanalization and placement of a covered stent within the superior mesenteric artery. Follow-up at 3, 6, and 12 months and 3 years demonstrated patency of the covered stent and continued exclusion of the aneurysm. Although the long-term success of this procedure is unknown this management option should be considered where facilities are available, to reduce the increased morbidity associated with open surgical procedure.

  1. Management of a ruptured mucinous mesenteric cyst with hyperthermic intraperitoneal chemotherapy.

    PubMed

    Nelson, John; Deneve, Jeremiah; Dickson, Paxton; Sylvestre, Pamela; Munene, Gitonga

    2014-01-01

    Mesenteric cysts are rare intra-abdominal cysts that are generally regarded as benign, and the incidence of malignancy is often cited to be 3%. The typical recommendation for treatment is complete excision to minimize recurrence. Excision can be performed laparoscopically, but this can lead to intra-abdominal dissemination of the cyst contents. There has been one case report describing the development of pseudomyxoma peritonei following rupture of a mesenteric cyst. We describe the treatment and outcome of a patient who underwent cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for the treatment of an incompletely resected mucinous cystadenocarcinoma originating from the colonic mesentery.

  2. Case report: elective removal of a large mesenteric cyst-our approach.

    PubMed

    Razi, Kasra; Al-Asaad, Obaida; Milind, Rao

    2017-03-01

    A mesenteric cyst is rare intra-abdominal pathology, with little literature to guide us on how to diagnose and manage it. We report the incident of a 57-year-old female who had an incidental finding of a sigmoid mesenteric cyst whilst undergoing an operation under the care of the Gynaecologists. A computed tomography scan and a flexible sigmoidoscopy followed to help diagnose the lesion as a cyst. A month later the 10 × 15 cm(2) cyst was excised laparoscopically with no complications.

  3. A ruptured infected mesenteric cyst diagnosed on laparoscopy for suspected appendicitis

    PubMed Central

    Ward, Stephen T.; Singh, Baljinder; Jones, Terence J.; Robertson, Charles S.

    2011-01-01

    Lower abdominal pain of acute onset in young women with a negative pregnancy test is a frequent reason for referral to the general surgical team and the differential diagnoses include acute appendicitis, complicated ovarian cysts and pelvic inflammatory disease. Intestinal and mesenteric cystic disease is a rare entity and less than half of cases present acutely. We present a case of a 25-year-old woman who underwent diagnostic laparoscopy for acute lower abdominal pain and was diagnosed with a ruptured, infected mesenteric cyst. PMID:24713757

  4. Giant mesenteric cyst of mesothelial origin in a haemodialysis patient with previous peritoneal dialysis therapy.

    PubMed

    Zeiler, Matthias; Santarelli, Stefano; Cangiotti, Angela Maria; Agostinelli, Rosa Maria; Monteburini, Tania; Marinelli, Rita; Ceraudo, Emilio; Cutini, Giorgio

    2010-03-01

    A 55-year-old female haemodialysis patient presented progressive abdominal liquid formation after having been excluded from peritoneal dialysis therapy because of recurrent peritonitis. Ultrasound was suspicious for ascites secondary to sclerosing peritonitis. Computed tomography revealed a thin-walled mesenteric cyst extending from the epigastric to the pelvic region. The cyst was excised incompletely as extensive adhesions were present. Histology was consistent with a mesothelial cyst of inflammatory origin. Three months after surgery, ultrasound detected a local recurrence at the descending colon. This case emphasizes the relation between mesenteric cyst, persistent inflammatory status and preceding peritoneal dialysis complicated by peritonitis.

  5. [Mesenteric cyst as a cause of acute abdomen. Report of 3 cases].

    PubMed

    Guzmán-Valdivia Gómez, Gilberto; Alonso-Avilés, Verónica

    2003-01-01

    Mesenteric cyst is a tumor of multiple origins that surely are found more frequently than the literature report, at any rate, this tumor is uncommon. Because of absence of characteristic clinical findings, diagnosis cumbersome, until these cysts are of such a size that palpation becomes possible or when they cause compression to nearby viscera. Occasionally, diagnosis is made during surgery, even when it was emergency surgery. The present paper reports on three patients with mesenteric cyst found during surgery as emergency treatment. Histopathologic reports showed lymphangioma in two cases and leiomyosarcoma in one case, quite uncommon in this kind of lesion.

  6. Relaxation of human isolated mesenteric arteries by vasopressin and desmopressin.

    PubMed Central

    Martínez, M C; Vila, J M; Aldasoro, M; Medina, P; Flor, B; Lluch, S

    1994-01-01

    1. The effects of vasopressin and deamino-8-D-arginine vasopressin (DDAVP, desmopressin) were studied in artery rings (0.8-1 mm in external diameter) obtained from portions of human omentum during the course of abdominal operations (27 patients). 2. In arterial rings under resting tension, vasopressin produced concentration-dependent, endothelium-independent contractions with an EC50 of 0.59 +/- 0.12 nM. The V1 antagonist d(CH2)5Tyr(Me)AVP (1 microM) and the mixed V1-V2 antagonist desGly-d(CH2)5D-Tyr(Et)ValAVP (0.01 microM) displaced the control curve to vasopressin to the right in a parallel manner without differences in the maximal responses. In the presence of indomethacin (1 microM) the contractile response to vasopressin was significantly increased (P < 0.01). 3. In precontracted arterial rings, previously treated with the V1 antagonist, d(CH2)5Tyr(Me)AVP (1 microM), vasopressin produced endothelium-dependent relaxation. This relaxation was reduced significantly (P < 0.05) by indomethacin (1 microM) and unaffected by the V1-V2 receptor antagonist desGly-d(CH2)5D-Tyr(Et)ValAVP (1 microM) or by NG-nitro-L-arginine methyl ester (L-NAME, 0.1 mM). 4. The selective V2 receptor agonist, DDAVP, caused endothelium-independent, concentration-dependent relaxations in precontracted arterial rings that were inhibited by the mixed V1-V2 receptor antagonist, but not by the V1 receptor antagonist or by pretreatment with indomethacin or L-NAME. 5. Results from this study suggest that vasopressin is primarily a constrictor of human mesenteric arteries by V1 receptor stimulation; vasopressin causes dilatation only during V1 receptor blockade. The relaxation appears to be mediated by the release of vasodilator prostaglandins from the endothelial cell layer and is independent of V2 receptor stimulation or release of nitric oxide.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7834191

  7. Laparoscopic excision of mesenteric duplication enteric cyst embedded in sigmoid mesocolon mimicking retroperitoneal neurogenic tumor in adults.

    PubMed

    Wang, Jui-Ho; Lin, Jen-Tai; Hsu, Chao-Wen

    2012-10-01

    Mesenteric cysts are rare abdominal tumors with an incidence of 1/105,000 to 250,000 hospitalized adult surgical patients. These cysts may occur in every part of the mesentery, from duodenum to rectum. Most frequently, cysts are localized in small bowel mesentery. They usually present during the first decade of life, mostly occurring in pediatric patients. These lesions characteristically arise from the mesenteric border of the bowel. The majority are asymptomatic and, if found, are discovered incidentally during abdominal exploration or radiologic examination. Traditionally, the treatment of mesenteric cyst is surgical excision by laparotomy. However, in 1993, Mackenzie described the first laparoscopic excision of a mesenteric cyst. Since then, several cases have been reported but mainly in small intestine. Here, we reported an adult patient of a mesenteric duplication enteric cyst embedded in sigmoid mesocolon mimicking retroperitoneal neurogenic tumor, which was completely excised using the laparoscopic approach (Supplemental Digital Content 1, http://links.lww.com/SLE/A73).

  8. Vascular relaxation of canine visceral arteries after ischemia by means of supraceliac aortic cross-clamping followed by reperfusion

    PubMed Central

    2010-01-01

    Background The supraceliac aortic cross-clamping can be an option to save patients with hipovolemic shock due to abdominal trauma. However, this maneuver is associated with ischemia/reperfusion (I/R) injury strongly related to oxidative stress and reduction of nitric oxide bioavailability. Moreover, several studies demonstrated impairment in relaxation after I/R, but the time course of I/R necessary to induce vascular dysfunction is still controversial. We investigated whether 60 minutes of ischemia followed by 30 minutes of reperfusion do not change the relaxation of visceral arteries nor the plasma and renal levels of malondialdehyde (MDA) and nitrite plus nitrate (NOx). Methods Male mongrel dogs (n = 27) were randomly allocated in one of the three groups: sham (no clamping, n = 9), ischemia (supraceliac aortic cross-clamping for 60 minutes, n = 9), and I/R (60 minutes of ischemia followed by reperfusion for 30 minutes, n = 9). Relaxation of visceral arteries (celiac trunk, renal and superior mesenteric arteries) was studied in organ chambers. MDA and NOx concentrations were determined using a commercially available kit and an ozone-based chemiluminescence assay, respectively. Results Both acetylcholine and calcium ionophore caused relaxation in endothelium-intact rings and no statistical differences were observed among the three groups. Sodium nitroprusside promoted relaxation in endothelium-denuded rings, and there were no inter-group statistical differences. Both plasma and renal concentrations of MDA and NOx showed no significant difference among the groups. Conclusion Supraceliac aortic cross-clamping for 60 minutes alone and followed by 30 minutes of reperfusion did not impair relaxation of canine visceral arteries nor evoke biochemical alterations in plasma or renal tissue. PMID:20642850

  9. Protective approaches against myocardial ischemia reperfusion injury

    PubMed Central

    Li, Xianchi; Liu, Min; Sun, Rongrong; Zeng, Yi; Chen, Shuang; Zhang, Peiying

    2016-01-01

    Myocardial ischemia-reperfusion is the leading cause for the events of cardiovascular disease, and is considered as a major contributor to the morbidity and mortality associated with coronary occlusion. The myocardial damage caused by ischemia-reperfusion injury constitutes the primary pathological manifestation of coronary artery disease. It results from the interaction between the substances that accumulate during ischemia and those that are delivered on reperfusion. The level of this damage can range from a small insult resulting in limited myocardial damage to a large injury culminating in myocyte death. Importantly, major ischemia-reperfusion injury to the heart can result in permanent disability or death. Given the worldwide prevalence of coronary artery disease, developing a strategy to provide cardioprotection against ischemia-reperfusion-induced damage is of great importance. Currently, the treatment of reperfusion injury following ischemia is primarily supportive, since no specific target-oriented therapy has been validated thus far. Nevertheless, therapeutic approaches to protect against myocardial ischemia-reperfusion injury remain an active area of investigation given the detrimental effects of this phenomenon. PMID:28101167

  10. Ligation of superior mesenteric vein and portal to splenic vein anastomosis after superior mesenteric-portal vein confluence resection during pancreaticoduodenectomy – Case report

    PubMed Central

    Tang, Jianlin; Abbas, Jihad; Hoetzl, Katherine; Allison, David; Osman, Mahamed; Williams, Mallory; Zelenock, Gerald B.

    2014-01-01

    62 year old Caucasian female with pancreatic head mass abutting the superior mesenteric vein (SMV) presented with fine needle aspiration biopsy confirmed diagnosis of ductal adenocarcinoma. CT scan showed near complete obstruction of portal vein and large SMV collateral development. After 3 months of neoadjuvant therapy, her portal vein flow improved significantly, SMV collateral circulation was diminished. Pancreaticoduodenectomy (PD) and superior mesenteric portal vein (SMPV) confluence resection were performed; A saphenous vein interposition graft thrombosed immediately. The splenic vein remnant was distended and adjacent to the stump of the portal vein. Harvesting an internal jugular vein graft required extra time and using a synthetic graft posed a risk of graft thrombosis or infection. As a result, we chose to perform a direct anastomosis of the portal and splenic vein in a desperate situation. The anastomosis decompressed the mesenteric venous system, so we then ligated the SMV. The patient had an uneventful postoperative course, except transient ascites. She redeveloped ascites more than one year later. At that time a PET scan showed bilateral lung and right femur metastatic disease. She expired 15 months after PD. Conclusion The lessons we learned are (1) Before SMPV confluence resection, internal jugular vein graft should be ready for reconstruction. (2) Synthetic graft is an alternative for internal jugular vein graft. (3) Direct portal vein to SMV anastomosis can be achieved by mobilizing liver. (4) It is possible that venous collaterals secondary to SMV tumor obstruction may have allowed this patient's post-operative survival. PMID:25568802

  11. [Myocardial ischemia and ventricular arrhythmia].

