Massive upper gastrointestinal bleeding due to a ruptured superior mesenteric artery aneurysm duodenum fistula

This case report describes sudden massive upper gastrointestinal bleeding due to a ruptured superior mesenteric artery aneurysm-duodenal fistula following mitral and aortic valvular replacement surgery due to infectious endocarditis. The superior mesenteric artery false aneurysm was diagnosed by computed tomography scanning. The intraoperative findings included a rupture at the trunk of superior mesenteric artery (SMA) and a perforation on the anterior wall of the third portion of the duodenum. The patient was treated by emergency surgery, which consisted of an interposition repair of the SMA with a saphenous vein graft for the superior mesenteric artery and a duodenojejunal Roux-en-Y anastomosis for the perforation of the duodenum. At 30-months follow-up, the patient is alive and well with no abdominal pain and eating a regular diet.     

自发孤立性肠系膜上动脉夹层CT血管造影诊断

目的探讨自发孤立性肠系膜上动脉夹层（SISMAD）的CT血管造影（CTA）特征。方法回顾性分析2011年1-7月间在深圳市南山人民医院接受腹腔动脉双源CTA检查的25例不明原因的急性腹痛患者的临床资料。结果CTA检查发现4例肠系膜上动脉夹层,均为男性,年龄（45．3±6．7）岁．2例有高血压病史。4例患者CTA检查均发现肠系膜上动脉管径增粗,2例呵见内膜瓣和真假腔．1例溃疡状破口,1例壁间血肿,近段破口均位于肠系膜上动脉近段;CTA分型：Ia型2例,Ⅱb型1例。Ⅲ型1例。2例出院时进行了DSCTA复查,出现了进行性变化。结论CTA可清晰显示肠系膜上动脉夹层的特征．并能为疾病分型和随访观察提供重要依据。     

Delayed bowel necrosis due to inferior mesenteric artery occlusion in Stanford type A acute aortic dissection

Although inferior mesenteric artery occlusion due to acute aortic dissection sometimes occurs, it is usually not considered an important finding. Herein, we present an extremely rare case of delayed bowel ischaemia due to inferior mesenteric artery occlusion in Stanford type A acute aortic dissection that highlights the need for cardiac surgeons to be mindful of inferior mesenteric artery occlusion in patients with superior mesenteric artery dissection or vascular anomalies in the mesenteric arteries.     

Dissecting aneurysms of the main trunk of the superior mesenteric artery.

We treated four symptomatic patients who were admitted with a spontaneous and isolated dissecting aneurysm of the superior mesenteric artery. All four patients underwent operation. The superior mesenteric artery was repaired by means of either a bypass graft in two cases or an endoaneurysmorraphy in the latter two cases. Complete symptomatic relief with no postoperative complications was achieved in every case. The arterial repairs remained patent, and the patients remained free of symptoms, with follow-up ranging from 6 to 47 months. The available literature on this unusual lesion is reviewed.     

Superior mesenteric artery injury during en bloc excision of a massive left adrenal tumor

Superior mesenteric artery (SMA) injury is a rare event during abdominal surgery. We report the first case of inadvertent injury of the superior mesenteric artery during surgery of a large malignant adrenocortical tumor with inferior vena cava thrombus. The cause of inadvertent injury was anatomical distortion of the great vessels due to the massive nature of the tumor. The case was managed successfully by immediate end-to-end anastomosis of the superior mesenteric artery.     

Revascularization Using Arterial Conduits for Abdominal Angina Due to Isolated and Spontaneous Dissection of the Superior Mesenteric Artery

Isolated spontaneous dissection of the superior mesenteric artery is rare, and the surgical treatment is not established. We performed successfully total revascularization using arterial conduits (left radial artery and right epigastric artery) and present here the first report to our knowledge of a surgically treated case.     

Midgut Volvulus Induced Extensive Bowel Infarction

Midgut volvulus, mostly occurs due to congenital midgut malrotation, has been reported as a rare but lethal complication of some acquired medical conditions, such as postoperative adhesion bands, tumors, and mesenteric cysts. It is a surgical emergency to cause extensive bowel ischemia resulted from torsion of superior mesenteric artery. Early diagnosis and intervention is the only manner to prevent extended bowel necrosis. Here, we report a case of midgut volvulus with typical computed tomography features—the whirl sign, the transposition of the superior mesenteric artery and vein, and the ischemic change of bowel supplied by superior mesenteric artery. Early operation prevented the fate of extended bowel resection.     

