Ileal Artery Research Articles

333. TECHNICAL CONSIDERATIONS IN UPPER-GI RECONSTRUCTION – A CASE SERIES

Abstract Background Oesophageal reconstruction post-oesophagectomy is performed for both benign and malignant pathologies. Generally, the stomach is the conduit of choice due to its simplicity, requiring only one anastomosis. However, in some cases the stomach may not be a viable option immediately or at all, and alternatives must be considered. We describe a case where the stomach was not immediately viable and two cases where alternative conduits were sought. Furthermore, we discuss techniques such as ‘supercharging’ and ‘superdrainage’ which enhance arterial flow and venous drainage respectively, in order to prevent ischaemia and related complications of the anastomosis site. Methods and Results Case 1 presents a 72-year-old with an incarcerated para-oesophageal hernia leading to necrosis of the distal oesophagus and proximal stomach. After resection, a feeding jejunostomy and a loop oesophagostomy in the neck was created. Months later, the oesophagostomy was closed, and the residual stomach was carefully mobilised into the thorax while preserving the gastro-epiploic arcade, and oesophago-gastric anastomosis was performed. Case 2 involves a 68-year-old female who had elective Nissen fundoplication for a hiatus hernia, which recurred early with strangulation of the distal oesophagus and proximal stomach requiring emergency oesophago-gastrectomy. She later underwent a colonic interposition using the left colon, with superdrainage through an anastomosis between a branch of the middle colic vein to the left external jugular vein. Case 3 describes a 61-year-old male with a gastro-oesophageal adenocarcinoma treated with an Ivor-Lewis oesophagectomy. A year later, he suffered from a strangulated diaphragmatic hernia causing necrosis of the gastric conduit. This was replaced with an isoperistaltic colonic interposition using the transverse and left colon with super drainage. Unfortunately, three years later, this was again complicated with pancreatitis and perforated gall bladder with associated ischaemia of the colonic conduit. A re-do of the colonic interposition using the right colon was done with an arterial graft between the right transverse cervical artery and branch of ileal artery and super drainage via a branch of the ileal and right external jugular veins. Conclusion Primary and in particular secondary re-constructions of the UGI tract are complex procedures and individual approaches are needed as residual anatomy varies. Consequently, such cases require meticulous planning and a multidisciplinary approach involving the cardio-thoracic, plastic and vascular surgeons and adequate support by the anaesthetic and intensive care team. Although associated with significant morbidity and mortality, reestablishment of a swallowing passage is often desired by patients to maintain quality of life.

Distribution pattern of the celiac, cranial mesenteric, and caudal mesenteric arteries to the gastrointestinal tract in the common marmoset (Callithrix jacchus).

Gastrointestinal diseases pose problems to captive common marmosets. Therefore, knowledge of the anatomy of the arterial supply to the gastrointestinal tract is an important prerequisite for implementing appropriate veterinary care. The common marmoset's intestinal tract has a well-developed cecum specialized for the fermentative digestion of tree gums. This specialized gastrointestinal tract may have a unique pattern of arterial distribution. This study aimed to elucidate the species-specific gastrointestinal tract arterial anatomy of the common marmoset. We traced the celiac, cranial mesenteric, and caudal mesenteric arteries in six male and nine female common marmosets using the latex injection method. We found that the celiac artery gave rise to the left gastric, common hepatic, splenic, and caudal pancreaticoduodenal arteries. In addition to these arteries, the celiac artery gave origin to the middle colic or jejunal arteries in seven or one cases, respectively. The branches of the cranial mesenteric artery consisted of 3-6 arteries, including the middle colic, caudal pancreaticoduodenal, jejunal, right colic, ileocolic, and ileal arteries, as well as a common trunk of the ventral cecal and ileal branches, and the dorsal cecal and colic branches. In four cases, the cranial mesenteric artery gave rise to the jejunal, ileocolic, and ileal arteries. In one of the 13 cases, the celiac and cranial mesenteric arteries formed a common trunk. The caudal mesenteric artery branched into the left colic, sigmoid, and cranial rectal arteries in all the cases. These findings provide an anatomical basis for gastrointestinal veterinary care of common marmosets.

