Mesentery Of Small Intestine Research Articles

Clinical characteristics and risk factors for acute abdomen in patients with abdominal lymphatic malformations

ObjectiveThe diagnosis of abdominal lymphatic malformations (ALMs) is often overlooked in clinical practice. However, reports in the literature about ALMs are limited to case reports/series with small sample sizes. This study aimed to review our currently available data to describe the clinical characteristics of ALMs and evaluate the risk factors for acute abdomen caused by ALMs. MethodsWe reviewed the records of patients with ALMs who were diagnosed between December 2008 and January 2023 in our institution. The associations between acute abdomen and ALMs were analyzed based on single-factor and multivariate logistic regression analyses. ResultsThis study included 345 patients with pathologically confirmed ALMs, with a slight female predominance of 1:1.4. Approximately 39.1% (135/345) of patients were asymptomatic, and 24.6% (85/345) presented with acute abdomen. Among the ALMs in the cohort, 42.6% (147/345) were retroperitoneal lymphatic malformations (LMs). The maximal lesion dimensions in patients with acute abdomen and nonacute abdomen were 10.0 cm and 7.8 cm, respectively, with no significant difference based on multivariate analyses. Children were more likely to develop acute abdomen than adults were (P=0.002; odds ratio [OR], 5.128; 95% confidence interval [CI], 1.835-14.326). ALMs accompanying acute abdomen were more common for lesions involving the small intestinal mesentery (P=0.023; OR, 2.926; 95% CI, 1.157-7.400). ConclusionALMs are rare with insidious onset, and retroperitoneal LMs are the most common ALMs, followed by jejunal MLMs. Our retrospective analysis suggested that young age and small intestinal mesenteric lymphatic malformation are independent risk factors for acute abdomen with ALMs.

Ameliorative Effects of Larazotide Acetate on Intestinal Permeability and Bacterial Translocation in Acute Pancreatitis Model in Rats.

Intestinal barrier dysfunction in acute pancreatitis (AP) may progress to systemic inflammatory response syndrome (SIRS) and multi-organ failures by causing bacterial translocation. Larazotide acetate (LA) is a molecule that acts as a tight junction (TJ) regulator by blocking zonulin (Zo) receptors in the intestine. In our study, we aimed to investigate the effects of LA on intestinal barrier dysfunction and bacterial translocation in the AP model in rats. Thirty-two male Sprague-Dawley rats were divided into 4 groups; control, larazotide (LAR), AP, and AP + LAR. The AP model was created by administering 250 mg/100 g bm L-Arginine intraperitoneally 2 times with an hour interval. AP + LAR group received prophylactic 0.01 mg/mL LA orally for 7 days before the first dose of L-Arginine. For intestinal permeability analysis, fluorescein isothiocyanate-dextran (FITC-Dextran) was applied to rats by gavage. The positivity of any of the liver, small intestine mesentery, and spleen cultures were defined as bacterial translocation. Histopathologically damage and zonulin immunoreactivity in the intestine were investigated. Compared to the control group, the intestinal damage scores, anti-Zo-1 immunoreactivity H-Score, serum FITC-Dextran levels and bacterial translocation frequency (100% versus 0%) in the AP group were significantly higher (all p < 0.01). Intestinal damage scores, anti-Zo-1 immunoreactivity H-score, serum FITC-Dextran levels, and bacterial translocation frequency (50% versus 100%) were significantly lower in the AP + LAR group compared to the AP group (all p < 0.01). Our findings show that LA reduces the increased intestinal permeability and intestinal damage by its effect on Zo in the AP model in rats, and decreases the frequency of bacterial translocation as a result of these positive effects.

