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Sato R, Matsumoto K, Otsuka M. A Duodenal Ulcer and Biliopancreatic Lesions: What Is the Culprit? Gastroenterology 2024:S0016-5085(24)05003-0. [PMID: 38821246 DOI: 10.1053/j.gastro.2024.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 05/12/2024] [Accepted: 05/14/2024] [Indexed: 06/02/2024]
Affiliation(s)
- Ryosuke Sato
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| | - Kazuyuki Matsumoto
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan.
| | - Motoyuki Otsuka
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
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Zhang H, Liu S, Dong B, Liu J, Guo X, Chen G, Jiang Y, Wu Y, Zhang J, Wang X. The Atlas of the Inferior Mesenteric Artery and Vein under Maximum-Intensity Projection and Three-Dimensional Reconstruction View. J Clin Med 2024; 13:879. [PMID: 38337571 PMCID: PMC10856009 DOI: 10.3390/jcm13030879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/12/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: Understanding vascular patterns is crucial for minimizing bleeding and operating time in colorectal surgeries. This study aimed to develop an anatomical atlas of the inferior mesenteric artery (IMA) and vein (IMV). (2) Methods: A total of 521 patients with left-sided colorectal cancer were included. IMA and IMV patterns were identified using maximum-intensity projection (MIP) and three-dimensional (3D) reconstruction techniques. The accuracy of these techniques was assessed by comparing them with surgical videos. We compared the amount of bleeding and operating time for IMA ligation across different IMA types. (3) Results: Most patients (45.7%) were classified as type I IMA, followed by type II (20.7%), type III (22.6%), and type IV (3.5%). Newly identified type V and type VI patterns were found in 6.5% and 1% of patients, respectively. Of the IMVs, 49.9% drained into the superior mesenteric vein (SMV), 38.4% drained into the splenic vein (SPV), 9.4% drained into the SMV-SPV junction, and only 2.3% drained into the first jejunal vein (J1V). Above the root of the left colic artery (LCA), 13.1% of IMVs had no branches, 50.1% had one, 30.1% had two, and 6.7% had three or more branches. Two patients had two main IMV branches, and ten had IMVs at the edge of the mesocolon with small branches. At the IMA root, 37.2% of LCAs overlapped with the IMV, with 34.0% being lateral, 16.9% distal, 8.7% medial, and both the marginal type of IMV and the persistent descending mesocolon (PDM) type represented 1.4%. MIP had an accuracy of 98.43%, and 3D reconstruction had an accuracy of 100%. Blood loss and operating time were significantly higher in the complex group compared to the simple group for IMA ligation (p < 0.001). (4) Conclusions: A comprehensive anatomical atlas of the IMA and IMV was provided. Complex IMA patterns were associated with increased bleeding and operating time.
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Affiliation(s)
- Hongwei Zhang
- Department of Gastrointestinal Surgery, Peking University First Hospital, Beijing 100034, China
| | - Shurong Liu
- Department of Gastrointestinal Surgery, Peking University First Hospital, Beijing 100034, China
| | - Bingqi Dong
- Department of Gastrointestinal Surgery, Peking University First Hospital, Beijing 100034, China
| | - Jing Liu
- Department of Radiology, Peking University First Hospital, Beijing 100034, China
| | - Xiaochao Guo
- Department of Radiology, Peking University First Hospital, Beijing 100034, China
| | - Guowei Chen
- Department of Gastrointestinal Surgery, Peking University First Hospital, Beijing 100034, China
| | - Yong Jiang
- Department of Gastrointestinal Surgery, Peking University First Hospital, Beijing 100034, China
| | - Yingchao Wu
- Department of Gastrointestinal Surgery, Peking University First Hospital, Beijing 100034, China
| | - Junling Zhang
- Department of Gastrointestinal Surgery, Peking University First Hospital, Beijing 100034, China
| | - Xin Wang
- Department of Gastrointestinal Surgery, Peking University First Hospital, Beijing 100034, China
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Ishimaru N, Tagami T, Takayasu K. Venous Congestive Ischemic Colitis After Sigmoid Colectomy: A Case Report. Cureus 2024; 16:e53880. [PMID: 38465067 PMCID: PMC10924825 DOI: 10.7759/cureus.53880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/12/2024] Open
Abstract
Venous congestion is a possible cause of ischemic colitis following colorectal surgery. As such, congestive ischemic colitis should be considered in such cases where the mesenteric artery is preserved. Herein, we describe the case of a 73-year-old man who presented to the hospital with a two-week history of difficult defecation and frequent mucous stools and was subsequently diagnosed with refractory ischemic enterocolitis due to venous congestion. The patient had undergone resection of the sigmoid colon cancer with preservation of the inferior mesenteric artery 11 months before presentation. Contrast-enhanced abdominal computed tomography revealed edematous wall thickening on the anal side of the anastomosis. A colonoscopy revealed a normal mucosa extending from the anastomosis to the descending colon; however, mucosal swelling, erythema, and erosion were observed on the rectal side of the anastomosis. Based on these findings, he was diagnosed with ischemic colitis. After two months of ineffective conservative treatment, the patient underwent surgery. Ischemic colitis was diagnosed as venous congestion based on the histopathological examination. Preservation of the mesenteric artery may result in ischemic colitis due to an imbalance between the arterial and venous blood flow. Chronic ischemic colitis due to venous congestion should be considered in cases of mesenteric artery preservation to reduce anastomotic leakage.
