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Kwon HJ, Cha JG, Park J. Endovascular treatment of traumatic pseudoaneurysm of the ileal branch of the superior mesenteric artery in a 9-year-old girl: Case report and literature review. Medicine (Baltimore) 2024; 103:e37978. [PMID: 38669393 PMCID: PMC11049689 DOI: 10.1097/md.0000000000037978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
RATIONALE Visceral artery aneurysm is a rare and potentially fatal vascular condition that typically affects the superior mesenteric or inferior mesenteric arteries, the splenic, hepatic, and celiac arteries, as well as their branches. Visceral artery aneurysms can usually be treated using endovascular intervention, open surgery, or percutaneous thrombin injection. PATIENT CONCERNS A 9-year-old girl was admitted to our trauma center with abdominal and bilateral leg pain after a car accident involving a head-on collision. DIAGNOSIS Abdominal computed tomography (CT) showed bowel herniation through a muscle defect in the left lateral abdominal wall. There was a small amount of fluid around the liver and spleen, mild thickening of the small bowel wall, and infiltration in the small bowel mesentery, indicating the possibility of small bowel injury. INTERVENTIONS Emergent exploratory laparotomy was performed. After resection of the ischemic parts of the terminal ileum and sigmoid colon, intestinal continuity was reestablished. Primary repair was performed on a traumatic left lateral abdominal wall hernia. She recovered well postoperatively without any complications. A follow-up abdominal CT scan after 2 months showed a pseudoaneurysm of the ileal branch of the superior mesenteric artery. Despite the absence of any gastrointestinal symptoms, the pseudoaneurysm was treated by endovascular intervention using numerous coils because of the significant risk of delayed rupture or massive bleeding. OUTCOMES Follow-up abdominal CT scan after 6 months showed complete occlusion and resorption of the pseudoaneurysm. LESSONS Although it is technically challenging, endovascular coil embolization may be a feasible technique in children with traumatic visceral artery pseudoaneurysms without complications.
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Affiliation(s)
- Hyung Jun Kwon
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jung Guen Cha
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jinyoung Park
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
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Vincenzi P, Gaudenzi D, Mulazzani L, Rebonato A, Patriti A. Crohn's Disease and Jejunal Artery Aneurysms: A Report of the First Case and a Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1344. [PMID: 36295505 PMCID: PMC9611918 DOI: 10.3390/medicina58101344] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/01/2022] [Accepted: 09/21/2022] [Indexed: 12/01/2023]
Abstract
Background and Objectives: Jejunal artery (JA) and ileal artery (IA) aneurysms constitute less than 3% of all visceral artery aneurysms (VAAs), carrying a risk of rupture as high as 30%, and a mortality of 20%. Though many etiologies have been reported in the literature, no mention exists on a causal association between these aneurysms and inflammatory bowel diseases (IBD). We present the first case of a JA aneurysm related to Crohn's Disease (CD) together with a review of the literature. Materials and Methods: A 74-year-old male presenting with CD intestinal relapse and an incidental finding at the computed tomography enterography (CTE) of a 53 × 47 × 25mm apparently intact JA pseudoaneurysm, arising from the first and second jejunal branches, underwent coil embolization followed by small bowel resection, with an uneventful outcome. We also included the review of literature on JA and IA aneurysms, analyzing all reports published in PubMed and Scopus from 1943 to July 2022. Results: 60 manuscripts with 103 cases of JA and IA aneurysms in 100 patients were identified. Among cases with available data, 34 (33.0%) presented acutely with rupture, 45 (43.7%) were described as non-ruptured. 83 (80.6%), and 14 (13.6%) were JA and IA aneurysms, respectively, having a median size of 15 (range:3.5-52) mm. Atherosclerosis (16.5%), infections (10.7%), and vasculitides/connective tissue disorders (9.7%) represented the main causes mentioned. Mean age was 53.6 (±19.2) years, male patients being 59.4%. One third of patients (32.4%) were asymptomatic. Overall, treatment was indicated in 63% of patients, with surgery and endovascular procedures performed in 61.9% and 38.1% cases, respectively. The technical success rate of endovascular treatment (EVT) was 95.8%. The mortality rate was 11.8%, being higher (21.2%) in the rupture group. Conclusions: The prompt treatment accomplished in our case granted a successful outcome. JA and IA aneurysms should be included among local complications of IBD. Considering their high potential for rupture, regardless of size, a low threshold for endovascular or surgical treatment should be applied.