    PubMed

    Vester, E G

    1998-01-01

    A relation between myocardial ischemia and induction of ventricular arrhythmias can be demonstrated in patients with coronary heart disease--in contrast to patients with primary non ischemic cardiac diseases--using a combined metabolic-electrophysiological investigation protocol consisting of programmed atrial and ventricular stimulation with simultaneous measurement of the arterio/coronary venous difference for lactate, pyruvate, free fatty acids and amino acids. There are significant metabolic distinctions between both ischemic and non ischemic heart disease under pacing stress conditions as well as at rest. Areas of "hibernating myocardium" resp. "mismatch" zones in the myocardium showing reduced or abolished perfusion and preserved metabolism during scintographic SPECT/PET studies, may be found more often in patients with ventricular tachycardias (VT) or ventricular fibrillation (VF) in the chronic post myocardial infarction state than in patients without VT/VF. The proof of such zones may be considered a possible risk factor for arrhythmic events and sudden cardiac death after myocardial infarction. Hereby the concept of an interaction between acute and chronic ischemia triggering the onset of polymorphic VT or VF gaines increasing acceptance. In contrast, monomorphic reentrant VT are usually generated in the border zone of scarred areas where islands of vital fibers are surrounded by fibrotic tissue. These arrhythmogenic origin regions are characterized by a "match" pattern presenting a comparably severe reduction of perfusion and metabolism. Under those circumstances a control resp. suppression of the VT focus can only be provided by interventional techniques like catheter ablation, antitachycardiac surgery or implantation of a cardioverter/defibrillator beyond antiarrhythmic drug therapy. An antiischemic causal treatment (bypass surgery or angioplasty) represents for maximal 40% of patients with ischemically induced ventricular arrhythmias an adequate and

  12. Stress-induced mesenteric vasoconstriction in rats is mediated by neuropeptide Y Y1 receptors.

    PubMed

    Zukowska-Grojec, Z; Dayao, E K; Karwatowska-Prokopczuk, E; Hauser, G J; Doods, H N

    1996-02-01

    The physiological role of neuropeptide Y (NPY), a sympathetic cotransmitter and vasoconstrictor, has not been determined yet. We used a specific nonpeptide antagonist to the NPY Y1 receptor [BIBP-3226; (R)-N2-(diphenacetyl)-N-[(4-hydroxyphenyl) methyl]-D-arginineamide] to study the involvement of NPY in stress-induced vasoconstriction in the mesenteric bed. In rats subjected to cold water stress (COLD), plasma NPY immunoreactivity levels increased progressively from 0.15 +/- 0.01 to 0.32 +/- 0.05 pmol/ml and remained elevated during recovery. Administration of BIBP-3226 (3 mg.kg-1.h-1 infusion) tended to decrease the stress-induced pressor response and significantly attenuated the post-COLD elevation of blood pressure. The COLD-induced fall in the superior mesenteric artery blood flow and the increase of up to 300% in the mesenteric vascular resistance were either reduced or eliminated by BIBP-3226. Conversely, the Y1 antagonist had no effect on the COLD-induced tachycardia. This study provides the first evidence of the physiological role of NPY. The peptide is released during stress and increases mesenteric vascular resistance via activation of its Y1 receptors. Specific Y1-receptor antagonists may therefore be of potential benefit in prevention or treatment of stress-induced vasospasm.

  13. [Various cases of direct connections between the celiac artery and the superior mesenteric].

    PubMed

    Bertelli, E; Di Gregorio, F; Civeli, L

    1991-01-01

    The authors produce three cases in which an anastomotic arterial trunk between the coeliac artery and the superior mesenteric artery was present. Although this finding is rather rare (0.4% in vivo) it is important for the surgeons who operate upon the pancreas.

  14. Internal abdominal hernia: Intestinal obstruction due to trans-mesenteric hernia containing transverse colon

    PubMed Central

    Crispín-Trebejo, Brenda; Robles-Cuadros, María Cristina; Orendo-Velásquez, Edwin; Andrade, Felipe P.

    2014-01-01

    INTRODUCTION Internal abdominal hernias are infrequent but an increasing cause of bowel obstruction still often underdiagnosed. Among adults its usual causes are congenital anomalies of intestinal rotation, postsurgical iatrogenic, trauma or infection diseases. PRESENTATION OF CASE We report the case of a 63-year-old woman with history of chronic constipation. The patient was hospitalized for two days with acute abdominal pain, abdominal distension and inability to eliminate flatus. The X-ray and abdominal computerized tomography scan (CT scan) showed signs of intestinal obstruction. Exploratory laparotomy performed revealed a trans-mesenteric hernia containing part of the transverse colon. The intestine was viable and resection was not necessary. Only the hernia was repaired. DISCUSSION Internal trans-mesenteric hernia constitutes a rare type of internal abdominal hernia, corresponding from 0.2 to 0.9% of bowel obstructions. This type carries a high risk of strangulation and even small hernias can be fatal. This complication is specially related to trans-mesenteric hernias as it tends to volvulize. Unfortunately, the clinical diagnosis is rather difficult. CONCLUSION Trans-mesenteric internal abdominal hernia may be asymptomatic for many years because of its nonspecific symptoms. The role of imaging test is relevant but still does not avoid the necessity of exploratory surgery when clinical features are uncertain. PMID:24880799

  15. Relaxation effect of a novel Danshensu/tetramethylpyrazine derivative on rat mesenteric arteries.

    PubMed

    Li, Rachel Wai-Sum; Yang, C; Shan, Luchen; Zhang, Zaijun; Wang, Yuqiang; Kwan, Y W; Lee, Simon M Y; Hoi, Maggie P M; Chan, S W; Cheung, Alex Chun; Cheung, K H; Leung, George P H

    2015-08-15

    Danshen (Radix Salviae miltiorrhizae) and ChuanXiong (Ligusticum wallichii) are two traditional herbal medicines commonly used in China for the treatment of cardiovascular diseases. The active components in Danshen and ChuanXiong are Danshensu (DSS, (R)-3, 4-dihydroxyphenyllactic acid) and tetramethylpyrazine (TMP), respectively. In the present study, a new compound named ADTM, which is a conjugation of DSS and TMP, was synthesized and its effect on the contractility of rat mesenteric arteries was examined. The relaxation effect of ADTM on rat mesenteric arteries was studied using myography. The effects of ADTM on Ca(2+) channels were measured by Ca(2+) imaging and patch-clamp techniques. The results showed that ADTM caused a concentration-dependent relaxation of rat mesenteric arteries. This relaxation effect was not affected by the removal of endothelium or inhibitors of nitric oxide synthase, cyclooxygenase, guanylyl cyclase and adenylyl cyclase. Potassium channel blockers including tetraethylammonium, iberiotoxin, apamin, 4-aminopyridine, BaCl2 and glibenclamide also failed to inhibit the relaxation response to ADTM. ADTM inhibited CaCl2-induced contractions and reduced the Ca(2+) influx in isolated mesenteric arterial muscle cells. Our results suggest that ADTM may be a novel relaxing agent. Its mechanism of action involves the direct blockade of voltage-gated Ca(2+) channels in vascular smooth muscle cells, resulting in a decrease in Ca(2+) influx into the cells. Copyright © 2015 Elsevier B.V. All rights reserved.

  16. Stenting of a Spontaneous Dissection of the Superior Mesenteric Artery: A New Therapeutic Approach?

    SciTech Connect

    Froment, P. Alerci, M.; Vandoni, R.E.; Bogen, M.; Gertsch, P.; Galeazzi, G.

    2004-09-15

    Spontaneous dissection of the superior mesenteric artery (SMA) is rare and has been reported only sporadically. Therapeutic options are either a surgical approach, which is the more frequently adopted, or a simple observation. We report a case of spontaneous dissection of the SMA with a review of the literature and present a new therapeutic approach.

  17. Altered potassium ATP channel signaling in mesenteric arteries of old high salt-fed rats

    PubMed Central

    Whidden, Melissa A.; Basgut, Bilgen; Kirichenko, Nataliya; Erdos, Benedek; Tümer, Nihal

    2016-01-01

    [Purpose] Both aging and the consumption of a high salt diet are associated with clear changes in the vascular system that can lead to the development of cardiovascular disease; however the mechanisms are not clearly understood. Therefore, we examined whether aging and the consumption of excess salt alters the function of potassium ATP-dependent channel signaling in mesenteric arteries [Methods] Young (7 months) and old (29 months) Fischer 344 x Brown Norway rats were fed a control or a high salt diet (8% NaCl) for 12 days and mesenteric arteries were utilized for vascular reactivity measurements. [Results] Acetylcholine-induced endothelium relaxation was significantly reduced in old arteries (81 ± 4%) when compared with young arteries (92 ± 2%). Pretreatment with the potassium-ATP channel blocker glibenclamide reduced relaxation to acetylcholine in young arteries but did not alter dilation in old arteries. On a high salt diet, endothelium dilation to acetylcholine was significantly reduced in old salt arteries (60 ± 3%) when compared with old control arteries (81 ± 4%). Glibenclamide reduced acetylcholine-induced dilation in young salt arteries but had no effect on old salt arteries. Dilation to cromakalim, a potassium-ATP channel opener, was reduced in old salt arteries when compared with old control arteries. [Conclusion] These findings demonstrate that aging impairs endothelium-dependent relaxation in mesenteric arteries. Furthermore, a high salt diet alters the function of potassium-ATP-dependent channel signaling in old isolated mesenteric arteries and affects the mediation of relaxation stimuli. PMID:27508155

  18. Nutrient stimulation of mesenteric blood flow - implications for older critically ill patients

    PubMed Central

    Nguyen, Thu AN; Abdelhamid, Yasmine Ali; Phillips, Liza K; Chapple, Leeanne S; Horowitz, Michael; Jones, Karen L; Deane, Adam M

    2017-01-01

    Nutrient ingestion induces a substantial increase in mesenteric blood flow. In older persons (aged ≥ 65 years), particularly those with chronic medical conditions, the cardiovascular compensatory response may be inadequate to maintain systemic blood pressure during mesenteric blood pooling, leading to postprandial hypotension. In older ambulatory persons, postprandial hypotension is an important pathophysiological condition associated with an increased propensity for syncope, falls, coronary vascular events, stroke and death. In older critically ill patients, the administration of enteral nutrition acutely increases mesenteric blood flow, but whether this pathophysiological response is protective, or precipitates mesenteric ischaemia, is unknown. There are an increasing number of older patients surviving admission to intensive care units, who are likely to be at increased risk of postprandial hypotension, both during, and after, their stay in hospital. In this review, we describe the prevalence, impact and mechanisms of postprandial hypotension in older people and provide an overview of the impact of postprandial hypotension on feeding prescriptions in older critically ill patients. Finally, we provide evidence that postprandial hypotension is likely to be an unrecognised problem in older survivors of critical illness and discuss potential options for management. PMID:28224105

  19. Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis

    PubMed Central

    Liu, Feng-Yong; Wang, Mao-Qiang; Fan, Qing-Sheng; Duan, Feng; Wang, Zhi-Jun; Song, Peng

    2009-01-01

    AIM: To summarize our methods and experience with interventional treatment for symptomatic acute-subacute portal vein and superior mesenteric vein thrombosis (PV-SMV) thrombosis. METHODS: Forty-six patients (30 males, 16 females, aged 17-68 years) with symptomatic acute-subacute portal and superior mesenteric vein thrombosis were accurately diagnosed with Doppler ultrasound scans, computed tomography and magnetic resonance imaging. They were treated with interventional therapy, including direct thrombolysis (26 cases through a transjugular intrahepatic portosystemic shunt; 6 through percutaneous transhepatic portal vein cannulation) and indirect thrombolysis (10 through the femoral artery to superior mesenteric artery catheterization; 4 through the radial artery to superior mesenteric artery catheterization). RESULTS: The blood reperfusion of PV-SMV was achieved completely or partially in 34 patients 3-13 d after thrombolysis. In 11 patients there was no PV-SMV blood reperfusion but the number of collateral vessels increased significantly. Symptoms in these 45 patients were improved dramatically without severe operational complications. In 1 patient, the thrombi did not respond to the interventional treatment and resulted in intestinal necrosis, which required surgical treatment. In 3 patients with interventional treatment, thrombi re-formed 1, 3 and 4 mo after treatment. In these 3 patients, indirect PV-SMV thrombolysis was performed again and was successful. CONCLUSION: Interventional treatment, including direct or indirect PV-SMV thrombolysis, is a safe and effective method for patients with symptomatic acute-subacute PV-SMV thrombosis. PMID:19859995

  20. Schistosomiasis Presenting as a Case of Acute Appendicitis with Chronic Mesenteric Thrombosis.

    PubMed

    Mosli, Mohammed H; Chan, Wilson W; Morava-Protzner, Izabella; Kuhn, Susan M

    2016-01-01

    The manifestations of schistosomiasis typically result from the host inflammatory response to parasitic eggs that are deposited in the mucosa of either the gastrointestinal tract or bladder. We present here a case of a 50-year-old gentleman with a rare gastrointestinal presentation of both schistosomal appendicitis and mesenteric thrombosis.

  1. Superior Mesenteric Vein Occlusion Causing Severe Gastrointestinal Haemorrhage in Two Paediatric Cases

    PubMed Central

    Fox, Anna L.; Jones, Matthew; Healey, Andrew; Auth, Marcus K. H.

    2012-01-01

    Reports about superior mesenteric vein thrombosis in childhood are very rare and have not been associated with gastrointestinal bleeding. We describe two cases of severe bleeding from the upper and lower gastrointestinal tract in children who had undergone complex abdominal surgery at considerable time before. The first child had a tracheoesophageal fistula, corrected by division, gastrostomy insertion, and repair of duodenal rupture. The child presented with severe bleeding from the gastrostomy site and was diagnosed with a thrombosis of the proximal superior mesenteric vein. The second child had a gastroschisis and duodenal atresia, and required duodenoplasty, gastrostomy insertion, hemicolectomy, and adhesiolysis. The child presented with intermittent severe lower gastrointestinal bleeding, resulting from collateral vessels at location of the surgical connections. He was diagnosed with a thrombosis of the superior mesenteric vein. In both children, the extensive previous surgery and anastomosis were considered the cause of the mesenteric thrombosis. CT angiography confirmed the diagnosis in both cases, in addition to characteristic findings on endoscopy. Paediatricians should suspect this condition in children with severe gastrointestinal bleeding, particularly in children with previous, complex abdominal surgery. PMID:23198238

  2. Cavitating mesenteric lymph node syndrome: a rare complication of celiac disease.

    PubMed

    Rodríguez-Sánchez, Joaquín; Martín-Dávila, Francisco; López-Viedma, Bartolomé; Galván-Fernández, M D; Alonso-Lablanca, María; Olmedo-Camacho, José; García-Rojo, Marcial; Rodríguez-Sánchez, Eduardo

    2011-12-01

    Among the many complications of celiac disease, mesenteric lymph node syndrome cavitated is considered one of the rarest, there is few case series published in the literature. The etiology and pathophysiology are unknown but because of its high mortality rate, estimated to be around 50%, it should recognize at an early stage in order to institute appropriate therapy as soon as possible.

  3. Arteriovenous Fistula of a Colic Branch of the Superior Mesenteric Artery: Endovascular Therapy

    SciTech Connect

    White, Richard D. Ananthakrishnan, Ganapathy; Bhat, Rajesh

    2010-08-15

    Arteriovenous fistulae (AVF) of the superior mesenteric artery and its branches are exceedingly rare. We report an unusual case of a patient who was found to be symptomatic from such an AVF, with diarrhea and terminal ileal thickening. We describe the findings from magnetic resonance imaging, computed tomography and catheter angiography and discuss the endovascular management.

