RESUMO
Traumatic superior mesenteric artery (SMA) and vein (SMV) injuries are rare but often lethal. The ideal management options of traumatic SMV injury are still controversial. Management options include venous repair and ligation. Splenic vein turndown procedure (SVTP) is a rare procedure that has been described in only 6 cases in the literature. Here, we reviewed the literature on the usage of the splenic vein turndown procedure (SVTP) as an alternative option in patients with traumatic SMV injury. METHODS: We performed a narrative review for the available literature on the usage of the splenic vein as an autologous graft in the management of the SMV injury. We included all studies of SVTP in traumatic SMV injuries only. RESULTS: We included only 5 studies. In total, 7 patients underwent SVTP. Five patients presented with a penetrating abdominal vascular trauma (AVT) and 2 patients with a blunt AVT. The advantages of the SVTP include no need for additional incisions to harvest potential autologous grafts, minimally increased operative time, and 1 less anastomotic site compared to other conduit options. CONCLUSIONS: In cases of traumatic SMV injuries with associated splenic or pancreatic injuries that need distal pancreatosplenectomy, surgeons may consider SVTP as an ideal management option rather than primary repair or ligation.
Assuntos
Veias Mesentéricas/cirurgia , Veia Esplênica/transplante , Enxerto Vascular , Lesões do Sistema Vascular/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Adulto , Feminino , Humanos , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/lesões , Veias Mesentéricas/fisiopatologia , Transplante Autólogo , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/fisiopatologia , Ferimentos por Arma de Fogo/diagnóstico por imagem , Ferimentos por Arma de Fogo/fisiopatologiaRESUMO
Intraabdominal vascular injuries due to blunt abdominal trauma are rare. It is very difficult to visualize superior mesenteric vein (SMV) and portal vein injuries under emergency conditions. In this case study, we reported a low-speed car accident, a patient with isolated SMV injury as a result of a blunt abdominal trauma that arose from a collision with a steering wheel. A 62-year-old male patient was admitted to the emergency department with minimal distention and diffuse tenderness in the abdomen. The presence of diffuse fluid in the abdomen and suspected liver injury were reported in ultrasonography. The presence of fluid in perihepatic and perisplenic areas was detected in abdominal tomography. No solid organ injury was observed. Laparotomy revealed an injury in the small intestine mesentery. There was a defect on SMV under splenic vein combination. End side vein anastomosis and primary repair were performed. During six months follow-up, the patient did not have active complaints, and there was no pathology in the SMV and portal vein. We think that the use of vascular repair techniques applied by experienced surgeons in hemodynamically stable superior mesenteric venous injuries is important concerning continuity of anatomical and functional integrity.
Assuntos
Traumatismos Abdominais , Veias Mesentéricas , Lesões do Sistema Vascular , Ferimentos não Penetrantes , Acidentes de Trânsito , Humanos , Masculino , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/lesões , Veias Mesentéricas/cirurgia , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Portal vein (PV) and superior mesenteric vein (SMV) injuries are lethal. We hypothesised outcomes have improved with modern trauma care. METHODS: We reviewed patients presenting to our Level 1 trauma centre over ten-years with PV/SMV injuries, analysing physiology, operative management, associated injuries, and outcomes. RESULTS: Twenty-four patients had 7 PV and 15 SMV injuries, 2 had both; all had operative exploration. Sixty-seven percent had penetrating trauma. While many had normal vitals, profound acidosis was common. All patients had ≥2 additional abdominal injuries, liver most common (50%). Additional abdominal vascular injuries were more common in non-survivors than survivors: IVC 46% vs 22%, common hepatic artery 20% vs 0%, SMA 26% vs 11%. The mean injury severity score (ISS) was 32.4, and the mean new injury severity score (NISS) was 44.5. Mortality was 63%. Eleven patients died from exsanguination, two from SMV thrombosis, and two from sequelae of other injuries. All survivors had venorrhaphy, as did 8 non-survivors. Non-survivors were also shunted; had ligation; or bypass, shunting, and ligation. Three exsanguinated prior to repair. Two survivors had SMV related complications. One with proximal SMV injury developed severe venous congestion and multiple enterocutaneous fistulae. Another developed an arterioportal fistula, managed with embolisation and percutaneous portal vein stenting. CONCLUSION: Despite advances (REBOA, damage control surgery and resuscitation, liberal use of ED thoracotomy), PV and SMV injuries remain lethal. Injuries to other structures are ubiquitous. Early exsanguination is the major cause of death. All survivors had successful venorrhaphy; those who required more complex repairs died. Compromised mesenteric venous flow causes morbidity and mortality.
