Superior Mesenteric Artery syndrome (SMA Sd) is a very rare disease. It is suspected in the case of intestinal obstruction in severely underweight patients. When conservative management fails surgery becomes needed, with laparoscopic duodenojejunostomy being the best approach...
Isolated traumatic rupture of the duodenum: Case report - Perforations, prefe...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The esophageal duplication cyst is a congenital defect of the digestive tract. It has an estimated prevalence of 0.012%, with higher predominance in males. Although it is a common fi nding in children, diagnosis of an esophageal duplication in adults is rare. Following ileal duplication, esophageal is the second most common duplication of the gastrointestinal tract, representing the 10-15% of all gastrointestinal duplication defects. For esophageal duplication, there are two main variants: cystic and tubular, the latter being the least common. They are usually developed during the third to fifth week of gestation due to failure of the vacuolar coalescence. Duplication cysts are commonly located in the distal third of the esophagus.Treatment should always be surgical, even at the asymptomatic stage
of disease, given the possibility of symptom development and complication appearance. Here we present a case of an adult patient presenting with an esophageal duplication cyst with a brief literature review.
This case series describes 8 patients who presented with acute mesenteric ischemia and bowel gangrene. The most common presenting symptom was abdominal pain. Four patients had pre-existing cardiac conditions that increased their risk. All patients underwent exploratory laparotomy where gangrenous bowel segments were resected. Post-operative complications occurred in 4 patients, and the mortality rate in the series was 37.5%. Acute mesenteric ischemia can be difficult to diagnose due to non-specific symptoms, but prompt surgical treatment is needed to prevent high mortality from bowel necrosis.
Abstract
This case report describes the diagnosis and management of a large mesenteric cyst in a 55 year old lady who presented with abdominal distension & with mass in the left upper quadrant. Mesenteric cysts are rare, benign, abdominal tumors to which <1000 cases have been reported in the literature. While 40% of cases are incidental findings found either through physical examination or imaging, they can cause non-specific abdominal symptoms including pain, altered bowel habits, nausea/vomiting or anorexia. Less commonly, 10% of cases can present with bowel obstruction, volvulus, torsion or shock. In general, the lack of characteristic clinical and radiological features presents as a diagnostic difficulty.
The mainstay in imaging is computerized tomography (CT). CT identifies and helps aid the decision to pursue a laparoscopic or open laparotomy approach, where complete surgical resection is the ultimate goal. In our patient a CT Abdomen & Pelvis showed a large, loculated cystic mass measuring 30cm in cranio-caudal length and 16cm in the transverse and anterior/posterior diameter. While different approaches have been described in the literature to surgically resect such cysts, our approach was largely reflective of size and adherence to surrounding structures in this case. A laparotomy was performed using an upper mid-line 7 cm incision; 4500cc of fluid was aspirated from the cyst which was found to originate from the small bowel mesentery. A complete resection of the multi-loculated cystic sac was done that included the resection of the middle mesenteric vein. The post-operative period was uneventful. The patient was discharged on post-operative day 2. The Histopathology identified the mass as a multi-loculated peritoneal inclusion-type cyst.
Simple liver cysts are congenital or acquired benign cysts formations and are commonly found incidentally. It has a prevalence of 3-5% in ultrasound studies and 18-24% in CT scans. Frequently asymptomatic, liver cysts may be associated with symptoms in 10-16% of patients. Hemoperitoneum is a far rare complication. Herein, we report a case presented at the emergency room with acute hemorrhagic rupture of a liver cyst.
Injuries to bowel and mesentery. Lecture pptxShashi Prakash
The document discusses traumatic injuries to the bowel and mesentery from blunt abdominal trauma. It notes that the bowel and mesentery are commonly injured structures after the liver and spleen. Delayed diagnosis of 8 hours or more of bowel and mesenteric injuries can result in severe complications like bleeding, peritonitis, and sepsis. CT scans are important for diagnosis as they can identify signs of intestinal perforation, bleeding, or vascular injuries that require immediate surgery. The most common sites of bowel injury are the small bowel, particularly the proximal jejunum and distal ileum. Colon injuries from blunt trauma are less common.