  4. Infarction of a polyp within a mesenteric cyst: An unusual presentation as an acute abdomen.

    PubMed

    Gon, Sonia; Majumdar, Bipasa; Bhattacharyya, Aditi; Das, Tushar K; Chatterjee, Indranil

    2010-04-01

    A case of mesenteric cyst in a five-year-old male child who presented with acute abdomen due to an infarcted polyp present within the cyst is reported. To the best of our knowledge, such an event has never been reported in the literature previously.

  5. Infarction of a polyp within a mesenteric cyst: An unusual presentation as an acute abdomen

    PubMed Central

    Gon, Sonia; Majumdar, Bipasa; Bhattacharyya, Aditi; Das, Tushar K.; Chatterjee, Indranil

    2010-01-01

    A case of mesenteric cyst in a five-year-old male child who presented with acute abdomen due to an infarcted polyp present within the cyst is reported. To the best of our knowledge, such an event has never been reported in the literature previously. PMID:20975788

  6. Altered potassium ATP channel signaling in mesenteric arteries of old high salt-fed rats.

    PubMed

    Whidden, Melissa A; Basgut, Bilgen; Kirichenko, Nataliya; Erdos, Benedek; Tümer, Nihal

    2016-06-01

    Both aging and the consumption of a high salt diet are associated with clear changes in the vascular system that can lead to the development of cardiovascular disease; however the mechanisms are not clearly understood. Therefore, we examined whether aging and the consumption of excess salt alters the function of potassium ATP-dependent channel signaling in mesenteric arteries. Young (7 months) and old (29 months) Fischer 344 x Brown Norway rats were fed a control or a high salt diet (8% NaCl) for 12 days and mesenteric arteries were utilized for vascular reactivity measurements. Acetylcholine-induced endothelium relaxation was significantly reduced in old arteries (81 ± 4%) when compared with young arteries (92 ± 2%). Pretreatment with the potassium-ATP channel blocker glibenclamide reduced relaxation to acetylcholine in young arteries but did not alter dilation in old arteries. On a high salt diet, endothelium dilation to acetylcholine was significantly reduced in old salt arteries (60 ± 3%) when compared with old control arteries (81 ± 4%). Glibenclamide reduced acetylcholine-induced dilation in young salt arteries but had no effect on old salt arteries. Dilation to cromakalim, a potassium-ATP channel opener, was reduced in old salt arteries when compared with old control arteries. These findings demonstrate that aging impairs endothelium-dependent relaxation in mesenteric arteries. Furthermore, a high salt diet alters the function of potassium-ATP-dependent channel signaling in old isolated mesenteric arteries and affects the mediation of relaxation stimuli.

  7. An unusual cause of paediatric abdominal pain: Mesenteric masses accompanied with volvulus.

    PubMed

    Yang, Chao; Wang, Shan; Zhang, Jun; Kong, Xiang Ru; Zhao, Zhenzhen; Li, Chang Chun

    2016-07-01

    Volvulus caused by mesenteric masses is rare and may result in serious consequences. This study aimed to better characterize volvulus caused by mesenteric masses in children. A retrospective study was conducted in 24 patients who underwent surgical treatment between January 1994 and January 2014 in one single institution. There were 10 boys and 14 girls. The most frequent findings were abdominal pain (100%), emesis (91.7%) and nausea (83.3%). Physical examination showed positive ileus signs in majority cases, and palpable mass was found in half of the patients. Ultrasound and CT scans revealed mesenteric masses in 21 and 24 patients, and 'whirlpool sign' was observed in 19 and 22 patients, respectively. Emergency laparotomy was performed in all patients. Histological examination revealed that 18 cystic masses were lymphangioma, 5 solid cases were lipoma and the remaining one was lipoblastoma. The postoperative course was uneventful in 22 patients, and postoperative obstruction and incision infection occurred in 2 patients. There was no evidence of recurrence at follow-up. Volvulus caused by mesenteric masses is a rare but potentially life-threatening cause of abdominal pain, which should be considered in the differential diagnosis of paediatric acute abdominal pain.

  8. Pediatric chylolymphatic mesenteric cyst - a separate entity from cystic lymphangioma: a case series.

    PubMed

    Rattan, Kamal Nayan; Nair, Vimoj J; Pathak, Manish; Kumar, Sanjay

    2009-11-09

    Chylolymphatic mesenteric cysts are rare entities with variable presentations and this has surgical implications in the pediatric age group. We carried out a retrospective analysis of the clinical and histopathological records of pediatric patients diagnosed and treated for chylolymphatic mesenteric cysts at our institute from 1998 to 2008. Eight patients met the histopathological criteria of chylolymphatic mesenteric cyst. These patients were in the age range 18 months to 10 years with a mean age of 4.5 years. Of these eight patients, four presented with an abdominal lump, and two each with abdominal pain and acute intestinal obstruction. On clinical examination, five out of the eight patients had a palpable abdominal mass. Laparotomy and complete excision of the cyst along with the involved gut was performed in all patients. There were no postoperative complications or any recurrence during the follow-up period which ranged from 4 months to 8 years. Although very rare, chylolymphatic mesenteric cyst should be kept in mind as one of the differential diagnoses of cystic masses of the abdomen including cystic lymphangioma. Ultrasonography and computed tomography suggest the diagnosis but histopathological examination is required for confirmation. Complete excision of the cyst yields excellent results.

  9. Giant mesenteric cyst of gastric origin: a case report with imaging findings.

    PubMed

    Ayaz, Umit Yaşar; Dilli, Alper; Api, Arman

    2011-01-01

    We present a very rare case of a giant gastric mesenteric cyst with ultrasonography (US) and computed tomography (CT) findings. An eight-year-old boy was referred for treatment of an intraabdominal cyst, known to exist for six years. On abdominal US, a giant, thin-walled, unilocular intraabdominal cyst was demonstrated, extending from the epigastric region to the pelvis and measuring 18 x 15 x 6 cm. In contrast-enhanced abdominal CT, the cyst was demonstrated as a giant, unilocular, hypodense, non-enhancing structure, located dominantly on the right side of the abdomen. During open surgery, the cyst was found to originate from the mesentery-serosa of the gastric antrum and was filled with serous fluid. The cyst was excised totally. Both surgery and pathology confirmed the diagnosis of mesenteric cyst, originating from the stomach. The patient was discharged in good health. US and CT were effective in defining the features of the giant gastric mesenteric cyst and in narrowing the differential diagnosis in favor of mesenteric cyst.

  10. Pediatric chylolymphatic mesenteric cyst - a separate entity from cystic lymphangioma: a case series

    PubMed Central

    2009-01-01

    Introduction Chylolymphatic mesenteric cysts are rare entities with variable presentations and this has surgical implications in the pediatric age group. Case presentation We carried out a retrospective analysis of the clinical and histopathological records of pediatric patients diagnosed and treated for chylolymphatic mesenteric cysts at our institute from 1998 to 2008. Eight patients met the histopathological criteria of chylolymphatic mesenteric cyst. These patients were in the age range 18 months to 10 years with a mean age of 4.5 years. Of these eight patients, four presented with an abdominal lump, and two each with abdominal pain and acute intestinal obstruction. On clinical examination, five out of the eight patients had a palpable abdominal mass. Laparotomy and complete excision of the cyst along with the involved gut was performed in all patients. There were no postoperative complications or any recurrence during the follow-up period which ranged from 4 months to 8 years. Conclusion Although very rare, chylolymphatic mesenteric cyst should be kept in mind as one of the differential diagnoses of cystic masses of the abdomen including cystic lymphangioma. Ultrasonography and computed tomography suggest the diagnosis but histopathological examination is required for confirmation. Complete excision of the cyst yields excellent results. PMID:19946589

  11. Dietary exposure to ergot alkaloids decreases contractility of bovine mesenteric vasculature

    USDA-ARS?s Scientific Manuscript database

    Ergot alkaloids are hypothesized to cause vasoconstriction in the midgut, and prior exposure may affect the vasoactivity of these compounds. The objectives of this study were to profile vasoactivity of ergot alkaloids in bovine mesenteric artery (MA) and vein (MV) and determine if previous exposure ...

  12. Dietary exposure to ergot alkaloids decreases contractility of bovine mesenteric vasculature

    USDA-ARS?s Scientific Manuscript database

    Ergot alkaloids are hypothesized to cause vasoconstriction in the midgut, and prior exposure may affect vasoactivity of these compounds. Objectives were to profile vasoactivity of ergot alkaloids in mesenteric artery and vein and determine if previous exposure to endophyte-infected tall fescue affec...

  13. Diagnosis and treatment of mesenteric volvulus in a red kangaroo (Macropus rufus).

    PubMed

    Knafo, S Emmanuelle; Rosenblatt, Alana J; Morrisey, James K; Flanders, James A; Thompson, Margret S; Knapp-Hoch, Heather M

    2014-04-01

    An 8-year-old male red kangaroo (Macropus rufus) was evaluated with a 2-week history of vomiting and anorexia. Four days prior, the patient became refractory to medical management. The kangaroo was admitted for diagnostic testing and treatment including whole body CT, blood work, and emergency laparotomy. CT findings of a severely enlarged stomach, splenic displacement, and a whirl sign were indicative of mesenteric volvulus with gastric dilatation-volvulus (GDV). Contrast enhancement of abdominal viscera suggested intact arterial blood supply; however, compression of the caudal vena cava and portal vein indicated venous obstruction. Results of preoperative blood work suggested biliary stasis without evidence of inflammation. Additionally, a tooth root abscess was diagnosed on the basis of results of CT. Exploratory laparotomy confirmed the diagnosis of mesenteric volvulus and GDV. The volvuli were corrected by clockwise derotation, and a gastropexy was performed. Tissue samples were obtained from the spleen and liver for evaluation. The kangaroo recovered from surgery, and the abscessed tooth was extracted 6 days later. Eight days after initial evaluation, the kangaroo was discharged. In the present report, the CT whirl sign was used to diagnose volvulus of the abdominal viscera, which suggests that this diagnostic indicator has utility in veterinary patients. Mesenteric volvulus with GDV was successfully treated in a nondomestic species. The tooth root abscess, a common condition in macropods, may explain the historic episodes of anorexia reported by the owner and may have contributed to the development of mesenteric volvulus and GDV in this kangaroo.

  14. Ethanol-induced myocardial ischemia: close relation between blood acetaldehyde level and myocardial ischemia.

    PubMed

    Ando, H; Abe, H; Hisanou, R

    1993-05-01

    A patient with vasospastic angina who developed myocardial ischemia following ethanol ingestion but not after exercise was described. Myocardial ischemia was evidenced by electrocardiograms (ECGs) and thallium-201 scintigrams. The blood acetaldehyde level after ethanol ingestion was abnormally high. The time course and severity of myocardial ischemia coincided with those of the blood ethanol and acetaldehyde level. Coronary arteriography showed ergonovine maleate-induced coronary vasospasm at the left anterior descending coronary artery. ECG changes similar to those induced by ethanol ingestion were observed at the same time. These findings suggest that the high blood acetaldehyde level might be responsible for the development of coronary vasospasm and myocardial ischemia in this patient.

  15. Influence of acute pancreatitis on the in vitro responsiveness of rat mesenteric and pulmonary arteries

    PubMed Central

    Camargo, Enilton A; Delbin, Maria Andréia; Ferreira, Tatiane; Landucci, Elen CT; Antunes, Edson; Zanesco, Angelina

    2008-01-01

    Background Acute pancreatitis is an inflammatory disease characterized by local tissue injury and systemic inflammatory response leading to massive nitric oxide (NO) production and haemodynamic disturbances. Therefore, the aim of this work was to evaluate the vascular reactivity of pulmonary and mesenteric artery rings from rats submitted to experimental pancreatitis. Male Wistar rats were divided into three groups: saline (SAL); tauracholate (TAU) and phospholipase A2 (PLA2). Pancreatitis was induced by administration of TAU or PLA2 from Naja mocambique mocambique into the common bile duct of rats, and after 4 h of duct injection the animals were sacrificed. Concentration-response curves to acetylcholine (ACh), sodium nitroprusside (SNP) and phenylephrine (PHE) in isolated mesenteric and pulmonary arteries were obtained. Potency (pEC50) and maximal responses (EMAX) were determined. Blood samples were collected for biochemical analysis. Results In mesenteric rings, the potency for ACh was significantly decreased from animals treated with TAU (about 4.2-fold) or PLA2 (about 6.9-fold) compared to saline group without changes in the maximal responses. Neither pEC50 nor EMAX values for Ach were altered in pulmonary rings in any group. Similarly, the pEC50 and the EMAX values for SNP were not changed in both preparations in any group. The potency for PHE was significantly decreased in rat mesenteric and pulmonary rings from TAU group compared to SAL group (about 2.2- and 2.69-fold, for mesenteric and pulmonary rings, respectively). No changes were seen in the EMAX for PHE. The nitrite/nitrate (NOx-) levels were markedly increased in animals submitted to acute pancreatitis as compared to SAL group, approximately 76 and 68% in TAU and PLA2 protocol, respectively. Conclusion Acute pancreatitis provoked deleterious effects in endothelium-dependent relaxing response for ACh in mesenteric rings that were strongly associated with high plasma NOx- levels as consequence of

  16. Ventrolateral medullary neurones: effects on magnitude and rhythm of discharge of mesenteric and renal nerves in cats.

