Pattern of anatomical variation of mesenteric veins detected on helical ct venography among patients with pancreatic pathologies

Background: Familiarity of the regular and commonest deviations of anatomy of the mesenteric venous system is of great significance for surgeons performing hepatobiliary, pancreatic and gastrointestinal surgeries

Objective: To delineate the variable anatomy of superior mesenteric vein and drainage site of inferior mesenteric vein on CT venograms

Methodology: A total of 114 patients undergoing helical CT venogram for pancreatic pathologies were included in this cross sectional study from 1stJanuary, 2014 to 31stJanuary, 2015 at Radiology department, Sharif Medical City Hospital, Lahore. The mesenteric venous system was analyzed in all patients. Appearance of the Superior Mesenteric Veins [SMV] and drainage site of the Inferior Mesenteric Veins [IMV] were assessed on CT venography. Two radiologists interpreted the images and reached a concensus on all findings. Data was analyzed by using SPSS version 20

Results: The study included 64 [56.14%] female and 50 [43.85%] male with a mean age of 49+/-4 years. The SMV was composed of single and double trunks around the splenoportal confluence in 109 [95.61%] and 4 [3.50%] patients, respectively. It was absent in 1 [0.8%] patient. The IMV were identified in all patients. The IMV was observed to drain into splenic vein in 40 [35.08%] patients, SMV in 59 [51.75%], the junction between the superior mesenteric vein and the splenic vein in 14[12.28%], and first jejunal trunk in 1 [0.8%] patient

Conclusion: Understanding of mesenteric venous tributaries is supportive for surgeons to safely perform peripancreatic surgery, and this study shows the

variability in its anatomy

Sonographic Journey for the detection of gastrointestinal masses from distal esophagus to rectum with histological correlation

Objective: To demonstrate the sonographic features of gut masses detected either incidentally or purposely through the gastrointestinal tract sonography with histological correlation to compare the detected abnormalities for their benign and malignant nature

Material and Methods: The study was conducted between September 2009 and February 2013. Ultrasound scanning was performed on 72 patients [20-75 years, mean age 46 years] presenting with clinical suspicion of underlying primary gastrointestinal pathology due to abdominal symptoms. The histological confirmation was done either through surgically resected specimen, trucut biopsy, flexible endoscopic biopsy or fine needle aspiration

Results: Out of 72 patients, upper GI tract masses included 2 distal esophageal and 7gastric cancers. Mid gut included 9 cases of primary small bowel lymphoma. Intussusception was found in 6 patients. Ileoceacal masses were found in 13 patients with one case of jejunal mass. 18 patients were diagnosed as acute appendicitis, 3 patients demonstrated appendicular mass. Large intestine revealed a single case of diverticulitis besides 15 cases of colorectal cancer. The masses were either lobulated or revealed a segmental wall thickening simulating appearance of kidney [Pseudokidney sign], or diffused wall thickening [Target sign]

Conclusion: In our experience, ultrasonography of the gastrointestinal tract is an extremely useful modality for evaluating gut masses from distal esophagus up to rectum. Sonographic appearance ofgut related masses helps to evaluate the clinical differential diagnosis. However, additional work-up may be needed in the form of contrast study, cross-sectional imaging or endoscopy for specifying the diagnosis with histological confirmation