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Thrombosis of the portomesenteric veins is an uncommon condition that can lead to serious complications, if left untreated. Bariatric reduction surgeries increase the probability for occurrence of this rare condition. This case study focuses on a patient who underwent a biliopancreatic diversion with duodenal switch procedure and consequently developed an occlusive thrombus in the superior mesenteric vein (SMV), which required stent placement. The patient ultimately developed a secondary thrombus, within the stent. Sonographic imaging aided in the diagnosis of occlusion of the SMV stent. [ABSTRACT FROM AUTHOR]

The article presents a clinical case of a 39-year-old patient with thrombosis and postoperative rethrombosis of the superior mesenteric vein. The disease was complicated by the small intestine necrosis and abdominal surgical infection. Successful thrombectomy and bowel resection made it possible to restore mesenteric blood supply, to stabilize the patient’s condition and to perform an enteroenteroanastomosis. Due to antithrombin III deficiency, rethrombosis in the early postoperative period was complicated by anastomotic leak, unformed intestinal fistula and peritonitis. A hybrid treatment (surgical, parasurgical and conservative) was performed, which included selective infusion of a thrombolysis activator at the superior mesenteric artery mouth. The patient recovered.Clinical and laboratory manifestations of superior mesenteric vein thrombosis, in contrast to acute circulatory disorders in the arteriomesenteric system, are nonspecific and do not always allow timely diagnosis of intestinal ischemia. MSCT angiography identifies venous mesenteric thrombosis in most cases. The ineffectiveness of anticoagulant therapy against the background of antithrombin III deficiency caused superior mesenteric vein thrombosis and rethrombosis. The treatment of the small intestine critical postoperative ischemia included an increase in the volume of antithrombin III and frozen plasma intravenous infusion and selective administration of a thrombolysis activator (actilyse) into the superior mesenteric artery, which made it possible to restore the arteriolovenular intramural blood flow of the small intestine and to prevent another stem rethrombosis of the superior mesenteric vein. Laparostomy using a silicone plate made it possible to constantly monitor the course of the abdominal infectious process and to make timely decisions about the next intervention if medically required. The vacuum assisted design provided permanent lavage of the abdominal cavity without trauma to the soft tissues of the abdominal wall and presenting intestinal loops.

Background The introduction of the 1 mm cut-off for resection margin according to the Leeds Pathology Protocol has transformed the concept of surgical radicality. Its impact on nodal-positive resected pancreatic ductal adenocarcinoma patients is unclear. The aim of this study was to analyse the effect of margin clearance on survival among resected, nodal-positive pancreatic ductal adenocarcinoma patients whose specimens were analysed according to the Leeds Pathology Protocol. Methods Data were collected retrospectively from multicentre clinical databases. Resected patients with nodal involvement were included. Overall survival and disease-free survival were analysed according to minimum reported margin clearances of 0, 0.5, 1, and 2 mm. The results are reported separately for patients who had not undergone venous resection and for patients for whom data were available regarding the superior mesenteric vein-facing margin or the vein specimen. The eighth edition of TNM classification by the AJCC was used. Results The study comprised 290 stage IIB patients and 215 stage III patients without venous resection. The superior mesenteric vein margin analysis comprised 127 stage IIB patients and 198 stage III patients. The different resection margin distances were not associated with overall survival and disease-free survival among patients without venous resection (P > 0.050). Receiving adjuvant therapy was associated with longer overall survival among stage IIB patients (P = 0.034) and stage III patients (P = 0.003) and with longer disease-free survival among stage III patients (P < 0.001). Conclusions In this study, a margin clearance greater than 1 mm showed no clear effect on overall survival in pancreatic ductal adenocarcinoma patients with nodal involvement, whereas adjuvant therapy was confirmed to be essential to ensure longer overall survival. [ABSTRACT FROM AUTHOR]

Idiopathic superior mesenteric vein (SMV) stenosis, where no clear causative factor is identifiable, remains a clinical rarity. We present a detailed case report of a patient with idiopathic stenosis of the SMV who underwent successful endovascular stenting. This report outlines the patient's clinical presentation, diagnostic imaging findings, procedural approach by the interventional radiology team, and subsequent management. Endovascular stenting is a viable therapeutic option for patients with idiopathic SMV stenosis. This case demonstrates that with appropriate interventional and post-procedural management, long-term stent patency and thrombosis prevention can be achieved. The success of this case encourages further investigation into endovascular treatments for venous stenoses. [ABSTRACT FROM AUTHOR]

