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Introduction. Superior mesenteric artery syndrome, also known as Wilkie syndrome, is a rare entity in which a reduction in the aorto-mesenteric angle or space determines extrinsic compression with obstruction of the distal third of the duodenum, demonstrating characteristic symptoms and signs of intestinal obstruction. The mainstay of treatment is conservative medical management with nutritional repletion, with the aim of increasing the thickness of the retroperitoneal fat and thereby resolving duodenal compression. Clinical case. A 16-year-old patient, with a chronic course marked by abdominal pain, constipation, bloating, heartburn and weight loss. Initially was treated as an acid-peptic disease, with poor improvement. Imaging studies were performed, which documented a decrease in the aorto-mesenteric angle. Conclusion. Based on the symptoms and findings on diagnostic images, the diagnosis of superior mesenteric artery syndrome was made, which is a cause of intestinal obstruction with a very low incidence. Its clinical presentation includes a wide variety of symptoms, among which abdominal pain and weight loss stand out. Confusion with other more common diseases is common, such as acid-peptic disease, gastrointestinal reflux and malabsorption. Its diagnosis requires a high index of suspicion, so it is important to know this entity and consider it in the study of patients with the aforementioned symptoms. [ABSTRACT FROM AUTHOR]

Introduction. Chronic mesenteric ischemia is a rare entity, with a prevalence of 0.03%, where more than 90% are due to arteriosclerotic disease that mainly affects the superior mesenteric artery. Its symptoms are chronic abdominal pain and weight loss, associated with imaging alterations that make the diagnosis. Treatment depends on the patient's clinical conditions and the number of vessels involved. It is clear that symptomatic multivessel disease requires revascularization. Clinical case. A 67-year-old woman, an active smoker with a history of high blood pressure and dyslipidemia, presented with an emergency-type hypertensive crisis that required management in the Intensive Care Unit. A diagnosis of Crawford IV thoracoabdominal aneurysm, aorto-iliac occlusion (TASC D), and chronic occlusion of the celiac trunk and superior mesenteric artery was made. Due to the symptoms of chronic mesenteric ischemia, she underwent surgical treatment with aorto-bifemoral bypass plus retrograde bypass to the superior mesenteric artery via an open approach. Result. The patient had improvement in symptoms and gained 13% weight at 3-month follow-up. Conclusion. Chronic mesenteric ischemia is an underdiagnosed condition, a marker of cardiovascular risk, with a high burden of morbidity and mortality, in which, with early identification, revascularization therapy can be offered, either endovascularly or open, in order to improve quality of life and weight gain, and avoiding intestinal necrosis. [ABSTRACT FROM AUTHOR]

Acute mesenteric ischemia (AMI) is a rare medical-surgical emergency that must be treated early due to its high morbidity and mortality. It corresponds to a sudden interruption of the blood supply to a segment of the intestine, producing ischemia, cell damage, intestinal necrosis and eventually death if it is not treated. The main etiology of this condition is embolic-type arterial occlusion, followed by thrombotic, nonocclusive, and venous thrombotic. It is an infrequent pathology with a low incidence of 12 per 100,000 inhabitants in international series. During the information collection, no data was found on the Chilean population since before 1983. Its main symptom is colicky abdominal pain with a sudden onset, vomiting and diarrhea that begins after the pain. On physical examination, signs of shock and abdominal distention may be noted. Hemodynamically unstable patients should be urgently taken to exploratory laparotomy as soon as the condition is suspected, and in stable patients, an angio-CT should be requested to confirm the diagnosis and plan treatment. There are two methods to treat this pathology, open surgery and endovascular or minimally invasive surgery. The form of therapy depends on the preoperative or intraoperative findings and the type of etiology. Finally, with the advancement of these new methods, the mortality rate has decreased in the last decade. [ABSTRACT FROM AUTHOR]