Ileal Artery to Sigmoid Fistula Following Cystectomy and Radiation: A Case Report

Abstract Arterial-enteric fistulas are a rare but devastating complication that can occur as a result of surgery or radiation exposure. Although this condition is most frequently seen following manipulation of the vasculature, especially in the presence of the vascular graft, other causes have been reported. Twenty-five cases have been reported in the literature, mostly related to previous vascular grafts. We present a case of ileal artery to sigmoid colon fistulas caused by previous resection of bladder cancer and radiation.

Preliminary report on embolization with quick-soluble gelatin sponge particles for angiographically negative acute gastrointestinal bleeding

Prophylactic embolization is usually performed using gelatin sponge particles, which are absorbed within several weeks, for managing angiographically negative gastrointestinal bleeding. This study aimed to evaluate the safety and effectiveness of transcatheter arterial embolization (TAE) with quick-soluble gelatin sponge particles (QS-GSP) that dissolve in less than 4 h for treating angiographically negative gastrointestinal bleeding. We included ten patients (M:F = 7:3; mean age, 64.3 years) who underwent prophylactic TAE with QS-GSP for angiographically negative acute gastrointestinal bleeding between 2021 and 2023. The technical success rate of TAE, clinical outcomes focusing on rebleeding, and procedure-related complications were evaluated. The embolized arteries were the gastroduodenal (n = 3), jejunal (n = 4), and ileal (n = 3) arteries. QS-GSP (150–350 µm or 350–560 µm) were used alone (n = 8) or in combination with a coil (n = 1). A 100% technical success rate was accomplished. In 1 patient (10%), rebleeding occurred 2 days after prophylactic TAE of the gastroduodenal artery, and this was managed by repeat TAE. There were no procedure-related complications. The use of QS-GSP for prophylactic TAE appears to be safe and effective for controlling bleeding among patients with angiographically negative gastrointestinal bleeding. There were no cases of related ischemic complications of the embolized bowels likely attributable to recanalization of the affected arteries following biodegradation of QS-GSP.

EGS P11 Super-charged colonic interposition after Upper Gastrointestinal tract resections: technical considerations from both benign and malignant cases and review of literature

Abstract Background Oesophageal reconstruction is performed after an oesophagectomy, for either malignant or benign pathology. During reconstruction, variables include choice of conduit, route of reconstruction, and site of anastomosis. The stomach is preferred for neo-oesophageal reconstruction. However, when the stomach is not viable, alternatives including colon, jejunum, skin, or anterolateral thigh (ALT) musculocutaneous flaps are considered. Of these, colon is preferred for its ability to provide long-length grafts and reliable vascular supply. However, complications remain significant problems, including ischaemia at the anastomosis. To address this, 'supercharging’ and ‘super drainage' techniques are used to enhance arterial flow and venous drainage via microvascular anastomosis. Methods Case 1 involves a 61-year-old male who underwent an oesophagectomy for GOJ adenocarcinoma. A year later he developed a strangulated diaphragmatic hernia with an ischaemic gastric conduit, which was replaced with an isoperistaltic colonic interposition using transverse and left colon with super-drainage. 3 years later, the patient presented with pancreatitis, perforated gallbladder, and duodenum. Diffuse ischaemic changes of the interposed colon were recognised. A re-do colonic interposition using right colon with an arterial graft between the right transverse cervical artery and branch of ileal artery and super-drainage via a branch of the ileal and right external jugular veins was created. Results Case 2 involves a 68-year-old female who underwent an elective hiatus hernia repair with Nissen’s fundoplication. She deteriorated shortly post-operatively where re-look surgery found early hernia recurrence causing strangulation of the distal oesophagus and proximal stomach leading to ischaemia, necrosis, and perforation. She underwent a laparotomy and resection of the ischaemic distal oesophagus and proximal stomach, oesophagostomy and feeding jejunostomy. 16 months later, she underwent interposition of the right colon between the proximal oesophagus and remaining stomach. Arterial flow was adequate and supercharging was performed between the left external jugular vein and a branch of the middle colic vein. Conclusions There is limited literature on methods of both supercharging and super-drainage, as well as the optimal choice of organ for neo-oesophageal reconstruction. Currently, no established treatment protocols exist. There is evidence that supercharging and super-drainage are associated with longer operative times. However, benefits include lower leak incidence, shorter duration to oral intake, and reduced length of stay in relation to interposition without supercharge. Associated venous congestion may contribute to anastomotic leak, and may be prevented by super-drainage. Whilst supercharging has been reported worldwide, our case series adds to the UK practice showing it improves patient outcomes in an NHS setting.

