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- •Foreword
- •Preface
- •Contents
- •Contributors
- •General
- •1 Redefining the Mesentery as an Organ
- •Definition of the Mesentery
- •Historic Development of the Understanding of the Mesentery
- •Conclusion
- •Suggested Reading
- •2 Embryology of the Mesentery
- •Introduction
- •Embryological Development of the Mesentery and Related Organs
- •The Ventral and Dorsal Mesentery
- •Development of the Upper Region of Mesentery and Associated Organs
- •Development of the Lower Region of Mesentery and Associated Organs
- •Development of the Peritoneum and Peritoneal Cavity
- •Migration Across the Mesentery
- •Regenerative Capacity of the Mesentery and Bioengineering of Abdominal Digestive Organs
- •The Science of the Mesentery
- •Suggested Reading
- •3 General Anatomy of the Mesentery
- •Introduction
- •The Mesentery
- •The Dorsal Mesogatsrium and Mesoduodenum
- •The Greater Omentum
- •The Lower Region of Mesentery
- •Small Bowel Mesentery and Right Mesocolon
- •Mesocolon Distal to Transverse Mesocolon
- •Mesosigmoid and Mesorectum
- •Mechanisms of Attachment
- •Central Mechanisms of Attachment
- •Intermediate Mechanism of Attachment
- •The Peritoneal Reflection
- •Abdominal Digestive System Surgery
- •Suggested Reading
- •Anatomy and Physiology
- •4 Vascular Anatomy of the Mesentery
- •Introduction
- •Suggested Reading
- •5 Introduction to the Physiology of the Mesentery
- •Anatomy
- •Vascular Physiology
- •Immunologic Physiology
- •Neuronal Physiology
- •Role of Mesenteric Adipose
- •Suggested Reading
- •6 Emergence of the Human Gut Microbiota as an Influencer in Health and Disease
- •The Gut Microbiome
- •Bacterial Translocation to Blood and the Mesentery
- •The Microbiome of Mesenteric Fat
- •The Microbiome of Mesenteric Lymph Nodes
- •The Mesentery—A Reservoir for Pathogenic Bacteria?
- •Mesenteric Abscess—A Special Microenvironment for Pathogenic Bacteria in Inflammatory Bowel Disease?
- •Conclusion
- •Suggested Reading
- •7 Cellular Anatomy of the Mesentery
- •Introduction
- •Mesenteric Histology
- •Gene Expression and Protein Synthesis in the Mesentery
- •Mesenteric Derived Mesothelial Cells
- •Connective Tissue Continuity
- •Mesenteric Adipocytes
- •Fibrocytes
- •The Peritoneal Reflection
- •Conventional Angiography
- •Description of Procedure
- •Indications
- •Complementary Procedures
- •Contraindications
- •Preparation of Patient
- •How the Procedure Is Performed
- •Complications
- •PET Scan
- •Description of Procedure
- •Indications
- •Complementary Procedures
- •Relative Contraindications
- •Histology of Toldt’s Fascia
- •The Mesentery in Disease States
- •Future Directions
- •Suggested Reading
- •Diagnostic Procedures
- •8 Radiography of the Mesentery
- •Plain Films of the Abdomen
- •Description of Procedure
- •Indications
- •Complementary Procedures
- •Contraindications
- •Preparation of Patient
- •How the Procedure Is Performed
- •Typical Abnormal Findings
- •Complications
- •Computed Tomography (CT)
- •Description of Procedure
- •Indications
- •Complementary Procedures
- •Contraindications
- •Relative Contraindications
- •Preparation of Patient
- •How the Procedure Is Performed
- •Typical Abnormal Findings
- •Complications
- •Additional Comments
- •Magnetic Resonance Imaging (MRI)
- •Description of Procedure
- •Contraindications
- •Relative Contraindications
- •Preparation of Patient
- •How the Procedure Is Performed
- •Typical Abnormal Findings
- •Complications
- •Preparation of Patient