    PubMed Central

    Stein, R D; Weaver, L C; Yardley, C P

    1989-01-01

    1. Discharge of whole mesenteric and renal nerves was recorded in eighteen chloralose-anaesthetized, artificially respired cats. 2. Inhibition of tonic activity of neurones within the rostral ventrolateral medulla (RVLM blockade) by bilateral application of glycine caused significant reductions in discharge of renal and mesenteric nerves, arterial blood pressure and heart rate. The decrease in discharge of renal nerves was significantly greater than that of mesenteric nerves. 3. During the response to glycine application, the spinal cord was transected at the first cervical segment. The magnitude of renal nerve discharge after transection was not different from that during blockade of the RVLM. On the other hand, mesenteric nerve activity increased following spinal cord transection, returning to control levels. 4. Power spectral analysis revealed that mesenteric and renal nerves discharged with periodicities ranging from 1 to 6 Hz. Application of glycine to the RVLM reduced the slow rhythm in firing of mesenteric and renal nerves similarly. Transection of the spinal cord resulted in further reduction in the rhythmicity in discharge of both nerves. 5. The results indicate that excitatory drive from the RVLM is crucial for the maintenance of on-going discharge of renal, but not of mesenteric nerves. However, such inputs are apparently essential to maintain the slow rhythm in firing of both nerves. PMID:2778740

  17. Acute limb ischemia due to ergotism.

    PubMed

    Naz, Iram; Sophie, Ziad

    2006-08-01

    Acute ischemia of an extremity potentially threatens limb loss and occasionally the life of the patient. We are reporting two cases of extremity ischemia secondary to ergot poisoning. The first patient was a 60 years old woman, who presented with a 15 days history of ischemia of the left arm with gangrene of the fingers and pain in the resting right hand for one day. Right brachial artery catheterization showed severe spasm of the artery which was resolved by passage of the inflated balloon catheter. She underwent amputation for gangrene of the left hand. The second patient presented with bilateral symmetrical ischemia of the lower extremities which improved upon withdrawal of the ergot containing medicine. She responded to nifedipine.

  18. Mitochondrial Targeted Antioxidant in Cerebral Ischemia.

    PubMed

    Ahmed, Ejaz; Donovan, Tucker; Yujiao, Lu; Zhang, Quanguang

    There has been much evidence suggesting that reactive oxygen species (ROS) generated in mitochondria during cerebral ischemia play a major role in programming the senescence of organism. Antioxidants dealing with mitochondria slow down the appearance and progression of symptoms in cerebral ischemia and increase the life span of organisms. The mechanisms of mitochondrial targeted antioxidants, such as SKQ1, Coenzyme Q10, MitoQ, and Methylene blue, include increasing adenosine triphosphate (ATP) production, decreasing production of ROS and increasing antioxidant defenses, providing benefits in neuroprotection following cerebral ischemia. A number of studies have shown the neuroprotective role of these mitochondrial targeted antioxidants in cerebral ischemia. Here in this short review we have compiled the literature supporting consequences of mitochondrial dysfunction, and the protective role of mitochondrial targeted antioxidants.

  19. Effects of spaceflight and ground recovery on mesenteric artery and vein constrictor properties in mice

    PubMed Central

    Behnke, Bradley J.; Stabley, John N.; McCullough, Danielle J.; Davis, Robert T.; Dominguez, James M.; Muller-Delp, Judy M.; Delp, Michael D.

    2013-01-01

    Following exposure to microgravity, there is a reduced ability of astronauts to augment peripheral vascular resistance, often resulting in orthostatic hypotension. The purpose of this study was to test the hypothesis that mesenteric arteries and veins will exhibit diminished vasoconstrictor responses after spaceflight. Mesenteric arteries and veins from female mice flown on the Space Transportation System (STS)-131 (n=11), STS-133 (n=6), and STS-135 (n=3) shuttle missions and respective ground-based control mice (n=30) were isolated for in vitro experimentation. Vasoconstrictor responses were evoked in arteries via norepinephrine (NE), potassium chloride (KCl), and caffeine, and in veins through NE across a range of intraluminal pressures (2–12 cmH2O). Vasoconstriction to NE was also determined in mesenteric arteries at 1, 5, and 7 d postlanding. In arteries, maximal constriction to NE, KCl, and caffeine were reduced immediately following spaceflight and 1 d postflight. Spaceflight also reduced arterial ryanodine receptor-3 mRNA levels. In mesenteric veins, there was diminished constriction to NE after flight. The results indicate that the impaired vasoconstriction following spaceflight occurs through the ryanodine receptor-mediated intracellular Ca2+ release mechanism. Such vascular changes in astronauts could compromise the maintenance of arterial pressure during orthostatic stress.—Behnke, B. J., Stabley, J. N., McCullough, D. J., Davis, R. T., III, Dominguez, J. M., II, Muller-Delp, J. M., Delp, M. D. Effects of spaceflight and ground recovery on mesenteric artery and vein constrictor properties in mice. PMID:23099650

  20. Perivascular Adipose Tissue's Impact on Norepinephrine-Induced Contraction of Mesenteric Resistance Arteries

    PubMed Central

    Ayala-Lopez, Nadia; Thompson, Janice M.; Watts, Stephanie W.

    2017-01-01

    Background: Perivascular adipose tissue (PVAT) can decrease vascular contraction to NE. We tested the hypothesis that metabolism and/or uptake of vasoactive amines by mesenteric PVAT (MPVAT) could affect NE-induced contraction of the mesenteric resistance arteries. Methods: Mesenteric resistance vessels (MRV) and MPVAT from male Sprague-Dawley rats were used. RT-PCR and Western blots were performed to detect amine metabolizing enzymes. The Amplex® Red Assay was used to quantify oxidase activity by detecting the oxidase reaction product H2O2 and the contribution of PVAT on the mesenteric arteries' contraction to NE was measured by myography. Results: Semicarbazide sensitive amine oxidase (SSAO) and monoamine oxidase A (MAO-A) were detected in MRV and MPVAT by Western blot. Addition of the amine oxidase substrates tyramine or benzylamine (1 mM) resulted in higher amine oxidase activity in the MRV, MPVAT, MPVAT's adipocyte fraction (AF), and the stromal vascular fraction (SVF). Inhibiting SSAO with semicarbazide (1 mM) decreased amine oxidase activity in the MPVAT and AF. Benzylamine-driven, but not tyramine-driven, oxidase activity in the MRV was reduced by semicarbazide. By contrast, no reduction in oxidase activity in all sample types was observed with use of the monoamine oxidase inhibitors clorgyline (1 μM) or pargyline (1 μM). Inhibition of MAO-A/B or SSAO individually did not alter contraction to NE. However, inhibition of both MAO and SSAO increased the potency of NE at mesenteric arteries with PVAT. Addition of MAO and SSAO inhibitors along with the H2O2 scavenger catalase reduced PVAT's anti-contractile effect to NE. Inhibition of the norepinephrine transporter (NET) with nisoxetine also reduced PVAT's anti-contractile effect to NE. Conclusions: PVAT's uptake and metabolism of NE may contribute to the anti-contractile effect of PVAT. MPVAT and adipocytes within MPVAT are a source of SSAO. PMID:28228728

  1. Mesenteric lymph duct drainage attenuates acute lung injury in rats with severe intraperitoneal infection.

    PubMed

    Zhang, Yanmin; Zhang, Shukun; Tsui, Naiqiang

    2015-01-01

    The purpose of this study is to investigate the hypothesis that the mesenteric lymphatic system plays an important role in acute lung injury in a rat model induced by severe intraperitoneal infection. Male Wistar rats weighing 250∼300 g were randomly divided into 3 groups and subjected to sham operation, intraperitoneal infection, or mesenteric lymphatic drainage. The activity of diamine oxidase (DAO) and myeloperoxidase (MPO) were measured by enzymatic assay. The endotoxin levels in plasma, lymph, and bronchoalveolar lavage fluid (BALF) were evaluated using the limulus amoebocyte lysate reagent. The cytokines, adhesion factors, chemokines, and inflammatory factors were detected by ELISA. TLR-4, NF-kB, and IRAK-4 were analyzed by Western blotting. Compared with sham-operated rats, rats with intraperitoneal infection had increased MPO and decreased DAO activity in intestinal tissues. Mesenteric lymph drainage reduced the alterations in MPO and DAO activity induced by intraperitoneal infection. The MPO activity in pulmonary tissue and the permeability of pulmonary blood vessels were also increased, which were partially reversed by mesenteric lymph drainage. The endotoxin levels in lymphatic fluid and alveolar perfusion fluid were elevated after intraperitoneal infection but decreased to control levels after lymph drainage. No alterations in the levels of plasma endotoxin were observed. The number of neutrophils was increased in BALF and lymph in the infected rats, and was also reduced after drainage. Lymph drainage also decreased the levels of inflammatory cytokines, chemokines, and adhesion factors in the plasma, lymph, and BALF, as well as the levels of TLR-4, NF-kB, and IRAK-4 in pulmonary and intestinal tissues. The mesenteric lymphatic system is the main pathway involved in early lung injury caused by severe intraperitoneal infection, in which activation of the TLR-4 signal pathway may play a role.

  2. Binding and functional pharmacological characteristics of gepant-type antagonists in rat brain and mesenteric arteries.

    PubMed

    Sheykhzade, Majid; Amandi, Nilofar; Pla, Monica Vidal; Abdolalizadeh, Bahareh; Sams, Anette; Warfvinge, Karin; Edvinsson, Lars; Pickering, Darryl S

    2017-03-01

    The neuropeptide calcitonin gene-related peptide (CGRP) is found in afferent sensory nerve fibers innervating the resistance arteries and plays a pivotal role in a number of neurovascular diseases such as migraine and subarachnoid bleedings. The present study investigates the binding and antagonistic characteristics of small non-peptide CGRP receptor antagonists (i.e. gepants) in isolated rat brain and mesenteric resistance arteries. The antagonistic behavior of gepants was investigated in isolated rat mesenteric arteries using a wire myograph setup while binding of gepants to CGRP receptors was investigated in rat brain membranes using a radioligand competitive binding assay. Furthermore, the histological location of the key components of CGRP receptor (RAMP1 and CLR) was assessed by immunohistochemistry. Our functional studies clearly show that all gepants are reversible competitive antagonists producing Schild plot slopes not significantly different from unity and thus suggesting presence of a uniform CGRP receptor population in the arteries. A uniform receptor population was also confirmed by radioligand competitive binding studies showing similar affinities for the gepants in rat brain and mesenteric arteries, the exception being rimegepant which had 50-fold lower affinity in brain than mesenteric arteries. CLR and RAMP1 were shown to be located in both vascular smooth muscle and endothelial cells of rat mesenteric arteries by immunohistochemistry. The present results indicate that, despite species differences in the CGRP receptor affinity, the antagonistic nature of these gepants, the distribution pattern of CGRP receptor components and the mechanism behind CGRP-induced vasodilation seem to be similar in resistance-sized arteries of human and rats. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. The role of CT in predicting the need for surgery in patients diagnosed with mesenteric phlebosclerosis

    PubMed Central

    Lin, Wei-Ching; Chen, Jeon-Hor; Westphalen, Antonio Carlos; Liao, Chun-Han; Chen, Cheng-Hong; Chen, Chun-Ming; Lin, Chien-Heng

    2016-01-01

    Abstract To determine if imaging findings on computed tomography (CT) can predict the need of surgery in patients with idiopathic mesenteric phlebosclerosis (IMP). This retrospective study included 28 patients with IMP. Abdominal CT images were reviewed to determine the extent and severity of mesenteric calcifications and the presence of findings related to colitides. We compared the number of colonic segments with mesenteric venous calcification, a total calcification score, and the rate of colonic wall thickening, pericolic fat stranding, and bowel loop dilatation between patients undergoing surgery (surgery group) and patients without surgery (nonsurgery group). Comparisons were made using the Mann–Whitney U test and Fisher exact test. Receiver operating characteristic analysis was also performed. Inter-reader agreement for the calcification scores was analyzed using kappa statistics. The number of colonic segments with mesenteric venous calcification and the total calcification scores were both significantly higher in the surgery group than the nonsurgery group (4.33 vs 2.96, P = 0.003; and 15.00 vs 8.96, P <0.001). The areas under the receiver operating characteristics to identify patients who need surgery were 0.96 and 0.92, respectively. The prevalence of bowel loop dilatation in the surgery group was also significantly higher than that in the nonsurgery group (16% vs 100%, P = 0.011). Evaluation of the severity and extent of IMP based on the total mesenteric venous calcification score, number of involved colonic segments, and the presence bowel loop dilatation on CT may be useful to indicate the outcomes of conservative treatment and need for surgery. PMID:27741142

  4. Copper induces vasorelaxation and antagonizes noradrenaline-induced vasoconstriction in rat mesenteric artery.

    PubMed

    Wang, Yu-Chun; Hu, Chao-Wei; Liu, Ming-Yu; Jiang, Hong-Chao; Huo, Rong; Dong, De-Li

    2013-01-01

    Copper is an essential trace element for normal cellular function and contributes to critical physiological or pathological processes. The aim of the study was to investigate the effects of copper on vascular tone of rat mesenteric artery and compare the effects of copper on noradrenaline (NA) and high K(+) induced vasoconstriction. The rat mesenteric arteries were isolated and the vessel tone was measured by using multi wire myograph system in vitro. Blood pressure of carotid artery in rabbits was measured by using physiological data acquisition and analysis system in vivo. Copper dose-dependently blunted NA-induced vasoconstriction of rat mesenteric artery. Copper-induced vasorelaxation was inhibited when the vessels were pretreated with NG-nitro-L-arginine methyl ester (L-NAME). Copper did not blunt high K(+)-induced vasoconstriction. Copper preincubation inhibited NA-evoked vasoconstriction and the inhibition was not affected by the presence of L-NAME. Copper preincubation showed no effect on high K(+)-evoked vasoconstriction. Copper chelator diethyldithiocarbamate trihydrate (DTC) antagonized the vasoactivity induced by copper in rat mesenteric artery. In vivo experiments showed that copper injection (iv) significantly decreased blood pressure of rabbits and NA or DTC injection (iv) did not rescue the copper-induced hypotension and animal death. Copper blunted NA but not high K(+)-induced vasoconstriction of rat mesenteric artery. The acute effect of copper on NA-induced vasoconstriction was depended on nitric oxide (NO), but the effect of copper pretreatment on NA-induced vasoconstriction was independed on NO, suggesting that copper affected NA-induced vasoconstriction by two distinct mechanisms. © 2013 S. Karger AG, Basel.