Isolated traumatic rupture of the duodenum: Case report - Perforations, prefe...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The esophageal duplication cyst is a congenital defect of the digestive tract. It has an estimated prevalence of 0.012%, with higher predominance in males. Although it is a common fi nding in children, diagnosis of an esophageal duplication in adults is rare. Following ileal duplication, esophageal is the second most common duplication of the gastrointestinal tract, representing the 10-15% of all gastrointestinal duplication defects. For esophageal duplication, there are two main variants: cystic and tubular, the latter being the least common. They are usually developed during the third to fifth week of gestation due to failure of the vacuolar coalescence. Duplication cysts are commonly located in the distal third of the esophagus.Treatment should always be surgical, even at the asymptomatic stage
of disease, given the possibility of symptom development and complication appearance. Here we present a case of an adult patient presenting with an esophageal duplication cyst with a brief literature review.
This case series describes 8 patients who presented with acute mesenteric ischemia and bowel gangrene. The most common presenting symptom was abdominal pain. Four patients had pre-existing cardiac conditions that increased their risk. All patients underwent exploratory laparotomy where gangrenous bowel segments were resected. Post-operative complications occurred in 4 patients, and the mortality rate in the series was 37.5%. Acute mesenteric ischemia can be difficult to diagnose due to non-specific symptoms, but prompt surgical treatment is needed to prevent high mortality from bowel necrosis.
Abstract
This case report describes the diagnosis and management of a large mesenteric cyst in a 55 year old lady who presented with abdominal distension & with mass in the left upper quadrant. Mesenteric cysts are rare, benign, abdominal tumors to which <1000 cases have been reported in the literature. While 40% of cases are incidental findings found either through physical examination or imaging, they can cause non-specific abdominal symptoms including pain, altered bowel habits, nausea/vomiting or anorexia. Less commonly, 10% of cases can present with bowel obstruction, volvulus, torsion or shock. In general, the lack of characteristic clinical and radiological features presents as a diagnostic difficulty.
The mainstay in imaging is computerized tomography (CT). CT identifies and helps aid the decision to pursue a laparoscopic or open laparotomy approach, where complete surgical resection is the ultimate goal. In our patient a CT Abdomen & Pelvis showed a large, loculated cystic mass measuring 30cm in cranio-caudal length and 16cm in the transverse and anterior/posterior diameter. While different approaches have been described in the literature to surgically resect such cysts, our approach was largely reflective of size and adherence to surrounding structures in this case. A laparotomy was performed using an upper mid-line 7 cm incision; 4500cc of fluid was aspirated from the cyst which was found to originate from the small bowel mesentery. A complete resection of the multi-loculated cystic sac was done that included the resection of the middle mesenteric vein. The post-operative period was uneventful. The patient was discharged on post-operative day 2. The Histopathology identified the mass as a multi-loculated peritoneal inclusion-type cyst.
Simple liver cysts are congenital or acquired benign cysts formations and are commonly found incidentally. It has a prevalence of 3-5% in ultrasound studies and 18-24% in CT scans. Frequently asymptomatic, liver cysts may be associated with symptoms in 10-16% of patients. Hemoperitoneum is a far rare complication. Herein, we report a case presented at the emergency room with acute hemorrhagic rupture of a liver cyst.
Injuries to bowel and mesentery. Lecture pptxShashi Prakash
The document discusses traumatic injuries to the bowel and mesentery from blunt abdominal trauma. It notes that the bowel and mesentery are commonly injured structures after the liver and spleen. Delayed diagnosis of 8 hours or more of bowel and mesenteric injuries can result in severe complications like bleeding, peritonitis, and sepsis. CT scans are important for diagnosis as they can identify signs of intestinal perforation, bleeding, or vascular injuries that require immediate surgery. The most common sites of bowel injury are the small bowel, particularly the proximal jejunum and distal ileum. Colon injuries from blunt trauma are less common.
