Treatment of colonic varices with a superior mesenteric venous stent: a case report describing a unique approach.
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ABSTRACT:
SUBMITTER: Naffouj S
PROVIDER: S-EPMC8677559 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description: Not available
| S-EPMC10837253 | biostudies-literature
Project description:Acute Mesenteric Ischemia (AMI) is a rare life-threatening entity caused by sudden interruption of the blood supply to a segment of the bowel due to impairment of mesenteric arterial blood flow or venous drainage. Clinical presentation varies according to the time course of vascular occlusion. Contrast-enhanced Computed Tomography (CT) of the abdomen represents the main diagnostic test for AMI diagnosis, enabling fast and excellent evaluation of the intestine, mesenteric vasculature, and other ancillary characteristics of AMI. Typical CT findings of AMI include paralytic ileus, decreased or absent bowel wall contrast-enhancement, pneumatosis intestinalis, and porto-mesenteric venous gas. We hereby report a case of an 89-year-old man presenting with AMI due to Superior Mesenteric Artery (SMA) thrombotic occlusion following endovascular stenting superficial femoral arteries. Typical findings were observed on abdominal CT imaging, yet associated with the presence of gas exclusively in the SMA district, without any involvement of the porto-mesenteric venous system. Different imaging features and pitfalls can help radiologists to accurately diagnose AMI, especially when irreversible bowel damage is about to occur. Therefore, radiologists and emergency physicians should be aware of the unusual association between gas in the SMA arterial district and AMI, even in the absence of porto-mesenteric venous system involvement, in order to urge prompt surgical consultation when observed.
| S-EPMC9130093 | biostudies-literature
Project description: Not available
| S-EPMC11294714 | biostudies-literature
Project description:Superior mesenteric artery (SMA) pseudoaneurysms are rare but fatal. Surgical repair is an ideal treatment; however, it is inappropriate in patients with SMA pseudoaneurysm due to advanced cancer, and endovascular therapy is an alternative treatment for nonsurgical candidates. Here, we report a case of SMA pseudoaneurysm in a patient with advanced pancreatic cancer, which was successfully treated with the placement of a biliary covered stent.
| S-EPMC6206321 | biostudies-literature
Project description:The etiology of large artery aneurysms has long been established as secondary to atherosclerotic disease and degenerative changes in the vessel walls. Less common, are aneurysms of the visceral arteries; the splanchnic and renal arteries. Rarer yet, are inferior mesenteric artery aneurysms, accounting for approximately 1% of visceral artery aneurysms. While causes range from inflammatory to congenital disease, a proposed etiology of proximal, solitary inferior mesenteric artery aneurysms, is correlated to the "jet disorder phenomenon," first described in a 1990 case report by Sugrue, and Hederman. This paradigm states that aneurysm formation may occur secondary to celiac and superior mesenteric artery occlusion, causing increased, and turbulent arterial flow distally. We present a case that demonstrates a small inferior mesenteric artery aneurysm without findings of celiac or superior mesenteric artery stenosis or occlusion. This patient did, however, have a large thrombosed common hepatic artery aneurysm which may serve as an alternate cause of jet disorder phenomenon. The findings in this case offers support for focused screening of proximal arterial vasculature when an inferior mesenteric artery aneurysm is encountered.
| S-EPMC9018125 | biostudies-literature
Project description:BackgroundMesenteric ischaemia is often a manifestation of severe vascular disease involving the superior mesenteric artery (SMA). Endovascular revascularization is challenging in a chronic total occlusion (CTO) of SMA.Case presentationA-73-year-old male patient was referred to our hospital because of a 2-year history of post prandial abdominal angina. Computed tomography (CT) images revealed a heavily calcified CTO in the ostium of SMA and three-dimensional CT (3D-CT) detected pancreaticoduodenal arcade with filling from the celiac artery. Then, endovascular procedure was attempted; however, angiography did not show the collateral route suitable for transcollateral approach. As demonstrated on the CT, we were successful in passing a guidewire through the SMA-CTO via the celiac trunk transcollateral route. After pull-through of the guidewire, two balloon-expandable stents were deployed in the ostium of SMA. During 3 months after stent implantation, the patient had no further episodes of abdominal angina on dual-anti-platelet therapy.ConclusionWe demonstrate a case of a heavily calcified SMA occlusion successfully treated with endovascular stenting employing a transcollateral approach, guided by 3D-CT.