Laser speckle contrast imaging for intraoperative assessment of intestinal microcirculation in normo- and hypovolemic circulation in a porcine model

Introduction: Healing is essential for successful colorectal surgery. Optimal microcirculation is needed to ensure this; however, this is only subjectively assessed by the surgeon. Laser Speckle Contrast Imaging (LSCI) is an objective non-contact, image-based method to quantify microcirculation in bowel ends. This study aimed to evaluate the application of LSCI in an open surgery porcine model, determine differences between normal and impaired microcirculation, and test the LSCI applicability to repeated measurements. Method: A midline laparotomy was made in ten healthy female pigs to expose the colon and small intestine. Subsequently, baseline measurements were conducted. A local arteria supplying the colonic or small intestine mesentery was clamped for 5 min. and LSCI measures were made again. After an hour’s rest, LSCI measurements were done in two unaffected areas on the colon and the small intestine, and baseline values were recorded. Hypotension was induced with rapid bleeding and LSCI measurements were done. After the mean arterial blood pressure (MAP) dropped to 50-60 mmHg, norepinephrine infusion was started. At a stable MAP of 85-100 mmHg, LSCI measurements were repeated at 0 min. and 30 min. during continuous norepinephrine infusion. Results: Cross-clamping caused LSCI levels to drop equally in both the colon and small intestine by 60% in the entire the clamped zone. Compared to baseline, the microcirculation measured by LSCI in the unclamped adjacent transition zone was diminished by 33% and 40%, colon and small intestines, respectively. During hypotension due to bleeding, LSCI decreased as expected. When MAP was stabilized by norepinephrine infusion, LSCI values dropped further: compared to baseline, measurements decreased with 24% and 20% in colon and small intestines, respectively. Conclusion: LSCI can be used as a quantitative, real-time, non-contact method to detect changes in the microcirculation during open intestinal surgery with large changes in microcirculation due to e.g., hypovolemic and norepinephrine infusion. It is simple to use and in contrast to the existing intraoperative microcirculation assessment techniques, LSCI stands out primarily for its elimination of the requirement for a dye. As our study has shown, this feature allows us to perform time-independent measurements and repeat them indefinitely in nearby regions without compromising the effectiveness of the method.

A case of lymphatic flow evaluation using indocyanine green fluorescence imaging for recurrence of anastomotic site after laparoscopic right hemicolectomy

BackgroundAnastomotic recurrence of colorectal cancer is rare, but reoperation improves prognosis. However, there is no clear evidence regarding the extent of dissection, and there are few reports on the details of surgery. We used intraoperative lymphatic flow imaging with indocyanine green (ICG) fluorescence as a reference to determine the range of additional resection.Case presentationThe patient was a 75-year-old man who underwent laparoscopic right hemicolectomy and extracorporeal functional terminal anastomosis for ascending colon cancer 4 years ago. Histopathological examination revealed a well-differentiated tubular adenocarcinoma, T4aN0M0, pathological stageIIB. During follow-up, anemia was observed, and colonoscopy indicated anastomotic recurrence, so additional laparoscopic resection was performed. Intraoperatively, ICG was injected into the anastomotic site, and the operation proceeded under near-infrared light observation. Lymphatic vessels along the middle colonic artery were visualized down to the root of the vessel. Using this as an indicator, the vessel was ligated from the root. Using the fact that the lymphatic vessels were also depicted in the small intestinal mesentery on the oral side of the anastomosis as an indicator, the small intestine and mesentery were resected about 7 cm from the anastomosis.ConclusionsThe optimal surgical approach for anastomotic recurrence of colorectal cancer has not been defined. Intraoperative ICG fluorescence imaging can provide images of lymphatic flow from the site of recurrence and may be an indicator of lymph node dissection in the case of anastomotic recurrence.

