The peritoneum, omentum, mesentery and retroperitoneal space
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
When the diagnosis can be made with assurance, bed rest and simple analgesia are the only treatment necessary. If, at a second examination a few hours later, acute appendicitis cannot be excluded, it is safer to perform either appendicectomy or diagnostic laparoscopy. If surgery is mistakenly undertaken, there is a small increase in the amount of peritoneal fluid. The ileocaecal mesenteric lymph nodes are enlarged, and can be seen and felt between the leaves of the mesentery. In very acute cases they are distinctly red, and many of them are the size of a walnut. The nodes nearest the attachment of the mesentery are the largest. They are not adherent to their peritoneal coats and, if a small incision is made through the overlying peritoneum, a node is extruded easily.
Gastrointestinal cancer
Peter Hoskin, Peter Ostler in Clinical Oncology, 2020
The tumour spreads longitudinally and circumferentially along the mucosa, in some cases leading to obstruction of the bowel lumen, and invades deep to the mucosa to infiltrate the muscular wall of the bowel and serosa. Penetration of the serosa leads to direct infiltration of the surrounding abdominal and pelvic viscera, while submucosal spread in the lamina propria can lead to skip lesions well away from the primary tumour. Tumour cells have a propensity to seed in abdominal scars, perineal skin, stomas and even anal fissures. Transcoelomic spread may lead to diffuse peritoneal involvement resulting in ascites and spread to the ovaries. The regional mesenteric lymph nodes can be involved, wherein there is a likelihood of lymph node metastases increasing with the depth of bowel wall invasion. The tumour spreads to the liver (Figure 9.8) via the portal circulation, and from there to the lungs, bone, brain and skin. Rectal cancer has a particular propensity for local recurrence and often this leads to a presacral mass (Figure 9.9).
Mantle Cell Lymphoma
Wojciech Gorczyca in Atlas of Differential Diagnosis in Neoplastic Hematopathology, 2014
MCLs usually present with advanced disease, including generalized lymphadenopathy and BM involvement, and with a tendency for extranodal involvement, most often in the gastrointestinal tract, followed by spleen, Waldeyer’s ring, and less often other locations (e.g., nasopharynx, salivary gland, skin, ocular adnexa, central nervous system; Figure 9.9). An extranodal involvement is seen in the majority of patients, and in 30%–50% of the patients, it is seen in more than two extranodal sites [16]. An extranodal presentation without apparent nodal involvement is observed in only 4%–15% of cases [16]. MCL in the gastrointestinal tract is the second most common type of lymphoma composed of small cells behind mucosa-associated lymphoid tissue (MALT) lymphoma and is present most often in microscopic involvement or less often, but more typical (although not specific) in the form of a polypoid nodular growth (lymphomatous polyposis). The involvement of the gastrointestinal tract may represent either primary or secondary lymphoma. It usually occurs in the ileocecal region and large intestine, but often disseminates to the large and small intestines and mesenteric lymph nodes. It rarely occurs in the stomach or duodenum.
An unexpected deterrent in diagnosing refractory celiac disease and enteropathy-associated T-cell lymphoma: a gluten-free diet
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
Nooreen Hussain, Faiz Hussain, Tulika Chatterjee, Jan N. Upalakalin, Teresa Lynch
In patients where there is a suspicion for EATL, workup studies such as ENT evaluation, video capsule enteroscopy (VCE), double-balloon enteroscopy for biopsy, CT with 18F-FDG-PET scan, and magnetic resonance enteroclysis are important in order to make a timely diagnosis. A complete workup improves the accuracy of detecting early EATL or recurring EATL [6]. Our patient initially had a CT of the abdomen done, followed by CT-guided biopsy of mesenteric lymph nodes that were negative for malignancy. He subsequently had an EGD with biopsy of the gastric and duodenal mucosa. Following persistent symptoms and over 60 lb of weight loss, the patient did have a VCE done with a plan for balloon enteroscopy. Further workup, however, was precluded because of an acute small bowel perforation with resection. Biopsy of small bowel perforated mass showed EATL Type I. It is reported in the literature that while EATL is almost always found in the small bowel, it is most commonly seen in the jejunum, followed by the ileum, then duodenum. Our patient’s initial biopsy was done solely in the duodenum. For RCD or EATL, it may be useful to biopsy the jejunum or ileum along with the proximal small bowel to evaluate for tissue abnormalities.
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.
Lactobacillus fermentum species ameliorate dextran sulfate sodium-induced colitis by regulating the immune response and altering gut microbiota
Published in Gut Microbes, 2019
You Jin Jang, Woon-Ki Kim, Dae Hee Han, Kiuk Lee, Gwangpyo Ko
Mesenteric lymph nodes (MLNs) were collected from the mice. The tissues were carefully crushed and filtered through a cell strainer (100 μm pore diameter). The cells were isolated, counted and subjected to FcγR blocking. The surfaces of the cells were stained for 30 min at 4°C using Fixable Viability Stain 510 (FVS510; BD Bioscience) for live cells and CD3+ fluorescein isothiocyanate (145-2C11; BD Bioscience), CD4+ Percep-Cyanine5.5 (RM4-5; BD Bioscience) and CD25+ phycoerythrin (PC61; BD Bioscience) for cell surface staining. The cells were permeabilized in fixation/permeabilization buffer (eBioscience, San Diego, CA, USA) and subjected to intracellular Foxp3 staining using the Alexa Fluor 647 anti-Foxp3 antibody (MF23; BD Bioscience). IgG isotypes were used as a control for all fluorescence-activated cell sorting experiments. The CD4+CD25+Foxp3+Treg population was analyzed using the BD FACSVerse™ Flow Cytometer (BD Bioscience).
Related Knowledge Centers
- Appendix
- Ascending Colon
- Ileocolic Artery
- Ileum
- Superior Mesenteric Artery
- Mesentery
- Small Intestine
- Duodenum
- Ileal Branch of Ileocolic Artery
- Cecum