Shepherd’s crook deformity of an early branching acute marginal artery

2019 ◽  
Vol 75 (2) ◽  
pp. 170-171
Author(s):  
Vineeta Ojha ◽  
Niraj Nirmal Pandey ◽  
Gurpreet Singh Gulati
Keyword(s):  
2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Yukiharu Hiyoshi ◽  
Yuji Miyamoto ◽  
Kojiro Eto ◽  
Yohei Nagai ◽  
Masaaki Iwatsuki ◽  
...  

Abstract Background Persistent descending mesocolon (PDM) is caused by the absence of fusion of the descending colon to the retroperitoneum. We herein report two colorectal cancer cases with PDM that were treated with laparoscopic surgery. Case presentation Case 1: a 50-year-old man with sigmoid colon cancer and synchronous liver metastasis. After neoadjuvant chemotherapy, he underwent laparoscopic sigmoidectomy with lymph node dissection cutting the root of the inferior mesenteric artery (IMA) and synchronous liver resection. He experienced postoperative stenosis of the reconstructed colon possibly due to an impaired arterial blood flow in the reconstructed colon. Case 2: a 77-year-old man with rectal cancer. Laparoscopic low anterior resection preserving the left colic artery (LCA) was performed. Intraoperative infrared ray (IR) imaging using indocyanine green (ICG) showed good blood flow of the reconstructed colon. He had no postoperative complications. In cases of PDM, the mesentery of the descending and sigmoid colon containing the LCA is often shortened, and the marginal artery of the reconstructed colon is located close to the root of the LCA. Lymph node dissection accompanied by cutting the LCA carries a risk of marginal artery injury. Therefore, we recommend lymph node dissection preserving the LCA in colorectal cancer patients with PDM in order to maintain the blood flow of the reconstructed colon. If the IMA and LCA absolutely need to be cut for complete lymph node dissection, the marginal artery should be clearly identified and preserved. In addition, intraoperative IR imaging is extremely useful for evaluating colonic perfusion and reducing the risk of anastomotic complications. Conclusion In colorectal cancer surgery in patients with PDM, surgeons should be aware of these tips for maintaining the blood flow of the reconstructed colon and thereby avoid postoperative complications caused by an impaired blood flow.


2008 ◽  
Author(s):  
Craig Hacking ◽  
Donna D'Souza

Author(s):  
Д.А. Пасічний
Keyword(s):  

Представлен собственный опыт применения метода digital fillet flap, в том числе предложенного лоскута переднебокового отдела подошвы с включением латеральной краевой артерии (arteriae plantaris lateralis digiti quinti, или fibular plantar marginal artery) и вариабельных подошвенных плюсневых артерий IV межплюсневого промежутка в сочетании с пластикой мягкими тканями V пальца, для восстановления длительно незаживающих ран и язв переднего отдела стопы у 5 пациентов. Показано, что данный способ позволяет восстанавливать дефект переднего отдела стопы подошвенным опороспособным лоскутом, имеющим множественное осевое кровоснабжение и чувствительную иннервацию. Предложен метод адаптации лоскута к поверхности раны, основанный на выполнении 3–5 радиальных разрезов длиной 2–3 мм мягких тканей гемисферических краев пальцевого лоскута без повреждения пальцевых сосудов и нервов, что позволяет снизить кривизну лоскута, минимизировать подлоскутное пространство, тканевое натяжение и закрыть большую раневую площадь. Лоскуты fillet flap были успешно применены для восстановления тканей нейротрофических язв и незаживающих ран переднего отдела стопы.


2013 ◽  
Vol 19 (2) ◽  
pp. 112-116
Author(s):  
V. Ispas ◽  
D.M. Iliescu ◽  
R. Baz ◽  
P. Bordei

Abstract In 68% of cases, the left coronary ostium is at the free edge of the left sigmoid valve in 22% of cases over the edge of the valve and in 8% of cases under the free edge of the valve. In 56% of cases, the right coronary ostium is at the free edge of the left sigmoid valve in 28% of cases over the edge of the valve and in 16% of cases under the free edge of the valve. We found 5 cases with two right coronary ostium and 2 cases with two left coronary ostium. We found that in 38% of cases, the left coronary artery ends in three branches, such as anterior interventricular, circumflex and left marginal arteries, in rest of the cases, the left coronary artery ending by two branches like the anterior interventricular and circumflex arteries in which case the marginal artery originate from circumflex artery and rarely from anterior interventricular artery, or both, in this last case the left marginal artery being double. We found only 8 cases in which the circumflex artery ends as posterior interventricular artery in rest of the cases being represented by the right coronary artery end. Circumflex artery ends by two branches quite often and rarely with three branches which can sometimes be long, down to near the apex of the heart. In 8% of cases, the circumflex artery was less developed and do not vascularize other than the left side of the posterior surface of the left ventricle, sometimes his terminal ramus being left marginal artery. The right coronary artery frequently ends on diaphragmatic surface of the heart either as a single branch in posterior interventricular groove, by bifurcation or even rarely by trifurcation, when one or two branches are located in the posterior interventricular groove. Sometimes the right coronary artery ends on the posterior surface of the left ventricle, where the posterior interventricular artery occurs as collateral branch of the right coronary artery, the right coronary artery extending their vascularization territory to the posterior surface of the left ventricle, right up to the apex of the heart, the right coronary dominance, the circumflex artery in this case ending on the lateral surface of the heart. The right coronary artery may end up on the posterior surface of the right ventricle in which case posterior interventricular artery is represented by the terminal portion of the circumflex artery. The right coronary artery rarely ended as the posterior interventricular artery can reach the apex of the heart. We have found that the dominant type of a coronary artery can be held not only in the number of collateral, but also by their caliber at their origin from the aorta. We encountered 7 cases in which there is a third coronary artery, in 5 cases the third coronary artery being an anterior right I called her middle coronary artery or right ventricular branch and anterior ventricular artery, and in two cases the third coronary artery represent the circumflex artery. In 6 cases of the 7 cases described the third coronary artery showed no atrial branches


2018 ◽  
Author(s):  
Yuranga Weerakkody ◽  
Mila Dimitrijevic
Keyword(s):  

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