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1.
Medicentro (Villa Clara) ; 25(3): 529-541, 2021. graf
Article in Spanish | LILACS | ID: biblio-1340201

ABSTRACT

RESUMEN El síndrome de Wilkie representa una rara causa de obstrucción intestinal por compresión externa de la tercera porción duodenal por la arteria mesentérica superior. Se presenta una mujer de 68 años que fue a consulta por presentar vómitos biliosos frecuentes, con distensión abdominal, y marcada pérdida de peso. Mediante estudios radiográficos baritados con control fluoroscópico y tomografía axial computarizada con contraste vía oral y endovenosa, se evidenció compresión duodenal extrínseca en la tercera porción; se diagnosticó un síndrome de Wilkie y se instauró un tratamiento conservador, el cual cursó favorablemente. El síndrome de Wilkie, a pesar de su baja incidencia, debe considerarse como diagnóstico diferencial en cuadros de obstrucción intestinal alta.


ABSTRACT Wilkie syndrome represents a rare cause of intestinal obstruction due to external compression of the third duodenal portion by the superior mesenteric artery. We present a 68-year-old woman who came to the consultation for frequent bilious vomiting, abdominal distension and marked weight loss. Extrinsic duodenal compression was evidenced in its third portion by means of barium radiographic studies with fluoroscopic control and computerized axial tomography with oral and intravenous contrast; Wilkie syndrome was diagnosed and conservative treatment was instituted, which progressed favorably. Wilkie syndrome, despite its low incidence, should be considered as a differential diagnosis in cases of upper intestinal obstruction.


Subject(s)
Mesenteric Artery, Superior , Intestinal Obstruction
2.
J. coloproctol. (Rio J., Impr.) ; 41(3): 325-328, July-Sept. 2021. ilus
Article in English | LILACS | ID: biblio-1346427

ABSTRACT

Intestinal malrotation is a congenital anomaly caused by incomplete rotation or absence of rotation of the primitive intestine along the axis of the upper mesenteric artery during embryonic development. Embryonic development and its anatomical variations were described by Dott in 1923. Intestinal malrotation is a rare condition among adults - prevalent in a mere 0.0001% to 0.19% of the population -, and it may be associated with other anatomical deformities. It can be asymptomatic or manifest with varying intensity, from obstruction to necrosis of intestinal segments. In general, this abnormality is diagnosed in the first year of life; however, symptomsmay appear later in life,making diagnosis in adults difficult on account of non-specific symptoms. In the present study, we report a case of intestinal malrotation associated with chronic non-specific symptoms progressing to mesenteric angina. (AU)


Subject(s)
Humans , Female , Aged , Torsion Abnormality/complications , Torsion Abnormality/diagnostic imaging , Mesenteric Artery, Superior , Internal Hernia , Meckel Diverticulum/diagnosis
3.
Int. j. morphol ; 38(6): 1662-1667, Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1134495

ABSTRACT

SUMMARY: The celiac trunk is the first major unpaired branch of the abdominal aorta found at the twelfth vertebral level (T12). It gives off branches supplying the spleen, liver and the stomach. However, the branching patterns of the celiac trunk tend to vary by population throughout the world. We sought to investigate the branching patterns of the celiac trunk in a South African Caucasian sample. The celiac trunk was assessed by visual observation in 66 dissected bodies comprised of both males (n= 30) and females (n=36). These samples were obtained at the School of Anatomical Sciences, University of the Witwatersrand, Johannesburg. The celiac trunk arose directly from the abdominal aorta in all cases, with none connected to the superior mesenteric artery. We observed celiac trunk trifurcation in 84.84 % of the sample, although a celiac trunk with four branches was observed in 10.61 %. Bifurcation into the common hepatic and splenic arteries forming a hepatosplenic trunk (2 females) or into the left gastric artery and splenic artery forming a splenogastric trunk (1 male) was also observed. The results are largely comparable with other studies in Caucasians, showing a high rate of celiac trunk trifurcation (above 75 %). Our sample exhibited fewer variations than reported in previous studies worldwide. Therefore, a larger study with more samples may be required in the future to ascertain all the existing celiac trunk branching patterns in the South African Caucasian population.


