scholarly journals Vascular abnormalities visualized by multislice computed tomography of the abdomen: accidental findings or immediate causes of pain syndrome? (topic review)

2021 ◽  
Vol 12 (4) ◽  
pp. 34-45
Author(s):  
N. K. Arutiunova ◽  
L. V. Araslanova ◽  
V. A. Riabchenko ◽  
E. A. Pisarenko ◽  
E. I. Ter-Ananiants
Keyword(s):  
Computed Tomography ◽  
Abdominal Aorta ◽  
Mesenteric Ischemia ◽  
Structural Changes ◽  
Morphological Changes ◽  
Duplex Ultrasound ◽  
Pain Syndrome ◽  
Chronic Mesenteric Ischemia ◽  
Internal Organs ◽  
First Choice

Abnormalities of the abdominal aorta branches may cause chronic mesenteric ischemia, progressive pathological changes of the internal organs in this setting, and chronic pain syndrome. The causes of chronic mesenteric ischemia may be divided into atherosclerotic and non-atherosclerotic. Atherosclerosis of the unpaired branches of the abdominal aorta involves stenosis or occlusion. Other causes include fibromuscular dysplasia, vasculitis (Takayasu, segmental mediolytic arteriopathy), and median arcuate ligament syndrome. These syndromes, the pathogenesis of some of which remains controversial, lead to nonspecific complaints such as abdominal pain, weight loss, and others. Digital subtraction angiography or duplex ultrasound may provide hemodynamic information in cases of vascular disease in this area. However, multislice spiral computed tomography is in many cases the first choice because it allows for a comprehensive assessment of the state of blood vessels and associated morphological changes of internal organs. Structural changes accompanying these syndromes can also occur in patients who are undergoing a medical examination for other reasons. However, these syndromes should not be diagnosed solely on the basis of imaging; instead, the findings should be compared with the clinical presentation, which implies collaboration of radiologists and clinicians.

scholarly journals Multidetector Computed Tomography in Diagnosis of Mesenteric Vascular ‎Occlusion

2021 ◽  
pp. 14-26
Author(s):  
Amira Mohammed Salah Abou Dalal ◽  
Mohammed Fathy Dawoud ◽  
Aymen Abdul Hameid Elnemr ◽  
Rania Sobhy Abou Khadrah
Keyword(s):  
Computed Tomography ◽  
Multidetector Computed Tomography ◽  
Mesenteric Ischemia ◽  
Vascular Occlusion ◽  
Invasive Technique ◽  
Bowel Loop ◽  
Chronic Mesenteric Ischemia ◽  
University Hospitals ◽  
Mesenteric Vascular Occlusion ◽  
The Impact

Background: Multidetector computed tomography (MDCT) has high sensitivity and ‎specificity for diagnosing acute primary mesenteric ischemia (MI). MDCT findings vary ‎widely depending on the cause and underlying pathophysiology. MDCT findings of ‎mesenteric ischemia should be characterized on the basis of the cause‏ ‏that lead to early ‎diagnosis and intervention. Aim: The aim of the study was to assess the impact of different MDCT phases in ‎diagnosis of mesenteric vascular occlusion (MVO).‎ Patients and Methods: This study that was carried out on 20 patients with suspected mesenteric vascular ‎occlusion who were referred to Tanta University Hospitals and General Surgery ‎Department during a period one year starting from May 2018 till May 2019.‎ Results: Out of the 20 studied patients, 11 (55%) of them was male and 9 (45‎‎%) was female, the age of the studied patients ranged from 40 to 73 years old ‎with mean age 57.10 ± 8.85 years. In our study the predisposing factors for MVO were as follow 6 (30%) had ‎Primary thrombosis, 9 (45%) had cirrhosis, 8 (40%) had Portal hypertension, ‎‎4 (20%) had DM, 4 (20%) had Atherosclerosis, and 2 (10%) had ischemic heart ‎disease.‎ Conclusion: Acute and chronic mesenteric ischemia are morbid conditions that are challenging to ‎diagnose. Patients present with variable, nonspecific signs and symptoms, and the ‎physical examination is often benign. A high index of clinical and radiologic suspicion ‎is thus required for diagnosis  MDCT is an accurate, fast, and non-invasive ‎technique which should be used in clinically suspected patients with MVO in order to ‎confirm the diagnosis identify the aetiology and in addition assessing the bowel loop ‎status for adequate management with good prognosis.‎ Familiarity with the MDCT imaging manifestations of mesenteric ischemia allows ‎for a more precise, prompt diagnosis, early institution of therapy and potentially ‎improved patient outcomes.‎

Management of chronic atherosclerotic mesenteric ischemia

VASA ◽  
2011 ◽  
Vol 40 (2) ◽  
pp. 99-107 ◽  
Author(s):  
Zeller ◽  
Macharzina
Keyword(s):  
Mesenteric Ischemia ◽  
Delayed Diagnosis ◽  
Clinical Signs ◽  
Duplex Ultrasound ◽  
Celiac Trunk ◽  
Mesenteric Arteries ◽  
Clinical Aspects ◽  
High Morbidity ◽  
Chronic Mesenteric Ischemia ◽  
External Compression

