scholarly journals Malrotation Induced Small Intestine Ischemia in an Adolescent

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Karadeniz Erdem ◽  
Atamanalp Selçuk Sabri
Keyword(s):  
Emergency Department ◽  
Small Intestine ◽  
Abdominal Pain ◽  
Superior Mesenteric Artery ◽  
Emergency Surgery ◽  
Mesenteric Artery ◽  
Duodenal Obstruction ◽  
Mesenteric Ischemia ◽  
Clockwise Rotation ◽  
Small Intestinal

Intestinal malrotation occurs if midgut does not complete or partially completes its 270° counter-clockwise rotation around the superior mesenteric artery during embryologic life. In general, it frequently manifests with vomiting due to duodenal obstruction and volvulus in the initial months of life, and it is very rare to manifest in the adulthood. A 20-year-old male patient who had severe abdominal pain, nausea, vomiting, and distention for one day was evaluated at the emergency department. On abdominal tomography “swirling appearance of structures around the superior mesenteric artery” was reported. CT appearance was considered compatible with a rotational anomaly. Emergency surgery was planned for the patient. In laparotomy, it was observed that an approximately 100 cm long small intestine segment was rotated around a band (Ladd) and ischemia was developed in this segment due to rotation of its mesentery. The rotation of the small intestinal mesentery was corrected by opening the bands. After the warm application to the intestinal mesenteric ischemia for a while, the color and the peristalsis of the intestines became normal. The patient was discharged on postoperative day 2 with suggestions.

Synchronous celiac axis and superior mesenteric artery embolism

VASA ◽  
2011 ◽  
Vol 40 (6) ◽  
pp. 495-498 ◽  
Author(s):  
Rajkovic ◽  
Zelic ◽  
Papes ◽  
Cizmek ◽  
Arslani
Keyword(s):  
Atrial Fibrillation ◽  
Small Intestine ◽  
Abdominal Pain ◽  
Ct Scan ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Abdominal Cavity ◽  
Celiac Axis ◽  
Contrast Administration ◽  
Artery Embolism

We present a case of combined celiac axis and superior mesenteric artery embolism in a 70-year-old patient that was examined in emergency department for atrial fibrillation and diffuse abdominal pain. Standard abdominal x-ray showed air in the portal vein. CT scan with contrast showed air in the lumen of the stomach and small intestine, bowel distension with wall thickening, and a free gallstone in the abdominal cavity. Massive embolism of both celiac axis and superior mesenteric artery was seen after contrast administration. On laparotomy, complete necrosis of the liver, spleen, stomach and small intestine was found. Gallbladder was gangrenous and perforated, and the gallstone had migrated into the abdominal cavity. We found free air that crackled on palpation of the veins of the gastric surface. The patient’s condition was incurable and she died of multiple organ failure a few hours after surgery. Acute visceral thromboembolism should always be excluded first if a combination of atrial fibrillation and abdominal pain exists. Determining the serum levels of d-dimers and lactate, combined with CT scan with contrast administration can, in most cases, confirm the diagnosis and lead to faster surgical intervention. It is crucial to act early on clinical suspicion and not to wait for the development of hard evidence.

scholarly journals EFFECTS OF LENGTH AND REGION OF SMALL INTESTINAL GLUCOSE EXPOSURE ON BLOOD PRESSURE, SUPERIOR MESENTERIC ARTERY BLOOD FLOW AND PLASMA NORADRENALINE IN HEALTHY OLDER PARTICIPANTS

2018 ◽  
pp. 1-7
Author(s):  
R.S. Rigda ◽  
L.G. Trahair ◽  
T. Wu ◽  
T.J. Little ◽  
K. Lange ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Small Intestine ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Plasma Noradrenaline ◽  
Glucose Exposure ◽  
Small Intestinal ◽  
Mesenteric Artery Blood Flow ◽  
Occluding Balloon

Background: A substantial postprandial reduction in blood pressure (BP), triggered by the interaction of nutrients with the small intestine and associated with increases in heart rate (HR) and splanchnic blood flow, occurs frequently in healthy older people. Objective: The aim of this study was to determine whether these responses are influenced by the length and/or region of small intestine exposed to nutrients. Design: Randomized, single blind study. Setting: Clinical research laboratory. Participants: Ten healthy older participants (9M, 1F; age 65 – 79 yr). Intervention: On 3 separate study days, participants were intubated with a small intestinal catheter incorporating two duodenal infusion ports and an aspiration port, as well as an occluding balloon, which was positioned ~ 60 cm beyond the pylorus. Each participant then received a 60 min (t = 0 – 60 min) intraluminal infusion of glucose (3 kcal/min) into either the proximal (< 60 cm “GP”), or the distal (> 70 cm “GD”), or both (i.e. proximal and distal “GPD”), small intestinal segments. Measurements: BP, HR (automated device), superior mesenteric artery (SMA) blood flow (Doppler ultrasound) and plasma noradrenaline (NA). Results: Small intestinal glucose infusion was associated with reductions in systolic (GP: P = 0.004, GD: P = 0.001, GPD: P = 0.001) and diastolic (GP: P = 0.007, GD: P = 0.004, GPD: P = 0.003) BP and increases in HR (GP: P = 0.001, GD: P = 0.001, GPD: P = 0.002) and plasma NA (GP: P = 0.001, GD: P = 0.002, GPD: P = 0.001), without any difference between the three days. Conclusion: In healthy older participants, the effects of small intestinal glucose to decrease BP and increase SMA flow in healthy older participants appear to be independent of the region, or length, of small intestine exposed.

