Superior Mesenteric Angiography Research Articles

Inferior vena cava diameter on CT angiography predicts mesenteric angiography positive for extravasation in colonic diverticular bleeding.

Transcatheter arterial embolization (TAE) for colonic diverticular bleeding (CDB), an established procedure for hemostasis, is sometimes complicated by spontaneous hemostasis and unclear bleeding site on angiography despite active arterial bleeding on preoperative computed tomography angiography (CTA). Therefore, to investigate and increase the feasibility of TAE, this retrospective study evaluates the clinical and radiological features related to positive extravasation on angiography. Sixty CDB patients with extravasation on CTA underwent TAE between January 2011 and February 2021 and were divided into extravasation-positive (P-group; n = 25) and -negative groups (N-group; n = 35) based on the superior or inferior mesenteric angiography. Patient characteristics, laboratory findings, the diameter of the inferior vena cava (IVCD), the diameter of superior and inferior mesenteric veins, and technical outcomes were evaluated. TAE was successful in 24 patients in the P-group (96%) and 14 in the N-group (40%) (p < 0.001). Univariate analysis revealed "usage of anticoagulant" (p < 0.05) and "larger IVCD (p < 0.05) on preoperative CTA" to be significant predictors of positive extravasation. In the multivariate analysis, IVCD remained significant with an adjusted odds ratio of 1.17. The IVCD cutoff value was 13.6mm (area under the curve = 0.72, sensitivity = 84.0%, specificity = 54.3%). There were no significant differences in other parameters. Measurement of IVCD in CDB with the cutoff value of 13.6mm can be a simple and useful indicator to predict the detectability of extravasation following TAE procedures.

Role of clinical data and multidetector computed tomography findings in acute superior mesenteric artery embolism.

BACKGROUNDSuperior mesenteric artery embolism (SMAE) has acute onset and fast progression, which seriously threatens the life of patients. Multidetector computed tomography (MDCT) is one of the most important diagnostic methods for SMAE, which plays an important role in the diagnosis and prognosis of SMAE.AIMTo evaluate the value of combined clinical data and MDCT findings in the diagnosis of acute SMAE and predict the risk factors for SMAE-related death.METHODSData from 53 SMAE patients who received abdominal MDCT multi-phase enhancement and superior mesenteric artery digital subtraction angiography examinations were collected. Univariate cox regression and multivariate cox model were used to analyze the correlation between death risk and clinical and computed tomography features in SMAE patients.RESULTSUnivariate Cox regression model showed that intestinal wall thinning, intestinal wall pneumatosis, blood lactate > 2.1 mmol/L and blood pH < 7.35 increased the risk of death in patients with SMAE. After adjusting for age, sex, embolic involvement length and embolic distribution region, multivariate Cox regression model I showed that blood lactate > 2.1 mmol/L (HR = 5.26, 95%CI: 1.04-26.69, P = 0.045) and intestinal wall thinning (HR = 9.40, 95%CI: 1.05-83.46, P = 0.044) were significantly increases the risk of death in patients with SMAE.CONCLUSIONFor patients with SAME, increased blood lactate and intestinal wall thinning are the risk factors for death; hence, close monitoring may reduce the mortality rate. Clinical observation combined with MDCT signs can significantly improve SMAE diagnosis.

Angiographic Diagnosis of a Meckel's Diverticulum in a 26-month-old Boy.