Preoperative Simulation of Ileal Pouch-Anal Anastomosis in Patients With Ulcerative Colitis Using a 3-Dimensional Printed Model.

During restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis-associated colorectal cancer or dysplasia, ileal pouch-anal handsewn anastomosis (IAA) is preferred to avoid the risk of cancer development in the remaining rectal mucosa. However, there is a risk of the ileal pouch not reaching the anus with this procedure. Here, we created deformable 3-dimensional (3D) models for simulation. Six patients who underwent IAA without vessel ligation and 5 patients who underwent ileal pouch-anal canal double-stapled anastomosis (IACA) because the ileal pouch did not reach the anus were studied. A 3D printer was used to create deformable 3D models from the data obtained from computed tomography scans. The positional relationship among the mesenteric arteries, pubis, and coccyx were evaluated. The distance between the superior mesenteric artery root and the tip of the ileal artery was longer in the IAA group than that in the IACA group (IAA vs IACA: 26.2 ± 2.1 cm vs 20.9 ± 1.6cm). The distance from the tip of the ileal artery to the coccyx (IAA vs IACA: 6.7 ± 1.7 cm vs 12.1 ± 2.1 cm) and the distance from the tip of the ileal artery to the lower edge of the pubis (IAA vs IACA; 8.1 ± 1.3 cm vs 12.7 ± 2.4 cm) were longer in the IACA group than those in the IAA group. We established a method for creating 3D deformable models of patients with ileal pouch-anal anastomosis. These 3D models may be useful for preoperative simulation.

S2586 Don’t Get 2 Comfortable: A Rare Case of Meckel’s Diverticulum Causing Hemorrhagic Shock in an Adult

Introduction: Meckel’s diverticulum (MD) is a true diverticulum that results from incomplete obliteration from the vitelline duct during embryonic development. It is a one of the most common congenital disorders of the gastrointestinal (GI) tract. Often characterized using “The Rule of 2’s”: MD occurs in approximately 2% of the population, is 2 inches long, is within 2 feet from the ileocecal valve, is twice as common in males than females, can contain 2 types of tissue (gastric or pancreatic), 2% become symptomatic, and most present before the age of 2. The majority of symptomatic MD occur as painless hematochezia in children and therefore is often lower on the differential of an adult with a GI bleed. Even when MD is suspected as an etiology for GI bleeding in an adult, the evaluation can be challenging. Case Description/Methods: A 25-year-old male with no significant past medical history was admitted to the hospital for GI bleeding and then developed hemorrhagic shock requiring resuscitation with transfusion of large volumes of blood products. The etiology of his GI bleed remained elusive for several days despite evaluation with upper endoscopy, three colonoscopies, three CT angiograms of the abdomen and pelvis, and a video capsule endoscopy. Subsequently, he underwent two separate fluoroscopic angiograms with interventional radiology. While the first angiogram was unrevealing, the second angiogram demonstrated a tortuous ileal artery branch with active extravasation that was treated with embolization. Given IR findings, a Meckel’s scan was performed which was negative. A multi-disciplinary review of the case prompted further review of the patient’s abdominal CT angiogram and a potential finding of MD was seen at the distal ileum. Ultimately, the surgery team decided to take the patient to the operating room where they found and resected a segment of small bowel with tissue examination revealing the MD (Figure 1). Discussion: A Meckel’s scan is often considered the modality of choice for diagnosing MD in children, however, its diagnostic accuracy is considered to be much lower in adults. The typical approach to GI bleeding via upper endoscopy, colonoscopy, capsule endoscopy, CT and procedural angiography may be negative, as seen in our case. Balloon assisted enteroscopy, where available, may also be a potentially useful tool for diagnosing MD. This case highlights the importance of maintaining a broad differential diagnosis for GI bleeding and the challenges with current diagnostic modalities.Figure 1.: Meckel's diverticulum at the level of distal small bowel, approximately 60 cm from the ileocecal valve.

Description of the arterial supply and venous drainage of the abdominal viscera in the puma (Puma concolor) (Linnaeus, 1771).