Assuntos
Traumatismos Abdominais/complicações , Veias Mesentéricas/lesões , Veia Porta/lesões , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular , Ferimentos Penetrantes/complicações , Adulto , Exsanguinação/etiologia , Exsanguinação/mortalidade , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Mortalidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Análise de Sobrevida , Centros de Traumatologia/estatística & dados numéricos , Estados Unidos/epidemiologia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/métodos , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/mortalidade , Lesões do Sistema Vascular/fisiopatologia , Lesões do Sistema Vascular/cirurgiaRESUMO
BACKGROUND: Traumatic superior mesenteric vein (SMV) injury is rare, and the ideal treatment is controversial. We compared the outcomes of ligation versus repair of SMV injury using the National Trauma Databank. MATERIALS AND METHODS: All adult patients who suffered from traumatic SMV injury were identified from the National Trauma Databank (2002-2014) by International Classification of Diseases (ICD) codes. Patients were stratified by treatment modality into no repair, ligation, and surgical repair using ICD procedure codes. Patient characteristics were compared between ligation and surgical repair groups using the Kruskal-Wallis test for continuous variables and Fisher's exact test for categorical variables. Outcomes, including mortality, rates of small bowel resection, length of stay (LOS), and ventilation days were compared using logistic regression. RESULTS: Among 952 patients with SMV injury, 192 patients (20.2%) had ligation, 428 (50%) underwent surgical repair, and 332 patients (34.9%) had neither repair nor ligation of the SMV. Overall hospital mortality was 32%. Age, gender, injury severity score (ISS), and Glasgow Coma Scale (GCS) were similar between groups that underwent ligation and surgical repair. Although the mortality rate (29.4% versus 36.5%, P = 0.20) and bowel resection rate (4% versus 3%, P = 0.12) were similar, patients who underwent repair had significantly longer hospital LOS (19.4 ± 24.8 versus15.2 ± 24.4 d, P < 0.001) and ICU LOS (13 ± 17.1 versus 9.3 ± 11.8 d, P = 0.02) compared to ligation. Similar results were observed in multivariable analysis when adjusted for race, associated vascular injuries, and other associated injuries. CONCLUSIONS: In patients with traumatic SMV injury, surgical repair does not appear to confer a significant survival advantage over ligation and can be associated with greater LOS and ICU LOS. Ligation may be an acceptable option for management of a traumatic SMV injury, especially when surgical repair cannot be performed, without compromising patient mortality or bowel resection rates.
Assuntos
Unidades de Terapia Intensiva/estatística & dados numéricos , Ligadura/efeitos adversos , Veias Mesentéricas/lesões , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Lesões do Sistema Vascular/cirurgia , Adulto , Bases de Dados Factuais , Feminino , Escala de Coma de Glasgow , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação/estatística & dados numéricos , Ligadura/estatística & dados numéricos , Masculino , Veias Mesentéricas/cirurgia , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/mortalidade , Adulto JovemRESUMO
Portopulmonary hypertension (PoPH) is a well-recognized complication of portal hypertension. This study reports a case of PoPH that was secondarily caused by post-traumatic mesenteric arteriovenous fistula. A 38-year-old man with a history of knife stabbing wounds in the abdomen in 2003 was admitted to the hospital with exertional shortness of breath and a mechanic murmur over the umbilical region. Computed tomography indicated signs of PoPH and mesenteric arteriovenous fistula. Percutaneous catheter-directed embolization was first performed but failed. Subsequently, the patient was successfully treated with fistula resection and partial enterectomy. The patient had been postoperatively followed regularly, and chief symptoms had been alleviated significantly and pulmonary pressure had successfully decreased to normal range. We believe that this is the first case of PoPH caused by mesenteric arteriovenous fistula.