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Copyright of Ege Journal of Medicine is the property of Ege University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To evaluate the variability of branching of the celiac trunk and superior mesenteric artery using CT angiography and to compare the evaluation performed by a 1st year student of General Medicine and an experienced radiologist Methodology: Three-dimensional imaging of CT angiography using volume rendering technique (VRT) was performed based on the arterial phase data of biphasic abdominal CT performed on a dual-source CT machine. CT angiography in 1000 consecutive examinations was first evaluated by a 1st year student of General Medicine, who recorded the examination in the form of three projections at least. The student recorded a variant of branching. The results were compared with those findings, which were evaluated independently of the student's results by an experienced radiologist with 23 years of experience in computed tomography. Results: A total of 17 branching patterns were recorded. Celiac trunk and superior mesenteric artery divide the most frequent in 80.3% in the classical variant of branching, in 9% left hepatic artery from left gastric artery. All other segmentation variants were below 5% in frequency. The agreement between the evaluation of the student and the radiologist was in 89.3%, in the remaining 10.7% there was only in the differences in the evaluation of segmentation beyond the level distant from the gastroduodenal artery origin. Conclusion: Classic variants of celiac trunk and superior mesenteric artery are present in most cases; correct evaluation of CT angiography is possible even by a less experienced evaluator. was only in the differences in the evaluation of segmentation beyond the level distant from the gastroduodenal artery origin. Conclusion: Classic variants of celiac trunk and superior mesenteric artery are present in most cases; correct evaluation of CT angiography is possible even by a less experienced evaluator. [ABSTRACT FROM AUTHOR]

Introducción. El síndrome de la arteria mesentérica superior, también conocido como síndrome de Wilkie, es una entidad infrecuente en la que una reducción del ángulo o espacio aorto-mesentérico determina una compresión extrínseca con obstrucción del tercio distal del duodeno, demostrando síntomas y signos característicos de obstrucción intestinal. El pilar del tratamiento es el manejo médico conservador con repleción nutricional, con el objetivo de aumentar el grosor de la grasa retroperitoneal y con esto resolver la compresión duodenal. Caso clínico. Paciente de 16 años, con un curso crónico marcado por dolor abdominal, estreñimiento, distensión, pirosis y pérdida de peso. Inicialmente se trató como una enfermedad ácido-péptica, con pobre mejoría, por lo que se realizaron estudios imagenológicos con lo que se documentó una disminución del ángulo aortomesentérico. Resultado. Se instauró un manejo médico con un protocolo de repleción nutricional por vía oral, para lograr ganancia de peso y evitar la cirugía. Conclusión. Con base a los síntomas y hallazgos en imágenes diagnósticas se hizo el diagnóstico de síndrome de la arteria mesentérica superior, que es una causa de obstrucción intestinal con muy baja incidencia. Su presentación clínica incluye gran variedad de síntomas, entre los que destaca el dolor abdominal y la pérdida de peso. Es frecuente la confusión con otras enfermedades más frecuentes, como enfermedad ácido-péptica, reflujo gastrointestinal y malabsorción. Su diagnóstico requiere un alto índice de sospecha, por lo que es importante conocer esta entidad y considerarla en el estudio de pacientes con los síntomas mencionados.

Introducción. La isquemia mesentérica crónica es una entidad infrecuente, con una prevalencia de 0,03 %, donde más del 90 % son debidas a enfermedad arterioesclerótica que compromete principalmente la arteria mesentérica superior. Sus síntomas son dolor abdominal crónico y pérdida de peso, asociado a alteraciones imagenológicas que hacen el diagnóstico. El tratamiento depende de las condiciones clínicas del paciente y el número de vasos comprometidos. Es claro que la enfermedad multivaso sintomática requiere revascularización. Caso clínico. Mujer de 67 años, fumadora activa con antecedentes de hipertensión arterial y dislipidemia, con cuadro de crisis hipertensiva tipo urgencia que requirió manejo en Unidad de Cuidados Intensivos. Se hizo diagnóstico de aneurisma toracoabdominal Crawford IV, oclusión aorto-ilíaca (TASC D) y oclusión crónica del tronco celíaco y la arteria mesentérica superior. Por los síntomas de isquemia mesentérica crónica fue llevada a tratamiento quirúrgico con baipás aorto-bifemoral más baipás retrógrado a la arteria mesentérica superior por vía abierta. Resultado. La paciente tuvo mejoría de la sintomatología y aumentó 13 % del peso al seguimiento a los 3 meses. Conclusión. La isquemia mesentérica crónica es una condición subdiagnosticada, marcador de riesgo cardiovascular, con alta carga de morbilidad y mortalidad, en la cual, con una identificación temprana se puede ofrecer una terapia de revascularización, sea por vía endovascular o abierta, con el fin de mejorar la calidad de vida y la ganancia de peso, y evitar la necrosis intestinal.