Ulcerative Colitis with Aseptic Abscesses Controlled by Vedolizumab: A Case R...pateldrona
This case report describes a patient with ulcerative colitis, aseptic abscesses in the mesenteric lymph nodes, liver and kidneys, and musculoskeletal manifestations who was successfully treated with the drug vedolizumab. The patient had failed multiple previous treatments including mesalazine, corticosteroids, and antibiotics. Vedolizumab treatment resulted in remission of the intestinal symptoms and improvement in the extraintestinal manifestations after 4 months as confirmed by various medical imaging and endoscopy results. This is the first reported case of using vedolizumab to treat ulcerative colitis with associated aseptic abscesses.
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This case report describes a rare presentation in a 21-year-old female patient with pentalogy of Fallot. Cardiac CT imaging revealed multiple sources of blood flow to the lungs including a dilated left main coronary artery to right pulmonary artery collateral, a patent ductus arteriosus to the left pulmonary artery, and multiple aortopulmonary collateral arteries. This represents an extremely rare occurrence of coronary-pulmonary connections providing a major source of pulmonary blood flow in addition to normally seen aortopulmonary collaterals. Detection of these varied collateral pathways has important implications for surgical planning in such complex congenital heart disease cases.
Patients with severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) infection mainly present severe pneumonia associated with complications related to cytokine storm syndrome. So, it was associated with thrombotic incidents like acute limb ischemia and pulmonary embolism.
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Benzodiazepines use in the elderly are associated with morbidity including increased falls, fractures, and mortality. The common reason for re-prescribing benzodiazepine by physicians is dependency. Our project proposal aims to enhance medication safety in the elderly. It requires a multidisciplinary approach and patient-centred care focusing on benzodiazepine deprescribing using the 3Es model of Educating, Empowering, and Engaging. The education starts with patients, providers, and the community about benzodiazepine adverse effects on the elderly and provides alternative approaches for symptoms management.
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including foodborne diseases, to this day remain a major health threat worldwide. Molecular diagnostics, based on nucleic acid (NA) amplification technologies, are in the forefront for the detection of pathogens. Polymerase chain reaction (PCR) is one of the most widely used methods for nucleic acid amplification in pathogen diagnostic.
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Chinese herbal medicine is considered relatively safe, inexpensive, and easily accessible. Furthermore, it is becoming increasingly popular in the western countries. Wen Dan Tang, a Jing Fang ancient classical Chinese herbal formula, with a broad indication profile, has been used for several centuries in China to treat various illnesses.
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Anthrax is a dangerous zoonotic infection that is transmitted from farm animals to humans, when cutting, butchering infected animals, contact with meat and other animal products. Infection occurs by contact, alimentary, aerogenic pathways, while developing corresponding clinical forms – skin /ulcerative, abdominal / intestinal, pulmonary /pneumonic Kazakhstan is an anthrax-endemic territory, cases of this infection are registered almost annually
Syringoma is a benign eccrine sweat gland tumor affecting mostly females at puberty projected with multiple soft papules usually 1-2 mm in diameter. During puberty, syringoma appears among females; it is presented as multiple soft papules, 1-2 mm in diameter, as a benign eccrine sweat gland tumor. The sites of predilection are lower eyelids, and cheeks. The regions of tendency are cheeks and lower eyelids. Syringoma of the vulvar is a rare disorder few cases of which have been reported in literature.
Rural Healthcare in Light of a Multinational Pandemic: A Global Perspectivepateldrona
Abstract Rural healthcare recently came into international spotlight, with recent reported influx of the COVID-19 into rural regions. This article focuses on susceptibilities of the rural population to pandemics and mitigating measures to prevent formation of disease epicentre. Rural Healthcare is by far one of the most neglected areas of medicine. The discrepancies in quality of rural healthcare has been evident for decades, yet no lasting measures have been able to bridge this gap till date. Lessons gleaned from the recent SARS and H1N1 pandemics has once again fallen through the cracks in a futile attempt to curb urban spread.