Detailed descriptions of the abdominal vasculature have not been reported on Puma concolor; thus, herein we provided a thorough description. Our findings include the following: a celiac artery branching into the hepatic and gastrolienal arteries, and this latter further branched into the left gastric, the left gastroepiploic, the lienal and three more arteries that supplied the greater omentum. We also found a cystic artery that derived from the right gastroduodenal artery; a right gastric artery that derived from the right hepatic artery; and an antimesenteric ileal artery that derived from the lateral cecal artery. The right gastric vein did not form the gastroduodenal vein as in other species, but it drained directly into the portal vein. Also, a middle pancreaticoduodenal vein was identified as the last branch of the cranial mesenteric vein. Finally, the left caudal phrenic vein drained into the left renal vein. The abdominal blood supply described herein corresponds to a single individual; further reviews are desirable to corroborate our observations and to detect potential intraspecific anatomical variations.

Blockage of the P2X7 Receptor Attenuates Harmful Changes Produced by Ischemia and Reperfusion in the Myenteric Plexus.

Our work analyzed the effects of a P2X7 receptor antagonist, Brilliant Blue G (BBG), on rat ileum myenteric plexus following ischemia and reperfusion (ISR) induced by 45min of ileal artery occlusion with an atraumatic vascular clamp with 24h (ISR 24-h group) or 14 d of reperfusion (ISR 14-d group). Either BBG (50mg/kg or 100mg/kg, BBG50 or BBG100 groups) or saline (vehicle) was administered subcutaneously 1h after ischemia in the ISR 24-h group or once daily for the 5 d after ischemia in the ISR 14-d group (n = 5 per group). We evaluated the neuronal density and profile area by examining the number of neutrophils in the intestinal layers, protein expression levels of the P2X7 receptor, intestinal motility and immunoreactivity for the P2X7 receptor, nitric oxide synthase, neurofilament-200, and choline acetyl transferase in myenteric neurons. The neuronal density and profile area were restored by BBG following ISR. The ischemic groups showed alterations in P2X7 receptor protein expression and the number of neutrophils in the intestine and decreased intestinal motility, all of which were recovered by BBG treatment. We concluded that ISR morphologically and functionally affected the intestine and that its effects were reversed by BBG treatment, suggesting the P2X7 receptor as a therapeutic target.

Gross Anatomy of the Celiac, Cranial Mesenteric and Caudal Mesenteric Arteries in Hooded Crow (Corvus cornix)

The Celiac artery in hooded crow originated from descending aorta. It gives off the proventricular artery, splenic arteries then terminated with the right and left celiac arteries. The right celiac artery detached the right hepatic, left hepatic, gastroduodenal and the right gastric arteries. The gastro duodenal artery supplies the pylorus and duodenum. The right gastric artery gives off the ventral proventricular, dorsal gastric and ventral gastric arteries. The dorsal and ventral gastric arteries supply the gizzard. The left celiac artery gives off the left gastric artery to gizzard, the jejunal branch, duodenal branch, and pancreatico-duodenal artery. The cranial mesenteric artery originated from the descending aorta then gives off the duodo-jejunal artery, ileal branches, jejunal arteries. the duodo-jejunal artery divided into duodenal and jejunal branches. The ileal branches are the dorsal and ventral ileal arteries. The caudal mesenteric artery arose from the descending aorta then di- vided into cranial and caudal branches. The cranial branch is distributed in the cranial part of rectum and cecum. The caudal branch sup- plies the caudal half of rectum, cloaca and cloacal bursa.

RA05.07: ESOPHAGEAL RECONSTRUCTION BY PEDICLED TERMINAL ILEUM AND RIGHT COLON WITH PRESERVED ILEOCOLIC VESSELS

Abstract Background In the case of esophageal cancer patient whose stomach is not available for reconstruction, we had been using pedicled jejunum for lower esphageal cancer or right colon reconstruction as an alternative. However, high incidence of postoperative anastomotic leakage regarding insufficient blood supply was a great distress. We started the unique reconstruction technique using terminal ileum and right colon with preserved ileocolic vessels in 2011. Based on our experience, we considered benefits of our method. Methods After esophagectomy and lymphadenectomy, the ascending colon was mobilized. The mid colic, right colic (if exist) and ileocolic vessels, as well as marginal vessels of terminal ileum, were preserved, the ileum was cut at the point approximately 20–30cm from the ileum end. The final ileal artery and vein may be ligated and cut, if necessary. The pedicled ileo-colon was, then, carefully lifted isoperistaltically via subcutaneous route. Esophagoileostomy was usually performed by functional end to end anastomosis. Additional anastomoses were performed by Billroth II or Roux en Y method. Results In total of 383 patients who were underwent transthoracic esophagectomy between 1998 and 2017, 15 pedicled jejunum (J), 4 traditional right colon (C) and 6 ileo-colon preserved ileocolic vessels (IC) were used for reconstruction. The incidence of esophagoileostomy-related complications were 6.7% (1/15) in J, 50.0% (2/4) in C and 33.3% (2/6) in IC. One in IC showed ileal necrosis caused by sclerotic obstruction on the root of ICA, then remained right colon was used for free flap salvage reconstruction. Two in C suffered from pneumonia at early post-operative days, probably because of microaspiration of colic bacterium, interestingly, there was no caces of pneumonia in IC. In addition, the subcutaneous space was occupied only with the ileum, therefore the antesternal skin bloating was not bulky. Conclusion The advantages of our technique are; i) less anastomotic complications, ii)possibility of less aspiration pneumonia, iii) better cosmetic appearance, and iv) no microvascular surgery required. Our technique could be used as the standard method of reconstruction after esophagectomy for patients in whom stomach is not available. Disclosure All authors have declared no conflicts of interest.