Duodenal ulcer penetration into the superior mesenteric artery after percutaneous transluminal angioplasty and stent placement for acute mesenteric ischemia: report of a case

A 78-year-old male presented with the chief complaints of abdominal pain and vomiting. Contrast-enhanced computed tomography and abdominal angiography showed occlusion of the superior mesenteric artery due to thrombosis, and emergency percutaneous transluminal angioplasty and stent placement were carried out. Two months later, stent thrombosis developed, and a second stent was placed. Eight months later, he complained of general fatigue and anorexia. Gastrointestinal endoscopy revealed a duodenal ulcer at the third portion close to the superior mesenteric artery. Thirteen days after conservative management, duodenal ulcer penetration into the superior mesenteric artery with subsequent air embolism developed, and the patient died of multiple organ failure.     

Hepatic perfusion index (HPI) in mesenteric angina and following successful revascularization

This is a case report of a 45 year old man who had previously undergone a small bowel resection for acute mesenteric ischaemia. He subsequently suffered from mesenteric angina due to stenosis of the origin of the superior mesenteric artery and intermittent claudication due to aorto-iliac atheroma. The patient underwent a successful aorto-bifemoral Y graft and small bowel revascularization with a saphenous vein graft between the Y graft and the accessible proximal portion of the superior mesenteric artery. Before vascular reconstruction, the hepatic perfusion indices (HPI) in both the fasted and fed states were elevated; after mesenteric revascularization the HPI values were substantially lowered. The hepatic perfusion index may, by demonstrating functional abnormality, be useful in the diagnosis of mesenteric ischaemia and also in the assessment of treatment. Further evaluation of HPI in patients with suspected mesenteric ischaemia is therefore required.     

Aorto-mesenteric compression syndrome. Description of clinical case and critical review of the literature]

Aorto-mesenteric duodenal compression syndrome is a rare disease in which superior mesenteric artery causes a substenosis of the duodenum. Pathogenesis of this syndrome is due to congenital or acquired factors. Symptomatology is usually non specific and intermittent. Diagnosis is given by selective superior mesenteric artery angiography. Therapy is only surgery.     

Thrombosis of the superior mesenteric artery and perforation of the appendix in a young girl

Intestinal infarction is due to arterial occlusion or to a thrombosis of the superior mesenteric vein in the case of intra-abdominal sepsis. We report a case unique as far as we know of thrombosis of the superior mesenteric artery due to an appendicular abscess in a young girl without any vascular-risk.     

Inferior mesenteric artery aneurysm

This case reports a very large inferior mesenteric artery aneurysm and highlights the importance of proper preoperative arteriography in the patients work-up. In addition the case demonstrates an anomalous arterial supply to the gastrointestinal tract from a dilated inferior mesenteric artery which due to occlusion of the superior mesenteric artery and coeliac axis may have been instrumental in the development of this aneurysm.     

Mesenteric shunting during thoracoabdominal aortic clamping to prevent disseminated intravascular coagulation in dogs

The current study was undertaken to determine if cold crystalloid perfusion of the mesenteric circulation or continuous arterial shunting into the superior mesenteric artery would prevent the subsequent development of disseminated intravascular coagulation in a dog model. Twenty-two dogs were divided into four groups: those with distal aortic occlusion; those with isolated washout of the mesenteric circulation via the superior mesenteric artery with cold crystalloid; those with continuous isolated arterial perfusion of the superior mesenteric artery via an open proximal aorta; and those with shunting of blood into the superior mesenteric artery from the proximal aorta with an Inahara-Pruitt shunt. Coagulation parameters were measured for 24 hours and compared to the results with 32 dogs in the following groups: sham operation; supraceliac aortic occlusion for 30 minutes, 60 minutes, 90 minutes; superior mesenteric occlusion for 90 minutes; and celiac axis occlusion for 90 minutes. Shunting or direct arterial perfusion of the superior mesenteric artery prevented disseminated intravascular coagulation from occurring. Infrarenal aortic occlusion resulted in no change in any of the coagulation factors, whereas crystalloid perfusion of the superior mesenteric artery resulted in death in all animals. These results indicate that the disseminated intravascular coagulation that occurs with supraceliac aortic occlusion or superior mesenteric occlusion of greater then one hour can be prevented by continuous arterial perfusion of the superior mesenteric artery during proximal aortic clamping.     

