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Only 50 cases of idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) have been reported since 1991 when it was first described. This rare etiology for chronic colonic ischemia is often debilitating to the patient’s quality of life, and no effective medical treatment is available. IMHMV is frequently confused with inflammatory bowel disease because the most common presenting symptoms include abdominal pain, diarrhea, and hematochezia. Surgical resection is curative; however, the diagnosis is rarely reached preoperatively. In the present report, we have described the seventh patient with a diagnosis of IMHMV before surgery and included a literature review to help clinicians recognize this condition.

ABSTRACT Background: Hypovolemic shock is a common disease in polytrauma patients and may develop ischemia in various organs, increasing morbidity and mortality. The bowel is usually most affected by this condition. Aim: To evaluate the effects of copaiba oil on the intestinal mucosa’s injury of rats submitted to hypovolemic shock. Method: Fifteen rats were divided into three groups: sham - simulated surgery; ischemia - animals submitted to hypovolemic shock; and copaiba - animals submitted to hypovolemic shock previously treated with copaiba oil. Mean blood pressure, arterial blood gas after shock induction, degree of intestinal lesion and villus length were evaluated. Results: The sham presented the lowest values of lactate and PaCO2 and the highest values of mean arterial pressure, pH and bicarbonate in relation to the other groups. The degree of mesenteric lesion was zero in the sham group; 3.00±1.00 in the ischemia group; and 3.00±0.71 in the copaiba group. The villus length was 173.60±8.42 in the sham, 142.77±8.33 in the ischemia and 143.01±9.57 in the copaiba group. There was a significant difference between the sham and the other groups (p

Endovascular approaches have replaced open surgical revascularization in most patients with mesenteric ischemia; however, flush ostial occlusions may not be amenable to traditional antegrade access. Retrograde mesenteric stenting has been previously described, but this technique requires a formal laparotomy and dissection of the proximal superior mesenteric artery. We present here a modification of this technique that requires only a “mini-laparotomy” and no open vascular repair of the superior mesenteric artery as well as a review of our initial institutional experience with this procedure. Our approach differs from previously described work by minimizing mesenteric dissection, avoiding the need for repair of an arteriotomy, and limiting the size of the laparotomy incision in this population of profoundly comorbid patients. [ABSTRACT FROM AUTHOR]

ABSTRACT Background: Mesenteric ischemia is a challenging diagnosis. Delay in diagnosis can lead to extent bowel necrosis and poor outcomes. Ischemia and reperfusion syndrome plays an important role in this scenario. Aim: To access effects of different post-conditioning cycles on mesenteric ischemia-reperfusion syndrome. Method: Twenty-five rats were assigned into five groups: Sham, used to establish normal parameters; control group, submitted to mesenteric ischemia for 30 min; in groups GP3, GP1 and GP30, ischemia was followed by post-conditioning protocol, which consisted of 1 cycle of 3 min (GP3), 3 cycles of 1 min (GP1) or 6 cycles of 30 s (GP30), respectively. Ileum samples were harvested after one hour of reperfusion. Intestinal mucosal injury was evaluated through histopathological analysis. Results: The average of mesenteric injury degree was 0 in the sham group, 3.6 in the control group, 3.4 in GP3, 3.2 in GP1, and 3.0 in GP30; villous length average was 161.59 in sham group, 136.27 in control group, 135.89 in GP3, 129.46 in GP1, and 135.18 in GP30. Was found significant difference between sham and other groups (p

Objectives Both open surgery (OS) and endovascular surgery (ES) have been proposed for the treatment of symptomatic chronic mesenteric ischaemia (CMI). OS was considered the gold standard but ES is increasingly proposed as the first option. The aim was to report long-term outcomes associated with OS in patients suffering CMI in the modern era in order to help in choose between the two techniques. Materials and methods A retrospective single centre analysis of all consecutive digestive artery revascularizations performed for CMI between January 2003 and December 2012 was carried out. Primary outcomes were 30 day mortality and morbidity, and secondary outcomes were survival, primary patency (PP), secondary patency (SP), and freedom from digestive symptoms, depending on the completeness of the revascularization performed. Results Eighty-six revascularizations were performed. Median follow up was 6.9 years (range 0.3–20.0). The 30 day mortality and morbidity rates were respectively 3.5% and 13.9%. Ten year survival was 88% for complete revascularization (CR) and 76% for incomplete revascularization (IR) ( p = .54). The PP was 84% at 10 years for CR and 87% respectively for IR ( p = .51). The 10 year SP was 92% for CR and 93% for IR ( p = .63). Freedom from digestive symptoms was influenced by the completeness of revascularization: 79% for CR versus 65% for IR at 10 years ( p = .04). Conclusions OS for CMI, especially complete revascularization, provides lasting results despite high morbidity. [ABSTRACT FROM AUTHOR]

