[IIio-mesenteric anastomosis, a process improving cavo-mesenteric vein anastomosis for portal hypertension].
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Humans↗
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Superior mesenteric vein thrombosis.
Superior mesenteric venous occlusion may be difficult to recognize, but is important as it carries a better prognosis than superior mesenteric arterial occlusion, and may be amenable to surgical treatment. Three successful cases treated by thrombectomy have appeared in the literature. A case of successful superior mesenteric vein thrombectomy with bowel resection is reported.
Duodenum↗
Aneurysm of the superior mesenteric vein.
A superior mesenteric vein aneurysm was diagnosed by ultrasound, computed tomography, and angiography in a 55-year-old woman. It was successfully treated by partial resection and reconstruction of the confluent veins.
Aneurysm↗
In vivo flow-independent T2 measurements of superior mesenteric vein blood in diagnosis of chronic mesenteric ischemia: a preliminary evaluation.
RATIONALE AND OBJECTIVES: The authors attempted to determine whether the T2 relaxation time of superior mesenteric vein (SMV) blood would decrease in patients with chronic mesenteric ischemia after a meal. MATERIALS AND METHODS: Thirty-two patients without chronic mesenteric ischemia and eight patients with symptomatic chronic mesenteric ischemia underwent magnetic resonance (MR) imaging. All examinations were performed with a 1.5-T unit, a modified Carr-Purcell-Meiboom-Gill sequence, final section-selective pulse of 180 degrees, and spiral readout gradients. Measurements of SMV blood T2 were obtained after at least 6 hours of fasting and 15 and 35 minutes after ingestion of 240 mL of a liquid nutritional supplement. Maximal change of the SMV blood T2 was expressed as a percentage of the fasting T2 in all patients. RESULTS: In control patients, SMV blood T2 increased postprandially by 9.4% +/- 1.3 (95% confidence level; range, 6.8%-11.9%) (data range, -7.3% to 25.6%) compared with fasting T2. In symptomatic patients, SMV blood T2 decreased postprandially by 15.8% +/- 2.2 (95% confidence level; range, -20.1% to -10.7%) (data range, -7.9% to -25.3%). The difference between the two groups was statistically significant (P < .0001 by Student unpaired t test). CONCLUSION: Measurement of SMV blood T2 is a promising test for chronic mesenteric ischemia diagnosis. Therefore, conversion of T2 measurements to estimate oxygen saturation may not be necessary for all cases of this clinical indication.
Adult↗
Co-release of endogenous ATP and noradrenaline from guinea-pig mesenteric veins exceeds co-release from mesenteric arteries.
1. The present study was designed to compare the overflow of sympathetic neurotransmitters of guinea-pig inferior mesenteric artery and mesenteric vein evoked by electrical field stimulation (EFS) with special emphasis on the simultaneous release of ATP and noradrenaline (NA). The stimulation-evoked overflow of ADP, AMP and adenosine was also evaluated. 2. Endothelium-denuded segments of inferior mesenteric arteries or veins were superfused in a small volume (200 microL)-chamber for EFS and subsequent detection of NA (HPLC- electrochemical detection) and adenine nucleotides and adenosine (HPLC-fluorescence detection) in samples of the superfusate. 3. Both arteries and veins responded to EFS (15 V, 4-16 Hz, 0.3 msec for 60 s) with overflow of ATP and NA in a tetrodotoxin (1 micromol/L)- and guanethidine (10 micromol/L)-sensitive manner. The EFS-evoked overflow of NA in veins exceeded the overflow of NA in arteries at all frequencies of stimulation, whereas the EFS-evoked overflow of ATP, ADP and AMP in veins exceeded the overflow of adenine nucleotides in arteries at 4 and 8 Hz but not at 16 Hz stimulation. The EFS-evoked overflow of adenosine was similar in arteries and veins. 4. Activation of alpha1-adrenoceptors with methoxamine (10 micromol/L) did not produce overflow of ATP. 5. Blockade of alpha1/alpha2-adrenoceptors with phentolamine (1 micromol/L) did not affect EFS-evoked overflow of ATP, ADP, AMP and adenosine. 6. It is concluded that overflow of ATP and NA from sympathetic nerves may constitute an effective mechanism in the complex balance between capacitance and resistance in splanchnic circulation.