Objective To compare the clinical efficacy and short-term prognosis of laparoscopic radical resection of right colon cancer guided by superior mesenteric artery and superior mesenteric vein. Methods 80 patients with right colon cancer of cT2-4 and/or N0-2M0 admitted from January 2020 to October 2022 were selected as the research objects, and they were randomly divided into observation group and control group, with 40 patients in each group. The observation group was treated with SMA-oriented laparoscopic radical resection of right colon cancer, while the control group was treated with SMV-oriented laparoscopic radical resection of right colon cancer. The curative effect and prognosis of the two groups were compared. Results There was no significant difference between the two groups in general condition, operation time, gastric tube placement time, recovery time of farting, postoperative fasting time, postoperative drainage time, postoperative nutritional index, total incidence of complications and postoperative hospitalization time(P > 0.05). The lymph nodes in the observation group were significantly more than those in the control group, and the difference was statistically significant(P < 0.05). In the observation group, the lymph nodes in the anterior and left side of superior mesenteric artery were examined (No. D3), and 273 lymph nodes were detected, and Seven patients (17.5%) were diagnosed with D3 metastasis, and 13 lymph nodes were positive (5.2%). Conclusion Laparoscopic radical resection of right colon cancer guided by superior mesenteric artery, without increasing the incidence of complications and high safety, can more thoroughly clean lymph nodes and reduce tumor recurrence, which is expected to significantly improve the prognosis of patients. [ABSTRACT FROM AUTHOR]

A female in her 60s with vague abdominal symptoms was found to have a pancreatic mass in her CT scan. A core needle biopsy done endoscopically demonstrated a poorly differentiated adenocarcinoma. The patient completed nine cycles of neoadjuvant systemic mFOLFIRINOX. Repeat staging demonstrated a partial radiographic response. She underwent an open pylorus-preserving pancreatoduodenectomy with segmental superior mesenteric vein resection with primary reconstruction (ISGPS Type 3). The final pathology demonstrated a poorly differentiated adenosquamous carcinoma, R1 margin status. The case report demonstrates the effect of mFOLFIRINOX on pancreatic adenosquamous (PASC) carcinoma with a review of the microscopic pictures following the neoadjuvant therapy. It can be postulated that glandular component being the major component in a PASC has a good response to mFOLFIRINOX like that seen in pancreatic ductal adenocarcinoma with some presumed effect on the squamous component as well. From the above case report, we are proposing that mFOLFIRINOX can be an effective chemotherapy regime in the management of PASC. [ABSTRACT FROM AUTHOR]

Gastrointestinal bleeding is a common clinical symptom. Finding the underlying cause is the first step for treatment. In a few patients, this can be difficult. The present work reports on the unusual case of a 53-year-old man who presented gastrointestinal bleeding. No bleeding site was found by gastrocolonoscopy or interventional examination, but after multidisciplinary consultation, we discovered that the cause of gastrointestinal bleeding was the obstruction of the upper mesenteric vein. [ABSTRACT FROM AUTHOR]

Idiopathic superior mesenteric vein (SMV) stenosis, where no clear causative factor is identifiable, remains a clinical rarity. We present a detailed case report of a patient with idiopathic stenosis of the SMV who underwent successful endovascular stenting. This report outlines the patient’s clinical presentation, diagnostic imaging findings, procedural approach by the interventional radiology team, and subsequent management. Endovascular stenting is a viable therapeutic option for patients with idiopathic SMV stenosis. This case demonstrates that with appropriate interventional and post-procedural management, long-term stent patency and thrombosis prevention can be achieved. The success of this case encourages further investigation into endovascular treatments for venous stenoses.

Abstract Background The hypereosinophilic syndrome (HES) is a group of rare blood disorders characterized by persistent eosinophilia and damage to multiple organs. HES can be either primary, secondary or idiopathic. Secondary HES are commonly caused by parasitic infections, allergic reactions or cancer. We described a pediatric case of HES associated with liver damage and multiple thrombi. Case summary A 12-year-old boy with eosinophilia was complicated with severe thrombocytopenia, liver damage, portal vein, splenic vein, and superior mesenteric vein thromboses. The thrombi recanalized after treatment with methylprednisolone succinate and low molecular weight heparin. No side effects appeared after 1-month. Conclusions Corticosteroids should be used at an early stage of HES to prevent further damage to vital organs. Anticoagulants should be recommended only in cases with thrombosis which should be actively screened as a part of evaluation of end organ damage.