Objective: to describe the clinical presentation, diagnosis, and surgical treatment of a patient with superior mesenteric artery syndrome or Wilkie syndrome combined with the nutcracker syndrome or left renal vein compression syndrome in a tertiary referral center in a Latin American country. Case description: a 25-yearold male patient from the United States who attended for a year of weight loss and intestinal obstruction episodes of unknown etiology after multiple imaging studies. Endoscopic studies were performed without findings. While in the recovery room, he developed abdominal pain requiring admission to the emergency service. The CT enterography showed dilation of the colon loops and small intestine with a decrease of the aortomesenteric (AOM) angle and the gastrointestinal series with the filiform passage of the contrast medium. Conservative management was attempted as initial therapy with intolerance to enteric nutritional support. Finally, we initially opted for surgical treatment, with a slow recovery process, but in the end, with a resolution of symptoms and weight gain. Conclusion: Wilkie syndrome is a rare disease and a diagnostic challenge in patients with weight loss and abdominal pain. We described a superior mesenteric artery compression case in which diagnosis was achieved with multiple diagnostic strategies and complete resolution after surgical treatment. The decreased aortomesenteric angle may compress the superior mesenteric artery and the left renal vein. In this case, it resulted in a combined Wilkie and nutcracker syndrome. [ABSTRACT FROM AUTHOR]

Introducción: basado en la embriología pueden diferenciarse el colon derecho y colon izquierdo según su vascularización provenga de las arterias mesentérica superior o inferior respectivamente. La descripción clásica de la arteria cólica media, originada en la arteria mesentérica superior, supone que la misma vasculariza el colon transverso conjuntamente con la arteria cólica superior izquierda que tiene origen en la arteria mesentérica inferior. Reporte de caso: se reporta el caso de una variante de la arteria cólica media que incide en la vascularización del colon izquierdo. La misma fue hallada durante la disección de un cadáver de sexo femenino, fijado en solución de formaldehído, donado al Departamento de Anatomía de la facultad de Medicina de la Universidad de la República. Se identificó a la arteria cólica media en su origen habitual, presentando una variante del trayecto según la cual descendió por el flanco izquierdo de la aorta abdominal, originando a la arteria cólica superior izquierda. Distalmente alcanzó el recto para participar de su vascularización. Discusión: las variantes en la vascularización del colon izquierdo son menos frecuentes respecto a las del colon derecho. En este caso una rama de la arteria mesentérica superior, incide en la vascularización del colon izquierdo. Esta variante no sólo plantea potenciales complicaciones a la hora del abordaje, sino que plantea la duda de cuál sería una resección oncológica adecuada para un tumor del colon izquierdo. El conocimiento anatómico de la vascularización del colon y sus variantes, sigue vigente y tiene implicancias en la práctica clínica quirúrgica.

Resumo A dissecção da artéria mesentérica superior é uma causa rara de dor abdominal, com quadro clínico variável. Seu diagnóstico é difícil, e não existe consenso sobre suas opções terapêuticas; elas variam em torno de tratamento conservador, correção aberta, endovascular ou combinada. Descrevemos o caso de um homem de 45 anos com dissecção isolada da artéria mesentérica superior, com quadro de dor abdominal persistente após tentativa de tratamento conservador. Ele foi submetido à revascularização cirúrgica aberta devido à localização e complexidade da dissecção. O tratamento com endarterectomia, arterioplastia com remendo de pericárdio bovino e acesso retrógrado para abertura da mesentérica com stent foi realizado com sucesso. A angina abdominal foi totalmente resolvida após estabilização do quadro. A combinação de abordagem aberta e endovascular deve ser considerada como terapia para casos de dissecção complexa isolada da artéria mesentérica superior.

