Inferior Mesenteric Artery
9 results
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Benign Disease- Laparoscopic left colectomy was performed for a 4-cm adenocarcinoma found at the mid-descending colon. A tension-free colorectal anastomosis was performed using the distal transverse colon at the splenic flexure as the proximal conduit. On postoperative day 4, an anastomotic leak was seen on computed tomography (CT). What is the most likely reason for failure of this anastomosis?
- A 34-year-old woman undergoes total abdominal colectomy with an ileostomy for fulminant ulcerative colitis. She strongly desires to avoid a permanent stoma. She is counseled extensively regarding J pouch and she chooses to undergo completion proctectomy. After constructing a J-pouch, you find that the apex of the pouch does not reach the divided rectal cuff. Which is the most appropriate next step?
- A 56-year-old patient with a BMI of 41 is transferred to your hospital after undergoing emergent sigmoid colectomy with colostomy for perforated diverticulitis. On postoperative day 3 she is found to have sloughed the distal portion of the ostomy due to necrosis and retraction of the stoma (see figure below). Bedside evaluation demonstrates ischemia that extends proximal to the fascia. The patient is currently hemodynamically stable. Computed tomography angiogram of the abdomen and pelvis demonstrates patency of the celiac and superior mesenteric arteries and no visualization of the the inferior mesenteric artery. What is the best next step in management?
- Malignancy
- A 64-year-old man recently underwent low anterior resection for stage III adenocarcinoma (T3, N1) of the mid-rectum after neoadjuvant chemoradiotherapy. He reports mild urinary incontinence and that he can achieve an erection and orgasm but does not ejaculate. Injury to which nerve structures is the most likely cause of his symptoms?
- You are counseling a 48-year-old man on laparoscopic low anterior resection for T2N0 rectal cancer, as shown on magnetic resonance imaging (MRI). He asks about possible risks of surgery. Which of the following nerves can be injured during high ligation of the inferior mesenteric artery (IMA)?
- Perioperative
- Anorectal Disease
- A patient undergoing anal manometry is asked to perform a squeeze maneuver. The neural innervation for the maneuver originates from
- A 51-year-old man is undergoing a screening colonoscopy during which a partially circumferential mass at the level of the upper rectal valve is found. On rigid proctoscopy, the mass is found to be located 11 cm from the anal verge. On pathologic evaluation, the lesion is identified as a moderately differentiated invasive adenocarcinoma. Pelvic magnetic resonance imaging (MRI) with and without contrast showed a T3N1 mass without extramural venous invasion (EMVI) and a radial margin of 7 mm. What is the immediate lymphatic drainage of the lesion?
- A 56-year-old patient is diagnosed with rectal cancer just above the dentate line. What is the lymphatic drainage of this lesion?