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Background: Spontaneous dissections of visceral arteries are rare and usually secondary to other disease. There is paucity of information about their natural course. Aim: To describe the imaging, clinical characteristics and follow-up of spontaneous visceral artery dissections diagnosed at our institution. Material and Methods: We report a series of 14 patients in whom a spontaneous dissection of a visceral artery was diagnosed on abdominal angio-CT between 2010 and 2018. Clinical features and evolution were recorded. Results: Isolated lesions of the celiac axis were the most common finding. Multiple territories were involved in 14% of cases. A dissection flap was observed in four cases, a hematoma-dissection complex in seven and an aneurysmal dilatation associated with the dissection in three. Of the 10 patients who were followed at our institution, 90% had stabilization or partial regression of the imaging findings. In the remaining case, new dissection events were observed. All cases were managed conservatively, and no death was reported. Conclusions: In this series of patients, spontaneous dissection of visceral arteries had a benign, favorable course, requiring only conservative management.

We aimed investigate the effects of 45 min of ischemia followed by 72 h of intestinal reperfusion (IR) in the ileum, liver, lungs, and kidneys in Wistar rats and the responses of these organs to curcumin treatment. Ischemia was induced by occluding the superior mesenteric artery. Rats were treated orally with 40 mg/kg curcumin. We analyzed oxidative stress and inflammation in the ileum, liver, lungs, and kidneys. Intestinal IR led to a reduction of reduced glutathione levels in the intestine, lungs, and kidneys and increased lipid hydroperoxide levels in all organs. An increase in the enzymatic activity of catalase was observed in all organs, and an increase in superoxide dismutase activity was observed in the ileum and lungs. Glutathione s-transferase levels increased only in the kidneys. Myeloperoxidase increased in all four organs, and n-acetyl-glycosaminidase increased only in the ileum and lungs. Curcumin prevented all of the changes in the ileum and liver. In the lungs, curcumin had no effect on n-acetyl-glycosaminidase. Curcumin did not prevent the changes in reduced glutathione, lipid hydroperoxides, or myeloperoxidase in the kidneys. Intestinal IR caused oxidative stress and inflammation in the ileum, lungs, and kidneys and to a lesser degree in the liver. Because of its systemic distribution, curcumin prevented changes mainly in the ileum, lungs, and liver and to a lesser degree in the kidneys. Nuestro objetivo fue investigar los efectos de 45 min de isquemia seguidos de 72 h de reperfusión intestinal (IR) en el íleon, hígado, pulmones y riñones en ratas Wistar y las respuestas de estos órganos al tratamiento con curcumina. La isquemia se indujo ocluyendo la arteria mesentérica superior. Las ratas se trataron con 40 mg / kg de curcumina. Analizamos el estrés oxidativo y la inflamación. La IR intestinal produjo una reducción de los niveles de glutatión en el intestino, los pulmones y los riñones y un aumento de los niveles de hidroperóxido de lípidos en todos los órganos. Se observó un aumento de la actividad enzimática de la catalasa en todos los órganos y un aumento de la actividad de la superóxido dismutasa en el íleon y los pulmones. Los niveles de glutatión s-transferasa aumentaron solo en los riñones. La mieloperoxidasa aumentó en los cuatro órganos y la n-acetil-glicosaminidasa aumentó sólo en el íleon y los pulmones. La curcumina previno todos los cambios en el íleon y el hígado. En los pulmones, la curcumina no tuvo ningún efecto sobre la n-acetil-glicosaminidasa. La curcumina no previno los cambios en el glutatión reducido, los hidroperóxidos de lípidos o la mieloperoxidasa en los riñones. La IR intestinal provocó estrés oxidativo e inflamación en el íleon, los pulmones y los riñones y, en menor grado, en el hígado. Debido a su distribución sistémica, la curcumina previno cambios principalmente en el íleon, pulmones e hígado y en menor grado en los riñones. Nosso objetivo foi investigar os efeitos de 45 min de isquemia seguidos por 72 h de reperfusão intestinal (IR) no íleo, fígado, pulmões e rins em ratos Wistar e as respostas desses órgãos ao tratamento com curcumina. A isquemia foi induzida pela oclusão da artéria mesentérica superior. Os ratos foram tratados por via oral com 40 mg/kg de curcumina. Analisamos o estresse oxidativo e a inflamação no íleo, fígado, pulmões e rins. A IR intestinal levou a uma redução dos níveis reduzidos de glutationa no intestino, pulmões e rins e aumentou os níveis de hidroperóxidos lipídicos em todos os órgãos. Um aumento na atividade enzimática da catalase foi observado em todos os órgãos, e um aumento na atividade da superóxido dismutase foi observado no íleo e nos pulmões. Os níveis de glutationa s-transferase aumentaram apenas nos rins. A mieloperoxidase aumentou em todos os quatro órgãos e a n-acetil-glicosaminidase aumentou apenas no íleo e nos pulmões. A curcumina evitou todas as alterações no íleo e no fígado. Nos pulmões, a curcumina não teve efeito sobre a n-acetil-glicosaminidase. A curcumina não preveniu as mudanças na redução da glutationa, hidroperóxidos lipídicos ou mieloperoxidase nos rins. A IR intestinal causou estresse oxidativo e inflamação no íleo, nos pulmões e nos rins e em menor grau no fígado. Devido à sua distribuição sistêmica, a curcumina evitou alterações principalmente no íleo, pulmões e fígado e, em menor grau, nos rins.