- •How the Procedure Is Performed
- •Typical Abnormal Findings
- •Complications
- •Additional Comments
- •Ultrasound
- •Description of Procedure
- •Indications
- •Complementary Procedures
- •Contraindications
- •Relative Contraindications
- •Preparation of Patient
- •How the Procedure Is Performed
- •Typical Abnormal Findings
- •Complications
- •Additional Comments
- •Suggested Reading
- •9 Mesenteric Biopsy
- •Indications
- •Contraindications
- •Description of the Procedure
- •Preparation of Patient
- •Image-Guided Percutaneous Mesenteric Biopsy
- •Diagnostic Laparoscopic Mesenteric Biopsy
- •Complications
- •Suggested Reading
- •10 Diagnosing Mesenteric Diseases: Laparoscopy
- •Indications
- •Traumatic Injury
- •Inflammatory Bowel Disease
- •Neoplastic Disease
- •Pediatric Applications
- •Ischemia
- •Internal Hernia
- •Contraindications
- •Complementary Procedures
- •Intra-operative Perfusion Assessment with Fluorescence
- •Preparation of the Patient
- •Technical Details
- •Abdominal Entry
- •Exploration of the Peritoneal Cavity and Mesentery
- •Abdominal Closure
- •Suggested Reading
- •11 Immunologic Function of the Mesentery
- •Introduction
- •Innate and Adaptive Responses of the Immune System
- •Mesenteric-Specific Immune Cells
- •Mesenteric Immunity and Crohn’s Disease (Also See Chap. 15 Crohn’s Disease)
- •Summary
- •Suggested Reading
- •12 Neurophysiologic Function of the Mesentery
- •Anatomy
- •The Sympathetic Nervous System
- •The Parasympathetic Nervous System
- •Neurologic Regulation of Mesenteric Blood Flow
- •Arterial and Venous Innervation
- •Arterial and Venous Components of Blood Pressure Regulation
- •Neuronal Control of Mesenteric Arteries and Veins
- •Anatomic Organization of Sympathetic Innervation of the Large Intestine
- •Activation of Vascular Innervation by Peripheral Reflexes
- •Innervation of the Lymphatic Vessels
- •The Mesenteric Nervous System and Inflammation
- •Suggested Reading
- •13 Physiology of the Mesenteric Circulation
- •Introduction
- •Review of Mesenteric Microcirculation and Fluid Dynamics
- •Mesenteric Microcirculation
- •Fluid Dynamics
- •The Intrinsic System
- •Metabolic Pathway
- •Oxygen Demand and Supply
- •Metabolic Byproducts
- •Intraluminal Hyperosmolarity
- •Myogenic Pathway
- •Extrinsic System
- •Central Cardiovascular Control
- •Autonomic Neuro-Regulation
- •Sympathetic Nervous System (SNS) Stimulation
- •Parasympathetic Nervous System (PNS) Stimulation
- •Neurohumoral Control
- •Catecholamines
- •Angiotensin II
- •Vasopressin
- •Suggested Reading
- •14 The Role of the Mesentery in Metabolic Syndrome and Diabetes Mellitus
- •Introduction
- •Pathogenesis
- •Treatment
- •Suggested Reading
- •15 Crohn’s Disease and the Mesentery
- •Introduction
- •Mesenteric Immunity and Crohn’s Disease
- •Crohn’s Disease and Fat Wrapping
- •Imaging Studies of the Mesentery in Crohn’s Disease
- •Mesenteric Disorders that Are Associated with Crohn’s Disease
- •Inflammatory Disorders of the Mesentery and Inflammatory Bowel Disease
- •Suggested Reading
- •16 The Role of the Mesentery in Pancreatic Diseases
- •Embryology of the Pancreas and Pancreatic Mesentery
- •Pancreatic Diseases
- •Acute Pancreatitis
- •Mesenteric Panniculitis Involving the Pancreas and Pancreatic Panniculitis
- •Heterotopic Pancreas
- •Suggested Reading
- •Embryology
- •Pancreatitis and Other Diseases
- •Panniculitis
- •Heterotopic Pancreas
- •17 IgG4-Related Diseases and the Mesentery
- •Introduction
- •Pathogenesis
- •Clinical Manifestations