A 26-month-old boy presented with recurrent hematochezia. Abdominal examination was normal. Laboratory findings showed hemoglobin of 7.5 g/dL. Abdominal ultrasound (US) for intussusception revealed a short (0.3 cm) segment of wall thickening in the distal ileum and Meckel’s scan was negative. The patient underwent two additional Meckel’s scans, tagged red blood cell scan, CT-angiography, upper endoscopy and colonoscopy, and video capsule endoscopy, but had normal results. Superior mesenteric angiography was performed revealing an area of abnormal vasculature in the terminal ileum (Fig. 1). Subsequently, exploratory laparotomy showed an obvious Meckel’s diverticulum (MD), and Meckel’s diverticulectomy was performed (Fig. 2).FIGURE 1.: Meckel's Diverticulectomy.FIGURE 2.: Meckel’s Diverticulectomy. A) Gross specimen of MD removed from patient and (B) histological examination of MD with the presence of ectopic gastric mucosa.MD is the most common congenital malformation of the gastrointestinal tract, occurring in approximately 2% of the population (1). The gold standard in diagnosing a MD is a Meckel’s scan which detects the accumulation of a radioisotope, Technetium-99m. However, false negatives do occur and this is likely due to insufficient gastric mucosa in the MD (2). The literature on typical angiographic findings for diagnosis of MD are limited to a few individual cases (3–6). Our patient exhibited multiple abnormal corkscrew-like arteries of the ileocolic artery. Angiography can detect MD in the absence of acute bleeding through visualization of the vitelline artery (7). ACKNOWLEDGMENTS A.P. was involved in conception and design, acquisition of data, drafting the work, final approval of the version to be published. M.R.A., P.M., T.R.B., and C.M.S. were involved in conception and design, critical revision of work, final approval of version to be published. L.A. was involved in conception and design, acquisition of data, critical revision of work, final approval of version to be published.

A Jejunal Angiodysplasia With Active Bleeding and Changing Position of Extravasation of Contrast Medium on Follow-Up Superior Mesenteric Angiography: A Case Report

A Jejunal Angiodysplasia With Active Bleeding and Changing Position of Extravasation of Contrast Medium on Follow-Up Superior Mesenteric Angiography: A Case Report

CT during celiac artery angiography for localization of clinically suspected small insulinomas

BackgroundTo identify location and number of insulinomas before operation is very important for improving the cure rate. The objective of the study was to assess performance of CT during celiac artery angiography for preoperative localization of clinically suspected small insulinomas (< 2 cm in diameter).MethodsFrom January 2013 to November 2016, 42 patients with hypoglycemic symptoms underwent celiac artery angiography, superior mesenteric artery angiography and CT during celiac artery angiography by a combined CT/digital subtraction angiography system, MIYABI Angio CT plus an Artiszeeceiling (SIEMENS, Germany). Patient group consisted of 13 males and 29 females, age 17–69 years (average, 45.4 ± 13.5 y). After diagnosis, all 42 patients were operated. Obtained images were retrospectively analyzed and compared with findings from post-operation pathology.ResultsAll interventional radiology procedures were performed successfully with no complications. Sensitivity of angiography alone for insulinoma was 76.1% (32/42), at combined CT/digital subtraction angiography, 4 more nodules were found (sensitivity, 85.7%, 36/42), while 6 false-negatives were observed (all false negative lesions were less than 2 cm). A total of 64 ml to 80 ml contrast media was used per patient.ConclusionCT during celiac artery angiography is a sensitive diagnostic procedure for localizing insulinomas. Combined with angiography, it can prioritize the pancreatic region for exploration and guide a pancreatic resection.Trial registrationEthical approval was obtained from the Hospital Research Ethics Committee. Informed consent was obtained from all patients included in the study.Duan Feng, Bai Yan-hua and Cui Li are co-first authors.

Acute thromboembolic occlusion of the superior mesenteric artery following covered stent occlusion in the superior mesenteric artery: endovascular therapy using mechanical rotational thrombectomy

Acute thromboembolic occlusion of the superior mesenteric artery is a rare and often fatal condition in which surgery represents the golden standard in therapy. We present a case in which a patient was treated with covered stent implantation for acute bleeding from the superior mesenteric artery following pancreatic resection, radiation, and embolization of a hepatic artery pseudoaneurysm. Some weeks later clinical signs were suggestive of acute thromboembolic occlusion of the superior mesenteric artery and digital subtraction angiography showed occlusion of the previously implanted covered stents. The patient was successfully treated transfemorally with percutaneous mechanical instent thrombectomy using a 6F Rotarex® catheter. We conclude that in selected cases percutaneous mechanical thrombectomy may represent a minimally-invasive alternative to open surgical thrombectomy for treatment of acute thromboembolic occlusion of the superior mesenteric artery.