The paper reports successful thrombolysis conducted in 64 years old woman admitted to the clinic with clinical and angiographic data for acute surgical abdomen caused by acute tromboembolia of arteria mesenterica superior (AMS). The therapeutic approach required to undertake lifesaving decision on i.e. surgical vs. invasive treatment in conditions of emergency. Finally, it was decided to undertake invasive treatment with successful restoration of blood flow in the related artery. The patient was discharged from the clinic with considerable clinical improvement on the fifth day of her stay. The case report includes discussion on issues relating the consequence of the diagnostic and interventional procedures in such patients, opportunities for conducting emergency thrombolysis in acute embolia of AMS and preventive measures in patients with high tromboembolic risk. Keywords: Mesenterial circulation, Abdominal thromboembolism, Arterial thrombolysis

ResumoA isquemia mesentérica aguda é uma entidade de elevada mortalidade e constitui frequentemente o culminar de um processo patológico crónico. A revascularização convencional permanece como abordagem de escolha nestes casos. Os autores apresentam 2 casos de isquemia mesentérica crónica agudizada operados na instituição. O primeiro caso refere‐se a um homem de 76 anos submetido a revascularização cirúrgica das artérias hepática comum e mesentérica superior por quadro arrastado de dor abdominal e perda ponderal. O segundo caso refere‐se a uma mulher de 83 anos com quadro de vómitos e diarreia de evolução rápida para abdómen agudo, submetida a bypass aorto‐mesentérico superior com veia grande safena e ressecção ileocecal. Os 2 casos tiveram desfecho favorável graças a um diagnóstico célere, a uma revascularização convencional pronta e à ressecção intestinal concomitante.AbstractAcute mesenteric ischemia is a disease with high mortality and is frequently the end result of a chronic process. Surgical revascularization is still the preferred therapy in these cases. We present two cases of “acute‐on‐chronic” mesenteric ischemia operated in our institution. The first was a 76 year‐old male with a protracted history of abdominal pain and weight loss treated with revascularization of the common hepatic and superior mesenteric arteries. The second was a 83 year‐old female with a history of vomiting and diarrhea that quickly evolved into an acute abdomen and was submitted to aorto‐mesenteric bypass with great saphenous vein and ileo‐cecal resection. The two cases had a favorable outcome due to a timely diagnosis, to a prompt surgical revascularization and to a bowel resection.

