Ileal Mesentery Research Articles

Chylolymphatic Cysts in Children: A Rare Condition

Objective: To find out the clinical findings, anatomical types and preferred operative treatment for paediatric chylolymphatic cysts. Study Design: Prospective study Place and Duration of Study: Department of Pediatric Surgery/General Surgery Bahawal Victoria Hospital, Bahawalpur and Department of Pediatric Surgery/General Surgery Unit-ll, DHQ Teaching Hospital, Dera Ghazi Khan from 1st January 2018 to 31st December 2020 Methodology: Fifteen patients of either gender with age from 18 months to 8 years (96 months) enrolled. Clinical data of all the patients diagnosed as chylolymphatic cyst on exploration was recorded. Results: There were 8 (53.3%) females and 7 (46.7%) males with mean age was 49.80±27.07 (months). Four patients (26.66%) presented with abdominal mass, 5 patients (33.33%) presented with abdominal pain, 1 patient (6.66%) with abdominal mass and pain while 5 patients (33.33%) presented with signs of intestinal obstruction. Three (20%) had cysts at multiple sites, i.e., mesentery of jejunum, ileum and mesentery of sigmoid colon, 5 (33.33%) patients had cysts in jejunal mesentery while 9 (53.33%) patients’ cyst was found in ileal mesentery and 1 (6.66%) had cyst in mesentery of cecum. Fourteen underwent exploratory laparotomy and 1 was managed laparoscopically. Post-operative recovery in 14 patients was uneventful and 1 patient managed by open surgery underwent respiratory complications and later expired. No recurrence was noted during follow up period up to 6 months. Conclusion: Surgical exploration and surgical excision and sometimes resection anastomosis of gut is mainstay of treatment with excellent results. Key words: Paediatric mass abdomen, Mesenteric cysts, Chylolymphatic cyst, Paediatric surgery

Vitelline artery remnant: A rare cause of chronic abdominal pain in an adult

Vitelline vascular remnant is a rare clinical entity in adults. Usually, they cause intestinal obstruction, especially in children. In adults, it can cause chronic abdominal pain. We report the case of a 53-year-old man who presented with recurrent abdominal pain for the past 1 year. Contrast-enhanced computed tomography of the abdomen and colonoscopy was normal. Diagnostic laparoscopy revealed a single band-like structure between the distal ileal mesentery and anterior abdominal wall near the umbilicus. Band resection was done. These bands are the rare cause of chronic abdominal pain in adults and difficult to diagnose, preoperatively. In these cases, laparoscopy is an effective diagnostic as well as a therapeutic tool.

Leiomyosarcoma of ileal mesentery in a middle age female: a rare case report

BackgroundLeiomyosarcoma arising from mesentery is a rare tumor associated with worse prognosis. The tumor arises from smooth muscles in vascular wall. Ileal mesentery is common site of this tumor origin.Case presentationA middle age female was presented with complain of abdominal distension. A mass was palpable on abdominal examination. CT scan showed large mesenteric cyst. 15 × 10 cm large mass excised with associated mesentery and small bowel segment and on histopathology was found, and it was diagnosed as mesenteric leiomyosarcoma. The patient was discharged and referred to oncology for chemotherapy.ConclusionLeiomyosarcoma is a rare disease with grave prognosis. There is a paucity of literature and proper guidelines for its management; however, surgical excision with healthy margins is a mainstay of management. Close follow-up is recommended post-operatively because there are high chances of recurrence and metastasis.

A case of recurrent perianal abscess with fistula-in-ano treated with homoeopathy: A case report

Vitelline vascular remnant is a rare clinical entity in adults. Usually, they cause intestinal obstruction, especially in children. In adults, it can cause chronic abdominal pain. We report the case of a 53-year-old man who presented with recurrent abdominal pain for the past 1 year. Contrast-enhanced computed tomography of the abdomen and colonoscopy was normal. Diagnostic laparoscopy revealed a single band-like structure between the distal ileal mesentery and anterior abdominal wall near the umbilicus. Band resection was done. These bands are the rare cause of chronic abdominal pain in adults and difficult to diagnose, preoperatively. In these cases, laparoscopy is an effective diagnostic as well as a therapeutic tool.

