Acute mesenteric thrombosis accounts for 25-30% of acute mesenteric ischemia and occurs usually alongside severe atherosclerotic disease. Acute mesenteric thrombosis primarily affects the superior mesenteric artery; thus, inferior mesenteric arterial thrombosis is an extremely rare form of the condition. Surgical treatment is mandatory to resolve impending or overt bowel infarction in acute mesenteric ischemia patients. However, here we report a case of colonic infarction caused by acute inferior mesenteric thrombosis successfully treated by conservative management.
Colon ; Humans ; Infarction* ; Ischemia ; Mesenteric Artery, Inferior ; Mesenteric Artery, Superior ; Thrombosis*

Vessel identification and dissection are the key processes of laparoscopic complete mesocolic excision (CME). Vascular injury will lead to complications such as prolonged operative time, intraoperative hemorrhage and ischemia of anastomotic stoma. Superior mesenteric artery (SMA), superior mesenteric vein(SMV), gastrointestinal trunk, left colic artery(LCA), sigmoid artery and marginal vessels in the mesentery have been found with possibility of heteromorphosis, which requires better operative techniques. Surgeons should recognize those vessel heteromorphosis carefully during operations and adjust strategies to avoid intraoperative hemorrhage. Preoperative abdominal computed tomography angiography(CTA) with three-dimensional reconstruction can find vessel heteromorphosis within surgical area before operation. Adequate dissection of veins instead of violent separation will decrease intraoperative bleeding and be helpful for dealing with the potential hemorrhage. When intraoperative hemorrhage occurs, surgeons need to control the bleeding by simple compression or vascular clips depending on the different situations. When the bleeding can not be stopped by laparoscopic operation, surgeons should turn to open surgery without hesitation.
Colonic Neoplasms ; surgery ; Dissection ; Hemorrhage ; prevention & control ; Humans ; Laparoscopy ; Mesenteric Artery, Inferior ; Mesenteric Veins ; Mesocolon ; surgery

PURPOSE: Acute mesenteric ischemia (AMI) is one of the most dramatic abdominal emergencies. The most common cause of AMI is a thrombo-embolism of the mesenteric artery or vein. The aim of this study was to evaluate the feasibility of CT angiography for evaluating mesenteric vascular steno-occlusive lesion in AMI. MATERIALS AND METHODS: Fifteen patients with clinically and angiographically proven AMI underwent a two-phase CT. The CT angiographic images were reconstructed using a 3D rendering algorithm, such as the maximum intensity projection and volume-rendering. All the CT angiographic images were reviewed with respect to stenosis or occlusion of mesenteric vessel by the consensus of two radiologists, and were correlated with the findings of digital subtraction angiography. RESULTS:Digital subtraction angiography (DSA) visualized 60 mesenteric vessels including the superior mesenteric artery (n=15) and vein (n=15), and the inferior mesenteric artery (n=15) and vein (n=15). DSA showed steno-occlusive lesions in 16 mesenteric vessels (13 superior mesenteric arteries, two superior mesenteric veins, and one inferior mesenteric artery). CT angiography detected steno-occlusive lesions in 16 mesenteric vessels (12 superior mesenteric arteries, one superior mesenteric vein, and three inferior mesenteric arteries). The sensitivity, specificity, and accuracy of CT angiography for evaluating mesenteric vascular steno-occlusive lesion were 87.5%, 95.4%, and 93.3%, respectively. CONCLUSION: CT angiography is an useful adjunct to abdominal CT in an AMI setting on account of its ability to detect the causes of AMI such as a steno-occlusive lesion of the mesenteric vessel.
Angiography* ; Angiography, Digital Subtraction* ; Consensus ; Constriction, Pathologic ; Emergencies ; Humans ; Ischemia* ; Mesenteric Arteries ; Mesenteric Artery, Inferior ; Mesenteric Artery, Superior ; Mesenteric Veins ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Veins

Anatomical variation in the abdominal aorta is common and extremely important. We found a rare variation of the abdominal aorta in a Korean male cadaver during a routine dissection course. The superior mesenteric artery gives off a small branch for the descending colon, named accessory left colic artery due to its distribution. The inferior mesenteric artery arises normally from the abdominal aorta and supplied the sigmoid colon and the upper part of the rectum. This variation was rare and it has not been reported previously in Korean. Knowledge of the arterial variation in this region is considerable important during abdominal surgery and invasive procedures. The authors describe this previously unreported case and discuss the clinical implications of such a variant with a brief review of the literature.
Aorta, Abdominal ; Arteries ; Cadaver ; Colic ; Colon, Descending ; Colon, Sigmoid ; Humans ; Male ; Mesenteric Artery, Inferior ; Mesenteric Artery, Superior ; Rectum