Objectives This study investigated the diagnostic value of signal peptide-CUB-EGF domain-containing protein 1 (SCUBE-1) and other oxidative stress parameters in the early diagnosis of acute mesenteric ischemia, which has high mortality and morbidity if not identified and treated in the early period. Methods Thirty-six female Sprague-Dawley rats were used in this randomized, controlled study. Rats were divided into six groups: three control groups (Groups I, III, and V) and three ischemia groups (Groups II, IV, and VI). In the control groups, blood and tissue specimens were sampled at 30 minutes (Group I), 2 hours (Group III), and 6 hours (Group V), following a simple laparotomy. In the ischemia groups, the superior mesenteric artery (SMA) was ligated following laparotomy, and blood and tissue samples were sampled at 30 minutes (Group II), 2 hours (Group IV), and 6 hours (Group VI). Results When comparing the ischemia and control groups, the differences in SCUBE-1, malondialdehyde (MDA), and total antioxidant status (TAS) levels in the 30-minute period were not significant (p > 0.05); at 2 hours, SCUBE-1 levels rose rapidly, and although the desired level of significance could not be obtained with Bonferroni correction, the level was significantly higher compared to the control group at the same time interval (for SCUBE-1, Group III vs. Group IV, p = 0.006). In these periods (30 minutes and 2 hours), only total oxidative status (TOS) and oxidative stress index (OSI) values were significantly higher in the ischemia group compared to the control group (for both, p = 0.004). A pronounced rise in SCUBE-1 levels was determined with 6-hour ischemia (for SCUBE-1, Group V vs. Group VI, p = 0.004). The changes in MDA, TAS, TOS, and OSI levels were not significant (p = 0.025, p = 0.321, p = 0.006, and p = 0.037, respectively). Conclusions SCUBE-1 levels have the potential to be used as a marker of early period injury in acute mesenteric ischemia, although it is impossible to state explicitly that they can be used for early diagnosis. The same can be said for plasma MDA and TAS levels. The authors believe that TOS and OSI levels, however, can be used in early diagnosis and as an injury marker. Moreover, OSI also exhibits a medium-strong correlation with histopathologic injury. ResumenEl Valor del Peptido Senal-CUB-Dominio EGF que Contiene Proteina 1 (SCUBE-1) y los Parametros de Estres Oxidativo en el Diagnostico de la Isquemia Mesenterica Aguda Objetivos Este estudio investiga el valor diagnostico del peptido senal-CUB-dominio EGF-que contiene proteina 1 (SCUBE-1) y otros parametros de estres oxidativo en el diagnostico precoz de la isquemia mesenterica aguda, la cual tiene una alta mortalidad y morbilidad si no es identificada y tratada precozmente. Metodologia Treinta y seis ratas hembras Sprague-Dawley se utilizaron en este estudio controlado con asignacion aleatoria. Las ratas se dividieron en seis grupos: tres grupos control (Grupos I, III y V) y tres grupos de isquemia (Grupos II, IV y VI). En los grupos control, se tomaron muestras de tejido y sangre a los 30 minutos (Grupo I), las 2 horas (Grupo III) y las 6 horas (Grupo V), seguido de una laparotomia simple. En los grupos de isquemia, se ligo la arteria mesenterica superior (AMS) tras la laparotomia, y se tomaron muestras de tejido y sangre a los 30 minutos (Grupo II), 2 horas (Grupo IV) y 6 horas (Grupo VI). Resultados Cuando comparamos los grupos de isquemia y control, las diferencias a los 30 minutos en SCUBE-1, malondialdehido (MDA) y en el del estado antioxidante total (EAT) no fueron significativas (p > 0,05). A las dos horas, los niveles de SCUBE-1 se elevaron rapidamente, y aunque el nivel deseado de significacion no pudo ser obtenido con la correccion de Bonferroni, el nivel fue significativamente mayor comparado con el grupo control en el mismo intervalo de tiempo (para SCUBE-1, Grupo III vs. Grupo IV, p = 0,006). En estos periodos (30 minutos y dos horas), solo los valores del estado oxidativo total (EOT) y del indice de estres oxidativo (IEO) fueron significativamente mayores en el grupo isquemia comparado con el grupo control (para ambos, p = 0,004). Se hallo un incremento pronunciado en los niveles de SCUBE-1 a las 6 horas de la isquemia (para SCUBE-1, Grupo V vs. Grupo VI, p = 0,004). Los cambios en los valores de MDA, TAS, EOT, y IEO no fueron significativos (p = 0,025, p = 0,321, p = 0,006, y p = 0,037, respectivamente). Conclusiones Los valores de SCUBE-1 tienen la potencialidad de ser usados como un marcador de lesion precoz en la isquemia aguda mesenterica, aunque es imposible declarar explicitamente que puedan ser usados para el diagnostico precoz. Lo mismo puede decirse para los valores plasmaticos de MDA y EAT. Los autores piensan que el EOT y el IEO, sin embargo, pueden ser usados en el diagnostico precoz y como un marcador de lesion. Sin embargo, el IEO tambien exhibe una correlacion media-fuerte con la lesion histopatologica.

AbsztraktBevezetés:A vékonybél ischaemiás-reperfusiós (I-R) károsodása napjainkban is magas mortalitással járó kórkép, mely az arteria mesenterica superior (AMS) occlusiója vagy keringési redisztribúció során jöhet létre. Kísérletünk célja a posztkondicionálás lokális és távoli szervekre kifejtett protektív hatásának vizsgálata volt, patkányvékonybél ischaemiás-reperfusiós modelljében.Módszerek:Hím Wistar-patkányokon az AMS 60 perces occlusióját hoztuk létre. Az állatokat (n= 30) három csoportra osztottuk: áloperált (Álop), I-R kontroll (I-R) és posztkondicionált (PC). Az utóbbi csoportban a kirekesztést követően 2 percen át 6 ciklusban 10 másodperces felengedés és reocclusio repetitív ismétlése után került sor reperfusióra. A 6 órás reperfusio végén az állatokat exsanguináltuk, a vékonybél mindhárom szakaszából, illetve a tüdőből, a veséből és a májból szövettani mintákat vettünk, valamint nyálkahártya-kaparékból homogenizátumot készítettünk az antioxidáns status meghatározása céljából.Eredmények:A kontrollcsoportban nagyobb szöveti destrukcióra utaló jeleket észleltünk a vékonybelek, a tüdő, a vese és a máj tekintetében egyaránt. A károsodás mértékével összhangban a „wet/dry” ratio (p= 0,026) és a szérumkreatinin (p= 0,013), ASAT (p= 0,038), LDH (p= 0,028) és CK (p= 0,038) szintjének szignifikáns emelkedése volt mérhető a kontrollcsoportban a posztkondicionált csoporthoz képest. Javult továbbá a vékonybél-nyálkahártya antioxidáns statusa és a szérum-IL-6 koncentrációja (420 pg/ml vs. 188 pg/ml).Következtetés:A posztkondicionálás csökkentette a vékonybél lokális ischaemiás-reperfusiós károsodását. A strukturális károsodás mérséklődésén túlmenően javult a szisztémás antioxidáns status, és csökkent a távoli szervek károsodása.