Successful treatment of recurrent volvulus in the afferent limb of the pouch following proctocolectomy for ulcerative colitis: a case report

BackgroundPouch volvulus after proctocolectomy for ulcerative colitis is a very rare postoperative complication. The common site of pouch volvulus has been reported to be the ileal pouch–anal anastomosis and the middle part of the pouch, but no reports on pouch volvulus in the afferent limb of the pouch have been observed. Here, we report the case of a patient with afferent limb volvulus who underwent afferent limbpexy, but required reoperation 7 months later.Case presentationA 38-year-old man with refractory ulcerative colitis had undergone open proctocolectomy 10 years ago at another hospital. He had been aware of lower abdominal pain and bowel movement difficulty for 2 years. After repeated bowel obstruction, he was referred to our hospital for surgery. Based on the radiographic findings, we diagnosed a pouch volvulus and performed an operation. Laparoscopically, counterclockwise rotation of the afferent limb of the pouch was recognized. Moreover, the ileal mesentery was adhered and fixed to the presacral space 20 cm from the oral side of the pouch. The antimesenteric side of the afferent limb was fixed using interrupted stiches on the left peritoneal wall of the pelvis. He was discharged uneventfully 18 days after surgery, and defecation improved immediately. However, he was readmitted 7 months after surgery with the same abdominal pain and defecation difficulty. A similar finding was found and diagnosed as recurrent volvulus. Therefore, we performed a laparoscopic surgery. The same volvulus as in the previous surgery was confirmed. The site fixed during the previous surgery showed scars, but the afferent limb was free. The dilated ileum that contained the volvulus was excised only on the oral side of the pouch and an intraluminal anastomosis was performed on the anterior wall of the pouch. He had a good postoperative course and was discharged.ConclusionProper diagnosis of volvulus based on the characteristic imaging findings is important. In principle, bilateral row fixation of the rotated ileum is the basic procedure for volvulus. However, fixation with this technique is sometimes difficult. Therefore, this procedure is one of the useful options for the fixation of difficult or recurrent cases.

Liver abscess caused by fish bone perforation of Meckel\u2019s diverticulum: a case report

BackgroundLiver abscess due to gastrointestinal perforation by foreign bodies is rare. Furthermore, there are few case reports of liver abscess via the portal vein caused by perforation of the lower gastrointestinal tract by a foreign body.Case presentationA 54-year-old man visited our hospital because of a fever that had lasted for 1 month. There were no physical findings except for the fever. Laboratory tests showed only elevated inflammatory markers. Abdominal contrast-enhanced computed tomography revealed an abscess in the right lobe of the liver and a high-density object in the small intestine. We diagnosed him with liver abscess secondary to intestinal perforation by a foreign body. The patient underwent drainage of the liver abscess and laparoscopic surgery for perforation of the small intestine. A fish bone had perforated the top of Meckel’s diverticulum, which had been covered by the ileal mesentery. We successfully performed diverticulectomy and removed the fish bone. The patient was discharged without complications on the 13th postoperative day.ConclusionsLiver abscess caused by foreign bodies requires multidisciplinary treatment, so we must detect and remove the cause of the abscess earlier. Liver abscess can form via the portal vein secondary to lower gastrointestinal perforation, as in this case. When exploring the cause of liver abscess, we should investigate the whole body, including the lower gastrointestinal tract.

