The article"Assessment of superior mesenteric vascular flow quantitation in children using four-dimensional flow magnetic resonance imaging"suggests to use of four-dimensional(4D)flow magnetic resonance imag...The article"Assessment of superior mesenteric vascular flow quantitation in children using four-dimensional flow magnetic resonance imaging"suggests to use of four-dimensional(4D)flow magnetic resonance imaging(MRI)which is also to measure the blood flow in the superior mesenteric vein(SMV)in pediatric patients over the traditional method.The study focuses on assessing the potential of SMV and superior mesenteric artery(SMA)flow quantification in children utilizing 4D flow MRI.It included 9 pediatric patients aged 18 years and below where 5 were male and 4 were female patients,on whom magnetic resonance enterorrhaphy(MRE)with 4D flow MRI protocol was used.Statistical analysis was performed using MedCalc.Measurements of SMV and SMA between two readers were calculated using Bland-Altman analysis.The results stated that six patients showed no MRE evidence of active inflammatory bowel disease,two patients showed unmarkable bowel appearance on MRI and one patient showed normal MRE without endoscopy performed at the same timeframe.The study utilized available 4D flow MRI sequences in this study aiming to show the feasibility of 4D flow quantitation of SMA and SMV flow in pediatric patients.The study also discovered good agreement for both peak velocity and peak speed measurements of SMA and SMV.展开更多
Intestinal autotransplantation(IATx)allows for radical resection to be performed on selected patients with superior mesenteric artery(SMA)involvement.However,the complexity of IATx is a major consideration.This surgic...Intestinal autotransplantation(IATx)allows for radical resection to be performed on selected patients with superior mesenteric artery(SMA)involvement.However,the complexity of IATx is a major consideration.This surgical technique requires a simpler approach,shorter operative time and lower perioperative risk.Our group has successfully pioneered a semi-ex vivo IATx approach for patients with locally advanced pancreatic cancer with the SMA,superior mesenteric vein(SMV),and jejunal artery(JA)branch involvement.The present report illustrates how this operation was carried out.At a follow-up of up to 8 months,there were no signs of tumor recurrence.展开更多
BACKGROUND Four-dimensional(4D)flow magnetic resonance imaging(MRI)is used as a noninvasive modality for assessing hemodynamic information with neurovascular and body applications.The application of 4D flow MRI for as...BACKGROUND Four-dimensional(4D)flow magnetic resonance imaging(MRI)is used as a noninvasive modality for assessing hemodynamic information with neurovascular and body applications.The application of 4D flow MRI for assessment of bowel disease in children has not been previously described.AIM To determine feasibility of superior mesenteric venous and arterial flow quantitation in pediatric patients using 4D flow MRI.METHODS Nine pediatric patients(7-14 years old,5 male and 4 female)with history or suspicion of bowel pathology,who underwent magnetic resonance(MR)enterography with 4D flow MR protocol from November 2022 to October 2023.Field strength/sequence:3T MRI using 4D flow MR protocol.Flow velocity and peak speed measurements were performed by two diagnostic radiologists placing the region of interest in perpendicular plane to blood flow on each cross section of superior mesenteric artery(SMA)and superior mesenteric vein(SMV)at three predetermined levels.Bland-Altman analysis,showed good agreement of flow velocity and peak speed measurements of SMV and SMA between two readers.RESULTS Mean SMV flow velocity increased from proximal to mid to distal(0.14 L/minute,0.17 L/minute,0.22 L/minute respectively).Mean SMA flow velocity decreased from proximal to mid to distal(0.35 L/minute,0.27 L/minute,0.21 L/minute respectively).Observed agreement was good for flow velocity measurements of SMV(mean bias-0.01 L/minute and 95%limits of agreement,-0.09 to 0.08 L/minute)and SMA(mean bias-0.03 L/minute and 95%limits of agreement,-0.23 to 0.17 L/minute)between two readers.Good agreement for peak speed measurements of SMV(mean bias-1.2 cm/second and 95%limits of agreement,-9.4 to 7.0 cm/second)and SMA(mean bias-3.2 cm/second and 95%limits of agreement,-31.4 to 24.9 cm/second).CONCLUSION Flow quantitation using 4D Flow is feasible to provide hemodynamic information for SMV and SMA in children.展开更多
BACKGROUND Acute mesenteric ischemia is a life-threatening disease.Intrasplenic gas is an extremely rare finding in such cases.CASE SUMMARY We report a case of a 79-year-old woman with a history of end-stage renal dis...BACKGROUND Acute mesenteric ischemia is a life-threatening disease.Intrasplenic gas is an extremely rare finding in such cases.CASE SUMMARY We report a case of a 79-year-old woman with a history of end-stage renal disease on hemodialysis for approximately 20 years,type 2 diabetes mellitus,and atrial fibrillation who presented with two days of epigastric pain.A computed tomography scan of the abdomen revealed intraperitoneal free air and significant intrasplenic gas.Laparoscopy revealed diffuse intestinal gangrene,and acute superior mesenteric ischemia was diagnosed.The patient died within 24 hours owing to profound shock.CONCLUSION Intrasplenic gas is an extremely rare finding on computed tomography imaging in cases of acute mesenteric ischemia.展开更多
BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of ...BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of patients after pancreatic resections.Globally recognized superior mesenteric artery(SMA)first approaches are invariably performed.The mesenteric dissection through the inferior infracolic approach has been discussed in this study emphasizing its post-operative impact on CL which is the cornerstone of this study.AIM To assess incidence,risk factors,clinical impact of CL following root of mesentery dissection,and the different treatment modalities.METHODS This is a retrospective study incorporating the patients who underwent dissection of the root of mesentery with inferior infracolic SMA first approach pancreat-oduodenectomy for the ventral body and uncinate mass of pancreas in the Department of Gastrointestinal and General Surgery of Kathmandu Medical College and Teaching Hospital from January 1,2021 to February 28,2024.Intraop-erative findings and postoperative outcomes were analyzed.RESULTS In three years,ten patients underwent root of mesentery dissection with inferior infracolic SMA first approach pancreatoduodenectomy.The mean age was 67.6 years with a male-to-female ratio of 4:5.CL was seen in four patients.With virtue of CL,Clavien-Dindo grade Ⅱ or higher morbidity was observed in four patients.Two patients had a hospital stay of more than 20 days with the former having a delayed gastric emptying and the latter with long-term total parenteral nutrition requirement.The mean operative time was 330 minutes.Curative resection was achieved in 100%of the patients.The mean duration of the intensive care unit and hospital stay were 2.55±1.45 days and 15.7±5.32 days,respectively.CONCLUSION Root of mesentery dissection with lymphadenectomy and vascular resection correlated with occurrence of CL.After complete curative resection,these were managed with total parenteral nutrition without adversely impacting outcome.展开更多
BACKGROUND Inferior mesenteric arteriovenous fistula(IMAVF)is an extremely rare condition characterized by abnormal communication between the inferior mesenteric artery and vein.IMAVF often mimics ischemic bowel disea...BACKGROUND Inferior mesenteric arteriovenous fistula(IMAVF)is an extremely rare condition characterized by abnormal communication between the inferior mesenteric artery and vein.IMAVF often mimics ischemic bowel disease and ulcerative colitis(UC),leading to diagnostic challenges and treatment failures.CASE SUMMARY Three consecutive cases presented with non-specific symptoms including perianal pain and bloody diarrhea were reported.Initial diagnosis included acute severe UC and ischemic colitis.Pathology suggested ischemic changes,and with further contrast-enhanced computed tomography together with digital subtraction angiography which confirmed the diagnosis of IMAVF.All three cases were treated by vascular embolization,and symptoms improved rapidly following treatment.CONCLUSION We presented the largest single center IMAVF series with detailed clinical characteristics,facilitating early diagnosis for similar cases in the future.展开更多
