OBJECTIVETo compare the difference of the diameters of superior mesenteric vein (SMV) and gastrocolic trunk (GCT) between patients with cecum-ascending colon cancer and normal individuals, and to assess the diagnostic value of the diameters of SMV and GCT in cecum-ascending colon cancer.

METHODSPreoperative imaging data of 60 patients with primary cecum-ascending colon cancer confirmed by postoperative pathology at the First Affiliated Hospital of Sun Yat-sen University from June 2014 to December 2016 were retrospectively analyzed. The diameters of SMV and GCT were measured on preoperative CT images. SMV was measured at about 2 cm below the junction of SMV and splenic vein. GCT was measured at 1 cm near the proximal junction of right colon vein, right gastroepiploic vein and anterior pancreaticoduodenal vein. Another 60 people receiving pelvic CT examination without organ illness were collected as control. The diameter differences of SMV and GCT between cancer group and control group were compared. The diagnostic value of the diameters of SMV and GCT in cecum-ascending colon cancer was evaluated by receiver operating characteristic (ROC) curves.

RESULTSAmong 60 cases of cecum-ascending colon cancer, 36 were males and 24 were females with median age of 48 years (range 28-84); 13 were cecum cancer, 47 were ascending colon cancer; 11 had no lymph node and liver metastasis, 40 had lymph node metastasis, 9 had liver metastasis (all with lymph node metastasis). Compared to control group, the diameters of SMV and GCT in cancer group were significantly longer [SMV:(11.2±1.3) mm vs. (9.5±1.7) mm, t=6.04, P<0.001; GCT:(5.5±0.9) mm vs. (3.5±1.0) mm, t=11.51, P<0.001]. However, there were no statistically significant differences in diameters of SMV and GCT among hepatic metastasis, lymph node metastasis and no metastasis cancer groups (all P>0.05). The ROC curve analysis showed that the area under the curve of SMV diameter was 0.777, and the optimal cut-off point was 10.5 mm in the diagnosis of cecum-ascending colon cancer, with the sensitivity and specificity of 95.0%(57/60) and 46.7%(28/60) respectively. The area under the curve of GCT diameter was 0.923, and the optimal cut-off point was 4.5 mm in the diagnosis of cecum-ascending colon cancer, with sensitivity and specificity of 88.3%(53/60) and 85.0%(51/60) respectively.

CONCLUSIONThe dilation of the SMV and GCT may be used as warning factors for cecum-ascending colon cancer, especially the diameter of GCT.

Adult ; Aged ; Aged, 80 and over ; Cecum ; Colon, Ascending ; pathology ; Colonic Neoplasms ; pathology ; Female ; Humans ; Male ; Mesenteric Veins ; anatomy & histology ; Middle Aged ; Retrospective Studies

No abstract available.
Abdomen/diagnostic imaging ; Adult ; Colonoscopy ; Humans ; Hyperplasia/*diagnosis ; Male ; Mesenteric Veins/pathology ; Tomography, X-Ray Computed

Colonic wall thickening is frequently encountered in various conditions, from acute or chronic inflammatory disease to colorectal carcinoma. Colonic wall thickening may be accompanied by calcifications in mucinous adenocarcinoma of the colon, leiomyosarcoma of the colon, schistosomiasis japonica, and phlebosclerotic colitis. Phlebosclerotic colitis is a rare entity of chronic ischemic colitis associated with sclerosis and fibrosis of mesenteric veins. Although its development is usually insidious, and, thus its diagnosis can be delayed, characteristic findings in phlebosclerotic colitis are calcifications of mesenteric veins as well as colonic wall thickening with calcifications. We report on a 71-year-old woman who presented with chronic diarrhea and intermittent hematochezia, who was first misdiagnosed as mucinous adenocarcinoma of the colon, but finally diagnosed as a rare entity of chronic ischemic colitis, phlebosclerotic colitis. Differential points of phlebosclerotic colitis from other diseases, including leiomyosarcoma and schistosomiasis japonica, are also described.
Adenocarcinoma, Mucinous/diagnosis ; Calcinosis/pathology ; Chronic Disease ; Colitis, Ischemic/*diagnosis ; Colonic Neoplasms/diagnosis ; Colonoscopy ; Diagnosis, Differential ; Female ; Humans ; Intestinal Mucosa/pathology ; Mesenteric Veins/pathology ; Radiography, Abdominal ; Sclerosis ; Tomography, X-Ray Computed

OBJECTIVETo investigate the risk factors associated with metastasis of lymph node along superior mesenteric vein (No.14v) in gastric cancer.