Assuntos
Traumatismos Abdominais/etiologia , Fístula Arteriovenosa/etiologia , Hipertensão Portal/etiologia , Hipertensão Pulmonar/etiologia , Artérias Mesentéricas/lesões , Veias Mesentéricas/lesões , Traumatismo Múltiplo/etiologia , Ferimentos Perfurantes/etiologia , Traumatismos Abdominais/diagnóstico , Adulto , Angiografia Digital , Pressão Arterial , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/fisiopatologia , Fístula Arteriovenosa/cirurgia , Angiografia por Tomografia Computadorizada , Humanos , Hipertensão Portal/diagnóstico por imagem , Hipertensão Portal/fisiopatologia , Hipertensão Portal/cirurgia , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/cirurgia , Masculino , Artérias Mesentéricas/diagnóstico por imagem , Artérias Mesentéricas/fisiopatologia , Artérias Mesentéricas/cirurgia , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/fisiopatologia , Veias Mesentéricas/cirurgia , Traumatismo Múltiplo/diagnóstico , Flebografia/métodos , Pressão na Veia Porta , Artéria Pulmonar/fisiopatologia , Ferimentos Perfurantes/diagnósticoRESUMO
AIM: To evaluate a 3D-printed coplanar template for iodine-125 seed implantation therapy in patients with pancreatic cancer. METHODS: A retrospective analysis of our database was performed, and a total of 25 patients with pancreatic cancer who underwent iodine-125 seed implantation between January 2014 and November 2017 were analyzed. Of these, 12 implantations were assisted by a 3D-printed coplanar template (group A), and 13 implantations performed freehand were selected as a control group (group B). A 3D coplanar template was designed and printed according to a preoperative CT scan and treatment planning system. The iodine-125 seeds were then implanted using the template as a guide. Dosimetric verification was performed after implantation. Pre- and postoperative D90, V100, and V150 were calculated. The success rate of iodine-125 seed implantation, dosimetric parameters, and complications were analyzed and compared between the two groups. RESULTS: Iodine-125 seed implantation was successfully performed in both groups. In group A, the median pre- and postoperative D90 values were 155.32 ± 8.05 Gy and 154.82 ± 16.43 Gy, respectively; the difference between these values was minimal and not statistically significant (P > 0.05). Postoperative V100 and V150 were 91.05% ± 4.06% and 64.54% ± 13.40%, respectively, which met the treatment requirement. A better dosimetric parameter was observed in group A than in group B, and the difference was statistically significant (V100: 91.05% ± 4.06% vs 72.91% ± 13.78%, P < 0.05). No major procedure-related complications were observed in either group. For group A, mild hemorrhage was observed in 1 patient with a peritoneal local hematoma due to mesenteric vein damage from the iodine-125 seed implantation needle. The hematoma resolved spontaneously without treatment. Postoperative blood amylase levels remained within the normal range for all patients. CONCLUSION: A 3D-printed coplanar template appears to be a safe and effective iodine-125 seed implantation guidance tool to improve implantation accuracy and optimize dosimetric distribution.
