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PubMed1993

Laparoscopically assisted subtotal colectomy.

A technique for laparoscopic total resection of the colon performed in six patients is reported. The diseased colon was separated from the mesocolon and the greater omentum by electrocoagulation and sharp dissection. The mesenteric vessels were divided using an Endo GIA stapling device (AutoSuture, France). The whole colon was removed after transection of the rectum and extraction through a right minilaparotomy. A primary stapled end-to-side ileorectal anastomosis was performed through the anus under laparoscopic guidance. This technique can be applied to cases involving a variety of benign lesions of the entire bowel or multifocal small malignant colonic neoplasms with a decrease in patient morbidity and shorter inpatient period.

Adult↗
PubMed2002

Maternal medication use and risks of gastroschisis and small intestinal atresia.

Gastroschisis and small intestinal atresia (SIA) are birth defects that are thought to arise from vascular disruption of fetal mesenteric vessels. Previous studies of gastroschisis have suggested that risk is increased for maternal use of vasoactive over-the-counter medications, including specific analgesics and decongestants. This retrospective study evaluated the relation between maternal use of cough/cold/analgesic medications and risks of gastroschisis and SIA. From 1995 to 1999, the mothers of 206 gastroschisis cases, 126 SIA cases, and 798 controls in the United States and Canada were interviewed about medication use and illnesses. Risks of gastroschisis were elevated for use of aspirin (odds ratio = 2.7, 95% confidence interval: 1.2, 5.9), pseudoephedrine (odds ratio = 1.8, 95% confidence interval: 1.0, 3.2), acetaminophen (odds ratio = 1.5, 95% confidence interval: 1.1, 2.2), and pseudoephedrine combined with acetaminophen (odds ratio = 4.2, 95% confidence interval: 1.9, 9.2). Risks of SIA were increased for any use of pseudoephedrine (odds ratio = 2.0, 95% confidence interval: 1.0, 4.0) and for use of pseudoephedrine in combination with acetaminophen (odds ratio = 3.0, 95% confidence interval: 1.1, 8.0). Reported fever, upper respiratory infection, and allergy were not associated with risks of either defect. These findings add more evidence that aspirin use in early pregnancy increases risk of gastroschisis. Although pseudoephedrine has previously been shown to increase gastroschisis risk, findings of this study raise questions about interactions between medications and possible confounding by underlying illness.

Acetaminophen↗
PubMed1989

Fatal small intestinal infarction due to occlusion by mesenteric carcinoid tumor.

A case of sudden death due to massive small intestinal infarction is reported. The cause of the intestinal infarction was occlusion of mesenteric vessels by massive fibrosis secondary to carcinoid tumor. Since no primary carcinoid tumor was found in the intestine or elsewhere, it is suggested that the carcinoid tumor had originated in the mesentery.

Carcinoid Tumor↗
PubMed1996

Fatal posture- and heroin-related intestinal infarction and leg muscle necrosis after snorting heroin. A case report.

We present a case of a male patient who spent several hours sitting with legs crossed and upper body bent forward after nasal insufflation of heroin (snorting). Death occurred 3 days later as a result of leg muscle necrosis and intestinal ileus with infarction. The autopsy findings, including microthrombi in small mesenteric vessels and necrosis of the leg muscles, were attributed to vascular compression due to the man's position and to metabolic processes resulting from drug ingestion.

Administration, Intranasal↗
PubMed1974

Fetus-in-fetu: An ususual cause for abdominal mass in infancy.

Fetus-in-fetu is an unusual cause of retroperitoneal abdominal mass in infants, which most likely arises from inclusion of a monozygotic, diamniotic twin. This entity is distinguished from teratoma by its embryological origin, its unusual location in the retroperitoneal space, its invariable benignity, and by the presence of vertebral organization with limb buds and well-developed organ systems. Diagnosis is made radiographically by the finding of a diminutive vertebral column on a plain abdominal film. The treatment of choice is total excision with special attention being given to the fetus' blood supply which may be directly from the host's superior mesenteric vessels. A well-documented example of this unusual entity that occurred in a six-week old infant male is presented.

Abdominal Neoplasms↗
PubMed1989

Total pancreatectomy for ductal cell carcinoma of the pancreas. An update.

