Chronic mesenteric ischemia: stenting of mesenteric arteries

This article focuses on stent placement in mesenteric arteries in patients with the rare diagnosis of chronic mesenteric ischemia. We present a survey from the initial stage of recognition of this gastrointestinal disorder and its manifestations to treatment by stenting to avoid further ischemic episodes and bowel infarction and necrosis. The advantages of stent placement in splanchnic arteries are discussed in comparison to open surgical revascularization.     

Congenital mesenteric aneurysm and mesenteric arterioportal fistula

A unique case with superior mesenteric artery aneurysm and arterioportal fistula resulting from mesenteric arteriovenous malformation is presented, and the relevant literature is reviewed. Received: 16 December 1994/Accepted after revision: 31 March 1995     

Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography

The purpose of this study was to explore the accuracy of multi-detector row helical CT (MDCT), using a biphasic mesenteric angiography protocol for evaluation of acute mesenteric ischemia (AMI). In total, 79 consecutive patients with clinical signs of AMI underwent contrast enhanced 16- or 40-channel MDCT. MDCT findings were correlated with surgery, endoscopy and clinical outcome. Sensitivity, specificity, and positive and negative predictive values were calculated using the patients in which AMI had been excluded as a control group. In 28 patients the final diagnosis was AMI. In 27 patients (96.4%) MDCT correctly diagnosed AMI (specificity of 97.9%). A sensitivity of 93%, specificity of 100%, and positive and negative predictive values of 100% and 94%, respectively were achieved for the CT findings of visceral artery occlusion, intestinal pneumatosis, portomesenteric venous gas or bowel wall thickening in combination with either portomesenteric thrombosis or solid organ infarction. Our findings suggest that mesenteric MDCT angiography is an accurate tool for fast diagnostic work-up of patients with suspected AMI.     

肠系膜上动脉与腹主动脉间隙面积诊断肠系膜上动脉综合征

目的 探讨肠系膜上动脉(SMA)与腹主动脉(AO)间隙面积对肠系膜上动脉综合征(SMAS)的诊断价值。方法 收集接受腹部CT增强检查的24例SMAS患者(SMAS组)及42例非SMAS患者(非SMAS组),测量SMA-AO间隙面积、夹角、经十二指肠水平部中心SMA-AO距离及SMA起始部至十二指肠水平部中心水平距离,并进行统计学分析。结果 两组SMA-AO间隙面积、夹角、经十二指肠水平部中心SMA-AO距离及SMA起始部至十二指肠水平部中心水平距离差异有统计学意义(P均<0.05),ROC分析显示SMA-AO间隙面积、夹角、经十二指肠水平部中心SMA-AO距离及SMA起始部至十二指肠水平部中心水平距离的ROC曲线下面积分别为0.997、0.783、0.867及0.751。结论 SMA-AO间隙面积对诊断SMAS具有较高的准确率,可作为诊断SMAS的参考标准。     

肠系膜血管闭塞症的误诊分析

肠系膜血管闭塞症是一种临床少见但预后极差的外科急症 ,发病急 ,合并症多 ,早期确诊率低 ,病死率高。我院 1993～ 2 0 0 3年收治该病 9例 ,其中误诊 7例。分析误诊原因如下。1　临床资料1 1　一般资料　男 7例 ,女 2例 ;年龄 4 7～ 84岁 ,平均 5 4 7岁。基础疾病 :糖尿病 6例     

Intravenous iloprost increases mesenteric blood flow in experimental acute nonocclusive mesenteric ischemia

