Mesenteric venous thrombosis: a surgical dilemma

The signs and symptoms of mesenteric vascular occlusion or stenosis have been well known and understood and may be of an acute or chronic nature. Mesenteric arterial compromise together with celiac artery stenosis or occlusion accounts for the vast majority of such occurrences. Much less frequently seen is abdominal visceral ischemia or infarction due to mesenteric venous outflow inadequacy. The clinical features of this entity are sometimes initially more vague than the arterial counterpart. Mesenteric venous thrombosis (MVT) may present acutely or chronically and leads eventually to disastrous and often fatal consequences. The specific diagnosis MVT has long been a difficult preoperative surgical dilemma. The aetiology of MVT includes: 1. Congenital haematological aberrations (antithrombin III deficiency, protein C or protein S deficiency) leading to hypercoagulation states 2. Carcinomatosis 3. Intra-abdominal vascular trauma (venous) 4. Intra-abdominal infections, pylephlebitis. A detailed interrogation including a family history is essential where a coagulopathy is suspected. Modern imaging techniques such as magnetic resonance imaging and computed tomography scans are specific in making an accurate and early diagnosis of this entity. Prompt treatment is the sole determinant of a satisfactory outcome. For a long time, surgery often followed by long term anticoagulation was the only available therapeutic modality. More recently, diagnostic imaging followed by thrombolytic therapy offers excellent results and frequently negates the necessity for surgery except where excision of infarcted bowel is manadatory. We report cases of MVT of varying aetiology. Methods of diagnosis, current therapy and outcome are discussed.(AU)

Arteriomesenteric duodenal occlusion associated with strongyloidiasis

Arteriomesenteric occlusion of the distal duodenum may occur in clinical conditions which result in narrowing of the angle between the aorta and superior mesenteric artery. Two patients with arteriomesenteric duodenal occlusion associated with Strongyloides stercoralis infection are described. In one patient the mechanism of occlusion appeared to be significant weight loss and associated visceroptosis, while in the other patient increased diameter of superior mesenteric vessels was the major factor. Strongyloidiasis, a curable parasitic infection, should be considered in patients presenting with arteriomesenteric occlusion of the distal duodenum. (AU)

Further investigations on the toxicity of crotalaria fulva in Jamaica

The lesions produced in rats and goats by oral doses of Crotalaria preparations include early hepato-cellular damage and later veno-occlusive disease. The effects of repeated dosages seem to be cumulative. Extracts prepared from fresh leaves are considerably more toxic than that from dried leaves (AU)