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Affiliation(s)
- Paolo Vincenzi
- Department of Surgery, Ospedali Riuniti Marche Nord, Piazzale Cinelli n 1, 61121 Pesaro, Italy
| | - Diletta Gaudenzi
- Department of Perioperative Services, AOU Ospedali Riuniti di Ancona, Via Conca n 71, 60126 Ancona, Italy
| | - Luca Mulazzani
- Department of Radiology, Division of Interventional Radiology, Ospedali Riuniti Marche Nord, Piazzale Cinelli n 1, 61121 Pesaro, Italy
| | - Alberto Rebonato
- Department of Radiology, Division of Interventional Radiology, Ospedali Riuniti Marche Nord, Piazzale Cinelli n 1, 61121 Pesaro, Italy
| | - Alberto Patriti
- Department of Surgery, Ospedali Riuniti Marche Nord, Piazzale Cinelli n 1, 61121 Pesaro, Italy
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Sartoris G, Seddon JA, Rabie H, Nel ED, Schaaf HS. Abdominal Tuberculosis in Children: Challenges, Uncertainty, and Confusion. J Pediatric Infect Dis Soc 2020; 9:218-227. [PMID: 31909804 DOI: 10.1093/jpids/piz093] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/06/2019] [Indexed: 02/06/2023]
Abstract
The diagnosis of abdominal tuberculosis (TB) is challenging, and the prevalence of abdominal TB in children is likely underestimated. It may present with nonspecific abdominal symptoms and signs, but children who present with pulmonary TB may have additional abdominal subclinical involvement. Diagnosis is specifically challenging because none of the available diagnostic tools provide adequate sensitivity and specificity. In this review, we summarize the best available evidence on abdominal TB in children, covering the epidemiology, pathogenesis, clinical presentation, diagnosis, and treatment. We propose a diagnostic approach that could be followed for symptomatic children. We believe that a combination of investigations could be useful to both aid diagnosis and define the extent of the disease, and we propose that abdominal ultrasound should be used more frequently in children with possible TB and any abdominal symptoms. This neglected disease has received little attention to date, and further research is warranted.
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Affiliation(s)
- Giulia Sartoris
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.,Department of Pediatric Sciences, Giannina Gaslini Institute, University of Genoa, Italy
| | - James A Seddon
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.,Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Helena Rabie
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Etienne D Nel
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - H Simon Schaaf
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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Santos ACEZ, Sztajnbok J, Duarte-Neto AN, Sousa AFT, Lopes AGD, Barrientos ACM. Severe gastrintestinal bleeding as an unusual presentation of pediatric tuberculosis: a situation for injectable antituberculous drugs use? Rev Inst Med Trop Sao Paulo 2020; 62:e78. [PMID: 33146307 PMCID: PMC7608070 DOI: 10.1590/s1678-9946202062078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/30/2020] [Indexed: 11/22/2022] Open
Abstract
Disseminated tuberculosis is a severe disease with high-mortality that requires early diagnosis and treatment. Intestinal tuberculosis accounts for only 2% of tuberculosis cases worldwide and is extremely rare in children. We report a case of a 4-year-old girl admitted due to disseminated tuberculosis with extensive intestinal involvement characterized by massive intestinal bleeding and hemorrhagic shock. The severity of the intestinal involvement precluded the exclusive use of oral anti-tuberculosis drugs and the patient was successfully treated with a combination of injectable and oral anti-tuberculosis agents. We discuss the importance of a regimen with injectable drugs for treating severe forms of tuberculosis in which the intestinal involvement impaired the use of oral drugs.
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Abstract
Gastrointestinal tuberculosis (TB) is a fascinating disease which can be observed both in the clinical context of active pulmonary disease and as a primary infection with no pulmonary involvement. It represents a significant clinical challenge because of the resurgence of TB as well as the diagnostic challenges it poses. A high clinical suspicion remains the most powerful tool in an era of medicine when reliance on diagnostic technology increases. Antimicrobial therapy is the mainstay of therapy, but surgical and endoscopic interventions are frequently required for intestinal TB. Gastrointestinal TB is truly the "great mimic" and continues to require the astute clinical acumen of skillful clinicians to diagnose and treat.