Management of Superior Mesenteric Arteriovenous Fistula after Small Bowel Resection 20 Years Previously: Endovascular Treatment

A 59-year-old man was admitted to the West China Hospital (Sichuan, China) with recurrent abdominal pain and diarrhea. The patient had undergone a resection of the small bowel due to small intestinal bleeding caused by an ulcer 20 years previously and had no history of trauma. Physical examination revealed stable vital signs, but there was tenderness in the area of the epigastrium radiating to the back without muscle tension and rebound pain. Laboratory tests revealed hemoglobin, white blood cell, total bilirubin, prothrombin time, albumin and creatinine levels of 97 g/L, 18.65×109/L, 53 umol/L, 12.0 s, 34.1 g/L, 112 μmol/L, respectively. Computed tomography (CT) angiography of the abdomen and pelvis revealed marked enhancement of the superior mesenteric vein (3.1 cm in diameter) in the arterial phase, the fistula of the neck between the superior mesenteric artery and the superior mesenteric vein (0.9 cm in diameter), the engorgement of the intestinal walls and mesentery, and abdominal ascites (Figure 1). Endovascular treatment was implemented in the hybrid operating room. If unsuccessful, open surgery would immediately follow. Superior mesenteric angiography demonstrated a superior mesenteric arteriovenous fistula (SMAVF) in accord with CT (Figure 2). Embolization of the fistula was performed with multiple 8 mm, 10 mm and 12 mm coils deployed at the neck of the SMAVF, respectively. An additional angiogram showed no opacification of the SMAVF (Figure 3). After the procedure, the patient was monitored carefully for any evidence of bowel ischemia. During the next several days, the patient’s abdominal pain disappeared and the initial watery diarrhea gradually resolved. Confirmation of these findings was obtained by ultrasound with no evidence of portal hypertension. At the three-month follow-up, the patient was in satisfactory condition and had no symptoms of bowel ischemia. Figure 1) Computed tomography angiography. A Axial view showing the superior mesenteric vein with marked enhancement in the arterial phase and aneurismal dilation. B Volume-rendered computed tomography showing the fistula between the superior mesenteric artery ... Figure 2) Superior mesenteric angiogram showing the distal superior mesenteric artery with direct shunting of contrast into the superior mesenteric vein, which is in accord with the volume-rendered computed tomography shown in Figure 1 B Figure 3) Postembolization angiogram. The fistula from the distal superior mesenteric artery to the superior mesenteric vein has been occluded with multiple 8 mm, 10 mm and 12 mm coils. An addirional angiography shows no further opacification of the superior mesenteric ...

A Rare Cause of Upper Gastrointestinal Bleeding

Hemosuccus pancreaticus (HP) is a rare cause of upper gastrointestinal bleeding. Pancreatitis are the most common cause of HP. Here, we report the case of a 48-year-old male with HP due to alcohol-induced chronic pancreatitis. Superior mesenteric angiography showed an inferior pancreaticoduodenal artery pseudoaneurysm. The patient underwent coil embolization for treatment of his pseudoaneurysm. Endoscopic retrograde cholangiopancreatography and pancreatic stents replacement was performed for pancreatic pseudocyst drainage. In patients with HP, angiographic and endoscopic combined treatment can protect from the risks of surgery.

Endovascular management of superior mesenteric artery pseudoaneurysm

A 31-year-old man underwent a Whipple procedure for a pancreatic neuroendocrine tumor, which consists of a pancreaticoduodenectomy and reconstruction to restore intestinal continuity. Six weeks after the operation, he presented with severe mid-epigastric pain radiating to his back. Imaging studies revealed a large pseudoaneurysm arising from the superior mesenteric artery. Selective superior mesenteric angiography confirmed the presence of the pseudoaneurysm. A 6 mm × 2.5 cm stent graft (Viabhan; W.L. Gore, Flagstaff, Ariz) was deployed across the pseudoaneurysm origin with preservation of the mesenteric branches. The patient had immediate resolution of symptoms and follow-up imaging showed patency of the stent graft and exclusion of the pseudoaneurysm.