Forty-eight patients with ductal cell carcinoma of the pancreas underwent total pancreatectomy. During 1970-1976, there were four deaths (a mortality of 18%). During the last twenty-eight operations (1977-1986), there were no hospital deaths. Seventeen per cent of the patients suffered intraoperative complications involving the mesenteric vessels. Twenty-seven per cent suffered postoperative complications. Twenty-five per cent of the patients left the hospital within 2 weeks, 50% left within 4 weeks, and another 25% remained in the hospital for longer than 4 weeks. Thirty-five per cent of the patients have returned to their preoperative job or similar life activity. Another 35% were able to lead an active life but did not return to regular work, and 30% were to some degree incapacitated by their operative procedure and disease. Twenty-one per cent of the patients lived for 4 years, and 14% survived for 5 years.

Adult↗
PubMed2001

Molecular mechanisms contributing to necrotizing enterocolitis.

OBJECTIVE: To examine the cellular mechanisms involved in the pathogenesis of necrotizing enterocolitis (NEC). SUMMARY BACKGROUND DATA: Necrotizing enterocolitis is a major cause of death and complications in neonates; the cellular mechanisms responsible for NEC are unknown. The inducible form of cyclooxygenase (i.e., COX-2) is activated by the transcription factor nuclear factor (NF)-kappaB and is thought to play a role in inflammation. METHODS: Segments of perforated and adjacent uninvolved small intestine from neonates with NEC were analyzed for COX-2 expression by immunohistochemistry. NEC was induced in weanling (18 days old) rats by occlusion of superior mesenteric vessels for 1 hour and intraluminal injection of platelet activating factor (50 micro/kg). Small intestine was harvested for protein extraction. Western immunoblot was performed to determine expression of COX-2. Gel shift assays were performed to assess NF-kappaB binding activity. RESULTS: Immunohistochemical analysis showed increased COX-2 protein expression in the perforated intestinal sections of all 36 neonates but not in adjacent normal intestine. Increased expression of COX-2 protein and NF-kappaB binding activity was noted in the small intestine of weanling rats at 0 and 3 hours after induction of NEC. CONCLUSIONS: Increased COX-2 expression was identified in all neonatal intestinal segments resected for perforated NEC. In addition, a coordinate induction of COX-2 expression and NF-kappaB binding was noted in a rodent model of NEC. These findings suggest that the COX-2/NF-kappaB pathway may play a role in the pathogenesis of NEC. Therapeutic agents that target this pathway may prove useful in the treatment or possible prevention of NEC.

Animals↗
PubMed1982

Relation of colloid concentration to volume expansion for resuscitation of rats subjected to intestinal ischemic shock.

This study was undertaken to determine the volumes of colloids (albumin and dextran 40) with concentrations varying from 0% (Ringer's solution) to 10% solutions required to obtain the same hemodilution. Shock was produced in rats by exteriorization of the small intestine with added complete occlusion of the superior mesenteric vessels with a rubber clamp. After 1 h the clamp was removed, the intestines returned, and the abdomen closed. Over a 6-h period, the fluids were infused continuously in volumes needed to maintain similar hematocrit. Each concentration was given over a wide range of volumes in order to obtain volume-hematocrit curves. Based on these curves, the effect of varying colloid concentration on blood volume expansion was calculated. Albumin and dextran 40 had similar volume expansion/g colloid substance regardless of concentration. When hematocrit of 50% was chosen, as an arbitrary endpoint for volume infusion, the colloid concentration in relation to volume required to be infused is expressed by the equation F50 (formula: see text) where C = colloid concentration and where F50 is the volume factor, or the number of times the volume required for a 10% solution, when a 10% solution is given the volume factor of 1. This relationship is now being used to find the optimal colloid concentration with regard to survival rate in animals subjected to the same intestinal shock.

Albumins↗
PubMedDate not supplied

CT features of mesenteric panniculitis.

Mesenteric panniculitis (MP) is an inflammatory process of the mesenteric fat associated with a variable amount of fibrosis. We present the CT findings in four patients with MP. In three patients CT showed a fatty mass in the root of the mesentery and surrounding the mesenteric vessels without distorting them. The fourth patient presented an unusual form of MP with radiologically visible calcifications. Diagnosis was suggested preoperatively in two cases.

Calcinosis↗
PubMedDate not supplied

CT differentiation of mesenteric ischemia due to vasculitis and thromboembolic disease.

PURPOSE: The purpose of this work was to differentiate CT findings of acute mesenteric ischemia due to vasculitis (MV) or thromboembolism (MTE). METHOD: CT scans of 69 patients with mesenteric ischemia caused by MV (n = 37) or MTE (n = 32) were analyzed. After dividing the patients into groups with and without MV, we compared them with regard to gastrointestinal tract involvement patterns, mesenteric changes, and presence or absence of vascular thrombosis, atherosclerosis, other organ changes, and ascites. RESULTS: Duodenum was involved only in the MV group (30%). The MV group had preferential involvement of the small intestine (89%) to large intestine (51%), whereas the MTE group showed even distribution. Multisegmental bowel involvement was more common in the MV group (86%) than in the MTE group (44%), especially in both jejunum and ileum and both small and large intestine. The MV group showed prominent involvement of the superior mesenteric vessel territory, although the MTE group showed even distribution. Splenomegaly and hydronephrosis were more frequently seen in the MV group and vascular thrombosis and atherosclerosis in the MTE group. CONCLUSION: Although considerable overlap was noted, CT is useful in differentiating MV from MTE.