Chronic mesenteric ischemia (CMI) is most likely caused by atherosclerosis and less frequently by external compression, fibromuscular dysplasia and vasculitis. Symptomatic CMI is an uncommon, potentially under-diagnosed condition caused by fixed stenoses or occlusion of in most conditions at least two visceral arteries. If only one of the three major bowel providing arteries - the celiac trunk, the superior and inferior mesenteric arteries - is affected, the patient is usually asymptomatic due to a tight collateral network. Symptoms and clinical signs of CMI may vary from the classical triad of postprandial pain, weight loss and upper abdominal bruit to nonspecific symptoms thus frequently resulting in delayed diagnosis. Established non-invasive diagnostic means are duplex ultrasound or CT- and MR-angiography offering excellent three dimensional reconstruction of the vessel pathology facilitating the decision for the appropriate revascularisation strategy. During the last decade, despite higher restenosis rates endovascular revascularization has replaced surgical revascularization as therapy of choice in most centers. If untreated CMI of atherosclerotic origin is associated with a high morbidity and mortality. This manuscript reviews the most relevant clinical aspects of the disease and the current practice of diagnosis and treatment of CMI.

scholarly journals Clinical implications of chronic mesenteric ischemia in elderly and senile patients

2020 ◽  
Vol 92 (2) ◽  
pp. 74-80
Author(s):  
A. I. Dolgushina ◽  
A. S. Kuznecova ◽  
A. A. Seljanina ◽  
V. V. Genkel ◽  
A. G. Vasilenko
Keyword(s):  
Weight Loss ◽  
Abdominal Pain ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Celiac Trunk ◽  
Mesenteric Arteries ◽  
Chronic Mesenteric Ischemia ◽  
Clinical Criteria

Aim.To evaluate the sensitivity and specificity of the clinical criteria for the diagnosis of chronic mesenteric ischemia in elderly and senile patients with mesenteric atherosclerosis. Materials and methods.The study included 142 patients (82 men and 60 women). The median age of patients is 66.0 [62.0; 72.0] years. Results.According to MDCT atherosclerotic lesions of the abdominal aorta and its unpaired visceral branches were diagnosed in 105 (73.9%) patients. A combination of atherosclerosis of the celiac trunk and the superior mesenteric artery with the presence of hemodynamically insignificant stenosis was revealed. Hemodynamically significant atherosclerotic narrowing of at least one mesenteric artery was present in 15% of cases. Among them, a single vascular lesion was found in 6 patients (4.2%), a combination of hemodynamically significant lesions of two arteries in 15 (11%) patients. Depending on the clinical manifestations, all patients are divided into two groups: the first group 30 (21.1%) patients with the presence of symptoms characteristic of chronic mesenteric ischemia (CMI). The second group consisted of 112 (78.8%) patients without a characteristic triad of symptoms. The clinical symptom complex of СMI, including postprandial abdominal pain, intestinal dysfunction and progressive weight loss, as a diagnostic criterion showed low sensitivity 13.3% and specificity 77.9%. At the same time, the sensitivity of such a clinical combination as a combination of atherosclerosis of the arteries of the lower extremities, weight loss and abdominal pain syndrome with a severity of more than 5.5 points, with respect to the detection of hemodynamically significant stenoses of two or more mesenteric arteries was sensitivity 86.7%, specificity 74.0%.

scholarly journals Морфологічні основи розвитку хронічного інтерстиційного сіалоаденіту при патології гепатобіліарної системи

2016 ◽  
Author(s):  
M. O. Levkiv
Keyword(s):  
Salivary Gland ◽  
Structural Changes ◽  
Morphological Changes ◽  
Bile Secretion ◽  
Secretion System ◽  
Internal Organs ◽  
Obstructive Cholestasis ◽  
Reactive Changes ◽  
Acinar Tissue ◽  
Destructive Processes

Reactive changes of different nature in salivary glands is accompanied by many diseases of internal organs. Due to the complex neurohormonal regulation, bile secretion system is functionally interconnected with all organs and systems of the digestive tract. The article presents data of structural changes of acinar tissue and bloodstream of parotid salivary gland in experimental obstructive jaundice. It was established that the degree of morphological changes in the parotid gland, angioarchitectonics state and nature of degenerative and destructive processes is directly dependent on the duration of obstructive cholestasis.