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Affiliation(s)
- Naoki Ishimaru
- Department of Surgery and Emergency Medicine, Suwa Central Hospital, Nagano, JPN
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kawasaki, JPN
| | - Kohei Takayasu
- Department of Surgery, Suwa Central Hospital, Nagano, JPN
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Lee GW, Park SB. Congestive ischemic colitis successfully treated with anti-inflammatory therapy: A case report. World J Clin Cases 2024; 12:142-147. [PMID: 38292639 PMCID: PMC10824190 DOI: 10.12998/wjcc.v12.i1.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/03/2023] [Accepted: 12/14/2023] [Indexed: 01/02/2024] Open
Abstract
BACKGROUND Congestive ischemic colitis is a rare subtype of ischemic colitis with an unknown pathophysiology. Excluding conservative management, such as fasting, no established treatment exists; therefore, surgical intervention should be considered in some cases if symptoms worsen. Current literature suggests that anti-inflammatory agents may effectively treat congestive ischemic colitis. CASE SUMMARY We present the case of a 68-year-old female patient who underwent laparoscopic left hemicolectomy for transverse colon cancer 3 years ago. Postoperatively, follow-up included an annual colonoscopy and abdominal computed tomography (CT) at a local clinic. However, progressive erythema and edema of the sigmoid colon were observed 1 year postoperatively. Upon admission to our hospital, she complained of abdominal pain and diarrhea. Abdominal CT showed thickening of the sigmoid colon walls, and colonoscopy revealed erythema, edema, and multiple ulcers with exudate in the sigmoid colon. CT angiography showed engorgement of the sigmoid vasa recta without any vascular abnormalities. The diagnosis was congestive ischemic colitis, and we treated the patient with anti-inflammatory agents. After 2 mo of glucocorticoid therapy (20 mg once daily) and 7 mo of 5-aminosalicylate therapy (1 g twice daily), the ulcers completely healed. She has not experienced any recurrence for 2 years. CONCLUSION Anti-inflammatory therapy, specifically glucocorticoids and 5-aminosalicylate, has demonstrated promising efficacy and introduces potential novel treatment options for congestive ischemic colitis.
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Affiliation(s)
- Geon Woo Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
| | - Su Bum Park
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
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Sato R, Horiguchi S, Otsuka M. A Rare Case of Severe Colitis Associated With a Pancreatic Neuroendocrine Tumor. Gastroenterology 2024; 166:e13-e16. [PMID: 37495180 DOI: 10.1053/j.gastro.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Ryosuke Sato
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| | - Shigeru Horiguchi
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan.
| | - Motoyuki Otsuka
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
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Inban P, Carredo CKC, Arslan F, Odoma VA, Okobia I, Adegbite A, Sharma S, Kc S, Zahdeh T, Rentiya ZS. Small Bowel Lymphoma Complicated With Ischemic Colitis: A Case Report. Cureus 2023; 15:e41792. [PMID: 37575763 PMCID: PMC10421726 DOI: 10.7759/cureus.41792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Ischemic colitis is thought to be an injury to the colon as a result of reduced blood flow. Certain infectious diseases such as the Epstein-Barr virus can aid in the reduction of blood flow. The insult can range from inflammation and superficial injury to full-thickness necrosis. The typical regions affected are the "watershed" areas of the colon: the splenic flexure, the rectosigmoid junction, and the right colon. Because patients can present with a wide spectrum of symptoms from vague abdominal discomfort to complete abdominal catastrophe, the diagnosis of ischemic colitis is sometimes challenging to make. Patients typically present with the acute onset of crampy abdominal pain and usually pass blood mixed with stool within 24 hours. Endoscopically, ischemia is suspected in the presence of bluish hemorrhagic nodules from submucosal bleeding, cyanotic or necrotic mucosa with bleeding ulcerations, or a segmental distribution with an abrupt transition point between injured and normal mucosa. We present a case of an 80-year-old male with a history of hypertension, hyperlipidemia, and basal cell carcinoma of the scalp diagnosed with ischemic colitis associated with positive Epstein-Barr virus B cell lymphoma.
