China
Africa
Explore chapters and articles related to this topic
Mesenteric Ischemia
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Diagnosis of mesenteric ischemia can prove challenging. Patients invariably present with abdominal pain and leukocytosis; while some exhibit “pain out of proportion to examination,” many do not. Importantly and unlike other vascular disorders, AMI primarily affects women; more than 70% of patients are female. Tenderness on examination suggests bowel necrosis causing peritoneal irritation. As the disease progresses and bowel ischemia sets in, lactic acidosis and signs of shock may ensue. The clinician should not wait for severe leukocytosis or lactic acidosis to intervene, as these often are markers of severe ischemia or irreversible bowel injury. A high index of suspicion is necessary with all forms of mesenteric ischemia but especially those with mesenteric venous thrombosis; lab values may be deceptively normal due to the lack of washout of the by-products of bowel ischemia secondary to a thrombosed outflow.
Paper 3
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
This is a rare, chronic inflammation of small bowel mesenteric fat. Typically on CT it manifests as a well-defined mesenteric root mass with a ‘misty’ appearance and surrounding fat halo. Classically it envelops but does not distort the mesenteric vessels and does not involve the bowel. It has a predilection for the jejunal mesentery. The finding of a low-attenuation fat halo surrounding the vessels is highly suggestive of mesenteric panniculitis.
Peritoneal metastases
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
The peritoneal cavity is a serous sac (or coelom) lying between the parietal and visceral peritoneum (Figure 33.1). It consists of a series of communicating potential spaces not normally seen on imaging unless distended by fluid or air. The visceral peritoneum covers the abdominal organs, and the parietal peritoneum lies against the abdominal wall and retroperitoneum, resulting in an extensive surface area as a potential site of tumour deposition. The greater omentum consists of four layers of peritoneum, two from the greater curve of the stomach and two from the transverse mesocolon, which fuse and pass anterior to the small bowel—this is often involved by metastases. The lesser omentum (or gastrohepatic ligament) joins the lesser curve of the stomach to the liver. Ligaments are peritoneal folds connecting abdominal organs. A mesentery is a peritoneal fold joining the small bowel or parts of the colon to the posterior abdominal wall and containing blood vessels, lymphatics, and nerves (3). Ligaments and mesenteries are suspended by the visceral peritoneum and so are not truly intraperitoneal (4).
Successful treatment of sclerosing mesenteritis with tamoxifen monotherapy
Published in Baylor University Medical Center Proceedings, 2023
Lauren Zammerilla Westcott, Dallas Wolford, Taylor G. Maloney, Ronald C. Jones
Sclerosing mesenteritis is a rare idiopathic disorder of fat necrosis, inflammation, and fibrosis of the mesentery. The etiology of the condition remains largely speculative; however, case reports attribute etiology most commonly to prior abdominal trauma or surgery, followed by malignancy and autoimmune conditions.1 While the disease is often asymptomatic, a subset of patients develop complications from the mass effect on gastrointestinal, mesenteric, vascular, or lymphatic structures.2 A small percentage of patients may develop further complications such as small bowel obstruction, chylous ascites, or superior mesenteric vein thrombosis.2 The differential diagnosis is broad and includes any cause of mesenteric edema, hemorrhage, or infiltration with inflammatory or neoplastic cells.3
Ultrasound-guided hydrostatic reduction of ileo-colic intussusception in childhood: first-line management for both primary and recurrent cases
Published in Acta Chirurgica Belgica, 2022
Berat Dilek Demirel, Sertac Hancıoğlu, Basak Dağdemir, Meltem Ceyhan Bilgici, Beytullah Yagiz, Ünal Bıçakcı, Ferit Bernay, Ender Arıtürk
No recurrent intussusception was seen in patients who had undergone surgery, but one episode of relapse is seen in 10 patients and two episodes in two patients who were previously managed with hydrostatic reduction. The recurrence rate was 16% for the 77 patients who did not undergo surgery. Seven (58%) of these patients were male and 5 (42%) were female. The mean age was 1.16 ± 1.64 years (median: 0.58 year, 5 months–6.33 years) (Table 1). Eight patients (66%) were younger than 1 year of age. Mesenteric lymph nodes were detected in 7 patients with recurrence (58%). The median length of the intussuscepted segment was 61 mm (35–90 mm) in the recurrent episode. The earliest recurrent intussusception was seen 18 days after the first hydrostatic reduction. The median recurrence time was 67.5 days (18−110 days). None of the patients with recurrent intussusception had electrolyte abnormality as in their initial intussusception. Intestinal blood flow was normal on US and there was no significant intra-abdominal fluid. US-guided hydrostatic reduction was successful in all of the patients in the recurrence group. The follow-up protocol of the patients with recurrence after the procedure is the same as the initial approach.
Pulmonary complications of acute pancreatitis
Published in Expert Review of Respiratory Medicine, 2020
Hariharan Iyer, Anshuman Elhence, Saurabh Mittal, Karan Madan, Pramod Kumar Garg
Dysregulated immune activation in response to the initial insult to the pancreas leads to many of the significant pulmonary complications and thereby leading to high mortality. There is a need for developing point-of-care rapid serum level estimation methods for inflammatory markers. Their role for disease prognostication needs to be studied, and specific drugs targeting inflammatory pathways need further evaluation. Extracorporeal blood filtration to specifically adsorb inflammatory cytokines, thereby reducing their blood levels, is an attractive option that needs exploration. There is a need to enhance the understanding of the role of gut barrier dysfunction and mesenteric lymph in the pathogenesis of AP. There is evidence that intestinal microcirculation is hampered in AP, which gives access to the gut bacteria and harmful endotoxins to the systemic circulation. These organisms enter the mesenteric lymph and lead to infection and inflammation in the distant organs like lung. One unusual therapeutic intervention that could be investigated is the role of mesenteric lymph diversion via drainage of the thoracic duct. This may drain out the harmful bacteria and endotoxins and prevent both local as well as systemic injury [47]. The role of High-frequency nasal cannula is well established in acute hypoxemic respiratory failure, whether the same can be applied for respiratory failure associated with AP is a question worth answering in the future. Finally, extracorporeal membrane oxygenation (ECMO) for refractory ARDS due to AP needs further evaluation.