Traumatic mesenteric bleeding: early diagnosis and interventional management.

We report a rare case of mesenteric bleeding following blunt abdominal trauma successfully treated with transcatheter arterial embolization (TAE) of the ileal artery branch. A 27-year-old man presented with mesenteric bleeding after motorcycle accident. Computed tomography (CT) demonstrated mesenteric hematoma with extravasation of contrast material, and no associated major injuries to other organs. A superior mesenteric angiogram revealed pseudoaneurysm of the ileal branch. After TAE with a single microcoil, control angiography showed cessation of bleeding. There was no need for repeat embolization or additional surgery due to mesenteric bleeding nor ischemic gastrointestinal complications during the 5 months following TAE. In isolated mesenteric injuries, TAE may be a reasonable minimally invasive alternative to emergency laparotomy.

Ileocolonic Transposition Esophagogastric Bypass as an Antireflux Treatment for Corrosive Esophageal Injury.

Because most surgeons perform an esophagectomy and colonic transposition as the main reconstruction method for patients with esophageal stenosis caused by swallowing corrosive materials, we report 2 cases in which ileocolonic transposition was used to treat such patients. Both patients displayed stenosis in the middle third of the esophagus. Their chief complaint was dysphagia. Ileocolonic transposition using vascularization of the Drummond and ileal arteries was followed by a prepared ileocolic graft by ligating ileocolic vessels. We performed an ileocolonic transposition esophagogastric bypass without an esophagectomy. All surgeries resulted in minimal intraoperative bleeding. Patients experienced no leakage, postoperative fistulas, dysphagia, or postoperative reflux. Three weeks after surgery, 1 patient experienced reversible hoarseness caused by extensive laryngeal-nerve manipulation. Cumulatively, ileocolonic transposition with cervical anastomosis for the treatment of patients with esophageal stenosis caused by corrosive esophageal injury can be considered to be an antireflux treatment because the ileocaecal sphincter is maintained.

Macroscopic anatomical study of the distribution of the cranial mesenteric artery to the intestine in the rabbit.

Intestinal surgery is commonly performed to cure bowel obstruction in rabbits, but detailed descriptions of the arterial supply to the intestine are incomplete. We investigated anatomical variations of the distribution of the cranial mesenteric artery to the intestine in 33 New Zealand White rabbits by injecting colored latex into the arteries. The cranial mesenteric artery arose independently from the abdominal aorta at about 2.0cm caudal to the celiac artery and branched off the pancreaticoduodenal, middle colic, ileocecocolic, jejunal and ileal arteries. One or occasionally two caudal pancreaticoduodenal arteries supplied the distal duodenum, and one to three middle colic arteries supplied the transverse colon and the initial portion of the descending colon. The ileocecocolic artery arose distal to the middle colic arteries and provided the right colic, ileocecal and appendicular arteries, and branches to the proximal colon, with various branching patterns, which were grouped into four major types. These arteries and branches supplied the ileum, cecum, appendix and proximal colon. The cranial mesenteric artery also provided the jejunal arteries (predominantly 17; range 11-21) and one ileal artery supplying the jejunum and proximal ileum, respectively. The results show that the distribution patterns of the cranial mesenteric artery to the intestine in the rabbit are highly specialized to this species. Such specialization should always be considered when performing intestinal surgery in rabbits.