Superior mesenteric venous (SMV) thrombosis is a rare complication of severe appendicitis. Early recognition is due to improved imaging modalities, which ultimately lead to more prompt intervention. Despite being an uncommon phenomenon, SMV thrombosis can have complications stemming from venous hypertension, such as gastric and esophageal varices, bowel ischemia, sepsis, and death. As this is a rare phenomenon, specific treatment guidelines and algorithms are lacking in the current literature. This case report describes a 23-year-old male patient whose recovery from a laparoscopic appendectomy was complicated with both an SMV and portal vein thrombosis. [ABSTRACT FROM AUTHOR]

This is a case report of a 55-year-old Caucasian male prescribed topical testosterone therapy for 12 months prior to admission, when he was diagnosed with acute thrombosis in the portal vein (PVT) and superior mesenteric vein (SMV). The patient had a negative thrombophilia workup, including Factor V Leiden, Prothrombin G20210A, and JAK2 V617F mutations. There were no other pertinent laboratory markers that raised concern for the cause of thrombus. No strong familial history of venous thromboembolism (VTE) was reported during the patient's initial workup. With this in mind, the patient's use of topical testosterone therapy was considered the most likely risk factor for the PVT and SMV thrombus. During hospitalization, the patient was initiated on therapeutic anticoagulation with a heparin drip and discharged to home on apixaban for 3 months with extended therapy to be determined by outpatient hematologist. With no other identified VTE risk factors, probability that this patient's VTE was attributed to testosterone was evaluated using the Naranjo scale with a calculated score of 6, which classifies the adverse reaction as "likely." Clinicians should be aware of the possibility that topical testosterone therapy may be a risk factor for venous thrombosis in unusual sites. [ABSTRACT FROM AUTHOR]

ObjectivesAlthough traumatic injuries to the superior mesenteric vein (SMV), portal vein (PV), and hepatic vein (HV) are rare, their impact is significant. Small single center reports estimate mortality rates ranging from 29% to 100%. Our aim is to elucidate the incidence and outcomes associated with each injury due to unique anatomic positioning and varied tolerance of ligation. We hypothesize that SMV injury is associated with a lower risk of mortality compared to HV and PV injury in adult trauma patients.MethodsThe Trauma Quality Improvement Program database (2010-2016) was queried for patients with injury to either the SMV, PV, or HV. A multivariable logistic regression model was used for analysis.ResultsFrom 1,403,466 patients, 966 (0.07%) had a single major hepatoportal venous injury with 460 (47.6%) involving the SMV, 281 (29.1%) involving the PV, and 225 (23.3%) involving the HV. There was no difference in the percentage of patients undergoing repair or ligation between SMV, PV, and HV injuries (P > .05). Compared to those with PV and HV injuries, patients with SMV injury had a higher rate of concurrent bowel resection (38.5% vs 12.1% vs 7.6%, P < .001) and lower mortality (33.3% vs 45.9% vs 49.3%, P < .01). After controlling for covariates, traumatic SMV injury increased the risk of mortality (odds ratio [OR] 1.59, confidence interval [CI] = 1.00-2.54, P = .05) in adult trauma patients; however, this was less than PV injury (OR = 2.77, CI = 1.56-4.93, P = .001) and HV injury (OR = 2.70, CI = 1.46-4.99, P = .002).ConclusionTraumatic SMV injury had a lower rate of mortality compared to injuries of the HV and PV. SMV injury increased the risk of mortality by 60% in adult trauma patients, whereas PV and HV injuries nearly tripled the risk of mortality.

Abernethy malformation or congenital portosystemic shunt is a rare congenital vascular malformation and anomaly of the splanchnic venous system defined by diverting portal blood away from the liver. It is commonly associated with multiple congenital anomalies. Imaging modalities such as computed tomography or magnetic resonance have a crucial role in prompting diagnosis and determining the prognosis based on the type of malformation and associated anomalies. Misdiagnosis could be harmful and may lead to inappropriate treatment. We present a case of Abernethy malformation with a complete end-to-side shunt of portal venous flow into the systemic venous flow and complete bypass of the liver, which was initially misdiagnosed with portal venous thrombosis.