Microsphere method in measurement of blood flow to wall layers of small intestine

1986 ◽  
Vol 250 (5) ◽  
pp. G670-G678 ◽  
Author(s):  
E. Dregelid ◽  
S. Haukaas ◽  
S. Amundsen ◽  
G. E. Eide ◽  
O. Soreide ◽  
...  
Keyword(s):  
Blood Flow ◽  
Small Intestine ◽  
Tissue Distribution ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Consistent Difference ◽  
Local Blood Flow ◽  
Microsphere Method ◽  
Small Intestinal ◽  
Log Linear

Microspheres of 10.90 +/- 0.65 micron (SD) were injected in the superior mesenteric artery of cats and their intramural distribution and diameter in the small intestine were studied microscopically under basal conditions and after vasodilation by isoproterenol. Approximately 2% of the spheres were shunted through the small intestinal vasculature and could be recovered in the liver. Analysis of the tissue distribution suggested that all spheres arrested in villi represented villous blood flow, spheres arrested in the crypt layer represented flow to the crypts, and the majority of microspheres trapped in the submucosa also represented crypt flow. Nutritive blood flow to the submucosa constituted only 1.5% of total intestinal flow. Log-linear analyses identified factors responsible for sphere distribution, including effects of sphere size, isoproterenol treatment, and local blood flow or vascular resistance. Spheres with diameters greater than 11.08 micron had 1.35 times larger odds than smaller spheres to embolize in the muscularis rather than in the mucosa, but no consistent difference between diameter profiles in the crypts and villi was found. With this reservation, 11-micron spheres seem to be appropriate for measuring blood flow to the muscle, crypt, and villous layers of the small intestine.

scholarly journals Percutaneous retrograde revascularization of chronic occlusions of the superior mesenteric artery via collaterals of the celiac artery

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Wilhelm H. Kersjes ◽  
Alexander Hesse
Keyword(s):  
Abdominal Pain ◽  
Clinical Outcome ◽  
Superior Mesenteric Artery ◽  
Abdominal Aorta ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Celiac Artery ◽  
Chronic Mesenteric Ischemia ◽  
Technical Success ◽  
Chronic Total Occlusions

Abstract Purpose To evaluate the technical success of percutaneous retrograde revascularization of the superior mesenteric artery (SMA) via the celiac artery (CA) in patients with chronic mesenteric ischemia (CMI). Methods We performed a retrospective review of three patients with chronic total occlusions (CTOs) of the origin of SMA which were recanalized retrograde via collaterals of the CA after frustrating attempt of antegrade revascularization from the abdominal aorta in our institute between May 2019 and June 2020. Results All technical procedures of retrograde revascularization of CTOs of SMA via collaterals of the CA were successful. The clinical outcome resulted in a sustained resolution of abdominal pain in all cases. Conclusion Retrograde recanalization of SMA via collaterals from the CA seems to be a successful endovascular option for patients with CMI and a chronically occluded superior mesenteric artery when antegrade recanalization fails as far as it can be concluded from the small number of presented cases.

scholarly journals A clinical case of using ICG-technologies to evaluate the results of the superior mesenteric artery stenting in a patient with acute mesenteric ischemia

2020 ◽  
pp. 103-109
Author(s):  
A. G. Khitaryan ◽  
A. S. Murlychev ◽  
I. V. Bondarenko ◽  
S. A. Kovalev ◽  
K. S. Veliev ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Clinical Case ◽  
Acute Mesenteric Ischemia ◽  
Spiral Computed Tomography ◽  
High Tech ◽  
Spiral Computed