Anatomical studies on the cranial and caudal mesenteric arteries of the Barbados Black Belly sheep

Abstract Introduction: The Barbados Black Belly is a breed of domestic sheep in the Caribbean island of Trinidad. Anatomical studies on the cranial and caudal mesenteric arteries are necessary to know the pattern of its blood supply to gain information in benefit of experimental surgery. Materials and Methods: The thoracic part of the aorta of five sheep was injected with red latex. Careful gross dissection of the cranial and caudal mesenteric arteries was performed either after embedding in 10% formalin solution for 2-3 days. Results: The cranial mesenteric artery originated from the abdominal aorta, caudally to the celiac trunk, giving caudal duodenal artery, jejunal arteries, ileal arteries, ileocolic artery and middle colic artery. The caudal mesenteric artery arises from the aorta, cranially to the external iliac arteries, originating the left colic and cranial rectal arteries. Conclusion: cranial and caudal mesenteric arteries supplied the small and large intestine of the Barbados Black Belly sheep except caudal part of the large intestine which were supplied by the middle and caudal rectal arteries.

Ileal angiodysplasia causing chronic, occult gastrointestinal bleeding in a 14-year-old boy

Abstract A 14-year old boy with anemia due to chronic gastrointestinal bleeding required recurrent transfusion. An extensive non-invasive evaluation that included detection of fresh blood in the small bowel followed by laparotomy with on-table pan-endoscopy (including enteroscopy) was unsuccessful in identifying a bleeding source. After repeat capsule endoscopy at our center confirmed bleeding in the distal small bowel, CT angiography identified a 6-mm focal area of enhancement in the ileum communicating with a distal branch of the superior mesenteric artery. Direct visceral angiography with super-selective arteriography identified a fast-flow vascular malformation supplied by terminal branches of the ileal artery. Diagnostic laparoscopy revealed intra-abdominal adhesions and no clear vascular malformation. Initial careful visual and manual examination of the bowel after conversion to laparotomy failed to identify the lesion. On-table retrograde enteroscopy demonstrated a small, pulsatile lesion without ulceration or adherent clot in the mucosa of the proximal ileum. With endoscopic transillumination, a cluster of serpiginous vessels could be seen within the wall of the small bowel. The lesion was resected and pathology was consistent with angiodysplasia. Angiodysplasia is a rare cause of occult, chronic gastrointestinal bleeding in children. A multidisciplinary approach optimizes the likelihood of therapeutic success.

The Effect of Ischemia and Reperfusion on Enteric Glial Cells and Contractile Activity in the Ileum.

We investigated the effects of ischemia followed by different periods of reperfusion (I/R) on immunoreactive S100β-positive glial and Hu-immunoreactive neurons co-expressing the P2X2 receptor in the myenteric plexus of the rat ileum. The ileal artery was occluded for 35 min with an atraumatic vascular clamp. The animals were killed 24 h, 72 h, and 1 week after ischemia. Sham animals were not submitted to ileal artery occlusion. The relative density, size, and co-localization of P2X2 receptor-expressing cells in relation to S100β-immunoreactive glial and Hu-immunoreactive neuronal cells were evaluated. Additionally, we analyzed the effects of I/R on gastrointestinal transit and ileum contractile activity. The cellular density of P2X2 receptor and neuronal Hu immunoreactivity/cm(2) decreased after I/R, whereas glial S100β immunoreactivity/cm(2) increased. No significant differences between sham and I/R groups were observed regarding the perikarya area of Hu-positive neurons. The area of S100β-immunoreactive glial cells increased by 24.1 % 1 week after I/R compared with the 24 h group. Methylene blue progression along the small intestine decreased (P < 0.05) from 24.5 ± 2.3 % in the sham group to 17.2 ± 2.0 % 1 week post-ischemia. We noted a significant (P < 0.05) decrease in the maximal contraction amplitude triggered by electrical field stimulation in the presence of ATP in preparations submitted to 24 h of I/R. Changes in the P2X2 receptor density parallel myenteric neuronal loss following I/R of the rat ileum. This, together with the increase in the activated (oversized) glial cells, may contribute to decreased GI motility after I/R.

