Superior Mesenteric Artery and Vein Injuries: Operative Strategies and Outcomes

2021 ◽  
pp. 153857442110424
Author(s):  
Patrick D. Melmer ◽  
Brant Clatterbuck ◽  
Virginia Parker ◽  
Christine A. Castater ◽  
Nathan J. Klingensmith ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Surgical Intervention ◽  
Management Strategies ◽  
Mortality Rates ◽  
Traumatic Injuries ◽  
Improved Outcomes ◽  
Operative Strategies ◽  
Mesenteric Vessels ◽  
Prompt Diagnosis

Traumatic injuries to the mesenteric vessels are rare and often lethal. Visceral vessels, such as the superior mesenteric artery (SMA) and vein (SMV), supply blood to the small and large bowel by a rich system of collaterals. Because fewer than 100 such injuries have been described in the literature, they pose challenges in both diagnosis and management and can unfortunately result in high mortality rates. Prompt diagnosis, surgical intervention, and resuscitation can lead to improved outcomes. Here, we review the literature surrounding traumatic injuries of the SMA/SMV and discuss management strategies.

scholarly journals Aneurysm of an aberrant splenic artery: An extremely rare occurrence

Vascular ◽  
2015 ◽  
Vol 23 (6) ◽  
pp. 637-638 ◽  
Author(s):  
Rohit Bhoil ◽  
Ashwani Tomar ◽  
Sushma Makhaik ◽  
RG Sood ◽  
Nishant Nayyar
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Rare Case ◽  
Splenic Artery ◽  
Surgical Planning ◽  
Medical Literature ◽  
Surgical Intervention ◽  
Rare Occurrence ◽  
Anatomical Variant ◽  
English Medical Literature

An aberrant splenic artery arising from the superior mesenteric artery, also known as the splenomesenteric trunk, is a rare anatomical variant seen in less than 1% of the population and is more common in females. Aneurysms of the splenic artery originating anomalously from the superior mesenteric artery are extremely rare; only 35 cases of aneurysm of an aberrant splenic artery have been described so far in the English medical literature. We report an extremely rare case of aneurysm of aberrant splenic artery in a 28-year-old man in whom the lesion was detected during routine abdominal scanning and confirmed on computed tomography angiography. Aneurysms of an anomalous splenic artery originating from the superior mesenteric artery are extremely rare; however, they are clinically important because possible rupture could be catastrophic. Exploring these variations is important especially if surgical intervention is contemplated. This could greatly affect the surgical planning and avoid injuries to major arteries and organs intraoperatively.

Surgical Intervention for Isolated Dissecting Aneurysm of the Superior Mesenteric Artery

2004 ◽  
Vol 38 (5) ◽  
pp. 469-472 ◽  
Author(s):  
Yoshihiko Tsuji ◽  
Yutaka Hino ◽  
Koji Sugimoto ◽  
Hitoshi Matsuda ◽  
Yutaka Okita
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Surgical Intervention ◽  
Dissecting Aneurysm

Changes in intestinal vascular diameter during norepinephrine vasoconstrictor escape

1976 ◽  
Vol 230 (6) ◽  
pp. 1466-1468 ◽  
Author(s):  
PH Guth ◽  
G Ross ◽  
E Smith
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Time Course ◽  
Vessel Diameter ◽  
Mesenteric Arteries ◽  
In Vivo Microscopy ◽  
Mesenteric Vessels ◽  
Arterial Constriction ◽  
Electro Magnetic

The hypothesis that escape from norepinephrine-induced vasoconstriction in the intestine is due to relaxation of initially constricted vessels was tested in 18 anesthetized cats. Intestinal blood flow was measured by an electro magnetic probe on the superior mesenteric artery. Intestinal submucosal and muscle arterioles and small mesenteric arteries were studied by in vivo microscopy with an image-splitting technic. Continuous recordings of mesenteric flow and vessel diameter were made during the infusion into the superior mesenteric artery of norepinephrine (NE) at a rate of 1-2 mug/min for 3 min. Mesenteric flow decreased soon after the NE infusion began but then escaped. Microscopically, arterial constriction and escape were noted in submucosal, muscle, and mesenteric vessels with a time course similar to that for flow. Arteriovenous anastomoses were not seen. These findings support the hypothesis that escape from Ne-induced vasoconstriction is due to relaxation of initially constricted vessels.

