No abstract availble.
Adult ; Appendicitis/*complications ; Humans ; Male ; Mesenteric Vascular Occlusion/*complications/microbiology ; Mesenteric Veins ; Thrombophlebitis/*diagnosis/etiology/radiography ; Tomography, X-Ray Computed

Idiopathic mesenteric phlebosclerosis, rare disease entity causing chronic mesenteric ischemia is a member of non-thrombotic, non-inflammatory stenosis or occlusion of the mesenteric veins. The histologic hallmark is marked fibrous mural thickening and sclerosis of the vessel wall. It is frequently accompanied by calcification in the vessel wall. We report the case of a 61-year-old woman with idiopathic mesenteric phlebosclerosis. To our knowledge, this is the first case reported in Korea.
Calcinosis/diagnosis ; Colitis, Ischemic/diagnosis/etiology ; Colonoscopy ; Female ; Humans ; Mesenteric Vascular Occlusion/*diagnosis/etiology/pathology ; Mesenteric Veins/*pathology ; Middle Aged ; Sclerosis/pathology ; Tomography, X-Ray Computed

Idiopathic mesenteric phlebosclerosis, rare disease entity causing chronic mesenteric ischemia is a member of non-thrombotic, non-inflammatory stenosis or occlusion of the mesenteric veins. The histologic hallmark is marked fibrous mural thickening and sclerosis of the vessel wall. It is frequently accompanied by calcification in the vessel wall. We report the case of a 61-year-old woman with idiopathic mesenteric phlebosclerosis. To our knowledge, this is the first case reported in Korea.
Calcinosis/diagnosis ; Colitis, Ischemic/diagnosis/etiology ; Colonoscopy ; Female ; Humans ; Mesenteric Vascular Occlusion/*diagnosis/etiology/pathology ; Mesenteric Veins/*pathology ; Middle Aged ; Sclerosis/pathology ; Tomography, X-Ray Computed

Acute mesenteric ischemia can result from emboli, arterial and venous thrombi or vasoconstriction secondary to low-flow states. Isolated spontaneous dissection of the superior mesenteric artery is a rare cause of acute mesenteric ischemia. The mortality rates of acute mesenteric ischemia averages 71% with a range of 59-93%. Diagnosis before the occurrence of intestinal infarction is the most important factor in improving survival rate for patients with acute mesenteric ischemia. A 68-year-old female presented with postprandial epigastric pain, and a dissection of the superior mesenteric artery and a gallbladder polyp were shown in abdominal computed tomographic scan. After the percutaneous metalic stent placement and laparoscopic cholecystectomy, her symptoms improved. We report a case of spontaneous dissection of main trunk of the superior mesenteric artery which was successfully treated by percutaneous stent placement with a review of literature.
Acute Disease ; Aged ; Aneurysm, Dissecting/complications/*therapy ; *Angioplasty, Balloon ; Female ; Humans ; Ischemia/etiology ; *Mesenteric Artery, Superior ; Mesenteric Vascular Occlusion/etiology ; *Stents

Isolated spontaneous dissection of the superior mesenteric artery (SMA) without aortic dissection is a rare cause of acute mesenteric ischemia. A sudden decrease of intestinal blood flow can lead to fatal complications such as ischemic necrosis, shock, and death. Therefore, early diagnosis and therapeutic approach before the occurrence of intestinal infarction are the most important factor to determine the patient's prognosis. A 52-year-old male presented with postprandial periumbilical pain, and isolated spontaneous dissection of the superior mesenteric artery with mural thrombus was detected by abdominal computed tomography with contrast enhancement. By the percutaneous implantation of vascular metallic stent via femoral artery, he was treated successfully. We report a case of isolated spontaneous dissection of the SMA treated by a percutaneous endovascular stent replacement with a review of literature.
Aneurysm, Dissecting/complications/*diagnosis/surgery ; Humans ; Male ; *Mesenteric Artery, Superior/radiography ; Mesenteric Vascular Occlusion/etiology/surgery ; Middle Aged ; *Stents ; Tomography, X-Ray Computed

Isolated spontaneous dissection of the superior mesenteric artery (SMA) without aortic dissection is a rare cause of acute mesenteric ischemia. A sudden decrease of intestinal blood flow can lead to fatal complications such as ischemic necrosis, shock, and death. Therefore, early diagnosis and therapeutic approach before the occurrence of intestinal infarction are the most important factor to determine the patient's prognosis. A 52-year-old male presented with postprandial periumbilical pain, and isolated spontaneous dissection of the superior mesenteric artery with mural thrombus was detected by abdominal computed tomography with contrast enhancement. By the percutaneous implantation of vascular metallic stent via femoral artery, he was treated successfully. We report a case of isolated spontaneous dissection of the SMA treated by a percutaneous endovascular stent replacement with a review of literature.
Aneurysm, Dissecting/complications/*diagnosis/surgery ; Humans ; Male ; *Mesenteric Artery, Superior/radiography ; Mesenteric Vascular Occlusion/etiology/surgery ; Middle Aged ; *Stents ; Tomography, X-Ray Computed

OBJECTIVETo analyze the clinical characteristics diagnosis and treatment of patients with mesenteric venous thrombosis early after operation.

METHODSA retrospective study was performed on the clinical data of 7 patients with mesenteric venous thrombosis early after operation from 1990 to 2004.