  5. Cumulative Effect of Repeated Brief Cerebral Ischemia

    DTIC Science & Technology

    1993-05-31

    KL, Pohost GM and Conger KA, Correlating EEG and Lactate Kinetics During Repeated Brief Cerebral Ischemia, Proceedings of the American Heart Association 1993...Cornelating EEG and Lactate Kinetics During Repeated Brief Cerebral Ischemia, Proceedings of the American Heart Association 1993. 4) HP Hetherington...thes Bernhard Foundation. ass- 134 󈧑&.1 n5. 9# American Heart Association 026085 66th Scientific Sessions Abstract Form Medical Research Nursing

  6. 5-hydroxytryptamine (5-HT) reduces total peripheral resistance during chronic infusion: direct arterial mesenteric relaxation is not involved

    PubMed Central

    2012-01-01

    Serotonin (5-hydroxytryptamine; 5-HT) delivered over 1 week results in a sustained fall in blood pressure in the sham and deoxycorticosterone acetate (DOCA)-salt rat. We hypothesized 5-HT lowers blood pressure through direct receptor-mediated vascular relaxation. In vivo, 5-HT reduced mean arterial pressure (MAP), increased heart rate, stroke volume, cardiac index, and reduced total peripheral resistance during a 1 week infusion of 5-HT (25 µg/kg/min) in the normotensive Sprague Dawley rat. The mesenteric vasculature was chosen as an ideal candidate for the site of 5-HT receptor mediated vascular relaxation given the high percentage of cardiac output the site receives. Real-time RT-PCR demonstrated that mRNA transcripts for the 5-HT2B, 5-HT1B, and 5-HT7 receptors are present in sham and DOCA-salt superior mesenteric arteries. Immunohistochemistry and Western blot validated the presence of the 5-HT2B, 5- HT1B and 5-HT7 receptor protein in sham and DOCA-salt superior mesenteric artery. Isometric contractile force was measured in endothelium-intact superior mesenteric artery and mesenteric resistance arteries in which the contractile 5- HT2A receptor was antagonized. Maximum concentrations of BW-723C86 (5- HT2B agonist), CP 93129 (5-HT1B agonist) or LP-44 (5-HT7 agonist) did not relax the superior mesenteric artery from DOCA-salt rats vs. vehicle. Additionally, 5-HT (10–9 M to 10–5 M) did not cause relaxation in either contracted mesenteric resistance arteries or superior mesenteric arteries from normotensive Sprague- Dawley rats. Thus, although 5-HT receptors known to mediate vascular relaxation are present in the superior mesenteric artery, they are not functional, and are therefore not likely involved in a 5-HT-induced fall in total peripheral resistance and MAP. PMID:22559843

  7. 5-hydroxytryptamine (5-HT) reduces total peripheral resistance during chronic infusion: direct arterial mesenteric relaxation is not involved.

    PubMed

    Davis, Robert Patrick; Pattison, Jill; Thompson, Janice M; Tiniakov, Ruslan; Scrogin, Karie E; Watts, Stephanie W

    2012-05-06

    Serotonin (5-hydroxytryptamine; 5-HT) delivered over 1 week results in a sustained fall in blood pressure in the sham and deoxycorticosterone acetate (DOCA)-salt rat. We hypothesized 5-HT lowers blood pressure through direct receptor-mediated vascular relaxation. In vivo, 5-HT reduced mean arterial pressure (MAP), increased heart rate, stroke volume, cardiac index, and reduced total peripheral resistance during a 1 week infusion of 5-HT (25 µg/kg/min) in the normotensive Sprague Dawley rat. The mesenteric vasculature was chosen as an ideal candidate for the site of 5-HT receptor mediated vascular relaxation given the high percentage of cardiac output the site receives. Real-time RT-PCR demonstrated that mRNA transcripts for the 5-HT2B, 5-HT1B, and 5-HT7 receptors are present in sham and DOCA-salt superior mesenteric arteries. Immunohistochemistry and Western blot validated the presence of the 5-HT2B, 5- HT1B and 5-HT7 receptor protein in sham and DOCA-salt superior mesenteric artery. Isometric contractile force was measured in endothelium-intact superior mesenteric artery and mesenteric resistance arteries in which the contractile 5- HT2A receptor was antagonized. Maximum concentrations of BW-723C86 (5- HT2B agonist), CP 93129 (5-HT1B agonist) or LP-44 (5-HT7 agonist) did not relax the superior mesenteric artery from DOCA-salt rats vs. vehicle. Additionally, 5-HT (10-9 M to 10-5 M) did not cause relaxation in either contracted mesenteric resistance arteries or superior mesenteric arteries from normotensive Sprague- Dawley rats. Thus, although 5-HT receptors known to mediate vascular relaxation are present in the superior mesenteric artery, they are not functional, and are therefore not likely involved in a 5-HT-induced fall in total peripheral resistance and MAP.

  8. Adipose tissue quantity and composition contribute to adipokine concentrations in the subclavian vein and the inferior mesenteric vein.

    PubMed

    Faber, D R; Moll, F L; Vink, A; van der Waal, C; Kalkhoven, E; Schipper, H S; Hajer, G R; Monajemi, H; Visseren, F L J

    2012-08-01

    Adipose tissue dysfunction is associated with inflammation, type 2 diabetes mellitus and vascular diseases. Visceral adipose tissue (VAT)-derived adipokines, which are released in the portal circulation may influence liver metabolism. (1) To estimate the contribution of VAT and subcutaneous adipose tissue (SAT) on adipokine levels by measuring differences in adipokine concentrations between the portal draining inferior mesenteric vein and the subclavian vein. (2) To determine the relation of both VAT and SAT quantity and composition to mesenteric and systemic concentrations of adipokines. Cross-sectional cohort study. A total of 32 patients undergoing abdominal aortic surgery. A panel of 18 adipokines was measured in perioperatively obtained blood samples from the subclavian vein and the inferior mesenteric vein. Adipocyte size, macrophage infiltration and capillary density were measured in subcutaneous and mesenteric adipose tissue biopsies; SAT and VAT areas were measured on computed tomography images. Serum interferon-γ-inducible protein 10 (IP-10) and hepatocyte growth factor (HGF) concentrations were significantly higher in the inferior mesenteric vein vs the subclavian vein. SAT area (β -18; 95% confidence interval (CI) -35 to -2), subcutaneous adipocyte size (β -488; 95% CI -938 to -38) and SAT macrophages quantity (β -1439; 95% CI -2387 to -491) were negatively associated with adiponectin levels in the systemic circulation. SAT area was related to systemic concentrations of leptin. Mesenteric adiponectin concentrations were related to VAT area (β -20; 95% CI -35 to -5) and visceral adipocyte size (β -1076; 95% CI -1624 to -527). VAT area, adipocyte size and capillary density were related to systemic adiponectin concentrations. SAT and VAT quantities as well as morphologic characteristics of both adipose tissue depots are related to systemic and mesenteric adipokine concentrations. There were no differences in adipokine concentrations between the

  9. Mesenteric near-infrared spectroscopy and risk of gastrointestinal complications in infants undergoing surgery for congenital heart disease.

    PubMed

    Iliopoulos, Ilias; Branco, Ricardo G; Brinkhuis, Nadine; Furck, Anke; LaRovere, Joan; Cooper, David S; Pathan, Nazima

    2016-04-01

    We hypothesised that lower mesenteric near-infrared spectroscopy values would be associated with a greater incidence of gastrointestinal complications in children weighing <10 kg who were recovering from cardiac surgery. We evaluated mesenteric near-infrared spectroscopy, central venous oxygen saturation, and arterial blood gases for 48 hours post-operatively. Enteral feeding intake, gastrointestinal complications, and markers of organ dysfunction were monitored for 7 days. A total of 50 children, with median age of 16.7 (3.2-31.6) weeks, were studied. On admission, the average mesenteric near-infrared spectroscopy value was 71±18%, and the systemic oxygen saturation was 93±7.5%. Lower admission mesenteric near-infrared spectroscopy correlated with longer time to establish enteral feeds (r=-0.58, p<0.01) and shorter duration of feeds at 7 days (r=0.48, p<0.01). Children with gastrointestinal complications had significantly lower admission mesenteric near-infrared spectroscopy (58±18% versus 73±17%, p=0.01) and higher mesenteric arteriovenous difference of oxygen at admission [39 (23-47) % versus 19 (4-27) %, p=0.02]. Based on multiple logistic regression, admission mesenteric near-infrared spectroscopy was independently associated with gastrointestinal complications (Odds ratio, 0.95; 95% confidence interval, 0.93-0.97; p=0.03). Admission mesenteric near-infrared spectroscopy showed an area under the receiver operating characteristic curve of 0.76 to identify children who developed gastrointestinal complications, with a suggested cut-off value of 72% (78% sensitivity, 68% specificity). In this pilot study, we conclude that admission mesenteric near-infrared spectroscopy is associated with gastrointestinal complications and enteral feeding tolerance in children after cardiac surgery.

  10. Ultrasound assessment of mesenteric blood flow in neonates with hypoplastic left heart before and after hybrid palliation.

    PubMed

    Cozzi, Corin T; Galantowicz, Mark; Cheatham, John P; Nicholson, Lisa; Fernandez, Richard; Backes, Carl H; McCaw, Carrie; Cua, Clifford L

    2015-08-01

    Altered mesenteric perfusion may be a contributor to the development of necrotising enterocolitis in patients with hypoplastic left heart syndrome. The goal of this study was to document mesenteric flow patterns in patients with hypoplastic left heart syndrome pre- and post-hybrid procedure. A prospective study on all patients with hypoplatic left heart syndrome undergoing the hybrid procedure was conducted. Doppler ultrasound analysis of the coeliac and superior mesenteric artery was performed. A total of 13 patients were evaluated. There was a significant difference in the coeliac artery effective velocity-time intergral pre- and post-hybrid procedure (8.69±3.84 versus 12.51±4.95 cm, respectively). There were significant differences in the superior mesenteric artery antegrade velocity-time integral pre- and post-hybrid procedure (6.86±2.45 versus 10.52±2.64 cm, respectively) and superior mesenteric artery effective velocity-time integral pre- and post-hybrid procedure (6.22±2.68 versus 9.73±2.73 cm, respectively). There were no significant differences between the coeliac and superior mesenteric artery Doppler indices in the pre-hybrid procedure; there were, however, significant differences in the post-hybrid procedure between coeliac and superior mesenteric artery antegrade velocity-time integral (13.8 2±5.60 versus 10.52±2.64 cm, respectively) and effective velocity-time integral (13.04±4.71 versus 9.73±2.73 cm, respectively). Doppler mesenteric indices of perfusion improve in patients with hypoplastic left heart syndrome after the hybrid procedure; however, there appears to be preferential flow to the coeliac artery versus the superior mesenteric artery in these patients post-procedure.

  11. Prophylactic Ozone Administration Reduces Intestinal Mucosa Injury Induced by Intestinal Ischemia-Reperfusion in the Rat

    PubMed Central

    Onal, Ozkan; Yetisir, Fahri; Sarer, A. Ebru Salman; Zeybek, N. Dilara; Onal, C. Oztug; Yurekli, Banu; Celik, H. Tugrul; Sirma, Ayse; Kılıc, Mehmet

    2015-01-01

    Objectives. Intestinal ischemia-reperfusion injury is associated with mucosal damage and has a high rate of mortality. Various beneficial effects of ozone have been shown. The aim of the present study was to show the effects of ozone in ischemia reperfusion model in intestine. Material and Method. Twenty eight Wistar rats were randomized into four groups with seven rats in each group. Control group was administered serum physiologic (SF) intraperitoneally (ip) for five days. Ozone group was administered 1 mg/kg ozone ip for five days. Ischemia Reperfusion (IR) group underwent superior mesenteric artery occlusion for one hour and then reperfusion for two hours. Ozone + IR group was administered 1 mg/kg ozone ip for five days and at sixth day IR model was applied. Rats were anesthetized with ketamine∖xyzlazine and their intracardiac blood was drawn completely and they were sacrificed. Intestinal tissue samples were examined under light microscope. Levels of superoxide dismutase (SOD), catalase (CAT), glutathioneperoxidase (GSH-Px), malondyaldehide (MDA), and protein carbonyl (PCO) were analyzed in tissue samples. Total oxidant status (TOS), and total antioxidant capacity (TAC) were analyzed in blood samples. Data were evaluated statistically by Kruskal Wallis test. Results. In the ozone administered group, degree of intestinal injury was not different from the control group. IR caused an increase in intestinal injury score. The intestinal epithelium maintained its integrity and decrease in intestinal injury score was detected in Ozone + IR group. SOD, GSH-Px, and CAT values were high in ozone group and low in IR. TOS parameter was highest in the IR group and the TAC parameter was highest in the ozone group and lowest in the IR group. Conclusion. In the present study, IR model caused an increase in intestinal injury.In the present study, ozone administration had an effect improving IR associated tissue injury. In the present study, ozone therapy prevented

  12. Ischemia modified albumin: does it change during pneumoperitoneum in robotic prostatectomies?

    PubMed Central

    Ozgen, Serpil Ustalar; Ozveren, Bora; Kilercik, Meltem; Aksu, Ugur; Ay, Binnaz; Tufek, Ilter; Kural, Ali Riza; N.Turkeri, Levent; Toraman, Fevzi

    2016-01-01

    . Conclusion We did not demonstrate any significant mesenteric-splanchnic ischemia which could be detected by serum IMA levels during robotic radical prostatectomies performed under steep Trendelenburg position and when IAP is maintained in between 11-14 mmHg PMID:27136469

  13. The ubiquitin proteasome system and myocardial ischemia

    PubMed Central

    Calise, Justine

    2013-01-01

    The ubiquitin proteasome system (UPS) has been the subject of intensive research over the past 20 years to define its role in normal physiology and in pathophysiology. Many of these studies have focused in on the cardiovascular system and have determined that the UPS becomes dysfunctional in several pathologies such as familial and idiopathic cardiomyopathies, atherosclerosis, and myocardial ischemia. This review presents a synopsis of the literature as it relates to the role of the UPS in myocardial ischemia. Studies have shown that the UPS is dysfunctional during myocardial ischemia, and recent studies have shed some light on possible mechanisms. Other studies have defined a role for the UPS in ischemic preconditioning which is best associated with myocardial ischemia and is thus presented here. Very recent studies have started to define roles for specific proteasome subunits and components of the ubiquitination machinery in various aspects of myocardial ischemia. Lastly, despite the evidence linking myocardial ischemia and proteasome dysfunction, there are continuing suggestions that proteasome inhibitors may be useful to mitigate ischemic injury. This review presents the rationale behind this and discusses both supportive and nonsupportive studies and presents possible future directions that may help in clarifying this controversy. PMID:23220331

  14. Superior Mesenteric Artery Stent-graft Placement in a Patient with Pseudoaneurysm Developing from a Pancreatic Pseudocyst

    SciTech Connect

    Ogino, H.; Banno, T.; Sato, Y.; Hara, M.; Shibamoto, Y.