Acute mesenteric venous thrombosis (MVT) is a rare but potentially fatal condition with superior mesenteric vein being the most common site of thrombosis development. It is more common in patients with underlying disorders which cause disruptions to Virchow's Triad of hypercoagulability, stasis and endothelial injury. The disease is often associated with intestinal ischemia in its acute form, further complicating its management. We present a case of acute superior mesenteric venous thrombosis, in a 65 years old man with initial features of intestinal infarction, diagnosed at Computed Tomography Angiography (CTA) scan. However, the patient was stable, with a nonperitonitic abdomen, and was subsequently managed with conservative measures.

Background: The hypereosinophilic syndrome (HES) is a group of rare blood disorders characterized by persistent eosinophilia and damage to multiple organs. HES can be either primary, secondary or idiopathic. Secondary HES are commonly caused by parasitic infections, allergic reactions or cancer. We described a pediatric case of HES associated with liver damage and multiple thrombi. Case summary: A 12-year-old boy with eosinophilia was complicated with severe thrombocytopenia, liver damage, portal vein, splenic vein, and superior mesenteric vein thromboses. The thrombi recanalized after treatment with methylprednisolone succinate and low molecular weight heparin. No side effects appeared after 1-month. Conclusions: Corticosteroids should be used at an early stage of HES to prevent further damage to vital organs. Anticoagulants should be recommended only in cases with thrombosis which should be actively screened as a part of evaluation of end organ damage. [ABSTRACT FROM AUTHOR]

The article focuses on the management of a traumatic superior mesenteric vein (SMV) pseudoaneurysm, presenting a case of a 16-year-old boy who was successfully treated with a covered endovascular stent using a transhepatic approach. Topics include the rarity of abdominal venous injuries, various management options for visceral venous injuries, and the challenges and considerations involved in choosing the appropriate treatment approach.

A detailed knowledge of the surgical anatomy of tributaries of the superior mesenteric vein, especially proximal jejunal venous anatomy (first jejunal vein and jejunal trunk), is a key prerequisite for performing a safe pancreatico-duodenectomy. However, the available literature on the anatomical course and surgical relevance of these vessels is scarce, the nomenclature across the articles is heterogeneous, and the resulting evidence is confusing to interpret. Standardized terminology and an in-depth review of these vessels with regard to their course, termination, vascular relations, and variations will help the surgeons in planning and performing this complex surgery safely, especially when a venous resection and reconstruction is planned in cases of borderline resectable pancreatic cancer. A uniform nomenclature and a unifying classification are proposed in this review for these two tributaries to help resolve the literature conundrum. This standardized terminology and anatomical description will assist the radiologists in reporting pancreatic protocol-computed tomography scans and surgeons in selecting the appropriate steps for the different anatomical orientations of these tributaries for the performance of safe pancreatic surgery. This will also help future researchers communicate in well-defined terms in reference to these tributaries so as to avoid confusion in future studies. [ABSTRACT FROM AUTHOR]

Background: Superior mesenteric artery (SMA) originates at L1 level as a ventral branch of abdominal aorta. It supplies the derivatives of midgut which extends below the opening of major duodenal papillae in the 2nd part of the duodenum till the junction between the right 2/3rd left 1/3rd of the transverse colon. After its origin, it descends obliquely inside the mesentery up to the root of right iliac fossa. It is accompanied by superior mesenteric vein to its right side and is surrounded by a plexus of autonomic nerves. The SMA gives branches to jejunum, ileum and right colic, inferior pancreaticoduodenal (IPD), ileocolic, and middle colic artery. Variations in the course and branching pattern of SMA are of significant importance in gastrointestinal surgeries. Methodology: A prospective study was conducted with the convenient sample size of thirty cadavers. After opening the anterior abdominal wall, peritoneum and viscera were carefully separated and cleaned. The abdominal aorta with its branches was identified. SMA was identified at its origin. The course of the artery and its branches were traced and noted. The findings were tabulated and analyzed. The relation of superior mesenteric vein with the artery was identified and noted. Results: Variations in the branches of SMA were observed in 14 cadavers. We observed the absence of middle colic artery in four cadavers. Higher origin of ileocolic artery was found in two cadavers. One common trunk divides into middle colic artery and accessory right colic artery and another common trunk divides into right colic artery and ileocolic artery in a cadaver. The right colic artery and middle colic artery were found to take origin from a common trunk in a cadaver. The common trunk for IPD (artery and middle colic artery was found in one cadaver. The common trunk for right colic artery and ileocolic artery was observed in four cadavers. Accessory right colic artery was observed in four cadavers. The common trunk for accessory right colic artery and middle colic artery was found in two cadavers. Accessory right colic artery, right colic artery, ileocolic artery, and ileal branches had their origins from a common trunk in a cadaver. Variations in relation between SMA and superior mesenteric vein were found in two cadavers. Conclusion: Awareness and knowledge regarding the variations in SMA and its relation with vein are important for surgeons and radiologists to avoid both intraoperative and postoperative complications during surgical and diagnostic procedures involving intestines.

