Ligament of Treitz: Anatomy, Relevance of Radiologic Findings, and Radiologic-Pathologic Correlation

Nassar, Sameh; Menias, Christine O.; Palmquist, Sarah; Nada, Ayman; Pickhardt, Perry J.; Shaaban, Akram M.; Gaballah, Ayman H.; Elsayes, Khaled M.

doi:10.2214/ajr.20.23273

Cited by 4 publications

(3 citation statements)

References 35 publications

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“…Hematochezia and melena are often used to distinguish between upper and lower GI sources of bleeding: hematochezia with the lower and melena with the upper [6]. An upper GI bleed is anatomically defined as occurring at a location proximal to the ligament of Treitz, while a lower GI bleed is distal [7]. This case was distinct in that the patient initially presented with melena but then later evolved to experience hematochezia.…”

Section: Discussionmentioning

confidence: 99%

A Rare Cause and Alternative Algorithm for the Treatment of Gastrointestinal (GI) Bleed: Complications of a Failed Pancreatic Transplant

Afzal¹,

Vennikandam²,

Ahmad³

et al. 2023

Cureus

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A 39-year-old woman with no known risk factors presented for a recurrent upper gastrointestinal (GI) bleed. She had a prior history of failed kidney and pancreatic transplants secondary to childhood diabetes mellitus type I. After an extensive workup, she was found to have active hemorrhage into an area of the small bowel from an artery supplying her failed pancreatic transplant. Here, we discuss the importance of a systematic approach to evaluation, a high index of suspicion, and a known but not entirely common method of treatment for this condition.

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Section: Discussionmentioning

confidence: 99%

A Rare Cause and Alternative Algorithm for the Treatment of Gastrointestinal (GI) Bleed: Complications of a Failed Pancreatic Transplant

Afzal¹,

Vennikandam²,

Ahmad³

et al. 2023

Cureus

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“…In addition,the emptying of the duodenum was not only controlled by the nerves, physiological reflex,and the contraction of duodenal smooth muscle, but was also affected by duodenojejunal curvature(Trojan angle) [9] . In our study,the morphological changes of the Trojan angle were closely related to the degree of proximal intestinal dilatation and the patency of the anastomotic stoma in the control group.The reason for this may be that the hanging ligament of the dilated duodenum was relatively short, and the distal duodenum was pulled upward and inward due to the weight of the contents of the stomach and duodenum.At the same time, as the mesentery of types II -IV atresia with distal intestinal defect needed to be repaired, the proximal jejunum was pulled inferomedially by mesenteric traction, and the distal shrunken jejunum by weight, which resulted in the angular deformity of Trojan angle.Due to the large curvature, the distal duodenum and the proximal jejunum were in sharp angle and went back and forth (Z-shaped).Under UGCS, duodenal peristalsis and retrograde peristalsis were observed frequently.The contrast agent lingers back and forth between the proximal duodenum and jejunum, unable to pass through the anastomotic site This article is protected by copyright.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Application of jejunal turnover and bowel plication technique in neonatal high intestinal atresia: a retrospective study

Zhao,

zhang,

2023

Eur J Pediatr Surg

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Introduction:To evaluate the outcomes of jejunal turnover and bowel plication (JTBP) in high jejunal atresia of neonates. Materials and Methods:The clinical data of neonates met the criteria were retrospectively analyzed from January 2012 to December 2021.The neonates were divided into the JTBP group and control group according to the surgical procedure.Demographics, postoperative morphology of the duodenum and proximal jejunum,intestinal recovery time and complications were compared. Results:75 patients were allocated to the JTBP (n=30) and control (n=45) groups, respectively. There was no significant difference between the two groups in terms of gestational age, birth weight, age at surgery,the pathological classification,and concomitant disease. UGCS showed that the diameter of the proximal bowel of the anastomotic stoma was normal and the duodenum and proximal jejunumin streamline shape in the JTBP group.While the duodenum dilated, and the shape of Trojan angle was classified into sharp angle and blunt round angle in the control group.The duration of total parenteral nutrition, postoperative oral feeding time and oral feeding time of 40 mL/3 h was significantly different between the JTBP group and control group(sharp and blunt round type): 9.0±3.5d,7.0±2.1d and 11.0±6.0d vs 16.9±4.2 d, 14.0±5.0 d and 19.0±7.4 d vs 11.9±8.3 d, 8.2±3.9d and 15.8±3.6d(P<0.05). Conclusions: JTBP for neonatal high jejunal atresia can significantly change the diameter of the proximal bowel and the course of duodenum jejunum flexure. Postoperative bowel movement was more in line with fluid dynamics, which was conducive to the recovery of the intestinal function and resulted in fewer complications.

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“…A gastrointestinal (GI) bleed is defined as blood loss occurring anywhere along the GI tract, from the oropharynx to the anus. Blood loss originating from any GI source above the ligament of Treitz, the suspensory ligament of the duodenum, is classified as an upper GI bleed (Nassar et al, 2021). An upper GI bleed is five times more likely than a lower GI bleed and, depending on its severity, carries a high risk of morbidity and mortality (Gibson, Scaturo, & Allen, 2018).…”

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confidence: 99%

Upper Gastrointestinal Bleeding

Banigan,

Kranenburg,

Vise

2023

Gastroenterology Nursing

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Upper gastrointestinal bleeding is a common medical emergency that requires prompt diagnosis and intervention. Patients may be hemodynamically stable or unstable depending on bleeding severity and vital signs. Immediate resuscitation and timely diagnosis are paramount to reducing mortality in this extremely vulnerable patient population. Upper gastrointestinal bleeding can be classified into two categories: variceal bleeding and nonvariceal bleeding, both of which can be life-threatening. This article aids bedside practitioners in understanding the pathogenesis of an upper gastrointestinal bleed to identify potential diagnoses. Furthermore, to ensure the proper diagnostic tests are prescribed, the algorithm provides guidance on collecting a pertinent medical history, discusses common presenting symptoms, and identifies the top risk factors for several disease processes that might present as an upper gastrointestinal bleed. A diagnostic algorithm that includes a myriad of the most common differential diagnoses of an upper gastrointestinal bleed is presented as a tool for bedside clinicians to utilize when encountering this serious gastrointestinal phenomenon.

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Ligament of Treitz: Anatomy, Relevance of Radiologic Findings, and Radiologic-Pathologic Correlation

Cited by 4 publications

References 35 publications

A Rare Cause and Alternative Algorithm for the Treatment of Gastrointestinal (GI) Bleed: Complications of a Failed Pancreatic Transplant

A Rare Cause and Alternative Algorithm for the Treatment of Gastrointestinal (GI) Bleed: Complications of a Failed Pancreatic Transplant

Application of jejunal turnover and bowel plication technique in neonatal high intestinal atresia: a retrospective study

Upper Gastrointestinal Bleeding

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