Replaced middle colic artery originating from the coeliac trunk

A 12-year-old girl with a medical history of neonatal repair of a lumbosacral meningomyelocoele presented with intermittent lower gastrointestinal haemorrhage. Diagnostic work-up included catheter visceral angiography. Contrast medium injection did not reveal any source of bleeding; however variant vascular anatomy was depicted. Figure 1 shows coeliac angiography with the middle colic artery (small arrows) supplying the transverse colon originated from the coeliac trunk instead of from the superior or inferior mesenteric artery. Overflow of contrast medium into the superior mesenteric artery (arrowheads) and left colic artery (large arrows) is also shown. This uncommon aberrant anatomy, without further clinical consequences, is only described in cadaver studies at a rate of 0.5–1% of cases [1, 2]. However, in cases of negative superior and inferior mesenteric angiography, cannulation of the coeliac trunk may be required to opacify a replaced middle colic artery and a potential bleeding point in the transverse colon.

Portal hypertension due to chronic pancreatitis

Objective To explore the diagnosis and management of portal hypertension due to chronic pancreatitis.Methods The clinical manifestations,diagnostic methods and therapeutic modalities of 21 cases of portaI hypertension due to chronic pancreatitis(16 with regional portal hypertension,5 prehepatic portal hypertension)treated in our hospital from March 1990 to October 2005 were retrospectively analyzed.The main diagnostic methods were ultrasonography(US),computerized tomography(CT)and endoscopy.Magnetic resonance angiography(MRA)and superior mesenteric angiography were performed selectively in 3 with prehepatic portal hypertension.Splenectomy was performed in 16 patients with regional portal hypertension,and superior mesenteric vein-inferior vena cava shunt was the treatment of choice in 5 with prehepatic portal hypertension(plus splenectomy in 2 cases).Results All the patients were followed up for 1-5 years and recovered nicer after treatment.No case of rebleeding occurred during the follow-up.Hypersplenism disappeared,and disappeared or improved obviously.Esophageal varices was detected by gastroscope in 15 cases after operation.Conclusion In the clinical procedure of pancreatic portal hypertension due to chronic pancreatitis,prehepatic portal hypertension should be noted. Key words: Panereatitis Portal hypertension

Pseudoaneurysm of the Gastroduodenal Artery in Chronic Pancreatitis

A 49-year-old man with alcoholic chronic pancreatitis had a pseudocyst 5 cm in diameter in the head of pancreas (A, arrow) with dilated pancreatic duct and calcifications of the gland. A followup CT scan showed marked enhancement within the lesion similar to that of the blood vessels, strongly suggesting a large pseudoaneurysm (B, arrow). Angiography confirmed the pseudoaneurysm arising from the gastroduodenal artery corresponding to the enhanced lesion that appeared on CT (C, arrow). After localizing the exact origin of the pseudoaneurysm, embolization was performed with coils through the gastroduodenal and inferior pancreaticoduodenal arteries. Postembolization gastroduodenal and superior mesenteric angiography confirmed obliteration of the pseudoaneurysm (D). Contrast-enhanced CT scan repeated the next day showed shrinkage of the lesion (E).The patient was discharged home one day after embolization, and did not require further treatment. He remains well over one year after the procedure. Pseudoaneurysmsofvisceralarteriesoccurinapproximately5%ofpatients

Successful Portal-Systemic Shunt Occlusion with Balloon-occluded Retrograde Transvenous Obliteration for Portosystemic Encephalopathy without Liver Cirrhosis

A 68-year-old woman was admitted to the authors' hospital for hepatic encephalopathy. Her laboratory data and computed tomography findings were not suggestive of liver cirrhosis. Superior mesenteric angiography revealed an extrahepatic portal-systemic shunt with a main cause of hepatic encephalopathy. Despite treatment with branched-chain amino acid, lactulose, and kanamycin, hyperammonemia was prolonged, and the portal-systemic shunt was therefore treated with balloon-occluded retrograde transvenous obliteration. After the procedure, hyperammonemia was improved, and there were no signs of recurrent portal-systemic encephalopathy.