A 74-year-old woman who was diagnosed with chronic mesenteric ischemia was under hemodialysis maintenance and had previously undergone axillobifemoral bypass surgery because of abdominal aortoiliac occlusion. Endovascular and antegrade or retrograde surgical revascularizations from the aortoiliac artery were contraindicated because of a severely calcified arteriosclerotic lesion, which included aortoiliac occlusion. During median laparotomy, revascularization consisting of bypass grafting from a previous prosthetic graft to the mesenteric arteries was performed using saphenous vein grafts. Although extra-anatomical bypass for chronic mesenteric ischemia is challenging, it provides a feasible option in cases where conventional endovascular or surgical revascularization is contraindicated., Competing Interests: Disclosure StatementAll authors have no conflict of interest., (© 2023 The Editorial Committee of Annals of Vascular Diseases.)

Purpose: The purpose of this study was to determine the prognostic factors and risk scorings that could have an impact on the in-hospital mortality of acute mesenteric ischemia (AMI). Methods: Forty consecutive patients received an operation due to AMI between January 2001 and June 2009. The hospital medical charts and clinical records were retrospectively reviewed. Clinical features, laboratory findings, operative findings, surgical procedure, and prognostic scoring system were collected and assessed as possible the prognostic factors for in-hospital mortality. Results: The overall hospital mortality rate was 32.5% (13/40). In a univariate analysis, significant predictorsof in-hospital mortality were decreased mentality (P=0.029), shock at admission (P=0.006), symptom duration (P=0.011), blood urea nitrogen (P=0.029), serum creatinine (P<0.001), glucose (P=0.004), total bilirubin (P=0.044), aspartate aminotransferase (P=0.001), lipase (P=0.039), pH (P=0.014), bicarbonate (P=0.027), prothrombintime-international normalized ratio (P=0.006), activated partial thromboplastin time (P=0.004), length of remnant bowel (P=0.008), postoperative inotropics (P=0.007), Acute Physiology and Chronic Health Evaluation II (P=0.009), and American Society of Anesthesiologists (ASA) grading (P=0.005). In a multivariate analysis, the variables hyperglycemia (P=0.013) and higher ASA (>II) (P=0.02) were identified as independent prognostic factors of in-hospital mortality. Conclusion: In conclusion, the prognostic factors in AMI who have hyperglycemia (>200 mg/dL) and high ASA grading (>II) are truly associated with very high in-hospital mortality. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Synchronous embolism to the superior mesenteric artery (SMA) and coeliac axis (CA) is a rare disease. Report: A 67-year-old man with atrial fibrillation developed acute liver failure due to an embolic occlusion of the CA and SMA, with a severe coagulation disorder. He was successfully managed with percutaneous stent placement and an exploratory laparotomy was not needed. He remains symptom-free 1 year after the procedure, and duplex follow-up showed stent patency. Conclusion: Endovascular techniques in patients with liver failure, no signs of peritonism, early diagnosis and high operative risk seem feasible and should be used if possible, as first-line option. [Copyright &y& Elsevier]

Introduction: The median arcuate ligament is a fibrous arch that unites the diaphragmatic crura on either side of the aortic hiatus. In 10-24% of the population it can cause compression of celiac axis, resulting in mesenteric ischemia presenting with post prandial pain abdomen, nausea, vomiting and weight loss. We report a case of Median Arcuate Ligament Syndrome (MALS) in a Type 1 Diabetic patient who presented with acute abdomen. Case Report: A 24 years old female patient, known type 1 diabetic of 10 years duration presented with intractable nausea & vomiting. She had a history of 1 year duration of intermittent abdominal pain and 8 kg weight loss USG abdomen was remarkable for multiple gall stones collectively measuring 2.5 cm with no e/o cholecystitis or e/o billiary obstrctution, pancreas was normal. Her liver and renal function tests were normal. S. Amylase was marginally elevated-204 units /L (25-115) with normal lipase- 64 units /L. Erect X-ray abdomen & chest X ray were normal. CECT abdomen revealed narrowing of the origin of celiac axis (with upward fish hook like configuration distally). Coeliac axis Doppler was not suggestive of MALS. A selective angiography & resection of MAL was planned. Conclusion: Mesenteric ischemia and MALS is a rare cause of abdominal pain. A diabetic patient presenting with acute upper abdominal pain will have DKA, pancreatitis, cholecystitis and MI in the differential diagnosis as a top priority. When these are ruled out as in our patient and if a chronic suggestive history is elicited MALS should be suspected. [ABSTRACT FROM AUTHOR]