BACKGROUND Idiopathic mesenteric phlebosclerosis(IMP)is a rare condition that causes ischaemic colitis,has various clinical manifestations,and may even be asymptomatic,often resulting in clinical misdiagnosis.CASE SUM...BACKGROUND Idiopathic mesenteric phlebosclerosis(IMP)is a rare condition that causes ischaemic colitis,has various clinical manifestations,and may even be asymptomatic,often resulting in clinical misdiagnosis.CASE SUMMARY We report the case of a 44-year-old woman with chief complaints of abdominal pain,vomiting and decreased defecation.One year prior,the patient was asymptomatic and therefore misdiagnosed with inflammatory bowel disease based on incidental findings on an abdominal computed tomography(CT)scan.The present abdominal CT scan revealed an intestinal obstruction,diffuse thickening of the entire colon wall and calcification of the mesenteric and colonic veins.Colonoscopy revealed multiple ulcerations and extensive dark purple discolouration of the oedematous mucosa.Colonic transit studies suggested a decrease in colonic motility.IMP was considered the underlying cause of her pseudoileus,which was potentially linked to her consumption of Chinese medicinal teas for more than 30 years.The patient underwent conservative medical treatment,and her symptoms gradually improved.She exhibited no signs of ileus or other significant discomfort at the outpatient follow-up one year after the discontinuation of Chinese herbal tea consumption.CONCLUSION IMP can present with symptoms of pseudoileus as initial complication.Clinicians can use CT and colonoscopy for differential diagnoses.展开更多
Heterotopic mesenteric ossification(HMO)is a rare medical condition,with<100 cases reported globally by 2024.This disorder is characterized by abnormal bone tissue formation within the mesentery,often following abd...Heterotopic mesenteric ossification(HMO)is a rare medical condition,with<100 cases reported globally by 2024.This disorder is characterized by abnormal bone tissue formation within the mesentery,often following abdominal trauma,ischemia,or infection.This editorial reviews the case presented by Zhang et al,involving a 34-year-old male who developed persistent left lower abdominal pain after sustaining blunt trauma to the abdomen.Diagnostic challenges arose due to the rarity and nonspecific presentation of HMO,which shares histopathological features with conditions such as myositis ossificans and necessitates differentiation from malignancies like sarcomas.Advanced imaging revealed calcifications suggestive of HMO,but definitive diagnosis was achieved only through surgical resection and histopathological analysis,which confirmed the presence of ectopic bone formation.Although benign,HMO can result in severe complications,such as bowel perforation or obstruction.Therefore,awareness of HMO is crucial for clinicians to ensure timely and appropriate treatment.展开更多
BACKGROUND Idiopathic myointimal hyperplasia of the mesenteric veins(IMHMV)is a rare disease characterized by narrowing of the lumen caused by mesenteric vein intimal hyperplasia,resulting in chronic intestinal ischem...BACKGROUND Idiopathic myointimal hyperplasia of the mesenteric veins(IMHMV)is a rare disease characterized by narrowing of the lumen caused by mesenteric vein intimal hyperplasia,resulting in chronic intestinal ischemia.Although the colorectum is the primary site affected by this condition,involvement of the small intestine is even more rare.Recurrence of IMHMV after surgical resection of the affected bowel is uncommon.CASE SUMMARY In this case report,we present a unique instance of IMHMV exclusively occurring in the small intestine.The patient experienced small intestinal perforation,infarction,and obstruction before receiving a clear diagnosis,which was achieved only during the third operation.In this review,we analyzed 84 reported cases to summarize the etiology,clinical manifestations,and diagnostic challenges of IMHMV,with the aim of raising awareness regarding this rare condition among clinicians.CONCLUSION Notably,IMHMV can also affect the small intestine alone.When refractory enteritis with endoscopic findings of nonspecific ischemic changes is encountered,IMHMV should be considered for potential diagnosis.展开更多
BACKGROUND Irreversible transmural intestinal necrosis(ITIN)is associated with high mortality rates in patients with acute occlusive mesenteric ischemia(AOMI).Currently,there are not many studies on the use of dual en...BACKGROUND Irreversible transmural intestinal necrosis(ITIN)is associated with high mortality rates in patients with acute occlusive mesenteric ischemia(AOMI).Currently,there are not many studies on the use of dual energy computed tomography(DECT)for evaluating ITIN.AIM To evaluate the diagnostic value of DECT for ITIN in AOMI.METHODS The cases and computed tomography(CT)images of 102 patients with clinically diagnosed AOMI(including 48 ITIN)from January 2012 to January 2022 were retrospectively collected.The CT scans included both multidetector CT and DECT.The raw data from DECT portal-venous phase were reconstructed into 120 kVp mixed energy image,50 keV virtual monoenergetic imaging,and iodine map.Two radiologists independently completed the subjective visual assessment of CT signs related to AOMI.Objective parameters,including the attenuation of the normal and_(lesion)intestinal wall segment(CT50 keV_(lesion),CT_(50 keV normal/lesion))and iodine concentrations(IC_(lesion)and I_(Cnormal/lesion)),were quantified.Furthermore,multivariate logistic regression,receiver operating characteristic curves,and area under the curve(AUC)values were used to evaluate the subjective and objective indicators in predicting ITIN.RESULTS Regarding subjective signs,logistic regression analysis revealed reduced or absent bowel wall enhancement[odds ratio(OR)=5.576,95%confidence interval(CI):1.547-20.093],bowel dilation(OR=11.613,95%CI:3.790-35.586),and parenchymatous organ infarction(OR=4.727,95%CI:1.536-14.551)were independent risk factors for the ITIN.CT subjective signs had a high diagnostic efficacy for ITIN(AUC=0.853).The two DECT objective parameters also exhibited excellent diagnostic value for ITIN,with an AUC of 0.79,a cut-off value of CT50 keV normal/_(lesion)=2.81,and an AUC of 0.777 with a cut-off value of I_(Cnormal/lesion)=2.39.The Delong test showed that there was no significant difference in the efficacy of subjective CT signs and objective DECT parameters(P>0.05).Importantly,we observed that I_(Cnormal/lesion)combined with subjective signs(bowel dilation and parenchymatous organ infarction)had the highest predictive performance(AUC=0.894),sensitivity(100%),and specificity(70.83%),which was statistically different from the AUC of CT subjective signs(P=0.017).CONCLUSION I_(Cnormal/lesion)(DECT-based features)combined with CT subjective signs(bowel dilatation and parenchymatous organ infarction)showed favorable predictive performance for ITIN in AOMI,which may help clinicians develop timely treatment strategies.展开更多