Primary Omental-Mesenteric Myxoid Hamartoma of the Mesoappendix Incidentally Detected After Abdominal Trauma in a Child: Report of a Case

A 14-year-old boy was brought to our hospital with abdominal pain and nausea after suffering a blow to the abdomen. A mass was felt in the right hypogastrium, and the patient was hospitalized for possible hematoma resulting from the abdominal trauma. Initially, we treated him conservatively and observed his course, but on the 20th day after trauma, enhanced computed tomography showed that the area of strong enhancement in the tumor was unchanged. Superior mesenteric angiography showed findings indicative of a pseudoaneurysm caused by the trauma, and surgery was performed 26 days after the injury. Laparotomy revealed a tumor with a clear boundary, thought to originate in the mesoappendix, without any sign of pseudoaneurysm. Histopathological examination confirmed that the tumor was an omental-mesenteric myxoid hamartoma. The patient had an uneventful postoperative course and was discharged from hospital on the 12th day after surgery. More than 5 years have elapsed since the operation and no sign of recurrence or metastasis has been recognized.

Multiple intrahepatic vascular shunts causing hyperammoniaemic encephalopathy in a patient without liver cirrhosis

The very rare case of a non-cirrhotic patient with multiple intrahepatic portosystemic and arteriosystemic vascular shunts, presenting with hyperammoniaemic type B encephalopathy and hypoalbuminaemia due to proteinuria, is reported. The correct diagnosis, suspected by abdominal ultrasound and colour-Doppler imaging, was confirmed by hepatic and superior mesenteric angiography. A comparison with the few similar cases existing in the literature is offered.

Wireless capsule endoscopy for obscure small-bowel disorders: Final results of the first pediatric controlled trial

Obscure small-bowel disorders are jejunal and ileal lesions undiagnosed by traditional imaging techniques (endoscopic, radiologic). We evaluated the diagnostic usefulness and safety of capsule endoscopy for obscure small-bowel disorders in children and adolescents. Comparative, prospective, self-controlled trials in patients (age, 10-18 y) suspected to have either small-bowel Crohn's disease, polyps, or obscure gastrointestinal (GI) bleeding. Capsule results were compared with the diagnostic imaging studies normally used in this age group. Among 20 patients suspected of Crohn's disease, multiple lesions consistent with this diagnosis were observed by capsule endoscopy in 50%. Small-bowel Crohn's disease was ruled out in 8 patients. Eosinophilic enteropathy was found in 2 others. For polyp detection (n = 6), capsule endoscopy yielded 100% concordance with the control studies when analyzed per patient. However, capsule endoscopy revealed a greater number (50%) of polyps. Among patients with obscure bleeding (n = 4), the capsule examination confirmed a diagnosis of vascular malformations in 3. Capsule endoscopy more accurately identified the precise source of bleeding compared with angiography. All 30 capsule studies were well tolerated, although 1 capsule was retained owing to an inflammatory stenosis. The capsule eventually was expelled after corticosteroid therapy. Capsule endoscopy correctly diagnosed or excluded a bleeding source, small-bowel polyps, or Crohn's disease of the small bowel in 29 of 30 patients. Capsule endoscopy permits an accurate, noninvasive approach for diagnosing obscure small bowel lesions in children over the age of 10.