METHODSClinicopathological data of 70 gastric cancer patients undergoing gastrectomy with No.14v dissection between September 2010 and October 2011 in the Gulou Hospital, Nanjing University School of Medicine were analyzed retrospectively. Associated factors of No.14v lymph nodes metastasis were investigated.

RESULTSOf 70 cases, positive No.14v lymph node metastasis was found in 8 cases (11.4%). Univariate analysis showed that the No.14v metastasis was associated with tumor location (P=0.019), tumor size (P=0.004), depth of invasion (P=0.001), TNM staging (P=0.006), and other lymph node group metastasis (all P<0.05), and was not associated with age, gender, Borrmann classification, Lauren classification or histological type (all P>0.05). Multivariate analysis revealed that lntra-pyloric lymph nodes (No.6) metastasis was an independent risk factor of No.14v metastasis (P<0.05). The predictive accuracy was 94.3% (66/70) and false-negative rate was 1.7% (1/60) for No.6 lymph node metastasis.

CONCLUSIONNo.6 lymph node metastasis status can predict the metastasis of No.14v more accurately.

Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Metastasis ; Mesenteric Veins ; pathology ; Neoplasm Staging ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; pathology ; surgery

OBJECTIVE: To evaluate the value of multi-slice CT angiography (MSCTA) in the diagnosis of super mesenteric artery (SMA) and super mesenteric vein (SMV), and discuss the 3D reconstruction method for detecting mesenteric vessel lesions. METHODS: Thirty-three patients suffering from mesenteric vessel diseases were analyzed. There were 14 SMA lesions, including 9 thromboses, 3 dissecting aneurysms, 1 pseudoaneurysm, and 1 malrotation. There were 19 SMV thromboses. The 3D reconstruction included volume rendering (VR), maximum intensity projection (MIP), and multi-planner reformation (MPR). RESULTS: The lesions appeared clear by MSCTA in the 33 patients. The SMA thrombosis was shown clear in the MIP in all 9 patients, and only 4 of them were detected in the VR. There was significant difference between MIP andVR in detecting SMA thrombosis (P=0.0294). Three dissecting aneurysms were best shown in the MPR; 1 pseudoaneurysm and 1 malrotation were clearly manifested in the VR. The thrombosis of SMV was clearly shown by both MIP and MPR in all 19 patients. Collateral vessels were clearly shown in the MIP in 12 patients; the collateral vessels were detected by VR only in 5, and the other 7 failed to show the collateral vessels. There was significant difference between the MIP and the VR in showing lateral collateral vessels (P=0.0046). CONCLUSION Both lesions of SMA and SMV can be detected by MSCTA. MIP is an ideal reconstruction method for SMA thrombosis and collateral vessels around the SMV.
Aneurysm, Dissecting ; diagnosis ; Angiography ; Humans ; Mesenteric Arteries ; pathology ; Mesenteric Veins ; pathology ; Thrombosis ; diagnosis ; Tomography, X-Ray Computed

OBJECTIVE: To compare the ancillary CT findings between superior mesenteric artery thromboembolism (SMAT) and superior mesenteric vein thrombosis (SMVT), and to determine the independent CT findings of life-threatening mesenteric occlusion. MATERIALS AND METHODS: Our study was approved by the institution review board. We included 43 patients (21 SMAT and 22 SMVT between 1999 and 2008) of their median age of 60.0 years, and retrospectively analyzed their CT scans. Medical records were reviewed for demographics, management, surgical pathology diagnosis, and outcome. We compared CT findings between SMAT and SMVT groups. Multivariate analysis was conducted to determine the independent CT findings of life-threatening mesenteric occlusion. RESULTS: Of 43 patients, 24 had life-threatening mesenteric occlusion. Death related to mesenteric occlusion was 32.6%. A thick bowel wall (p < 0.001), mesenteric edema (p < 0.001), and ascites (p = 0.009) were more frequently associated with SMVT, whereas diminished bowel enhancement (p = 0.003) and paralytic ileus (p = 0.039) were more frequent in SMAT. Diminished bowel enhancement (OR = 20; p = 0.007) and paralytic ileus (OR = 16; p = 0.033) were independent findings suggesting life-threatening mesenteric occlusion. CONCLUSION: The ancillary CT findings occur with different frequencies in SMAT and SMVT. However, the independent findings indicating life-threatening mesenteric occlusion are diminished bowel wall enhancement and paralytic ileus.
Arteries ; Contrast Media/diagnostic use ; Female ; Humans ; Iohexol/diagnostic use ; Male ; Mesenteric Vascular Occlusion/mortality/pathology/*radiography ; Middle Aged ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Tomography, X-Ray Computed/*methods ; Veins

