No abstract available.
Ischemia* ; Mesenteric Veins* ; Thrombosis*

Chronic Mesenteric Ischemia (CMI) is a rare cause of abdominal pain as vascular disorders tend to be last of the differential diagnoses considered in patients presenting with gastrointestinal symptoms. This is a case of a 58-year-old male who presented with a 2-year history of intermittent abdominal pain associated with sitophobia and undocumented weight loss. He had several in-hospital admissions and after a series of unremarkable diagnostic tests he was diagnosed with chronic mesenteric ischemia secondary to superior mesenteric artery stenosis as evidenced through computed tomography angiography. He underwent an aorto-SMA bypass with an 8mm Dacron graft. The main goals for revascularization of CMI are improving quality of life and prevention of bowel infarction. As CMI is a rare cause of abdominal pain, the patients tend to be victims of diagnostic delays. Early recognition and timely intervention are key in the management of this condition.
Mesenteric Ischemia ; Abdominal Pain ; Vascular Diseases

OBJECTIVE: This study was conducted to investigate the relationship between invasive treatments and computed tomographic (CT) classification or findings in symptomatic spontaneous isolated superior mesenteric artery dissection (SISMAD). METHODS: This retrospective observational study included 30 patients with SISMAD from Jan 2012 to Dec 2016. Demographic data, risk factor, treatment modalities, and CT findings including morphological classification, dissection length, and true lumen relative diameter (TLRD) were reviewed. The enrolled patients were classified into two groups (conservative management group, CG; invasive management group, IG). RESULTS: Based on CT classifications, one patient was type I (CG, n=1; IG, n=0), two were type IIa (CG, n=2; IG, n=0), five were type IIIa (CG, n=5; IG, n=0), 10 were type IIIb (CG, n=9; IG, n=1), and 12 were type IIIc (CG, n=1; IG, n=11). There was a high tendency to undergo invasive treatment among type IIIc (P < 0.001). The TLRD, distance from the aorta to dissection point, and dissection length were 18.3% (range, 0%–29.8%), 1.7 cm (range, 0–3.5 cm), and 7.3 cm (range, 4.9–10.0 cm), respectively. There TLRD (CG, 26.8% [range, 22.2%–48.8%]; IG, 0%; P < 0.001) and distance from the aorta to dissection point (CG, 1.0 cm [range, 0–2.1 cm]; IG, 3.5 cm [range, 0.8–5.4 cm]; P=0.024) differed significantly between groups. However, there was no significant difference in dissection length between CG and IG (P=0.527). CONCLUSION: The TLRD, distance from the aorta to dissection point, and CT classification such as type IIIc were associated with invasive management. Further studies on extended natural course of the disease from a larger number of subjects are necessary to draw a strong conclusion.
Abdominal Pain ; Aorta ; Classification ; Humans ; Mesenteric Arteries ; Mesenteric Artery, Superior* ; Mesenteric Ischemia ; Observational Study ; Retrospective Studies ; Risk Factors

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*

Fractional Flow Reserve, Myocardial ; physiology ; Humans ; Mesenteric Ischemia ; physiopathology

Supra-celiac aortic cross clamping is often utilized during aortic reconstruction for aneurysmal/occlusive disease involving the pararenal aorta. However, this may be accompanied a myriad of complications related to hemodynamic disturbances, cardiopulmonary compromise and hepatic ischemia. Supra-mesenteric aortic cross clamping may be an excellent option in selected patients with suitable anatomy to minimize or avoid these complications. Herein, the merits of and technical tips for supra-mesenteric aortic cross clamping are discussed.
Aorta ; Celiac Artery ; Constriction ; Hemodynamics ; Humans ; Ischemia ; Mesenteric Artery, Superior

Angioplasty ; Embolectomy ; Ischemia ; pathology ; surgery ; Mesenteric Artery, Superior ; pathology ; surgery ; Mesenteric Ischemia ; Thrombosis ; pathology ; surgery ; Vascular Diseases ; pathology ; 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

Superior mesenteric artery (SMA) syndrome is a rare disorder, characterized by a decreased aortomesenteric angle that causes a duodenal obstruction. Various medical and psychiatric conditions may result in the initial rapid weight loss that causes narrowing of the aortomesenteric angle. Isolated dissection of the superior mesenteric artery (DSMA) is an uncommon cause of acute mesenteric ischemia. Several literature reports suggest that medical treatment in combination with close observation is reasonable in uncomplicated dissection with stable hemodynamic status. Recently, as several reports describe, rapid revascularization by percutaneous angioplasty and endovascular stent insertion can prevent bowel ischemia that progresses to irreversible bowel necrosis. However, the stability of endovascular stents at the DSMA has not been confirmed, because its use is reasonably infrequent. Here, we report a case of SMA syndrome, as a complication of endovascular stent placement at the DSMA.
Angioplasty ; Duodenal Obstruction ; Hemodynamics ; Ischemia ; Mesenteric Artery, Superior ; Necrosis ; Stents ; Superior Mesenteric Artery Syndrome ; Vascular Diseases ; Weight Loss

Pneumatosis intestinalis is a rare condition that affects 0.03% of the population. Pneumatosis cystoides intestinalis (PCI) is characterized by the presence of multiple gas-filled cysts in the intestinal wall and the submucosa and/or intestinal subserosa. It is usually a secondary finding caused by a wide variety of underlying gastrointestinal or extragastrointestinal diseases. Here, we present the case of a 47-year-old man who was referred to our gastroenterology department with a history suggestive of intermittent small bowel obstruction associated with abdominal pain. Abdominal computed tomography demonstrated PCI of the small bowel. The mesentery and branches of the superior mesenteric artery and superior mesenteric vein were twisted with minimal pneumoperitoneum. Exploratory laparotomy was performed, and demonstrated segmental small bowel PCI secondary to hypermobile mesentery. The affected segment of the ileum was resected, and jejunoileal anastomosis was performed. Here, we report a rare case of segmental PCI probably due to repeated twisting of hypermobile mesentery. The clinical and imaging features of this disorder may mimic those of visceral perforation or bowel ischemia. PCI can be a cause of severe abdominal pain that may require surgical intervention.
Abdominal Pain ; Gastroenterology ; Humans ; Ileum ; Ischemia ; Laparotomy ; Mesenteric Artery, Superior ; Mesenteric Veins ; Mesentery* ; Middle Aged ; Pneumatosis Cystoides Intestinalis* ; Pneumoperitoneum