Treatment of colonic varices with a superior mesenteric venous stent: a case report describing a unique approach.
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SUBMITTER: Naffouj S
PROVIDER: S-EPMC8677559 | biostudies-literature | 2021 Dec
REPOSITORIES: biostudies-literature
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Treatment of colonic varices with a superior mesenteric venous stent: a case report describing a unique approach.
Naffouj Sandra S Al-Shammari Mustafa M Salgia Reena R
Gastroenterology report 20210204 6
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Project description:Introduction Mesenteric venous thrombosis is due to blood clot in veins that drain blood from the intestine. It may lead to mesenteric ischemia. Protein S deficiency is one of the causes of superior mesenteric vein thrombosis. Case presentation A 47 years old male patient presented with pain in the abdomen. Contrast CECT shows filling defect in the superior mesenteric venous thrombosis. Coagulometer showed lower protein S activity than that of normal. Clinical discussion Proper diagnosis is needed for early detection so that proper intervention can be made on time. Anticoagulation and vitamin K antagonists are given. Conclusions Though rare, protein S deficiency should be considered a possible cause of mesenteric venous thrombosis. Highlights • Mesenteric venous thrombosis is one of the causes of mesenteric ischemia which occurs as a result of local blood coagulation impairing the venous return of bowel.• Protein C and S are vitamin K dependent glycoprotein deficiency of these proteins leads to thrombosis.• CECT is the diagnostic modality for the proper diagnosis which should be done as early, so that proper intervention and treatment can be done in time.• aPTT and PT/INR should monitored in time, to identify the risk factors so that lifetime medication can be started early.
| S-EPMC9142700 | biostudies-literature
Project description:SARS-CoV-2, an etiological agent of COVID-19, has been reported to inflict remarkably diverse manifestations in different subjects across the globe. Though patients with COVID-19 predominantly have fever, respiratory and constitutional symptoms, atypical presentations are becoming increasingly evident. COVID-19 may predispose to both venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilization, and diffuse intravascular coagulation in moderate to severe symptomatic cases. In this case report, we are reporting thromboembolic complications of COVID-19 in a mild symptomatic subject incidentally diagnosed with mesenteric venous occlusion with no abdominal symptoms. Early recognition of the abdominal symptoms, diagnosis, initiation of anticoagulants, and timely surgical intervention may improvise the outcome in a patient with COVID-19 infection-induced mesenteric thrombosis. Superior mesenteric artery and venous thrombosis may lead to subsequent ischemia necessitating emergency laparotomy. Thus, the usage of low-dose anticoagulants in all the patients of COVID-19 irrespective of the categorization into mild, moderate, and severe COVID-19 disease should be considered.
| S-EPMC9363859 | biostudies-literature
Project description: Not available
| S-EPMC10837253 | biostudies-literature
Project description:Acute Mesenteric Ischemia (AMI) is a rare life-threatening entity caused by sudden interruption of the blood supply to a segment of the bowel due to impairment of mesenteric arterial blood flow or venous drainage. Clinical presentation varies according to the time course of vascular occlusion. Contrast-enhanced Computed Tomography (CT) of the abdomen represents the main diagnostic test for AMI diagnosis, enabling fast and excellent evaluation of the intestine, mesenteric vasculature, and other ancillary characteristics of AMI. Typical CT findings of AMI include paralytic ileus, decreased or absent bowel wall contrast-enhancement, pneumatosis intestinalis, and porto-mesenteric venous gas. We hereby report a case of an 89-year-old man presenting with AMI due to Superior Mesenteric Artery (SMA) thrombotic occlusion following endovascular stenting superficial femoral arteries. Typical findings were observed on abdominal CT imaging, yet associated with the presence of gas exclusively in the SMA district, without any involvement of the porto-mesenteric venous system. Different imaging features and pitfalls can help radiologists to accurately diagnose AMI, especially when irreversible bowel damage is about to occur. Therefore, radiologists and emergency physicians should be aware of the unusual association between gas in the SMA arterial district and AMI, even in the absence of porto-mesenteric venous system involvement, in order to urge prompt surgical consultation when observed.
| S-EPMC9130093 | biostudies-literature
Project description:In patients with chronic mesenteric ischemia, options for revascularization include endovascular angioplasty, stenting and open surgery, with the latter typically favored in patients who have failed or who are not candidates for endovascular intervention. Here we describe a retroperitoneal approach for open surgical revascularization in patients with a hostile abdomen. We present a case series of five patients from our institution. The median age was 72 years, the mean operative time was 143.6 minutes and 90-day mortality rate was 0. This case series demonstrates the technical feasibility, success, and safety of this approach in patients with anatomic factors that would render a traditional open surgical approach for revascularization technically difficult.