    2004-01-15

    Pseudoaneurysm is a relatively rare but serious complication of pancreatitis which is often fatal. We report successful stent-graft placement in the superior mesenteric artery in a 45-year-old man with a pancreatic pseudocyst that grew during therapy for chronic pancreatitis and developed into a pseudoaneurysm. After a stent graft was inserted in the superior mesenteric artery, the pseudoaneurysm disappeared and no further complications developed. Stent-graft placement was considered to be a useful therapy for pseudoaneurysms in the superior mesenteric arterial region.

  15. Digital Ischemia Associated With Cancer

    PubMed Central

    Le Besnerais, Maëlle; Miranda, Sébastien; Cailleux, Nicole; Girszyn, Nicolas; Marie, Isabelle; Lévesque, Hervé; Benhamou, Ygal

    2014-01-01

    Abstract Digital ischemia associated with cancer (DIAC) is increasing in frequency and recent reports have suggested the concept of paraneoplastic manifestation. The aims of this study were to characterize the clinical presentation of DIAC and identify clinical features that could lead physicians to diagnose underlying cancer. From January 2004 to December 2011, 100 patients were hospitalized in the Department of Internal Medicine at Rouen University Hospital, France for a first episode of DI. Fifteen (15%) exhibited symptomatic or asymptomatic cancer during the year preceding or following vascular episode and constituted the DIAC group. Other patients without cancer made up the digital ischemia (DI) group. Median time between diagnosis of cancer and episode of digital necrosis was 2 months [0.25–9]. Diagnosis of DI and concomitant cancer was made in 7 of the 15 patients, while DI preceded the malignant disorder in 2 cases and followed it in 6 cases. Histological types were adenocarcinoma for 7 (46.7%), squamous cell carcinoma for 4 (26.7%), and lymphoid neoplasia for 3 patients (20%). Six patients (40%) had extensive cancer. Three patients were lost to follow-up and 5 patients died <1 year after diagnosis of cancer. Cancer treatment improved vascular symptoms in 6 patients (40%). Patients with DIAC, compared to patients with DI, were significantly older (56 years [33–79] vs 46 [17–83] P =0.005), and had significantly lower hemoglobin and hematocrit levels (12.7 g/dl vs 13.9 g/dl; P =0.003 and 38% vs 42%; P =0.003, respectively). Patients with DIAC had a higher platelet rate (420 vs 300 G/L P =0.01), and 6 patients with DIAC (40%) had thrombocytosis. There was no difference between groups either in C-reactive protein level (12 mg/L vs 5 mg/L; P =0.08) or regarding cardiovascular risk factors, presence of autoimmunity, or monoclonal protein. This retrospective study suggests that DIAC may be more prevalent than previously reported. Outcomes

  16. The GPR55 agonist lysophosphatidylinositol relaxes rat mesenteric resistance artery and induces Ca2+ release in rat mesenteric artery endothelial cells

    PubMed Central

    AlSuleimani, Y M; Hiley, C R

    2015-01-01

    Background and Purpose Lysophosphatidylinositol (LPI), a lipid signalling molecule, activates GPR55 and elevates intracellular Ca2+. Here, we examine the actions of LPI in the rat resistance mesenteric artery and Ca2+ responses in endothelial cells isolated from the artery. Experimental Approach Vascular responses were studied using wire myographs. Single-cell fluorescence imaging was performed using a MetaFluor system. Hypotensive effects of LPI were assessed using a Biopac system. Key Results In isolated arteries, LPI-induced vasorelaxation was concentration- and endothelium-dependent and inhibited by CID 16020046, a GPR55 antagonist. The CB1 receptor antagonist AM 251 had no effect, whereas rimonabant and O-1918 significantly potentiated LPI responses. Vasorelaxation was reduced by charybdotoxin and iberiotoxin, alone or combined. LPI decreased systemic arterial pressure. GPR55 is expressed in rat mesenteric artery. LPI caused biphasic elevations of endothelial cell intracellular Ca2+. Pretreatment with thapsigargin or 2-aminoethoxydiphenyl borate abolished both phases. The PLC inhibitor U73122 attenuated the initial phase and enhanced the second phase, whereas the Rho-associated kinase inhibitor Y-27632 abolished the late phase but not the early phase. Conclusions and Implications LPI is an endothelium-dependent vasodilator in the rat small mesenteric artery and a hypotensive agent. The vascular response involves activation of Ca2+-sensitive K+ channels and is not mediated by CB1 receptors, but unexpectedly enhanced by antagonists of the ‘endothelial anandamide’ receptor. In endothelial cells, LPI utilizes PLC-IP3 and perhaps ROCK-RhoA pathways to elevate intracellular Ca2+. Overall, these findings support an endothelial site of action for LPI and suggest a possible role for GPR55 in vasculature. PMID:25652040

  17. Transradial Approach for Transcatheter Selective Superior Mesenteric Artery Urokinase Infusion Therapy in Patients with Acute Extensive Portal and Superior Mesenteric Vein Thrombosis

    SciTech Connect

    Wang Maoqiang Guo Liping; Lin Hanying; Liu Fengyong; Duan Feng; Wang Zhijun

    2010-02-15

    The purpose of this investigation was to assess the feasibility and effectiveness of transradial approach for transcatheter superior mesenteric artery (SMA) urokinase infusion therapy in patients with acute extensive portal and superior mesenteric venous thrombosis. During a period of 7 years, 16 patients with acute extensive thrombosis of the portal (PV) and superior mesenteric veins (SMV) were treated by transcatheter selective SMA urokinase infusion therapy by way of the radial artery. The mean age of the patients was 39.5 years. Through the radial sheath, a 5F Cobra catheter was inserted into the SMA, and continuous infusion of urokinase was performed for 5-11 days (7.1 {+-} 2.5 days). Adequate anticoagulation was given during treatment, throughout hospitalization, and after discharge. Technical success was achieved in all 16 patients. Substantial clinical improvement was seen in these 16 patients after the procedure. Minor complications at the radial puncture site were observed in 5 patients, but trans-SMA infusion therapy was not interrupted. Follow-up computed tomography scan before discharge demonstrated nearly complete disappearance of PV-SMV thrombosis in 9 patients and partial recanalization of PV-SMV thrombosis in 7 patients. The 16 patients were discharged 9-19 days (12 {+-} 6.0 days) after admission. Mean duration of follow-up after hospital discharge was 44 {+-} 18.5 months, and no recurrent episodes of PV-SMV thrombosis developed during that time period. Transradial approach for transcatheter selective SMA urokinase infusion therapy in addition to anticoagulation is a safe and effective therapy for the management of patients with acute extensive PV-SMV thrombosis.

  18. Peripheral and mesenteric serum levels of CEA and cytokeratins, staging and histopathological variables in colorectal adenocarcinoma

    PubMed Central

    Ivankovics, Ivan Gregório; Fernandes, Luis César; Saad, Sarhan Sydeney; Matos, Delcio

    2008-01-01

    AIM: To evaluate the differences that exist bet-ween peripheral and mesenteric serum levels of carcinoembryonic antigen (CEA) and cytokeratins in patients with colorectal adenocarcinoma. METHODS: One hundred and thirty-eight patients with colorectal adenocarcinoma who underwent surgery at Hospital São Paulo (Discipline of Surgical Gastroenterology of UNIFESP-EPM) between December 1993 and March 2000 were retrospectively analyzed. Differences between CEA and cytokeratin (TPA-M) levels in peripheral blood (P) and in mesenteric blood (M) were studied. Associations were investigated between peripheral and mesenteric levels and the staging and histopathological variables (degree of cell differentiation, macroscopic appearance, tumor dimensions and presence of lymphatic and venous invasion). RESULTS: Differences were observed in the numerical values of the marker levels: CEA (M) (39.10 mg/L ± 121.19 mg/L) vs CEA (P) (38.5 mg/L ± 122.55 mg/L), P < 0.05; TPA-M (M) (325.06 U/L ± 527.29 U/L) vs TPA-M (P) (279.48 U/L ± 455.81 U/L), P < 0.01. The mesenteric CEA levels were higher in more advanced tumors (P < 0.01), in vegetating lesions (34.44 mg/L ± 93.07 mg/L) (P < 0.01) and with venous invasion (48.41 mg/L ± 129.86 mg/L) (P < 0.05). Peripheral CEA was higher with more advanced staging (P < 0.01) and in lesions with venous invasion (53.23 mg/L ± 158.57 mg/L) (P < 0.05). The patients demonstrated increased mesenteric and peripheral TPA-M levels with more advanced tumors (P < 0.01 and P < 0.01) and in non-ulcerated lesions [530.45 U/L ± 997.46 U/L (P < 0.05) and 457.95 U/L ± 811.36 U/L (P < 0.01)]. CONCLUSION: The mesenteric levels of the tumor markers CEA and cytokeratins were higher than the peripheral levels in these colorectal adenocarcinoma patients. Higher levels of these biologic tumor markers are associated with an advanced state of cancerous dissemination. PMID:19034974

  19. Superior mesenteric venous injuries: to ligate or to repair remains the question.

    PubMed

    Asensio, Juan A; Petrone, Patrizio; Garcia-Nuñez, Luis; Healy, Matthew; Martin, Matthew; Kuncir, Eric

    2007-03-01

    Superior mesenteric vein injuries are rare and incur high mortality. Given their low incidence, little data exist delineating indications for when to institute primary repair versus ligation. The purposes of this study are to review our institutional experience, to determine the additive effect on mortality of associated vascular injuries, to correlate mortality with the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) for abdominal vascular injury and to examine and define the indications and outcomes for primary repair versus ligation. Retrospective 156 months study (January 1992 through December 2004) in a large Level I urban trauma center of all patients admitted with superior mesenteric vein injuries. Patients were stratified, according to surgical technique employed to deal with their injuries, into those undergoing primary repair versus ligation to determine outcomes and define the surgical indications of these methods. The main outcome measure was overall survival. Cases of survival were stratified according to surgical method: primary repair versus ligation. There were 51 patients with a mean Injury Severity Score of 25 +/- 12. Mechanism of injury was penetrating for 38 (76%), blunt for 13 (24%), and patients undergoing emergency department thoracotomy for 4 (8%). Surgical management was ligation for 30 (59%), primary repair for 16 (31%), and 5 (10%) patients were exsanguinated before repair. The overall survival rate was 24/50 (47%). The survival rate excluding patients undergoing emergency department thoracotomy was 51%. The survival rate excluding patients that sustained greater than 3 to 4 associated vessels injured was 65%. The survival rates of patients with superior mesenteric vein and superior mesenteric artery was 55% and superior mesenteric vein and portal vein (PV) was 40%. The survival rate of patients with isolated superior mesenteric vein injuries was 55%. Mortality stratified to AAST-OIS grade III, 44%; grade IV

  20. Production of anterior segment ischemia.

    PubMed Central

    Hiatt, R L

    1977-01-01

    Anterior segment ischemic changes can occur without detachment of any muscles. The most common cause of such ischemic changes of the anterior segment is the removal of too many rectus muscles in one operation. Twenty dog eyes and eight monkey eyes were subjected to the disinsertion and detachment of various combinations of extraocular muscles. The dogs were sacrificed at intervals from 30 to 90 days. During the observation period, they were observed for gross and slit-lamp changes. The enucleated eyes were studied microscopically for signs of ischemic and necrotic changes. Two patients who were studied, observed, and treated for anterior segment ischemia following muscle surgery are described. The changes which occur after extraocular muscle surgery are extensive and include corneal edema, cataract, chemosis, corneal changes, decreases in intraocular pressure, decreases in outflow or glaucoma, and frank necrosis. The variables which lead to this reaction are described in detail. Also, some unanswered queries, such as the duration of the reaction and the time interval of the reaction after multiple muscle operations are discussed. Images FIGURE 1 A FIGURE 1 B FIGURE 1 C FIGURE 2 A FIGURE 2 B FIGURE 2 C FIGURE 2 D FIGURE 3 FIGURE 4 PMID:418549

  1. [Critical limb ischemia--update].

    PubMed

    Melamed, Eitan; Kotyba, Baydousi; Galili, Offer; Karmeli, Ron

    2010-12-01

    Critical limb ischemia (CLI) is the most severe manifestation of peripheral artery occlusive disease. Without timely diagnosis and revascularization, patients with CLI are at risk of devastating complications including loss of limb and life. Therapeutic goals in treating patients with CLI include reducing cardiovascular risk factors, relieving ischemic pain, heating ulcers, preventing major amputation, improving quality of life and increasing survival. These aims may be achieved through medical therapy, revascularization or amputation. The past decade has seen substantial growth in endovascular therapies and options now exist for treating long segment occlusive disease, but surgical bypass may still yield more durable results. Patients who are younger, more active, and at low risk for surgery, may have better outcomes undergoing an operation. This is also indicated for endovascular failures, which may include technical failures or late occlusions after stents or other procedures. In contrast, frail patients with a limited life expectancy may experience better outcomes with endovascular therapy. For patients who are non-ambulatory, demented, or unfit to undergo revascularization, an amputation should be considered.

