Elevación del lactato en el postoperatorio como marcador de isquemia mesentérica aguda. Descripción de dos casos

Serum lactate is a non-specific marker of tissue hypoperfusion. Elevated serum lactate is used in the differential diagnosis of acute intestinal ischemia. Although this practice is controversial, in the absence of other validated markers lactate is still used because of its high sensitivity.We present the cases of two patients who developed acute mesenteric ischemia as a post-surgical complication. The patients reported moderate abdominal pain —a non-specific symptom in the postoperative context— and tests showed progressively increasing serum lactate levels, which facilitated suspicion and subsequent diagnostic confirmation through an imaging test.These cases highlight the physiopathological importance of lactate elevation in the perioperative context and of performing a differential diagnosis of its possible causes, including mesenteric ischemia. Although the outcome was negative in the first case, early suspicion allowed us to make an effective diagnosis and administer appropriate treatment in the second patient.     

Mesenteric and omental cysts: An ultrasonographic and clinical study of 15 patients

The clinical and ultrasonographic (US) features of 15 cases of mesenteric or omental cyst are herein described. This series included seven male and eight female patients, whose age ranged from 2–89 years. Correct clinical diagnosis was made in two children only, but preoperative US examination accurately demonstrated the lesion in 11 of 13 patients (85%). These cystic lesions usually had a thin wall, internal septations, and fluid content with sedimentation. Enteric duplication cysts had a relatively thick wall merging with the muscle layer of bowel loop, and multiloculation was noted mainly with cystic lymphangiomas or pseudocysts. The diagnostic and surgical management of these lesions are briefly reviewed and their US appearance is illustrated.     

联合门静脉和/或肠系膜上静脉切除的扩大胰十二指肠切除术

目的探讨胰头癌侵犯门静脉和／或肠系膜上静脉（PV／SMV）时的根治切除的可行性。方法回顾分析包括受侵PV／SMV在内的扩大胰头十二指肠切除术16例的临床资料。16例均行胰头十二指肠切除术，其中9例行血管壁部分切除，5例行血管节段性切除及对端吻合，2例行受侵血管切除＋自体静脉移植。结果全组患者术后均未发生血管栓塞、肠坏死、肝衰竭等并发症。除1例并发多器官衰竭于术后2d死亡外，均康复出院。15例均随访。存活超过3年者3例，超过5年者1例，存活3～26个月4例。结论对单纯侵犯PV／SMV的胰头癌施行联合PV／SMV住内的胰头癌扩大根治术是可行的。     

Hepatic falciform artery

The hepatic falciform artery is an occasional terminal branch of the left or middle hepatic artery, and may provide an uncommon but important collateral route when the principal visceral arteries are occluded.     

Mesenteric cyst with milk of calcium

A mesenteric cyst with milk of calcium in an adult patient is presented. Preoperative evaluation included plain film, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). To our knowledge, the presence of milk of calcium in a mesenteric cyst has not been previously described.     

Imaging of acute mesenteric ischemia using multidetector CT and CT angiography in a porcine model

Acute mesenteric ischemia, a frequently lethal disease, requires prompt diagnosis and intervention for favorable clinical outcomes. This goal remains elusive due, in part, to lack of a noninvasive and accurate imaging study. Traditional angiography is the diagnostic gold standard but is invasive and costly. Computed tomography (CT) is readily available and noninvasive but has shown variable success in diagnosing this disease. The faster scanning time of multidetector row CT (M.D.CT) greatly facilitates the use of CT angiography (CTA) in the clinical setting. We sought to determine whether M.D.CT-CTA could accurately demonstrate vascular anatomy and capture the earliest stages of mesenteric ischemia in a porcine model. Pigs underwent embolization of branches of the superior mesenteric artery, then imaging by M.D.CT-CTA with three-dimensional reconstruction protocols. After scanning, diseased bowel segments were surgically resected and pathologically examined. Multidetector row CT and CT angiography reliably defined normal and occluded mesenteric vessels in the pig. It detected early changes of ischemia including poor arterial enhancement and venous dilatation, which were seen in all ischemic animals. The radiographic findingsd—compared with pathologic diagnosesd—predicted ischemia, with a positive predictive value of 92%. These results indicate that M.D.CT-CTA holds great promise for the early detection necessary for successful treatment of acute mesenteric ischemia. Presented at the Forty-Sixth Annual Meeting of The Society for Surgery of the Alimentary Tract, Chicago, Illinois, May 14–18, 2005 (oral presentation). Supported by the Karin Grunebaum Research Fellowship, Harvard Medical School (D.E.R.), the German Research Fellowship, German Research Foundation STR 690/1-1 (O.S.), and the Phillip H. Meyers Grant from the Society of Gastrointestinal Radiologists (S.P.T.).     