| S-EPMC11294714 | biostudies-literature
Project description:Superior mesenteric artery (SMA) pseudoaneurysms are rare but fatal. Surgical repair is an ideal treatment; however, it is inappropriate in patients with SMA pseudoaneurysm due to advanced cancer, and endovascular therapy is an alternative treatment for nonsurgical candidates. Here, we report a case of SMA pseudoaneurysm in a patient with advanced pancreatic cancer, which was successfully treated with the placement of a biliary covered stent.
| S-EPMC6206321 | biostudies-literature
Project description:The etiology of large artery aneurysms has long been established as secondary to atherosclerotic disease and degenerative changes in the vessel walls. Less common, are aneurysms of the visceral arteries; the splanchnic and renal arteries. Rarer yet, are inferior mesenteric artery aneurysms, accounting for approximately 1% of visceral artery aneurysms. While causes range from inflammatory to congenital disease, a proposed etiology of proximal, solitary inferior mesenteric artery aneurysms, is correlated to the "jet disorder phenomenon," first described in a 1990 case report by Sugrue, and Hederman. This paradigm states that aneurysm formation may occur secondary to celiac and superior mesenteric artery occlusion, causing increased, and turbulent arterial flow distally. We present a case that demonstrates a small inferior mesenteric artery aneurysm without findings of celiac or superior mesenteric artery stenosis or occlusion. This patient did, however, have a large thrombosed common hepatic artery aneurysm which may serve as an alternate cause of jet disorder phenomenon. The findings in this case offers support for focused screening of proximal arterial vasculature when an inferior mesenteric artery aneurysm is encountered.
| S-EPMC9018125 | biostudies-literature
Project description:BackgroundMesenteric ischaemia is often a manifestation of severe vascular disease involving the superior mesenteric artery (SMA). Endovascular revascularization is challenging in a chronic total occlusion (CTO) of SMA.Case presentationA-73-year-old male patient was referred to our hospital because of a 2-year history of post prandial abdominal angina. Computed tomography (CT) images revealed a heavily calcified CTO in the ostium of SMA and three-dimensional CT (3D-CT) detected pancreaticoduodenal arcade with filling from the celiac artery. Then, endovascular procedure was attempted; however, angiography did not show the collateral route suitable for transcollateral approach. As demonstrated on the CT, we were successful in passing a guidewire through the SMA-CTO via the celiac trunk transcollateral route. After pull-through of the guidewire, two balloon-expandable stents were deployed in the ostium of SMA. During 3 months after stent implantation, the patient had no further episodes of abdominal angina on dual-anti-platelet therapy.ConclusionWe demonstrate a case of a heavily calcified SMA occlusion successfully treated with endovascular stenting employing a transcollateral approach, guided by 3D-CT.
| S-EPMC8167909 | biostudies-literature
Project description:BackgroundSuperior mesenteric artery (SMA) pseudoaneurysm is a very rare condition, typically associated with trauma, inflammation, and infection, and as a post-operative complication. If left untreated it can lead to serious consequences such as rupture and fatal haemorrhage.ReportA 17 year old male presented to the emergency department with a history of intermittent progressive epigastric pain with no preceding significant symptoms of a possible cause. He was initially treated conservatively until the intensity of pain was so severe an abdominal computed tomography (CT) scan was justified. A pseudoaneurysm of the SMA was found. Full inflammatory and immunological workup was unremarkable. Repeat CT scan showed the SMA pseudoaneurysm was larger, mandating surgical intervention; the vascular surgeon suggested an exploratory laparotomy. Intra-operatively, unexpectedly, a wooden foreign body measuring 5.0 × 0.3 × 0.5 cm was seen once the aneurysm sac was opened. The pseudoaneurysm was repaired and the abdomen closed after ascertaining that all other organs were intact. The patient had a simple recovery with no complications and was discharged home. The follow up CT scans were unremarkable.ConclusionPseudoaneurysm of the SMA in the paediatric age group is an extremely rare and life threatening phenomenon. The clinical presentation may be subtle, leading to delayed diagnosis. Early surgical intervention may be lifesaving and prevent further complications.
| S-EPMC8819108 | biostudies-literature
Project description:Thrombosis of the celiac artery trunk is a rare cause of acute abdominal pain. Thrombosis of the celiac artery carries a high mortality and morbidity when the diagnoses and treatment are delayed. It is frequently associated with other cardiovascular events. The most common etiology is atherosclerosis. 20-30% of cases may have symptoms of chronic mesenteric ischemia. Main goal of the treatment is to reestablish the diminished or stopped mesenteric blood flow and to avoid end-organ ischemia. Essential thrombocythemia is a chronic myeloproliferative disorder characterized by marked increase in thrombocyte number and clinical presentation may be with thrombotic episodes, hemorrhage, or both. To our knowledge this is the first report of celiac artery thrombosis and superior mesenteric artery stenoses in a patient with essential thrombocythemia. The patient was managed successfully with surgical treatment.
| S-EPMC3530234 | biostudies-literature