- •Type 1 Autoimmune Pancreatitis (AIP)
- •IgG4-Related Sclerosing Cholangitis (SC)
- •Retroperitoneal Fibrosis, Chronic Sclerosing Aortitis and Periaortitis
- •Diagnosis of IgG4-RD
- •Treatment
- •Suggested Reading
- •18 Role of the Mesentery in Systemic Inflammation Response Syndrome (SIRS) and Multiple Organ Dysfunction Syndrome (MODS)
- •Introduction
- •Pathophysiology
- •MODS Pathophysiology
- •Mesenteric Lymph, SIRS and MODS
- •Interventions Directed at Mesenteric Lymph
- •Mesenteric Duct Ligation and the Inflammatory Response
- •Vagal Nerve Stimulation (VNS)
- •Adipocytes, SIRS and MODS
- •Adiponectin, SIRS and MODS
- •Leptin, SIRS and MODS
- •CRP, Resistin and SIRS/MODS
- •Fibrocytes, SIRS and MODS
- •Summary
- •Suggested Reading
- •Medical Disorders of the Mesentery
- •19 Mesenteric Hemorrhage
- •Definition
- •Epidemiology and Risk Factors
- •Pathophysiology
- •Symptoms
- •Physical Findings
- •Imaging and Diagnosis
- •Management
- •Suggested Reading
- •20 Mesenteric Panniculitis
- •Definition and Nomenclature
- •Epidemiology
- •Patients at Risk
- •Pathophysiology
- •Symptoms and Signs
- •Diagnosis
- •Physical Findings
- •Laboratory Testing
- •Imaging
- •Biopsies and Histologic Findings
- •Treatments
- •Medical
- •Surgery
- •Sugggested Reading
- •21 PPP Syndrome: Pancreatitis, Panniculitis, Polyarthritis
- •Definition
- •Epidemiology
- •Patients at Risk
- •Pathophysiology
- •Signs and Symptoms
- •Diagnosis
- •Physical Findings
- •Laboratory Testing
- •Imaging
- •Histologic Findings
- •Treatments
- •Medical
- •Surgical
- •Additional Comments
- •Suggested Reading
- •22 Mesenteric Adenitis
- •Definition
- •Epidemiology
- •Patients At Risk
- •Pathophysiology
- •Symptoms
- •Physical Findings
- •Laboratory Testing
- •Imaging
- •Treatment
- •Medical
- •Surgical
- •Suggested Reading
- •23 Mesenteric Abscess
- •Definition
- •Pathophysiology
- •Epidemiology
- •Symptoms
- •Physical Findings
- •Laboratory Testing
- •Diagnosis and Imaging
- •Treatment
- •Suggested Reading
- •24 Mesenteric Venous Thrombosis
- •Introduction
- •Epidemiology
- •Anatomy
- •Pathophysiology
- •Patient At Risk for MVT
- •Clinical Presentation
- •Diagnosis
- •Imaging
- •Laboratory Findings
- •Treatment
- •Nonoperative Management
- •Interventional Radiology Procedures
- •Surgery
- •Prognosis
- •Suggested Reading
- •25 Mesenteric Arterial Occlusion
- •Definition and Description of the Disease
- •Epidemiology
- •Anatomy
- •Pathophysiology
- •Signs and Symptoms
- •Diagnosis
- •Physical Findings
- •Laboratory Findings
- •Imaging
- •Treatment
- •Overview
- •Surgical
- •Surgical Revascularization
- •Endovascular Procedures
- •Medical Therapy
- •Prognosis
- •Suggested Reading
- •26 Ischemic Enteropathy (Also Called Mesenteric Ischemia)
- •Definition and Description of the Disease
- •Classification and Terminology
- •Intestinal Vascular Anatomy
- •Epidemiology
- •Patients at Risk
- •Pathophysiology
- •Acute Mesenteric Ischemia of Arterial Origen
- •SMA Thrombosis (SMAT)
- •Nonocclusive Mesenteric Ischemia (NOMI)
- •Focal Segmental Ischemia (FSI)
- •Acute Mesenteric Ischemia of Venous Origen (MVT)
- •Signs and Symptoms of Ischemic Enteropathy
- •Diagnosis
- •Physical Findings
- •Laboratory Findings
- •Imaging
- •Histologic Findings
- •Treatments for Acute Mesenteric Ischemia
- •Medical
- •Surgical
- •Treatments for Chronic Mesenteric Ischemia
- •Medical
- •Surgical
- •Prognosis
- •Suggested Reading
- •27 Colonic Ischemia (Also Known as Ischemic Colitis)
- •Introduction
- •Epidemiology