MP41-08 URETERAL SUBSTITUTION WITH INTESTINAL SEGMENTS

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I (MP41)1 Apr 2020MP41-08 URETERAL SUBSTITUTION WITH INTESTINAL SEGMENTS Boris Komyakov, Viktor Ochelenko*, and Husam Mhanna Boris KomyakovBoris Komyakov More articles by this author , Viktor Ochelenko*Viktor Ochelenko* More articles by this author , and Husam MhannaHusam Mhanna More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000890.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral substitution with ileum and appendix remains a technique of choice in patients with extended ureteral strictures, but data about long-term results and complications of these interventions is still limited. The aim of this study is to examine the long-term efficacy and safety of these procedures on the basis of 170 ureteral substitutions with ileum and appendix. METHODS: From 2001 to 2019 170 patients underwent ureteral substitution with ileum – 144 (84.7%) and appendix - 26 (15.3%) at our clinic. 31 (19.3%) patients underwent laparoscopic reconstruction of ureter: 27 (15.9%) - with ileal segment and 4 (2.4%) – with appendix. There were 105 (61.7%) women and 65 (38.3%) men with a median age of 53.6 ± 9.3 years (range from 18 to 69 years). The main causes of ureteral strictures were: retroperitoneal fibrosis following radiation therapy, colorectal and gynecological cancer surgery. All patients underwent long-term follow-up including routine laboratory analysis and urinary tract imaging. Outpatient visits occurred at 3 and 6 months postoperatively and at least annually thereafter. RESULTS: The follow up period was from 3 months up to 18 years (mean 8.5±0.8 years). Postoperative complications developed in 16 (9.4%) cases. Short-term complications (less than 30 days postoperatively) occurred in 12 (7.1%) patients and included: intestinal obstruction -4 (2.4%), ileal graft mesentery thrombosis -2 (1.2%), bleeding -2 (1.2%), and acute pyelonephritis – 4 (2.4%). Late complication – stricture of uretero-ileal anastomosis developed in 4 patients (2.4%) in 3 months after operation. Thus, the complications which have required surgical treatment occurred at 12 (7.1%) patients. The results of all operations were successful. According to all patients the renal function was restored. There were no cases of metabolic acidosis. CONCLUSIONS: Ileal and appendicular ureteral reconstruction is a safe and efficacious procedures in patients with extended and multiple ureteral strictures. During long-term follow-up major complications are rare and renal function remains good. Source of Funding: no © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e597-e598 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Boris Komyakov More articles by this author Viktor Ochelenko* More articles by this author Husam Mhanna More articles by this author Expand All Advertisement PDF downloadLoading ...

Multiple liver metastases originating from synchronous double cancer of neuroendocrine tumor and rectal cancer: a case report

BackgroundNeuroendocrine tumor (NET) is a relatively rare tumor and can develop in almost any organ, but primary mesenteric NETs are extremely rare. In addition, liver metastases from synchronous double cancer of neuroendocrine tumor graded as G1 and second primary malignancies (SPMs) have never been reported before. We herein report a case of multiple liver metastases from synchronous double cancer of NET (G1) at the ileal mesentery and rectal cancer.Case presentationA 66-year-old man was identified as having tumors in the rectum and the ileal mesentery by computed tomography (CT). He underwent laparoscopic low anterior resection for rectal cancer and biopsy of the ileal mesentery lymph node and was diagnosed with rectal cancer as pT3 pN1 cM0 (stage IIIB) and NET (G1) of the ileal mesentery. He received oxaliplatin and capecitabine (XELOX) for 3 months as adjuvant chemotherapy for rectal cancer. The NET (G1) of the ileal mesentery was low grade and had not expanded at follow-up. A CT scan performed 4 years after the surgery indicated multiple liver metastases. All the metastases had the same findings on CT and magnetic resonance imaging (MRI). Thus, the patient underwent the first stage of modified associating liver partition and portal vein ligation for staged hepatectomy (modified ALPPS), comprising partial hepatectomies of segments 3 and 4, ligation of the right branch of portal vein, and hepatic partition on the demarcation line, followed by the second stage of modified ALPPS (right lobectomy). Histopathological findings revealed that the 14 nodules were metastatic liver tumors of rectal cancer and the 2 nodules were liver metastases of the NET (G1).ConclusionsOur findings suggest that synchronous double cancer of NET and gastrointestinal cancer may be indistinguishable in preoperative images. However, curative resection, precise pathological diagnosis, and adequately adjusted treatment may result in a better prognosis.

