Selective Superior Mesenteric Arteriography Research Articles

Diagnostic and Therapeutic Tricks in a Rare Case of Pediatric Ileal Congenital Arteriovenous Malformation

Diagnostic and Therapeutic Tricks in a Rare Case of Pediatric Ileal Congenital Arteriovenous Malformation

Superior mesenteric artery syndrome: an uncommon cause of upper intestinal obstruction.

A previously healthy young boy who was operated for upper gastrointestinal obstruction, 12 weeks earlier, without relief of his symptoms of projectile bilious emesis and colicky pain, is described. He underwent upper gastrointestinal contrast studies, suggesting duodenal obstruction at its third part and superior mesenteric artery syndrome, which was confirmed by selective superior mesenteric arteriography. Duodenojejunostomy was carried out. The patient was symptom-free with normal built and growth after 4 years of follow-up.

Angiodysplasia of the Appendix

Angiodysplasia of the gastrointestinal tract is thought to be one of the most common causes of lower gastrointestinal bleeding in the elderly, and, in the majority of cases, lesions are located in the cecum or ascending colon. The authors report an extremely rare case of appendicular angiodysplasia. A 76-yr-old woman was hospitalized with massive recurrent red anal bleeding. Selective superior mesenteric arteriography revealed an extravasation of contrast material from the appendicular artery, and this finding proved to be bleeding from an angiodysplasia of the appendix. An appendectomy was performed, and anal bleeding did not recur postoperatively. A review of the literature revealed this to be an extremely rare case of angiodysplasia.

Iatrogenic superior mesenteric arteriovenous fistula: Ultrasonographic, CT and angiographic features and histological findings of the liver biopsy

Iatrogenic superior mesenteric arteriovenous fistula is rare. We treated a patient with this problem 6 years after small bowel resection for intestinal obstruction. The symptoms and signs were those of intestinal ischaemia and portal hypertension with an abdominal bruit. Ultrasonography and enhanced computerized tomography of the abdomen suggested the presence of superior mesenteric arteriovenous fistula, with a dilated portal vein and a communication between the dilated superior mesenteric vein and its artery. The exact location of the fistula was then determined by selective superior mesenteric arteriography. The fistula was ligated in an emergency operation to prevent cardiac or renal failure and to relieve portal hypertension. Liver biopsy showed no cirrhotic changes, but fibrosis was seen around the portal veins. We describe here not only the diagnostic arteriographic findings of superior mesenteric arteriovenous fistula, but also the interesting and suggestive ultrasonographic and computed tomographic findings. Early correction of such fistulas is recommended to prevent cardiac or liver failure.

ARTERIOVENOUS MALFORMATION OF THE ILEUM ITS RECURRENT INTESTINAL BLEDDING

A 67-year-old female was referred to Yokohama City University Hospital because of reccurent intestinal bleeding for two months. Upper gastrointestinal series, endoscopic examination, and abdominal CT failed to demonstrate the bleeding CT failed to demonstrate the bleeding site. Selective superior mesenteric arteriography demonstrate the bleeding CT failed to demonstrate the bleeding site. Selective superior mesenteric arteriography malformation was recongnized in the terminal portion of the ileum at laparotomy, and wedge resection was performed. The pathologic study showed a proliferation of the convoluted arteries and veins ranging from mucosal to subserosal layer of the intestine. A rare case of ileal arteriovenous malformation, which was diagnosed by selective arteriographgy, was reported.

A CASE REPORT OF SUPERIOR MESENTERIC ARTERY SYNDROME -USEFULNESS OF ULTRASONIC DIAGNOSIS-

We report a case of superior mesenteric artery syndrome in which ultrasonography revealed marked narrowing of the angle between the abdominal arota and the superior mesenteric artery (aortomesenteric angle). A 24-year-old woman with loss of weight caused by anorexia nervosa was hospitalized with abdomiral fullness and vomiting. Gastrointestinal radiographic examinaton revealed dilatation of the duodenum and extrinsic compression of the third portion of the duodenum. Hypotonic duodenography and selective superior mesenteric arteriography suggested the presence of an obstruction where the superior mesenteric artery crossed the doudenum. Ultrasonography revealed narrowing of the aortomesenteric angle. A translocation of the duodenum was successfully performed and the result was satisfactory. Ultrasonography can easily detect the superior mesenteric artery and abdominal aorta without the harmfulness effects of angiography. It is emphasized that ultrasonography is useful for screening for superior mesenteric artery syndrome.

A SUCCESSFUL CASE OF SUPERIOR MESENTERIC ARTERIAL EMBOLECTOMY WITH PARTIAL BOWEL RESECTION

A successful case of superior mesenteric arterial embolectomy with bowel resection is reported. The patient, an 82-year-old man with atrial fibrillation and cerebral infarction, complained of severe periumbilical pain of acute onset. Physical examination of the abdomen did not reveal tenderness or rebound tenderness. Alightly increased small bowel gas was shown on plain abdominal X-ray film. Ultrasonography and CT of the abdomen revealed no abnormal findings. Since mesenteric arterial occlusion was suspected, intravenous digital subtraction angiography, followed by selective superior mesenteric arteriography, was performed. The artery was completely obstructed at 5cm distal from its origin. About five and a half hours after the onset of the symptoms, the patient underwent an operation. Embolectomy with a Fogarty catheter and small bowel resection of about 65cm were performed. Postoperatively, he was complicated with aspiration pneumonia and renal failure, but he soon recovered. This patient is the oldest of the successful cases of superior mesenteric arterial embolectomy to be reported in the Japanese literature.