Background: Complete mesocolic excision + D3 lymphadenectomy for right-sided colon cancer is standard procedure in Japan. A postmortem study has shown that in patients with the ileocolic artery (ICA) crossing posterior to the superior mesenteric vein (SMV), D3 lymphadenectomy may be potentially inadequate due to anatomical difficulties in lymphadenectomy of the ventral and lateral areas of the ICA. However, whether the ICA crossing pattern is associated with oncologic outcomes of right-sided colon cancer remains unclear. This study aimed to clarify whether differences in ICA crossing patterns are associated with disease-free survival and overall survival. Methods: In this retrospective study, we searched a prospectively maintained database to identify medical records of patients with right-sided colon cancer who underwent right hemicolectomy and D3 lymphadenectomy. We classified patients into two groups based on the ICA crossing pattern: ICA crossing anterior to the SMV (group A) and ICA crossing posterior to the SMV (group P). We compared oncologic outcomes between the two groups. Results: A total of 336 patients were included in the final analytic cohort: 175 in group A and 161 in group P. There was no significant difference in the number of harvested lymph nodes between the two groups. The two groups did not differ in 5-year overall survival within any disease stage. Similarly, the 5-year disease-free survival rates did not differ significantly between the two groups within any disease stage. We performed univariate and multivariate analyses, which showed the ICA crossing pattern had no clinical relevance. Conclusion: Our study did not show an association between the ICA crossing pattern and oncologic outcomes in patients with right-sided colon cancer who underwent right hemicolectomy with D3 lymphadenectomy. [ABSTRACT FROM AUTHOR]

The yolk sac is supplied by the vitelline artery and vein (VA, VV), which run through the yolk stalk in combination with the omphaloenteric duct. Moreover, the VV takes a free posterior course outside the midgut mesentery containing the secondarily-developed superior mesenteric vein (SMV). However, the regression process of these structures has not been demonstrated photographically. The present study evaluated serial histological sections from 20 embryos of stages 15-19 or crown-rump length (CRL) 7.5-20 mm. All specimens carried the SMV as sequential tissue slits. However, an omphaloenteric duct with epithelia continuous with the midgut loop was not observed. In smaller embryos (CRL <13 mm) the VA extended distally or anteriorly from the midgut apex in the extra-embryonic coelom, whereas in larger embryos (CRL 16-20 mm) the artery was absent from the distal side of the apex. The entire course or part of the VV outside the mesentery was always seen, but four larger embryos lacked the venous terminal near the duodenum. A vacuole-like remnant of the yolk sac was present in all smaller embryos (CRL <10 mm), but was absent from 7 of the 11 larger embryos. The size of the remnant was equal to the thickness of the VA or VV, with the remnant being sandwiched between the VA and VV. Moreover, the regressing yolk sac often communicated with or opened to the VV. Consequently, the yolk sac regressed first, followed by the regression of the VA until 6 weeks. The yolk stalk was clearly observed until 5 weeks. [ABSTRACT FROM AUTHOR]

Purpose: To demonstrate the entire course of the human vitelline vein (VV) in specimens after degeneration of the yolk sac. Methods: Sagittal and horizontal histological sections from 8 embryos and 19 fetuses (gestational age approximately 6–12 weeks; crown-rump length 11–61 mm) were examined. Results: Two types of VV remnants were observed: a long VV on the right superior side of the mesentery of the jejunum (VV1) and a short VV on the left inferior side of the mesentery (VV2). The VV1, observed in 12 specimens, was 20–30 microns in diameter and ran dorsally between the right liver lobe and the jejunum, subsequently merging with an initial superior mesenteric vein on the pancreatic head immediately below the superior portion of the duodenum. The VV2, observed in four specimens, passed dorsally between loops of the ileum on the left side of the mesentery of the ileum and connected to the mesentery. Many of the VVs did not originate from the umbilical cord but suddenly started in the sack of physiological herniation. At 10–12 weeks, after herniation, the VVs originated from the umbilicus and were involved by the expanding greater omentum. Conclusions: The right-sided and left-sided VVs seemed to correspond to right and left VV remnants, respectively, and both took an upstream course outside the mesentery of the jejunum and ileum. The right VV upstream portion was likely to disappear later than the left one, but the timing of degeneration varied greatly among individuals, depending on the topographical relationship between the right liver lobe and the jejunum. [ABSTRACT FROM AUTHOR]