A case report of ectopic pancreatitis in an isolated enteric duplication cyst

BackgroundIsolated enteric duplication cyst is an intestinal duplication cyst found in a distant location from the intestinal tract and it is said to have its own blood supply. Meckel’s diverticulm is considered as an antimesenteric structure and has its own blood supply. However, there are some reported cases of Meckele’s diverticum in the mesenteric side. Ectopic pancreas may be found in both entities.Case presentationA 5-year-old girl presented with increasing abdominal pain around the umbilicus. On laboratory investigation serum pancreatic enzymes and C-reactive protein were elevated. Abdominal computed tomography (CT) revealed a normal pancreas but a cystic lesion in the mesentery of the ileum. A nodule with a marked enhancement was observed in the wall of the lesion. During the laparoscopy, the lesion was found at the root of the mesentery and was distant from the ileum. The lesion was resected suspecting an abscess. Pathologically, the wall of the lesion consisted of small bowel like tissue, and pancreatic tissue was seen beneath the mucosa. There were some post inflammatory changes in the pancreatic tissue. Retrospectively on thin slice enhanced CT, an independent blood supply was noted. Based on these findings, a diagnosis of ectopic pancreatitis in an iliac intestinal duplication cyst was made.ConclusionIsolated enteric duplication cyst in the root of ileal mesentery and mesenteric Meckel’s diverticulum have similarities. In the present case, the diagnosis of isolated enteric duplication cyst was made since it was found distant from the ileum. It is important to consider the possibility of ectopic pancreatitis when serum pancreatic enzymes are elevated even when the pancreas appears normal.

Small intestine neuroendocrine adenocarcinoma with multiple liver metastases and ectopic benign pancreatic tumor in a 24-year-old woman – case report

Abstract : Neuroendocrine tumors represent a varied group of neoplasms which have the potential to produce and secrete a wide range of hormones along with other vasoactive substances.The care of these patients involves several specialties including:surgery, oncology, radiotherapy, interventional radiology and nuclear oncology. Despite this large number of options there is currently no consensus on the optimal sequence of these treatment resources for metastatic patients.We present the case of a 24 year women who was diagnosed with a gastric tumor (could not be biopsied) by imagistics and liver metastatsis. A Pean resection with metastasectomy was done. The histopathology study revealed that the gastric tumor was benign ectopic pancreas tissue and the metastases were actualle of neuroendocrine origin. A somatostatin receptor scintigraphy (OctreoScan) was done which revealed the primary tumor in the ileal mesentery which was resected in a secondary intervention. The patient was started on long acting sandostatin with no recurence.

Hemoperitoneum from Ruptured Uterine Tumor Invading Ileal Mesentery and Mesosigmoid Case report and literature review

Uterine sarcomas are rare but very aggressive gynecologic malignancies. The most frequent signs and symptoms at the moment of diagnosis include abnormal uterine bleeding or diffuse abdomino-pelvic pains while acute abdomen by uterine rupture is an uncommon situation. We present the case of a 72 year old patient who presented in emergency for diffuse abdominal pain and hypotension. An emergency laparotomy was performed and a ruptured uterine tumor with small bowel and sigmoidian serosal invasion and intra-peritoneal bleeding was found. The tumor was resected en bloc with total hysterectomy, bilateral adnexectomy, segmental enterectomy and sigmoidectomy, pelvic and para-aortic lymph node dissection. The histopathological and immunohistochemistry examination revealed a poorly differentiated sarcoma. Although it is a rare condition, a uterine sarcoma can rupture and cause hemoperitoneum; emergency surgery while respecting oncologic principles of complete resection is mandatory.