Morphological changes in the small intestine mesentery of cats with infectious peritonitis

The research relevance is determined by an insufficient study of morphological changes in the mesentery of cats with infectious peritonitis, even though their understanding is necessary to explain the mechanism of development of the main symptom of the disease – the effusion of fluid into the abdominal cavity. The research aims to establish gross and microscopic changes in the mesentery of the small intestine of cats with infectious peritonitis. The research employs gross and histological examination of the mesentery of the small intestine of cats at the infectious peritonitis. Slides of the mesentery were stained with haematoxylin and eosin. At dry and mixed forms of infectious peritonitis, gross and microscopic changes in the mesentery of the small intestine of cats are similar. In the mesentery grossly, small white spots were found, which protruded above the general surface and had a homogeneous appearance on the section. Microscopic changes in the mesentery of the small intestine of cats with dry and mixed forms of infectious peritonitis were also similar. When conducting histological studies, it was established that the mesothelium on the surface of the mesentery was necrotized or absent. The submesothelial layer of collagen fibres was necrotized or contained partially lysed and fragmented fibres. The loose fibrous connective tissue of the mesentery was swollen, necrotized in places, and infiltrated by lymphocytes, monocytes, and macrophages. Eosinophilic inclusion bodies were detected in the cytoplasm of some monocytes and macrophages. Foci of adipose tissue in the mesentery of the small intestine were infiltrated by lymphocytes and monocytes. Necrosis and destruction of their walls were found in blood vessels and destruction of endothelial cells in lymphatic vessels. Perivascular lymphoid nodules were markedly enlarged due to their swelling and an increase in the number of cells in them. In perivascular lymphoid nodules, expansion of lymphatic vessels and destruction of part of their endothelium cells were also established. Some of the lymphatic vessels of the mesentery were expanded and filled with lymph, which contained a significant number of lymphocytes, monocytes, and single neutrophils. The materials presented in the article are of practical value for anatomists, histologists and pathomorphologists, as well as for scientists who study the pathogenesis of infectious peritonitis in cats

Castleman disease. A rare clinical case of retroperitoneal tumor localization in an elderly patient

Castleman disease is an extremely rare benign disease of the lymphatic system with an estimated incidence of 1–9 cases per 1,000,000. Its etiology remains unknown; interleukin 6 (IL-6) plays an important role in pathogenesis. Castleman disease has two clinical forms: localized (up to 90 % of cases) with a favorable prognosis, treated predominantly by surgical method; generalized (up to 10 % of cases) with less favorable prognosis, treated by pharmacological therapy. The diagnosis is rarely established at the preoperative stage.The aim. To present a clinical case of diagnosis and treatment of Castleman tumor of a rare topical localization.Results. A 66-year-old patient was admitted at the Abdominal Oncology Department of the G.E. Ostroverkhov Kursk Oncology Scientific and Clinical Center.Diagnosis: Retroperitoneal mass on the right found at the preventive examination; no peripheral lymphadenopathy was detected on ultrasound and computed tomography (CT). After the examination, a preliminary diagnosis was made: Gastrointestinal stromal tumor (GIST) of the small intestine mesentery. Based on the results of the case conference, the decision was taken to perform a surgery – laparoscopic removal of the tumor under endotracheal anesthesia. For surgical approach, a fan-shaped arrangement of ports was chosen. The surgery had no complications. Intraoperative blood loss was 50.0 ml. The total operating time was 98 minutes.According to the results of the histological study, the following diagnosis was made: Castleman disease, unicentric form, hyaline-vascular variant. En bloc surgery is the standard method for the treatment of localized forms of the Castleman disease. In all cases, long-term follow-up shows a long relapse-free period in almost all patients.During follow-up examinations (ultrasound of the abdominal cavity and retroperitoneal space, CT of the abdominal cavity with contrast enhancement, CT of the chest), no disease recurrence was detected during the year of observation.Castleman disease is a rare non-clonal lymphoproliferative disease of unknown etiology. A rare case of its retroperitoneal localization indicates that in cases with an uncertain nature of the peritoneal mass, Castleman disease should be included in the differential diagnostic search.

Desmoid-type fibromatosis of the mesentery: a clinicopatho-logical and genetic analysis of 9 cases.