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de Troia A, Mottini F, Biasi L, Azzarone M, Tecchio T, Salcuni P. Superior Mesenteric Artery Aneurysm Caused by Aortic Valve Endocarditis. Vasc Endovascular Surg 2016; 50:88-93. [DOI: 10.1177/1538574415627867] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Infectious aneurysms of the superior mesenteric artery are a rare but life-threatening condition due to the risk of visceral ischemia, sepsis, or hemorrhage. In this study, we report the case of a superior mesenteric artery aneurysm (SMAA) secondary to a bioprosthetic valve endocarditis, successfully managed with aneurysm resection and saphenous vein interposition graft. We performed an extensive PubMed-based rewiew of the literature of the last 10 years on SMAA, which include the detection of 38 articles quoting 41 SMAAs. The case histories were divided in 2 groups: 18 cases belonged to nonmycotic group A and 23 cases were included in mycotic group B. In group A, 44.4% of patients were treated surgically, whereas in group B, 90.5%. The 2 study groups significantly differed ( P = .01) in terms of surgical treatment. The surgical approach still remains the first choice of treatment in mycotic aneurysm.
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Affiliation(s)
- Alessandro de Troia
- Unit of Vascular Surgery, Department of Surgical Sciences University Hospital of Parma, Italy
| | - Francesca Mottini
- Unit of Vascular Surgery, Department of Surgical Sciences University Hospital of Parma, Italy
| | - Lukla Biasi
- Unit of Vascular Surgery, Department of Surgical Sciences University Hospital of Parma, Italy
| | - Matteo Azzarone
- Unit of Vascular Surgery, Department of Surgical Sciences University Hospital of Parma, Italy
| | - Tiziano Tecchio
- Unit of Vascular Surgery, Department of Surgical Sciences University Hospital of Parma, Italy
| | - PierFranco Salcuni
- Unit of Vascular Surgery, Department of Surgical Sciences University Hospital of Parma, Italy
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Delisle M, Seguin J, Zeilinski D, Moore DL. Paediatric abdominal tuberculosis in developed countries: case series and literature review. Arch Dis Child 2016; 101:253-8. [PMID: 26699532 DOI: 10.1136/archdischild-2015-308720] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 11/27/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To provide an insight into the presentation, diagnosis and management of paediatric abdominal tuberculosis (TB) in developed countries. METHODS The records of all children at the Montreal Children's Hospital (MCH) admitted with abdominal TB between 1990 and 2014 were reviewed. An automated and manual literature search from 1946 to 2014 was performed. RESULTS (1) CASE SERIES: six cases were identified at the MCH. All were male between 5 and 17 years of age. All were from populations known to have high rates of TB (aboriginal, immigrant). Three underwent major surgical interventions and three underwent ultrasound (US) or CT aspiration or biopsy for diagnosis. (2) LITERATURE REVIEW: 29 male (64%) and 16 female subjects (36%) aged between 14 months and 18 years were identified, including the MCH patients. All patients except one were from populations with a high incidence of TB. Most presented with a positive tuberculin skin test (90%), abdominal pain (76%), fever (71%) and weight loss (68%). On imaging, 22 (49%) were classified with gastrointestinal TB with colonic wall irregularity (41%) and 19 (42%) with peritoneal TB with ascites (68%). A positive culture was obtained in 33 (73%) patients. Three cases used CT- or US-guided aspiration or biopsy to obtain tissue samples. A surgical intervention was performed in 34 (76%) children; 13 (38%) of these were for diagnosis. CONCLUSIONS Diagnosis based on clinical features (abdominal pain, fever and weight loss) and CT- or US-guided aspiration or biopsy may encourage physicians to adopt a more conservative approach to abdominal TB.
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Affiliation(s)
| | - Jade Seguin
- Department of Emergency Medicine, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - David Zeilinski
- Division of Respiratory Medicine, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Dorothy L Moore
- Division of Infectious Diseases, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
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