Brilliant Blue G attenuates the effects of intestinal ischemia/reperfusion injury in rats (LB747)

During pathological conditions there is an increased release ATP into the extracellular space, activating the P2X7 receptor. Several studies have shown that injury can be attenuated by the antagonist of this receptor, the Brilliant Blue G (BBG). In the present work we analyzed the effects of intestinal ischemia and reperfusion (I/R) and the effects of the BBG on rats ileum. Tissues were obtained from male Wistar rats (n=5). The ileal artery was occluded for 45 minutes with an atraumatic vascular clamp. BBG (50 and 100 mg/kg) or saline (vehicle) was given subcutaneous 1 h after injury (24 h group). The sham group was rats without the arterial occlusion. We analyzed also the I/R 0 h group (not reperfusion). Myenteric neurons were evaluated for immunoreactivity (ir) against the P2X7 receptor, nitric oxide synthase (NOS), neurofilament (NF), choline acetyl transferase (ChAT) and anti‐HuC/D (Hu). Technique histology staining to hematoxylin and eosin (HE) was performed to evaluate the integrity of the intestinal wall and myeloperoxidase technique (MPO) to verify the marking of neutrophils. Our qualitative results showed that I/R caused histological damage to the mucosa and muscle and infiltration of neutrophils into the muscle layers. Our quantitative results showed that there was a decrease in density (neurons/cm2) P2X7‐ir, NOS‐ir, NF‐ir, ChAT‐ir and Hu‐ir neurons in I/R 0 h and 24 h groups. In I/R groups where the antagonist BBG was injected, the neuronal density was less affected. Analysis in the area of the cell body profile different classes showed generally decreases in the profile area in the I/R groups and recovery profile area of the I/R BBG‐50 and BBG‐100 groups. This work indicates that deleterious effects are greater in groups subjected to I/R in rats without application BBG, suggesting that BBG has protective effects on the intestinal wall and in different neuronal classes.Grant Funding Source: FAPESP

Effects of Ischemia and Reperfusion on Subpopulations of Rat Enteric Neurons Expressing the P2X7 Receptor

Intestinal ischemia followed by reperfusion (I/R) may occur following intestinal obstruction. In rats, I/R in the small intestine leads to structural changes accompanied by neuronal death. To analyze the impact of I/R injury on different neuronal populations in the myenteric plexus of rat ileum. The ileal artery was occluded for 35 min and animals were euthanized 6, 24, and 72 h, and 1 week later. Immunohistochemistry was performed with antibodies against the P2X7 receptor as well as nitric oxide synthase (NOS), calbindin, calretinin, choline acetyltransferase (ChAT), or the pan-neuronal marker anti-HuC/D. Double immunolabeling demonstrated that 100% of NOS-, calbindin-, calretinin-, and ChAT-immunoreactive neurons in all groups expressed the P2X7 receptor. Following I/R, neuronal density decreased by 22.6% in P2X7 receptor-immunoreactive neurons, and decreased by 46.7, 38, 39.8, 21.7, and 20% in NOS-, calbindin-, calretinin-, ChAT-, and HuC/D-immunoreactive neurons, respectively, at 6, 24, and 72 h and 1 week following injury compared to the control and sham groups. We also observed a 14% increase in the neuronal cell body profile area of the NOS-immunoreactive neurons at 6 and 24 h post-I/R and a 14% increase in ChAT-immunoreactive neurons at 1 week following I/R. However, the average size of the calretinin-immunoreactive neurons was reduced by 12% at 6 h post-I/R and increased by 8% at 24 h post-I/R. This work demonstrates that I/R is associated with a significant loss of different subpopulations of neurons in the myenteric plexus accompanied by morphological changes, all of which may underlie conditions related to intestinal motility disorder.

Computed Tomography Imaging Features and Classification of Isolated Dissection of the Superior Mesenteric Artery

To analyze computed tomography (CT) imaging features of isolated dissection of the superior mesenteric artery (SMA). The imaging findings of 20 consecutive patients with isolated dissection of the SMA were retrospectively evaluated and categorized according to a new imaging classification: Type A, dissections localized at the curved part of the SMA and extended proximally; Type B, dissections limited to the curved part; Type C or D, dissections localized at the curved part and extended distally without or with involved ileocolic or distal ileal arteries. The relationship between classification and symptoms and treatment effect is discussed, and prior reported cases where CT images were available were classified and analyzed. The dissections were around the curved part of the SMA in all 20 patients. In symptomatic patients, the true lumen was more stenosed, the dissection started nearer the SMA ostium, and the dissection was longer. The best effect of conservative treatment was achieved in Type B cases. When dissection extended distally, the effect progressively worsened from Type B to Type D. The new classification is useful for describing the imaging features of isolated dissection of the SMA.