Nine cases of mesenteric desmoid-type fibromatosis were diagnosed and treated in Taizhou Hospital, Wenzhou Medical University between January 2010 and May 2022, including 2 females and 7 males, aged 16 to 59 years. The lesions were in the mesentery of small intestine with 7 cases, ileocecal junction with 1 cases and transverse colon with 1 case. The tumors had an unclear boundary and no envelope, the section was solid, gray and tough. The mean maximum diameter was (10.7±8.5) cm (range 3.5-33.0 cm). Microscopically, fusiform fibroblasts and myofibroblasts were parallel, bunched or staggered, buried in a large amount of extracellular collagen. The cell morphology was relatively consistent, without obvious atypia, and mitosis was rare. Immunohistochemistry showed that the tumor cells were positive for vimentin (9/9), β-catenin (9/9), while smooth muscle actin (5/9) stains were focally positive. Ki-67 proliferation index was 1%-10%. Cytokeratin Pan, S-100, STAT6, CD117, DOG1, CD34, desmin and anaplastic lymphoma kinase stains were negative. Genetic analysis showed that there were 7 cases of c.121G>A(p.Thr41Ala) mutation of CTNNB1 gene, 1 case of c.121G>A(p.Thr41Ala) and 1 case of c.134C>T(p.Ser45Phe) double mutation, and 1 case of wild type. Tumors were surgically resected in all 9 cases. Eight cases had no recurrence or metastasis, 1 case had recurrence 6 months later, and no recurrence or metastasis after additional surgical resection.

Acute abdominal pain due to sigmoid volvulus with persistent descending mesocolon: a case report

BackgroundPersistent descending mesocolon, an anomaly of fixation of the mesentery of the descending colon, can sometimes cause complications such as intestinal obstruction and intussusception. We present the first reported case of sigmoid volvulus with persistent descending mesocolon.Case presentationAn 82-year-old Japanese man had intermittent lower abdominal pain. Abdominal computed tomography showed dilation and a shift to the right side of the sigmoid colon, but no findings of volvulus. The next day, he presented continuous lower abdominal pain with bloody stool. A second abdominal computed tomography showed strangulation and dilation of the sigmoid colon, with shift from the right side of the abdominal cavity to the pelvic space. This suggested the descending colon was running to the medial side with sigmoid volvulus. Emergency surgery was performed for volvulus with persistent descending mesocolon. Operative findings revealed dilation of the sigmoid colon with a partial poorly colored region and strangulation that caused volvulus. After releasing the strangulation of the sigmoid colon, the descending colon was revealed to be running more to the medial side, with adherence to small intestinal mesentery. There was no Toldt’s fusion fascia at the descending colon. Persistent descending mesocolon was therefore diagnosed due to abnormality of fixation of the descending colon. The sigmoid colon, including the poorly colored region, was resected and reconstructed, while the inferior mesenteric and left colonic arteries were preserved because of the complexity of the vascular system running around the descending and sigmoid colon due to the shortened mesentery. These findings were pathologically compatible with circulatory compromise and intestinal degeneration due to sigmoid volvulus. The patient had no complications after discharge, including in relation to defecation.ConclusionPersistent descending mesocolon can occasionally cause acute abdominal symptoms requiring immediate treatment. A computed tomography finding of the descending colon running more to the medial side than ordinary cases can aid diagnosis of persistent descending mesocolon.

Tomographic findings in peritoneal tuberculosis: case report

Introduction: Peritoneal tuberculosis (TBCP) is a diagnostic challenge because the clinical, radiological and laboratory findings are nonspecific and can be confused with other pathologies. Presentation of the clinical case: Patient who consulted for intense abdominal pain, fever and diarrhea. TBCP was suggested based on abdominal CT findings, which was confirmed by histopathological analysis of parietal peritoneum biopsy and granulomatous lesions of the small intestine mesentery. The patient received an antituberculous regimen and was discharged from the hospital. Discussion and literature review: CPTB represents between 25-50% of abdominal tuberculosis cases and 0.1-0.7% of all tuberculosis cases, its clinical presentation includes ascites, abdominal pain, fever and diarrhea, making it indistinguishable from tuberculosis. Bacterial peritonitis and other chronic abdominal conditions. Conclusions: The diagnosis of TBCP is a challenge, however, the tomographic findings provide information that increases its suspicion and helps to avoid treatment delay and complications.