- •Risk Factors
- •Pathophysiology
- •Clinical Presentations
- •Diagnosis
- •Laboratory Findings
- •Imaging
- •Colonoscopy
- •Histologic Findings
- •Treatments
- •Medical
- •Complications
- •Suggested Readings
- •28 Mesenteric Lymphangioma
- •Definition
- •Epidemiology
- •Patients at Risk
- •Pathophysiology
- •Clinical Presentation
- •Physical Findings
- •Laboratory
- •Histology
- •Imaging
- •Diagnosis
- •Treatment
- •Medical
- •Surgery
- •Suggested Reading
- •29 Radiation-Induced Mesenteric Injury
- •Pathophysiology of Radiation-Induced Tissue Injury
- •Radiation-Induced Intestinal Injury-Enteropathy and Colopathy
- •Medical Literature on Radiation and the Mesentery
- •Basic Research
- •Clinical Publications
- •Summary
- •Suggested Reading
- •30 Drug Induced Mesenteric and Retroperitoneal Diseases
- •Definition
- •Epidemiology
- •Patients at Risk
- •Pathophysiology
- •Diagnosis, Physical Findings and Laboratory Findings
- •Imaging
- •Treatment
- •Prognosis
- •Angiotensin Converting Enzyme (ACE)-Inhibitor Induced Visceral Edema
- •Definition
- •Epidemiology
- •Patients at Risk
- •Pathophysiology
- •Signs and Symptoms
- •Laboratory Findings
- •Imaging
- •Drug Induced Retroperitoneal Fibrosis
- •Definition, Description, and Epidemiology
- •Pathophysiology
- •Diagnosis, Physical Findings and Laboratory Findings
- •Imaging
- •Histologic Findings
- •Treatments
- •Surgical
- •Prognosis
- •Drug Induced Pancreatitis
- •Introduction
- •Suggested Reading
- •Neoplasms of the Mesentery
- •31 Primary Solid Neoplasms
- •Introduction
- •Desmoid Tumor of the Mesentery
- •Symptoms and Signs
- •Pathophysiology
- •Diagnosis
- •Treatment
- •Prognosis
- •Primary Leiomyosarcoma of the Mesentery
- •Symptoms and Signs
- •Pathophysiology
- •Diagnosis
- •Treatment
- •Prognosis
- •Primary Carcinoid Tumors of the Mesentery
- •Symptoms and Signs
- •Pathophysiology
- •Diagnosis
- •Treatment
- •Prognosis
- •Primary Liposarcoma of the Mesentery
- •Symptoms and Signs
- •Pathophysiology
- •Diagnosis
- •Treatment
- •Prognosis
- •Primary Stromal Tumor of the Mesentery
- •Symptoms and Signs
- •Pathophysiology
- •Diagnosis
- •Treatment
- •Prognosis
- •Summary
- •Suggested Reading
- •32 Metastatic Diseases of the Mesentery
- •Symptoms
- •Pathophysiology
- •Diagnosis
- •Treatment
- •Malignant Bowel Obstructions and Palliative Care
- •Conclusion
- •Suggested Reading
- •33 Mesenteric Lymphoma
- •Symptoms and Signs
- •Pathophysiology
- •Diagnosis
- •Treatment
- •Prognosis
- •Summary
- •Suggested Reading
- •34 Castleman Disease with Mesenteric Involvement
- •Definition and Description of the Disease
- •Epidemiology
- •Patients at Risk
- •Pathophysiology
- •Signs and Symptoms
- •Diagnosis
- •Physical Findings
- •Laboratory Findings
- •Imaging
- •Histologic Findings
- •Treatments
- •Prognosis
- •Suggested Reading
- •Surgical Diseases of the Mesentery
- •35 Mesenteric Resection in Upper Abdominal Surgery
- •Indications for Surgery
- •Contraindications
- •Description of Surgery
- •Small Bowel Resection with Adjacent Mesentery (Open Approach, Hand Sewn Anastomosis)
- •Complications
- •Summary
- •Suggested Reading
- •36 Mesenteric Considerations in Surgery of the Colon and Rectum
- •Introduction
- •Mesenteric Role in Diseases of the Colon and Rectum
- •Malignancy
- •Benign Disease
- •Colon Cancer Principles
- •Studies of Anatomy and Embryology
- •Surgical Principles
- •Preoperative Vascular Anatomical Considerations
- •Surgical Approach
- •Surgical Management of Colon Cancer
