An update of available innovative staple line reinforcement materials in colorectal surgery.

Despite refinements in the field of gastrointestinal surgical stapling, anastomotic leakage and bleeding still remain a serious problem associated with substantial morbidity and mortality. To prevent or reduce these complications, a diversity of staple line reinforcement techniques have been developed. The available literature from 1977 through 2007 was reviewed to find relevant data about innovative colorectal staple line reinforcement techniques. Many different forms of staple line reinforcement are available. Reinforcement methods can be material applied exogenously to the staple line or incorporated into the staple line. Reinforcement materials can be nonabsorbable, semi-absorbable, or fully absorbable. Gastrointestinal staple line reinforcement is well known, but it is a relatively new method for colorectal surgery. Staple line reinforcement is an effective technique in reducing complications in stapled anastomoses only if proper buttressing material is used. Absorbable material seems to have several advantages over non- or semi-absorbable staple line reinforcement. New and promising techniques are fibrin glue, C-seal, and biosynthesized absorbable cellulose used as staple line reinforcement material. Unfortunately, there is not much experience reported with these new materials, thus further investigation is needed.

Superior mesenteric arterial branch occlusion causing partial jejunal ischemia: a case report.

INTRODUCTION: Ischemic bowel disease comprises both mesenteric ischemia and colonic ischemia. Mesenteric ischemia can be divided into acute and chronic ischemia. These are two separate entities, each with their specific clinical presentation and diagnostic and therapeutic modalities. However, diagnosis may be difficult due to the vague symptomatology and subtle signs. CASE PRESENTATION: We report the case of a 68-year-old Caucasian woman who presented with abdominal discomfort, anorexia, melena and fever. A physical examination revealed left lower quadrant tenderness and an irregular pulse. Computed tomography of her abdomen as well as computed tomography enterography, enteroscopy, angiography and small bowel enteroclysis demonstrated an ischemic jejunal segment caused by occlusion of a branch of the superior mesenteric artery. The ischemic segment was resected and an end-to-end anastomosis was performed. The diagnosis of segmental small bowel ischemia was confirmed by histopathological study. CONCLUSION: Mesenteric ischemia is a pathology well-known by surgeons, gastroenterologists and radiologists. Acute and chronic mesenteric ischemia are two separate entities with their own specific clinical presentation, radiological signs and therapeutic modalities. We present the case of a patient with symptoms and signs of chronic mesenteric ischemia despite an acute etiology. To the best of our knowledge, this is the first report presenting a case of acute mesenteric ischemia with segmental superior mesenteric artery occlusion.