BACKGROUND Acute mesenteric vein thrombosis(MVT)accounts for only 2%–10%of all cases of acute mesenteric ischaemia,with an incidence rate of~0.1%in Europe and the United States.It represents<10%of mesenteric infar...BACKGROUND Acute mesenteric vein thrombosis(MVT)accounts for only 2%–10%of all cases of acute mesenteric ischaemia,with an incidence rate of~0.1%in Europe and the United States.It represents<10%of mesenteric infarction cases and is seen predominantly in older adults.In younger individuals,MVT is uncommon,with 36%of cases having unidentified mechanisms and causes.CASE SUMMARY A 27-year-old man presented to the emergency department on February 29,2024,with a chief complaint of intermittent abdominal pain for 3 day.He was previously in good health.As the abdominal pain was not alleviated by conventional treatment,an abdominal computed tomography(CT)scan was performed,which showed increased density in the portal and mesenteric veins.Further imaging,including portal vein ultrasound,mesenteric CT angiography,and enhanced abdominal CT,revealed widespread thrombosis of the portal vein system(including the main portal vein,left and right branches,proximal mesenteric vein,and splenic vein).After 10 day of thrombectomy and anticoagulation therapy,the patient’s abdominal pain had improved significantly.Follow-up assessments indicated that portal venous blood flow had largely returned to normal.He was discharged on March 9,2024.During a follow-up exam 2 months later,repeat abdominal enhanced CT showed that the previously detected thrombi were no longer visible.CONCLUSION Clinicians should remain vigilant for acute MVT in young patients presenting with abdominal pain,to prevent misdiagnosis of this fatal condition.展开更多
BACKGROUND Superior mesenteric artery(SMA)syndrome is a rare cause of duodenal obstruction by extrinsic compression between the SMA and the aorta(SMA-Ao).Although the left lateral recumbent position is considered effe...BACKGROUND Superior mesenteric artery(SMA)syndrome is a rare cause of duodenal obstruction by extrinsic compression between the SMA and the aorta(SMA-Ao).Although the left lateral recumbent position is considered effective in the treatment of SMA syndrome,individual variations in the optimal patient position have been noted.In this report,we present two elderly cases of SMA syndrome that exhibited rapid recovery due to ultrasonographic dynamic evaluation of the optimal position for each patient.CASE SUMMARY Case 1:A 90-year-old man with nausea and vomiting.Following diagnosis of SMA syndrome by computed tomography(CT),ultrasonography(US)revealed the SMA-Ao distance in the supine position(4 mm),which slightly improved in the lateral position(5.7–7.0 mm)without the passage of duodenal contents.However,in the sitting position,the SMA-Ao distance was increased to 15 mm accompanied by improved content passage.Additionally,US indicated enhanced passage upon abdominal massage on the right side.By day 2,the patient could eat comfortably with the optimal position and massage.Case 2:An 87-year-old woman with vomiting.After the diagnosis of SMA syndrome and aspiration pneumonia by CT,dynamic US confirmed the optimal position(SMA-Ao distance was improved to 7 mm in forward-bent position,whereas it remained at 5 mm in the supine position).By day 7 when her pneumonia recovered,she could eat with the optimal position.CONCLUSION The optimal position for SMA syndrome varies among individuals.Dynamic US appears to be a valuable tool in improving patient outcomes.展开更多
Background:Visceral adipose tissue(VAT)has been linked to the severe acute pancreatitis(SAP)prognosis,although the underlying mechanism remains unclear.It has been reported that pyroptosis worsens SAP.The present stud...Background:Visceral adipose tissue(VAT)has been linked to the severe acute pancreatitis(SAP)prognosis,although the underlying mechanism remains unclear.It has been reported that pyroptosis worsens SAP.The present study aimed to verify whether mesenteric adipose tissue(MAT,a component of VAT)can cause secondary intestinal injury through the pyroptotic pathway.Methods:Thirty-six male Sprague Dawley(SD)rats were divided into six different groups.Twelve rats were randomly divided into the SAP and control groups.We monitored the changes of MAT and B lymphocytes infiltration in MAT of SAP rats.Twelve SAP rats were injected with MAT B lymphocytes or phosphate buffer solution(PBS).The remaining twelve SAP rats were first injected with MAT B lymphocytes,and then with MCC950(NLRP3 inhibitor)or PBS.We collected blood and tissue samples from pancreas,gut and MAT for analysis.Results:Compared to the control rats,the SAP group showed inflammation in MAT,including higher expression of tumor necrosis factor(TNF-α)and interleukin-6(IL-6),lower expression of IL-10,and histological changes.Flow cytometry analysis revealed B lymphocytes infiltration in MAT but not T lymphocytes and macrophages.The SAP rats also exhibited intestinal injury,characterized by lower expression of zonula occludens-1(ZO-1)and occludin,higher levels of lipopolysaccharide and diamine oxidase,and pathological changes.The expression of NLRP3 and n-GSDMD,which are responsible for pyroptosis,was increased in the intestine of SAP rats.The injection of MAT B lymphocytes into SAP rats exacerbated the inflammation in MAT.The upregulation of pyroptosis reduced tight junction in the intestine,which contributed to the SAP progression,including higher inflammatory indicators and worse histological changes.The administration of MCC950 to SAP+MAT B rats downregulated pyroptosis,which subsequently improved the intestinal barrier and ameliorated inflammatory response of SAP.Conclusions:In SAP,MAT B lymphocytes aggravated local inflammation,and promoted the injury to the intestine through the enteric pyroptotic pathway.展开更多
In this letter,we commented on the article by Wu et al.We examined the interactions between mesenteric adipose tissue,creeping fat,and gut microbiota in Crohn’s disease(CD),a condition marked by chronic gastrointesti...In this letter,we commented on the article by Wu et al.We examined the interactions between mesenteric adipose tissue,creeping fat,and gut microbiota in Crohn’s disease(CD),a condition marked by chronic gastrointestinal inflammation with a rising global incidence.The pathogenesis of CD involves complex genetic,environmental,and microbial factors.Dysbiosis,which is an imbalance in gut microbial communities,is frequently observed in CD patients,highlighting the pivotal role of the gut microbiota in disease progression and the inflammatory response.Recent studies have shown that mesenteric adipose tissue and creeping fat actively contribute to inflammation by producing proinflammatory cytokines.The relationship between creeping fat and altered microbiota can shift from a potentially protective role to one that encourages bacterial translocation,further complicating disease management.Recent research has suggested that fecal microbiota transplantation could help restore microbial balance,offering a promising therapeutic strategy to improve clinical disease response.展开更多
BACKGROUND Advanced rectal cancer with submesenteric lymph node metastasis is a common complication of advanced rectal cancer,which has an important impact on the treatment and prognosis of patients.AIM To investigate...BACKGROUND Advanced rectal cancer with submesenteric lymph node metastasis is a common complication of advanced rectal cancer,which has an important impact on the treatment and prognosis of patients.AIM To investigate the clinical and pathological characteristics of inferior mesenteric artery(IMA)root lymph node metastases in patients with rectal cancer.The findings of this study provided us with fresh medical information that assisted us in determining the appropriate treatment for these patients.METHODS Our study searched PubMed,Google Scholar,and other databases and searched the relevant studies and reports on the risk factors of IMA root lymph node metastasis of rectal cancer published in the self-built database until December 31,2023.After data extraction,the Newcastle-Ottawa scale was used to evaluate the quality of the included literature,and RevMan5.3 software was used for meta-analysis and heterogeneity testing.The fixed effect modules without heterogeneity were selected to combine the effect size,and the random effect modules with heterogeneity were selected to combine the effect size.The cause of heterogeneity was found through sensitivity analysis,and the data of various risk factors were combined to obtain the final effect size,odds ratio(OR)value,and 95%confidence interval(CI).Publication bias was tested by drawing funnel plots.RESULTS A total of seven literature were included in this study.By combining the OR value of logistic multivariate regression and the 95%CI of various risk factors,we concluded that the risk factors for lymph node metastasis in the IMA region of rectal cancer were as follows:Preoperative carcinoembryonic antigen(CEA)>5 ng/mL(OR=0.32,95%CI:0.18-0.55,P<0.05),tumor located above peritoneal reflexive(OR=3.10,95%CI:1.78-5.42,P<0.05),tumor size≥5 cm(OR=0.36,95%CI:0.22-0.57,P<0.05),pathological type(mucinous adenocarcinoma/sig-ring cell carcinoma)(OR=0.23,95%CI:0.13-0.41,P<0.05),degree of tumor differentiation(low differentiation)(OR=0.17,95%CI:0.10-0.31,P<0.05),tumor stage(T3-4 stage)(OR=0.11,95%CI:0.04-0.26,P<0.05),gender and age were not risk factors for IMA root lymph node metastasis in rectal cancer(P>0.05).CONCLUSION Preoperative CEA level,tumor location,tumor size,tumor pathologic type,tumor differentiation,and T stage were correlated with IMA root lymph node metastasis.展开更多
