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Laparoscopic Ileocecal Resection
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
The vasa recta of the terminal ileum are very crowded and smaller in diameter near the mesenteric border of the ileum, and in benign conditions we do not require to resect all the way to the root of the mesentery; we can use energy sources to divide vascular supply close to the bowel. The ileocolic artery and vein are generally surrounded with a thick fat pad and lymph nodes, and one should be cautious in handling these vessels. The marginal artery of Drummond connects the ileocolic artery and the right colic artery (if present) and the right branch of middle colic artery, so we can safely divide the ileocolic artery without the risk of ischemia to ascending colon.
Experimental Transplantation of the Small Intestine
Published in Waldemar L. Olszewski, CRC Handbook of Microsurgery, 2019
After shaving and disinfection, the abdomen of the donor is opened by a midline incision. The ileocolic artery and the middle colic artery and their branches are ligated and the mesocolon divided. Beginning from the porta hepatis, the portal vein and the superior mesenteric vein are divided after ligature of their tributaries and isolation from the pancreas (Figure 4). The retroperitoneum is entered and the celiac trunk freed of surrounding tissue. The common hepatic artery, the lienal artery and a lumbar artery are ligated; then an aortic cuff with the superior mesenteric artery, which takes off from it, is ligated (Figure 5). This is followed by proximal and distal cross-clamping of the aorta, division of the portal vein close to where it enters the liver, and division of the intestine at the Flexura duodeno-jejunalis and in the terminal ileum. The aortic cuff is punctured (Figure 6) and the graft perfused with 0.9% NaCl solution at 4°C until the graft appears white and the effluent clear. The aortic cuff is ligated distally and the graft removed (Figure 7). The lumen of the intestinal graft is perfused with 20 cm3 0.9% NaCl solution to remove remnants of the intestinal contents.
Anatomy
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Reza Mirnezami, Alex H. Mirnezami
The ileocaecal valve is a rudimentary structure consisting of two horizontal folds of mucous membrane that project around the orifice of the terminal ileum. The caecum receives its arterial blood supply from the ileocolic artery via anterior and posterior caecal branches (Figure 1.2). Veins drain into corresponding branches of the superior mesenteric vein. Lymphatic drainage is to local paracolic nodes and ultimately to the superior mesenteric lymph node basin. Autonomic nerve supply is provided by the superior mesenteric plexus via sympathetic and parasympathetic nerve fibres.
Routine CT scan one year after surgery can be used to estimate the level of central ligation in colon cancer surgery
Published in Acta Oncologica, 2019
Ditte Louise E. Munkedal, Mona Rosenkilde, Nicholas P. West, Soren Laurberg
The available images included scans undertaken prior to surgery, 2 days after surgery and approximately 1 year after surgery. The study radiologist first assessed the images taken 1 year after surgery in order to identify the residual arterial stump and measure its length. If this was not possible, the preoperative CT-scan was used for identification. Afterwards, the CT-scan performed 2 days after surgery was used as a control. On the right side only, the ileocolic artery was measured from its origin at the superior mesenteric artery to the ligation. On the left side only, the inferior mesenteric artery was measured from its origin at the aorta to the ligation. The arterial stumps were classified as: a normal vessel (Figure 1(a)), thrombosed (visible thrombosis within the vessel, Figure 1(b)), a fibrotic line (mostly degenerated, Figure 1(c)) and not visible.
Transmesenteric hernia: a rare case of acute abdominal pain in children: a case report and review of the literature
Published in Acta Chirurgica Belgica, 2018
Edward Willems, Bart Willaert, Sam Van Slycke
Rokitansky first reported a transmesenteric herniation in 1836. He described the herniation of the caecum alone through a hole in the mesentery near the ileocolic junction at a post-mortem examination [5,8]. In 1885, Treves described an area in the mesentery near the ileocaecal angle circumscribed by the ileocolic artery and its anastomosis with the terminal branch of the ileal artery. This area was later named Treves’ field correspondingly. He noted that this mesenterial area contained no blood vessels, no fat and no mesenterial glands, hypothesizing that it is therefore very prone to injury during fetal development. Subsequently, a congenital defect in the mesentery can develop through which the intestine might herniate. Treves described these defects to be round to oval-shaped with a diameter of 2–3 cm and a thickened margin [2,9,10]. Congenital defects in the mesentery have also been found in other areas of the mesentery, yet they occur most commonly in parts of the mesentery that are thin and avascular, such as in the mesentery of the terminal ileum and the sigmoid and transverse mesocolon [4,6,11].
The evolving management of small bowel adenocarcinoma
Published in Acta Oncologica, 2018
Eelco de Bree, Koen P. Rovers, Dimitris Stamatiou, John Souglakos, Dimosthenis Michelakis, Ignace H. de Hingh
For duodenal tumors, a Whipple resection should be performed for a tumor located in the second segment of the duodenum or for an infiltrating tumor in the proximal or distal duodenum. Additionally, resection of the periduodenal, peripancreatic and hepatic lymph nodes should also be performed, as well as resection of the right side of the celiac and superior mesenteric arteries. A duodenal resection alone could be performed for a proximal duodenal tumor or a distal duodenal tumor with no infiltration of adjacent organs, despite the fact that this procedure is associated with poor prognosis [42]. An R0 resection is to be preferred, as R1 or R2 resections are strongly associated with poor prognosis [43]. For jejunal and ileal tumors, an R0 resection with lymph node resection and jejuno–jejunal or ileo–ileal anastomosis should be performed. If the last ileal loop or Bauhin’s valve is involved, an ileocecal resection or right hemicolectomy should be performed with ligation of the ileocolic artery so as to allow for adequate lymph node resection.