En términos sencillos la hematuria es la presencia de sangre en orina. La misma puede clasificarse en hematuria macroscópica (si la orina y visiblemente roja) o en microscópica (si se logran identificar hematíes en el examen microscópico de orina). Existen diversas causas para la hematuria, una más frecuentes entre las cuales se encuentran tumores, infecciones, litiasis, y otras entidades más raras como el síndrome de cascanueces.

Resumo Os aneurismas de artérias viscerais (AAVs) e pseudoaneurismas de artérias viscerais (PAAVs) são condições raras e potencialmente letais quando rotos. Em geral, são encontrados incidentalmente na tomografia computadorizada de pacientes assintomáticos. Embora a cirurgia aberta convencional seja considerada atualmente o tratamento padrão ouro, a abordagem endovascular vem ganhando relevo por ser considerada um procedimento minimamente invasivo e com riscos cirúrgicos menores. Destaca-se, nessa abordagem, o uso de embolização por molas (coils) em AAVs e PAAVs saculares e implante de stent modulador de fluxo como alternativa de tratamento para aneurismas fusiformes. Apresentamos o caso de uma paciente de 51 anos com queixa de dor abdominal aguda, taquicardia e hipotensão, com evidência de sangramento abdominal em angiotomografia e diagnóstico de pseudoaneurisma de artéria ileocólica (AIC) roto. Ela foi submetida a tratamento endovascular precoce de embolização da AIC com sucesso, e houve melhora do quadro clínico.

Introduction: based on embryology right and left colon can be distinguished according to whether they are vascularized by the superior or inferior mesenteric artery respectively. In its classic description, middle colic artery arises from the superior mesenteric artery and supplies the transverse colon. Left colic artery usually originates from the inferior mesenteric artery. Case report: we described an anatomical variation in which middle colic artery directly irrigates de left colon. It was found during the dissection of a female cadaver fixed in formalin solution, in the Medicine Faculty of the University of the Republic in Montevideo, Uruguay. Middle colic artery was identified from its usual origin, and had a variation of its course, descending at the left flank of the abdominal aorta, and giving rise to the left colic artery. Distally it participated in the rectum supply. Discussion: anatomical variations of the left colon vascularization has been said to be less frequent than those of the right colon. In this case a branch of the superior mesenteric artery supplied the left colon. These could not only implicate possible complications during colon surgery, but also set an interrogant about the best oncologic solution in cases of left colon tumor. Importance of anatomical knowledge of left colon vascularization and its variations remains important and has implicances in surgical practice. [ABSTRACT FROM AUTHOR]

Introdução: As variações anatômicas das artérias hepáticas e do tronco celíaco são de grande importância para cirurgias laparoscópicas, transplantes hepáticos, intervenções radiológicas e tratamento de lesões abdominais. O grande aumento de intervenções minimamente invasivas deixou os atos cirúrgicos com menos espaço para o reconhecimento de estruturas anatômicas. Metodologia: Foi realizado um estudo retrospectivo do banco de dados do Hospital São Vicente de Paulo durante o ano de 2016, analisando imagens abdominais de tomografia computadorizada com contraste e angiotomografias que envolvem a aorta abdominal e seus ramos - um total de 461 imagens foram analisadas. Resultados: Dos 461 pacientes analisados, 86,9% apresentaram a conformação usual do tronco celíaco - cuja anatômica é a origem tríplice com as artérias gástrica esquerda, esplênica e hepática comum e artéria mesentérica superior se originando sozinha da aorta abdominal. Dentre as anatomias anômalas (13%), o padrão mais comum desses ramos foi a presença em 4,5% de um tronco hepatomesentérico e um tronco gastroesplênico. No sistema arterial hepático a conformação mais prevalente foram as artérias hepáticas direita e esquerda sendo ramos da hepática próprias em 66,3%. Das alterações anatômicas (33,2%), as mais comuns foram a presença de uma artéria hepática esquerda acessória ramo da artéria gástrica esquerda (7,8%). Conclusão: Variações anatômicas do sistema arterial hepático e do tronco celíaco são prevalentes, podendo apresentar diversos arranjos organizacionais. Palavras-chave: Artéria celíaca; artéria mesentérica superior; artéria hepática; variação anatômica