RESUMEN: El tronco celíaco es la primera rama principal de la parte abdominal de la aorta en el nivel de la duodécima vértebra torácica (T12), con ramas que irrigan el bazo, el hígado y el estómago. Sin embargo a nivel mundial, las ramificaciones del tronco celíaco tienden a variar según la población. En este estudio se investigaron los patrones de ramificación del tronco celíaco en una muestra caucásica sudafricana. El tronco celíaco se analizó mediante observación visual en 66 cuerpos disecados compuestos por hombres (n = 30) y mujeres (n = 36). Estas muestras se obtuvieron en la Facultad de Ciencias Anatómicas de la Universidad de Witwatersrand, Johannesburgo. El tronco celíaco surgió directamente de la parte abdominal de la aorta en todos los casos, sin que ninguno estuviera unido a la arteria mesentérica superior. Se observó trifurcación del tronco celíaco en el 84,84 % de la muestra, aunque en el 10,61 % se observó un tronco celíaco con cuatro ramas. También se observó bifurcación en las arterias hepática y esplénica común formando un tronco hepatoesplénico (2 mujeres) o en la arteria gástrica izquierda y la arteria esplénica formando un tronco esplenogástrico (1 hombre). Los resultados son comparables con otros estudios en caucásicos que muestran una alta tasa de trifurcación del tronco celíaco (mayor al 75%). Nuestra muestra presentó menos variaciones que las reportadas en estudios previos. Por lo tanto, es posible que se requieran estudios más amplios con más muestras en el futuro, para determinar todos los patrones de ramificación del tronco celíaco en la población caucásica sudafricana.


Subject(s)
Humans , Male , Female , Celiac Artery/anatomy & histology , Anatomic Variation , Aorta, Abdominal , South Africa , Splenic Artery , Stomach/blood supply , Mesenteric Artery, Superior , Liver/blood supply
4.
Rev. Asoc. Méd. Argent ; 133(1): 21-24, mar. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1097699

ABSTRACT

La isquemia mesentérica aguda (IMA) es consecuencia de la oclusión de la arteria mesentérica superior (AMS) por trombosis o embolia, y es considerada la más letal del síndrome de abdomen agudo. Se presenta el caso de paciente femenina de 69 años con clínica difusa y confirmación diagnóstica radiológica, El objetivo de este caso clínico es proporcionar una revisión bibliográfica actual del tema y facilitar la adecuada actuación ante este problema de salud de amplio compromiso sistémico, y de aparición no tan infrecuente. (AU)


Acute mesenteric ischemia (IMA) is a consequence of occlusion of the superior mesenteric artery (AMS) by thrombosis or embolism; and it is considered the most lethal of acute abdomen syndrome. The case of a 69 years old female patient with diffuse clinic and radiological diagnostic confirmation is presented. The objective of this clinical case is to provide a current bibliographic review of the topic and facilitate adequate action in the face of this health problem with a broad systemic commitment, and with no appearance so infrequent. (AU)


Subject(s)
Humans , Female , Aged , Mesenteric Artery, Superior/diagnostic imaging , Mesenteric Ischemia/diagnostic imaging , Mesenteric Vascular Occlusion/complications , Acute Disease , Mesenteric Artery, Superior/surgery , Multidetector Computed Tomography , Mesenteric Ischemia/etiology , Mesenteric Ischemia/therapy
5.
ABCD arq. bras. cir. dig ; 33(2): e1508, 2020. tab, graf
Article in English | LILACS | ID: biblio-1130527

ABSTRACT

ABSTRACT Introduction: Superior mesenteric artery (SMA) usually arises from the abdominal aorta, just below the celiac trunk and it supplies the midgut-derived embryonic structures. Anatomical variations in this vessel contribute to problems in the formation and/or absorption of this part of the intestine and its absence has been recognized as the cause of congenital duodenojejunal atresia. Objective: To analyze SMA anatomical variations in humans and the possible associated clinical and surgical implications. Methods: This is a systematic review of papers indexed in PubMed, SciELO, Springerlink, Science Direct, Lilacs, and Latindex databases. The search was performed by two independent reviewers between September and December 2018. Original studies involving SMA variations in humans were included. SMA presence/absence, level, place of origin and its terminal branches were considered. Results: At the end of the search, 18 studies were selected, characterized as for the sample, method to evaluate the anatomical structure and main results. The most common type of variation was when SMA originated from the right hepatic artery (6.13%). Two studies (11.11%) evidenced the inferior mesenteric artery originating from the SMA, whereas other two (11.11%) found the SMA sharing the same origin of the celiac trunk. Conclusion: SMA variations are not uncommon findings and their reports evidenced through the scientific literature demonstrate a great role for the development of important clinical conditions, making knowledge about this subject relevant to surgeons and professionals working in this area.