scholarly journals Necrotising enterocolitis in an adult with anorexia nervosa

2020 ◽  
Vol 102 (8) ◽  
pp. 560-565
Author(s):  
B Schapira ◽  
S Nazarian ◽  
M Thanapal ◽  
C Parmar ◽  
H Mukhtar
Keyword(s):  
Anorexia Nervosa ◽  
Surgical Intervention ◽  
Case Reports ◽  
Mortality Rates ◽  
Necrotising Enterocolitis ◽  
Emergency Laparotomy ◽  
Good Recovery ◽  
Successful Management ◽  
Necrotic Bowel ◽  
Prompt Diagnosis

Necrotising enterocolitis (NEC) is a rare cause of the acute abdomen in adults and carries one of the highest mortality rates in gastroenterology. However, its rarity confines research to small case reports. Both its pathogenesis and aetiology remain enigmatic in adult patients, proving timely diagnosis and management a challenge. This paper reports on one case of NEC in an adult patient with underlying anorexia nervosa, following a seven-day period of starvation. She underwent emergency laparotomy for resection of necrotic bowel and subsequently made a good recovery. To date, there have only been eight reports linking NEC with anorexia nervosa. We review our patient in the context of plausible mechanisms hypothesised in these cases. Successful management depends on prompt diagnosis, resuscitation and surgical intervention.

Superior Mesenteric Artery Syndrome: An Uncommon Cause of Abdominal Pain Mimicking Gastroenteritis

2008 ◽  
Vol 15 (4) ◽  
pp. 235-239 ◽  
Author(s):  
CM Lo ◽  
HK Lau ◽  
SK Kei
Keyword(s):  
Abdominal Pain ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Surgical Intervention ◽  
Epigastric Pain ◽  
Superior Mesenteric Artery Syndrome ◽  
Computed Tomography Scan ◽  
Gastrointestinal Series ◽  
Upper Gastrointestinal ◽  
Tomography Scan

Abdominal pain and vomiting are frequently encountered in the emergency department. We report a 54-year-old man with an uncommon cause of intestinal obstruction – superior mesenteric artery syndrome – who presented with epigastric pain and vomiting. Diagnosis is clinical with radiological confirmation by upper gastrointestinal series or computed tomography scan. Most patients respond to conservative and supportive treatment. A minority may need surgical intervention.

scholarly journals Superior Mesenteric Artery Syndrome: A Single-institution Experience

2021 ◽  
Vol 3 (1) ◽  
pp. FIRST
Author(s):  
Chun-huang Chen ◽  
Victor T.K. Chen ◽  
Shao-Jiun Chou ◽  
Hsiang-Chun Jan ◽  
Tzu-Hung Chen ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Surgical Intervention ◽  
Water Soluble ◽  
Superior Mesenteric Artery Syndrome ◽  
Electrolyte Imbalance ◽  
Surgical Approaches ◽  
Severe Malnutrition ◽  
Mini Laparotomy

Background: Superior mesenteric artery syndrome (SMAS) is a rare disease in adult. SMAS is characterized by acute, or, more commonly, chronic nonspecific symptoms due to duodenal obstruction and severe malnutrition with reduced arterio-mesenteric angle and distance. Surgical treatment may be necessary in most cases with chronic symptoms or when conservative treatment fails in SMAS. Methods: A retrospective chart review was performed on patients who underwent operation for SMAS from January 2008 to August 2020 in Cardinal Tien Hospital. Patients’ clinical presentations, surgical intervention, and outcomes. Results: Data from a total of 14 patients diagnosed with SMAS were analyzed, of which seven were diagnosed with SMAS by abdominal computed tomography and upper gastrointestinal series with water-soluble barium contrast. Six of the confirmed cases underwent surgery, namely, gastric decompression using a nasogastric tube, and correction of electrolyte imbalance. The nasoduodenal tube was placed through the obstructed duodenum to provide a high-nutrient fluid supplement. After conservative treatment failure, the patients underwent surgery. Of the six patients, four underwent duodenojejunostomy, one underwent a mini-laparotomy duodenojejunostomy bypass, and the last one underwent Roux-en-Y duodenojejunal bypass with duodenal feeding tube insertion. Conclusion: Patients with SMAS should initially be treated conservative. Surgical intervention should be considered in patients in whom conservative treatments were not effective. Complete resolution of all symptoms may not always be guaranteed after surgical intervention. Laparoscopy is currently widely used. In well-selected patients, minimally invasive or mini-laparotomy duodenojejunostomy is a safe and effective treatment for SMAS. The main advantages of mini-laparotomy duodenojejunostomy over other surgical approaches include half-length surgical incision and a shorter operative time. Duodenojejunostomy is rapidly becoming the standard procedure of this condition, and it has excellent outcomes comparable with those of open surgery.