In bioelectronic terms, the organism is understood as an integrated circuit of biological piezo, pyroelectrics, ferromagnets and semiconductors, filled with bioplasm and managed electronically by quantum processes. The presence of semiconductors in a biological system is synonymous with the presence of an electronic integrated device, therefore a living organism can be seen as a complex electronic device, analogous to technical devices.
Sexual Function and Dysfunction among Patients with Systemic and Auto-Immune ...pateldrona
Systemic autoimmune diseases affect various organs and they can determine sexual dysfunction in females and males patients particularly with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis (SSc), Sjögren syndrome (SS), antiphospholipid syndrome, Behçet’s disease and other vasculitis. Sexual dysfunction among patients with rheumatic diseases is multifactorial due to disease-related factors (chronic disease aspects, disease activity) as well as therapy.
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This case report describes a patient with ulcerative colitis, aseptic abscesses in the mesenteric lymph nodes, liver and kidneys, and musculoskeletal manifestations who was successfully treated with the drug vedolizumab. The patient had failed multiple previous treatments including mesalazine, corticosteroids, and antibiotics. Vedolizumab treatment resulted in remission of the intestinal symptoms and improvement in the extraintestinal manifestations after 4 months as confirmed by various medical imaging and endoscopy results. This is the first reported case of using vedolizumab to treat ulcerative colitis with associated aseptic abscesses.
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This case report describes a rare presentation in a 21-year-old female patient with pentalogy of Fallot. Cardiac CT imaging revealed multiple sources of blood flow to the lungs including a dilated left main coronary artery to right pulmonary artery collateral, a patent ductus arteriosus to the left pulmonary artery, and multiple aortopulmonary collateral arteries. This represents an extremely rare occurrence of coronary-pulmonary connections providing a major source of pulmonary blood flow in addition to normally seen aortopulmonary collaterals. Detection of these varied collateral pathways has important implications for surgical planning in such complex congenital heart disease cases.
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Chinese herbal medicine is considered relatively safe, inexpensive, and easily accessible. Furthermore, it is becoming increasingly popular in the western countries. Wen Dan Tang, a Jing Fang ancient classical Chinese herbal formula, with a broad indication profile, has been used for several centuries in China to treat various illnesses.
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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Superior Mesenteric Artery Syndrome Treated by Laparoscopic Duodenojejunostomy
1. Annalsof Clinicaland Medical
Case Reports
ISSN 2639-8109
Case Report
Superior MesentericArtery Syndrome Treated by Laparoscopic
Duodenojejunostomy
El-Khoury Elias1,*
, El-Darazi Elham2
and El-Attrache Najib3
1
Department of Surgery, Central Military Hospital, Beirut, Lebanon
2
Department of Nutrition, Faculty of Arts and Sciences, USEK, Lebanon
3
Department of Surgery, Lebanese University, Lebanon
1. Abstract
Superior Mesenteric Artery syndrome (SMA Sd) is a very rare disease. It is suspected in the case
of intestinal obstruction in severely underweight patients. When conservative management fails
surgery becomes needed, with laparoscopic duodenojejunostomy being the best approach.