RESUMO Introdução: A artéria mesentérica superior (AMS), normalmente, tem sua origem a partir da aorta abdominal, um pouco abaixo do tronco celíaco e é responsável pela irrigação das estruturas derivadas, embrionariamente, do intestino médio. Variações anatômicas nesse vaso contribui para defeitos na formação e/ou absorção dessa parte do intestino e a sua ausência tem sido reconhecida como a causa da atresia duodenojejunal congênita. Objetivo: Analisar as variações anatômicas dela em humanos e as possíveis implicações clínicas e cirúrgicas associadas. Métodos: Trata-se de uma revisão sistemática de artigos indexados nas bases de dados PubMed, SciELO, Springerlink, Scienc Direct, Lilacs e Latindex. A busca ocorreu por dois revisores independentes entre setembro e dezembro de 2018. Foram incluídos artigos originais envolvendo as variações da AMS em humanos. Considerou-se para este estudo a presença/ausência da AMS, o nível, local de origem e seus ramos terminais. Resultados: Ao final da busca foram selecionados 18 artigos, caracterizados quanto à amostra, método para avaliar a estrutura anatômica e principais resultados. O tipo de variação mais comum foi aquele cuja AMS se originou da artéria hepática direita (6,13%). Dois estudos (11,11%) evidenciaram a artéria mesentérica inferior originando-se a partir da AMS, enquanto outros dois (11,11%) constataram ser ela compartilhada na mesma origem do tronco celíaco. Conclusão: Variações na AMS não são achados incomuns e seus relatos evidenciados através da literatura científica demonstram grande importância para o desenvolvimento de condições clínicas importantes, tornando o conhecimento sobre esse assunto relevante para os cirurgiões e profissionais atuantes nesta área.


Subject(s)
Humans , Celiac Artery/anatomy & histology , Mesenteric Artery, Superior/anatomy & histology , Surgeons , Hepatic Artery/anatomy & histology , Mesenteric Artery, Superior/surgery
6.
Rev. Col. Bras. Cir ; 47: e20202379, 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1136551

ABSTRACT

RESUMO Objetivos: A irrigação arterial hepática tem como característica a elevada frequência de variações da anatomia. O objetivo do estudo foi descrever o trajeto anatômico da artéria hepática direita quando originada da artéria mesentérica superior. Métodos: Foram analisadas 5147 tomografias computadorizadas com contraste endovenoso de pacientes atendidos no Serviço de Radiologia do Hospital de Clínicas de Passo Fundo - RS, no período outubro de 2016 a dezembro de 2017. Foram selecionados 125 pacientes portadores de variação anatômica da artéria hepática direita na origem. Os achados foram categorizados pela variação do trajeto vascular, emergência da artéria mesentérica superior e a relação com demais estruturas. Resultados: Obtivemos o trajeto mais frequente desta variação como retropancreático (88,8%), retroportal (76,8%) e pós-coledociano (75,2%), emergindo cerca de 2,33 cm da origem da artéria mesentérica superior. Conclusão: Demonstramos que na maioria das vezes, a artéria hepática direita variante, apresenta trajeto posterior ao pâncreas e ao pedículo hepático e emerge próxima da origem da artéria mesentérica superior.


ABSTRACT Objective: Liver arterial irrigation is characterized by a high frequency of variations in its anatomy. The aim of the study was to describe the anatomic position of the right hepatic artery as a brunch of the superior mesenteric artery. Methods: A total of 5147 intravenous contrast-enhanced computed tomography scans of patients seen at the Radiology Service of the Passo Fundo Clinical Hospital (RS), from October 2016 to December 2017, were selected. 125 patients with anatomic variation of the right hepatic artery were selected. The findings were categorized by the variation of the vascular position, emergence from the superior mesenteric artery and the relationship with other structures. Results: The most frequent position was retropancreatic (88.8%), retroportal (76.8%) and post-choledocian (75.2%), emerging about 2.33 cm from the superior mesenteric artery. Conclusion: We have shown that most common variant of the right hepatic artery presents its posterior origin from the pancreatic and hepatic pedicle, and arises close to the origin of the superior mesenteric artery.