  2. Epigenetic mechanisms in cerebral ischemia

    PubMed Central

    Schweizer, Sophie; Meisel, Andreas; Märschenz, Stefanie

    2013-01-01

    Treatment efficacy for ischemic stroke represents a major challenge. Despite fundamental advances in the understanding of stroke etiology, therapeutic options to improve functional recovery remain limited. However, growing knowledge in the field of epigenetics has dramatically changed our understanding of gene regulation in the last few decades. According to the knowledge gained from animal models, the manipulation of epigenetic players emerges as a highly promising possibility to target diverse neurologic pathologies, including ischemia. By altering transcriptional regulation, epigenetic modifiers can exert influence on all known pathways involved in the complex course of ischemic disease development. Beneficial transcriptional effects range from attenuation of cell death, suppression of inflammatory processes, and enhanced blood flow, to the stimulation of repair mechanisms and increased plasticity. Most striking are the results obtained from pharmacological inhibition of histone deacetylation in animal models of stroke. Multiple studies suggest high remedial qualities even upon late administration of histone deacetylase inhibitors (HDACi). In this review, the role of epigenetic mechanisms, including histone modifications as well as DNA methylation, is discussed in the context of known ischemic pathways of damage, protection, and regeneration. PMID:23756691

  3. Echocardiographic assessment of myocardial ischemia

    PubMed Central

    Dworrak, Birgit; Sanchis-Gomar, Fabian; Lucia, Alejandro; Buck, Thomas; Erbel, Raimund

    2016-01-01

    Over the last 60 years, echocardiography has emerged as a dominant and indispensable technique for the detection and assessment of coronary heart disease (CHD). In this review, we will describe and discuss this powerful tool of cardiology, especially in the hands of an experienced user, with a focus on myocardial ischemia. Technical development is still on-going, and various new ultrasound techniques have been established in the field of echocardiography in the last several years, including tissue Doppler imaging (TDI), contrast echocardiography, three-dimensional echocardiography (3DE), and speckle tracking echocardiography (i.e., strain/strain rate-echocardiography). High-end equipment with harmonic imaging, high frame rates and the opportunity to adjust mechanical indices has improved imaging quality. Like all new techniques, these techniques must first be subjected to comprehensive scientific assessment, and appropriate training that accounts for physical and physiological limits should be provided. These limits will constantly be redefined as echocardiographic techniques continue to change, which will present new challenges for the further development of ultrasound technology. PMID:27500160

  4. Ileum preserving expanded jejunectomy and pancreaticoduodenectomy with combined resection of the superior mesenteric artery for huge retroperitoneal solitary fibrous tumor.

    PubMed

    Egashira, Akinori; Ikeda, Yasuharu; Morita, Masaru; Taguchi, Ken-Ichi; Kinjyo, Nao; Tsujita, Eiji; Minami, Kazuhito; Yamamoto, Manabu; Toh, Yasushi

    2017-08-01

    We encountered a patient with a large retroperitoneal solitary fibrous tumor, in whom we could preserve approximately 150 cm of the ileum even after pancreaticoduodenectomy combined with resection of the superior mesenteric artery, thus preventing short bowel syndrome.

  5. Changes of loading tensile force-stretch relationships of rabbit mesenteric vein after 21 days of head-down rest

    NASA Astrophysics Data System (ADS)

    Yao, Yong-Jie; Sun, Hui-Pin; Yue, Yong; Sun, Xi-Qing; Wu, Xing-Yu

    Changes of venous compliance may contribute to postflight orthostatic intolerance; however, direct animal studies to address the changes of venous compliance to microgravity have been rare. The purpose of this study was to determine compliance changes of mesenteric veins of rabbits after 21 days of head-down rest (HDR). Twenty-four healthy male New Zealand Rabbits were randomly divided into 21 days of HDR group, horizontal immobilization group (HIG) and control group (Ctrl), with eight in each. Loading tensile force-stretch relationships of mesenteric vein segments were constructed after 21 d HDR. With the increase of loading tensile force, both longitudinal and circumferential stretches of vein samples increased significantly. Under the same loading tensile force, mesenteric vein of the HDR showed significant increase both in circumferential stretch and longitudinal stretches compared to those of Ctrl group and HIG group. These results indicate that, a 21-day simulated weightlessness leads to increase of mesenteric venous compliance.

  6. Quercetin attenuates the ischemia reperfusion induced COX-2 and MPO expression in the small intestine mucosa.

    PubMed

    Tóth, Štefan; Jonecová, Zuzana; Čurgali, Kristína; Maretta, Milan; Šoltés, Ján; Švaňa, Martin; Kalpadikis, Theodore; Caprnda, Martin; Adamek, Mariusz; Rodrigo, Luis; Kruzliak, Peter

    2017-08-28

    Quercetin, the active substance of tea, fruits and vegetables, exerts a broad spectrum of pharmacological activities and is considered to have potential therapeutic application. The present study was designed to investigate the beneficial effect of quercetin against experimental ischemia- reperfusion (IR) injury of the small intestine in rats. Quercetin was administrated intraperitoneally 30min before 1h ischemia of superior mesenteric artery with following reperfusion periods lasting 1, 4 and 24h. The male specific pathogen-free Charles River Wistar rats were used (n=45). In acute phase, 4h after start of reperfusion, the quercetin induced a significant decrease in mucosal injury index (p<0.05) accompanied by a significant decrease in cyclooxygenase-2 (COX-2) expression in the epithelial lining of the intestinal villi in comparison with the control group (p<0.01). In the epithelium of the intestinal glands, COX-2 expression resulting from IR injury significantly increased regardless quercetin application (in control group p<0.001; in quercetin group p<0.05), but in quercetin group, significant decrease in it during 24h of reperfusion in a late phase of IR injury was detected (p<0.001). Based on morphology of COX-2 positive cells, the COX-2 positivity was found particularly in goblet cells of the intestinal villi epithelium and enteroendocrine cells respectively, in the glandular epithelium. We concluded that quercetin application attenuated mucosal damage from IR injury by inhibiting neutrophil infiltration which was demonstrated by a lower number of myeloperoxidase positive cells in the lamina propria during both phases of IR injury and the significant decrease in that in a late phase after 24h of reperfusion (p<0.05). Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  7. Prognostic value of Tissue Transition Projection 3D transparent wall CT reconstructions in bowel ischemia.

    PubMed

    Moschetta, Marco; Scardapane, Arnaldo; Telegrafo, Michele; Lucarelli, Nicola Maria; Lorusso, Valentina; Angelelli, Giuseppe; Stabile Ianora, Amato Antonio

    2016-10-01

    Multi-detector computed tomography (MDCT) represents the gold standard in patients with acute abdomen syndrome and suspected bowel ischemia. It provides a correct diagnosis and contributes to appropriate treatment planning. This study aims to evaluate the role of 3D Tissue Transition Projection (TTP) transparent wall CT reconstruction for detecting the degree of bowel dilatation and to correlate this finding with the aetiology and prognosis in patients affected by mesenteric infarction. Forty-seven patients affected by bowel infarction due to vascular obstruction (arterial in 66% of cases, venous in 34%) were assessed by MDCT examination searching for the degree of bowel dilatation (subdivided into 4 groups: entire small bowel (SB); ≥50% of SB; < 50% of SB; large bowel only). Two blinded radiologists evaluated TTP 3D transparent wall and multi-planar reconstructions. Chi square test was used to correlate CT findings with the disease course and the mortality rate. Cohen's kappa statistics was used in order to assess inter-observer agreement. The overall mortality rate was 64%, with a 90% value for arterial forms and 10% in case of venous infarctions. The entire SB (n = 10) or a ≥50% SB dilatation (n = 16) correlated with poor prognosis in all cases (p < 0.05); a <50% SB dilatation (n = 16) correlated with good prognosis in 87.5% of cases (p < 0.05). A large bowel only dilatation (n = 5) did not show a significant prognostic value (p = 0.13). Almost perfect agreement between the two readers was found (k = 0.84). MDCT offers different reconstruction software for diagnosing bowel ischemia. 3D TTP transparent wall reconstructions represent a rapid and automatic tool for identifying loop dilatation, which significantly correlates with an arterial aetiology and poor prognosis. Copyright © 2016. Published by Elsevier Ltd.

  8. Tumor Necrosis Factor α-Dependent Neutrophil Priming Prevents Intestinal Ischemia/Reperfusion-Induced Bacterial Translocation.

    PubMed

    Lu, Yen-Zhen; Huang, Ching-Ying; Huang, Yi-Cheng; Lee, Tsung-Chun; Kuo, Wei-Ting; Pai, Yu-Chen; Yu, Linda Chia-Hui

    2017-06-01

    Intestinal ischemia/reperfusion (I/R) causes barrier impairment and bacterial influx. Protection against I/R injury in sterile organs by hypoxic preconditioning (HPC) had been attributed to erythropoietic and angiogenic responses. Our previous study showed attenuation of intestinal I/R injury by HPC for 21 days in a neutrophil-dependent manner. To investigate the underlying mechanisms of neutrophil priming by HPC, and explore whether adoptive transfer of primed neutrophils is sufficient to ameliorate intestinal I/R injury. Rats raised in normoxia (NM) and HPC for 3 or 7 days were subjected to sham operation or superior mesenteric artery occlusion for I/R challenge. Neutrophils isolated from rats raised in NM or HPC for 21 days were intravenously injected into naïve controls prior to I/R. Similar to the protective effect of HPC-21d, I/R-induced mucosal damage was attenuated by HPC-7d but not by HPC-3d. Naïve rats reconstituted with neutrophils of HPC-21d rats showed increase in intestinal phagocytic infiltration and myeloperoxidase activity, and barrier protection against I/R insult. Elevated free radical production, and higher bactericidal and phagocytic activity were observed in HPC neutrophils compared to NM controls. Moreover, increased serum levels of tumor necrosis factor α (TNFα) and cytokine-induced neutrophil chemoattractant-1 (CINC-1) were seen in HPC rats. Naïve neutrophils incubated with HPC serum or recombinant TNFα, but not CINC-1, exhibited heightened respiratory burst and bactericidal activity. Lastly, neutrophil priming effect was abolished by neutralization of TNFα in HPC serum. TNFα-primed neutrophils by HPC act as effectors cells for enhancing barrier integrity under gut ischemia.

  9. Mesenteric thrombus associated with pulmonary, splenic, portal, and caval thrombi in a dog that was presented for an acute abdomen

    PubMed Central

    Rudinsky, Adam Joseph; Parker, Valerie Jill; Guillaumin, Julien

    2016-01-01

    A 6-year-old Labrador retriever dog was presented for acute abdominal pain. A tentative diagnosis of mesenteric thrombosis was established antemortem. The dog was treated with supportive care and anti-coagulation but was ultimately euthanized due to disease-related complications. Necropsy examination confirmed an acute mesenteric thrombus along with widespread thromboembolic disease. Potential causes were protein-losing nephropathy, hepatopathy, and/or corticosteroid administration. PMID:27708446

  10. Mesenteric Th1 polarization and monocyte TNF-alpha production: first steps to systemic inflammation in rats with cirrhosis.

    PubMed

    Muñoz, Leticia; Albillos, Agustín; Nieto, Mónica; Reyes, Eduardo; Lledó, Lourdes; Monserrat, Jorge; Sanz, Eva; de la Hera, Antonio; Alvarez-Mon, Melchor

    2005-08-01

    A systemic inflammatory state with increased circulating tumor necrosis factor alpha (TNF-alpha) has been related to the bacterial infection susceptibility and hemodynamic derangement of patients with cirrhosis. We compared the activation status of immune cell subpopulations defined by 4-color cytometry in mesenteric and peripheral lymph nodes and blood of rats with CCl(4)-cirrhosis to define the immune response initiation site, the T-cell and monocyte contribution to pro-inflammatory cytokine production, as well as the pathogenic role of enteric bacteria in the cirrhosis immune response. Th1 cells and monocytes were expanded in the mesenteric nodes (P < .001) and blood (P < .001) of rats with cirrhosis, and activated to produce interferon gamma (P < .0001) and TNF-alpha (P < .0001), respectively. The greater numbers of recently activated CD134(+) Th cells in mesenteric nodes compared with blood, the correlation between their numbers in mesenteric nodes and blood (r = 0.66, P < .001), and the expansion of activated CD45RC(-) Th cells, which are unable to re-enter lymph nodes, in mesenteric nodes but not in blood or axillary nodes points to mesenteric nodes as the origin site of activated Th cells. Abrogation of bacterial translocation by bowel decontamination reduced the number of activated Th cells and monocytes, and normalized interferon gamma production by Th cells and TNF-alpha production by monocytes in mesenteric nodes and blood, respectively. In conclusion, in cirrhosis, enteric bacteria start off an orchestrated immune response cascade in mesenteric nodes involving Th1 polarization and monocyte activation to TNF-alpha production. Later, the recirculation of these activated effector immune cells into blood promotes systemic inflammation.

  11. Digoxin-specific antibody fragments and a calcium antagonist for reversal of digoxin-induced mesenteric vasoconstriction.

