Mesenteric Arterial Thrombosis Diagnosed on CT

Ridley, Nick; Green, Sandra E. M.

doi:10.2214/ajr.176.2.1760549

Cited by 9 publications

(2 citation statements)

References 8 publications

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“…High resolution abdominal CT scan with contrast is very accurate and specific in delineating not only the extent of visceral ischemia but the status of flow in the mesenteric vasculature (10). Both mesenteric arterial and portal venous blood flow is accurately assessed with contrast CT scanning (11). Findings of abnormal intestinal wall blood flow, arterial intraluminal defects, or a halo sign in the mesenteric veins are very well demonstrated and accurately diagnose the presence and the causes of mesenteric ischemia.…”

Section: Diagnosismentioning

confidence: 99%

Mesenteric Ischemia: The Whole Spectrum

Sise

2010

Scand J Surg

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tic branches to the foregut, midgut, and hindgut. However, many of these patients have intestinal angina when eating large meals. The venous drainage of the gut is via the portal venous system. Gastric drainage is via the splenic vein. The small bowel and the proximal colon through the splenic flexure drain via the superior mesenteric vein. The remainder of the colon drains via the inferior mesenteric vein. Collateral venous vessels are present between each major area.The celiac and mesenteric artery origins from the aorta are closely associated with the renal artery origins in the upper abdomen just below the aortic hiatus of the diaphragm. Their proximal portions each have a closely applied plexus of lymphatic and neurologic tissue. These vessels are relatively thin-walled, unlike similarly sized extremity arteries, and must be handled with care. The portal vein and major mesenteric veins are also thin-walled, easily torn, and equally easily injured during exposure. CliniCAl prESEnTATionThe pathophysiology of mesenteric ischemia is based upon insufficient blood flow to meet the metabolic demand of the bowel. Acute ischemia leads to initial hyperperistalsis, gut emptying, followed by intense ischemia pain from gut wall hypoperfusion. Since this is visceral pain, it is vague and projected across the area of the superficial abdominal wall with innervation shared with the visceral innnervation. Foregut structures generate visceral pain in the epigastrium, midgut in the periumbilical regions, hindgut in the infraumbilical region, and cloacal derivatives in the supra-pubic region of the abdomen. ischemia BACKGroUnD

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Section: Diagnosismentioning

confidence: 99%

Mesenteric Ischemia: The Whole Spectrum

Sise

2010

Scand J Surg

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“…The status of arterial flow in the mesenteric vasculature is a successful diagnostic tool for identifying the presence and the causes of mesenteric I/R (Ridley and Green, 2001). However, little has changed in the last four decades with regard to overall mortality, which remains approximately 40%, and medical management (i.e., anticoagulation or antiplatelet therapy) is essential for all survivors (Sise, 2010).…”

Section: Introductionmentioning

confidence: 99%

Transient Mesenteric Ischemia Leads to Remodeling of Rat Mesenteric Resistance Arteries

Caracuel¹,

Jiménez‐Altayó²,

Romo³

et al. 2012

Front. Physio.

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Mesenteric ischemia/reperfusion (I/R) is associated with high rates of morbidity and mortality. We studied the effect of mesenteric I/R on structural and mechanical properties of rat mesenteric resistance artery (MRA) that, once disrupted, might impact the outcome of this devastating clinical condition. Superior mesenteric artery from Wistar–Kyoto rats was occluded (90 min) and reperfused (24 h). The effect of tezosentan, a dual endothelin (ET)-receptor antagonist, was studied in ischemic (IO) and sham-operated (SO) animals. MRA structure and mechanics were assessed by pressure myography. Nuclei distribution, elastin content and organization, collagen I/III and ET-1 expression, ET-1 plasma levels, superoxide anion (O2⋅−) production, and mRNA levels of NAD(P)H-oxidase subunits were measured. To assess ET-1 effects on O2⋅− production, MRA from non-operated rats were incubated in culture medium with ET-1. Mesenteric I/R increased MRA wall thickness (P < 0.05) and cross-sectional area (P < 0.05) but decreased wall stiffness (P < 0.05). Arterial remodeling was paralleled by enhancement of: (i) collagen I/III expression (P < 0.01), ET-1 expression (P < 0.05), and O2⋅− formation (P < 0.01) in the vessel wall; (ii) number of internal elastic lamina (IEL) fenestrae (P < 0.05); and (iii) plasma levels of ET-1 (P < 0.05). Moreover, ET-1 increased O2⋅− (P < 0.05) production in cultured MRA. Tezosentan prevented hypertrophic remodeling and collagen I/III deposition, and enhanced O2⋅− production, but it did not affect the decreased wall stiffness after mesenteric I/R. These results indicate that 90 min occlusion/24 h reperfusion induces hypertrophic remodeling of MRA linked to ET-1-mediated increase of collagen and O2⋅−. Decreased stiffness may be associated with increased number of IEL fenestrae. The resulting MRA remodeling, initially adaptive, might become maladaptive contributing to the pathology and poor outcome of mesenteric I/R, and might be a valuable treatment target for mesenteric I/R.

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Intraabdominal Vasculature

Meier

Sayed

2007

Acute Care Surgery

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Mesenteric Arterial Thrombosis Diagnosed on CT

Cited by 9 publications

References 8 publications

Mesenteric Ischemia: The Whole Spectrum

Mesenteric Ischemia: The Whole Spectrum

Transient Mesenteric Ischemia Leads to Remodeling of Rat Mesenteric Resistance Arteries

Intraabdominal Vasculature

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