INTRODUÇÃO: A síndrome de quebra-nozes (SQN) é uma condição na qual há compressão da veia renal esquerda pela aorta e a artéria mesentérica superior, associada a uma sintomatologia característica, porém pouco específica. RELATO DO CASO: Trata-se de uma paciente de 37 anos, apresentando hematúria macroscópica intermitente sem etiologia estabelecida até então. Durante a investigação, uma angiotomografia evidenciou compressão da veia renal esquerda no seu trajeto entre a artéria mesentérica superior e aorta abdominal, associada a importante dilatação de veia ovariana esquerda. DISCUSSÃO: A síndrome desencadeada pela compressão da veia renal esquerda pela aorta e artéria mesentérica superior apresenta prevalência provavelmente aumentada no sexo feminino e postula-se que seja associada a situações particulares, como a nefroptose e a escassez de gordura retroperitoneal. Hematúria, sinal típico, teria como causa a ruptura do fino septo que separa as veias do sistema coletor urinário. Vários exames de imagem podem auxiliar no diagnóstico. O tipo de tratamento que deve ser adotado ainda é controverso, existindo diversas opções cirúrgicas, como o uso de stent intravascular e a conduta conservadora. De diagnóstico costumeiramente tardio, essa síndrome deve ser incluída na investigação de pacientes com quadro de hematúria a esclarecer. INTRODUCTION: The nutcracker syndrome is defined by the compression of the left renal vein between the aorta and superior mesenteric arteries, accompanied by a classic, but less specific, symptomatology. CASE REPORT: We reported a case of a 37-year-old woman who had been investigated because of intermittent gross hematuria of unknown origin. Computed tomographic angiography revealed compression of the left renal vein as it ran between the superior mesenteric artery and the abdominal aorta, associated with significant dilation of the left ovarian vein. DISCUSSION: The nutcracker syndrome, caused by compression of the left renal vein by the aorta and superior mesenteric arteries, is probably more prevalent in women, and it is caused by specific situations, such as renal ptosis and paucity of retroperitoneal fat. Hematuria, a typical symptom, is due to rupture of the thin-walled septum separating the veins of the urinary collecting system. Imaging tests may help with the diagnosis. The best treatment is still elusive, but there are several surgical approaches, such as intravascular stenting, and also a conservative management. Diagnosis is usually delayed, and the syndrome should be included in the differential of hematuria of unknown origin.

Pseudoaneurysms arising from the visceral arteries are rare. We present 2 patients who developed pseudoaneurysms arising from branches of the superior mesenteric artery (SMA) following laparoscopic appendicectomy. Both cases were successfully treated by endovascular embolization. The diagnosis and management of SMA branch pseudoaneurysms are discussed.

Arteriosklerose ist die haufigste Ursache der chronisch mesenterialen Ischamie, die oft mit postprandialen Schmerzen, unerwunschtem Gewichtsverlust und einem Vermeidungsverhalten von Essen einhergeht. Die Verwendung von endovaskularen Techniken zur Revaskularisierung chronischen Mesenterialarterienstenosen und -verschlussen hat in den vergangenen 10 Jahren erheblich zugenommen. Die Ergebnisse der endovaskularen Therapien zeigen eine deutlich geringere Morbiditat und Mortalitat verglichen mit offen-chirurgischen Techniken wie dem Bypass oder der Thrombendarterektomie. Fruhe Publikationen haben eine hohere Restenoserate, einen haufigeren symptomatischen Ruckfall und haufigere Reinterventionen im Vergleich zu offen-chirurgischen Techniken berichtet, wahrend einige neuere publizierte Fallserien vergleichbare Offenheitsraten der beiden Verfahren zeigen. Diese Ubersichtsarbeit beschreibt die viszerale arterielle Gefasanatomie, Gefasanomalien und endovaskulare Techniken zur Behandlung der chronisch mesenterialen Ischamie.

ResumenSe presenta un paciente de sexo femenino y 13 de años, sin antecedentes de relevancia, que consultó por episodios de dolor abdominal posprandial. El diagnóstico fue síndrome de la arteria mesentérica superior. La tomografía computada multicorte mostró una disminución del diámetro del compás aortomesentérico y del ángulo de apertura, con atrapamiento de la tercera porción del duodeno. Se desarrollan las características clínicas e imagenológicas del caso, y se realiza una revisión de los hallazgos radiológicos.AbstractWe report a case of superior mesenteric artery syndrome in a 13 year-old female patient, with no relevant medical history, who had been having episodes of postprandial abdominal pain. Multislice Computed Tomography showed decrease of the aorta-superior mesenteric artery distance and narrowing of the normal angle between the aorta and the superior mesenteric artery, with obstruction of the duodenum. The clinical and imaging features of the case, as well as a review of the radiological findings of this disease are presented.