RESULTSPatients had main clinical manifestations of severe abdominal pain and vomiting, but abdominal signs were slight. The systemic toxic symptoms occurred in 2 cases at late course. The examination of abdominal X- ray showed intestinal obstruction of all patients. Four patients received abdominal CT- scanning, of whom 3 patients were diagnosed as mesenteric venous thrombosis. Seven patients received exploratory operation. The necrotic intestinal segments were resected. Two patients had short intestinal syndromes after operation, one of them died of serious malnutrition. Four patients who had recurrence of portal, mesenteric and iliac venous thrombosis needed a long-term therapy of warfarin and aspirin after discharge.

CONCLUSIONIt is easy to make a mistake in diagnosis because of the lacking of characteristic clinical manifestations. Exploratory operation immediately plus anticoagulant therapy is strongly recommended.

Adult ; Female ; Humans ; Male ; Mesenteric Vascular Occlusion ; diagnosis ; drug therapy ; etiology ; Middle Aged ; Postoperative Complications ; diagnosis ; drug therapy ; Retrospective Studies ; Thrombolytic Therapy ; Venous Thrombosis ; diagnosis ; drug therapy ; etiology

OBJECTIVETo study the clinical and pathologic features of ischemic intestinal disease due to mesenteric phlebitis.

METHODThe clinical and pathologic features of the mesenteric venous lesions in 3 patients of ischemic intestinal disease admitted during the period from 2003 to 2004 were studied.

RESULTSAll 3 patients had a clinical history of acute abdominal pain accompanying with a diffuse peritonitis. During operation, an infarcted intestinal segment was identified and was resected respectively in each patient. Histologic examination showed a lymphocytic infiltration and fibrinoid necrosis of the small to medium-sized veins, associated with mural thrombosis and infarction of the corresponding intestinal wall and mesentery. The mesenteric arteries were spared. Two-year follow up of one case showed no evidence of local recurrence or systemic vasculitis.

CONCLUSIONSIschemic intestinal disease due to mesenteric phlebitis is a rare entity with a pathological feature of inflammation of venous wall accompanying with the development of mural thrombosis and subsequent haemorrhagic infarction of intestine. The etiology is unknown and surgical resection of the involved intestinal segment is usually recommended.

Adult ; Aged ; Colitis, Ischemic ; etiology ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Intestinal Diseases ; etiology ; pathology ; surgery ; Intestine, Small ; blood supply ; pathology ; surgery ; Ischemia ; complications ; Male ; Mesenteric Vascular Occlusion ; complications ; Mesenteric Veins ; pathology ; Middle Aged ; Phlebitis ; complications

OBJECTIVETo evaluate the application of multi-detector row CT (MDCT) and CT angiography (CTA) for detecting early signs of acute bowel ischemia (ABI) in experimental porcine models.

METHODSTwelve pigs were assigned to four groups with 3 in each group. The digital subtraction angiography of superior mesenteric artery (SMA) and the embolization of branches of SMA with gelatin sponge and blood clot were performed by percutaneous transfemoral artery puncture and catheterization. MDCT pre- and post-contrast scanning in the arterial, venous and delay phase and CTA with three-dimensional reconstruction were carried out at pre-operation, 3 h, 6 h, 9 h, and 12 h after occlusion. The normal mesenteric vascular anatomy, arterial occlusion, mesentery and bowel changes, and dynamic change were evaluated.

RESULTSABI changes were identified pathologically in all the 12 experimental pigs, and the severity of ischemia increased over time after embolization. CTA showed all 57 embolized branches of SMA and 29 of 34 unoccluded arterial branches with 5 false-positive vessel occlusions. The sensitivity and specificity of CTA were 100% and 85.3%, respectively. Thin-slab maximum intensity projection (TSMIP) revealed the disappearance of distal comb-like vessel branches and brush-like vasa recta, which were clearly delineated in the normal bowel segments. Using this criterion, TSMIP correctly defined 23 of 24 ischemic bowel segments and all the 12 normal bowel segments with a sensitivity of 95.8% and a specificity of 100%.

CONCLUSIONSMDCT and CTA reliably define normal and occluded mesenteric vessels in the pig. It can easily detect ischemic bowel segment by identified early changes of ischemia. The early direct ischemic signs are occluded vessels, the disappearance of distal comb-like branches or brush-like vasa recta, and poor bowel enhancement. The early indirect sign is bowel dilatation with fluid collection.

Angiography ; methods ; Animals ; Female ; Intestinal Diseases ; diagnostic imaging ; etiology ; Ischemia ; diagnostic imaging ; etiology ; Mesenteric Arteries ; diagnostic imaging ; Mesenteric Vascular Occlusion ; complications ; diagnostic imaging ; Mesentery ; blood supply ; Swine ; Tomography, X-Ray Computed ; methods

Acutely aggravated dissecting flap and consequent occlusion of the superior mesenteric artery (SMA) by simple contrast passage during initial angiography for percutaneous stent placement is a uncommon event, which usually is not reported. After analysis of many factors that underlie development of such complications, we present herein one case of successful treatment of isolated SMA dissection and its complications with favorable outcomes during 25 months follow-up after percutaneous stent placement.
Adult ; Aneurysm, Dissecting/*surgery ; Angiography/adverse effects ; Contrast Media/adverse effects ; Embolectomy ; Humans ; Male ; Mesenteric Artery, Superior/radiography/*surgery ; Mesenteric Vascular Occlusion/etiology ; Stents/*adverse effects ; Tomography, X-Ray Computed