Introduction: Anatomical variations in the hepatic arteries and the celiac trunk are of great importance for laparoscopic surgeries, liver transplants, radiological interventions and treatment of abdominal injuries. A large increase in the number of minimally invasive interventions hampered the recognition of anatomical structures in surgical procedures. Methods: A retrospective study was performed using the 2016 São Vicente de Paulo Hospital database of contrast-enhanced abdominal computed tomography images and computed tomography angiographies showing the abdominal aorta and its branches. In total, 461 images were analyzed. Results: Of the 461 patients analyzed, 86.9% had usual conformation of the celiac trunk, which trifurcates into the left gastric artery, the common hepatic artery and the splenic artery, while the superior mesenteric artery originates alone from the abdominal aorta. Among the cases of anomalous anatomy (13%), the most common pattern in these branches was the presence of a hepatomesenteric trunk and a gastrosplenic trunk in 4.5%. In the hepatic arterial system, the most prevalent conformation was the right and left hepatic arteries being branches of the hepatic artery proper in 66.3%. Of all anatomical variations (33.2%), the most common were the presence of a left accessory hepatic artery of the left gastric artery (7.8%). Conclusion: Anatomical variations in the hepatic arterial system and the celiac trunk are common, having different structural arrangements. [ABSTRACT FROM AUTHOR]

Superior mesenteric artery aneurysms are rare, accounting for less than 0.5% of all intra-abdominal aneurysms. They are mainly caused by atherosclerosis and septic emboli resulting from bacterial endocarditis. Although uncommon, these aneurysms are considered dangerous because of possible complications such as rupture with hemorrhage and intestinal ischemia. Since the consequences can be very serious, early diagnosis and treatment are essential to improve outcomes. Although there is no well-defined consensus, recommended treatments include open surgery, endovascular therapy, and watchful waiting with periodic examinations. In this article we report the case of an asymptomatic 58-year-old man with an incidental and unusual finding of two superior mesenteric artery aneurysms. Since anatomy was not favorable for an endovascular approach, open surgery was performed, using a dacron graft to successfully repair the artery. [ABSTRACT FROM AUTHOR]

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Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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.

Se 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.

O pseudoaneurisma de artéria mesentérica superior é uma doença rara, porém com alta taxa de ruptura e mortalidade. Sua etiologia geralmente é infecciosa e comumente o diagnóstico é feito por meio de achado nos exames de imagem. Historicamente, seu tratamento de eleição tem sido o reparo cirúrgico aberto; entretanto, é associado a inúmeras complicações e dificuldades técnicas. Relatamos um caso de pseudoaneurisma de artéria mesentérica superior em um paciente portador de abscesso hepático no qual, após resolução do processo infeccioso, foi empregado, com sucesso, um tratamento minimamente invasivo endovascular, com implante de micromolas e stent não-recoberto.Pseudoaneurysm of the superior mesenteric artery is a rare disease, however it is associated to a high incidence of rupture and mortality. The etiology is usually infectious and the diagnosis is commonly made by means of occasional imaging. Historically, the treatment of choice has been open surgical repair; however it is associated to numerous complications and technical difficulties. We reported a case of a pseudoaneurysm of superior mesenteric artery in a patient with liver abscess who, after resolution of infection, underwent successfully a minimally invasive endovascular approach, with deployment of microcoils and bare stent.

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.

