Mesentery Of Terminal Ileum Research Articles

Measurement of the stiffness of the normal terminal ileum mesentery using shear-wave elastography

ObjectiveTo investigate the feasibility of using shear-wave elastography (SWE) to measure the stiffness of the normal terminal ileum mesentery, and to establish its normal reference range. MethodsNinety-five normal subjects and 22 patients with mesentery-related disease were included. The average Young's modulus of the normal terminal ileal mesentery was measured by SWE ultrasound. The thickness and the extent to which mesenteric fat extended around the intestinal circumference of the normal terminal ileum were also recorded. The normal reference range was established and the SWE values of normal and diseased subjects were compared. ResultsTransabdominal SWE examination of the terminal ileum mesentery was successfully performed on 91 subjects (95.8 %). The mean extent range, thickness, and SWE value of the normal terminal ileum mesentery were 1/4 (1/5–1/3), 6.8 ± 2.4 mm, and 4.3 ± 2.1 kPa, respectively. These parameters did not differ significantly between genders, and across age and body mass index groups (all P > 0.05). The intra- and inter-operator consistencies were excellent for the replicated SWE measurements (0.801 [95 % confidence interval: 0.560–0.916] and 0.751 (95 % confidence interval: 0.388–0.900], respectively). The mean mesenteric elasticity in diseased subjects was 21.9 ± 10.7 kPa, which was significantly higher than that in normal subjects (P < 0.001). The cut-off value for mesenteric elasticity was 9.3 kPa, with a sensitivity of 90 % and a specificity of 100 % (P < 0.001). ConclusionSWE can be used to reliably evaluate the stiffness of the terminal ileum mesentery in normal subjects.

Cecum Necrosis with Terminal Ileum Perforation Due to Invasive Fungal Infection in a Patient with Diabetes Mellitus and Acute Myeloid Leukemia: A Case Report

Introduction: Immunosuppression conditions are the leading risk factors for opportunistic fungal infections. The clinical manifestation is related to the site of infection. Gastrointestinal (GI) mucormycosis is a rare form of this disease, even in immunosuppressed patients. Case Presentation: We report rare cecum necrosis with terminal ileum perforation resulting from infiltration of mucormycosis in the cecum wall and terminal ileum mesentery in a patient with diabetes mellitus and acute myeloid leukemia (AML). During chemotherapy for AML, the patient presented diarrhea followed by constipation, severe progressive abdominal pain, and fecaloid peritonitis. Perforation of the terminal ileum was observed during the surgery. Ileostomy, right hemicolectomy, and resection of necrotic tissue were performed, and bowel mucormycosis was confirmed on histologic examination. Unfortunately, the patient expired five days after surgery. Conclusions: Gastrointestinal mucormycosis is an uncommon infection with symptoms like abdominal pain, nausea, vomiting, and melena. The mortality of GI involvement is due to perforation, peritonitis, and GI bleeding.

Right retrocolic intrasaccular duodenum: Is it a novel variant of isolated duodenal nonrotation? A case report

Background: Almost all of the studies on anomalies of the midgut rotation and fixation in the literature and related sections in textbooks were designed according to Dott's classification. Focusing only on common rotation anomalies has led to the exclusion and neglect of other rare variants. Isolated pure duodenal nonrotation is such a variant. Case Presentation: We report a case of an unusual form of isolated pure duodenal nonrotation, in a 3-day-old newborn presenting with bilious vomiting. Ultrasonographic examination revealed the sign of 'whirlpool'. When this finding was evaluated together with bilious vomiting, midgut volvulus was considered and the patient was operated on urgently. Peroperatively, it was observed that the jejunum entered between the leaves of the terminal ileum mesentery. Proximally, the duodenum was located posterior to the right colon in a "sack". This "sack" was surrounded by thick Ladd's bands laterally, mesentery of the ascending colon medially, the posterior surface of the cecum and ascending colon anteriorly, and by the posterior abdominal wall posteriorly. Conclusion: In isolated duodenal nonrotation, the duodenum may be completely retro-colic. Consequently, the duodenojejunal junction and the ileocecal region may almost overlap. Unlike isolated duodenal nonrotation cases, in the surgical treatment of this variant, separation of Ladd bands alone is not sufficient, additionally, the right colon should be placed in a nonrotation position and care should be taken not to kink the terminal ileum under the cecum.