OBJECTIVE: To evaluate the effect of an intravenously administered synthetic epoprostenol analog, iloprost, in nonocclusive acute mesenteric ischemia induced by cardiac tamponade. DESIGN: Prospective, randomized, controlled experimental study. SETTING: Animal research laboratory at a university medical center. SUBJECTS: Ten Yorkshire pigs (weight range, 20-25 kg). INTERVENTIONS: Nonocclusive acute mesenteric ischemia was induced by pericardial tamponade. Pigs were randomized to receive either a low-dose, continuous intravenous infusion of iloprost (0.075 microg/kg/min) or an equivalent volume of normal saline to serve as the control. Infusion of iloprost or saline was continued after pericardial tamponade was reversed. METHODS: Ten anesthetized and ventilated pigs underwent laparotomy and thoracotomy. A pulmonary artery catheter was inserted, a magnetic flow probe was positioned around the superior mesenteric artery (SMA), and cannulation of the pericardial space was performed. Pericardial tamponade was induced by injecting 5% dextrose in water into the pericardial space until blood flow in the superior mesenteric artery decreased to half of baseline. After 60 mins, animals received either a continuous intravenous infusion of iloprost at 0.075 microg/kg/min (n = 6) or an equal volume of normal saline (n = 4) for 60 mins. Pericardial fluid was then removed, and iloprost or normal saline infusion was continued for another 60 mins. MEASUREMENTS: Heart rate, blood pressure, cardiac output, oxygen delivery, oxygen consumption, SMA blood flow, ileal Pco2, ileal intramucosal pH, and serum lactate levels of mixed venous blood and mesenteric venous blood were recorded at baseline, after pericardial tamponade was induced, during the iloprost or normal saline infusion with pericardial tamponade, and after removal of pericardial fluid (reperfusion period). RESULTS: Iloprost infusion increased SMA blood flow by 60% in this model of nonocclusive mesenteric ischemia (from 168 +/- 41 to 269 +/- 76 mL/min; p <.05). The effect of iloprost infusion was more prominent after the tamponade (422 +/- 87 mL/min in the iloprost group vs. 232 +/- 111 mL/min in the control group; p <.05). Increased mesenteric perfusion decreased intestinal mucosal hypercarbia, leading to improvement of intramucosal pH.     

Intra-abdominal mesenteric desmoid tumor

We have presented a case of mesenteric desmoid tumor, with analysis of 21 such cases previously reported in Japan.     

Recurrent retroperitoneal mesenteric cyst

A mesenteric cyst is an uncommon cause of a palpable abdominal mass. A correct preoperative diagnosis can be made by the combined use of radiographic and sonographic examinations in conjunction with the clinical features. A patient with a retroperitoneal cyst extending into the leaves of the mesentery is presented. The cyst recurred 4 years after surgery.     

Functional abnormalities of mesenteric blood flow

Analysis of functional as well as anatomic aspects of blood flow greatly increases the diagnostic accuracy of superior mesenteric artery angiography. In almost all normal individuals the major branches of the superior mesenteric artery empty within a span of two seconds. The corresponding draining veins all first appear within a two second span. Deviations from the pattern must be explained, as they usually signal abnormality. Five pertinent cases illustrate functional abnormalities leading to the detection of tumors where definite tumor vascularity was not demonstrated, the localization of a bleeding site where extravasation was not detected, and the recognition of obstructing adhesive bands.     

Proteomic analysis of human mesenteric lymph

Extensive animal work has established mesenteric lymph as the mechanistic link between gut ischemia/reperfusion 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 11 patients with lymphatic injuries, during semielective 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 polymorphonuclear neutrophils in a pattern similar to that observed in previous rodent, swine, and primate studies. A total of 477 proteins were identified from the 11 subjects' lymph samples with greater than 99% confidence. In addition to classic 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 proinflammatory lymph. These human data corroborate the current body of research implicating postshock 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.     

肠系膜上动脉综合征超声诊断研究

目的探讨诊断肠系膜上动脉综合征（SMAS）的方法。方法应用美国GE公司的超声诊断仪,测定腹主动脉（AO）与肠系膜上动脉（SMA）的夹角（AMA）及AO与SMA间隙距离（AMD）。结果35例正常人AMA为（38.2±12）°,7例SMAS患者为（13.5±5）°,两者比较有机显著差异。对照组AMD为（22±8）mm,SMAS组为（8±4）mm,有极显著差异（P＜0．01）。结论应用B超测定AMA与AMD诊断SMAS是针对发病机制的方法,该法简单快速、准确易重复、且患者无痛苦易接受,是较好的方法。     

Sonographic diagnosis of mesenteric hematoma.

Blunt abdominal trauma is common in children. Handlebar injuries may produce duodenal hematoma and pancreatic injuries, but mesenteric hematoma is relatively uncommon. We report a mesenteric hematoma resulting from a handlebar injury in a 4-year-old boy. Abdominal sonography showed a heterogeneous hypoechoic mass with an echogenic wall in the central portion of the abdomen. Color Doppler study revealed vascularity at the periphery of the lesion, suggesting mesenteric hematoma. CT, upper gastrointestinal endoscopy, and a small bowel x-ray series confirmed the diagnosis.     

Laparoscopic diagnosis of mesenteric venous thrombosis

Diagnosis of mesenteric venous thrombosis is almost always delayed, due to the aspecificity of the complaints and the clinical findings, as well as the laboratory investigations. Earlier diagnosis is essential to improve the present grim mortality rate. We report a case of mesenteric venous thrombosis in a 25-year-old female. Early diagnosis was made by gynecological laparoscopy. After resection and anastomosis, the outcome was uneventful.