Assuntos
Braquiterapia/métodos , Radioisótopos do Iodo/administração & dosagem , Neoplasias Pancreáticas/radioterapia , Planejamento da Radioterapia Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Braquiterapia/efeitos adversos , Braquiterapia/instrumentação , Feminino , Humanos , Masculino , Veias Mesentéricas/lesões , Pessoa de Meia-Idade , Agulhas/efeitos adversos , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Neoplasias Pancreáticas/diagnóstico por imagem , Impressão Tridimensional , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/efeitos adversos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: Acute pancreatitis may cause massive intra-abdominal bleeding as vascular complications caused by the erosion of a major pancreatic or peripancreatic vessel. In terms of treatment, the differentiation between arterial bleeding and venous bleeding using abdominal computed tomography (CT) angiography is important. In addition, hypovolemic shock caused by bleeding from the inferior mesenteric vein (IMV) in acute pancreatitis has not been reported. CASE REPORT: A 58-year-old man presented to our emergency department with complaints of abdominal pain of 10 hours' duration. The pain had an abrupt onset and started with alcohol consumption. After performing initial laboratory tests and an abdominal CT scan, he was diagnosed with acute pancreatitis. However, he complained of severe abdominal pain and was drowsy 2 h later. Follow-up CT angiography revealed acute necrotizing pancreatitis with massive hemoperitoneum and hypovolemic shock. We also found active bleeding from the IMV. We did not consider emergency catheter angiography with embolization; instead, exploratory laparotomy and hematoma evacuation with IMV ligation was performed. He was discharged without complications 14 days later. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Massive bleeding from the IMV accompanied by shock bowel syndrome is a rare complication of acute pancreatitis that can be confused with arterial bleeding. Emergency physicians should consider this diagnosis in acute pancreatitis as a possible cause of hypovolemic shock and anatomic course of the IMV and prevent fulminant shock by administering appropriate treatment.
Assuntos
Hemorragia/complicações , Veias Mesentéricas/lesões , Pancreatite Necrosante Aguda/complicações , Pancreatite Necrosante Aguda/diagnóstico , Dor Abdominal/etiologia , Angiografia por Tomografia Computadorizada/métodos , Serviço Hospitalar de Emergência/organização & administração , Hemorragia/etiologia , Humanos , Masculino , Veias Mesentéricas/fisiopatologia , Pessoa de Meia-Idade , Pancreatite Necrosante Aguda/etiologia , Choque/etiologiaRESUMO
BACKGROUND: D3 extended mesenterectomy (D3EM) for right colon cancer has received increased attention owing to suggested improvement of oncological outcomes. The aim of this study was to evaluate the proficiency-based progression of content-valid metrics in a cadaveric model for right colectomy with D3EM. MATERIALS AND METHODS: Three expert surgeons were enrolled. Surgeon one performed the procedure robotically and surgeons two and three performed open D3EM. Proficiency-based progression was recorded for eight content-valid outcomes. The superior mesenteric vein (SMV) and artery were cannulated by independent observers to evaluate vascular tears. The specimens were analyzed for lymph node harvest by a pathologist blinded to surgical access and to the surgeon. RESULTS: Operating times did not differ among surgeons (50.2, 32.4 and 43.7 min). SMV tears occurred in procedures A and B only. There was no significant progression in lymph node harvest for D2 (p=0.913) and D3EM (p=0.264). CONCLUSIONS: Cadaveric training in D3EM was associated with progression in avoidance of vascular tears with no significant changes in operating time and lymph node harvest.
Assuntos
Colectomia/educação , Colectomia/métodos , Neoplasias do Colo/cirurgia , Mesentério/cirurgia , Modelos Biológicos , Competência Clínica , Humanos , Linfonodos/cirurgia , Veias Mesentéricas/lesões , Estudos Prospectivos , Procedimentos Cirúrgicos Robóticos/educação , Procedimentos Cirúrgicos Robóticos/métodos , CirurgiõesRESUMO
Superior mesenteric arteriovenous fistulae (SMAVFs) are extremely rare with no consensus about therapeutic indications and optimal approach. Here, we present a case of a symptomatic SMAVF found in a young patient a few years after a penetrating abdominal injury. Following a complex clinical management of the acute status, we successfully managed the fistula with 3 covered stents in 2 consecutive endovascular procedures. Technical details of the performed procedures, including the main pitfalls and chosen solutions, have been explored and discussed.