A Síndrome da Artéria Mesentérica Superior (SAMS) é uma entidade rara que se caracteriza pela obstrução, aguda ou crónica, da terceira porção do duodeno pela Artéria Mesentérica Superior (AMS) e Aorta Abdominal (AA). Nesta síndrome verifica-se uma diminuição do ângulo aorto-mesentérico até cerca de 6-25º (normal 38-56º), assim como da distância entre as referidas estruturas vasculares até 2-8mm (normal 10-20mm). Mulher de 54 anos, com queixas de pirose, desconforto epigástrico e distensão abdominal. Referia perda ponderal de 5kg nos últimos 3 meses (8% peso total) em relação com anorexia marcada. Ao exame objectivo e analiticamente sem alterações de relevo. Exames complementares sem alterações de relevo. Por agravamento das queixas abdominais, realizou tomografia abdominal que revelou estreitamento da 3ª porção do duodeno ao nível do cruzamento com a AMS, que por sua vez distava apenas 4,8mm da AA e com a qual formava um ângulo de 23º, sugerindo pinça mesentérica. Optou-se por dieta fraccionada e procinético com boa resposta. Os autores salientam que o diagnóstico da SAMS deve ser considerado sempre que pacientes emagrecidos apresentem um quadro sugestivo de obstrução digestiva alta.

OBJETIVO: A avaliação do fluxo sangüíneo mesentérico utilizando-se a Dopplervelocimetria transcutânea de artéria mesentérica superior (AMS) é método não invasivo que permite avaliar fatores envolvidos na perfusão sangüínea intestinal. Este estudo teve como objetivo determinar as variáveis Dopplervelocimétricas da AMS em recém-nascidos normais a termo, relacionando-as aos fatores ligados a gestação e crescimento fetal. MÉTODOS: A amostra continha 58 mães e 59 recém-nascidos a termo (1 gestação gemelar), cujos partos ocorreram no Hospital Israelita Albert Einstein. Utilizou-se equipamento Toshiba SSH 140 com sistema duplex-Doppler colorido de alta resolução, avaliando-se a AMS na sua origem, determinando-se calibre, velocidade sistólica, velocidade diastólica, velocidade média e índices de resistência e pulsatilidade. RESULTADOS: Verificou-se que a média do calibre da artéria mesentérica superior foi 1.94 mm, a média da velocidade sistólica. 86.47 cm/s, a média da velocidade diastólica 17.66 cm/s e a média da velocidade média, 36.93 cm/s. Os valores médios dos índices de resistência e pulsatilidade foram respectivamente 0.79 e 1.91. O calibre da AMS correlacionou-se positivamente com o peso de nascimento e negativamente com o perímetro cefálico ; velocidades e índices guardam relação com os dados antropométricos do recém-nascido, com o número de horas de vida, com o número de minutos em jejum e com o peso da mãe no fim da gestação. CONCLUSÃO: As variáveis Doppleervelocimetricas estão relacionadas a variáveis maternas e dos recém-nascidos, discutem-se fatores possivelmente implicados na associação. Sexo do recém-nascido e peso da mãe no inicio da gestação não alteraram nossos resultados.

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.

Knowledge of variant vascular supply of the gastrointestinal tract is essential, especially in minimal access surgical procedures. We describe the rare variation of double middle colic arteries, the main right middle colic artery from the superior mesenteric artery and the accessory left middle colic artery from the celiac trunk in a female cadaver during dissection for undergraduate students. A pre-operative selective arteriogram is important to determine such anomalies prior to performing elective pancreatic resections [ABSTRACT FROM AUTHOR]