Subject(s)
Humans , Mesenteric Artery, Superior , Hepatic Artery , Pancreas , Anatomic Variation , Liver
7.
Article in Chinese | WPRIM | ID: wpr-828499

ABSTRACT

To access the efficacy of stents for spontaneous isolated dissection of the superior mesenteric artery (SIDSMA). The study is a prospective single-arm study which has been registered on Clinical Trials (NCT03916965). Clinical data and follow-up information of the SIDSMA patients who received stent implantation in the First Affiliated Hospital of Zhejiang University during April 1, 2019 and September 30, 2019 were collected. The patients were recommended to be followed up at 1, 3, 6 and 12 months. A total of 34 patients were enrolled. Their mean age was (54±8) years. Abdominal pain was the most common symptom. Patients received (2.1±0.6) stents on the average. Post-operation hospital stay was (2.7±1.6) days, and the patients were followed up for (2.3±1.9) months (CT angiography) and (5.5±1.7) months (clinical visit/phone call). There was no recurrence of abdominal pain. The CT angiography showed complete remodeling and incomplete remodeling took place in 23 and 9 patients (69.7% and 27.3%), respectively. Two patients (6.1%) had mild in-stent stenosis. No stent rupture or migration was reported. This study demonstrated a satisfactory short-term result of stents implantation for SIDSMA, which indicated the endovascular treatment could be the first-line therapy for SIDSMA.


Subject(s)
Aneurysm, Dissecting , Endovascular Procedures , Humans , Mesenteric Artery, Superior , Middle Aged , Prospective Studies , Retrospective Studies , Stents , Treatment Outcome
8.
Rev. cir. (Impr.) ; 71(6): 552-556, dic. 2019. tab, ilus
Article in Spanish | LILACS | ID: biblio-1058317

ABSTRACT

Resumen Objetivo: Presentar un caso clínico infrecuente, con una resolución novedosa. Caso Clínico: Paciente con aneurisma micótico de la arteria mesentérica superior manejado satisfactoriamente en forma endovascular. Los aneurismas micóticos viscerales son entidades infrecuentes, con alta morbimortalidad. Es por ello que su manejo debe ser multidisciplinario y considerar diferentes factores al momento de tomar decisiones. En el contexto de la continua mejoría y disponibilidad de las técnicas endovasculares, estas han emergido como una opción terapéutica válida, con posiblemente menos complicaciones. Conclusión: La resolución endovascular del aneurisma micótico visceral es factible, pero su indicación y el manejo completo es aún caso a caso.


Objective: to discuss an infrequent vascular case with a novel resolution. Case Report: Superior mesenteric artery mycotic aneurysm successfully managed with coil embolization. A visceral mycotic aneurysm is an infrequent vascular pathology with high risk of complications and mortality. The endovascular management might offer a treatment option with lower morbimortality rates in selected cases. Conclusion: Endovascular resolution of mycotic visceral aneurysms is both feasible and secure but it must be done in a case to case basis.


Subject(s)
Humans , Male , Aged , Aneurysm, Infected/therapy , Mesenteric Artery, Superior/pathology , Embolization, Therapeutic/methods , Endovascular Procedures/methods , Aneurysm, Infected/etiology , Mesenteric Artery, Superior/diagnostic imaging
9.
Acta cir. bras ; 34(5): e201900501, 2019. tab, graf
Article in English | LILACS | ID: biblio-1010875

ABSTRACT

Abstract Purpose: To analyze the effects of ischemic preconditioning (IPC) in the expression of apoptosis-related genes in rat small intestine subjected to ischemia and reperfusion. Methods: Thirty anesthetized rats underwent laparotomy and were drive into five groups: control (CG); ischemia (IG); ischemia and reperfusion (IRG); IPC and ischemia (IG+IPC); IPC and ischemia and reperfusion (I/RG+IPC). Intestinal ischemia was performed by clamping the superior mesenteric artery for 60 minutes, whereas reperfusion lasted for 120 minutes. IPC was carried out by one cycle of 5 minutes of ischemia followed by 10 minutes of reperfusion prior to the prolonged 60-minutes-ischemia and 120-minutes-reperfusion. Thereafter, the rats were euthanized and samples of small intestine were processed for histology and gene expression. Results: Histology of myenteric plexus showed a higher presence of neurons presenting pyknotic nuclei and condensed chromatin in the IG and IRG. IG+IPC and I/RG+IPC groups exhibited neurons with preserved volume and nuclei, along with significant up-regulation of the anti-apoptotic protein Bcl2l1 and down-regulation of pro-apoptotic genes. Moreover, Bax/Bcl2 ratio was lower in the groups subjected to IPC, indicating a protective effect of IPC against apoptosis. Conclusion: Ischemic preconditioning protect rat small intestine against ischemia/reperfusion injury, reducing morphologic lesions and apoptosis.