- •Cecal and Ascending Colon Carcinoma
- •Hepatic Flexure Carcinoma
- •Transverse Colon Carcinoma
- •Splenic Flexure Carcinoma
- •Descending Colon Carcinoma
- •Sigmoid Carcinoma
- •Total Mesorectal Excision Principles
- •Surgical Quality
- •Surgical Complications
- •Conclusion
- •Suggested Readings
- •37 Mesocolic Resection in Colon Cancer
- •Description of the Procedure
- •Indications
- •Contraindications
- •Preparation of the Patient
- •How the Procedure Is Performed
- •General Principles
- •Specific Considerations
- •Right Colon
- •Transverse Colon and Flexures
- •Left and Sigmoid Colon
- •Anatomical Variants and Typical Abnormal Findings
- •Complications
- •Outcomes
- •Conclusion
- •Suggested Reading
- •38 Mesenteric Resection in Rectal Cancer
- •Description of Rectal Cancer and the Mesorectum
- •Indications for Surgery of the Rectum and Mesorectum
- •Contraindications of Surgery of the Rectum and Mesorectum
- •Surgical Management: Technique
- •Surgical Complications
- •Early
- •Late
- •Summary
- •Suggested Readings
- •39 Mesenteric Resection in Crohn’s Disease
- •Introduction
- •Gross Features of the Bowel and Mesentery in Crohn’s Disease
- •Histopathologic Features of the Bowel and Mesentery in Crohn’s Disease
- •Mesenteric Adipose Tissue and Crohn’s Disease
- •Lymphatic System, Mesenteric Lymph Nodes Granulomas and Crohn’s Disease
- •Timing of Mesenteric Events in CD
- •Risk Factors for Recurrence and Extended Mesenteric Resection
- •Mesenteric Resection in Crohn’s Disease
- •Conclusion
- •Suggested Reading
- •40 Mesenteric Resection in Crohn’s Disease
- •Introduction
- •Inclusion of the Mesentery During Ileocolic Resection
- •Long-Term Outcomes
- •Short Term Outcomes
- •Indications for Inclusion of the Mesentery During Surgery for Crohn’s Disease
- •The Mesenteric Transition Zone
- •Advanced Mesenteric Disease Predicts Increased Surgical Recurrence
- •Discussion
- •Conclusion
- •Suggested Reading
- •Surgery for Individual Conditions
- •41 Surgical Management of Intestinal Volvulus
- •Definition and Clinical Features
- •Description of Surgery
- •Indications for Surgery
- •Contraindications
- •Preparation of Patient
- •How the Procedures Are Performed
- •Typical Abnormal Findings
- •Alternatives to Surgery
- •Outcomes
- •Complications
- •Summary
- •Suggested Reading
- •42 Embryologic Abnormalities of the Mesentery
- •Background
- •Malrotations and Indications for Surgery
- •Surgeries for Malrotations and Mesocolic Hernias
- •Complications
- •Summary
- •Suggested Reading
- •43 Mesenteric Hernia
- •Background
- •Clinical Presentation
- •Diagnosis
- •Management
- •Summary
- •Suggested Reading
- •44 Surgical Management of Bands and Adhesions
- •Definition and Clinical Features
- •Description of Procedures
- •Indications for Surgery
- •Contraindications
- •Preparation of the Patient
- •How the Procedure is Performed
- •Typical Abnormal Findings M
- •Outcomes and Complications
- •Summary
- •Suggested Reading
- •45 Mesenteric Trauma
- •Epidemiology
- •Pathophysiology
- •Diagnosis
- •Clinical Exam
- •Diagnostic Peritoneal Lavage (DPL) and Focused Assessment with Sonography in Trauma (FAST)
- •Operative Assessment
- •Grading
- •Predictive Variables
- •Management
- •Concern for Injury
- •High Suspicion for Injury
- •Intraoperative Finding
- •Proximal Mesenteric Injury
- •Future Directions
- •Suggested Reading
- •46 Mesenteric Cysts
- •Cystic Tumors of the Mesentery
- •Description of Condition
- •Mesenteric Lymphangioma
- •Simple Mesothelial Cysts
- •Multicystic Mesothelioma
