Intestinal malrotation
Prem Puri in Newborn Surgery, 2017
Abdominal ultrasonography that demonstrates an abnormal orientation of the mesenteric vessels can also be indicative of intestinal malrotation. In a normal situation, the superior mesenteric vein is located to the right of the superior mesenteric artery. Hence, a reversed arrangement of these vessels is suggestive of malrotation. Color Doppler ultrasonography may reveal a “whirlpool sign,” which is created when the superior mesenteric vein and the mesentery wrap around the superior mesenteric artery in midgut volvulus. Ancillary ultrasonographic findings suggestive of malrotation are found when looking at the third part of the duodenum: dilatation of the proximal portion indicating obstruction and abnormal position between the superior mesenteric artery and the aorta in the retroperitoneal space are suggestive of malrotation.
Malrotation and midgut volvulus
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
From the list of options above, choose which one is the most likely pathology for the clinical scenario described. Each option may be used once, more than once, or not at all. A 6-hour-old infant with a radiographic finding of complete obstruction of the second part of the duodenum is taken to the operating room, where a malrotation was found and Ladd’s bands were divided. Postoperatively, the patient continues to have bilious drainage per nasogastric tube. He was taken back to the operating room on the fifth day. What is the operative finding?An infant is in the neonatal intensive care unit with complex congenital heart disease. An ultrasound of the abdomen shows inversion of the position of the superior mesenteric artery (SMA)/superior mesenteric vein (SMV). What other finding might the ultrasound reveal?A 3-day-old infant presents with bilious vomiting and abdominal distension. He is diagnosed with a malrotation with volvulus and is taken to the operating room urgently. Postoperatively, he remains distended and has not passed stools at 5 days post surgery. What other entity should be considered at this point?
Mesenteric vein thrombosis
Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki in Handbook of Venous and Lymphatic Disorders, 2017
Contrast-enhanced computed tomography (CT) is considered by many to be the test of choice for suspected cases of MVT.27–30 The mesenteric vessels are well seen and the extent of bowel involvement can be simultaneously evaluated. Furthermore, other causes of abdominal pain can be excluded at the same time. An acute venous thrombus is identified as a central filling defect within the mesenteric vein (Figure 28.1). Engorgement of the superior mesenteric vein with varying degrees of wall enhancement may also be observed. Other CT findings are less specific and represent manifestations of the accompanying bowel ischemia. These include thickening of the small bowel wall and peritoneal fluid. If these non-specific signs are seen in the setting of MVT, bowel infarction should be strongly considered.
Antenatal sonographic features of persistent extrahepatic vitelline vein aneurysm confused with umbilical vein varix
Published in Fetal and Pediatric Pathology, 2019
Song-Hwa Chae, Il Woon Ji, Seung Hwa Hong, Jin Young Choi, Ho-chang Lee, Jung-Sun Kim, Bitna Kim, Ji-Hun Kim, KiHyeok Song
The development of the venous system consists of three pairs of veins (vitelline, umbilical, and cardinal veins). Among the three veins, the portal system encompasses the vitelline and umbilical vein. The vitelline veins carry the blood from the yolk sac to the heart, while the umbilical veins carry oxygenated blood to the embryo. During embryonic development, the vitelline veins form an anastomotic network around the duodenum and consequently become the hepatic sinusoids. After the yolk sac disappears, the paired vitelline veins regress almost completely with only the cranial segment of the right vitelline vein and the caudal segment of left vitelline vein persisting. In the cranial part of the liver, the right vitelline trunk becomes a suprahepatic portion of the inferior vena cava. In the caudal part of the liver, the vitelline vein forms a single trunk, the portal vein [6]. The superior mesenteric vein and splenic vein drain into the portal vein. In our case, the right vitelline vein, originating from the yolk sac, did not regress normally during embryonic development and maintained the connection between the umbilicus and the distal portal veins (Fig. 4).
Laparoscopic Pancreatectomy in Rats: The Development of an Experimental Model
Published in Journal of Investigative Surgery, 2022
José Marcus Raso Eulálio, Manoel Luiz Ferreira, Paulo César Silva, Juan Miguel Renteria, Andrei Ferreira Costa Nicolau, Thales Penna de Carvalho, Adrielle Rodas Fernandes, Julia Radicetti de Siqueira Paiva e Silva, Alberto Schanaider, José Eduardo Ferreira Manso
In summary, the pancreas of the rat has the following relevant anatomical landmarks:Considering its limits, the duodenum on the right, the stomach anteriorly, the spleen on the left, and the colon attached to the anterior face of the mesoduodenum.Considering its parenchyma, an intraperitoneal layer inside the omental pouch, with mobility from the spleen, duodenum and stomach.Considering its vascularization, the superior mesenteric vein and the superior mesenteric artery crosses the parenchyma posteriorly at the junction between the splenic and duodenal lobes receiving the arterial and venous tributaries. The splenic vessels follow the splenic lobe on its upper margin, from the hilum of the spleen to the root of the mesentery, where the splenic vein merges with the superior mesenteric vein to form the portal vein.Considering the ductal structure, the pancreatobiliary duct has its intrapancreatic path toward the second duodenal portion, directly receiving the lobular and lobar ducts. There is a major duodenal papilla, where the pancreatobiliary duct flows and several small ducts drains directly to the duodenum.
Neoadjuvant treatment for borderline resectable pancreatic adenocarcinoma is associated with higher R0 rate compared to upfront surgery
Published in Acta Oncologica, 2021
Mario Terlizzi, Etienne Buscail, Olayidé Boussari, Sarah Adgié, Nicolas Leduc, Eric Terrebonne, Denis Smith, Jean-Frédéric Blanc, Bruno Lapuyade, Christophe Laurent, Laurence Chiche, Geneviève Belleannée, Karine Le Malicot, Renaud Trouette, Claudia Pouypoudat, Véronique Vendrely
Laparotomy with “artery-first approach” was performed to assess resectability. [11] Pancreaticoduodenectomy (Whipple procedure) was carried out for tumours located in the pancreatic head and distal pancreatectomy with splenectomy for those located at pancreatic tail. Total pancreatectomy was carried out in case of involvement of head and tail. Vascular resection was performed according to intraoperative findings. Circumferential margins including Superior Mesenteric Vein (SMV) groove, Superior Mesenteric Artery (SMA), Portal Vein and posterior margins were inked before being sent for pathological analysis [12]. As recommended by ISGPS, lymph node dissection was performed [13]. Postoperative complications were analysed according to the Clavien–Dindo classification [14]. Grade ≥ 3 complications were considered as severe.