Intraoperative packing of a pancreatic pseudocyst complicated with bleeding pseudoaneurysm

Hemosuccus pancreaticus (HP) is a rare cause of gastrointestinal bleeding, usually due to rupture of a visceral artery aneurysm in chronic pancreatitis. Other causes of HP are rare. We present a case of HP which occurred in a patient with chronic calcifying pancreatitis and a pancreatic pseudocyst documented by ultrasonography and computed tomography. With detectable fresh blood in the descending duodenum, an aneurysm in the pancreatic head was revealed by superior mesenteric angiography as the suspected origin of intermittent bleeding from the pancreatic duct. Because an artery feeding the pseudocyst could not be identified, angiographic embolization was not possible. Surgical resection or ligation was difficult by laparotomy; therefore, intraoperative packing of the pseudocyst with absorbable gelatin sponges was achieved via a cannula through a directly punctured site in the pseudocyst wall. The patient has been followed for 4.25 years with no further episodes of HP. It is possible that the packing of a pancreatic pseudocyst with gelatin sponges is a method that can be used in similar cases, where control of hemostasis is the primary concern. The packing of a pancreatic pseudocyst with gelatin sponges is a technique that can be performed not only via laparotomy but also via laparoscopy or concomitant angiography and ultrasonography.

Incidence and consequence of an hepatic artery injury in patients with postcholecystectomy bile duct strictures.

To compare the clinical presentation and results of treatment of postcholecystectomy bile duct injuries in patients with and without arterial injuries. Incidence and impact of arterial injuries in patients with a postcholecystectomy biliary injury are unknown, although they are claimed to increase the risk of septic complications, difficulty of biliary repair and risk of recurrent stricture. Fifty-five patients referred for postcholecystectomy biliary strictures and who underwent surgical repair were prospectively evaluated by celiac and superior mesenteric angiography. Circumstance and presenting symptoms of the biliary injury in patients with and without vascular injury as well as intra- and postoperative outcome in the 43 patients who underwent a Hepp-Couinaud biliary repair were compared. Incidence of vascular injury was 47%, the most frequent of which was right-sided hepatic artery disruptions (36%). Indication of cholecystectomy (cholecystitis, 42 vs. 45%), technique of resection (laparoscopy, 80 vs. 79%) as well as delay of recognition and presenting symptom of the biliary injury were comparable in patients with and without vascular injury. Among patients undergoing a biliary repair, the level of the biliary injury (Bismuth's type III or IV 63% vs. 54%), duration of surgery, and incidence of postoperative complications (21 vs. 21%) were also comparable in patients with and without arterial injury. One patient in each group experienced recurrent biliary stricture. The discovery of a disruption of the right branch of the hepatic artery should not affect management of the biliary stricture when if a Hepp-Couinaud repair is performed.

Angiographic and immunologic studies in acute necrotizing jejunoileitis.

Eighteen cases of laparotomy-proven acute necrotizing jejunoileitis were treated during the period 1992-1998. Routine laboratory investigations and bacteriological studies were non-contributory towards establishing an etiological basis for the diagnosis. Superior mesenteric artery digital subtraction angiography, carried out in five patients, demonstrated extensive neovascularization. IgG, IgM and IgA were normal in all eight children in whom it was measured; IgE levels were grossly elevated (mean 900 IU/ml; normal range 0-100 IU/ml). Four cases had evidence of hypersensitivity reactions (type I in one patient and type III in three patients) on histopathological examination of the resected small bowel. In addition, histopathological examination also showed the neovascularization observed on angiography. The evidence suggests an immunologically mediated insult resulting in intense vasculitis, which in turn causes ischemic damage to the bowel wall.

Diffuse colon cancer with tumor thrombus in the portal vein

A 64-year-old woman was seen with a chief complaint of abdominal distension. Laboratory studies included negative results for hepatitis B virus antigen and antibody, hepatitis C virus antibody, and tumor markers. Abdominal US showed portal vein thrombosis with ascites. Superior mesenteric artery angiography disclosed a hypervascular lesion in the region of the transverse colon (A). Barium contrast radiography demonstrated marked narrowing in the distal transverse colon, splenic flexure, descending, and distal sigmoid colon (B).