BACKGROUND Cystic lymphangioma is a rare benign tumor that affects the lymphatic system.Mesenteric lymphangiomas in the small bowel are extremely uncommon.CASE SUMMARY We present a 21-year-old female patient who compl...BACKGROUND Cystic lymphangioma is a rare benign tumor that affects the lymphatic system.Mesenteric lymphangiomas in the small bowel are extremely uncommon.CASE SUMMARY We present a 21-year-old female patient who complained of abdominal pain.The diagnosis of ovarian torsion was suspected after abdominopelvic unenhanced computed tomography and ultrasound revealed a large cyst in contact with the bladder,ovary,and uterus.The patient underwent emergency laparotomy per-formed by gynecologists,but it was discovered that the cystic tumor originated from the jejunum.Gastrointestinal surgeons were then called in to perform a cystectomy.Pathological examination confirmed the diagnosis of cystic lymphangioma of the mesentery.The patient had an uneventful postoperative recovery.CONCLUSION Mesenteric lymphangiomas can cause abdominal pain,and imaging techniques can help determine their characteristics,location,and size.Complete surgical excision and pathological examination are considered the standard treatment and diagnostic method.展开更多
BACKGROUND Cyclic vomiting syndrome(CVS)is a chronic functional gastrointestinal disorder involving the gut–brain interaction that is characterized by recurring episodes of nausea,vomiting,abdominal pain,and interspe...BACKGROUND Cyclic vomiting syndrome(CVS)is a chronic functional gastrointestinal disorder involving the gut–brain interaction that is characterized by recurring episodes of nausea,vomiting,abdominal pain,and interspersed complete normal periods.Superior mesenteric artery(SMA)syndrome(SMAS)is a vascular condition in which the horizontal portion of the duodenum is compressed due to a reduced angle between the aorta and the SMA.This condition presents with symptoms similar to CVS,posing challenges in distinguishing between the two and often resulting in misdiagnosis or inappropriate treatment.CASE SUMMARY A 20-year-old female patient presented with recurrent episodes of vomiting and experienced a persistent fear of vomiting for the past 2 years.She adopted conscious dietary restrictions,which led to severe malnutrition.Initially,she was diagnosed with SMAS,as revealed by computed tomography angiography.Despite efforts to increase the angle between the aorta and the SMA through weight gain,her vomiting did not improve.Finally,she was diagnosed with comorbidities including CVS,SMAS and anxiety disorder.She underwent comprehensive interventions,including enteral and parenteral nutritional supplementation,administration of antiemetic and anti-anxiety agents,and participation in mindfulness-based cognitive therapy.The patient eventually experienced a notable improvement in both body weight and clinical symptoms.CONCLUSION We present a rare case of CVS in an adult complicated with SMAS and propose additional treatment with nutritional support,pharmacological intervention,and psychotherapy.展开更多
BACKGROUND Idiopathic mesenteric phlebosclerosis(IMP)is a rare type of ischemic colitis characterized by thickening of the wall of the right hemicolon and calcification,sclerosis,and fibrosis of mesenteric veins.The d...BACKGROUND Idiopathic mesenteric phlebosclerosis(IMP)is a rare type of ischemic colitis characterized by thickening of the wall of the right hemicolon and calcification,sclerosis,and fibrosis of mesenteric veins.The diagnosis of IMP is based on typical clinical features and imaging findings.We report a case of IMP that was initially missed by the radiologist.CASE SUMMARY A 77-year-old woman was admitted to the hospital due to chronic diarrhea for over 2 months.She had been consuming Chinese patent medicines(CPM)containing fructus gardeniae for more than 15 years.Colonoscopy revealed an edematous mucosa,bluish-purple discoloration,erosions,and ulcerations throughout the colorectal area.Abdominal computed tomography(CT)showed diffuse mural thickening of the entire colorectum,with tortuous thread-like calcifications in the right hemicolon,left hemicolon,and rectum.Most of the calcifications were located in the mesenteric vein.The diagnosis of IMP was established based on medical history,colonoscopy,CT findings,and histopathological examination.The patient was treated conservatively with papaverine and rifaximin,and CPM was stopped.Her diarrhea symptoms improved,indicating the effectiveness of the treatment.Over the next several years,she took opium alkaloids for an extended period and did not require hospitalization for the aforementioned gastrointestinal disorder.CONCLUSION IMP is a rare gastrointestinal disease affecting Asian populations,possibly related to long-term herbal medicine intake.Accurate imaging analysis is crucial for diagnosis,but insufficient understanding of the disease can lead to misdiagnosis or missed diagnosis.Treatment strategies should be personalized.展开更多
BACKGROUND Superior mesenteric artery(SMA)injuries rarely occur during blunt abdominal injuries,with an incidence of<1%.The clinical manifestations mainly include abdominal hemorrhage and peritoneal irritation,whic...BACKGROUND Superior mesenteric artery(SMA)injuries rarely occur during blunt abdominal injuries,with an incidence of<1%.The clinical manifestations mainly include abdominal hemorrhage and peritoneal irritation,which progress rapidly and are easily misdiagnosed.Quick and accurate diagnosis and timely effective treatment are greatly significant in managing emergent cases.This report describes emergency rescue by a multidisciplinary team of a patient with hemorrhagic shock caused by SMA rupture.CASE SUMMARY A 55-year-old man with hemorrhagic shock presented with SMA rupture.On admission,he showed extremely unstable vital signs and was unconscious with a laceration on his head,heart rate of 143 beats/min,shallow and fast breathing(frequency>35 beats/min),and blood pressure as low as 20/10 mmHg(1 mmHg=0.133 kPa).Computed tomography revealed abdominal and pelvic hematocele effusion,suggesting active bleeding.The patient was suspected of partial rupture of the distal SMA branch.The patient underwent emergency mesenteric artery ligation,scalp suture,and liver laceration closure.In view of conditions with acute onset,rapid progression,and high bleeding volume,key points of nursing were conducted,including activating emergency protocol,opening of the green channel,and arranging relevant examinations with various medical staff for quick diagnosis.The seamless collaboration of the multidisciplinary team helped shorten the preoperative preparation time.Emergency laparotomy exploration and mesenteric artery ligation were performed to mitigate hemorrhagic shock while establishing efficient venous accesses and closely monitoring the patient’s condition to ensure hemodynamic stability.Strict measures were taken to avoid intraoperative hypothermia and infection.CONCLUSION After 3.5 h of emergency rescue and medical care,bleeding was successfully controlled,and the patient’s condition was stabilized.Subsequently,the patient was transferred to the intensive care unit for continuous monitoring and treatment.On the sixth day,the patient was weaned off the ventilator,extubated,and relocated to a specialized ward.Through diligent medical intervention and attentive nursing,the patient made a full recovery and was discharged on day 22.The follow-up visit confirmed the patient’s successful recovery.展开更多