Leiomyoma of mesentery in a young male: a case report and review of literature

Primary tumours of mesentery are relatively rare, and its biological behaviour is unpredictable. We herein describing a case of incidentally detected mesenteric leiomyoma along with review of literature in a 19-year-old gentleman, who had a mass in the mesentery of terminal ileum, which was detected during surgery. Mesentric masses can be both solid as well as cystic. Published reports have consisted of small numbers of cases, which makes it difficult to determine the incidence of specific tumor types. Reasonable estimates of incidence ranges from 1 case per 200,000 population and in 30-40% cases they are cystic and more in females. Diagnosis is delayed unless they become symptomatic with haemorrhage, obstruction or mass per abdomen. As primary mesenteric tumors are rare, particularly in young patients, it is considered important that this type of unusual tumor be included in the differential diagnosis for mesenteric tumors. Since the biologic behaviour of mesenteric smooth muscle tumours seems to be unpredictable long term follow up is warranted.

Fluorescence angiography for blood flow assess during right hemicolectomy. Case study

Fluorescent laparoscopy enables to visualize blood vessels and blood flow in the organs of the gastrointestinal tract, which can be used in colon resection. Laparoscopic right hemiclectomy was performed in a patient aged 55 years with an adenomatous polyp of Bauginia flap without dysplasia. The operation was performed through four trocars: 1 — 10 mm, 1 — 13 mm, 2 — 5 mm. During surgery, the hepatic flexure of the colon was saved due to the expressed a. colica dextra. After intracorporal ileotransversoanastomosis formation of with the device Endo GIA‑60 fluorescence angiography was performed: Indocyanine green in a dose of 0.3 mg/kg of body weight was injected intravenously. After 2 minutes, in near‑infrared survey regime, a satisfactory vascularization of the terminal ileum mesentery and accumulation of the fluorescing substance in the walls of the ileum and the stomach stump, in particular the finite regions of the stump, have been achieved. Regarding the received data, there was no risk of failure of anastomosis and bowel stump. The operation was completed on a planned extension. No technical difficulties with fluorescence angiography were found. Allergic reactions to the administered drug and the failure of anastomosis were not. The first experience of using fluorescence angiography for assessing blood supply in the anastomosis area during resection of the colon demonstrated the convenience and safety of the technique. Fluorescence angiography helped to evaluate the blood supply to intestinal walls and mesentery, which allowed to execute a limited variant of operation with the preservation of hepatic flexure of the colon with blood supply from a. colica dex.

Haematoma in the mesentery of terminal ileum and intramural haematoma of caecum, ascending colon with hemoperitoneum due to abdominal massage

Mesenteric hematoma is a rare clinical condition and difficult to diagnose due to its variable presentation. We report a case of 45 year old male who presented with pain abdomen for two days with no history of fever vomiting or trauma to abdomen. USG abdomen showed collection in the right iliac fossa and right paracolic gutter. On exploration hematoma was noticed in the seromuscular layer of caecum ascending colon and mesentery of terminal ileum caecum and ascending colon. Having a high level of suspicion and ordering appropriate imaging is essential to make this diagnosis.nbsp

PEComa of the terminal ileum mesentery as a secondary tumour in an adult survivor of embryonal rhabdomyosarcoma.

Perivascular epithelioid cell tumours (pecomas) are rare mesenchymal tumours that are characterized by perivascular epithelioid cell differentiation and immunoreactivity to myogenic and melanocytic markers. These tumours can be classified as benign, uncertain malignant potential, or malignant. Because of the rarity of pecomas, their cause and clinical prognosis remain unclear. To the best of our knowledge, no reports in the literature describe a pecoma of the terminal ileum mesentery as a secondary tumour in an adult survivor of childhood embryonal rhabdomyosarcoma, let alone any childhood cancer. Here, we present the case of a 27-year-old man with a pecoma involving the mesentery of the terminal ileum. At the age of 5, he had been treated with a combination of chemotherapy and high-dose pelvic radiation therapy for embryonal rhabdomyosarcoma, most likely arising from the posterior bladder wall. During routine follow-up 22 years after this patient's initial treatment, computed tomography imaging revealed a mass within the terminal ileum mesentery. The tumour was successfully treated with surgical resection, and pathology examination determined the mass to be a pecoma with uncertain malignant potential. This first case of a pecoma of the terminal ileum mesentery arising within a high-dose radiation therapy field as a secondary tumour in an adult survivor of childhood cancer highlights the importance of screening and surveillance in high-risk childhood cancer survivors treated with high-dose radiation therapy. Further research to build a better understanding of this remarkably rare tumour is warranted.