Subject(s)
Animals , Male , Reperfusion Injury/prevention & control , Apoptosis/genetics , Ischemic Preconditioning/methods , Apoptosis Regulatory Proteins/analysis , Jejunum/blood supply , Jejunum/pathology , Reference Values , Random Allocation , Down-Regulation , Gene Expression , Reproducibility of Results , Rats, Wistar , Mesenteric Artery, Superior , Constriction , Endothelial Cells/pathology , Apoptosis Regulatory Proteins/genetics , Real-Time Polymerase Chain Reaction , Mesenteric Ischemia/genetics , Mesenteric Ischemia/pathology
10.
J. vasc. bras ; 18: e20190037, 2019. ilus
Article in Portuguese | LILACS | ID: biblio-1040372

ABSTRACT

A síndrome de nutcracker é manifesta na presença de um aprisionamento sintomático da veia renal esquerda entre a aorta abdominal e a artéria mesentérica superior. Uma variação mais efêmera desta desordem é dita síndrome de nutcracker posterior, quando a compressão da veia renal não mais ocorre frontalmente à aorta, mas posteriormente a ela, entre esta e a coluna vertebral. A despeito de variáveis opções terapêuticas, as técnicas presentes visam aliviar os sintomas e diminuir a pressão venosa da veia renal esquerda. Este relato descreve um caso de Síndrome de nutcracker posterior, em que a abordagem de escolha foi a cirurgia aberta, transpondo distalmente a veia gonadal esquerda na veia cava inferior


The Nutcracker Syndrome is manifest in the presence of a symptomatic entrapment of the left renal vein between the abdominal aorta and the superior mesenteric artery. In a more ephemeral variation of this disorder, called the Posterior Nutcracker Syndrome, the renal vein is not compressed anterior to the aorta, but posteriorly, between the artery and the spine. Although there are multiple treatment options, current techniques aim to relieve the symptoms and reduce venous pressure on the left renal vein. This report describes a case of Posterior Nutcracker Syndrome in which the management approach chosen was open surgery, transposing the gonadal vein distally, to the inferior cava vein


Subject(s)
Abdominal Pain , Renal Nutcracker Syndrome/diagnosis , Renal Nutcracker Syndrome/therapy , Aorta, Abdominal , Renal Veins , Vena Cava, Inferior , Tomography, X-Ray Computed/methods , Mesenteric Artery, Superior , Endovascular Procedures/methods
11.
J. vasc. bras ; 18: e20180135, 2019. ilus
Article in Portuguese | LILACS | ID: biblio-1012623

ABSTRACT

A dor pélvica crônica é uma doença debilitante, com impacto na qualidade de vida e custos para os serviços de saúde. A síndrome de quebra-nozes é uma importante causa dessa dor, e se refere a um conjunto de sinais secundários à compressão da veia renal esquerda, mais comumente entre a artéria mesentérica superior e a aorta. Seu tratamento ainda permanece controverso e varia de acordo com a gravidade clínica do paciente. Contudo, a técnica endovascular com implante de stent em veia renal tem obtido excelentes resultados. Relatamos um caso de uma paciente de 59 anos submetida a correção endovascular com stent autoexpansível de nitinol. São apresentados dados clínicos, detalhes do procedimento e resultados do acompanhamento dessa paciente. O sucesso técnico foi obtido e não houve relato de complicações pós-operatórias. Pôde-se observar alívio dos sintomas e melhora nos exames de imagem realizados no acompanhamento de curto prazo


Chronic pelvic pain is a debilitating disease that directly impacts on quality of life and generates costs for health services. Nutcracker Syndrome is an important cause of pelvic pain and consists of a set of signs secondary to compression of the left renal vein, most commonly between the superior mesenteric artery and the aorta. Treatment remains controversial and varies depending on the patient's clinical severity. However, endovascular treatment with renal vein stenting has achieved excellent results. We report the case of a 59 year-old female treated by endovascular repair with a self-expanding nitinol stent. Clinical data, details of the procedure, and follow-up results are presented. Technical success was achieved and there patient reported no postoperative complications. Short-term, there was relief from symptoms and follow-up imaging tests showed improvement


Subject(s)
Humans , Female , Middle Aged , Endovascular Procedures/methods , Renal Nutcracker Syndrome/diagnosis , Renal Nutcracker Syndrome/therapy , Pelvis , Renal Veins , Phlebography/methods , Tomography/methods , Stents , Prevalence , Mesenteric Artery, Superior , Constriction, Pathologic , Lower Extremity , Drug Therapy/methods , Embolization, Therapeutic/methods
12.
Korean Journal of Radiology ; : 1627-1637, 2019.
Article in English | WPRIM | ID: wpr-786369

