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Concept: Mesentery


BACKGROUND: Sigmoid volvulus (SV) is the wrapping of the sigmoid colon around itself and its mesentery. The goal of this study was to investigate the diagnosis approach to 938 patients with SV treated at our institution and their clinical outcomes. METHODS: The clinical records of 938 patients with SV treated at our institution between June 1966 and January 2012 were retrospectively reviewed. RESULTS: The mean age was 58.6 years (range 10 weeks to 98 years), and 774 patients (82.5 %) were male. A total of 210 (25.1 %) of 837 patients, who provided information on anamnesis and clinical features, had recurrent episodes of volvulus; 215 patients (25.7 %) had comorbidities, and 108 patients (12.9 %) presented with toxic or hypovolemic shock. The mean duration of symptoms was 38.7 h (range 6 h to 7 days), and the most common clinical features were abdominal pain and tenderness (827 of 837 patients, 98.8 %), distention (805 patients, 96.2 %), and obstipation (771 patients, 92.1 %). The final diagnosis was made with endoscopy in 519 patients (55.3 %), endoscopy followed by surgery in 154 patients (16.4 %) and at surgery in 265 patients (28.3 %). The correct diagnosis rate was 71.6 % based on clinical findings compared with 66.7 % based on plain X-ray films, 81.4 % based on both clinical and plain X-ray findings, and 100.0 % based on CT or MRI findings. CONCLUSIONS: Sigmoid volvulus is common in adult men. The disease is generally associated with recurrent episodes, comorbidity, and shock. SV generally presents as a large-bowel obstruction. Although plain X-rays may help with diagnosis, CT and MRI are more reliable diagnostic tools, and flexible endoscopy is always diagnostic. However, surgery is used to diagnose SV in limited situations.

Concepts: Medicine, X-ray, Diagnosis, Medical imaging, Abdominal pain, Rectum, Volvulus, Mesentery


Laparoscopic esophagojejunostomy using a circular stapler is associated with technical difficulties in the purse-string sutures used to insert the anvil head and in obtaining an adequate visual field to prevent rolling the mesentery and the wall of the jejunum on the mesenteric side into the anastomosis. To overcome these difficulties, we used the EndoStitch to create the purse-string suture and the ENDOCAMELEON to create the visual field to stretch the jejunum. After resecting the esophagus, purse-string sutures were placed using the EndoStitch. A total of five to six needle deliveries were performed. Next, the anvil head was inserted into the esophagus. The main unit of the EEA was inserted from the end of the resected jejunum. Then, the scope was changed to the ENDOCAMELEON. The main unit was slowly moved toward the anvil head. After making sure that the mesentery and the wall of the jejunum on the mesenteric side were not rolled into the anastomosis under the visual field created by the ENDOCAMELEON, the main unit was then fired. Thereafter, esophagojejunostomy was successfully completed. This technique was applied in 20 patients between April 2010 and May 2012. Laparoscopic esophagojejunostomy after total gastrectomy for gastric cancer was completed in all 20 patients. No case required conversion to open surgery. Neither anastomotic leakage nor stenosis was observed. This method is simple and useful for laparoscopic esophagojejunostomy after total gastrectomy for gastric cancer.

Concepts: Scientific method, Surgery, Digestive system, Stomach, Peritoneum, Abdomen, Jejunum, Mesentery


