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자연 용해된 급성 췌장염에 동반된 고립성 상장간막정맥 혈전증
나병수 ( Byung Soo Na ),전병민 ( Byung Min John ),김기범 ( Ki Bum Kim ),이제수 ( Je Soo Lee ),조현우 ( Hyun Woo Jo ),석창현 ( Chang Hyeon Seock ),김동휘 ( Dong Hui Kim ),이기성 ( Ki Sung Lee ) 대한소화기학회 2011 대한소화기학회지 Vol.57 No.1
Acute pancreatitis can result in many vascular complications in both artery and vein. Venous complication usually occurs as a form of splenic or portal vein thrombosis, and also can simultaneously occur in superior mesenteric vein as well. Rarely, isolated superior mesenteric vein thrombosis occurs as a venous complication. Although it is uncommon, mesenteric vein thrombosis is an important clinical entity because of the possibility of mesenteric ischemia and infarction of small bowel. The treatments of mesenteric venous thrombosis include anticoagulation therapy, transcatheter therapy and surgical intervention. We report a case of 45-yearold man who had acute pancreatitis with isolated superior mesenteric vein thrombosis, which was spontaneously dissolved with the resolution of underlying inflammation without anticoagulation or surgical intervention. (Korean J Gastroenterol 2011;57:38-41)
Suh Min Kim,Seung-Kee Min,Daedo Park,Sang-Il Min,Jin-Young Jang,Sun-Whe Kim,Jongwon Ha,Sang Joon Kim 대한외과학회 2013 Annals of Surgical Treatment and Research(ASRT) Vol.84 No.6
Purpose: Tumor invasion to the portal vein (PV) or superior mesenteric vein (SMV) can be encountered during the surgery for pancreatic cancer. Venous reconstruction is required, but the optimal surgical methods and conduits remain in controversies. Methods: From January 2007 to July 2012, 16 venous reconstructions were performed during surgery for pancreatic cancer in 14 patients. We analyzed the methods, conduits, graft patency, and patient survival. Results: The involved veins were 14 SMVs and 2 PVs. The operative methods included resection and end-to-end anastomosis in 7 patients, wedge resection with venoplasty in 2 patients, bovine patch repair in 3 patients, and interposition graft with bovine patch in 1 patient. In one patient with a failed interposition graft with great saphenous vein (GSV), the SMV was reconstructed with a prosthetic interposition graft, which was revised with a spiral graft of GSV. Vascular morbidity occurred in 4 cases; occlusion of an interposition graft with GSV or polytetrafluoroethylene, segmental thrombosis and stenosis of the SMV after end-to-end anastomosis. Patency was maintained in patients with bovine patch angioplasty and spiral vein grafts. With mean follow-up of 9.8 months, the 6- and 12-month death-censored graft survival rates were both 81.3%. Conclusion: Many of the involved vein segments were repaired primarily. When tension-free anastomosis is impossible, the spiral grafts with GSV or bovine patch grafts are good options to overcome the size mismatch between autologous vein graft and portomesenteric veins. Further follow-up of these patients is needed to demonstrate long-term patency.
Sami F. AL-Asari,임대로,민병소,김남규 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.6
Purpose: Our aim to assess clinical significance of the relation between inferior mesenteric vein ligation and collateral blood supply (meandering mesenteric artery)to the splenic flexure with elaboration more in anatomical landmarks and technical tips. Materials and Methods: We review the literature regarding the significance of the collateral vessels around inferior mesenteric vein (IMV) root and provide our prospective operative findings, anatomical landmarks and technical tips. We analyzed the incidence and pattern of anatomic variation of collateral vessels around the IMV. Results: A total of 30 consecutive patients have been prospectively observed in a period between June 25-2012 and September 7-2012. Nineteen males and eleven females with mean age of 63 years. Major colorectal procedures were included. There were three anatomical types proposed, based on the relation between IMV and the collateral vessel. Type A and B in which either the collateral vessel crosses or runs close to the IMV with incidence of 43.3% and 13.3%, respectively, whereas type C is present in 43.3%. There was no definitive relation between the artery and vein. No intra or postoperative ischemic events were reported. Conclusion: During IMV ligation, inadvertent ligation of Arc of Riolan or meandering mesenteric artery around the IMV root “in type A&B” might result in compromised blood supply to the left colon, congestion, ischemia and different level of colitis or anastomotic dehiscence. Therefore, careful dissection and skeletonization at the IMV root “before ligation if necessary” is mandatory to preserve the collateral vessel for the watershed area and to avoid further injury.