Retrograde superior mesenteric artery stenting (ROMS) represents a significant development in the treatment of acute mesenteric ischemia. Compared to traditional surgical mesenteric bypass, ROMS is a less invasive technique that avoids many complications associated with emergent mesenteric bypass. This case report illustrates that retrograde superior mesenteric artery (SMA) stenting is an option for the treatment of acute mesenteric ischemia for patients in extremis.

A new experimentally proven method for diagnosis and localisation of acute bleeding in the flow area of the arteria mesenterica superior is reported. By selective intra-arterial nuclide injection microhemorrhage below the proof limit of angiography can be registered and relatively exact localized by additional geometric procedure. Using this method, the exact location of angiographic, negative bleedings could be determined in experimentally produced bleedings in the jejunoileal transit and in the distal ileum. We explain the experimental arrangement and the results. The diagnostic value of the examination is discussed.

Resume Le syndrome de la pince aortomesenterique resulte de la compression de la troisieme portion du duodenum par l'artere mesenterique superieure sur l'aorte. Observation. – Une jeune femme de 21 ans, aux antecedents neurologiques, a ete hospitalisee pour vomissements bilieux et douleurs epigastriques. Le diagnostic de syndrome de la pince aortomesenterique a ete fait par la realisation d'un scanner abdominal. Une duodenojejunostomie laterolaterale a ete realisee par laparotomie. La patiente n'etait plus symptomatique apres cette intervention. Conclusion. – Le scanner abdominal injecte ou au mieux couple a une ingestion de produit de contraste (enteroscanner) permet de faire le diagnostic de syndrome de la pince aortomesenterique. Le diagnostic et la prise en charge de ce syndrome peu frequent sont rediscutes dans ce travail.

Surgery of visceral arteries is mainly indicated for ostial and juxtaostial atherosclerosis of the celiac axis and superior mesenteric arteries. Their surgical exposures are often difficult because of their deepness.

Spontaneous and isolated dissecting aneurysm of the superior mesenteric artery is a rare event that has been successfully treated by surgery in several reported cases. To our knowledge, we present the first case of a patient with spontaneous and isolated dissecting aneurysm of the superior mesenteric artery that was successfully treated by endovascular stent-graft placement.

Fragestellung. Ziel war die Implementierung eines Protokolls fur die abdominelle CT-Angiographie an einem 16-Detektorzeilen-CT. Zudem erfolgte der Vergleich mit der selektiven Katheterangiographie.

L’atresie duodenale est la resultante d’une revacualisation incomplete de l’intestin primitif, alors que l’atresie grelique type apple peel est secondaire a un accident vasculaire au niveau de l’artere mesenterique superieure. On rapporte le cas d’un nouveau-ne qui presente une atresie de la portion distale du duodenum associee a une atresie grelique type apple peel. Il s’agit du quatrieme cas rapporte dans la litterature de cette association inhabituelle. On propose une revue de la litterature afin de determiner l’ethiopathogenie commune de cette association, les caracteristiques embryologiques et therapeutiques de cette association particuliere.

Influence of Reflex Zone Therapy of the Feet on Intestinal Blood Flow Measured by Color Doppler Sonography Objective: An influence on organ-associated blood flow

BACKGROUND: Blunt pancreatic injuries occur when a high-energy crushing force is applied to the upper abdomen. In adults, the majority of blunt pancreatic injuries result from motor vehicle accidents. CASE REPORT: Male with 32 years old had a high-energy crushing history in witch he was pressured by the chest on the front car area. His life signs demonstrated to be regular. Ct scan demonstrated body pancreatic edema. All routine laboratorial exams were normal, EUS revealed pancreatic lesion grade II without involvement of the pancreatic duct and an impressive superior mesenteric vein thrombosis. He was sustained by means of anti- coagulation for about two months and after that time the multislice CT scan showed a mesenteric vein recanalization and a normal pancreatic parenchyma. The patient had an uneventfull follow-up. CONCLUSION: Patients presenting possible pancreatic trauma associated to superior mesenteric vein thrombosis, EUS must be used firstly. INTRODUÇÃO: Traumas pancreáticos fechados ocorrem em acidentes que promovem força intensa no abdome superior, principalmente em acidentes automobilísticos. RELATO DO CASO: Homem de 32 anos foi jogado contra a área frontal de seu automóvel. Seus sinais vitais eram normais. CT mostrou edema pancreático. EUS mostrou lesão pancreática grau II sem envolvimento do ducto pancreático, mas com impressionante trombose da veia mesentérica superior. Ele foi mantido com anticoagulants por dois meses e após este period novo scan mostrou recanalização e pâncreas normal. Teve seguimento favorável. CONCLUSÃO: Paciente apresentando edema pancreático associado a possível trombose de veia mesentérica superior deve ser submetido à EUS para monitorização e acompanhamento.