Laparoscopic treatment of intestinal obstruction due to a vitelline vascular remnant and simultaneous appendicitis: a case report

BackgroundThe presence of a vitelline vascular remnant is rare, and definitive preoperative diagnosis is difficult. We herein describe a case of intestinal obstruction caused by a vitelline vascular remnant with mild chronic appendicitis successfully diagnosed and treated with laparoscopic surgery.Case presentationA 14-year-old male was admitted to our hospital with sudden-onset right lower abdominal pain and vomiting. A blood test on admission revealed slight leukocytosis. Computed tomography scan showed that the appendiceal wall was enhanced and thickened. Although the ileum was slightly dilated and ascites was present at the recto-vesical pouch, these were thought to be inflammatory changes secondary to appendicitis. Laparoscopic surgery was performed using three trocars. Strangulated small bowel obstruction caused by a band connecting the right medial umbilical fold to the ileal mesentery was found intraoperatively. After reduction, neither ischemic change of the small intestine nor Meckel’s diverticulum was detected. The appendix was slightly inflamed, and serous ascites was present at the recto-vesical pouch; therefore, appendectomy was also performed. The patient was discharged on postoperative day 4 without complications. Pathological examination revealed that the band consisted of blood vessels, and it was diagnosed as a vitelline vascular remnant. The appendix included fecal stones and showed chronic inflammatory change histologically; the patient was thus diagnosed with chronic appendicitis.ConclusionsDefinitive preoperative diagnosis of a vitelline vascular remnant, especially with coexisting appendicitis, might be difficult. Laparoscopic surgery might be useful for patients who demonstrate unusual symptoms because it allows for simultaneous diagnosis and treatment.

Pediatric Chylo Lymphatic Mesentric Cyst

Chylolymphatic cysts are rare variants of mesenteric lesions constituting 7.3% to 9.5% of all abdominal cysts displaying variable presentation and having surgical implications in the pediatric age group. The preoperative imaging studies are suggestive however histopathological examination remains the gold standard for diagnosis. A two months old male child was admitted with complaints of bilious vomiting for three days which was initially nonbilious in nature. There were no other significant medical or surgical complaints. X ray abdomen showed evidence of intestinal obstruction.Ultrasound revealed a large cystic lesion in abdominal cavity with internal echos arising from the ileal mesentery on ultrasonography. Subsequently exploratory laparotomy with excision of ileal segment involved by cyst and ileoileal anastomosis was performed and cyst was sent for histopathological examination. On syringing milky white fluid was aspirated which on biochemical analysis confirmed the chylous nature. The histopathological examination revealed an unilocular cyst having a fibrous wall infiltrated by lymphocytes and macrophages and lined by single layer of flattened epithelium with few dilated lymphatic channels consistent with chylolymphatic cyst. Although vary rare, chylomesenteric cyst should be kept as one of the differential diagnosis of cystic masses of the abdomen.

Acute small intestinal inflammation results in persistent lymphatic alterations.

Inflammatory bowel disease (IBD) has a complex pathophysiology with limited treatments. Structural and functional changes in the intestinal lymphatic system have been associated with the disease, with increased risk of IBD occurrence linked to a history of acute intestinal injury. To examine the potential role of the lymphatic system in inflammation recurrence, we evaluated morphological and functional changes in mouse mucosal and mesenteric lymphatic vessels, and within the mesenteric lymph nodes during acute ileitis caused by a 7-day treatment with dextran sodium sulfate (DSS). We monitored whether the changes persisted during a 14-day recovery period and determined their potential consequences on dendritic cell (DC) trafficking between the mucosa and lymphoid tissues. DSS administration was associated with marked lymphatic abnormalities and dysfunctions exemplified by lymphangiectasia and lymphangiogenesis in the ileal mucosa and mesentery, increased mesenteric lymphatic vessel leakage, and lymphadenopathy. Lymphangiogenesis and lymphadenopathy were still evident after recovery from intestinal inflammation and correlated with higher numbers of DCs in mucosal and lymphatic tissues. Specifically, a deficit in CD103+ DCs observed during acute DSS in the lamina propria was reversed and further enhanced during recovery. We concluded that an acute intestinal insult caused alterations of the mesenteric lymphatic system, including lymphangiogenesis, which persisted after resolution of inflammation. These morphological and functional changes could compromise DC function and movement, increasing susceptibility to further gastrointestinal disease. Elucidation of the changes in mesenteric and intestinal lymphatic function should offer key insights for new therapeutic strategies in gastrointestinal disorders such as IBD. NEW & NOTEWORTHY Lymphatic integrity plays a critical role in small intestinal homeostasis. Acute intestinal insult in a mouse model of acute ileitis causes morphological and functional changes in mesenteric and intestinal lymphatic vessels. While some of the changes significantly regressed during inflammation resolution, others persisted, including lymphangiogenesis and altered dendritic cell function and movement, potentially increasing susceptibility to the recurrence of gastrointestinal inflammation.