Background: Acute mesenteric ischemia is a vascular emergency with mortality above 60%, which requires opportune treatment. However, due to its heterogeneous pathophysiology and differences in degree and extent of ischemic damage, the clinical and radiological manifestations are varied and often nonspecific; consequently, a thorough analysis of antecedents, laboratory studies, and clinical and radiological findings is recommended in order to establish a timely diagnosis. Objective: Identify the most common findings, direct and indirect, by computed tomography and determine low, intermediate, and high probability of a patient's suffering from acute mesenteric ischemia on the basis of risk factors and clinical, biochemical, and radiological findings. Material and methods: We performed a retrospective, observational, cross-sectional study, with analysis of findings from computed tomography images, of a series of cases of patients with diagnosis of acute mesenteric ischemia in a period of 9 years, 3 months and literature review. The purpose was to analyze the risk factors and clinical and biochemical data most commonly associated with acute mesenteric ischemia. Results: Our universe included tomographic studies of 27 cases of acute mesenteric ischemia, with average age of 60.8 years. The most common clinical datum was acute abdominal pain syndrome in 19 patients (70%); the most commonly associated antecedents were type 2 diabetes mellitus and systemic high blood pressure in 7 (26%) patients each; 13 patients (48%), per clinical notes, had laboratory studies, of whom 11 (85%) had leukocyte values of 9,200 to 68,000; the most commonly identified findings were: arterial filling defect 48%, intestinal pneumatosis 29%, venous filling defect 22%, bowel obstruction syndrome 22%, and identification of free fluid 22%. Conclusion: It is recommendable to conduct a quantitative analysis giving a specific value to the different findings, including risk factors, physical exploration, laboratory studies, and image findings, to determine the risk of acute mesenteric ischemia in a patient with acute abdominal pain syndrome. Angiotomography is the study with the greatest diagnostic precision. [ABSTRACT FROM AUTHOR]

Arteriosclerosis is the most common cause of chronic mesenteric ischemia, which is characterized by postprandial pain, unintentional weight loss and food avoidance. The use of endovascular techniques for revascularization of chronic stenoses and occlusions of the mesenteric arteries has rapidly increased over the last 10 years. The results of endovascular therapy have shown less morbidity and mortality compared to open surgical procedures, such as bypass and thrombendarterectomy. Early publications have reported higher rates of restenosis, symptomatic recurrence and reinterventions but recent case series show comparable patency rates. This article reviews visceral arterial anatomy and anomalies and endovascular techniques for the revascularization of mesenteric arteries. [ABSTRACT FROM AUTHOR]

Background: The ocasional 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.Asignificant 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. [ABSTRACT FROM AUTHOR]

This study was to ascertain the pattern of arrangements and distributions of the superior mesenteric artery (SMA) in a Nigerian population. Seventy-five cadavers certified as Nigerians were obtained from the dissecting room of the Department of Anatomy, University of Calabar after ethical approval from the Institution's Ethics Committee. Their abdomens and their contents were excise to expose the vessels. Based on the pattern of arrangements of the SMA, the cadavers were grouped into three (A, B, and C). Group A had 45 cadavers and this constituted 60% which were similar to the commonly documented patterns. Groups B and C had 20 and 10 cadavers respectively constituting 26.7% and 13.3% pattern of arrangement, some of which have not been documented before. In conclusion these peculiar patterns in this population are to be noted in surgical procedure, since damage to these variant vessels may result in severe haemorrhage that may lead to other complications. [ABSTRACT FROM AUTHOR]

The knowledge of the arterial variations is very important for the diagnosis and the surgical procedures. The purpose of this study was determine the number and the origin-levels of the renal and superior mesenteric arteries in relation to the vertebral bodies. For this, we used the angiographies of 31 patients, Chileans, adult, of both sexes. The angiographies were obtained by Helicoidal Computed Tomography, in these we localized the origin points of the mentioned arteries. We divided the vertebral bodies in three parts, superior, middle and inferior, considering too the intervertebral disc. In 26 patients, in both sides the renal artery was only; in the right side it was double in 2 patients and in the left side in 3. The right renal artery originated from the level of L1 vertebra in 11 cases; from the level of L1-L2 intervertebral disc in 7; from the level of the L2 vertebra in 10 and from the level of the L2-L3 intervertebral disc in 2. The left renal artery originated from the level of the L1 vertebra in 9 cases; from the level of the L1-L2 intervertebral disc in 6; from the level of the L2 vertebra in 12 and from the level of the L2-L3 intervertebral disc in 2. The superior mesenteric artery was only in all cases; it origin level was always cranial to the renal arteries origin. The origin level of the superior mesenteric artery was observed in relation to the L1 vertebra in 16 cases and to the level of the L2 vertebra in 8. We considered specifical origin levels associated to the vertebral body division. The results of this study will complete the knowledge of these arteries and are a contribution to the surgical anatomy of abdominal region. [ABSTRACT FROM AUTHOR]