Resume Le syndrome de l'artere mesenterique superieure est une complication rare de la chirurgie rachidienne. Il resulte de la compression extrinseque du troisieme duodenum dans l'angle constitue par l'artere mesenterique superieure en avant et l'aorte et le rachis lombaire en arriere. Une maigreur importante en est la cause principale. Les modifications de la lordose lombaire, apres chirurgie ou traumatisme du rachis, ou le port d'un corset plâtre en sont les autres causes. Il realise un tableau d'occlusion digestive haute, d'evolution parfois fatale. Une tomodensitometrie avec injection, couplee a l'ingestion d'un produit radio-opaque ou un transit gastroduodenal permettent generalement le diagnostic. L'interet de ce dernier est de permettre la mise en place dans le meme temps d'une sonde d'alimentation jejunale, sous scopie. Le traitement est debute avant meme d'avoir la confirmation diagnostique. Il comprend dans un premier temps la correction des desordres hydroelectrolytiques et l'instauration precoce d'une nutrition, si possible enterale, pour assurer une reprise ponderale. La chirurgie n'est envisagee qu'en cas d'echec du traitement medical.

Les avantages de l’abord premier de l’artere mesenterique superieure (AMS) sont de : – commencer l’intervention par l’exploration des relais ganglionnaires situes a l’origine de l’AMS. En cas d’envahissement de ce groupe ganglionnaire, l’intervention est recusee, sauf s’il s’agit d’une tumeur endocrine ; – permettre la dissection par en arriere de l’AMS et degager ainsi progressivement l’axe veineux mesenterico-porte par son flanc droit ; – realiser une exerese complete du tissu cellulaire retro-pancreatique en pratiquant la dissection de droite a gauche et d’arriere en avant, a partir de la gaine de l’artere ; – faciliter le reperage et la dissection d’une artere hepatique anormale droite ou commune nee de l’AMS ; – faciliter la mise en place des clamps en cas de necessite de resection portale, la piece etant alors « pediculisee » sur la zone d’envahissement de la paroi veineuse ; – permettre de terminer l’exerese par la section pancreatique dont l’emplacement est determine avec precision.

O aumento da atividade simpática durante o exercício dinâmico progressivo associa-se à resposta da concentração de lactato sangüíneo. Com o objetivo de testar a hipótese de que a diminuição do fluxo da artéria mesentérica superior também tenha relação com a lactiacidemia, oito indivíduos saudáveis (idade de 21-26 anos) foram submetidos a exercício com incremento progressivo de cargas ajustadas para os limiares de lactato, sendo o fluxo da artéria mesentérica superior medido pelo EcoDoppler. O fluxo na artéria mesentérica superior, calculado por medidas planimétricas das velocidades e medidas da área de secção, foi avaliado em repouso, após carga de 30 Watts, no primeiro e segundo limiares de lactato e esforço máximo, O fluxo (média ± EP) no repouso foi de 1.034 ± 112 ml/min, de 1.002 ± 124 na carga de 30 Watts, de 869 ± 122 ml/min no primeiro limiar de lactato, de 866 ± 127 ml/min no segundo limiar de lactato e de 689 ± 104 ml/min logo após o esforço máximo, Ocorreu uma redução linear, sendo a redução média na carga máxima de 34% do fluxo de repouso, não havendo correlação com os limiares de lactato. Portanto, a redução do fluxo da artéria mesentérica superior apresenta uma resposta linear ao exercício progressivo. Mesenteric artery blood flow was measured by Doppler ultrasound in eight healthy subjects (age 21-26 years, mean=25.8) submitted to incremental exercise. As cardiovascular responses change above the point at which blood lactate starts to accumulate, a protocol was designed to determine the velocity profile and mesenteric artery flow redistribution along incremental exercise. On the first part of the protocol all individuals were submitted to determinations of lactate thresholds by the enzimatic method modified by Ribeiro et al (1986). On the second test mesenteric artery blood flow and sistolic, reverse and diastolic velocities were measured at rest and immediately after 30 Watts, first lactate threshold, second lactate threshold and at peak exercise. In this way exercise intensities were adjusted for each individual independently of training and physical conditions. Total mesenteric artery blood flow was calculated using planimetric measurement of the velocities waves and area determinations. The Friedman test was used to analise de data. There was no significant change of sistolic velocities during incremental exercise. In the other hand there was a marked decrease of diastolic velocities; a linear decrease of initial diastolic velocities and an abrupt decrease of end-diastolic velocities after the first lactate threshold. At peak exercise a redution of 77% in end-diastolic velocities was observed. A linear reduction of mesenteric artery blood flow was observed and there was no correlation with lactate thresholds; at peak exercise a decrease of 34% was detected. Resting mesenteric blood flow was 1.034± 112 (SE), at 30 Watts 1.002± 124 (SE), at the first lactate threshold 869± 122 (SE), at the second lactate threshold 866± 127 (SE) and at peak exercise 689± 104 (SE).