BACKGROUND This study aimed to describe the findings of double superior mesenteric veins(SMVs),a rare anatomical variation,on multidetector computer tomography(MDCT)and magnetic resonance imaging(MRI)images.CASE SUMMA...BACKGROUND This study aimed to describe the findings of double superior mesenteric veins(SMVs),a rare anatomical variation,on multidetector computer tomography(MDCT)and magnetic resonance imaging(MRI)images.CASE SUMMARY We describe the case of a 34-year-old male,who underwent both MDC and MRI examinations of the upper abdomen because of liver cirrhosis.MDCT and MRI angiography images of the upper abdomen revealed an anatomic variation of the superior mesenteric vein(SMV),the double SMVs.CONCLUSION The double SMVs are a congenital abnormality without potential clinical manifestation.Physicians need to be aware of this anatomical variation during abdominal surgery to avoid iatrogenic injury.展开更多
文摘The article"Assessment of superior mesenteric vascular flow quantitation in children using four-dimensional flow magnetic resonance imaging"suggests to use of four-dimensional(4D)flow magnetic resonance imaging(MRI)which is also to measure the blood flow in the superior mesenteric vein(SMV)in pediatric patients over the traditional method.The study focuses on assessing the potential of SMV and superior mesenteric artery(SMA)flow quantification in children utilizing 4D flow MRI.It included 9 pediatric patients aged 18 years and below where 5 were male and 4 were female patients,on whom magnetic resonance enterorrhaphy(MRE)with 4D flow MRI protocol was used.Statistical analysis was performed using MedCalc.Measurements of SMV and SMA between two readers were calculated using Bland-Altman analysis.The results stated that six patients showed no MRE evidence of active inflammatory bowel disease,two patients showed unmarkable bowel appearance on MRI and one patient showed normal MRE without endoscopy performed at the same timeframe.The study utilized available 4D flow MRI sequences in this study aiming to show the feasibility of 4D flow quantitation of SMA and SMV flow in pediatric patients.The study also discovered good agreement for both peak velocity and peak speed measurements of SMA and SMV.
基金supported by grants from the National Natural Science Foundation of China(82373189)the Science and Technology Department of Sichuan Province(2021YFS0375 and2022YFS0596)。
文摘Intestinal autotransplantation(IATx)allows for radical resection to be performed on selected patients with superior mesenteric artery(SMA)involvement.However,the complexity of IATx is a major consideration.This surgical technique requires a simpler approach,shorter operative time and lower perioperative risk.Our group has successfully pioneered a semi-ex vivo IATx approach for patients with locally advanced pancreatic cancer with the SMA,superior mesenteric vein(SMV),and jejunal artery(JA)branch involvement.The present report illustrates how this operation was carried out.At a follow-up of up to 8 months,there were no signs of tumor recurrence.
文摘BACKGROUND Four-dimensional(4D)flow magnetic resonance imaging(MRI)is used as a noninvasive modality for assessing hemodynamic information with neurovascular and body applications.The application of 4D flow MRI for assessment of bowel disease in children has not been previously described.AIM To determine feasibility of superior mesenteric venous and arterial flow quantitation in pediatric patients using 4D flow MRI.METHODS Nine pediatric patients(7-14 years old,5 male and 4 female)with history or suspicion of bowel pathology,who underwent magnetic resonance(MR)enterography with 4D flow MR protocol from November 2022 to October 2023.Field strength/sequence:3T MRI using 4D flow MR protocol.Flow velocity and peak speed measurements were performed by two diagnostic radiologists placing the region of interest in perpendicular plane to blood flow on each cross section of superior mesenteric artery(SMA)and superior mesenteric vein(SMV)at three predetermined levels.Bland-Altman analysis,showed good agreement of flow velocity and peak speed measurements of SMV and SMA between two readers.RESULTS Mean SMV flow velocity increased from proximal to mid to distal(0.14 L/minute,0.17 L/minute,0.22 L/minute respectively).Mean SMA flow velocity decreased from proximal to mid to distal(0.35 L/minute,0.27 L/minute,0.21 L/minute respectively).Observed agreement was good for flow velocity measurements of SMV(mean bias-0.01 L/minute and 95%limits of agreement,-0.09 to 0.08 L/minute)and SMA(mean bias-0.03 L/minute and 95%limits of agreement,-0.23 to 0.17 L/minute)between two readers.Good agreement for peak speed measurements of SMV(mean bias-1.2 cm/second and 95%limits of agreement,-9.4 to 7.0 cm/second)and SMA(mean bias-3.2 cm/second and 95%limits of agreement,-31.4 to 24.9 cm/second).CONCLUSION Flow quantitation using 4D Flow is feasible to provide hemodynamic information for SMV and SMA in children.
文摘BACKGROUND Acute mesenteric ischemia is a life-threatening disease.Intrasplenic gas is an extremely rare finding in such cases.CASE SUMMARY We report a case of a 79-year-old woman with a history of end-stage renal disease on hemodialysis for approximately 20 years,type 2 diabetes mellitus,and atrial fibrillation who presented with two days of epigastric pain.A computed tomography scan of the abdomen revealed intraperitoneal free air and significant intrasplenic gas.Laparoscopy revealed diffuse intestinal gangrene,and acute superior mesenteric ischemia was diagnosed.The patient died within 24 hours owing to profound shock.CONCLUSION Intrasplenic gas is an extremely rare finding on computed tomography imaging in cases of acute mesenteric ischemia.
文摘BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of patients after pancreatic resections.Globally recognized superior mesenteric artery(SMA)first approaches are invariably performed.The mesenteric dissection through the inferior infracolic approach has been discussed in this study emphasizing its post-operative impact on CL which is the cornerstone of this study.AIM To assess incidence,risk factors,clinical impact of CL following root of mesentery dissection,and the different treatment modalities.METHODS This is a retrospective study incorporating the patients who underwent dissection of the root of mesentery with inferior infracolic SMA first approach pancreat-oduodenectomy for the ventral body and uncinate mass of pancreas in the Department of Gastrointestinal and General Surgery of Kathmandu Medical College and Teaching Hospital from January 1,2021 to February 28,2024.Intraop-erative findings and postoperative outcomes were analyzed.RESULTS In three years,ten patients underwent root of mesentery dissection with inferior infracolic SMA first approach pancreatoduodenectomy.The mean age was 67.6 years with a male-to-female ratio of 4:5.CL was seen in four patients.With virtue of CL,Clavien-Dindo grade Ⅱ or higher morbidity was observed in four patients.Two patients had a hospital stay of more than 20 days with the former having a delayed gastric emptying and the latter with long-term total parenteral nutrition requirement.The mean operative time was 330 minutes.Curative resection was achieved in 100%of the patients.The mean duration of the intensive care unit and hospital stay were 2.55±1.45 days and 15.7±5.32 days,respectively.CONCLUSION Root of mesentery dissection with lymphadenectomy and vascular resection correlated with occurrence of CL.After complete curative resection,these were managed with total parenteral nutrition without adversely impacting outcome.