Accessory renal artery (ARA) is a kind of developmental anomaly in renal artery. It is important in respect to clinical medicine, for example primary hypertension, renovascular disease, inferior vena caval obstruction, ureteral obstruction, occurrence of other vascular anomalies such as accessory renal veins, surgical importance and renal transplantation. However, up to few research of ARA was reported in dissection of cadavers. In our dissecting theater, 12 accessory renal arteries for 10 cadavers were found during dissection the 22 cadavers from 1995 to 1996. 1. Two cases were bilateral and 8 cases were unilateral accessory renal arteries. 2. Seven cases were left and 5 cases were right accessory renal arteries. 3. Two cases originated at the abdominal aorta between celiac trunk and superior mesenteric artery, 7 cases originated between superior mesenteric artery and inferior mesenteric artery, and 3 cases originated below inferior mesenteric artery. 4. Seven cases have no branches during their courses, 4 cases have 3 branches, and a case has 2 branches. 5. Seven cases entered into renal parenchyma through renal hilum, 5 cases entered into apical and arterosuperior segments, and 6 cases entered into inferior segment.
Aorta, Abdominal ; Cadaver ; Clinical Medicine ; Hypertension, Renovascular ; Kidney Transplantation ; Mesenteric Arteries ; Mesenteric Artery, Inferior ; Mesenteric Artery, Superior ; Renal Artery* ; Renal Veins ; Ureteral Obstruction

OBJECTIVES: Compared with all other patterns, isolated right colon ischemia has been found to be more associated with coronary artery disease and a poor prognosis. However, there has been no research on comparing isolated left side ischemic colitis (ILIC) and non-ILIC with vascular assessment. The aim of the present study was to evaluate the clinical and laboratory findings between these two different forms of ischemic colitis (IC). METHODS: We retrospectively investigated differences in clinical features, course, and mesenteric vascular (superior mesenteric artery, SMA; inferior mesenteric artery, IMA) findings between ILIC and non-ILIC patients who were hospitalized at Kosin University Gospel Hospital from 2004 to 2010. RESULTS: Our study population comprised 221 patients, all of whom met our entry criteria of biopsy-proven or -compatible IC. Of the 221 patients, 46 (20.8%) had non-ILIC. Congestive heart failure and hypercholesterolemia were more frequently observed in the non-ILIC group (P = 0.003 and P = 0.020, respectively). SMA atherosclerosis and SMA stenosis were more frequently observed in the non-ILIC group (P = 0.006 and P = 0.001, respectively). Recovery periods were longer in the non-ILIC group (P = 0.039), and mortality was lower in the ILIC group (6.9% vs. 17.3%, P = 0.026). CONCLUSIONS: ILIC has favorable outcomes compared with non-ILIC. Furthermore, non-ILIC showed a close relationship with SMA atherosclerosis and SMA stenosis, which should be investigated carefully in the clinical field.
Atherosclerosis ; Colitis, Ischemic* ; Colon ; Constriction, Pathologic ; Coronary Artery Disease ; Heart Failure ; Humans ; Hypercholesterolemia ; Ischemia ; Mesenteric Arteries ; Mesenteric Artery, Inferior ; Mesenteric Artery, Superior ; Mortality ; Prognosis ; Retrospective Studies

Horseshoe kidney (HSK) is an unusual congenital anomaly showing fusion of both kidneys anterior to the aorta. Surgical repair of an abdominal aortic aneurysm (AAA) concomitant with HSK may be technically demanding because of the complex anomaly of the kidney and of its collecting system and arteries. We report a 76-year-old man with an AAA associated with HSK. The preoperative CT angiography showed a HSK and an AAA measuring 6.4 cm in diameter. In addition, there was an aberrant isthmus renal artery arising from the aneurysm. The aneurysm was exposed via a transperitoneal approach and the AAA repair was performed successfully without division of the isthmus of the HSK. The aberrant renal artery and inferior mesenteric artery were successfully re-implanted to the graft. The renal function showed no impairment postoperatively.
Aged ; Aneurysm ; Angiography ; Aorta ; Aortic Aneurysm, Abdominal* ; Arteries ; Humans ; Kidney* ; Mesenteric Artery, Inferior ; Renal Artery ; Transplants

Coronary arterial involvement in Takayasu arteritis (TA) is not uncommon. Herein, we describe a case of TA with celiac trunk and superior mesenteric artery occlusion combined with coronary artery disease. Bilateral huge internal thoracic arteries (ITAs) and the inferior mesenteric artery provided the major visceral collateral circulation. After percutaneous intervention to the right coronary artery, off-pump coronary artery bypass grafting for the left coronary territory was done using a right ITA graft and its large side branch because of its relatively minor contribution to the visceral collateral circulation.
Collateral Circulation* ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Coronary Artery Disease ; Coronary Vessels* ; Mammary Arteries* ; Mesenteric Artery, Inferior ; Mesenteric Artery, Superior ; Takayasu Arteritis* ; Transplants

Adult ; Arterial Occlusive Diseases ; etiology ; Blood Sedimentation ; Celiac Artery ; Humans ; Iliac Artery ; Male ; Mesenteric Artery, Inferior ; Mesenteric Artery, Superior ; Renal Artery Obstruction ; etiology ; Takayasu Arteritis ; blood ; complications

Pheochromocytomas can arise wherever chromaffin cells are found, and most of them(90%) are in one or both adrenal glands. But they may be located anywhere along the sympathetic chain and rarely in aberrant sites. One of the common extra-adrenal sites from which these tumors can arise is a collection of para-aortic and para-ganglion cells around the origin of the inferior mesenteric artery. We experienced a case of extra-adrenal pheochromocytoma located at the organ of Zukerkandl in a 21-year-old female patient with abdominal colic and paroxysmal hypertension, whose symptoms and blood pressure returned to normal after successful surgical excision of the tumor.
Adrenal Glands ; Blood Pressure ; Chromaffin Cells ; Colic* ; Female ; Humans ; Hypertension* ; Mesenteric Artery, Inferior ; Pheochromocytoma* ; Young Adult