CONTEXT: Restorative proctocolectomy with anastomosis of an ileal pouch to the anal canal is a new and rare cause for triggering the syndrome of duodenal compression by the superior mesenteric artery. Restorative proctocolectomy requires assessment of the position of the duodenum in relation to aortomesenteric constriction to avoid the occurrence of duodenal compression by the superior mesenteric artery. CASE REPORT: The authors report on a case of this syndrome in a patient with familial adenomatous polyposis and review the literature on the etiopathogenesis, diagnosis, treatment and prevention of this unusual entity. CONTEXTO: A proctocolectomia restaurativa com anastomose de bolsa ileal no canal anal é causa nova de desencadeamento da síndrome da compressão duodenal pela artéria mesentérica superior. A proctocolectomia restaurativa requer avaliação da posição do duodeno em relação ao pinçamento aortomesentérico para evitar a sua compressão pela artéria mesentérica superior. RELATO DE CASO: Os autores relatam um caso desta síndrome em doente com polipose adenomatosa familiar e realizam revisão da literatura no tocante à etiopatogênese, diagnóstico, tratamento e prevenção desta inusitada entidade.

Resume Nous rapportons le troisieme cas de thrombose de l'artere mesenterique superieure au cours d'un syndrome de Behcet repondant aux criteres de la classification de Mason et Barnes. Les manifestations cliniques fonctionnelles de la patiente se resument a un angor intestinal severe associe a une alteration de l'etat general. Une revue de la litterature des atteintes vasculaires, notamment thrombotiques, de la maladie de Behcet est colligee. L'interet des techniques d'exploration arterielles digestives non invasives est discute.

Progress in operative techniques in surgery of the upper abdomen necessitates extensive preoperative diagnostic studies. Mesenterico-coeliacography along with CAT-SCAN form the basis for effective operative planning. In the angiography, the clinician is often confronted by variations in the arterial supply of the liver. These variations of the norm which are scarcely mentioned in anatomical textbooks must be carefully taken into consideration by the surgeon. In order to clarify the operative significance of these variations, we have conducted a retrospective study of the angiographies of the truncus coeliacus as well as of the arteria mesenterica superior. We found variations in 25.5% of 204 angiographies. The incidence of deviant and accessory hepatic arteries was 33.8% and of variations in the truncus coeliacus was 6.7%. These variations of the norm are discussed as to clinical and embryological aspects.

Obstruction and dilatation of the duodenum are caused by a variety of diseases. Chronic intermittent arteriomesenteric obstruction (AMO) is the most common of the extrinsic disorders that cause duoden

We present case reports of three recent patients to reinforce the argument that upper gastrointestinal series is the method of choice with which to document malrotation. It has been 9 years since there was a major discussion of this subject in the literature. Ultrasonography cannot confidently exclude malrotation. Radiographic study with contrast continues to be the best diagnostic tool.

Endoscopic ultrasonography (EUS)-guided celiac plexus neurolysis (EUS-CPN) is safe and effective but not beneficial for some patients with extended abdominal cancer. We compared the effectiveness of standard EUS-CPN and EUS-guided broad plexus neurolysis (EUS-BPN) that extends over the superior mesenteric artery (SMA) using a 25-gauge needle.Consecutive patients referred to our quaternary EUS centers were eligible for inclusion. To evaluate the neurolytic spread, contrast was mixed with the neurolytic agent and post-procedure computed tomography scanning was performed. The regions containing the celiac, superior, and inferior mesenteric arteries were divided on the frontal plane into six areas: upper right and left, middle right and left, and lower right and left. The number of contrast-bearing areas after EUS-CPN and EUS-BPN were related to the degree of pain relief achieved.A total of 67 patients with advanced abdominal cancer were included (34 EUS-CPN and 33 EUS-BPN). The qualitative variables of the two groups did not differ significantly. The EUS-BPN group had more patients with six contrast-bearing areas (42%) than the EUS-CPN group (0%). These patients had significantly better short-term and long-lasting pain relief than patients with less than five contrast-bearing areas. EUS-BPN patients exhibited significantly greater reductions in days 7 and 30 visual analog pain scale scores than EUS-CPN patients.Our preliminary data suggested that EUS-BPN using a 25-gauge needle provides patients with advanced abdominal cancer with better pain relief than standard EUS-CPN, and without incurring serious complications. Moreover, it seems that broad neurolysis over the SMA may provide superior analgesia.