Adult↗
PubMed1996

Perforation of small intestine caused by Churg-Strauss syndrome.

In Churug-Strauss Syndrome (CSS), gastrointestinal tract (GIT) is an uncommon site of involvement. In addition to review of recent literature, we herein report a case of CSS with unusual involvement of GIT. The patient was being treated for idiopathic hypereosinophilic syndrome for 2 years; he later developed acute peritonitis and an emergency laparotomy revealed 3-cm-diameter perforation in the small intestine. In order to establish a correlation between the clinical features and the histopathological findings, we highlight the importance of adequate sampling and examination of mesenteric vessels in the attached mesentry in the resected specimen.

Adolescent↗
PubMed2001

The analysis of resectability and survival in pancreatic cancer patients with vascular invasion.

One of the major limitations of curative resection in patients with pancreatic cancer is local tumor extension to the mesenteric vessels. Thus, the purposes of our study were to assess the clinical value of contrast-enhanced spiral computed tomography (CT) in predicting the resectability and survival of patients with pancreatic cancer with suspicious vascular invasion and to assess the influence of curative resection on the survival of these patients. We enrolled 40 patients with pancreatic cancer who were suspected of having an involvement of the adjacent large vessels and who subsequently underwent operation with curative intent in the study. Resectability and survival were correlated with CT findings such as segment length, degree of encasement, and type and number of vessels involved. The survival rate was compared between the curative and palliative resection groups, and survival rate was compared between the resected and unresected groups. Of the 40 patients with adenocarcinoma of the pancreas, 14 had curative resections and 26 had palliative resections. The probability of curative resection was higher in patients with segment lengths less than 2 cm, as compared with segment lengths more than 2 cm. However, there was no difference in survival between the two groups. There were no differences in resectability and survival according to the degree of encasement and type and number of vessels involved. There was no difference in survival between the curative and palliative resection groups. There was no difference in survival between the resected and unresected groups. A survival benefit was not achieved by curative resection in patients with pancreatic cancer with vascular invasion. Therefore, it would be better to avoid aggressive surgery in patients with pancreatic cancer with vascular invasion.

Humans↗
PubMed1983

Hepatic abscess as a complication of Crohn's disease.

A 17-year-old male with Crohn's disease presented with persistent fever and right upper quadrant tenderness. Ultrasonography and abdominal computerized axial tomography (CAT scan) showed two large loculated abscess cavities in the right lobe of the liver. Surgical drainage and antibiotic therapy led to resolution of both cavities over a 5-month period. Unlike six previously reported patients, our patient had no evidence of pylephlebitis or mesenteric abscess formation at surgery. We speculate that his abscesses arose through seeding of mesenteric vessels and portal bacteremia.

Adolescent↗
PubMed1999

Nitric oxide decreases microvascular permeability in bradykinin stimulated and nonstimulated conditions.

This study examined the occurrence of endothelial nitric oxide (NO)-synthase (NOS-III) in terminal mesenteric vessels and the involvement of NO in microvascular permeability. Possible effects were studied in bradykinin (BK)-induced and basal conditions. NOS expression was investigated by using NOS-III immunohistochemistry and nicotinamide adenine dinucleotide phosphate (NADPH)-diaphorase histochemistry on the light- and electron-microscopic levels. Permeability was examined in dissected mesenteries of male rats weighing 250-300 g. Tissue treatment was performed with BK (100 nM), sodium nitroprusside (SNP, 1 and 10 microM), L-nitroarginine (L-NA, 300 microM), BK and L-NA, BK and SNP, L-NA and SNP, as well as with BK, SNP (10 microM), and the guanylylcyclase inhibitor ODQ (10 microM), and BK and ODQ alone. Pharmacologically induced permeability changes were studied with fluorescein isothiocyanate (FITC)-dextran 70 kDa as a tracer for macromolecular transport. Video images were analyzed with computer determination of integrated optical density (IOI). Results were statistically verified by analysis of variance and t test. Microvascular permeability was increased by 168% after BK treatment and was enhanced by NO-synthesis inhibition with L-NA by 607%. However, the NO donor SNP led to a reduced tracer extravasation to 105 and 58%, respectively, an effect blocked by ODQ. Under basal conditions without prior BK induction, L-NA also causes an increase of IOI by 25%, whereas coapplication with SNP resulted in only a 10% increase of permeability. These results point out that NO has a modulatory role for microvascular permeability by supporting the barrier function of the endothelial lining in stimulated and nonstimulated conditions.