文摘BACKGROUND Inferior mesenteric arteriovenous fistula(IMAVF)is an extremely rare condition characterized by abnormal communication between the inferior mesenteric artery and vein.IMAVF often mimics ischemic bowel disease and ulcerative colitis(UC),leading to diagnostic challenges and treatment failures.CASE SUMMARY Three consecutive cases presented with non-specific symptoms including perianal pain and bloody diarrhea were reported.Initial diagnosis included acute severe UC and ischemic colitis.Pathology suggested ischemic changes,and with further contrast-enhanced computed tomography together with digital subtraction angiography which confirmed the diagnosis of IMAVF.All three cases were treated by vascular embolization,and symptoms improved rapidly following treatment.CONCLUSION We presented the largest single center IMAVF series with detailed clinical characteristics,facilitating early diagnosis for similar cases in the future.
文摘BACKGROUND Idiopathic mesenteric phlebosclerosis(IMP)is a rare condition that causes ischaemic colitis,has various clinical manifestations,and may even be asymptomatic,often resulting in clinical misdiagnosis.CASE SUMMARY We report the case of a 44-year-old woman with chief complaints of abdominal pain,vomiting and decreased defecation.One year prior,the patient was asymptomatic and therefore misdiagnosed with inflammatory bowel disease based on incidental findings on an abdominal computed tomography(CT)scan.The present abdominal CT scan revealed an intestinal obstruction,diffuse thickening of the entire colon wall and calcification of the mesenteric and colonic veins.Colonoscopy revealed multiple ulcerations and extensive dark purple discolouration of the oedematous mucosa.Colonic transit studies suggested a decrease in colonic motility.IMP was considered the underlying cause of her pseudoileus,which was potentially linked to her consumption of Chinese medicinal teas for more than 30 years.The patient underwent conservative medical treatment,and her symptoms gradually improved.She exhibited no signs of ileus or other significant discomfort at the outpatient follow-up one year after the discontinuation of Chinese herbal tea consumption.CONCLUSION IMP can present with symptoms of pseudoileus as initial complication.Clinicians can use CT and colonoscopy for differential diagnoses.
基金Supported by the Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Education,No.NRF-RS-2023-00237287 and No.NRF-2021S1A5A8062526Local Government-University Cooperation-Based Regional Innovation Projects,No.2021RIS-003.
文摘Heterotopic mesenteric ossification(HMO)is a rare medical condition,with<100 cases reported globally by 2024.This disorder is characterized by abnormal bone tissue formation within the mesentery,often following abdominal trauma,ischemia,or infection.This editorial reviews the case presented by Zhang et al,involving a 34-year-old male who developed persistent left lower abdominal pain after sustaining blunt trauma to the abdomen.Diagnostic challenges arose due to the rarity and nonspecific presentation of HMO,which shares histopathological features with conditions such as myositis ossificans and necessitates differentiation from malignancies like sarcomas.Advanced imaging revealed calcifications suggestive of HMO,but definitive diagnosis was achieved only through surgical resection and histopathological analysis,which confirmed the presence of ectopic bone formation.Although benign,HMO can result in severe complications,such as bowel perforation or obstruction.Therefore,awareness of HMO is crucial for clinicians to ensure timely and appropriate treatment.
基金Supported by the National Natural Science Foundation of China,No.81970493 and No.82270590.
文摘BACKGROUND Idiopathic myointimal hyperplasia of the mesenteric veins(IMHMV)is a rare disease characterized by narrowing of the lumen caused by mesenteric vein intimal hyperplasia,resulting in chronic intestinal ischemia.Although the colorectum is the primary site affected by this condition,involvement of the small intestine is even more rare.Recurrence of IMHMV after surgical resection of the affected bowel is uncommon.CASE SUMMARY In this case report,we present a unique instance of IMHMV exclusively occurring in the small intestine.The patient experienced small intestinal perforation,infarction,and obstruction before receiving a clear diagnosis,which was achieved only during the third operation.In this review,we analyzed 84 reported cases to summarize the etiology,clinical manifestations,and diagnostic challenges of IMHMV,with the aim of raising awareness regarding this rare condition among clinicians.CONCLUSION Notably,IMHMV can also affect the small intestine alone.When refractory enteritis with endoscopic findings of nonspecific ischemic changes is encountered,IMHMV should be considered for potential diagnosis.
基金Supported by The Project of Nantong City Health Committee,No.MS2023027 and WKZL2018017The“333”Talent Funding Project of Jiangsu Province,No.BRA2020198+1 种基金The Project of Jiangsu Provincial Health Commission,No.ZD2021059The Youth Research Fund of Nantong Municipal Health Commission,No.QNZ2023027.
文摘BACKGROUND Irreversible transmural intestinal necrosis(ITIN)is associated with high mortality rates in patients with acute occlusive mesenteric ischemia(AOMI).Currently,there are not many studies on the use of dual energy computed tomography(DECT)for evaluating ITIN.AIM To evaluate the diagnostic value of DECT for ITIN in AOMI.METHODS The cases and computed tomography(CT)images of 102 patients with clinically diagnosed AOMI(including 48 ITIN)from January 2012 to January 2022 were retrospectively collected.The CT scans included both multidetector CT and DECT.The raw data from DECT portal-venous phase were reconstructed into 120 kVp mixed energy image,50 keV virtual monoenergetic imaging,and iodine map.Two radiologists independently completed the subjective visual assessment of CT signs related to AOMI.Objective parameters,including the attenuation of the normal and_(lesion)intestinal wall segment(CT50 keV_(lesion),CT_(50 keV normal/lesion))and iodine concentrations(IC_(lesion)and I_(Cnormal/lesion)),were quantified.Furthermore,multivariate logistic regression,receiver operating characteristic curves,and area under the curve(AUC)values were used to evaluate the subjective and objective indicators in predicting ITIN.RESULTS Regarding subjective signs,logistic regression analysis revealed reduced or absent bowel wall enhancement[odds ratio(OR)=5.576,95%confidence interval(CI):1.547-20.093],bowel dilation(OR=11.613,95%CI:3.790-35.586),and parenchymatous organ infarction(OR=4.727,95%CI:1.536-14.551)were independent risk factors for the ITIN.CT subjective signs had a high diagnostic efficacy for ITIN(AUC=0.853).The two DECT objective parameters also exhibited excellent diagnostic value for ITIN,with an AUC of 0.79,a cut-off value of CT50 keV normal/_(lesion)=2.81,and an AUC of 0.777 with a cut-off value of I_(Cnormal/lesion)=2.39.The Delong test showed that there was no significant difference in the efficacy of subjective CT signs and objective DECT parameters(P>0.05).Importantly,we observed that I_(Cnormal/lesion)combined with subjective signs(bowel dilation and parenchymatous organ infarction)had the highest predictive performance(AUC=0.894),sensitivity(100%),and specificity(70.83%),which was statistically different from the AUC of CT subjective signs(P=0.017).CONCLUSION I_(Cnormal/lesion)(DECT-based features)combined with CT subjective signs(bowel dilatation and parenchymatous organ infarction)showed favorable predictive performance for ITIN in AOMI,which may help clinicians develop timely treatment strategies.