2. Keywords:
Superior Mesenteric Artery; Duo-
denojejunostomy; Laparoscopy
3. Case report
A 22-year-old patient, with a BMI of 22 kg/m2, presented to us
with a history of intestinal obstruction for more than five days, and
a severely distended abdomen on physical exam. Abdominal CT
Scan confirmed the diagnosis of SMA sd with an aortomesenteric
angle of 20 degrees and a distance of 7 mm (Figure 1). He was
managed conservatively with nasojejunal feeding, with no relief in
his symptoms after five days. Laparoscopic duodenojejunostomy
was decided. Under general anesthesia, the patient waspositioned
in Trendelenbourg decubitus positon and the surgeon standed
between his legs. The Camera trocar was placed 2 cm below the
umbilicus and the two operating trocars at the midclavicular line
bilaterally on the same level. The transverse colon andmesocolon
were retracted superiorly till clear vision of the third part of the
duodenum (D3) (Figure 2-3). The retroperitoneum is entered by
incising the thin peritoneal layer below the middle of D3, the In-
ferior Vena Cava (IVC) became visualized. (Figure 4) Then, D3
was completely mobilised from the aorta and the IVC posteriorly
(Figure 5), and dissected from its junction with the secondduode-
num (D2) medially (Figure 6), from the Superior Mesenteric Vein
(SMV) laterally and from the transverse mesocolon anteriorly (Fi-
gure 7). Finally, the proximal Jejunum was anastomosed mechani-
cally to D3 laterolaterally (Figure 8). The post operative course was
uneventful. The patient was relieved from his obstructive symp-
toms and subsequently regained weight.
Figure 1: Aortomesenteric angle of 20 degrees compressing the distal D3 (arrow).
Severely distended stomach (Long arrow)
Figure 2: Third duodenum (Arrow) Retracted transverse colon with its mesentery
(grasper)
*Corresponding Author (s): El-Khoury Elias, Department of Surgery, Central Military Hospi-
tal, Beirut, Lebanon, E-mail : efkhoury@gmail.com
http://www.acmcasereport.com/
Citation: El-Khoury Elias, El-Darazi Elham and El-Attrache Najib.Superior Mesenteric Artery
Syndrome Treated by Laparoscopic Duodenojejunostomy. Annals of Clinical and Medical Case
Reports. 2020; 4(1): 1-4.
Volume 4 Issue 1- 2020
Received Date: 29 Apr 2020
Accepted Date: 08 May 2020
Published Date: 11 May 2020
3. Volume 4 Issue 1-2020 Case Report
http://www.acmcasereport.com/ 3
complication like in scoliosis surgery, [14, 15] ileoanal pouchsur-
gery, [16] abdominal aortic aneurysm repair [15]. SMA Sd may ra-
rely coexist with the Nutcracker syndrome when the left renal vein
becomes compressed [17, 18]. CT scan is the standard diagnostic
radiological tool as it allows the measurement of the aortomesen-
teric angle and distance. SMA Sd presents like any intestinal obs-
tructive disease. Relief occurs when the patient goes from supine
to prone position because gravity contributes to the duodenal
compression. Initially, SMA Sd should be treated conservatively,
and surgery is needed when medical treatment fails [19, 20]. The
surgical options include duodenojejunostomy, gastrojejunostomy
and duodenal derotation. Gastrojejunostomy does not relieve the
proximal duodenal obstruction and patients can continue to have
postoperative vomiting [21]. Duodenal derotation has the advan-
tages that it does not require an anastomosis, however it has a high
failure rate [9, 22, 23]. Laparoscopic duodenojejunostomy, first
performed in 1998, [24] is considered to be the best surgical treat-
ment for SMA Sd with the same outcome as open surgery but with
less morbidity with 90% success rate [6, 17, 22, 25-28].
References
1. Von Rokitansky C. In: Lehrbuch der pathologischen Anatomie. 3rd
ed. Vienna: Braumüller; 1861. Superior mesenteric artery syndrome;
p. 87.
2. Wilkie DPD. Chronic Duodenal Ileus. The American Journal of the
Medical Sciences. 1927; 173:643-48.
3. Ganss A, Rampado S, Savarino E, Bardini R. Superior Mesenteric
Artery Syndrome: a Prospective Study in a Single Institution. J Gas-
trointest Surg. 2019; 23:997-1005.
4. Shiu JR, Chao HC, Luo CC, Lai MW,Kong MS, Chen SY, et al. Clin-
ical and nutritional outcomes in children with idiopathic superior
mesenteric artery syndrome. J Pediatr Gastroenterol Nutr. 2010; 51:
177-82.
5. Smith BM, Zyromski NJ, Purtill MA. Superior mesenteric artery syn-
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