Pancreatic duct adenocarcinoma (PDAC) accounts for about 85-90% of all solid pancreatic tumors, which is well-known for poor prognosis and high morbidity. Despite the massive advent of chemotherapy and radiotherapy in recent years, surgical removal is still considered the cornerstone management option in this situation. Pancreaticoduodenectomy or Whipple procedure is generally contraindicated in metastasis or tumors that encase more than 50% of vessels. Vascular reconstruction is a state-of-the-art technique which requires the remarkable involvement of vascular experts in the setting of PDAC-invading vessels. In this article, we present an exceptional case of a 38-year-old male patient who underwent radical resection for advanced pancreatic cancer with superior mesenteric vein reconstruction by a great saphenous vein., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

This is a case report of acute superior mesenteric vein (SMV) thrombosis in a 24-year-old male with history of underlying psychiatric symptoms who had no traditional risk factors. The patient presented with abdominal pain, fever, and constipation. The patient's worsening symptoms led to an eventual diagnosis via computed tomography (CT) imaging. Management included anticoagulation therapy and multidisciplinary care. This case highlights the importance of considering SMV thrombosis in young adults and suggests a potential link between psychiatric conditions and thrombotic events, as evidenced by this patient's psychiatric history., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board (IRB) of the Royal Medical Services - Military Hospital / Research and Publication & Ethics Committee (RMS-MH/P&PEC) issued approval 2023-729. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Abulfateh et al.)

Objectives: Abnormal relative positioning of the superior mesenteric artery (SMA) and vein (SMV) can lead to intestinal malrotation that predisposes to midgut volvulus. The aim of this study was to assess the prenatal ultrasound ability to visualize the relative position of SMA and SMV in normal pregnancies., Methods: Prospective cohort study performed in Montpellier University Hospital Centre, including 80 fetuses during routine 3rd trimester ultrasound scan. For each fetus included, the relative position of the vessels on an axial image was defined as SMV on the right, forward, or on the left of SMA. Doppler imaging was additionally used if necessary. Data were compared to the neonatal abdominal scans performed by pediatric radiologist., Results: The superior mesenteric vessels were identified in 79 fetuses. Prenatal findings showed a usual relative position of the vessels, that is, the vein on the right of the artery, in 96.2%. In 2 cases, the vein was strictly in front of the artery, and in 1 case, the vein was on the left side of the artery. Seventy-four neonates were examined and comparison with prenatal finding showed a perfect agreement (Kappa coefficient of 100%). An intestinal malrotation was postnatally diagnosed corresponding to the case where vein was on the left side of the artery., Conclusion: This study showed that the relative position of the SMA and SMV could be assessed using ultrasound prenatal examination with a perfect agreement with postnatal findings. In case of abnormal vessels positioning more examinations should be promote including prenatal MRI and postnatal conventional radiologic examinations to confirm intestinal malrotation., (© 2024 The Author(s). Journal of Ultrasound in Medicine published by Wiley Periodicals LLC on behalf of American Institute of Ultrasound in Medicine.)