- •Enteric Duplication Cysts
- •Urogenital Cysts of the Mesentery
- •Mature Cystic Teratoma
- •Mesenteric Pseudocyst
- •Presentation and Diagnosis
- •Diagnostic Studies in Uncomplicated Mesenteric Cysts
- •Physical Exam
- •Imaging
- •Lymphangioma
- •Mesothelial Cysts
- •Multicystic Mesothelioma
- •Enteric Duplication Cysts
- •Mature Cystic Teratoma
- •Mesenteric Pseudocyst
- •Endoscopy and Endoscopic Ultrasound
- •Acute Complications of Mesenteric Cysts
- •Obstruction, Volvulus and Intussusception
- •Ureteral Obstruction
- •Cyst Rupture
- •Cyst Hemorrhage
- •Infected Mesenteric Cyst
- •Peptic Ulceration
- •Management
- •Indications for Surgery
- •Contraindications to Surgery
- •Surgical Options
- •Summary
- •Suggested Reading
- •47 Mesenteric Abscess
- •Description of the Condition
- •Diagnosis of Mesenteric Abscess
- •Management of Mesenteric Abscess
- •Indications, Contraindications, and Challenges of Surgery for Mesenteric Abscess
- •Complications of Mesenteric Abscess
- •Outcome of Mesenteric Abscess
- •Summary
- •Colonic Abscess
- •Definition and Incidence
- •Causes
- •Diagnosis
- •Treatment
- •Conclusions
- •Suggested Reading
- •48 Mesenteric Neoplasms
- •Introduction
- •Description of Mesenteric Neoplasms
- •Lymphoma
- •Desmoid Tumors
- •Mesenteric Gastrointestinal Stromal Tumors
- •Mesenteric Carcinoid Tumors
- •Mesenteric Liposarcoma
- •Castleman’s Disease
- •Cystic Lesions
- •Conclusions
- •Suggested Reading
- •49 Mesenteric Artery Thrombosis and Embolism
- •Description of This Condition
- •Anatomy and Pathophysiology
- •Presentation
- •Laboratory Findings
- •Imaging Workup
- •Treatment
- •Outcomes
- •Suggested Readings
- •Future
- •50 Future Research on the Role of the Mesentery in Health and Disease
- •Introduction
- •Genetic Investigations and Mesenteric Disease
- •Clinical Pharmacology
- •Mesenteric Panniculitis
- •New and Future Developments in Mesenteric Surgery
- •Inflammatory Bowel Disease
- •Radiologic Advances
- •Mesenteric and Bowel Injuries
- •Fluorescence Lymphangiography
- •Use of Next Generation Technology to Advance Our Understanding of the Role of the Mesentery in Human Disease
- •Suggested Reading
- •Medical and Pharmacology
- •Surgery
- •Radiology
- •Next Generation Technology
- •Index

Contents
Part I General
1 Redefining the Mesentery as an Organ
...................... 3
J. Calvin Coffey and Peter O’Leary
2 Embryology of the Mesentery
............................. 9
Kevin G. Byrnes and J. Calvin Coffey
3 General Anatomy of the Mesentery
........................ 15
Christina A. Fleming, Dara Walsh, and J. Calvin Coffey
Part II Anatomy and Physiology
4 Vascular Anatomy of the Mesentery
........................ 27
Ahmed Khattab, Saad Hashmi, Eli D. Ehrenpreis,
and J. Calvin Coffey
5 Introduction to the Physiology of the Mesentery
............... 35
Karl Andersen, Assad Munis, and Eli D. Ehrenpreis
6 Emergence of the Human Gut Microbiota as an Influencer
in Health and Disease
................................... 43
Miranda G. Kiernan, Suzanne S. Dunne, and Colum P. Dunne
7 Cellular Anatomy of the Mesentery
........................ 53
Miranda G. Kiernan and J. Calvin Coffey
Part III Diagnostic Procedures
8 Radiography of the Mesentery
............................ 61
Scott Sorensen and Abraham H. Dachman
9 Mesenteric Biopsy
...................................... 71
Fons F. van den Berg and John C. Alverdy
10 Diagnosing Mesenteric Diseases: Laparoscopy
John Anagnostakos and Joshua H. Wolf
................ 75
xiii

