Ectopic varices are an uncommon cause of gastrointestinal bleeding in patients with portal hypertension. A 43-year-old female with alcoholic cirrhosis developed massive hematochezia and hemorrhagic shock, requiring emergent angiography and image-guided intervention. Angiography revealed active extravasation from a branch of the right colic vein. The patient underwent percutaneous transhepatic embolization of the bleeding colic vein with technical success demonstrated on post-embolization angiography. Treatment of bleeding ectopic varices may require endoscopic, image-guided, or surgical approaches.
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http://dx.doi.org/10.7759/cureus.25736 | DOI Listing |
Ann Gastroenterol Surg
January 2025
Division of Frontier Surgery, The Institute of Medical Science The University of Tokyo Bunkyō Japan.
In right-sided colon cancer surgery, lymph node dissection around the superior mesenteric artery is necessary but technically challenging. Here we introduce the concept of "outermost layer-oriented robotic surgery" to improve the safety, efficacy, and reproducibility of superior mesenteric artery nodal dissection. In this procedure, the thin, loose connective tissue layer between the autonomic nerve sheath of the superior mesenteric artery and adipose tissue bearing lymph nodes, termed "the outermost layer of the autonomic nerve," is dissected.
View Article and Find Full Text PDFAnn Surg Oncol
December 2024
Abdominal Surgery and Transplantation Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Background: The Resection and Partial Liver Transplantation with Delayed Total Hepatectomy (RAPID) procedure for unresectable colorectal liver metastases (uCRLM) has renewed interest by increasing, in selected cases, patients' long-term survival. Initially described using deceased donor graft, this technique evolved to living donors, tackling organ-shortage issues, allowing better scheduling, and reducing liver failure risk.
Methods: A 50-year-old patient presented 18 months earlier with a colic adenocarcinoma with synchronous uCRLM.
Sci Rep
December 2024
Department of general surgery (intestinal surgery), The Sixth Affiliated Hospital, Sun Yat-Sen University, 26 Yuancun Erheng Rd, Guangzhou, 510655, Guangdong, People's Republic of China.
In hepatic flexure and transverse colon cancer surgeries, mobilizing the right mesocolon and precisely dissecting the gastrocolic trunk of Henle (GTH) are crucial. Previous classifications of GTH tributaries do not guide radical right hemicolectomy due to post-procedural anatomical acquisition. This study analyzed vessel associations, including the middle colic vein (MCV) converging site, right colic artery (RCA) presence, and other GTH tributaries, using ultra-thin CT for reconstruction.
View Article and Find Full Text PDFFolia Morphol (Warsz)
December 2024
Department of Anatomy, Division of Basic Medicine, Tokai University School of Medicine, Isehara, Japan.
Background: The superior mesenteric vein appears as a fusion between irregularly-shaped slits of the midgut mesentery tissue at 5-6 weeks. In contrast, there might be no report when and how the inferior mesenteric vein (IMV) develops. We aimed to find the human initial IMV.
View Article and Find Full Text PDFSurg Endosc
January 2025
Department of General and Digestive Surgery, University Hospital Virgen Macarena, University of Sevilla, Seville, Spain.
Background: Complete mesocolon excision (CME) and D3-lymphadenectomy concepts have gained popularity for the surgical treatment of right colon cancer in comparison to the conventional laparoscopic right hemicolectomy (CLRH). The rationale of CME is to dissect the embryological planes between the mesenteric plane and the parietal fascia to remove the mesentery within a complete envelope of mesenteric fascia and visceral peritoneum that contains lymph nodes, the central vascular ligation, and adequate bowel length to remove involved pericolic lymph nodes in the longitudinal direction, having as the main goal to improve the oncological results. CME with D3-lymphadenectomy is challenge since involves the excision of the lymph adipose tissue covering the medial edge of the superior mesenteric vein (SMV) (trunk of Gillot, TG), and the gastrocolic trunk of Henle (GTH).
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