Assuntos
Traumatismos Abdominais/cirurgia , Fístula Arteriovenosa/cirurgia , Procedimentos Endovasculares , Artéria Mesentérica Superior/cirurgia , Veias Mesentéricas/cirurgia , Lesões do Sistema Vascular/cirurgia , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/etiologia , Adulto , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/lesões , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/lesões , Flebografia , Stents , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologiaRESUMO
Mesenteric vessels, including the superior mesenteric artery (SMA) and vein (SMV), provide and drain the rich blood supply of the midgut and hindgut. SMA and SMV injuries are rare and often lethal. Clinical management of these injuries is not well established, but treatment options include operative, non-operative, and endovascular strategies. A narrative review of the literature was conducted using MEDLINE Complete-EBSCO. Relevant studies, specifically those focusing on diagnosis and management of SMA and SMV injuries, were selected. Only original reports and collected series were selected to prevent duplication of cases. A search of the literature for mesenteric arterial injuries yielded 87 studies. Vessel-specific breakdown of the studies yielded 40 with SMA injuries and 41 with SMV injuries. These searches were winnowed to 26 individual studies, which were included in this collective review. Limitations of this study are similar to all narrative literature reviews: the dependence on previously published research and availability of references as outlined in our methodology. Although historically rare, mesenteric vessel injuries are seen with increasing incidence and continue to present a challenge to trauma surgeons due to their daunting mortality rates. Currently, universal treatment guidelines do not exist, but the various options for their management have been extensively reviewed in the literature.
Assuntos
Artéria Mesentérica Superior/lesões , Veias Mesentéricas/lesões , Lesões do Sistema Vascular/cirurgia , Procedimentos Endovasculares , Humanos , Ligadura , Traumatologia/métodos , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/mortalidadeRESUMO
PURPOSE: To review the different vascular repair options of superior mesenteric vein (SMV) damage during oncologic right colectomy. METHODS: This is a retrospective chart review of 5 cases in which severe damage to the SMV occurred during oncological right colectomy in an academic medical center. RESULTS: During a 10-year study period, we encountered 5 cases in which severe damage to the SMV and its tributaries occurred. Two of the patients underwent primary venous repair for partial lacerations. The other 3 underwent interposition graft repair using a great saphenous vein (GSV) graft. Two of the grafts remained patent, while the third required replacement with a bovine pericardial patch. CONCLUSIONS: The SMV injury during oncologic right colectomy is a technically challenging injury. Based on our own experience and review of the literature, we formulated the following set of recommendations: (1) Venous ligation should be avoided, and revascularization should be attempted whenever feasible. (2) Primary venorrhaphy in cases of partial lacerations is the preferred treatment option. (3) End-to-end anastomosis is an efficient but seldom available repair option in the setting of complete SMV transection without segmental loss. (4) Autologous vein graft using the GSV is the preferred mode of repair during SMV injury with tissue loss. (5) Use of polytetrafluoroethylene (PTFE) graft should be avoided if possible due to greater risk of graft contamination. (6) A low threshold for reexploration depending on laboratory and imaging findings is advisable.
