Inferior mesenteric artery laceration associated with blunt abdominal trauma with Casper's sign in a physically abused child: An autopsy case and literature review.

There have been few studies of the death of children secondary to child abuse-related abdominal compression, and the detailed pathophysiology of such deaths is therefore unknown. The autopsy findings of a 3-year-old boy who died of hemorrhagic shock due to non-accidental severe blunt abdominal trauma were compared to those of children who died of other non-accidental abdominal injuries. Old and acute subcutaneous hemorrhages, abrasions, and scars were present all over the subject's body. No superficial injuries were found on the ventral midline, but a minor hemorrhage was found in the subcutaneous fat tissue, as well as in the rectus abdominis muscle. The intraperitoneal space contained 450 mL of blood, including coagulated blood. There was a tear in the transverse mesocolon and a crush injury in the small bowel mesentery. The inferior mesenteric artery was transected 0.5 cm from the aortic root. The transverse colon was necrotic, with hemorrhages in the mucosa. Since various organs were ischemic, the cause of death was determined to be blood loss from the inferior mesenteric artery injuries. Blunt abdominal trauma in children usually causes organ damage and intestinal injury, but because it is caused on the posterior surface of the mesentery, vascular injury should also be considered, and an autopsy should be performed. In the case of child abuse-related deaths, damage to the skin surface may not always be present; therefore, imaging tests, histopathological examinations, and biochemical tests should be performed with a focus on the gross anatomy to determine the cause of death and pathology.

A Rare Case of Isolated Idiopathic Inferior Mesenteric Artery Dissection.

BACKGROUND Isolated dissection of a mesenteric artery is very rare and usually presents with acute gastrointestinal symptoms. There have been previously published reports on the isolated dissection of the superior mesenteric artery. However, isolated dissection of the inferior mesenteric artery is rare. CASE REPORT A 43-year-old man presented with sudden onset of lower abdominal pain. Abdominal computed tomography (CT) imaging confirmed isolated dissection of the inferior mesenteric artery. To prevent exacerbation of the dissection, his systolic blood pressure was controlled to <140 mmHg, and his progress was observed for ten days while in hospital during which time the dissection stabilized. There was no extension of the dissection. After three years, the dissection had healed and did not recur. CONCLUSIONS To our knowledge, this is the first case report of isolated dissection of the inferior mesenteric artery that resolved spontaneously. This case shows the importance of blood pressure control in the management of arterial dissection.

Superselective microcoil embolization of the vasa recta of sigmoid artery for hemorrhaging after laparoscopic adnexectomy for corpus luteum hematoma with severe adhesion.

A 44-year-old multipara woman was referred because of the sudden onset of left lower abdominal pain. Corpus luteum hematoma was suspected and conservatively managed. Two days later, due to worsening of abdominal symptoms, emergency laparoscopic surgery was performed. Severe pelvic adhesion around the left ovary forming corpus luteum hematoma was identified. After adhesiolysis, which was complicated by massive bleeding, left adnexectomy was performed. Hemostasis was achieved by the coagulation of bleeding vessels, followed by spraying fibrin glue with the placement of oxidized cellulose cotton for bleeding oozing from dissected surface. Two hours after surgery, emergency computed tomography performed due to the development of hemodynamic instability demonstrated extravasation from the versa recta of the sigmoid artery. After the confirmation of hemorrhaging, superselective catheterization to the bleeding vessel followed by embolization by platinum microcoils were performed. Hemodynamic stability was immediately achieved, and the postoperative course was uneventful without manifestation of bowel ischemia.

Estudio anatómico de la arteria mesentérica inferior en el hombre / Anatomic study of the inferior mesenteric artery in man

En el presente trabajo se estudió la morfología de la arteria mesentérica inferior y sus ramas, así como su forma de distribución, grosor y cantidad de divisiones y arcadas en el hombre. Para ello se utilizó una muestra de 15 preparaciones anatómicas, obtenidas por el método de macro y macromicrodisección, se realizaron mediciones de los distintos elementos, y se procesaron luego estos datos estadísticos. El sistema de la arteria mesentérica inferior posee un esquema general que va de formas más simples a más complejas según el nivel de desarrollo. Tiene un vaso visceral impar que termina en el borde mesocólico del intestino grueso mediante vasos rectos. Las ramas terminales y las arcadas simples constituyen los elementos que hacen más complejo el árbol vascular intestinal de los mamíferos, pero que alcanzan su desarrollo más elevado en su representante superior: el hombre. Las ramas secundarias en los sitios de emergencia o dicotomización presentan grosores semejantes, así como los vasos rectos que penetran en la pared intestinal, lo que garantiza de esta forma una irrigación uniforme en el órgano(AU)

Preservation of the pelvic circulation during infrarenal aortic surgery.

Paraplegia, ischemia of the colon, and gluteal necrosis are uncommon but devastating sequelae of surgery of the infrarenal aorta. These complications are ischemic in nature, secondary to the following technical maneuvers, individually or in combination: bilateral occlusion of the hypogastric arteries; division of a patent inferior mesenteric artery; or proximal end-to-end aortic to common femoral artery bypass grafting accompanied by stenosis of the external iliac arteries. The etiology of paraplegia after infrarenal aortic surgery is of particular interest since it now appears that it is more likely due to interruption of flow to lumbosacral branches of the hypogastric arteries supplying the conus of the spinal cord and/or to division of a low-lying 'conus medullaris artery' rather than to occlusion of the higher-lying great radicularis artery of Adamkiewicz. Knowledge of the pelvic circulation to the colon, buttocks, and terminal spinal cord allows the surgeon prophylactically to avoid or reconstruct critical branches during operations on the infrarenal aorta. While rare, severe complications cannot be completely eliminated; hopefully their incidence can be reduced by an understanding of their etiology.