Endoscopic classification and pathological features of primary intestinal lymphangiectasia.

BACKGROUNDThe appearance of the intestinal mucosa during endoscopy varies among patients with primary intestinal lymphangiectasia (PIL).AIMTo classify the endoscopic features of the intestinal mucosa in PIL under endoscopy, combine the patients’ imaging and pathological characteristics of the patients, and explain their causes.METHODSWe retrospectively analyzed the endoscopic images of 123 patients with PIL who were treated at the hospital between January 1, 2007 and December 31, 2018. We compared and analyzed all endoscopic images, classified them into four types according to the endoscopic features of the intestinal mucosa, and analyzed the post-lymphographic computed tomography (PLCT) and pathological characteristics of each type.RESULTSAccording to the endoscopic features of PIL in 123 patients observed during endoscopy, they were classified into four types: nodular-type, granular-type, vesicular-type, and edematous-type. PLCT showed diffuse thickening of the small intestinal wall, and no contrast agent was seen in the small intestinal wall and mesentery in the patients with nodular and granular types. Contrast agent was scattered in the small intestinal wall and mesentery in the patients with vesicular and edematous types. Analysis of the small intestinal mucosal pathology revealed that nodular-type and granular-type lymphangiectasia involved the small intestine mucosa in four layers, whereas ectasia of the vesicular- and edematous-type lymphatic vessels largely involved the lamina propria mucosae, submucosae, and muscular layers. CONCLUSIONEndoscopic classification, combined with the patients’ clinical manifestations and pathological examination results, is significant and very useful to clinicians when scoping patients with suspected PIL.

150 When the maternal abdomen holds more than just a baby - an unexpected finding in a 15-year-old patient’s cesarean section

Introduction and aims of the study: Lymphangiomas are rare and benign cystic lymphatic tumors. Less than 1% occur in small intestine mesentery. The authors describe the incidental finding of such a mesenteric tumor in a 15-year-old patient’s emergent cesarean section. Methods: Clinical information was obtained from CHTMAD’s Obscare® and SClinico® databases. Results: A 15-year-old pregnant patient was referred to CHTMAD’s outpatient obstetrical clinic at 32 weeks due to inadequate pregnancy surveillance.

Jejunal intussusception due to an atypical lipomatous tumor: a rare case report.

Intussusception in adults is rare, and the clinical symptoms of intussusception are subtle, making the diagnosis quite challenging. Gastrointestinal lipomas are rare benign tumors and are essentially adipose growths, most frequently found within the small intestine wall or mesentery. Limited up-to-date evidence exists regarding such lipomas. Intussusception due to a gastrointestinal lipoma constitutes an infrequent clinical entity, and the diagnosis of duodenal lipoma mainly depends on endoscopy examination, supplemented by computed tomography and magnetic resonance imaging. The present report describes a case of jejunal intussusception in an adult with a history of intermittent colicky abdominal pain located in the left upper quadrant over the last month. Contrast-enhanced computed tomography of the abdomen showed the typical target sign of a small intestinal intussusception along the left upper quadrant and a well-defined, low-density tumor in the intussusception. Exploratory laparotomy revealed jejuno-jejunal intussusception secondary to a lipoma, which was successfully treated with segmental intestinal resection.

Robot-assisted laparoscopic low anterior resection for rectal cancer with persistent descending mesocolon: A case report.