xiv Contents
11 Immunologic Function of the Mesentery ..................... 83
David H. Kruchko and Eli D. Ehrenpreis
12 Neurophysiologic Function of the Mesentery
.................. 97
Amir Patel, Jeffrey Prochot, and Eli D. Ehrenpreis
13 Physiology of the Mesenteric Circulation
.................... 107
Saad Hashmi, Ahmed Khattab, and Eli D. Ehrenpreis
Part IV Role of Mesentery in Systemic Medical Diseases
14 The Role of the Mesentery in Metabolic Syndrome and Diabetes
Mellitus
.............................................. 123
Natasha Shah, David H. Kruchko, and Eli D. Ehrenpreis
15 Crohn’s Disease and the Mesentery
........................ 131
Eli D. Ehrenpreis
16 The Role of the Mesentery in Pancreatic Diseases
............. 141
Charles Broy, Chloe Lee, and Eli D. Ehrenpreis
17 IgG4-Related Diseases and the Mesentery
.................... 149
Ahmed Khattab, David H. Kruchko, and Eli D. Ehrenpreis
18 Role of the Mesentery in Systemic Inflammation Response
Syndrome (SIRS) and Multiple Organ Dysfunction Syndrome
(MODS)
............................................. 157
Cindy G. Pulido and Eli D. Ehrenpreis
Part V Medical Disorders of the Mesentery
19 Mesenteric Hemorrhage
................................. 171
Ryan T. Hoff and Eli D. Ehrenpreis
20 Mesenteric Panniculitis
.................................. 181
Eli D. Ehrenpreis
21 PPP Syndrome: Pancreatitis, Panniculitis, Polyarthritis
Eli D. Ehrenpreis
22 Mesenteric Adenitis
..................................... 195
Eli D. Ehrenpreis
23 Mesenteric Abscess
..................................... 203
Ryan T. Hoff and Eli D. Ehrenpreis
24 Mesenteric Venous Thrombosis
............................ 211
Nyi Nyi Tun and Eli D. Ehrenpreis
25 Mesenteric Arterial Occlusion
............................. 223
Adib Chaus, Khaja M. Siraj, and Eli D. Ehrenpreis
......... 191

Contents xv
26 Ischemic Enteropathy (Also Called Mesenteric Ischemia) ........ 239
Dorsa Samsami and Eli D. Ehrenpreis
27 Colonic Ischemia (Also Known as Ischemic Colitis)
............ 255
Chloe Lee and Eli D. Ehrenpreis
28 Mesenteric Lymphangioma
............................... 267
Eli D. Ehrenpreis and Siddhartha Guru
29 Radiation-Induced Mesenteric Injury
....................... 275
Eli D. Ehrenpreis and Charles Broy
30 Drug Induced Mesenteric and Retroperitoneal Diseases
Sarah Burroughs and Eli D. Ehrenpreis
Part VI Neoplasms of the Mesentery
31 Primary Solid Neoplasms
................................ 299
Jasper B. van Praag, Robert C. Keskey, Eli D. Ehrenpreis,
and John C. Alverdy
32 Metastatic Diseases of the Mesentery
....................... 313
John C. Alverdy and Robert C. Keskey
33 Mesenteric Lymphoma
.................................. 317
Emily Papazian, Robert C. Keskey, and John C. Alverdy
34 Castleman Disease with Mesenteric Involvement
.............. 321
Eli D. Ehrenpreis
Part VII Surgical Diseases of the Mesentery
......... 281
35 Mesenteric Resection in Upper Abdom inal Surgery
............ 329
Sara Gaines and John C. Alverdy
36 Mesenteric Considerations in Surgery of the Colon
and Rectum
........................................... 335
Hermann Kessler, Mariane G. M. Camargo, and Kristen T. Crowell
37 Mesocolic Resection in Colon Cancer
....................... 359
Felipe Quezada-Díaz, Winson Jianhong Tan, and J. Joshua Smith
38 Mesenteric Resection in Rectal Cance r
...................... 371
Craig A. Messick
39 Mesenteric Resection in Crohn’s Disease
.................... 389
Sherief Shawki and Steven D. Wexner