Integrated resection of the pancreatic head is the most difficult step in radical pancreaticoduodenectomy (RPD) in patients with the portal vein (PV) and superior mesenteric vein (SMV) invasion or oppression by the tumor. This study introduced a new idea and skill named the "total arterial devascularization first" (TADF) technique and its applications in RPD. Three arterial blood supplies of pancreatic head were obstructed before dissection of veins. The critical steps included exposure of the anterior surface of the abdominal aorta (AA) by completely transecting neural and connective tissue between superior mesenteric artery (SMA) and pancreatic mesounsinate, and transection of the mesounsinate from the origin of SMA to the root of the celiac trunk. From January 2012 through May 2013, a total of 58 patients with PV/SMV invasion or oppression underwent RPD using this technique. The median operative time was 5.1 h (ranging 4.5-8.1 h). The median intraoperative blood loss was 450 mL (ranging 200-900 mL). No intraoperative and postoperative bleeding of pancreatic head region occurred. Among the 58 patients, 21 were subjected to vessel lateral wall angiectomy or angiorrhaphy, and 10 to angiectomy and end-to-end anastomosis. The incidence of postoperative bleeding, postoperative pancreatic fistula and biliary fistula was 5.2%, 6.8%, and 1.7%, respectively. No patients died 3 months after operation. The TADF technique is a new method for intricate RPD and could improve the security of surgery and reduce intraoperative bleeding, which is expected to become standardized surgical approach for RPD.
Adult ; Aged ; Arteries ; physiopathology ; Blood Loss, Surgical ; prevention & control ; Female ; Humans ; Male ; Mesenteric Veins ; pathology ; surgery ; Neoplasm Invasiveness ; Pancreatic Neoplasms ; blood supply ; surgery ; Pancreaticoduodenectomy ; methods ; Portal Vein ; pathology ; surgery ; Postoperative Hemorrhage ; prevention & control ; Reproducibility of Results ; Time Factors ; Vascular Surgical Procedures ; methods

OBJECTIVETo investigate the technique of radical pancreaticoduodenectomy for malignant tumor in pancreatic head with pressed superior mesenteric blood vessel or portal vein.

METHODSFrom March 2005 to March 2007, thin slice scan and vessel-reconstruction of 56 patients of malignant tumor in pancreatic head with pressed superior mesenteric blood vessels or portal vein were carried out using multidetector spiral CT to evaluate whether peripheral vessels of pancreatic tumor were invaded and whether the tumor was resectable. During the operation, 3 vascular blocking bands for superior mesenteric vein, portal vein and spleen vein or 4 vascular blocking bands (additional one for inferior mesenteric vein) were preset. Under the cross and traction between superior mesenteric vein and superior mesenteric artery, resected the uncinate process of pancreas thoroughly. Using those methods, radical pancreaticoduodenectomy for 56 patients above-mentioned were successfully accomplished.

RESULTSThe accuracy for preoperative judging by using multidetector spiral CT whether the peripheral vessels of pancreatic cancer were invaded and whether the tumor was resectable was 98% and 100% separately. Thirty-seven of 56 patients, whose superior mesenteric blood vessels or portal veins were pressed by the tumor of pancreatic head, were operated using 3 vascular blocking bands and 2 patients using 4 vascular blocking bands, followed by suturing the bleeding points of the superior mesenteric vein with 5-0 vascular suture Proline. One patient's superior mesenteric vein was partially resected and restored. The operations cost 5-8 h each and the blood loss was 200-600 ml. There were no operative or postoperative hemorrhage or pancreatic juice leakage. According to the follow-up up to now, 2 patients died of multiple live tumor metastases 7 and 9 months separately after operation, the other 54 patients were still alive.

CONCLUSIONSThin slice scan and vessel-reconstruction using multidetector spiral CT can accurately judge whether the blood vessels near the pancreatic tumor were invaded and whether the tumor was resectable, using 3 vascular blocking bands or 4 vascular blocking bands and cross, traction of the superior mesenteric blood vessels, operator can easily accomplish the radical pancreaticoduodenectomy of malignant tumor in pancreatic head with pressed superior mesenteric blood vessels and portal vein, which was not resectable or need combined resection of the blood vessels in the traditional opinion.

Adult ; Aged ; Female ; Humans ; Male ; Mesenteric Artery, Superior ; pathology ; surgery ; Mesenteric Veins ; pathology ; surgery ; Middle Aged ; Neoplasm Invasiveness ; Pancreas ; pathology ; Pancreatic Neoplasms ; pathology ; surgery ; Pancreaticoduodenectomy ; methods ; Portal Vein ; pathology

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