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

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.     

Gastrointestinal bleeding and obstructive jaundice:Think of hepatic artery aneurysm

Hemobilia is an uncommon and potential life-threatening condition mainly due to hepato-biliary tree traumatic or iatrogenic injuries.Spontaneously ruptured aneurysm of the hepatic artery is seldom described.We report the case of an 89-year-old woman presenting with abdominal pain,jaundice and gastrointestinal bleeding,whose ultrasound and computed tomography revealed a non-traumatic,spontaneous aneurysm of the right hepatic artery.The oeso-gastro-duodenoscopy and colonoscopy did not reveal any bleeding at the ampulla of Vater,nor anywhere else.Selective angiography confirmed the diagnosis of hepatic artery aneurysm and revealed a full hepatic artery originating from the superior mesenteric artery.The patient was successfully treated by selective embolization of microcoils.We discuss the etiologies of hemobilia and its treatment with selective embolization,which remains favored over surgical treatment.Although aneurysm of the hepatic artery is rare,especially without trauma,a high index of suspicion is needed in order to ensure appropriate treatment.     

62例急性肠系膜上动脉栓塞的诊断和治疗

目的探讨急性肠系膜上动脉栓塞的临床表现及早期诊断和治疗方法。方法回顾性分析62例急性肠系膜上动脉栓塞患者的临床资料。结果术前确诊22例(35.5%)。62例患者均行肠系膜上动脉切开取栓,58例患者行坏死肠管切除术,其中35例患者行多次肠管切除术。术后16例患者死亡(25.8%)。术后随访3～24个月。结论肠系膜上动脉栓塞误诊率高,病死率高。对心律失常特别是房颤、心脏瓣膜病及既往有急性动脉栓塞病史患者突发剧烈腹痛,应警惕肠系膜上动脉栓塞可能。肠系膜上动脉切开取栓是治疗急性肠系膜上动脉栓塞缩小肠管切除范围有效方法。     

Successful management in the case of mesenteric ischemia complicated with acute type a dissection.

We report a case of acute type A dissection with ischemic enterocolitis due to blood flow insufficiency in the superior mesenteric artery. A 67 year-old man, with medicated ischemic heart disease and hypertension, presented to another hospital with chest pain radiating to the back and epigastrium. Contrast-enhanced computed tomography revealed a type A dissecting aneurysm, that extended from the ascending aorta to the left common iliac artery, with a 50-mm diameter in the ascending aorta. Celiac trunk and left renal artery arose from the false lumen, and the superior mesenteric artery (SMA) was compressed by the thrombosed false lumen. Symptoms of acute mesenteric ischemia clearly developed. Then, a large amount of tarry stool (melena) was discharged. First, an emergency saphenous vein bypass was performed from the common iliac artery to the superior mesenteric artery at the orifice of the ileocolic artery where it was free from dissection. Then total arch replacement was performed using cardiopulmonary bypass. The patient's postoperative course was uneventful, and the abdominal symptoms completely disappeared. This case demonstrates that prompt surgical relief of ischemia in major organs is important to save lives in the cases of acute aortic dissection with ischemic complications.     

Surgical treatment of spontaneous dissection of the superior mesenteric artery: a case report.

A case of a 46-year-old man with spontaneous dissection of the superior mesenteric artery (SMA) demonstrated by ultrasonography is presented. He was successfully treated by emergency aorto-SMA bypass surgery, but complicated with bilateral internal iliac aneurysm. The patient has remained asymptomatic with full employment.     

Superior mesenteric artery stenting to augment splenorenal arterial bypass for intractable complex renovascular hypertension

An alternative source of visceral arterial inflow is sometimes necessary for renal revascularization when aortorenal endarterectomy or bypass is inappropriate due to severely diseased aorta. We report the case of a 46-year-old male with recurrent intractable renovascular hypertension in renal failure secondary to occlusion of the celiac axis due to progression of aortoarteritis following splenorenal arterial bypass performed 5 years before. Aortogram visualized intestinal arterial arcade supporting patent bypass with critically stenosed superior mesenteric artery. Successful angioplasty with stenting of superior mesenteric artery restored adequate renal flow through the bypass leading to recovery and easy control of hypertension.