Roughly 10% – 20% of pancreatic cancer patients are candidates for curative intent surgical treatment. In the 2000s, many studies showed similar survival rates comparing pancreatic surgery with or without vein resection and reconstruction. The aim was to identify the best method of venous reconstruction. This was a retrospective cohort study. A total of 1 375 patients undergoing pancreatectomy between 2005 and 2018 were identified. Patients undergoing a combined pancreatic resection and venous reconstruction were included retrospectively. When tumour infiltration to the portal/superior mesenteric vein was detected, excision and reconstruction with tangential suturing/patch, end to end anastomosis, or a spiral graft from the great saphenous vein was performed. Next, 90 day and long term survival and outcomes across reconstruction techniques were analysed. Overall, 198 patients had venous involvement visible in pre-operative scans or detected during surgery, broken down as follows: 171 (86%) pancreaticoduodenectomy, 12 (6%) total pancreatectomy, and 15 (8%) distal pancreatectomy. In total, 69 (35%) spiral graft reconstructions, 77 (39%) end to end anastomoses, and 52 (26%) tangential/patch reconstructions were performed. Tumour histology revealed pancreatic adenocarcinomas in 162 (82%) patients, intraductal mucinous pancreatic neoplasia in 14 (7%), cholangiocarcinoma in five (3%), neuro-endocrine neoplasia in nine (5%), and eight other diagnoses. Overall, 183 (92%) were malignant and 15 (8%) benign. Two patients died within 90 days, one in hospital and one on post-operative day 38 due to thrombosis of the superior mesenteric vein and intestinal necrosis, a Clavien–Dindo grade 5 complication. In addition, 50 (23%) patients had Clavien–Dindo grade 3 – 4 complications. No differences in complications comparing vein reconstruction techniques or in the long term survival of pancreatectomy patients with or without venous reconstruction were detected. The spiral graft technique, used when more advanced venous infiltration occurs, does not increase complications, with outcomes mirroring those accompanying shorter venous resections. [ABSTRACT FROM AUTHOR]

We report a rare case of midgut malrotation and volvulus with “whirlpool sign” in a new-born infant. The “whirlpool sign” is an imaging characteristic of midgut volvulus and has a high predicting value for volvulus. Malrotation or malrotation with volvulus can be effectively diagnosed based on these characteristics. Ultrasound diagnosis has the advantage of no radiation exposure. Color Doppler documenting the reversal or aberrant superior mesenteric vein/superior mesenteric artery axis is not only predictive but also diagnostic of malrotation of gut. The rapid and accurate diagnosis of volvulus by ultrasound helps to establish the diagnosis of malrotation in time and thus allows for urgent surgical intervention to avoid bowel necrosis.

Background: Portal vein anastomotic complications related to size discrepancy are important causes of morbidity and mortality in pediatric liver transplantation. Interposed vascular grafts in portal vein anastomosis can solve this problem. The aim of this study is to evaluate the results of pediatric liver transplantations performed using cryopreserved interposed vascular grafts between graft portal vein and superior mesenteric vein (SMV)‐splenic vein (SpV) confluence. Methods: Twenty‐nine pediatric patients received liver transplantation using cryopreserved venous grafts in our Liver Transplant Institute between 2013 and 2020 were included in this study. Demographic, clinical, and operative characteristics and postoperative follow‐up were analyzed. Results: Sixteen patients (55.2%) had portal hypoplasia and five patients (17.2%) had portal vein thrombosis. In total, six patients (20.6%) suffered portal vein thrombosis in the early postoperative period. Three patients (10.3%) experienced portal vein thrombosis in the late postoperative period. Late portal vein thrombosis rate was significantly higher in patients with early portal vein thrombosis (3/6 patients [50%] versus 0/23 patients [0%]; p =.034). Lack of portal flow was significantly higher in patients with both early (50% versus 0%; p =.002) and late portal vein thrombosis (66.7% versus 6.7%; p =.03). Conclusion: Preoperative portal vein thrombosis and insufficient flow are important factors affecting success of liver transplant in children. The use of interposed vein grafts in problematic portal anastomoses can overcome portal flow problems. [ABSTRACT FROM AUTHOR]

