Transmesenteric hernia: A rare cause of bowel ischaemia in adults

Butterworth, James A.; Cross, Trent; Butterworth, William; Mousa, Paul; Thomas, S.

doi:10.1016/j.ijscr.2013.01.032

Cited by 22 publications

(23 citation statements)

References 16 publications

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“…These mesenteric vessels form a very complex network with several small branches including the caudal pancreatico‐duodenal branches, jejunal branches, ileal branches, ileocolic branches, right colic branches, middle colic branches, left colic branches, and cranial rectal branches, and have wide variations in dogs and cats . Deterioration of mesenteric circulation can induce ischemia of the small intestine, and mesenteric volvulus, intussusception, mesenteric internal hernia of the small intestine, and abdominal trauma can result in complete or partial obstruction of the mesenteric vessels and eventual intestinal necrosis . Mesenteric vascular thrombosis can be associated with disseminated abdominal tumors such as hemangiosarcoma, or various underlying diseases including hypertrophic cardiomyopathy, hepatopathy, protein‐losing nephropathy, or corticosteroid imbalance in dogs and cats .…”

Section: Introductionmentioning

confidence: 99%

Triple‐phased mesenteric CT angiography using a test bolus technique for evaluation of the mesenteric vasculature and small intestinal wall contrast enhancement in dogs

Lee

Yoon

Kim

et al. 2019

Vet Radiology Ultrasound

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Computed tomography angiography is widely used for the assessment of various mesenteric vascular and bowel diseases in humans. However, there are only few studies that describe CT angiography application to mesenteric vessels in dogs. In this prospective, experimental, exploratory study, the mesenteric vasculature and enhancement pattern of the intestinal wall were evaluated on triple-phase CT angiography, and improvement of the visibility of vasculature was assessed on multiplanar reformation, maximum intensity projection, and volume rendering technique. After test bolus scanning at the level of the cranial mesenteric artery arising from the aorta, mesenteric CT angiography was performed in 10 healthy, male, Beagle dogs. Scan delay was set based on time-to-attenuation curves, drawn by placing the regions of interest over the aorta, intestinal wall, and cranial mesenteric vein. Visualization and enhancement of mesenteric arteries and veins were evaluated with multiplanar reformation, maximum intensity projection, and volume rendering techniques. The degree of intestinal wall enhancement was assessed on the transverse images in precontrast, arterial, intestinal, and venous phases. Pure arterial images were obtained in the arterial phase. Venous phase images allowed good portal vascular mapping. All CT angiography images were of high quality, allowing for excellent visualization of the anatomy of mesenteric vasculature including the small branches, particularly on maximum intensity projection and volume rendering technique. Distinct contrast enhancement of the intestinal wall was observed in both intestinal and venous phases. Findings indicated that this technique is feasible for the evaluation of mesenteric circulation in dogs. K E Y W O R D Sbowel wall, canine, dynamic CT study, mesenteric vessels, test bolus

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Section: Introductionmentioning

confidence: 99%

Triple‐phased mesenteric CT angiography using a test bolus technique for evaluation of the mesenteric vasculature and small intestinal wall contrast enhancement in dogs

Lee

Yoon

Kim

et al. 2019

Vet Radiology Ultrasound

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“…Although usually within normal range, leukocyte count may increase and metabolic acidosis may develop in the case of development of intestinal gangrene. The cases in the literature were generally admitted to hospital with symptoms of intestinal obstruction and strangulation and most of them needed a resection and anastomosis of bowel (15). However, in our case, the patient was admitted to the hospital with the symptoms of acute appendicitis.…”

Section: Discussionmentioning

confidence: 73%

Congenital Transmesenteric Hernia Without Bowel Strangulation in a Young Adult

Kaya¹,

Kafadar²,

Gök³

et al. 2018

Haseki

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“…We report a case of bowel obstruction with caecal ischaemia due to an internal hernia caused by a congenital transverse mesenteric defect in an adult patient, initially misdiagnosed on CT as congenital midgut malrotation. Acute bowel obstruction secondary to internal hernia from a congenital mesenteric defect is extremely rare with only a few reported cases in the literature 1. To the authors' knowledge, this is the first reported case of internal hernia secondary to a congenital mesenteric defect in an adult patient resulting in colonic involvement and caecal ischaemia.…”

Section: Figurementioning

confidence: 79%

Congenital transverse colon mesenteric defect in an adult patient leading to acute large bowel obstruction

Ganguly

Lewis

2020

ANZ Journal of Surgery

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synchronous NRAS genetic mutation confirmed the ultimate diagnosis of metastatic de-differentiated melanoma. The authors' experience here reinforces the importance of seeking the correct diagnosis through meticulous clinical and pathological investigation and highlights the benefits of discussion at a multidisciplinary meeting. This ensures that patients do not receive misguided treatment. Our case also serves to reinforce the longstanding adage in medicine that common things occur commonly and the principle of 'Occam's Razor' in seeking a single unifying diagnosis for the patient's presentation. Specifically, for this patient, it was far more likely for the popliteal mass in the draining distribution of a previously excised heel melanoma to correspond with a metastatic deposit rather than a new primary sarcoma (despite the apparent findings of the initial pathology). Through clinician scepticism and experience as well as further considered investigation, the correct diagnosis was ultimately clinched. In conclusion, this is a rare case highlighting the diagnostic difficulties associated with the increasingly recognized clinical entity of de-differentiated melanoma and the critical role of genetic testing in confirming this diagnosis. Of interest in this case was that the standard melanoma markers were lost from the primary melanoma to its metastasis; however, the same somatic genetic aberration persisted. Notably, this genetic mutation was not the more commonly identified BRAF V600E mutation but a more rarely reported NRAS p.Q61R mutation. Surgeons and pathologists involved in the treatment of patients with melanoma and sarcoma must be aware of dedifferentiated melanoma when formulating their differential diagnosis, as otherwise it will frequently be missed which may result in incorrect diagnosis and inappropriate treatment.

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Transmesenteric hernia: A rare cause of bowel ischaemia in adults

Abstract: Close monitoring of the patient's general condition in cases of non-specific abdominal pain is essential to identify the rare deteriorating patient for early surgical intervention and optimal outcome.

Cited by 22 publications

References 16 publications

Triple‐phased mesenteric CT angiography using a test bolus technique for evaluation of the mesenteric vasculature and small intestinal wall contrast enhancement in dogs

Triple‐phased mesenteric CT angiography using a test bolus technique for evaluation of the mesenteric vasculature and small intestinal wall contrast enhancement in dogs

Congenital Transmesenteric Hernia Without Bowel Strangulation in a Young Adult

Congenital transverse colon mesenteric defect in an adult patient leading to acute large bowel obstruction

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