Introduction. Acute mesenteric ischemia is a rare, but extremely severe life-threatening condition with a mortality rate of 40 to 60%, despite the development of modern high-tech diagnostic and treatment methods. Unfortunately, acute mesenteric ischemia does not have any pathognomonic symptoms or highly specific laboratory and instrumental symptoms and manifests as abdominal pain syndrome, which makes it harder to differentiate diagnosis and results in a delay in taking appropriate therapeutic measures.Clinical case. This clinical case report describes a case of a 70-year-old patient who was admitted to the cardiology department after undergoing percutaneous coronary intervention due to acute myocardial infarction. On the third day, the patient developed severe diffuse abdominal pain and diarrhea. After the series of diagnostic measures have been performed, an acute impairment of mesenteric circulation was suspected and a decision was made to perform spiral computed tomography, which confirmed the presence of a thrombus in the superior mesenteric artery. The patient underwent X-ray endovascular thrombospiration, transluminal balloon angioplasty and stenting of the superior mesenteric artery. Due to the persistence of abdominal pain on the following day, the patient also underwent a diagnostic laparoscopy using ICG technologies to assess the presence and severity of ischemic and necrotic intestinal changes. After six months from the date of discharge, the patient continues to be followed-up by a cardiologist.Conclusions. The timely performance of spiral computed tomography in patients with suspected acute mesenteric ischemia in the vascular regimen, angiography, endovascular interventions to restore blood supply to the intestine and ICG control of perfusion is appropriate to improve the treatment outcomes of this category of patients.

scholarly journals Superior mesenteric artery aneurysm in a patient with infective endocarditis

CJEM ◽  
2014 ◽  
Vol 16 (01) ◽  
pp. 84-87 ◽  
Author(s):  
Jennifer Devon ◽  
Philip Miller
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Infective Endocarditis ◽  
Physical Examination ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Artery Aneurysm ◽  
Recent Advances ◽  
Predisposing Conditions

ABSTRACT Infective endocarditis (IE) is a rare but serious condition. We present a case of endocarditis in a healthy 40-year-old male with no predisposing conditions. His physical examination was suggestive of peripheral microembolization and prompted us to consider the diagnosis of IE and order the appropriate investigations. After treatment, he later presented to the emergency department with abdominal pain, and a superior mesenteric artery aneurysm was discovered. We discuss recent advances in the changing epidemiology and microbiology of IE, review the presentation and diagnosis of IE, and highlight the potential complications of this disease.

scholarly journals Anatomic Revascularization of the Celiac Trunk and the Superior Mesenteric Artery

Aorta ◽  
2018 ◽  
Vol 06 (01) ◽  
pp. 041-042
Author(s):  
Murat Ugurlucan ◽  
Nihat Aksakal ◽  
Yilmaz Onal ◽  
Didem Oztas ◽  
Ufuk Alpagut
Keyword(s):  
Weight Loss ◽  
Abdominal Pain ◽  
Major Depression ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Celiac Trunk ◽  
Endovascular Techniques ◽  
Risks And Benefits ◽  
Severe Weight Loss

AbstractChronic atherosclerotic mesenteric ischemia is a debilitating disorder. It may cause postprandial abdominal pain leading to severe weight loss. Patients are usually emotionally affected with major depression. The disease can be treated with open surgical and endovascular techniques and both methods have individual risks and benefits. In this report, the authors present anatomical revascularization of the superior mesenteric artery and the celiac trunk.

scholarly journals Gallstone ileus: a rare cause of small intestine obstruction

2021 ◽  
Author(s):  
Levan Tchabashvili ◽  
Dimitris Kehagias ◽  
Charalampos Kaplanis ◽  
Elias Liolis ◽  
Ioannis Perdikaris ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Small Intestine ◽  
Abdominal Pain ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Emergency Surgery ◽  
Gallstone Ileus

A 77-year-old woman was admitted to our emergency department complaining of abdominal pain. Computed tomography was performed and showed aerobilila and a large 5.1 cm gallstone lodged in the small intestine. She underwent emergency surgery. Intraoperative findings noted small bowel obstruction caused by a large gallstone.

Antibiotic Therapy Did Not Prevent the Rupture of Mycotic Aneurysm of the Superior Mesenteric Artery

2015 ◽  
Vol 18 (3) ◽  
pp. 088
Author(s):  
Ye-tao Li ◽  
Xiao-bin Liu ◽  
Tao Wang
Keyword(s):  
Abdominal Pain ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mycotic Aneurysm ◽  
Acute Abdominal Pain ◽  
Rare Complication ◽  
Emergency Operation ◽  
History Of

<p class="p1"><span class="s1">Mycotic aneurysm of the superior mesenteric artery (SMA) is a rare complication of infective endocarditis. We report a case with infective endocarditis involving the aortic valve complicated by multiple septic embolisms. The patient was treated with antibiotics for 6 weeks. During preparation for surgical treatment, the patient developed acute abdominal pain and was diagnosed with a ruptured SMA aneurysm, which was successfully treated with an emergency operation of aneurysm ligation. The aortic valve was replaced 17 days later and the patient recovered uneventfully. In conclusion, we present a rare case with infective endocarditis (IE) complicated by SMA aneurysm. Antibiotic treatment did not prevent the rupture of SMA aneurysm. Abdominal pain in a patient with a recent history of IE should be excluded with ruptured aneurysm.</span></p>

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