Mesenteric ischemia is a broad term encompassing several clinical conditions leading to impaired vascularity of bowel loops. Absence of specific clinical presentation and a definitive laboratory marker often lead to delayed diagnosis with high morbidity and mortality in the acute setting. Imaging plays a crucial role in the diagnosis and management. Multi-detector CT (MDCT) is the first line imaging modality for the evaluation of patients with suspected mesenteric ischemia and plays an important role for assessing its severity and complications. This review article highlights the causes, pathophysiology, imaging features and possible endovascular treatment options of mesenteric ischemia. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to clarify the prognostic influence of venous resection of the portal vein (PV) or superior mesenteric vein (SMV) on long-term outcomes in patients with pancreatic ductal adenocarcinoma (PDAC) of the head with suspected vascular invasion. Methods: From May 1995 to December 2014, a total of 557 patients underwent surgery with curative intent for pancreatic cancer of the head. Results: Among 557 patients, 106 (19%) underwent pancreaticoduodenectomy (PD) with PV-SMV resection and 89 (75.5%) of these patients were confirmed to have true pathological invasion. The 5-year overall survival rate in patients underwent PV-SMV resection was significantly lower compared with those who did not (18.7% versus 24.3%; p = 0.002). Patients with negative resection margins who underwent PV-SMV resection had a better prognosis than those with positive resection margins who did not undergo PV-SMV resection with positive resection margins (17% versus 6.3% in 5-year overall survival rate; p = 0.003). The overall morbidity rate was not significantly different between PV-SMV resection group and no PV-SMV resection group (p = 0.064). On multivariate analysis, margin status, advanced T stage (3 or 4), lymph node metastasis, and adjuvant therapy were independent prognostic factors for survival. Conclusion: PV-SMV resection was related to lower overall survival. However, on multivariate analysis, margin status was a more important prognostic factor than PV-SMV resection and true pathological invasion for survival. Therefore, en bloc PV-SMV resection should be performed when PV-SMV invasion is suspected to achieve R0 resection.

Intestinal malrotation is a rare fetal anomaly resulting from the failure of midgut rotation and fixation. Sonography is typically the first modality of choice for assessing pediatric pathology due to its high sensitivity, portability, real-time imaging capability, and non-ionizing technique; however, its role in diagnosing small bowel rotational anomalies remains limited and controversial. Fluoroscopic upper gastrointestinal imaging (UGI) is the primary diagnostic examination at most institutions. However, even on UGI, imaging findings may be equivocal. In such cases, sonography may provide additional information at facilities where it is not used as a primary diagnostic tool. This case report represents the first reported case showing how patient position is important as the typical vascular sonographic features of rotation were normal in one position but abnormal in another. In addition, this case shows how congenital intestinal malrotation was decisively diagnosed using sonographic imaging. [ABSTRACT FROM AUTHOR]

Pseudocyst formation is common in chronic pancreatitis. A rare subset of these patients may develop fistulization between the pseudocyst and the portal vein system. We report a case of spontaneous pancreatic pseudocyst – superior mesenteric vein fistula in a 61-year-old male with a history of chronic recurrent calcifying pancreatitis. The fistulous connection was correctly identified on both computed tomography and magnetic resonance cholangiopancreatography (MRCP), and the patient was treated successfully with a conservative approach. Our case report aims to educate on this rare and potentially fatal vascular complication of chronic pancreatitis and to discuss the role of modern noninvasive imaging techniques, such as T2-weighted MRI/MRCP, in establishing this diagnosis and making a decision regarding its management.

Background: This study aimed to describe the findings of double superior mesenteric veins (SMVs), a rare anatomical variation, on multidetector computer tomography (MDCT) and magnetic resonance imaging (MRI) images., Case Summary: We describe the case of a 34-year-old male, who underwent both MDC and MRI examinations of the upper abdomen because of liver cirrhosis. MDCT and MRI angiography images of the upper abdomen revealed an anatomic variation of the superior mesenteric vein (SMV), the double SMVs., Conclusion: The double SMVs are a congenital abnormality without potential clinical manifestation. Physicians need to be aware of this anatomical variation during abdominal surgery to avoid iatrogenic injury., Competing Interests: Conflict-of-interest statement: All authors have no conflicts of interest to disclose., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background/Aim: Pancreatic cancer represents the most lethal abdominal malignancy, the only chance for achieving an improvement in terms of survival being represented by radical surgery. Although it has been considered that venous invasion represents a contraindication for resection, recently it has been demonstrated that in regards to overall survival after radical resection, it is similar to the one reported after standard pancreatoduodenectomy. Case Report: A 53-year-old patient with no significant medical past was diagnosed with a borderline resectable pancreatic adenocarcinoma invading the superior mesenteric vein. The patient was submitted to pancreatoduodenectomy en bloc with superior mesenteric vein resection; the two jejunal veins were further anastomosed to the remnant portal vein. The postoperative outcome was favorable; the patient was discharged in the 10th postoperative day. Conclusion: Although technically more demanding, pancreatoduodenectomy en bloc with superior mesenteric vein resection and jejunal portal anastomosis is feasible and might offer a chance for long-term survival in borderline pancreatic head carcinoma invading the superior mesenteric vein [ABSTRACT FROM AUTHOR]