Animals↗
PubMed1996

Computed tomography detection of active mesenteric hemorrhage following blunt abdominal trauma.

Following blunt abdominal trauma, patients still may be actively bleed ing, despite seeming hemodynamically stable. By detecting extravasation of contrast-enhanced blood in the absence of any other evidence to support solid visceral injury as the source, computed tomography (CT) scanning was able to indicate ongoing hemorrhage in two patients, thought most likely of mesenteric origin. This information influenced the decision for intervention, which in these two cases was laparotomy, where bleeding torn mesenteric vessels were confirmed.

Abdominal Injuries↗
PubMed1999

The timing and nature of neovascularization of jejunal free flaps: an experimental study in a large animal model.

The present study was designed (1) to determine whether a free jejunal transfer in a large animal model can develop collateral circulation that is adequate to maintain viability after division of the pedicle and (2) to determine the earliest time pedicle ligation is safe after transplantation. A 15-cm jejunal segment was transferred to the necks of 18 dogs weighing 25 to 35 kg. The bowel segment was inset longitudinally under the skin on one side of the neck, partially covered by the neck muscles, and the mesenteric vessels were anastomosed to recipient vessels in the neck. The proximal and distal bowel stomas were exteriorized through skin openings 12 cm apart and matured. The dogs were subjected to ligation of the vascular pedicle at different intervals: postoperative day 7 (group I, n = 3), day 14 (group II, n = 5), day 21 (group III, n = 5), and day 28 (group IV, n = 5). Blood perfusion was measured in the proximal and distal bowel stomas before pedicle division (control) and 24 hours later using hydrogen gas clearance and fluorescein dye. Bowel necrosis was analyzed using planimetry. The bowel was also stained with hematoxylin and eosin and factor VIII, and new blood vessels were counted. Mean values (+/- standard deviation) were compared with control values for each test and with normal values in the intact bowel using analysis of variance with Neumann-Keuls post-hoc test for multiple comparisons. No jejunal free flaps survived when the vascular pedicle was divided 1 week postoperatively. Bowel survival was 60 percent at 2 weeks, 83 percent at 3 weeks, and 100 percent at 4 weeks. Hydrogen gas clearance values (ml/min/100 g) were 49.6 +/- 8.7 in the mucosa of the intraabdominal jejunum and 37.9 +/- 9.4 in the jejunum that was transferred to the neck before division of the pedicle. Twenty-four hours after pedicle division, hydrogen gas clearance values were 2.8 +/- 6.4 in group I (p < 0.05), 22.4 +/- 12.4 in group II, 23.9 +/- 9.3 in group III, and 34.2 +/- 7.5 in group IV. FluoroScan readings in the transferred jejunum were 201 +/- 7.2 in the control group, 9.3 +/- 2.8 in group I (p < 0.05), 79.1 +/- 10.6 in group II, 66.2 +/- 7.3 in group III, and 164 +/- 11.9 in group IV. New vessel formation as identified by factor VIII staining correlated with increasing bowel perfusion and flap survival rate. Bowel neovascularization, perfusion, and survival increased progressively 1 week after transfer. Significant portions of the transferred bowel will neovascularize and survive as early as 2 weeks postoperatively. However, a minimum of 4 weeks before ligation of the pedicle is necessary to maximize flap perfusion and guarantee survival.

Animals↗
PubMed2003

Variant human pancreas: aberrant uncinate process or an extended mesenteric process.

Variations in the morphology of pancreas are not very common. We observed a rare variant of the uncinate process of the pancreas that extended in the mesentery of the small intestine. After its origin from the lower part of the head of the pancreas, the mesenteric process (MP) passed over the third part of the duodenum to enter the mesentery of the jejunum and ileum and extended up to the level of the pelvic brim. The branches of the superior mesenteric vessels were embedded in the extended MP of the pancreas. This aberrant extension of the pancreas was drained by a narrow duct, which joined the main pancreatic duct inside the head. We did not observe a separate uncinate process arising from the head. On histology normal acini and endocrine cells were observed in the extension. This variant is important as symptoms of pancreatic disease from such extensions may be confused with other commonly encountered acute or chronic abdominal conditions.

Cadaver↗