ABSTRACT

Nutcracker syndrome (NCS) is a syndrome caused by compression of the left renal vein (LRV), between the abdominal aorta and the superior mesenteric artery, resulting in hypertension of the LRV and hematuria. Doppler ultrasonography (US) has been commonly used for the diagnosis of NCS. However, several technical issues, such as Doppler angle and sample volume, need to be considered to obtain satisfactory results. In addition, morphologic changes of the LRV and a jetting phenomenon across the aortomesenteric portion of the LRV on contrast-enhanced computed tomography (CECT) are diagnostic clues of NCS. With proper Doppler US and CECT, NCS can be diagnosed noninvasively.


Subject(s)
Aorta, Abdominal , Diagnosis , Hematuria , Hypertension , Mesenteric Artery, Superior , Renal Veins , Tomography, X-Ray Computed , Ultrasonography, Doppler
13.
Article in Korean | WPRIM | ID: wpr-765779

ABSTRACT

Bariatric surgery is the most effective and durable treatment for morbidly obese patients. However, there are remained unsolved problems with various types of complications. Superior mesenteric artery syndrome is a rarely known condition occurred following bariatric surgery. We experienced 54-year-old female patient diagnosed with superior mesenteric artery syndrome 5 year later after laparoscopic adjustable gastric banding. Because symptoms have not improved with conservative care, laparoscopic duodenojejunal bypass was successfully performed for this patient.


Subject(s)
Bariatric Surgery , Female , Humans , Mesenteric Artery, Superior , Middle Aged , Superior Mesenteric Artery Syndrome
14.
Article in English | WPRIM | ID: wpr-762688

ABSTRACT

PURPOSE: Colon perfusion status is one of the most important factors for the determination of postoperative anastomotic complications. Colonic hypoperfusion can be induced by inferior mesenteric artery (IMA) ligation in some patients. This study aimed to evaluate atherosclerotic risk assessment and vascular parameters of CT angiography as predictors of colonic hypoperfusion. METHODS: This prospective study was conducted at a tertiary referral hospital and included 46 rectosigmoid colon cancer patients undergoing laparoscopic anterior resection between August 2013 to July 2014. Atherosclerotic risk scores were assessed using the Framingham cardiovascular risk score system. The IMA length, branching pattern, atherosclerotic calcification, and intermesenteric artery and mesenteric vascular diameters were evaluated using CT angiography. Mesenteric marginal artery pressures were measured before and after IMA clamping. The mean arterial pressure (MAP) index was calculated by dividing the mesenteric marginal MAP into the systemic MAP to determine the mesenteric hypoperfusion status after IMA clamping. A critically low MAP index was defined as <0.4. RESULTS: Critically low MAP index (<0.4) was observed in 6 cases (13.0%) after IMA clamping. Atherosclerotic calcification of the IMA and superior mesenteric artery occurred in 11 (23.9%) and 5 patients (10.9%), respectively. Low MAP index was associated with high atherosclerotic risk score and short IMA length, rather than atherosclerotic calcification and other vascular parameters of the major mesenteric arteries. Multivariate analysis indicated that high atherosclerotic risk and short IMA length were independent predictors of critically low MAP index. CONCLUSION: Atherosclerotic risk assessment and IMA length were useful predictors of the mesenteric hypoperfusion status following IMA ligation during laparoscopic rectosigmoid colon surgery.


Subject(s)
Angiography , Arterial Pressure , Arteries , Atherosclerosis , Colon , Colonic Neoplasms , Constriction , Humans , Ligation , Mesenteric Arteries , Mesenteric Artery, Inferior , Mesenteric Artery, Superior , Multivariate Analysis , Perfusion , Prospective Studies , Risk Assessment , Tertiary Care Centers
15.
Article in English | WPRIM | ID: wpr-762024

ABSTRACT

Behçet’s disease (BD) is a multisystemic, chronic autoimmune inflammatory vasculitic disease with an unknown etiology. Although the literature reports that vascular involvement occurs in 7% to 38% of all BD cases, the arteries are rarely involved; however, arterial involvement is usually associated with significant mortality and morbidity. We report the case of a young female patient who presented to the emergency department with severe abdominal pain and a history of weight loss. The patient was evaluated using computed tomography angiography, which revealed a ruptured suprarenal aortic pseudoaneurysm with occlusion of both the superior mesenteric and celiac arteries. Urgent surgery was performed with aortic repair with an interposition graft and superior mesenteric artery embolectomy. The patient’s clinical history and radiological imaging findings were strongly suggestive of the diagnosis of BD with vascular involvement.