Diagnosis by selective arteriography in hemorrhage resulting from typhoid fever.

Two cases of complicating hemorrhage resulting from typhoid fever which were demonstrated by selective superior mesenteric arteriography are presented. The site of bleeding was at the caecum which is an uncommon site in typhoid hemorrhage. In both cases there was failure to stop the bleeding by using a vasopressin infusion. However, arteriography proved very helpful in locating the site of bleeding and vasopressin infusion can still be recommended to decrease intraluminal hemorrhage and improve the general condition of the patient before undergoing operation.

Delayed hemorrhage from a gastrointestinal anastomotic suture line: report of a case.

The unusual occurrence of bleeding from a gastrointestinal anastomosis 29 days after right colectomy and ileotransverse colostomy is described. Diagnosis and prompt treatment were facilitated by the use of selective superior mesenteric arteriography.

Serum enzyme changes following selective superior mesenteric arteriography in dogs.

Methylglucamine diatrizoate (Renografin-60) was injected into the mesenteric circulation of mongrel dogs and its effects upon serum enzyme activity were studied. A significant elevation in both SGOT and alkaline phosphatase levels was demonstrated, most marked 24 hours after injection. This increase is attributed to possible liver damage.

Selective superior mesenteric arteriography in reticulum-cell sarcoma of the small bowel.

Abstract Four cases are reported of reticulum-cell sarcoma of the small bowel in which superior mesenteric arteriography was performed. In none of these did the angiography contribute to the diagnosis, because of a lack of commonly accepted angiographic tumor criteria.

Traumatic mesenteric arteriovenous fistula.

A case of traumatic mesenteric arteriovenous fistula is presented. The clinical and angiographic findings are reviewed and discussed. Early recognition of the fistula is of utmost importance. Arteriography is essential for confirmation of the diagnosis and localisation of the lesion. Selective superior mesenteric arteriography is recommended in all suspected cases. Reprints of this article can be obtained from Rubem Pochaczevsky, M.D., Department of Radiology, Greenpoint Hospital Affiliation, The Jewish Hospital and Medical Center of Brooklyn, 300 Skillman Avenue, Brooklyn, N.Y., 11211, U.S.A.

Arteriographic appearance of intestinal adhesions.

Atypical distribution of one or more arterial branches of the superior mesenteric artery is often a sign of intestinal adhesions with abnormal fixation of the bowel. Selective superior mesenteric arteriography can verify such an abnormal distribution and thereby explain the abdominal pain.

The arteriographic appearance of carcinoma of the uncinate process of the pancreas.

THE ARTERIOGRAPHIC APPEARANCE OF CARCINOMA OF THE UNCINATE PROCESS OF THE PANCREASMURRAY G. BARON, M.D., HAROLD A. MITTY, M.D. and BERNARD S. WOLF, M.D.Audio Available | Share

Arteriographic demonstration of pancreatic tumor in the Zollinger-Ellison syndrome.

The gastrointestinal manifestations of the Zollinger-Ellison syndrome are well known, but to our knowledge direct radiologic demonstration of the pancreatic tumor has not been previously described. The case reported here is that of a patient with a clinical diagnosis of Zollinger-Ellison syndrome in whom the diagnosis of isletcell carcinoma was made by selective angiography prior to surgery. Case Report A 55-year-old white man was treated for a peptic ulcer from 1963 until 1965 when a clinical diagnosis of Zollinger-Ellison syndrome was first made on the basis of gastric analysis values typical of this condition. In 1966 the patient's symptoms became refractory to anticholinergic therapy. Radiologic examinations had demonstrated gastric hypersecretion, an ulcer of the duodenal bulb, questionable ulceration of the third part of the duodenum, and prominent mucosal folds in the stomach, duodenum, and proximal jejunum. A few punctate calcifications had been noted in the body of the pancreas. There was no clear evidence of a pancreatic mass on gastrointestinal examination. Selective celiac arteriography revealed a large area of hypervascularity in the body of the pancreas. A dense irregular tumor stain persisted for several seconds (Fig. 1). The dorsal pancreatic and pancreatic magna arteries were the principal source of blood supply to the tumor. Selective superior mesenteric arteriography was normal. The radiologic diagnosis of probable islet-cell carcinoma of the pancreas was based on the large size of the tumor and its high incidence in the Zollinger-Ellison syndrome. At laparotomy a grayish-white tumor measuring 3 × 4 × 8 ern was found, involving the body of the pancreas, with evidence of local invasion but no distant metastases. Total gastrectomy was performed. Biopsy of the tumor revealed a regular trabecular pattern of cells with a rich capillary network (Fig. 2). There was extensive hyalinization of some portions of the tumor, but no calcification was found in the biopsy specimen. Na mitoses were noted, but tumor cells were present in lymphatic channels in the periphery of the lesion. Special stains failed to reveal beta islet cells. The pathologic diagnosis was non-beta islet-cell carcinoma. Discussion The experience which has been gained in the angiographic diagnosis of pancreatic tumors provides the rationale for selective arteriography in the Zollinger-Ellison syndrome. The usual adenocarcinoma of the pancreas is a relatively avascular lesion, and diagnosis has been based primarily on tumor invasion and distortion of existing vessels (1, 5–7, 10, 11). On the other hand, tumor neovascularization or readily recognizable tumor stains have been regular features in the small number of reported cases of beta islet-cell (insulin-producing) tumors (1, 3, 7, 8, 11), cystadenomas (2, 9, 10, 12), and pancreatic sarcomas (7, 11) studied by angiography.