IntroductionPersistent descending mesocolon (PDM) is a fixed abnormality in which the descending to sigmoid colon adheres to the small intestinal mesentery or right pelvic wall through right displacement. Surgery for colorectal cancer with PDM is difficult. Therefore, in addition to the anatomical characteristics of PDM, the extent of adhesion and characteristics of vascular courses need to be assessed in individual patients. The number of patients now undergoing laparoscopic or robot-assisted surgery for colorectal cancer has rapidly increased. We herein report a rectal cancer patient with PDM who safely underwent robot-assisted laparoscopic low anterior resection (RLAR).Presentation of caseA 71-year-old male was referred to our hospital for a detailed examination following a fecal occult blood-positive reaction. Lower gastrointestinal endoscopy revealed a type 2 lesion of the rectum. Moderately differentiated adenocarcinoma was diagnosed based on the results of a histopathological examination. Preoperative contrast-enhanced thoracoabdominal computed tomography showed abnormalities in the colonic course and characteristic vascular courses, suggesting rectal cancer with PDM. RLAR was performed.DiscussionIn surgery, it is important to initially perform adhesiolysis accurately in order to reconstruct the original shape of the colonic mesentery and confirm/dissect vascular bifurcations due to the risk of marginal arterial injury.ConclusionIn the present case, a detailed anatomical understanding of the site of intestinal adhesion and vascular courses, as well as surgical procedures, facilitated safe RLAR. We described this case and reviewed the anatomical characteristics of PDM and cautions for surgery.

A fetus excised from the small intestinal mesentery of a neonate (fetus in fetu): a case report

BackgroundFetus in fetu is a rare congenital anomaly. Its incidence is 1/500,000 births. So, pediatric surgeons may encounter this pathology only once or twice during their professional careers.Case presentationWe present a rare case of a fetus extracted from the small intestinal mesentery of a healthy neonate who was explored after delivery. The extracted fetal mass included a fully differentiated skull and limbs with a celomic cavity. The fetal mass was supplied by a main feeding vessel branching from the superior mesenteric artery.ConclusionFetus in fetu, despite being a rare variant, must be kept in mind when dealing with a neonatal abdominal mass showing bony parts on radiography.

Closed loop intestinal obstruction secondary to Ileo-sigmoid knotting (ISK) – A diagnostic challenge

Intestinal obstruction due to Ileo-sigmoid knotting is a very rare phenomenon associated with high mortality rate leading to bowel gangrene and peritonitis. We present a rare cause of closed loop intestinal obstruction in a 46-year-old male patient who presented to the emergency department with complaints of severe abdominal pain, distension and multiple episodes of vomiting in the past 1 day. Prompt resuscitation and exploratory laparotomy revealed knotting of the sigmoid colon around the mesentery of small intestine with segmental gangrene of both sigmoid colon and small intestine. Resection of the gangrenous ileal segment with end-to-end anastomosis followed by Hartman’s procedure to the gangrenous sigmoid colon was performed. Ileo-sigmoid knotting is a surgical emergency with rapid progression to bowel gangrene and peritonitis leading to sepsis and has a very high mortality. Early diagnosis, fluid resuscitation and prompt surgical intervention are key steps towards management.

Small Bowel Obstruction as a Rare Complication of Progressive Sclerosing Mesenteritis