Noncommunicating isolated enteric duplication cyst in the abdomen in children

Noncommunicating isolated enteric duplications in the abdomen are an extremely rare variant of enteric duplications with their own blood supply. We report a case of a noncommunicating isolated ileal duplication in a 10-month-old boy. He was admitted because of severe abdominal distension and developed irritability abruptly. Abdominal ultrasound and computed tomography scan revealed a closed loop of small bowel that was dilated severely. A large tubular cyst hanging on the narrow vascular pedicle arising from the base of the terminal ileum mesentery was found with torsion of the pedicle in the right upper quadrant of the abdomen. Laparoscopic excision was performed successfully. Here, we will also review the previously reported cases to raise awareness of noncommunicating isolated enteric duplications in the literature. Keywords: Abdomen, Children, Duplication, Isolated, Noncommunicating

Mesenteric paraganglioma: Report of a case

We report a rare case of paraganglioma that developed in the mesentery of terminal ileum. A 78-year-old woman complained of right-sided abdominal pain. Abdominal computed tomography revealed a solid heterogeneously enhanced mass in the right lower abdomen. The tumor was laparoscopically excised. The mesenteric tumor was well circumscribed, ovoid, and encapsulated and measured 3 cm × 1.5 cm × 1.5 cm. Histological examination showed a cellular neoplasm comprised of nests and groups of tumor cells separated by fibrovascular connective tissue, giving a characteristic nested Zellballen pattern. Immunohistochemically, the tumor cells were positive for chromogranin, synaptophysin, CD56, and vimentin and negative for cytokeratins, SMA, CD34, CD117/c-kit and S100. On the basis of histologic and immunohistochemical features, a diagnosis of mesenteric paraganglioma was made. The operative and postoperative courses were unremarkable, and the patient was discharged on postoperative day 7. She was doing well 1 year after the surgery with no signs of recurrence. Extra-adrenal paragangliomas most commonly develop adjacent to the aorta, particularly the area corresponding to the organ of Zuckerkandl. Mesenteric paraganglioma, as in our case, is extremely rare; only 11 cases have been reported in the literature. We herein discuss the clinical findings of these cases.

Laparoscopic right hemicolectomy with intracorporeal anastomosis

Dear Editor, Dr. Ho may have planned to write a scientific paper on an innovative surgical technique. I applaud Dr. Ho’s decision, as section editor, to invite Dr. Yamaguchi’s comment, which elevates the debate to a scientific level [1]. However, there are a number of methodological aspects of Dr. Ho’s publication that can give the wrong take-home message. These aspects, outlined below, may not be readily understood by inexperienced readers. Although there is certainly a need for innovation in surgery, it is beneficial to the patients that innovation happens in accordance with the rules of evidence [2]. As Dr. Ho’s technique is performed by a single surgeon, the reproducibility of his results is debatable, or at best, unknown. Other authors have previously emphasized how standardization and sequential execution are essential to outcomes and safety in surgical technique [3]. Ho sends a different message; he does it his way: lateral-to-medial! medial-to-lateral! It is dangerous as readers can get the wrong message. Laparoscopic right colectomy with intracorporeal anastomosis is no news to the well-informed reader. I agree with Dr. Ho that intracorporeal anastomosis is advantageous compared with extracorporeal. Potential advantages of intracorporeal anastomosis include: (1) anastomosing away from the abdominal wall could reduce surgical-site infection rates; (2) no manipulation of abdominal cavity by the surgeon could reduce creation of adhesions and possibly rates of adhesive small bowel obstruction; (3) a 50% reduction in the abdominal wall incision for specimen extraction could lead to clinically relevant benefits; and (4) laparoscopic visualization during the creation of the anastomosis could reduce unrecognized twisting of the terminal ileum mesentery. Nevertheless, I have the following concerns regarding Dr. Ho’s choice to promote totally stapled intracorporeal ileocolic anastomosis. Potential disadvantages of totally stapled intracorporeal ileocolic anastomoses include: (1) leads to an everted anastomosis with potential for increased risk of complications as opposed to its handsewn inverted counterpart; (2) requires usage of 60 mm long cartridge for side-to-side ileocolic stapling as it inevitably excises tissue and thereby potentially reduces the size of the anastomosis; (3) most likely requires an additional port if performed on the transverse colon; (4) does not obviate the need for intracorporeal suturing as stay stitches are required to ensure safe stapler application on the enterocolotomy; (5) may require multiple firings depending on the size of the enterocolotomy or whether the previous stapled line is being excised; and (6) leads to higher costs due to additional cartridges. An alternative option to totally stapled intracorporeal ileocolic anastomosis is to handsew the enterocolotomy [4]. Without standardization of a surgical technique and proof of reproducibility by others, Dr. Ho’s ‘‘How I do it’’ paper lacks external validity.