Role of the mesenteric arteries in the arterial blood supply to the lower limbs

Summary The arteries of the gut, and in particular in the inferior mesenteric artery (a. mesenterica inferior), normally play a minimal role in supplying blood to the lower limbs. However, this is far from being the case in aorto-iliac obstruction. The anatomical anastomoses between the intestinal arterial system and the arteries of the lower limb hypertrophy and in one case out of ten become predominant.In the present study the path taken and the relations of the collaterals of the intestinal arteries and of their anastomoses have been traced, and several collateral pathways are described.

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Rôle des artères mésentériques dans la revascularisation artérielle des membres inférieurs

Résumé Les artères digestives, et en particulier l'artère mésentérique inférieure (a. mesenterica inferior), jouent à l'état normal un rôle minime dans la vascularisation des membres inférieurs. Il n'en est pas de même en cas d'oblitération aorto-iliaque. Les anastomoses anatomiques entre le système artériel digestif et les artères du membre inférieur s'hypertrophient et, dans un cas sur 10, deviennent prédominantes.Dans cette étude, le trajet et les relations des collatérales des artères digestives et leurs anastomoses sont étudiés. Plusieurs voies collatérales sont possibles.

     

Fine structure and mineral components of fibrous stonelike masses obtained from the human mesenteries

We investigated the fine structure and mineral components of 29 stonelike masses obtained from the mesenteries of four adult cadavers, using optical microscopy, backscattered electron imaging, scanning electron microscopy, energy-dispersive X-ray microanalysis, and X-ray diffraction. Although the overall appearance of the stonelike masses measuring about 5–20mm in diameter and 0.06–3.1g in dry weight was roughly grouped into smooth bulb- and uneven bulk-shaped types, all the calcified masses basically consisted of core and mantle regions. The smooth bulb-shaped masses had a broad mantle with many concentric rings, whereas the uneven bulk-shaped masses contained a large core. In their core regions, spherulitic and short bundle-shaped deposits composed of needle-shaped apatite crystals were mainly found among loose collagen fibers. Their mantle regions, on the other hand, showed the concentric structures of dense collagen fibers in the intra- and/or extrafibrous calcification with fine sandy grain-shaped deposits. The mineral elements were mainly Ca and P, and the major crystals were hydroxyapatite. Hexahedral whitlockite containing Mg was a minor component. The fiber-rich mantle regions showed lower calcification and lesser crystallization than the fiber-poor core region. When necrotic or some tumor adipose tissues and necrotic lymphoid tissues that might have been caused by some digestive diseases are recognized as foreign matter, their tissues occasionally will be calcified and grow into stonelike masses. These stonelike masses tend to occur more often in women than in men.     

肠系膜淋巴管结扎对MODS大鼠体液免疫功能的影响

目的观察结扎肠系膜淋巴管对二次打击致大鼠多器官功能障碍综合征(MODS)体液免疫功能的影响,探讨淋巴途径在MODS发病学中的意义。方法雄性Wistar大鼠均分为结扎组、未结扎组、假手术组三组。前两组以失血-LPS二次打击方法,复制大鼠MODS模型。所有动物实验前后的血清均以免疫比浊法检测IgG、IgA、IgM、C3、C4含量,同时以放射免疫法检测血清TNFα作为反映炎症的指标。结果成功复制了MODS大鼠模型。二次打击后,未结扎组大鼠血清IgG、IgA、IgM、C3、C4及TNFα均显著高于结扎组、假手术组及实验前(P<0.01～0.05),而结扎组与假手术组无显著差异(P>0.05)。结论失血-LPS二次打击可使大鼠免疫球蛋白及补体增多,反映炎症反应剧烈及抗炎反应增强,而肠系膜淋巴管结扎可缓解炎症与抗炎反应,提高存活率,对机体有较好的保护作用。