Abstract Introduction/Objective Sclerosing Mesenteritis is an uncommon, idiopathic, localized inflammatory syndrome involving the small intestine and colonic mesentery. It is considered a benign condition that commonly occurs in elderly with a gender predilection for males, and its etiology remains unknown. Small Bowel Obstruction (SBO) is a rare, unexpected, but detrimental complication of progressive Sclerosing Mesenteritis. Herein, we present a case of an enlarging, progressive Sclerosing Mesenteritis with extensive involvement of the small bowel and mesentery requiring two consecutive major surgical interventions. Methods/Case Report A 72-year-old male with Myelodysplastic Syndrome (MDS) and recent history of loop ileostomy due to distal intestinal obstruction secondary to enlarging Sclerosing Mesenteritis, presented to our institution with non-specific symptoms of worsening abdominal pain and multiple episodes of gastrointestinal bleeding. Radiographic investigation revealed SBO and he subsequently underwent exploratory laparotomy resulting in total enterectomy with excision of mesenteric mass, extended right colectomy, Whipple procedure, and gastrostomy. The specimens were sent to pathology for histopathological evaluation and gross examination revealed several bosselated, tan-white, firm and rubbery, fibrotic lesions with associated lobulated fibroadipose tissue. Microscopic examination showed extensive mesenteric fibrosis with dense bundles of collagen fibers, areas of fat necrosis, mucosal ischemia and calcification involving the small bowel and serosal surface of large intestine and peritoneum. The lesional cells showed minimal atypia, mitoses, and lacked the Beta-catenin nuclear staining seen in mesenteric fibromatosis. Given the clinical history and histopathological findings of the lesion, we favored the diagnosis of Sclerosing Mesenteritis. Results (if a Case Study enter NA) N/A Conclusion The etiology of Sclerosing Mesenteritis is not well-understood and there are cases of Sclerosing Mesenteritis reported in the literature in association with trauma, surgery, malignancy, and IgG4-related disease. Our patient’s post-operative history was complicated by short gut syndrome, and he is currently requiring small bowel transplant. We report this case for its unusual and aggressive clinical presentation, and to heighten clinical awareness for detrimental consequences of this seemingly benign condition.

Clinical and Variant Anatomy of the Blood Supply to the Body and Tail of the Human Pancreas

The aim of the study was to specify peculiarities of the blood supply to the body and tail of the human pancreas determining topographic variants and vascular bed of the splenic artery.Material and methods. The artery basin of the pancreas body and tail was studied in 46 native and 42 organ complexes consisting of the pancreas, duodenum, spleen, retropancreatic tissue, celiac trunk with the main branches, a section of the superior mesenteric artery up to the entrance into the root of the small intestine mesentery with the preliminary artery injection by gelatin mass. The organ complexes were fixed in 10% formalin solution.Results. The study revealed two variants of the splenic artery topography in relation to the pancreas and determined the degree of tortuosity of the artery. In 31.7% of cases the vessel passed retro-pancreatically and in 68.3% suprapancreatically. Moderate tortuosity of the splenic artery was detected most frequently (44.82%); in 34.48% of cases severe tortuosity was detected; in 17.24% of cases there was no tortuosity in the artery. The correlation between area/convolution and the number of pancreatic arteries was found to be 0.864 (p=0.05), which is considered to be a high parameter according to the Cheddock scale. In severe tortuosity of the splenic artery 3.16±0.37 pancreatic arteries on average closed to the corpus caudal segment of the pancreas, in moderate tortuosity – 5.09±1.24, in straight passage – 9±1.22.Conclusion. The regularities revealed in the spleen artery topography, blood supply of the pancreas body and tail allow determining operational risks and tactics of surgical interventions on the corpus caudal segment of the pancreas.

Risk factors for failure of ileal pouch-anal anastomosis in patients with refractory ulcerative colitis

BackgroundProctocolectomy with ileal pouch-anal anastomosis is the standard surgical procedure for ulcerative colitis refractory to medical treatment. In a few cases, ileal pouch-anal anastomosis cannot be completed due to intraoperative technical problems. The aim of this single-center study was to identify risk factors for a technically failed ileal pouch-anal anastomosis. MethodsIn total, 391 patients with ulcerative colitis who received ileal pouch-anal anastomosis were identified. Clinical and perioperative data from patients with successful ileal pouch-anal anastomosis (IPAA+) were compared to data from failed ileal pouch-anal anastomosis (IPAA-). Definition of failed ileal pouch-anal anastomosis was intraoperative failure to perform ileal pouch-anal anastomosis. Risk factors for failed ileal pouch-anal anastomosis were assessed by logistic regression. Cut-off values were calculated on the basis of receiver operating characteristic curves and the Youden Index. ResultsThe rate of failed ileal pouch-anal anastomosis was 26 of 391 (6.6%). In 22 of 26 cases (84.6%), there was an insufficient length of the small intestinal mesentery. Patients with failed ileal pouch-anal anastomosis were more often male (80.8% vs 54.5%, P = .009), older (47.1 ± 14.1 vs 39.2 ± 12.8 years, P = .007), had a higher body mass index 27.2 ± 4.5 vs 23.7 ± 4.3 kg/m2, P < .001), and had extraintestinal manifestations more frequently (65.4% vs 26.3%, P < .001). Further risk factors for failed ileal pouch-anal anastomosis were hypertension and Cushing’s syndrome. ConclusionTechnical failure of ileal pouch-anal anastomosis is elevated in patients with higher body mass index, with refractory ulcerative colitis, and/or extended immunosuppressive medication. Three-staged ileal pouch-anal anastomosis and optimizing preoperative conditions may help to elevate the rate of successful ileoanal pouch construction in these patients.

