Isquemia mesentérica aguda: a propósito de un caso / Acute mesenteric ischemia: a purpose of a case

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)

Trombosis segmentaria sigmoidea consecuente a neoplasia maligna de colon. A propósito de un caso interesante / Sigmoid segmental thrombosis consequent to colon malignant neoplasia. On the purpose of a case

RESUMEN Se presentó un caso de una paciente de 78 años de edad, procedente del municipio de Calimete, con antecedentes patológicos personales de infarto agudo miocárdico sin elevación del segmento ST e hipertensión arterial. Llegó a la Unidad de Cuidados Intensivos de Emergencia, de Colón con un estado toxico infeccioso severo. Fue intervenida quirúrgicamente con el diagnóstico presuntivo de una trombosis mesentérica. Se constató dicho diagnóstico complementario a una neoplasia maligna de colon sigmoides. Falleció producto a un shock séptico refractario a aminas. En la necropsia se reportaron hallazgos de interés.

ABSTRACT The authors present the case of a 78-years-old female patient from the municipality of Calimete, with personal pathological antecedents of acute myocardial infarct without ST segment elevation and arterial hypertension. She arrived to the Emergency Intensive Care Unit of Colon with a severe toxic-infectious status. She underwent a surgery with a presumptive mesenteric thrombosis. It was stated that diagnosis, complementary to a sigmoid colon malignant neoplasia. She died as a product of an amine-refractory septic shock. The autopsy showed findings of interest.

Mesenteric lymph reperfusion after superior mesenteric artery occlusion shock exacerbates endotoxin translocation in brain

PURPOSE: To determine the role of mesenteric lymph reperfusion (MLR) on endotoxin translocation in brain to discuss the mechanism of brain injury subjected to superior mesenteric artery occlusion (SMAO) shock. METHODS: Twenty-four rats were randomly assigned to MLR, SMAO, MLR+SMAO and sham groups. MLR was performed by clamping the mesenteric lymph duct (MLD) for 1 h and then allowing reperfusion for 2 h in the MLR group; SMAO involved clamping the superior mesenteric artery (SMA) for 1 h, followed by reperfusion for 2 h in the SMAO group; occlusion of both the SMA and MLD for 1 h was followed by reperfusion for 2 h in the MLR+SMAO group rats. RESULTS: SMAO shock induced severe increased levels of the endotoxin, lipopolysaccharide receptor, lipopolysaccharide-binding protein, intercellular adhesion molecule-1 and tumor necrosis factor-α. Concurrently, MLR after SMAO shock further aggravates these deleterious effects. CONCLUSION: Mesenteric lymph reperfusion exacerbated the endotoxin translocation in brain; thereby increased inflammatory response occurred, suggesting that the intestinal lymph pathway plays an important role in the brain injury after superior mesenteric artery occlusion shock. .

Mesenteric lymph reperfusion exacerbates spleen injury caused by superior mesenteric artery occlusion shock

The intestinal lymph pathway plays an important role in the pathogenesis of organ injury following superior mesenteric artery occlusion (SMAO) shock. We hypothesized that mesenteric lymph reperfusion (MLR) is a major cause of spleen injury after SMAO shock. To test this hypothesis, SMAO shock was induced in Wistar rats by clamping the superior mesenteric artery (SMA) for 1 h, followed by reperfusion for 2 h. Similarly, MLR was performed by clamping the mesenteric lymph duct (MLD) for 1 h, followed by reperfusion for 2 h. In the MLR+SMAO group rats, both the SMA and MLD were clamped and then released for reperfusion for 2 h. SMAO shock alone elicited: 1) splenic structure injury, 2) increased levels of malondialdehyde, nitric oxide (NO), intercellular adhesion molecule-1, endotoxin, lipopolysaccharide receptor (CD14), lipopolysaccharide-binding protein, and tumor necrosis factor-α, 3) enhanced activities of NO synthase and myeloperoxidase, and 4) decreased activities of superoxide dismutase and ATPase. MLR following SMAO shock further aggravated these deleterious effects. We conclude that MLR exacerbates spleen injury caused by SMAO shock, which itself is associated with oxidative stress, excessive release of NO, recruitment of polymorphonuclear neutrophils, endotoxin translocation, and enhanced inflammatory responses.