PURPOSE: The aim of this study was to determine the length of the sigmoid colon and sigmoid mesocolon in living subjects and fresh cadavers. METHODS: The subjects for the study were consecutive 50 living subjects undergoing abdominal surgeries via midline incision and 50 fresh cadavers undergoing a medicolegal postmortem at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria. RESULTS: The study showed that the mean length of the sigmoid colon in living subjects was 48.9 ± 1.3 cm (range 30.5-65 cm) while the mean length of the sigmoid colon in cadaver subjects was 50.1 ± 1.6 cm (range 34.5-67.8 cm) and this was not statistically significantly different. Two patterns of the shape of the sigmoid loop were identified: dolichomesocolic and brachymesocolic pattern. In about 80 % of subjects in both groups, dolichomesocolic-type was seen. The gender analysis showed that males had statistically significant longer sigmoid colon (P = 0.040). The dimension of sigmoid colon significantly increased with age of the patients in cadaver subjects and in both sexes (P = 0.001). CONCLUSIONS: The study concluded that the lengths of sigmoid colon are not different in living and cadaver subjects but are relatively longer than measurement from western countries. The lengths of sigmoid colon and mesocolon also increases with age and this may possibly be the anatomical basis for the frequent occurrence of sigmoid volvulus and failed colonoscopy among the older population in our environment.

Concepts: Statistics, Peritoneum, Rectum, Mesentery, Sigmoid mesocolon, Obafemi Awolowo University, Sigmoid colon, Osun State


Recent advances in mesenteric science have demonstrated that the mesentery is a continuous structure with a ‘watershed’ area at the mesenteric apex between the right colon and terminal ileum, where lymphatic flow can proceed either proximally or distally. With this new understanding of the anatomy, functional features are emerging, which can have an impact on surgical management. Fluorescence lymphangiography or lymphoscintigraphy with indocyanine green allows real-time visualization of lymphatic channels, which highlights sentinel lymph nodes and may facilitate identification of the ideal margins for mesenteric lymphadenectomy during bowel resection for colon cancer. By using this novel technology, it is possible to demonstrate a watershed area in the ileocolic region and may facilitate more precise mesenteric dissection. In the present study, we provide proof of concept for the ileocolic watershed area using fluorescence lymphangiography.

Concepts: Cancer, Lymph node, Colon, Lymphatic system, Bowel obstruction, Lymph, Sentinel lymph node, Mesentery


There is no standard consensus for the ligation level of the inferior mesenteric artery during radical resection of sigmoid colon cancer. Especially, there is little research about low ligation combined with D3 dissection. The study was performed to compare feasibility and oncologic safety between low ligation with D3 dissection to high ligation in intermediately advanced sigmoid colon cancer.

Concepts: Colorectal cancer, Colon, Peritoneum, Rectum, Mesentery, Inferior mesenteric artery, Hindgut, Sigmoid arteries


Diagnosis of peritoneal carcinomatosis (PC) may be missed by preoperative imaging. We are presenting our experience with incidentally detected PC of colorectal origin treated with cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) at the same operation.

Concepts: Surgery, Chemotherapy, Radiation therapy, Physician, Colon, Peritoneum, Blood transfusion, Mesentery


Mesenteric hematoma is a rare condition caused by bleeding localized in the mesenteric vascular tree. This is a first report of spontaneous mesenteric hematoma caused by rivaroxaban.

Concepts: Blood, Colon, Peritoneum, Rectum, Mesentery, Sigmoid colon, Ascending colon, Iliac colon


Ultrasound examinations during pregnancy are routine procedures used to detect fetal congenital malformations. Ultrasound monitoring of sigmoid colon mesenterial development could be useful for early detection of subjects at risk of sigmoid colon volvulus.

Concepts: Developmental biology, Peritoneum, Congenital disorder, Congenital disorders, Congenital, Mesentery, Sigmoid colon


Little is known about the anatomy of the jejunal veins (JVs) flowing into the superior mesenteric vein (SMV), and whether they can be safely divided during pancreaticoduodenectomy.

Concepts: Vein, Hepatic portal vein, Superior mesenteric artery, Jejunum, Mesentery


Sclerosing mesenteritis (SM) and mesenteric panniculitis are rare processes of the mesentery which pose a major clinical and imaging challenge. This review article attempts to introduce a systematic nomenclature to address typical symptoms, imaging and major differential diagnoses.

Concepts: Medical terms, Differential diagnosis, Mesentery