Mesenteric Lymphatic Malformations in Children: Report of 7 Cases

Introduction Mesenteric lymphatic malformations (MLMs) are rare, the most common etiology being benign proliferation of ectopic lymphatics in the mesentery, with these lymphatics lacking communication with the remainder of the lymphatic system. Case presentation The medical records of 7 patients treated for MLMs at our center between 2001 and 2015 were reviewed. The 7 patients included 4 boys and 3 girls of a median age of 96 months (range: 4–161 months). The main symptoms were abdominal pain in 5 patients, fever in 2, and vomiting in 2. Four of the 5 patients with abdominal pain had elevated inflammatory reactions. Five patients had abdominal masses, and 2 had asymptomatic abdominal masses incidentally diagnosed during infant health checkups. Of the 4 patients with elevated inflammatory reactions, 2 required emergency surgery, and the other 2 underwent surgery after antibiotic treatment. MLMs were located in the jejunal mesentery of 3 patients, in the ileal mesentery in 3, and in the transverse mesocolon in 1. Surgical procedures included excision of the MLMs and adjacent segment of the intestine in 4 patients and cystectomy in 3. No patient experienced recurrence of MLM. Conclusions Clinical features of MLMs can vary from asymptomatic to acute abdominal pain and may affect adjacent organs. MLM should be treated surgically before it can cause serious complications.

Small Bowel Obstruction due to Anomalous Congenital Bands in Children.

Introduction. The aim of the study was to evaluate our children who are operated on for anomalous congenital band while increasing the awareness of this rare reason of intestinal obstruction in children which causes a diagnostic challenge. Patients and Methods. We retrospectively reviewed the records of fourteen children treated surgically for intestinal obstructions caused by anomalous congenital bands. Results. The bands were located between the following regions: the ascending colon and the mesentery of the terminal ileum in 4 patients, the jejunum and mesentery of the terminal ileum in 3 patients, the ileum and mesentery of the terminal ileum in 2 patients, the ligament of Treitz and mesentery of the jejunum in one patient, the ligament of Treitz and mesentery of the terminal ileum in one patient, duodenum and duodenum in one patient, the ileum and mesentery of the ileum in one patient, the jejunum and mesentery of the jejunum in one patient, and Meckel's diverticulum and its ileal mesentery in one patient. Band excision was adequate in all of the patients except the two who received resection anastomosis for intestinal necrosis. Conclusion. Although congenital anomalous bands are rare, they should be considered in the differential diagnosis of patients with an intestinal obstruction.

Congenital Treves' field transmesenteric hernia in children: A case series and literature review

Abstract Transmesenteric hernia is abdominal visceral herniation through a congenital or acquired mesenteric defect. Treves' field is the area of terminal ileal mesentery circumscribed by the ileocolic artery and its last ileal branch. It is very susceptible to congenital defects. To clarify the clinical course of congenital Treves' field transmesenteric hernia (cTFTH), we retrospectively reviewed pediatric cases and conducted a literature review. Five consecutive pediatric cTFTH cases (one male, four females) underwent emergency laparotomy at our institutions from April 2009 and December 2014. We analyzed their demographics, preoperative findings, surgical procedures, and outcomes, along with a literature review. Abdominal plain X-ray showed displaced intestinal gas with gas paucity in the center of the abdomen in two cases and diffusely increased intestinal gas in two others. Abdominal computed tomography (CT) in four cases showed intestinal loop clusters, mesenteric vessel changes, small-bowel obstruction, and ascites. All cases underwent emergency laparotomy for ileal resection with ileocecal valve preservation. Simultaneous anastomoses were performed in four cases; the remaining case underwent ileostomy because of prematurity. Although one case needed reoperation for postoperative bowel obstruction, all patients survived. Literature review of pediatric cTFTH showed a high frequency of necrosis (70.5%) and mortality (26.5%). Among pediatric cTFTH cases, 67.6% were aged