A Case of Thrombophlebitis in Superior Mesenteric Vein due to Appendicitis / 대한소화기학회지

No abstract availble.

A Case of Budd-Chiari Syndrome and Superior Mesenteric Vein Thrombosis in Ulcerative Colitis / 대한소화기학회지

Patients with inflammatory bowel disease are at increased risk for thromboembolic complications. Its prevalence rate ranges from 1% to 7% in clinical studies and reaches 39% in autopsy series. The cause of thrombotic complications in inflammatory bowel disease is generally considered to be associated with hypercoagulability. We experienced a case of ulcerative colitis associated with Budd-Chiari syndrome and superior mesenteric vein thrombosis. This rare complication of ulcerative colitis was successfully managed by conventional treatment for ulcerative colitis and anticoagulation therapy.

Acute mesenteric ischemia

Acute mesenteric ischemia [AMI] is a morbid condition with a difficult diagnosis and a high rate of complications, which is associated with a high mortality rate. For the evaluation of the hospital results of diagnosis and treatment of acute mesenteric ischemia we reviewed our experience. The clinical data of 24 patients diagnosed with acute mesenteric ischemia between 2001 and 2004 were reviewed, assessed and hospital results analyzed. The dominant population were males [83%] whereas females were only [17%]. The median age was 61.5, and cases increased with age. Smoking had been studied as a causative factor for acute mesenteric ischemia. 18 patients in the study were regular smokers [75%]. 22 patients [92%] had previous medical or surgical problems, and the most frequent were respectively heart disease [62%], recent surgical procedures [26%], DM [13%], CVA [11%], and previous digestive problems [11%]. 11 patients [46%] had previous thrombosis events. 6 patients [25%] had recent stress [acute illness] associated with mesenteric ischemia. The most common symptoms and signs were respectively: abdominal pain [91%], nausea and vomiting [79%], intestinal obstrucion [58%], gastrointestinal bleeding [33%]. The Median time of pain was 45.6 h, and the most frequent duration was 24 h and less. Abdominal distension was the the most frequent sign [71%], followed by peritoneal irritation [58%]. On ECG series at the time of admission an Atrial Fibration was found in 33% of cases, heart ischemia signs in 66, 67% of cases, enlargment of heart in 17.5%, and arrhythmias in 17.5%. 11 patient [45%] had problems of the chest at the time of admission, and [96%] had cardiopulmonary problems. laboratory findings were non-specific, and the most important signs were:- increased WBC, and the mean value was 18604 mm3-decreased blood PH, and the mean value was 7.2. -the other findings were not helpful in diagnosing acute mesenteric ischemia. Abdominal scanning by AXR and U/S were not helpful and showed some non-specific finding. Angiography was not performed for any cases. CT scan was performed in 6 cases of those had high suspision of acute mesenteric ischemia, 3 of them were diagnosed [and included in this study], it showed specific signs [embolism] in 2 patients [8%], nothing in one case [4%]. The predictive value, sensitivity, and specificity were 67%, 67%, 67%, respectively. All patients underwent open surgery [100%] without any case of laparoscopic, and the indications were: explorative laparotomy [7 cases] 29%, intestinal obstruction [2 cases] 8%, peritoneal irritation [14 cases] 59%, fecal fistula after previous surgery [1 case] 4%. The surgery was performed after admision 31 h as a mean. Surgery showed that there is one or more foci of gangrenous lesions in all patient [100%], these lesions were supplied by SMA in 23 cases [96%], and 1 case was supplied by IMA. and the median leangth of its was 282 cm. Selected procedure to the gangrenous intestine was done in 21 cases [87%], which was colointestinal resection with primary anastomosis in 19 cases and with stoma in 2 cases, while only 2 patient [8%]underwent revascularization procedures [thromboembolectomy] Secound operation was done in 3 cases [12.5%], the indication was fecal fistula [2 cases] and intestinal obstruction [1 case]. The cause of occlusion was determined by clinical and imaging study and the results: 19 cases [79%] were arterial occlusion [14 cases [58%] embolism, and 5 cases [21%] thrombosis], 3 cases [13%] were mesenteric venous thrombosis, and 2 cases [8%] were non-occlusive mesenteric ischemia [NOMI]. Mortality associated with surgery was 14 cases [58%], and higher mortality rate occured in:-Mesenteric venous thrombosis patients [67% of this group], arterial thrombosis [60%], and embolism [5 7%]-At the group of late surgery-The patient at advanced age-Patients having recent heart or chest problems. Most cases of death were at the first 24 h after operation, and less by the time. Multiorgan failure [MOF] was the most frequent cause of death in this group of patients [71.5%], then hemorrhagic shock [2 1%], then heart failure [7%]. Complications occurred in 14 cases of total amount of patient [58%], and in 8 of surviving patients [80%]. -The complications in survived cases were: wound infection in [2], sepsis in [3], gastrointestinal bleeding in [1], short bowel syndrome in [2], bowel obstruction in[1], faecal fistula in [I], multiorgan failure in 2. Total Parenteral nutrition [TPN] was necessary in 60% of survived patients