scholarly journals Rare bowel emphysema with superior mesenteric artery syndrome after surgery

2020 ◽  
Vol 102 (2) ◽  
pp. e26-e28
Author(s):  
Y Furuya ◽  
T Wakahara ◽  
A Furuya ◽  
H Yanagie ◽  
H Yasuhara
Keyword(s):  
Computed Tomography ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Duodenal Obstruction ◽  
Surgical Intervention ◽  
Superior Mesenteric Artery Syndrome ◽  
Serious Infection ◽  
Old Japanese ◽  
Precise Diagnosis ◽  
Gastric Decompression

Superior mesenteric artery syndrome, a rare cause of duodenal obstruction, occasionally requires surgery. Bowel emphysema might also require surgery and might be an ominous sign of a serious condition. We report the case of a 69-year-old Japanese man with left pneumothorax who was also diagnosed as having bowel emphysema and superior mesenteric artery syndrome simultaneously without serious infection after surgery for the pneumothorax. Following gastric decompression via a nasogastric tube, his general condition resolved quickly with no need for surgical intervention. Prompt and precise diagnosis by computed tomography and both adequate judgment and treatment can avoid surgery in such cases.

scholarly journals Leiomyosarcoma of the superior mesenteric artery: a case report

2019 ◽  
Vol 2019 (11) ◽  
Author(s):  
Augusto Striano ◽  
Francesco Esposito ◽  
Francesco Crafa
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Distal Part ◽  
Near Infrared ◽  
Intestinal Resection ◽  
Vascular Reconstruction ◽  
Distal Portion ◽  
Rare Tumour ◽  
First Case ◽  
Mesenteric Vessels

Abstract Arterial leiomyosarcoma (A-LMS) is a very rare tumour and no cases originating from the superior mesenteric artery (SMA) have been described. We present a case of A-LMS originating from distal part of SMA and incorporating superior mesenteric vein (SMV). SMA and SMV were prepared along their course by laparotomy. Prior to resection, the superior mesenteric vessels were clamped, and intra-operative infrared angiography after intravenous injection of indocyanine green was performed. Once confirmed the vitality of the bowel, mass resection including the distal portion of the SMA and SMV was executed. The postoperative course was uneventful. Histology confirmed initial diagnosis. Six months after surgery no recurrence was highlighted. This is the first case of A-LMS originating from SMA, successfully treated without any intestinal resection or vascular reconstruction. The use of near-infrared angiography associated with a preoperative angiographic workup is indispensable for the success of the surgery.

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.

The Distribution of Vasculokinase in Human Blood Vessels

1962 ◽  
Vol 08 (01) ◽  
pp. 096-100
Author(s):  
Marvin Murray ◽  
Robert Johnson
Keyword(s):  
Inferior Vena Cava ◽  
Superior Mesenteric Artery ◽  
Blood Vessels ◽  
Human Blood ◽  
Iliac Artery ◽  
Popliteal Artery ◽  
Mesenteric Artery ◽  
Inferior Vena ◽  
Vena Cava ◽  
High Concentrations

Summary133 blood vessels were evaluated for vasculokinase concentration in the freshly morbid state. High concentrations of activity were found in the aorta, iliac artery, superior mesenteric artery and popliteal artery. Activity was occasionally found in the inferior vena cava and common iliacs veins. Other vessels evaluated had no activity. Evaluation of the data with respect to vas-culokinase activity and atherosclerosis suggests higher levels of vasculokinase in those vessels having atherosclerosis.

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