Adenosine↗
A retrospective study of diagnosis and management of mesenteric vein thrombosis.
BACKGROUND: Mesenteric vein thrombosis (MVT) is an uncommon type of intestinal ischemia associated with significant mortality and morbidity because of its delay in diagnosis. METHODS: A retrospective analysis of 9 patients treated surgically for MVT during 1982 to 1997 was performed. RESULTS: Nine patients underwent surgical therapy for intestinal ischemia due to MVT. The most common presenting symptom was abdominal pain with bloody diarrhea in 3 patients; preoperative diagnosis of MVT was suspected in 2. Radiologic tests included plain roentgenograms, computed axial tomography, and ultrasound. Time to surgery ranged from 3 hours to 7 days after admission. All patients underwent resection of infarcted bowel with primary anastomosis and immediate postoperative anticoagulation. No patient underwent a second-look operation. The postoperative morbidity and mortality rates were 55% and 11%, respectively. CONCLUSION: Diagnosis of intestinal ischemia from MVT is often delayed, and strong clinical suspicion and aggressive treatment are necessary in its management.
Adult↗
CT appearance of the inferior mesenteric vein.
The CT appearance of the inferior mesenteric vein (IMV) was studied. It can best be identified by its location behind or to the left of the duodenojejunal flexure. Superiorly, it drains into either the splenic vein, superior mesenteric vein, or the splenoportal junction. Inferiorly, it continues to the left of the fourth stage of the duodenum, lying in the left anterior pararenal space. Occasionally, the left colic vein is seen draining into the IMV. In 14 normal cases the diameter of the IMV, measured behind or to the left of the duodenojejunal flexure, was 3-6 mm with a mean of 3.9 mm and a standard deviation of 0.83 mm. In a case of portal hypertension it measured 9 mm. Thus, the IMV can be used to suggest portal hypertension.
Adult↗
Ligation as definitive management of injury to the superior mesenteric vein.
Ligation of the injured superior mesenteric vein in patients with multisystem trauma has been regarded as a hazardous procedure with a narrow spectrum of indications. We present three patients who underwent ligation of their superior mesenteric veins. A collective review of 33 superior mesenteric vein ligations and 75 superior mesenteric venorrhaphies indicated that ligation of this vein is indeed a valid option when a simple repair cannot easily be performed.
Adolescent↗
Excitatory cholinergic innervation in canine portal and mesenteric veins.
A possibility that the canine portal and mesenteric veins may have an excitatory cholinergic innervation similar to that observed in the middle segment of the inferior vena cava (IVC) was investigated. After adrenergic blockade with prazosin, contractile responses of isolated longitudinal strips of the portal and mesenteric veins to transmural electrical stimulation were greatly diminished. Subsequent anticholinesterase (neostigmine or physostigmine) treatment, however, revealed in the nerve-evoked contraction a component that was antagonized by atropine. The same phenomenon was also observed in circular strips of the portal and mesenteric veins but was absent in those of the external jugular, saphenous, and splenic veins. In accord with the results of nerve stimulation, concentration-response curves of acetylcholine-induced contraction were shifted leftward by neostigmine in strips of the portal and mesenteric veins as well as of the middle segment of IVC. In contrast, no shift was observed in 12 other different sites of the venous system. Cholinesterase staining demonstrated positively stained smooth muscle and nerve fibers in the portal and mesenteric veins and in the middle segment of IVC. These findings indicate the existence of excitatory cholinergic innervation in the portal and mesenteric veins, which may reflect the common embryological origin of smooth muscle of these veins with the intestinal muscle.
Acetylcholine↗
Significance of blood flow in the inferior and superior mesenteric veins for the formation of oesophageal varices.
The degree of involvement of blood flow in the superior mesenteric vein and inferior mesenteric vein in the formation of oesophageal varices is not known. We have developed a method by which the contributions of these veins to portal blood flow can be evaluated simultaneously in a relatively non-invasive way. An enteric-coated capsule containing [123I]iodoamphetamine (IMP) is given by mouth and 3 h later [123I]IMP is instilled into the rectum. The data obtained are treated by computer to calculate the portal shunt index via the inferior and superior mesenteric veins. In chronic hepatitis and cirrhosis, when varices were absent, the difference in these indices was not significant. In the presence of varices, the portal shunt index via the inferior mesenteric vein was significantly higher than that via the superior mesenteric vein. It was suggested that the contribution of blood flow in the inferior mesenteric vein the portal/splenic axis is important in the formation of varices.