정현광 ( Hyun Gwang Jung ),고진우 ( Jin Woo Koh ),이무열 ( Moo Yeol Lee ) 대한소화기학회 2008 대한소화기학회지 Vol.52 No.4
Idiopathic mesenteric phlebosclerosis, rare disease entity causing chronic mesenteric ischemia is a member of non-thrombotic, non-inflammatory stenosis or occlusion of the mesenteric veins. The histologic hallmark is marked fibrous mural thickening and sclerosis of the vessel wall. It is frequently accompanied by calcification in the vessel wall. We report the case of a 61-year-old woman with idiopathic mesenteric phlebosclerosis. To our knowledge, this is the first case reported in Korea. (Korean J Gastroenterol 2008;52:261-264)
특발성 정맥경화성 대장염: 만성 허혈성 장염의 드문 예
최종민 ( Jong Min Choi ),이강녕 ( Kang Nyeong Lee ),김해수 ( Hae Su Kim ),이상기 ( Sang Ki Lee ),이정규 ( Jung Gyu Lee ),이성원 ( Sung Won Lee ),이오영 ( Oh Young Lee ),최호순 ( Ho Soon Choi ) 대한소화기학회 2014 대한소화기학회지 Vol.63 No.3
Colonic wall thickening is frequently encountered in various conditions, from acute or chronic inflammatory disease to colorectal carcinoma. Colonic wall thickening may be accompanied by calcifications in mucinous adenocarcinoma of the colon, leiomyosarcoma of the colon, schistosomiasis japonica, and phlebosclerotic colitis. Phlebosclerotic colitis is a rare entity of chronic ischemic colitis associated with sclerosis and fibrosis of mesenteric veins. Although its development is usually insidious, and, thus its diagnosis can be delayed, characteristic findings in phlebosclerotic colitis are calcifications of mesenteric veins as well as colonic wall thickening with calcifications. We report on a 71-year-old woman who presented with chronic diarrhea and intermittent hematochezia, who was first misdiagnosed as mucinous adenocarcinoma of the colon, but finally diagnosed as a rare entity of chronic ischemic colitis, phlebosclerotic colitis. Differential points of phlebosclerotic colitis from other diseases, including leiomyosarcoma and schistosomiasis japonica, are also described.
Seung Chul Han,Tae Hwan Kim,Hee Chul Yang,Jae Uk Chong 소화기인터벤션의학회 2020 International journal of gastrointestinal interven Vol.9 No.3
Delayed massive hemorrhage after pancreaticoduodenectomy is known as a fatal complication, frequently caused by gastroduodenal artery stump bleeding or hepatic artery pseudoaneurysm. Transarterial hepatic artery embolization is one of the treatment options in such cases. However, hepatic artery embolization can also result in ischemic complications of the liver, even fatal sometimes. We report a case of a 70-year-old male patient with distal common bile duct cancer who underwent pancreaticoduodenectomy. After three weeks, there was a bloody drain component accompanied with a decreased hemoglobin level. The immediate computed tomography scan and subsequent angiography demonstrated a hepatic artery pseudoaneurysm (1.8 cm in size) with segmental narrowing of the portal vein and superior mesenteric vein. The pseudoaneurysm and common hepatic artery were embolized using microcoils, following percutaneous portomesenteric stenting. There was no such ischemic complication as hepatic infarction after the procedure, and the patient was well tolerable. We suggest that the simultaneous portomesenteric stenting prior to hepatic artery embolization may be helpful to reduce the risk of hepatic infarction/failure in a patient with hepatic artery pseudoaneurysm accompanying portomesenteric vein stenosis after pancreaticoduodenectomy.
Hoseinzadeh, Samaneh,Shafiei, Babak,Salehian, Mohamadtaghi,Asli, Isa Neshandar,Ghodoosi, Iraj The Korea Society of Nuclear Medicine 2010 핵의학 분자영상 Vol.44 No.3
Ectopic varices (EcV) are enlarged portosystemic venous collaterals, which usually develop secondary to portal hypertension (PHT). Mesocaval collateral vessels are unusual pathways to decompress the portal system. Here we report the case of a huge varicose inferior mesenteric vein (IMV) that drained into perirectal collateral veins, demonstrated by $^{99m}Tc$-labeled red blood cell (RBC) scintigraphy performed for lower gastrointestinal (GI) bleeding in a 14-year-old girl. This case illustrates the crucial role of $^{99m}Tc$-labeled RBC scintigraphy for the diagnosis of rare ectopic lower GI varices.
김경호,강경아,박지연,김선정,이정주 대한영상의학회 2017 대한영상의학회지 Vol.77 No.3
Uterine smooth muscle neoplasms that cannot be clearly diagnosed as benign or malignant based on generally applied histopathologic parameters are classified as “smooth muscle tumors of uncertain malignant potential (STUMP)”. Herein, we report on the first case of a STUMP that originated from the superior mesenteric vein (SMV), with emphasis on the radiologic findings. Magnetic resonance imaging showed a well-defined mass encasing the SMV with progressive and homogeneous enhancement in the arterial and portal venous phases. The lesion showed mild hyperintensity on T2-weighted images when compared with skeletal muscle, which was quite different from typical leiomyomas. The lesion also showed hyperintensity on the diffusion- weighted images, and hypointensity on the apparent diffusion coefficient map. These results may reflect the high cellularity of the mass.
Seung Chul Han,Tae Hwan Kim,Hee Chul Yang,Jae Uk Chong 소화기인터벤션의학회 2020 Gastrointestinal Intervention Vol.9 No.3
Delayed massive hemorrhage after pancreaticoduodenectomy is known as a fatal complication, frequently caused by gastroduodenal artery stump bleeding or hepatic artery pseudoaneurysm. Transarterial hepatic artery embolization is one of the treatment options in such cases. However, hepatic artery embolization can also result in ischemic complications of the liver, even fatal sometimes. We report a case of a 70-year-old male patient with distal common bile duct cancer who underwent pancreaticoduodenectomy. After three weeks, there was a bloody drain component accompanied with a decreased hemoglobin level. The immediate computed tomography scan and subsequent angiography demonstrated a hepatic artery pseudoaneurysm (1.8 cm in size) with segmental narrowing of the portal vein and superior mesenteric vein. The pseudoaneurysm and common hepatic artery were embolized using microcoils, following percutaneous portomesenteric stenting. There was no such ischemic complication as hepatic infarction after the procedure, and the patient was well tolerable. We suggest that the simultaneous portomesenteric stenting prior to hepatic artery embolization may be helpful to reduce the risk of hepatic infarction/failure in a patient with hepatic artery pseudoaneurysm accompanying portomesenteric vein stenosis after pancreaticoduodenectomy.