    PubMed

    Hess, T; Scholtysik, G; Salzmann, R; Riesen, W

    1983-10-01

    The effect of digoxin-specific antibody fragments on glycoside-induced mesenteric vasoconstriction were investigated. Digoxin caused a sustained contraction of strips of isolated feline mesenteric artery lasting for several hours, while in anaesthetized cats it produced a significant decrease in blood flow and increase in resistance in the mesenteric artery. In-vitro, digoxin's contractile effect was inhibited by 'prophylactic' addition of antibody to the organ bath, but the clinical use for prophylaxis is not a practical proposition. When the antibodies were added with the contraction of the arterial strip in response to digoxin already established, the tone of the preparation decreased significantly over 3 h, but the effect of the glycoside was not fully reversible. In-vivo, control animals not treated with antibodies developed arrhythmias, mesenteric blood flow fell by more than 50% and resistance increased by more than 80% relative to the initial values. These animals died of ventricular fibrillation before the end of the experiment. Animals treated with digoxin-specific antibody fragments after receiving digoxin injections showed no further decrease in mesenteric blood flow and 90 min after the last dose of digoxin, the flow was recovering and mesenteric resistance decreasing. Furthermore, all the animals that had received antibodies remained in sinus rhythm to the end of the experiment. In view of the latent period to onset of action of the antibodies, valuable time may be lost in impaired mesenteric blood flow. To bridge the gap or, indeed, as primary treatment, calcium antagonists merit consideration; in our experiments mesenteric vasoconstriction was abolished within a few minutes by application of the dihydropyridine calcium antagonist 4-(2,1,3-benzo-oxadiazol-4-yl)-2,6-dimethyl-1,4-dihydropyridine-3,5-dicarboxylic aid, diethyl ester (PY 108-068).

  12. Multi- and single-fibre mesenteric and renal sympathetic responses to chemical stimulation of intestinal receptors in cats.

    PubMed Central

    Stein, R D; Weaver, L C

    1988-01-01

    1. In cats anaesthetized with alpha-chloralose and artificially respired, stimulation of intestinal receptors with bradykinin caused greater reflex excitation of mesenteric than of renal efferent multifibre nerve activity and significant pressor responses. 2. Activity of all nerve bundles used in this study was inhibited by stimulation of pressoreceptors. Increases in systemic arterial pressure caused inhibition of activity of renal nerves which was significantly greater than that of mesenteric nerves. 3. Spinal transection caused significant decreases in tonic renal nerve activity without altering the ongoing discharge rate of mesenteric nerves. Stimulation of intestinal receptors in spinal cats still caused significant increases is discharge of mesenteric and renal nerves, indicating that this reflex contains a spinal component. 4. Recordings of activity of individual fibres within mesenteric (21) and renal (23) nerves provided information regarding the basis for the multifibre responses to stimulation of intestinal receptors. The same proportion of fibres from both nerves was excited, but the increase in activity of mesenteric fibres was significantly greater than that of renal fibres. 5. Mesenteric fibres could be classified into two groups, based on their sensitivity to pressoreceptor influences. Fibres that exhibited pressoreceptor-independent discharge had the greatest responses to stimulation of intestinal receptors. 6. Following spinal transection the majority of mesenteric fibres continued to fire, whereas most renal fibres became quiescent. 7. The non-uniform pattern of neuronal excitation to chemical stimulation of intestinal receptors was manifest after spinal transection, demonstrating that exclusively spinal pathways can mediate this differential response pattern. 8. These results support the hypothesis that viscero-sympathetic reflexes may be organized to cause preferential excitation of neural activity directed to the organ from which the reflex

  13. Assessment of Renal Ischemia By Optical Spectroscopy

    SciTech Connect

    Fitzgerald, J T; Demos, S; Michalopoulou, A; Pierce, J L; Troppmann, C

    2004-01-07

    Introduction: No reliable method currently exists for quantifying the degree of warm ischemia in kidney grafts prior to transplantation. We describe a method for evaluating pretransplant warm ischemia time using optical spectroscopic methods. Methods: Lewis rat kidney vascular pedicles were clamped unilaterally in vivo for 0, 5, 10, 20, 30, 60, 90 or 120 minutes; 8 animals were studied at each time point. Injured and contra-lateral control kidneys were then flushed with Euro-Collins solution, resected and placed on ice. 335 nm excitation autofluorescence as well as cross polarized light scattering images were taken of each injured and control kidney using filters of various wavelengths. The intensity ratio of the injured to normal kidneys was compared to ischemia time. Results: Autofluorescence intensity ratios through a 450 nm filter and light scattering intensity ratios through an 800 nm filter both decreased significantly with increasing ischemia time (p < 0.0001 for each method, one-way ANOVA). All adjacent and non-adjacent time points between 0 and 90 minutes were distinguishable using one of these two modalities by Fisher's PLSD. Conclusions: Optical spectroscopic methods can accurately quantify warm ischemia time in kidneys that have been subsequently hypothermically preserved. Further studies are needed to correlate results with physiological damage and posttransplant performance.

  14. Assessment of renal ischemia by optical spectroscopy.

    PubMed

    Fitzgerald, Jason T; Demos, Stavros; Michalopoulou, Andromachi; Pierce, Jonathan L; Troppmann, Christoph

    2004-11-01

    No reliable method currently exists for quantifying the degree of warm ischemia in kidney grafts before transplantation. We describe a method for evaluating pretransplant warm ischemia time using optical spectroscopic methods. Lewis rat kidney vascular pedicles were clamped unilaterally in vivo for 0, 5, 10, 20, 30, 60, 90, or 120 min; eight animals were studied at each time point. Injured and contralateral control kidneys were then flushed with Euro-Collins solution, resected, and placed on ice. 335 nm excitation autofluorescence as well as cross-polarized light scattering images were then taken of each injured and control kidney using filters of various wavelengths. The intensity ratio of the injured to normal kidneys was compared to ischemia time. Autofluorescence intensity ratios through a 450-nm filter and light scattering intensity ratios through an 800-nm filter both decreased significantly with increasing ischemia time (P < 0.0001 for each method, one-way analysis of variance). All adjacent and nonadjacent time points between 0 and 90 min were distinguishable using one of these two modalities by Fisher's protected least significant difference. Optical spectroscopic methods correlate with warm ischemia time in kidneys that have been subsequently hypothermically preserved. Further studies are needed to correlate results with physiological damage and posttransplant performance.

  15. Ischemia-induced endothelial cell dysfunction.

    PubMed

    Keep, R F; Andjelkovic, A V; Stamatovic, S M; Shakui, P; Ennis, S R

    2005-01-01

    Hemorrhagic transformation upon reperfusion therapy has focused attention on ischemia-induced endothelial dysfunction. This study examined whether hyperglycemia may induce hemorrhagic transformation by enhancing endothelial mitochondrial damage during ischemia and whether preconditioning (PC) stimuli may limit ischemia-induced endothelial damage. In vivo, rats received 2.8 M D-glucose or arabinose (1 ml/100 g; i.p.) prior to undergoing two hours of middle cerebral artery occlusion and transcardiac fixation for electron microscopy. In vitro, brain endothelial cells were exposed to a PC impulse (short-term oxygen glucose deprivation; OGD) prior to an injurious event (5 hours OGD). Endothelial injury was assessed by measuring lactate dehydrogenase release. Hyperglycemia during cerebral ischemia resulted in marked changes in endothelial morphology and mitochondrial swelling. Thus, in the ischemic hemisphere, there was no evidence of endothelial mitochondrial swelling in normoglycemic rats (mean profile width 0.22 +/- 0.04 vs. 0.17 +/- 0.01 microm in contralateral hemisphere) but there was marked swelling in hyperglycemic rats (0.44 +/- 0.02 microm). In vitro, cells preconditioned with one hour of OGD one day prior to 5 hours of OGD, showed reduced lactate dehydrogenase release (p < 0.05). In conclusion, hyperglycemia may have specific adverse effects on endothelial cell mitochondria during ischemia. Preventing those effects may help to ameliorate blood-brain barrier disruption on reperfusion. Insights into how to prevent endothelial injury may come from determining the mechanisms involved in endothelial preconditioning.

  16. [Mesenteric venous trombosis and pregnancy--a case report and a short review of the problem].

    PubMed

    Terzhumanov, R; Uchikova, E; Paskaleva, V; Milchev, N; Uchikov, A

    2005-01-01

    Mesenteric venous thrombosis is extremely rare surgical pathology during pregnancy and frequently is associated with hemoglobinopathies beta-thalassemia, congenital defects of the coagulation and antiphospholipide syndrome. It has nontypical clinical appearance, which hardens the timely diagnosis and the adequate surgical treatment. We present a case of a 22 year-old girl with hemozygote form of beta thalassemia, pregnant in ml II, with mesenteric venose thrombosis. The diagnosis was made on the 24th hour from the beginning of the disease. The patient was operated successfully by a resection of the necrotic changed part of the intestine. She noticed vaginal bleeding due to a missed abortion on the 22nd day after the operation.

  17. Surgical treatment of giant mesenteric fibromatosis presenting as a gastrointestinal stromal tumor: a case report.

    PubMed

    Stoidis, Christos N; Spyropoulos, Basileios G; Misiakos, Evangelos P; Fountzilas, Christos K; Paraskeva, Panorea P; Fotiadis, Constantine I

    2010-09-23

    Intra-abdominal fibromatosis, usually located at the mesenteric level, is a locally invasive tumor of fibrous origin, with no ability to metastasize, but a tendency to recur. Certain non-typical cases of intra-abdominal fibromatosis with involvement of the bowel wall can be misdiagnosed because of their different biological behavior. We describe the case of a 64-year-old Caucasian man presenting with mesenteric fibromatosis and involvement of the bowel wall, who was treated surgically. The macroscopic and microscopic appearance of the lesion mimicked a gastrointestinal stromal tumor, a tumor with potential malignant behavior. It is essential to make an early and correct diagnosis in such equivocal cases, so that the appropriate treatment can be chosen and suitable patients admitted to clinical trials if appropriate. New and reliable criteria for discriminating between intra-abdominal fibromatosis and gastrointestinal stromal tumor should be proposed and established because novel sophisticated therapeutic strategies have been introduced in the international literature.

  18. Percutaneous drainage and sclerosis of mesenteric cysts: literature overview and report of an innovative approach.

    PubMed

    Pozzi, Giada; Ferrarese, Alessia; Busso, Marco; Borello, Alessandro; Catalano, Silvia; Surace, Alessandra; Marola, Silvia; Gentile, Valentina; Martino, Valter; Solej, Mario; Nano, Mario

    2014-01-01

    We present the case of a 29-years-old male patient, affected by a voluminous post-traumatic mesenteric cyst, a rare abdominal disease; our patient represents a rarely affected age group. Treatment was based on interventional radiology with an US-guided drainage and sclerosis by ethyl alcohol of the lesion. The intervention performed on this patient represents the application of a standardized radiological technique to a new contest, mesenteric cysts, whose gold-standard treatment is represented in literature by surgery. In our case we obtained an optimal result, with complete regression of the treated cyst: it proved to be an effective, feasible, safe and minimally invasive procedure. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  19. Increased wall tension in response to vasoconstrictors in isolated mesenteric arterial rings from patients with high blood pressure.

    PubMed

    Tahvanainen, Anna; Taurio, Jyrki; Mäki-Jouppi, Jenni; Kööbi, Peeter; Mustonen, Jukka; Kähönen, Mika; Sand, Juhani; Nordback, Isto; Pörsti, Ilkka

    2006-12-01

    Essential hypertension is associated with several alterations in arterial function. A wealth of information from animal models is available concerning hypertensive changes in the mesenteric circulation, while only few studies have examined human mesenteric arterial function. The tone of isolated mesenteric arterial segments (outer diameter 0.7-0.9 mm) was examined from individuals with high (n=17) or normal (n=22) blood pressure, grouped using the current definition of elevated blood pressure (140/90 mmHg). Since the majority of them were operated because of malignancies, we evaluated whether functional vascular properties provided information about patient prognosis. Wall tension development (mN/mm) in response to vasoconstrictors (noradrenaline, 5-hydroxy tryptamine, potassium chloride) was higher in mesenteric arterial rings from patients with high than normal blood pressure. There was no difference in vasoconstrictor sensitivity, or endothelium-dependent and endothelium-independent vasorelaxation. Arterial segment weight was higher in hypertensive subjects, suggesting vascular wall hypertrophy. The 10-year follow-up showed no differences in the control of arterial tone between the surviving (n=14) or deceased (n=25) patients. In conclusion, isolated mesenteric arterial segments from hypertensive patients showed increased wall tension in response to vasoconstrictors. Since the mesenteric circulation is an important regulator of peripheral arterial resistance, possible functional alterations in this vascular bed should be further investigated in hypertensive patients.

  20. Myocardial infarction-prone Watanabe heritable hyperlipidemic rabbits with mesenteric fat accumulation are a novel animal model for metabolic syndrome.

    PubMed

    Shiomi, Masashi; Kobayashi, Tsutomu; Kuniyoshi, Nobue; Yamada, Satoshi; Ito, Takashi

    2012-01-01

    To examine whether the myocardial infarction-prone Watanabe heritable hyperlipidemic (WHHLMI) rabbit with visceral fat accumulation is a new animal model for human metabolic syndrome, we examined the relationship between mesenteric fat accumulation and insulin resistance, hyperlipidemia and atherosclerosis. Glucose tolerance tests were performed using adult (11- to 15-month-old) and middle-aged (17- to 21-month-old) WHHLMI rabbits fed standard chow restrictedly. In addition, lipoprotein lipid levels, serum C-reactive protein (CRP) levels, mesenteric fat weight and physical and physiological parameters were measured. Mesenteric fat was stained immunohistochemically. The mesenteric adipose tissue was positive for monoclonal antibodies against macrophages, C-reactive protein and monocyte chemoattractant protein. In adult rabbits, mesenteric fat correlated to aortic lesion area, insulin resistance, fasting immunoreactive insulin, serum CRP, abdominal circumference and body weight. In middle-aged rabbits, mesenteric fat correlated to lipoprotein lipid levels in addition to the parameters showing a significant correlation in adult rabbits, excluding aortic lesion area. The WHHLMI rabbit with visceral fat accumulation is a new animal model for metabolic syndrome. Copyright © 2012 S. Karger AG, Basel.