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 Enteric nervous system with chronic mesenteric ischemia: experimental study

2020 ◽  
Vol 10 (4) ◽  
pp. 401-410
Author(s):  
Evgeniya S. Pimenova ◽  
Natal′ya S. Korchagina ◽  
Grigoriy A. Korolev ◽  
Dar′ya D. Zyuz′ko ◽  
Margarita S. Saakyan ◽  
...  
Keyword(s):  
Nervous System ◽  
Mesenteric Ischemia ◽  
Morphological Changes ◽  
Chronic Mesenteric Ischemia ◽  
Normal Colon ◽  
Functional Changes ◽  
Enteric Ganglia ◽  
Two Samples ◽  
Mesenteric Vessels ◽  
Ischemic Segment

Introduction. The pathology of the enteric ganglia can lead to different diseases (Hirschsprungs, neuronal intestinal dysplasia, ganglioneuromatosis, and Chagasse). Causes of acquired dysganglionosis remained unclear. Some authors hypothesized that pathology of the enteral nervous system may be secondary to intestinal ischemia. Aim. To investigate the intestinal function and histological changes of the colon in rats with chronic ischemia. Materials and methods. A total of 20 Sprague Dawley rats underwent surgery (ligation of the terminal mesenteric vessels next to the descending colon). The appetite of animals were checked, and stool were collected after the procedure. Reoperation was performed after 7 (n = 1), 9 (n = 2), 12 (n = 2), 14 (n = 1), 21 (n = 1), 42 (n = 1), 53 (n = 1), and 62 (n = 1) days. The diameter of the colon and changes of the serosa were visualized. In the experimental group, two samples biopsy was performed (ischemic and normal colon). Results. Functional changes were observed in 90% of rats after the ligation of mesenteric vessels (constipation/impact, softening stool/diarrhea, and hemocolitis). Colonic stenosis of the ischemic area in 30% was detected. 70% animals have the intestinal dilatation above the ischemic segment (partial bowel obstruction). Necrosis of the ischemic colon was observed in 20%. Spontaneous fixation of the omentum to the ischemic segment was found in 40% animals. A microscopically inflamed infiltration of the mucosa in the ischemic zone (70%) and in normal colon (50%) was revealed in the ligation group. The number of the enteric ganglia decreased in the ischemic segment. Conclusion. Functional disorders (colitis and obstruction) and morphological changes (inflammation and ganglion cells pathology) were found in rats with chronic mesenteric ischemia.

scholarly journals Percutaneous transluminal angioplasty and stenting as first-choice treatment in patients with chronic mesenteric ischemia

2010 ◽  
Vol 51 (2) ◽  
pp. 386-391 ◽  
Author(s):  
Bram Fioole ◽  
Hendrik J.M. van de Rest ◽  
Joost R.M. Meijer ◽  
Marc van Leersum ◽  
Sebastiaan van Koeverden ◽  
...  
Keyword(s):  
Percutaneous Transluminal Angioplasty ◽  
Mesenteric Ischemia ◽  
Transluminal Angioplasty ◽  
Chronic Mesenteric Ischemia ◽  
First Choice ◽  
Angioplasty And Stenting ◽  
Percutaneous Transluminal

scholarly journals PP8. Percutaneous Angioplasty and Stenting as First-Choice Treatment in Patients with Chronic Mesenteric Ischemia

2009 ◽  
Vol 49 (5) ◽  
pp. S16 ◽  
Author(s):  
Bram Fioole ◽  
Joost Meijer ◽  
Sebastiaan van Koeverden ◽  
Frans L. Moll ◽  
Michiel van de Rest ◽  
...  
Keyword(s):  
Mesenteric Ischemia ◽  
Chronic Mesenteric Ischemia ◽  
Percutaneous Angioplasty ◽  
First Choice ◽  
Angioplasty And Stenting

CHRONIC MESENTERIC ISCHEMIA IN TYPE 2 DIABETES PATIENTS

2021 ◽  
pp. 62-64
Author(s):  
S Mahaboob Fayaz ◽  
V Sai Vivek
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Duplex Ultrasound ◽  
The Other ◽  
Chronic Mesenteric Ischemia ◽  
Coeliac Artery ◽  
Ct Angiogram

BACKGROUND: Type 2 Diabetes mellitus (T2DM) currently effects 8.9% of the world's population.The macrovascular complications of diabetes are 3 times more common than the microvascular complications.Involvement of the vessels of gut in T2DM hasn't been studied exclusively like the other known macrovascular complications.This study focusses on the effect of T2DM on the Coeliac artery(CA) and Superior Mesenteric artery (SMA) which are the main source of blood supply to the organs derived from fore and midgut . METHODS: In our study over 2 years, 72 patients of T2DM were subjected to Duplex Ultrasonography.15 randomly selected patients who satised the Fasting Duplex velocity criteria and 15 randomly selected patients who did not were subjected to CT Angiography. RESULTS: We found that 22 patients (30.55%) out of the 72 had features suggestive of Chronic Mesenteric Ischemia (CMI) in both the coeliac artery and SMA on duplex ultrasound and 8 patients (26.66%) out of 30 had conrmed CMI by CT angiogram. CONCLUSION: th We found that every 4 diabetic had CMI. We would like to emphasize that the vasculature of the gut can be affected in T2DM and this should inspire a lot of research and prospective studies relating CMI to GIT manifestations of T2DM.

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