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Affiliation(s)
- Pugazhendi Inban
- Department of General Medicine, Government Medical College, Omandurar, Chennai, IND
| | | | - Faiza Arslan
- Department of Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Victor A Odoma
- Department of Cardiology/Oncology, Indiana Iniversity (IU) Health, Bloomington, USA
| | - Isioma Okobia
- Department of Surgery, University of Benin Medical School, Benin City, NGA
| | | | - Shristi Sharma
- Department of Internal Medicine, University of Dhaka, Dhaka, BGD
| | - Sandip Kc
- Department of Internal Medicine, University of Dhaka, Dhaka, BGD
| | - Tamer Zahdeh
- Department of Internal Medicine, Hadassah Medical Center, Jerusalem, ISR
| | - Zubir S Rentiya
- Department of Surgery, MedStar Georgetown University Hospital, Washington, USA
- Department of Radiation Oncology & Radiology, University of Virginia School of Medicine, Charlottesville, USA
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Inferior mesenteric vein preserving lymphadenectomy in high left segmental colectomy for splenic flexure melanoma: A case report. Int J Surg Case Rep 2023; 104:107956. [PMID: 36878180 PMCID: PMC10009196 DOI: 10.1016/j.ijscr.2023.107956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Surgical resection is the mainstay for management of splenic flexure cancers, with the aim of achieving adequate lymphadenectomy. Left-sided bowel resections often require ligation of the inferior mesenteric vein (IMV) for mesocolic dissection or lymphadenectomy which can result in congestive colitis on the anal side of the anastomosis secondary to poor venous outflow. Preserving the IMV may mitigate this risk but is technically difficult and can compromise oncological resection. This case report is a rare example of high left segmental resection of the splenic flexure with preservation of the IMV in a patient with splenic flexure melanoma. CASE PRESENTATION A non-obstructing lesion was discovered in a 73-year-old male who underwent colonoscopy following a positive faecal occult blood test. Biopsy of the lesion confirmed a melanoma. This patient had a history of cutaneous melanoma which was excised 20 years prior. A laparoscopic high left segmental colectomy was performed, and metastatic melanoma was identified in 3 of 12 regional lymph nodes. The patient recovered with no complications. CLINICAL DISCUSSION This patient underwent high left segmental colectomy to achieve oncological clearance while resecting minimal bowel and preserving bowel function. The IMV was spared in this surgery to prevent venous congestion. Reports of colitis following left sided colectomy have been described, whereby colitis is thought to result from a mismatch in arterial perfusion and venous drainage following IMV resection. CONCLUSION This case highlights the potential role of preservation of the inferior mesenteric vein in a rare case of splenic flexure melanoma.
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Aslam A, Dutton P, Yeh ZYT. Congestive ischaemic colitis after laparoscopic anterior resection. ANZ J Surg 2023; 93:770-772. [PMID: 36121106 DOI: 10.1111/ans.18013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Anoosha Aslam
- Department of Surgery, Blacktown Hospital, Sydney, New South Wales, Australia
| | - Peter Dutton
- Department of Surgery, Blacktown Hospital, Sydney, New South Wales, Australia
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Suh JW, Park J, Lee J, Yang IJ, Ahn HM, Oh HK, Kim DW, Kang SB. Clinical impact of inferior mesenteric vein preservation during left hemicolectomy with low ligation of the inferior mesenteric artery for distal transverse and descending colon cancers: A comparative study based on computed tomography. Front Oncol 2022; 12:986516. [PMID: 36081545 PMCID: PMC9445569 DOI: 10.3389/fonc.2022.986516] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Presence of a long remnant sigmoid colon after left hemicolectomy with inferior mesenteric vein (IMV) ligation for distal transverse and descending colon cancers may be a risk factor for venous ischemia. This study aimed to evaluate the clinical impact of IMV preservation in patients who underwent left hemicolectomy with inferior mesenteric artery (IMA) preservation. Methods We included 155 patients who underwent left hemicolectomy with IMA preservation for distal transverse and descending colon cancers from 2003 to 2020. Technical success of IMV preservation was determined by assessing pre- and post-operative patency of the IMV on computed tomography (CT) by an abdominal radiologist. Intestinal complications comprising ulceration, stricture, venous engorgement, and colitis in remnant colon were compared between the IMV preservation and ligation groups. Results IMV was preserved in 22 (14.2%) and ligated in 133 (85.8%) patients. Surgical time, postoperative recovery outcomes, and number of harvested lymph nodes were similar in both groups. The technical success of IMV preservation was 81.8%. Intestinal complications were less common in the preservation group than in the IMV ligation group (4.5% vs. 23.3%, P=0.048). The complications in the IMV ligation group were anastomotic ulcer (n=2), anastomotic stricture (n=4), venous engorgement of the remnant distal colon (n=4), and colitis in the distal colon (n=21). Conclusions IMV preservation may be beneficial after left hemicolectomy with IMA preservation for distal transverse and descending colon cancers. We suggest that IMV preservation might be considered when long remnant sigmoid colon is expected during left hemicolectomy with low ligation of IMA.
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Affiliation(s)
- Jung Wook Suh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jihoon Park
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeehye Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - In Jun Yang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hong-Min Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- *Correspondence: Sung-Bum Kang,
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