Subject(s)
Abdominal Pain , Aneurysm, False , Angiography , Arteries , Behcet Syndrome , Celiac Artery , Diagnosis , Embolectomy , Emergency Service, Hospital , Female , Humans , Mesenteric Artery, Superior , Mortality , Transplants , Vasculitis , Weight Loss
16.
Article in English | WPRIM | ID: wpr-762019

ABSTRACT

Supra-celiac aortic cross clamping is often utilized during aortic reconstruction for aneurysmal/occlusive disease involving the pararenal aorta. However, this may be accompanied a myriad of complications related to hemodynamic disturbances, cardiopulmonary compromise and hepatic ischemia. Supra-mesenteric aortic cross clamping may be an excellent option in selected patients with suitable anatomy to minimize or avoid these complications. Herein, the merits of and technical tips for supra-mesenteric aortic cross clamping are discussed.


Subject(s)
Aorta , Celiac Artery , Constriction , Hemodynamics , Humans , Ischemia , Mesenteric Artery, Superior
17.
Korean Circulation Journal ; : 400-418, 2019.
Article in English | WPRIM | ID: wpr-738801

ABSTRACT

The objective of this study was to analyze the three different management modalities for isolated superior mesenteric artery (SMA) dissection. We did a comprehensive literature search and found 703 articles on the initial search, out of which 111 articles consisting of 145 patients were selected for analysis. The mean age was 55.7 years (standard deviation,9.7;33–85) and 80.6% were male. These patients were managed conservatively (41.3%), endovascularly (28.1%) or surgically (30%). The median follow-up was 10 months (interquartile range [IQR], 4–18 months), 12 months (IQR, 6–19 months) and 14 months (IQR, 6–20 months) respectively. Contrast-enhanced computed tomography (CT) was the most commonly used diagnostic tool in the conservative group (43.8%), while conventional CT scan was the most widely used in endovascular (58.1%) and surgical group (50%). 17% percent of the conservative group had SMA angiography for diagnosis, while this was less than 3% in the other groups. Of these patients, 96.7%, 97.4%, and 100.0% recovered successfully in the conservative, endovascular, and surgical groups respectively. There was no significant difference in the mortality between the three groups (Pearson χ²=0.482). This suggests a conservative and endovascular approach could be used in most patients, which can reduce costs and surgery-related morbidity and mortality. Surgical management should be reserved for cases having infarction or widespread bowel ischemia and in cases where other treatment modalities fail.


Subject(s)
Angiography , Diagnosis , Follow-Up Studies , Humans , Infarction , Ischemia , Male , Mesenteric Artery, Superior , Mortality , Tomography, X-Ray Computed
18.
Article in Chinese | WPRIM | ID: wpr-819026

ABSTRACT

OBJECTIVE@#To analyze the application of three-dimensional power Doppler sonography (3-DPDS) in evaluation of the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) in second-trimester fetus.@*METHODS@#Three-dimensional volume probe was used to collect the 3-DPDS blood flow images in 50 normal fetuses of 22-24 weeks and 50 fetuses of 30-32 weeks, respectively. The characteristics of three-dimensional ultrasound were analyzed. The clinical and imaging data of 4 fetuses of 26-32 weeks with midgut volvulus were analyzed retrospectively.@*RESULTS@#The display rates of SMA and SMV were 93%in normal group by 3-DPDS and those in volvulus group were 4/4 and 3/4, respectively. The SMV trunk was parallel to and on the right side of the SMA in the normal group, while 3 cases in volvulus group showed the characteristic relationship of SMV swirling around SMA.@*CONCLUSIONS@#3-DPDS can be used to observe the spatial relationship of SMA and SMV visually in fetus during the second trimester and is of value to diagnose and predict the outcome of midgut volvulus.