文摘BACKGROUND Acute mesenteric vein thrombosis(MVT)accounts for only 2%–10%of all cases of acute mesenteric ischaemia,with an incidence rate of~0.1%in Europe and the United States.It represents<10%of mesenteric infarction cases and is seen predominantly in older adults.In younger individuals,MVT is uncommon,with 36%of cases having unidentified mechanisms and causes.CASE SUMMARY A 27-year-old man presented to the emergency department on February 29,2024,with a chief complaint of intermittent abdominal pain for 3 day.He was previously in good health.As the abdominal pain was not alleviated by conventional treatment,an abdominal computed tomography(CT)scan was performed,which showed increased density in the portal and mesenteric veins.Further imaging,including portal vein ultrasound,mesenteric CT angiography,and enhanced abdominal CT,revealed widespread thrombosis of the portal vein system(including the main portal vein,left and right branches,proximal mesenteric vein,and splenic vein).After 10 day of thrombectomy and anticoagulation therapy,the patient’s abdominal pain had improved significantly.Follow-up assessments indicated that portal venous blood flow had largely returned to normal.He was discharged on March 9,2024.During a follow-up exam 2 months later,repeat abdominal enhanced CT showed that the previously detected thrombi were no longer visible.CONCLUSION Clinicians should remain vigilant for acute MVT in young patients presenting with abdominal pain,to prevent misdiagnosis of this fatal condition.
文摘BACKGROUND Superior mesenteric artery(SMA)syndrome is a rare cause of duodenal obstruction by extrinsic compression between the SMA and the aorta(SMA-Ao).Although the left lateral recumbent position is considered effective in the treatment of SMA syndrome,individual variations in the optimal patient position have been noted.In this report,we present two elderly cases of SMA syndrome that exhibited rapid recovery due to ultrasonographic dynamic evaluation of the optimal position for each patient.CASE SUMMARY Case 1:A 90-year-old man with nausea and vomiting.Following diagnosis of SMA syndrome by computed tomography(CT),ultrasonography(US)revealed the SMA-Ao distance in the supine position(4 mm),which slightly improved in the lateral position(5.7–7.0 mm)without the passage of duodenal contents.However,in the sitting position,the SMA-Ao distance was increased to 15 mm accompanied by improved content passage.Additionally,US indicated enhanced passage upon abdominal massage on the right side.By day 2,the patient could eat comfortably with the optimal position and massage.Case 2:An 87-year-old woman with vomiting.After the diagnosis of SMA syndrome and aspiration pneumonia by CT,dynamic US confirmed the optimal position(SMA-Ao distance was improved to 7 mm in forward-bent position,whereas it remained at 5 mm in the supine position).By day 7 when her pneumonia recovered,she could eat with the optimal position.CONCLUSION The optimal position for SMA syndrome varies among individuals.Dynamic US appears to be a valuable tool in improving patient outcomes.
基金This study was supported by a grant from Beijing Natural Science Foundation(7234399).
文摘Background:Visceral adipose tissue(VAT)has been linked to the severe acute pancreatitis(SAP)prognosis,although the underlying mechanism remains unclear.It has been reported that pyroptosis worsens SAP.The present study aimed to verify whether mesenteric adipose tissue(MAT,a component of VAT)can cause secondary intestinal injury through the pyroptotic pathway.Methods:Thirty-six male Sprague Dawley(SD)rats were divided into six different groups.Twelve rats were randomly divided into the SAP and control groups.We monitored the changes of MAT and B lymphocytes infiltration in MAT of SAP rats.Twelve SAP rats were injected with MAT B lymphocytes or phosphate buffer solution(PBS).The remaining twelve SAP rats were first injected with MAT B lymphocytes,and then with MCC950(NLRP3 inhibitor)or PBS.We collected blood and tissue samples from pancreas,gut and MAT for analysis.Results:Compared to the control rats,the SAP group showed inflammation in MAT,including higher expression of tumor necrosis factor(TNF-α)and interleukin-6(IL-6),lower expression of IL-10,and histological changes.Flow cytometry analysis revealed B lymphocytes infiltration in MAT but not T lymphocytes and macrophages.The SAP rats also exhibited intestinal injury,characterized by lower expression of zonula occludens-1(ZO-1)and occludin,higher levels of lipopolysaccharide and diamine oxidase,and pathological changes.The expression of NLRP3 and n-GSDMD,which are responsible for pyroptosis,was increased in the intestine of SAP rats.The injection of MAT B lymphocytes into SAP rats exacerbated the inflammation in MAT.The upregulation of pyroptosis reduced tight junction in the intestine,which contributed to the SAP progression,including higher inflammatory indicators and worse histological changes.The administration of MCC950 to SAP+MAT B rats downregulated pyroptosis,which subsequently improved the intestinal barrier and ameliorated inflammatory response of SAP.Conclusions:In SAP,MAT B lymphocytes aggravated local inflammation,and promoted the injury to the intestine through the enteric pyroptotic pathway.
文摘In this letter,we commented on the article by Wu et al.We examined the interactions between mesenteric adipose tissue,creeping fat,and gut microbiota in Crohn’s disease(CD),a condition marked by chronic gastrointestinal inflammation with a rising global incidence.The pathogenesis of CD involves complex genetic,environmental,and microbial factors.Dysbiosis,which is an imbalance in gut microbial communities,is frequently observed in CD patients,highlighting the pivotal role of the gut microbiota in disease progression and the inflammatory response.Recent studies have shown that mesenteric adipose tissue and creeping fat actively contribute to inflammation by producing proinflammatory cytokines.The relationship between creeping fat and altered microbiota can shift from a potentially protective role to one that encourages bacterial translocation,further complicating disease management.Recent research has suggested that fecal microbiota transplantation could help restore microbial balance,offering a promising therapeutic strategy to improve clinical disease response.
文摘BACKGROUND Advanced rectal cancer with submesenteric lymph node metastasis is a common complication of advanced rectal cancer,which has an important impact on the treatment and prognosis of patients.AIM To investigate the clinical and pathological characteristics of inferior mesenteric artery(IMA)root lymph node metastases in patients with rectal cancer.The findings of this study provided us with fresh medical information that assisted us in determining the appropriate treatment for these patients.METHODS Our study searched PubMed,Google Scholar,and other databases and searched the relevant studies and reports on the risk factors of IMA root lymph node metastasis of rectal cancer published in the self-built database until December 31,2023.After data extraction,the Newcastle-Ottawa scale was used to evaluate the quality of the included literature,and RevMan5.3 software was used for meta-analysis and heterogeneity testing.The fixed effect modules without heterogeneity were selected to combine the effect size,and the random effect modules with heterogeneity were selected to combine the effect size.The cause of heterogeneity was found through sensitivity analysis,and the data of various risk factors were combined to obtain the final effect size,odds ratio(OR)value,and 95%confidence interval(CI).Publication bias was tested by drawing funnel plots.RESULTS A total of seven literature were included in this study.By combining the OR value of logistic multivariate regression and the 95%CI of various risk factors,we concluded that the risk factors for lymph node metastasis in the IMA region of rectal cancer were as follows:Preoperative carcinoembryonic antigen(CEA)>5 ng/mL(OR=0.32,95%CI:0.18-0.55,P<0.05),tumor located above peritoneal reflexive(OR=3.10,95%CI:1.78-5.42,P<0.05),tumor size≥5 cm(OR=0.36,95%CI:0.22-0.57,P<0.05),pathological type(mucinous adenocarcinoma/sig-ring cell carcinoma)(OR=0.23,95%CI:0.13-0.41,P<0.05),degree of tumor differentiation(low differentiation)(OR=0.17,95%CI:0.10-0.31,P<0.05),tumor stage(T3-4 stage)(OR=0.11,95%CI:0.04-0.26,P<0.05),gender and age were not risk factors for IMA root lymph node metastasis in rectal cancer(P>0.05).CONCLUSION Preoperative CEA level,tumor location,tumor size,tumor pathologic type,tumor differentiation,and T stage were correlated with IMA root lymph node metastasis.