Assuntos
Implante de Prótese Vascular , Colectomia/efeitos adversos , Neoplasias do Colo/cirurgia , Laparoscopia/efeitos adversos , Veias Mesentéricas/cirurgia , Pericárdio/transplante , Veia Safena/transplante , Técnicas de Sutura , Lesões do Sistema Vascular/cirurgia , Idoso , Animais , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Bovinos , Colectomia/métodos , Neoplasias do Colo/patologia , Xenoenxertos , Humanos , Ligadura , Masculino , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/lesões , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Técnicas de Sutura/efeitos adversos , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologiaRESUMO
PURPOSE: The purpose of this review is to highlight the perils and pitfalls associated with high vascular ligation during right colectomies for adenocarcinoma and to identify the various mechanisms of injury to the superior mesenteric vein (SMV) and its tributaries. METHODS: This is a retrospective chart review of 304 right colectomies (159 open and 145 laparoscopic) performed over a period of 10 years (1 June 2006-31 May 2016) for right-sided colonic adenocarcinoma in an academic medical center. RESULTS: During a 10-year study period, we encountered five cases in which significant damage to the SMV and its tributaries occurred. This accounts for a total of 1.6 % of all right colectomies performed for colonic adenocarcinoma. CONCLUSIONS: Iatrogenic superior mesenteric vein injury is a rare, severe, and underreported complication of both open and laparoscopic right colectomy for colonic adenocarcinoma. We identified several mechanisms of injury such as anatomic misperception, excessive traction and pulling on the venous system, extensive tumor involvement of the mesentery, and uncontrolled suturing attempts at hemostasis. We believe that increased awareness of this complication with profound understanding of vascular anatomy and the different mechanisms of injury will allow surgeons to avoid this often devastating complication.
Assuntos
Doença Iatrogênica , Ligadura/efeitos adversos , Veias Mesentéricas/lesões , Humanos , Veias Mesentéricas/patologia , Estudos RetrospectivosAssuntos
Traumatismos Abdominais/complicações , Oclusão com Balão/métodos , Hemorragia/etiologia , Ferimentos não Penetrantes/complicações , Traumatismos Abdominais/cirurgia , Acidentes de Trabalho , Adulto , Aorta , Serviço Hospitalar de Emergência , Hemorragia/cirurgia , Hemostasia Cirúrgica , Humanos , Masculino , Veias Mesentéricas/lesões , Veias Mesentéricas/cirurgia , Veias/lesões , Veias/cirurgia , Ferimentos não Penetrantes/cirurgiaRESUMO
PURPOSE: The objective of this study is to determine which imaging features of blunt mesenteric injuries best predict the presence of a bowel injury requiring surgical correction. METHODS: The radiology archives at a Level 1 trauma center were searched over a 5-year period to identify patients with mesenteric injuries seen on admission 64 slice MDCT. Two emergency radiologists, blinded to clinical and surgical outcomes, retrospectively recorded mesenteric injury size, the presence/absence of active mesenteric bleeding, bowel wall thickening, adjacent interloop free fluid, extraluminal gas, mesenteric vessel termination, mesenteric vessel "beading", focal bowel wall defect, and bowel wall perfusion abnormality. Based on all of the imaging findings, the radiologists were asked to determine if they thought the patient had a surgical bowel injury. RESULTS: One hundred twenty-six patients with mesenteric injuries were identified. Eighteen patients underwent laparotomy confirming the presence of bowel injury in 15. The remaining patients were successfully managed non-operatively. There was no statistically significant difference in size of mesenteric injury for surgical vs. non-surgical bowel injuries. Active bleeding, adjacent interloop free fluid, and bowel wall perfusion defects were strong predictors of the presence of a surgically significant bowel injury (p < 0.001, 0.002, and 0.020, respectively). The overall accuracy, sensitivity, specificity, PPV, and NPV of 64-MDCT were 73.8%, 80%, 73.0%, 28.6%, and 96.4%, respectively. CONCLUSIONS: Mesenteric active bleeding, adjacent interloop free fluid and bowel wall perfusion defects are associated with surgically significant bowel injuries. The diagnosis of surgical bowel injuries remains challenging despite 64-slice MDCT technology.
Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Intestinos/lesões , Artérias Mesentéricas/lesões , Veias Mesentéricas/lesões , Tomografia Computadorizada Multidetectores , Ferimentos não Penetrantes/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Intestinos/cirurgia , Masculino , Artérias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/diagnóstico por imagem , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto JovemRESUMO
Acute conditions affecting the mesenteric vessels can cause abdominal pain and result in significant morbidity and mortality if not diagnosed and treated quickly. As bowel viability depends on patency of the mesenteric vessels, prompt diagnosis is essential. Helical multidetector computed tomography (MDCT) provides a rapid, widely available, non-invasive method to promptly evaluate the mesenteric arteries, veins, and abdominopelvic viscera. Given the value of MDCT in diagnosing vascular disease, it is important the radiologist understand technical and imaging findings of mesenteric vascular injury. Therefore, successful diagnosis hinges on familiarity with MDCT angiography and the extended capabilities of volume rendering and multiplanar reformation. In this review, we illustrate and describe key MDCT findings of congenital, inflammatory, traumatic, infectious, and thromboembolic conditions affecting the mesenteric vasculature in adult patients.