Amphetamines↗
Mesenteric panniculitis of the colon with obstruction of the inferior mesenteric vein: report of a case.
Mesenteric panniculitis is a rare disease characterized by nonspecific inflammation of the fat tissue of the mesentery. We present an extremely rare case of mesenteric panniculitis of the sigmoid colon, complicated by occlusion of the inferior mesenteric vein. A 75-year-old male presented with a one-month history of abdominal distention and abdominal mass without pain. Physical examination revealed a firm mass in the lower abdomen. Barium enema study demonstrated rugged mucosa and a serrated contour in the rectosigmoid colon. Computed tomography showed that the mass arose from the mesentery, which surrounded the mesenteric vessels. The density of the mass was slightly higher than that of fatty tissue. Based on these radiologic findings, the patient was diagnosed as having mesenteric panniculitis of the rectosigmoid colon. Colonoscopy showed narrowing with edematous mucosa in the rectosigmoid colon, whereas marked dilated vessels were noted in the proximal portion of the sigmoid colon. Angiography showed occlusion of the inferior mesenteric vein, with venous flow returning via a collateral vein. The patient was observed without medication because his condition was satisfactory. His symptoms subsequently disappeared during a period of several weeks. The mass in the lower abdomen gradually diminished in size, disappearing three months later. Computed tomography and barium enema showed improvement of the lesion. The favorable outcome of the present case was probably because of formation of a collateral vein. The present case suggests that aggressive therapy for mesenteric panniculitis should be avoided, because the outcome of this disorder is good, even when there is obstruction of vessels.
Abdominal Pain↗
Superior mesenteric vein thrombosis complicating appendicular masses.
Mesenteric vein thrombosis (MVT) is rare. Its diagnosis is usually difficult and delayed. Herein, we report 2 patients who developed MVT as a complication of an appendicular mass. One of them had appendectomy and developed fever 10 days postoperatively. The other was treated conservatively. An abdominal computerized tomography (CT) scan with intravenous contrast was helpful in diagnosing the superior MVT in both patients, which were not suspected. Intravenous contrast should be used when performing CT of an appendicular mass. Special interest should be directed at studying the superior mesenteric vein. Early diagnosis of our patients helped to start early medical treatment with anticoagulation.
Abdominal Pain↗
Superior mesenteric vein stenosis complicating Crohn's disease.
BACKGROUND: Superior mesenteric vein stenosis as a consequence of mesenteric fibrosis, causing the development of small bowel varices, is an unrecognised association of Crohn's disease. CASE REPORTS: Two cases of gastrointestinal bleeding occurring in patients with Crohn's disease, and a third case, presenting with pain and diarrhoea, are described. In all three patients, visceral angiography showed superior mesenteric vein stenosis with dilatation of draining collateral veins in the small bowel. Overt gastrointestinal bleeding or iron deficiency anaemia resulting from mucosal ulceration is common in Crohn's disease, but acute or chronic bleeding from small bowel varices as a result of superior mesenteric vein stenosis due to fibrosis has not previously been reported.
Adult↗
Extrahepatic portal hypertension treated by anastomosing inferior mesenteric vein to left portal vein at Rex recessus.
For the treatment of recurrent bleeding despite sclerotherapy or clinically significant hypersplenism, portosystemic shunt procedures should be performed in cases of extrahepatic portal hypertension caused by extrahepatic portal vein thrombosis. A novel alternative to portosystemic shunt procedures in extrahepatic portal hypertension is mesenterico-left portal bypass. Portal vein thrombosis is bypassed by an autologous vein graft (usually left internal jugular vein) interposed between superior mesenteric vein and left portal vein. In the presence of an enlarged right gastroepiploic vein, the distal end of this vein can be anastomosed to left portal vein without disturbing its proximal end. Herein, the authors report a case of extrahepatic portal hypertension treated by anastomosing enlarged inferior mesenteric vein to left portal vein to bypass portal vein thrombosis.
Anastomosis, Surgical↗
The rabbit mesenteric vein: a specific bioassay for substance P.