Contexto: A eventual relação entre a aterosclerose das artérias dos membros inferiores com a aterosclerose das artérias intestinais foi pouco estudada. Objetivo: Avaliar pela ecografia vascular (Doppler) presença de lesões com estenose 70% na artéria mesentérica superior e/ou tronco celíaco em doentes com arteriopatia obstrutiva crônica dos membros inferiores. Método: Foram estudados dois grupos, cada um com 60 doentes (40 homens e 20 mulheres). O grupo-caso foi composto por doentes com arteriopatia obstrutiva crônica dos membros inferiores, claudicação intermitente limitante ou dor de repouso e/ou lesões tróficas de extremidade, sem queixas gastrintestinais. O grupo-controle foi constituído por enfermos sem doença arterial obstrutiva dos membros inferiores e sem queixas gastrintestinais. Consideraram-se fatores de risco presença de diabetes melito, hipertensão arterial, obesidade, angina/infarto, tabagismo e dislipidemia. Todos os doentes foram submetidos a ecografia vascular do tronco celíaco e da artéria mesentérica superior. Os doentes do grupo-caso foram separados pela presença de claudicação intermitente limitante (N = 12) ou lesão trófica e/ou dor de repouso (N = 48). Resultados: Houve associação significante entre idade (p = 0,04) e cardiopatia isquêmica (p = 0,04) com aterosclerose da artéria mesentérica superior. Os fatores de risco não mostraram associação significante com presença de estenose do tronco celíaco. Observou-se associação significante entre arteriopatia dos membros inferiores e lesão estenótica da artéria mesentérica superior (p = 0,006) e do tronco celíaco (p < 0,001). Conclusões: Na ecografia vascular, o achado de arteriopatia periférica sugere presença de lesão estenótica em artéria mesentérica superior e/ou tronco celíaco. A aterosclerose na artéria mesentérica superior está associada com cardiopatia isquêmica e idade avançada. Background: The occasional relationship between arterial atherosclerosis of lower limbs and atherosclerosis of intestinal arteries has not been fully studied yet. Objective: To assess the presence of lesions with ≥ 70% stenosis in the superior mesenteric artery and/or in the celiac trunk in patients with chronic obstructive arteriopathy of the lower limbs using vascular ultrasound (Doppler). Method: Two groups were involved, a study group and a control group, each comprising 60 patients (40 men and 20 women). The study group consisted of patients with chronic obstructive arterial disease of the lower limbs, limiting intermittent claudication or rest pain, and/or trophic lesions of the extremities but no gastrointestinal complaints. The control group comprised patients without obstructive arterial disease of the lower limbs or gastrointestinal complaints. The presence of diabetes mellitus, arterial hypertension, obesity, angina/infarct, smoking or dyslipidemia was considered a risk factor. All patients were submitted to vascular ultrasound of the celiac trunk and superior mesenteric artery. The patients of the study group were divided according to the presence of limiting intermittent claudication (n = 12) or trophic lesion and/or rest pain (n = 48). Results: A significant association was found between age (p = 0.04) and presence of ischemic cardiopathy (p = 0.04) with atherosclerosis of the superior mesenteric artery. The risk factors showed no significant association with presence of stenosis of the celiac trunk. A significant association was found between the presence of arteriopathy of the lower limbs and stenotic lesion of the superior mesenteric artery (p = 0.006) and the celiac trunk (p < 0.001). Conclusions: On vascular ultrasound, a finding of peripheral arteriopathy of the lower limbs suggests the presence of stenotic lesion in the superior mesenteric artery and /or the celiac trunk. The atherosclerosis in the superior mesenteric artery is associated with ischemic cardiopathy and advanced age.

Visceral arterial injuries account for a small but important portion of major abdominal vascular trauma. A case of proximal superior mesenteric artery trauma is presented. The advantages and drawbacks of the surgical approaches to these injuries are discussed. On the basis of a review of the literature describing the management of these injuries, ligation of the proximal superior mesenteric artery for trauma cannot be recommended. Prompt surgical intervention with revascularization offers the best chance for the survival of these critically injured patients.

Klinische Untersuchung: stark reduzierter AZ und EZ, Gewichtsabnahme von mehr als 10 kg wahrend der letzten 3 Wochen (Grose 164 cm, Gewicht 48 kg). Abdomen wirkt eingefallen, epigastrisch sind hochgestellte Darmgerausche mit stenosetypischer Peristaltik auskultierbar. Bei klinischem Verdacht auf eine adhasionsbedingte Symptomatik im oberen Dunndarm wird der orale Kostaufbau gestoppt und eine weiterfuhrende Diagnostik eingeleitet. In der Abdomenubersichtsaufnahme Luft in Projektion auf das Duodenum, im ubrigen Abdomen nur wenig Luft nachweisbar. Zur weiteren Abklarung Magen-Darm-Passage nach oraler Gabe von wasserloslichem jodhaltigem Kontrastmittel (Abb. 1). Zusatzlich wurde eine Abdomen-CT durchgefuhrt. Eine den Darm komprimierende Raumforderung last sich nicht nachweisen (Abb. 2).

Two cases of superior mesenteric artery syndrome are presented. In both, conclusive diagnosis was made noninvasively in the presence of acute symptoms by obtaining details of the duodenum and vessels

J Vasc Surg 2003;37:1131.

International audience; The authors report the case of a 39-year-old man with a common origin of three arteries-the celiac, superior mesenteric, and inferior mesenteric arteries-that has not been described previously in the literature, to their knowledge. This variant, which they call the celiac-bimesenteric trunk, is documented with a selective angiogram, and an embryologic explanation is offered.

Aneurysms of the superior mesenteric artery (SMA) and its branches are rare. We describe three patients with aneurysms in the SMA or its branches found at angiography in our department. The importance of mesenteric aneurysms and different procedures for treatment are discussed.