| S-EPMC8167909 | biostudies-literature
Project description:Thrombosis of the celiac artery trunk is a rare cause of acute abdominal pain. Thrombosis of the celiac artery carries a high mortality and morbidity when the diagnoses and treatment are delayed. It is frequently associated with other cardiovascular events. The most common etiology is atherosclerosis. 20-30% of cases may have symptoms of chronic mesenteric ischemia. Main goal of the treatment is to reestablish the diminished or stopped mesenteric blood flow and to avoid end-organ ischemia. Essential thrombocythemia is a chronic myeloproliferative disorder characterized by marked increase in thrombocyte number and clinical presentation may be with thrombotic episodes, hemorrhage, or both. To our knowledge this is the first report of celiac artery thrombosis and superior mesenteric artery stenoses in a patient with essential thrombocythemia. The patient was managed successfully with surgical treatment.
| S-EPMC3530234 | biostudies-literature
Project description:BackgroundSuperior mesenteric artery (SMA) pseudoaneurysm is a very rare condition, typically associated with trauma, inflammation, and infection, and as a post-operative complication. If left untreated it can lead to serious consequences such as rupture and fatal haemorrhage.ReportA 17 year old male presented to the emergency department with a history of intermittent progressive epigastric pain with no preceding significant symptoms of a possible cause. He was initially treated conservatively until the intensity of pain was so severe an abdominal computed tomography (CT) scan was justified. A pseudoaneurysm of the SMA was found. Full inflammatory and immunological workup was unremarkable. Repeat CT scan showed the SMA pseudoaneurysm was larger, mandating surgical intervention; the vascular surgeon suggested an exploratory laparotomy. Intra-operatively, unexpectedly, a wooden foreign body measuring 5.0 × 0.3 × 0.5 cm was seen once the aneurysm sac was opened. The pseudoaneurysm was repaired and the abdomen closed after ascertaining that all other organs were intact. The patient had a simple recovery with no complications and was discharged home. The follow up CT scans were unremarkable.ConclusionPseudoaneurysm of the SMA in the paediatric age group is an extremely rare and life threatening phenomenon. The clinical presentation may be subtle, leading to delayed diagnosis. Early surgical intervention may be lifesaving and prevent further complications.
| S-EPMC8819108 | biostudies-literature
Project description:IntroductionLymphatic malformations are low-flow vascular malformations most commonly located in the head and neck; isolated intraabdominal involvement is rare.Presentation of caseAn 8-month-old previously healthy male presented with a 9-day history of fevers. On examination, right-sided abdominal tenderness was noted. Ultrasound revealed a large heterogeneous mass, and CT scan revealed a rim-enhancing cystic mass adjacent to the right colon. Laboratory investigation including blood cultures was normal. His fever resolved with broad-spectrum antibiotics. Diagnostic laparoscopy revealed a large, firm mass arising from the mesentery of the right colon. An open right hemicolectomy with ileocolonic anastomosis was performed. The infant tolerated the procedure well, and he was discharged home on postoperative day four, pathologic examination identified a mesenteric lymphatic malformation with secondary abscess formation.ConclusionThis atypical presentation of an uncommon entity was instructive in several ways, particularly illustrating the diagnostic pitfalls that can be introduced by superinfection.
| S-EPMC5573788 | biostudies-literature
Project description:ObjectivesTo report the utility of abdominal ultrasonography (US) to identify the presence of portal venous gas (PVG) during non-occlusive mesenteric ischemia (NOMI), and to follow the disappearance of portal venous gas after resolution of the NOMI.Data sourcesThis was a clinical observation of a patient, with images of abdominal computed tomography (CT), and a video of portal venous gas identified by ultrasonography.Data synthesisWe describe the case of an adult patient admitted to our ICU for NOMI developing 48h after cardiac surgery. Medical intensive care associated with jejunal resection and vacuum-assisted closure led to rapid recovery. Three weeks later, the patient presented acute pulmonary edema, and developed a new episode of NOMI that was suspected by identification of PVG on US, and then confirmed on abdominal CT. The patient rapidly improved after orotracheal intubation and treatment of pulmonary edema. A second US performed 9h later showed disappearance of PVG. The laparotomy performed 10h after the first US did not find evidence of small bowel or colon ischemia. The postoperative period was uneventful.ConclusionsUS is a useful tool for the detection of PVG in critically ill patients, prompting suspicion of AMI. PVG can be observed at the early phase of AMI, even before irreversible transmural gut ischemia; transient PVG that disappears rapidly (within several hours) may suggest resolution of the NOMI.
| S-EPMC5480224 | biostudies-literature