Superior mesenteric vein thrombosis complicating appendicular masses

Mesenteric vein thrombosis [MVT] is rare. Its diagnosis is usually difficult and delayed. Herein, we report 2 patients who developed MVT as a complication of an appendicular mass. One of them had appendectomy and developed fever 10 days postoperatively. The other was treated conservatively. An abdominal computerized tomography [CT] scan with intravenous contrast was helpful in diagnosing the superior MVT in both patients, which were not suspected. Intravenous contrast should be used when performing CT of an appendicular mass. Special interest should be directed at studying the superior mesenteric vein. Early diagnosis of our patients helped to start early medical treatment with anticoagulation

Angina mesentérica: causa infrecuente de dolor crónico en paciente en hemodiálisis / Mesenteric angina as a cause of abdominal pain in a patient in chronic hemodialysis: report of one case

We report a 73 years old male undergoing chronic hemodialysis with a history of seven years of abdominal pain and weight loss. A mesenteric angiography disclosed a critical stenosis of the celiac artery and a partial stenosis of the superior mesenteric artery. Other causes of abdominal pain were excluded. The patient was subjected to a successful angioplasty with stent placement that resulted in a complete relief of the pain

Estenosis segmentaria de intestino delgado luego de trombosis de vena mesentérica superior: caso clínico / Segmental short bowel stenosis after a superior mesenteric vein thrombosis: report of 1 case

We report a 24 years old female with a superior mesenteric and portal vein thrombosis due to an antithrombin III factor deficiency, associated to oral contraceptive use and smoking. She presented with severe abdominal pain and the diagnosis was reached after surgery with a CT scan. The patient was treated with intravenous heparin and oral anticoagulation, with a good clinical and doppler endosonographic response. One month after the onset, she developed an intestinal occlusion caused by two concentric jejunal stenoses, measuring 2 and 0.7 cm in length and demonstrated with a barium jejunogram. A 35 cm intestinal resection was done and the patient recovered uneventfully. The pathological study showed granulation tissue on both stenotic zones with an ulcer near to the distal stricture, that reached the internal muscularis propria, with subserosal fibrosis. The development of segmental stenosis is a rare complication superior mesenteric vein thrombosis, that must be bore in mind

Síndrome do intestino curto: análise retrospectiva de 42 pacientes internados no Hospital das Clínicas de Ribeiräo Preto / Short-bowel syndrome: follow-up of 42 hospitalized patients at the Hospital das Clínicas de Ribeiräo Preto

Foram analisados os prontuários de 42 pacientes (26 homens e 16 mulheres) submetidos à ressecçäo intestinal durante o período de 1979-1987. A causa mais freqüente de ressecçäo intestinal foi a trombose mesentérica seguida pelo volvo. A maior incidência ocorreu aos 30-50 anos. A taxa global de mortalidade foi 57% e as principais "causas de mortalidade" foram os distúrbios metabólicos (56%) e a sepse (30%)