Alternative ileal flap for bladder augmentation if mesentery is short

To date the clam ileocystoplasty is the preferred method of bladder augmentation in children when the urodynamic problem is non-compliance and/or detrusor overactivity. The key to this technique is the incision of the bladder wall deep into the pelvis down to the trigone in order to avoid a diverticulum like neobladder and to provide adequate margin for augmentation. The detubularised ileum flap therefore has to reach to the bottom of the divided bladder on a reliable vascular pedicle without significant tension. A short ileal mesentery caused by previous surgery, peritonitis, peritoneal dialysis or ventriculo-peritoneal shunt may complicate surgery and compromise outcome. We hypothesized we can rely on the communication of the intramural vessels within the intestine and can detubularise the ileum adjacent to the mesentery rather than along the antimesenteric line and this could be combined with ligation of some vasa recta (VR) in order to create alternative ileum flaps, which reach further into the pelvis. Our aim was to assess the viability of the alternative flaps detubularised along the paramesenteric line and measure how many VR could be sacrificed beyond the tertiary arcades. After ethical approval adjacent ileal segments were detubulirased along the antimesenteric line (Group 1) and along the paramesenteric line (Group 2) in 5 minipigs in general anaesthesia. Ligation of 0,1,2,3 and 4 VR has been performed starting from the free end of the segments. The length of the ileal flaps was recorded. The microcirculation of flap edges was detected by in vivo microscopy using orthogonal polarising spectral imaging (Cytoscan A/R Cytometrics, PA, USA). Clam ileocystoplasty was performed with the ileum detubularised along the paramesenteric line without ligation of VR. Specimens of the augmented bladder were obtained after 4 weeks and stained with Hematoxilin + Eosin. No alteration in capillary red blood cell velocity (RBCV) and perfusion rate (PR) was observed after paramesenteric detubularisation. The flaps in Group 2 reached 20.25 ± 0.5 mm longer vs. This is 98% of the mean bowel width (20.5 ± 0.57 mm) measured in the animals. Ligation of each VR further increased the length of both flaps (mean: 10.59 ± 3.18 mm) however ligation of more than 2 VR gradually decreased the microcirculation in both groups. All animals augmented with alternative flap survived, there was no urine leak or suture break down. Histology confirmed viable bowel flaps. Paramesenteric detubularisation of the ileum is fully tolerated and results in longer reaching ileal flap vs. Only limited ligation of VR is tolerated. This study showed the first time that clam ileocystoplasty is feasible with ileal flap detubularised along the paramesenteric line. The use of the animal model and the relative short postoperative observation are the main limitations of this study.

Congenital transmesenteric hernia in a neonate.

Congenital transmesenteric hernia in neonates is a rare cause of intestinal obstruction with devastating outcomes. Patients are often managed with urgent surgical exploration and may require extensive bowel resection.[1-3] We present a case of a newborn presenting with intestinal obstruction found to have a strangulated transmesenteric hernia through a congenital defect in the ileal mesentery, which was managed successfully.

A Urachal Cyst Case with Painful Mass Locates at Ileal Mesentery

Urachal cyst is an unusual clinical condition, which is usually asymptomatic. In some adult cases, it may lead to complications. The cyst is between umbilicus and urinary bladder. It is diagnosed via ultrasonography and computed tomography. However, in some cases, the diagnosis is made by means of surgical exploration and histopathological evaluation. In this paper, we report a case of a 17-year-old female presenting with painful abdominal mass. At the first evaluation, the case was diagnosed as a mesenteric cyst because the mass located in the mesentery, and final histopathological report revealed the urachal cyst.