An unusual origin of liposarcoma in an elderly man: a case report

Liposarcoma is a type of cancer with mesenchymal origin in which the bulk of tumor differentiates into adipose tissue. Liposarcoma can be found in any part of the body with fat cells, but most cases occur in the muscles of the limbs or in the retroperitoneum. Here we report a case of an elderly man with an uncommon origin of liposarcoma. A 76-year-old man presented to hospital with gastrointestinal symptoms and a palpable mass over lower abdomen. Abdominal computer tomography revealed colonic tumor with another huge intraperitoneal mass, looks like originated from mesentery of small intestine. The patient underwent an exploratory laparotomy. During operation, despite colon cancer, a 17cm mass, originated from distal ileum mesentery was noted. The specimen histopathology of the tumor resection showed well-differentiated liposarcoma with prominent myxoid stroma. Finally, the patient was discharged on the tenth postoperative day. Most of liposarcomas origin from the extremities, retroperitoneum and inguinal region. However, we have chance to find liposarcomas everywhere in our body. In our case, it was a liposarcoma derived from mesentery of small intestine and it had few reports before.

Lymphflow stimulation in microvessels of lung peptides in acute lung edema

Introduction . The relevance of the problem of high mortality in acute lung edema (ALE) is associated with the insufficient effectiveness of treatment methods for extreme rapidly occurring lung pathology. The goal is a comprehensive study of the role of lymph flow stimulation using a lymph-stimulating peptide in the pathogenesis of ALE under conditions of lung biomicroscopy. Materials and methods . Biomicroscopy of the lungs using an implanted chamber and mesentery of the rat small intestine, laser Doppler lung flowmetry, morphological and histological examination of the lungs. Registration of contractile activity of the wall, valves of the lymphatic microvessels of the mesentery by photometry and the rate of lymph flow; determination of the diameter of microvessels, solids and pulmonary coefficient in the lungs. photo and video registration of the lungs. Results . The direct peptidic lymphostimulant caused activation of lymphatic flow in the lymphatic microvessels of the mesentery and lungs in patients with ALE, followed by restoration of microcirculation in the lungs. The reduction and elimination of edema of the interstitial space in the lungs was associated with the restoration of the diameter of the lymphatic and venous microvessels. Prophylactic use of the peptide was accompanied by an increase in animal survival by 3 times. The use of the peptide after the ALE did not affect survival, however, it increased the life expectancy of rapidly dying animals during the first 10 min up to a day from 16 to 46 %. Conclusions . Activation of motility of the lymphatic microvessels and lymph flow in ALE with the help of a peptidic lymphostimulator, an agonist of the delta opiate receptors, helps to eliminate edema as a result of removing excess interstitial fluid through the lymphatic vessels of the lungs to the main venous collectors and then to the right atrium, than reduces the load on the left half of the heart with cardiogenic ALE. The restoration of microlymph- and microhemocirculation in the lungs contributed to the restoration of the structure of the lung tissue and a 3-fold increase in the survival and longevity of animals. Activation of the lymphatic system is an effective, but unused reserve of the body playing an important role in the pathogenesis of ALE.