Assuntos
Artérias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Doenças Vasculares/diagnóstico por imagem , Doença Aguda , Aneurisma Infectado/diagnóstico por imagem , Humanos , Artérias Mesentéricas/lesões , Veias Mesentéricas/lesões , Mesentério/lesões , Tromboembolia/diagnóstico por imagem , Vasculite/diagnóstico por imagemRESUMO
Superior mesenteric arteriovenous fistula is a rare vascular disorder. Endovascular embolization has been widely used to treat this disease. Patients receiving successful fistula embolization generally have good prognoses. We present a man with iatrogenic superior mesenteric arteriovenous fistula who received endovascular embolization. Portal thrombus was detected on postoperative day 2, and the patient eventually died of multiple organ failure on postoperative day 13 despite having received antithrombotic and antiplatelet therapy. We identified portal thrombosis as a serious complication of transcatheter superior mesenteric arteriovenous fistula embolization.
Assuntos
Fístula Arteriovenosa/terapia , Embolização Terapêutica/efeitos adversos , Doença Iatrogênica , Artéria Mesentérica Superior , Veias Mesentéricas , Veia Porta , Trombose Venosa/etiologia , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/etiologia , Evolução Fatal , Fibrinolíticos/uso terapêutico , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/lesões , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/lesões , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Flebografia/métodos , Inibidores da Agregação Plaquetária/uso terapêutico , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Trombose Venosa/diagnóstico , Trombose Venosa/tratamento farmacológicoAssuntos
Neoplasias Colorretais/cirurgia , Quilo/metabolismo , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/mortalidade , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Humanos , Veias Mesentéricas/lesões , Veias Mesentéricas/patologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Taxa de SobrevidaRESUMO
Arteriovenous fistulae (AVF) of the superior mesenteric vasculature are rarely encountered. We present a case of an iatrogenic superior mesenteric AVF following subtotal colectomy, which was successfully treated with coil embolization. Cross-sectional imaging and angiographic findings are reviewed along with the options for endovascular therapy.
Assuntos
Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/terapia , Colectomia/efeitos adversos , Embolização Terapêutica , Procedimentos Endovasculares , Artéria Mesentérica Superior/lesões , Veias Mesentéricas/lesões , Angiografia Digital , Fístula Arteriovenosa/etiologia , Feminino , Humanos , Doença Iatrogênica , Imageamento por Ressonância Magnética , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/patologia , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/patologia , Pessoa de Meia-Idade , Flebografia/métodos , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Traumatismos Abdominais/etiologia , Acidentes de Trânsito , Fístula Arteriovenosa/etiologia , Ascite/etiologia , Artérias Mesentéricas/lesões , Veias Mesentéricas/lesões , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/terapia , Idoso de 80 Anos ou mais , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/terapia , Ascite/diagnóstico por imagem , Ascite/terapia , Oclusão com Balão , Embolização Terapêutica , Humanos , Masculino , Artérias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/diagnóstico por imagem , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
A 38-year-old man underwent ligation of the superior mesenteric vein due to traumatic disruption. He developed severe bowel edema with large fluid losses through the open abdominal incision. On postoperative day 9, a superior mesenteric vein bypass was performed with autogenous femoral vein, and this resulted in prompt resolution of the bowel edema and allowed abdominal wound closure. He was able to resume a normal diet and was discharged on postinjury day 39. A magnetic resonance imaging scan performed 1 year later showed a patent graft.