Subject(s)
Digestive System Abnormalities , Diagnostic Imaging , Female , Fetus , Humans , Intestinal Volvulus , Diagnostic Imaging , Mesenteric Artery, Superior , Diagnostic Imaging , Pregnancy , Pregnancy Trimester, Second , Retrospective Studies , Ultrasonography, Doppler , Reference Standards
19.
Acta cir. bras ; 33(12): 1061-1066, Dec. 2018. tab
Article in English | LILACS | ID: biblio-973491

ABSTRACT

Abstract Purpose: To investigate the role of atenolol in the gene expression of caspase 1 (Casp1) and Bcl2L1 on vascular endothelium of rat intestine after ischemia and reperfusion (IR). Methods: Eighteen adult male Wistar rats were randomly divided into 3 groups (n=6): SG (Sham group): no clamping of the superior mesenteric artery; IRG: IR plus saline group: IRG+At: IR plus Atenolol group. Rats from IRG and IRG+At were subjected to 60 min of intestinal ischemia and 120 min of reperfusion. Atenolol (2mg/kg) or saline were injected in the femoral vein 5 min before ischemia, 5 min and 55 min after reperfusion. Thereafter, intestinal segments were appropriately removed and processed for Endothelial Cell Biology Rat RT2 Profiler PCR Array. Results: the anti-apoptotic Bcl2L1 gene expression was significantly down-regulated (-1.10) in the IRG and significantly up-regulated in the IRG+At (+14.15). Meanwhile, despite Casp1 gene expression was upregulated in both groups, it was significantly higher in the IRG (+35.06) than the IRG+At (+6.68). Conclusions: Atenolol presents antiapoptotic effects on rat intestine subjected to IR partly by the up-regulation of the anti-apoptotic Bcl2L1 gene expression. Moreover, atenolol can mitigate the pro-apoptotic and pro-inflammatory effects of Casp1 gene on rat intestine after IR.


Subject(s)
Animals , Male , Atenolol/pharmacology , Reperfusion Injury/prevention & control , Gene Expression/drug effects , Protective Agents/pharmacology , Caspase 1/drug effects , bcl-X Protein/drug effects , Intestine, Small/blood supply , Time Factors , Endothelium, Vascular , Random Allocation , Down-Regulation/drug effects , Up-Regulation/drug effects , Polymerase Chain Reaction , Reproducibility of Results , Treatment Outcome , Rats, Wistar , Mesenteric Artery, Superior , Apoptosis/drug effects , Constriction , Cytoprotection/drug effects , Caspase 1/genetics , bcl-X Protein/genetics , Mesenteric Ischemia/prevention & control
20.
J. vasc. bras ; 17(4): 328-332, out.-dez. 2018. ilus
Article in Portuguese | LILACS | ID: biblio-969168

ABSTRACT

Os aneurismas de artéria mesentérica superior são raros, representando menos de 0,5% de todos os aneurismas intra-abdominais. São causados principalmente por aterosclerose e por êmbolos sépticos decorrentes de endocardite bacteriana. Apesar de incomuns, são considerados graves, devido a possíveis complicações como ruptura com hemorragia e isquemia intestinal. Com consequências potencialmente devastadoras, o diagnóstico e o tratamento em tempo hábil são essenciais para se otimizarem os resultados. Ainda sem um consenso bem definido, os tratamentos propostos envolvem cirurgia convencional, terapia endovascular e conduta expectante com exames periódicos. Este trabalho relata o caso de um homem de 58 anos, assintomático, com achado incidental e incomum de dois aneurismas de artéria mesentérica superior. Perante uma anatomia desfavorável à abordagem endovascular, foi realizado o tratamento cirúrgico aberto, utilizando-se prótese de dácron na reconstrução arterial, com sucesso


Superior mesenteric artery aneurysms are rare, accounting for less than 0.5% of all intra-abdominal aneurysms. They are mainly caused by atherosclerosis and septic emboli resulting from bacterial endocarditis. Although uncommon, these aneurysms are considered dangerous because of possible complications such as rupture with hemorrhage and intestinal ischemia. Since the consequences can be very serious, early diagnosis and treatment are essential to improve outcomes. Although there is no well-defined consensus, recommended treatments include open surgery, endovascular therapy, and watchful waiting with periodic examinations. In this article we report the case of an asymptomatic 58-year-old man with an incidental and unusual finding of two superior mesenteric artery aneurysms. Since anatomy was not favorable for an endovascular approach, open surgery was performed, using a dacron graft to successfully repair the artery


Subject(s)
Humans , Male , Middle Aged , Mesenteric Artery, Superior/diagnostic imaging , Endovascular Procedures/methods , Aneurysm/surgery , Prostheses and Implants , Shock, Hemorrhagic , Diagnostic Imaging/methods , Ultrasonography/methods
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