文摘BACKGROUND Cystic lymphangioma is a rare benign tumor that affects the lymphatic system.Mesenteric lymphangiomas in the small bowel are extremely uncommon.CASE SUMMARY We present a 21-year-old female patient who complained of abdominal pain.The diagnosis of ovarian torsion was suspected after abdominopelvic unenhanced computed tomography and ultrasound revealed a large cyst in contact with the bladder,ovary,and uterus.The patient underwent emergency laparotomy per-formed by gynecologists,but it was discovered that the cystic tumor originated from the jejunum.Gastrointestinal surgeons were then called in to perform a cystectomy.Pathological examination confirmed the diagnosis of cystic lymphangioma of the mesentery.The patient had an uneventful postoperative recovery.CONCLUSION Mesenteric lymphangiomas can cause abdominal pain,and imaging techniques can help determine their characteristics,location,and size.Complete surgical excision and pathological examination are considered the standard treatment and diagnostic method.
基金Supported by 1·3·5 Project for Disciplines of Excellence,West China Hospital,Sichuan University,No.ZYJC21004.
文摘BACKGROUND Cyclic vomiting syndrome(CVS)is a chronic functional gastrointestinal disorder involving the gut–brain interaction that is characterized by recurring episodes of nausea,vomiting,abdominal pain,and interspersed complete normal periods.Superior mesenteric artery(SMA)syndrome(SMAS)is a vascular condition in which the horizontal portion of the duodenum is compressed due to a reduced angle between the aorta and the SMA.This condition presents with symptoms similar to CVS,posing challenges in distinguishing between the two and often resulting in misdiagnosis or inappropriate treatment.CASE SUMMARY A 20-year-old female patient presented with recurrent episodes of vomiting and experienced a persistent fear of vomiting for the past 2 years.She adopted conscious dietary restrictions,which led to severe malnutrition.Initially,she was diagnosed with SMAS,as revealed by computed tomography angiography.Despite efforts to increase the angle between the aorta and the SMA through weight gain,her vomiting did not improve.Finally,she was diagnosed with comorbidities including CVS,SMAS and anxiety disorder.She underwent comprehensive interventions,including enteral and parenteral nutritional supplementation,administration of antiemetic and anti-anxiety agents,and participation in mindfulness-based cognitive therapy.The patient eventually experienced a notable improvement in both body weight and clinical symptoms.CONCLUSION We present a rare case of CVS in an adult complicated with SMAS and propose additional treatment with nutritional support,pharmacological intervention,and psychotherapy.
文摘BACKGROUND Idiopathic mesenteric phlebosclerosis(IMP)is a rare type of ischemic colitis characterized by thickening of the wall of the right hemicolon and calcification,sclerosis,and fibrosis of mesenteric veins.The diagnosis of IMP is based on typical clinical features and imaging findings.We report a case of IMP that was initially missed by the radiologist.CASE SUMMARY A 77-year-old woman was admitted to the hospital due to chronic diarrhea for over 2 months.She had been consuming Chinese patent medicines(CPM)containing fructus gardeniae for more than 15 years.Colonoscopy revealed an edematous mucosa,bluish-purple discoloration,erosions,and ulcerations throughout the colorectal area.Abdominal computed tomography(CT)showed diffuse mural thickening of the entire colorectum,with tortuous thread-like calcifications in the right hemicolon,left hemicolon,and rectum.Most of the calcifications were located in the mesenteric vein.The diagnosis of IMP was established based on medical history,colonoscopy,CT findings,and histopathological examination.The patient was treated conservatively with papaverine and rifaximin,and CPM was stopped.Her diarrhea symptoms improved,indicating the effectiveness of the treatment.Over the next several years,she took opium alkaloids for an extended period and did not require hospitalization for the aforementioned gastrointestinal disorder.CONCLUSION IMP is a rare gastrointestinal disease affecting Asian populations,possibly related to long-term herbal medicine intake.Accurate imaging analysis is crucial for diagnosis,but insufficient understanding of the disease can lead to misdiagnosis or missed diagnosis.Treatment strategies should be personalized.
基金Supported by The Health Science and Technology Program of Zhejiang Province,No.2022KY836.
文摘BACKGROUND Superior mesenteric artery(SMA)injuries rarely occur during blunt abdominal injuries,with an incidence of<1%.The clinical manifestations mainly include abdominal hemorrhage and peritoneal irritation,which progress rapidly and are easily misdiagnosed.Quick and accurate diagnosis and timely effective treatment are greatly significant in managing emergent cases.This report describes emergency rescue by a multidisciplinary team of a patient with hemorrhagic shock caused by SMA rupture.CASE SUMMARY A 55-year-old man with hemorrhagic shock presented with SMA rupture.On admission,he showed extremely unstable vital signs and was unconscious with a laceration on his head,heart rate of 143 beats/min,shallow and fast breathing(frequency>35 beats/min),and blood pressure as low as 20/10 mmHg(1 mmHg=0.133 kPa).Computed tomography revealed abdominal and pelvic hematocele effusion,suggesting active bleeding.The patient was suspected of partial rupture of the distal SMA branch.The patient underwent emergency mesenteric artery ligation,scalp suture,and liver laceration closure.In view of conditions with acute onset,rapid progression,and high bleeding volume,key points of nursing were conducted,including activating emergency protocol,opening of the green channel,and arranging relevant examinations with various medical staff for quick diagnosis.The seamless collaboration of the multidisciplinary team helped shorten the preoperative preparation time.Emergency laparotomy exploration and mesenteric artery ligation were performed to mitigate hemorrhagic shock while establishing efficient venous accesses and closely monitoring the patient’s condition to ensure hemodynamic stability.Strict measures were taken to avoid intraoperative hypothermia and infection.CONCLUSION After 3.5 h of emergency rescue and medical care,bleeding was successfully controlled,and the patient’s condition was stabilized.Subsequently,the patient was transferred to the intensive care unit for continuous monitoring and treatment.On the sixth day,the patient was weaned off the ventilator,extubated,and relocated to a specialized ward.Through diligent medical intervention and attentive nursing,the patient made a full recovery and was discharged on day 22.The follow-up visit confirmed the patient’s successful recovery.
文摘BACKGROUND This study aimed to describe the findings of double superior mesenteric veins(SMVs),a rare anatomical variation,on multidetector computer tomography(MDCT)and magnetic resonance imaging(MRI)images.CASE SUMMARY We describe the case of a 34-year-old male,who underwent both MDC and MRI examinations of the upper abdomen because of liver cirrhosis.MDCT and MRI angiography images of the upper abdomen revealed an anatomic variation of the superior mesenteric vein(SMV),the double SMVs.CONCLUSION The double SMVs are a congenital abnormality without potential clinical manifestation.Physicians need to be aware of this anatomical variation during abdominal surgery to avoid iatrogenic injury.