The anterior mesenteric vein of the rabbit responds to substance P with dose-dependent contractions and is among the vascular smooth muscles most sensitive to this peptide. In spite of its high sensitivity to numerous other agents, including angiotensin and bradykinin, the rabbit mesenteric vein can be made selective for substance P by the use of specific inhibitors that will prevent the myotropic effects of acetylcholine, catecholamines, histamine, 5-hydroxytryptamine, and of the two above-mentioned peptides, without modifying the contractions elicited by substance P. It appears that this peptide acts directly on specific receptors and not through the release of neurotransmitters. Interference by intramural prostaglandins is excluded because substance P is equally active on tissues pretreated with indomethacin or untreated. Dose-response curves obtained with substance P are close to the theoretical curves predicted by the mass action law. The rabbit mesenteric vein contains a new type of receptor for bradykinin, recently identified (REGOLI, D., MARCEAU, F., and BARABE, J. 1978. De novo formation of vascular receptors for bradykinin. Can, J. Physiol. Pharmacol. 56, in press.). The action of bradykinin on this receptor can be prevented with the use of specific and competitive inhibitors and, therefore, the mesenteric vein will distinguish between peptides of the kinins or of the substance P types.
Animals↗
Mesenteric vein thrombosis: is it one disease?
OBJECTIVES: to compare the clinical course and outcome of mesenteric vein thrombosis due to known causes and mesenteric vein thrombosis of unknown aetiology. DESIGN: a retrospective study. SETTING: two major general hospitals in Kuwait. SUBJECTS: 12 patients who had mesenteric vein thrombosis due to known causes and seven patients who had mesenteric vein thrombosis of unknown aetiology were treated over eight years. CHIEF OUTCOME MEASURES: severity of clinical findings and outcome. RESULTS: There was no statistical difference between the two groups in the clinical presentation or in outcome. CONCLUSION: 36% of mesenteric vein thrombosis occurred without an obvious cause although the disease appeared to be the same. More work on the aetiology of this condition is required.
Adult↗
[Aneurysm of the superior mesenteric vein].
Aneurysms originating in the superior mesenteric vein are extremely rare: 4 cases have been reported in the international literature. The authors describe a case of a female patient admitted to hospital for vague abdominal pain. The CT findings revealed a cyst-like neoformation. By means of angiography it was then identified as a dilatation of the superior mesenteric vein. The causes of such dilatations are not altogether clear. Current interpretations refer to possible congenital and acquired factors, as well as trauma. The accompanying symptoms are abdominal pain, icterus, gastrointestinal haemorrhage or portal hypertension, but occasionally patients may present no symptoms whatsoever.
Aneurysm↗
Hepatic distribution of blood flow from the superior or inferior mesenteric vein mapped by portal scintigraphy with iodine-123-iodoamphetamine.
UNLABELLED: We previously reported the clinical meaning of measurements of the relative contributions of the superior and inferior mesenteric veins with [123I]iodoamphetamine after oral (in an enteric capsule) and rectal administration. The same method was used to map blood flow in the liver from both of these veins in 82 subjects, 31 with chronic hepatitis and 51 with cirrhosis. METHODS: Three hours after administration of a capsule containing 22.8 MBq of [123I]iodoamphetamine, data showing hepatic blood flow from the superior mesenteric vein were collected for 10 min. Next, 111 MBq of [123I]iodoamphetamine was administered rectally and data showing hepatic blood flow from the inferior mesenteric vein were collected for 30 min. Shunt indices from the superior and inferior mesenteric veins were calculated from these data. RESULTS: In patients with chronic hepatitis, blood from the superior mesenteric vein flowed into the right lobe or both lobes, but, in some patients with cirrhosis, blood from this vein flowed into the left lobe. In some patients with chronic hepatitis, blood from the inferior mesenteric vein flowed into the left lobe, but, in most patients with cirrhosis, the liver was not visualized during this examination and evaluation was not possible. Of the 53 patients in whom blood flow from both veins could be evaluated, 47 had blood from the two veins mixed to some extent in the liver and 6 had portal streamlining, with blood from the superior mesenteric vein going to the right lobe and blood from the inferior mesenteric vein going to the left lobe. CONCLUSION: These results suggest that blood flow in the superior and inferior mesenteric veins can be found mixed in the liver in most subjects with liver disease.
Amphetamines↗