40 Mesenteric Resection in Crohn’s Disease
.................... 397
Tara M. Connelly, Shoaib Ash faq, and J. Calvin Coffey

xvi Contents
Part VIII Surgery for Individual Conditions
41 Surgical Management of Intestinal Volvulus
.................. 407
Ashley J. Williamson and John C. Alverdy
42 Embryologic Abnormalities of the Mesentery
................. 415
Sara Gaines, Thomas Q. Xu, Richard A. Jacobson,
and John C. Alverdy
43 Mesenteric Hernia
...................................... 421
Richard A. Jacobson, Robert C. Keskey, and John C. Alverdy
44 Surgical Management of Bands and Adhesions
................ 427
Ashley J. Williamson, Robert C. Keskey, and John C. Alverdy
45 Mesenteric Trauma
..................................... 433
Evan G. Wong and Joseph V. Sakran
46 Mesenteric Cysts
....................................... 445
Paul T. Hernandez, and Nicole M. Saur
47 Mesenteric Abscess
..................................... 461
Sameh Hany Emile
48 Mesenteric Neoplasms
................................... 475
Rishabh Sehgal, J. Calvin Coffey, and Deborah S. Kel ler
49 Mesenteric Artery Thrombosis and Embolism
................ 489
Salvatore Parascandola and Vincent Obias
Part IX Future
50 Future Research on the Role of the Mesentery in Health and
Disease
.............................................. 507
Eli D. Ehrenpreis, Steven D. Wexner, John C. Alverdy,
and David H. Kruchko
Index
...................................................... 513

Contributors
John C. Alverdy Department of Surgery, University of Chicago, Chicago, IL,
USA
John Anagnostakos Department of Surgery, Sinai Hospital of Baltimore, Baltimore, MD, USA
Karl Andersen Department of Medicine, Advocate Lutheran General Hospital,
Park Ridge, IL, USA
Shoaib Ashfaq School of Medicine and Department of Surgery, University of
Limerick Hospital Group, Raheen, Dooradoyle, Limerick, Ireland
Charles Broy Department of Gastroenterology, Edward Hines Jr VA Hospital,
Hines, IL, USA
Sarah Burrou ghs Department of Medicine, Advocate Lutheran General Hospital,
Park Ridge, IL, USA
Kevin G. Byrnes School of Medicine and Department of Surgery, University of
Limerick Hospital Group, Raheen, Dooradoyle, Limerick, Ireland
Mariane G. M. Camargo Digestive Disease and Surgery Institute, Department of
Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
Adib Chaus Department of Internal Medicine – Cardiology, Advocate Lutheran
General Hospital, Park Ridge, IL, USA
J. Calvin Coffey School of Medicine and Department of Surgery, University of
Limerick Hospital Group, Raheen, Dooradoyle, Limerick, Ireland
Tara M. Connelly School of Medicine and Department of Surgery, University of
Limerick Hospital Group, Raheen, Dooradoyle, Limerick, Ireland
Kristen T. Crowell Department of Surgery, Division of Colon and Rectal Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
Abraham H. Dachman Department of Radiology, The University of Chicago,
Chicago, IL, USA
xvii

xviii Contributors
Colum P. Dunne School of Medicine and Centre for Interventions in Infection,
Inflammation and Immunity, University of Limerick, Castleroy, Limerick, Ireland
Suzanne S. Dunne School of Medicine and Centre for Interventions in Infection,
Inflammation and Immunity, University of Limerick, Castleroy, Limerick, Ireland
Eli D. Ehrenpreis Department of Medicine, Advocate Lutheran General Hospital,
Park Ridge, IL, USA
Sameh Hany Emile Department of Colorectal Surgery, Mansoura University
Hospitals, Mansoura, Dakahlia, Egypt
Christina A. Fleming School of Medicine and Depa rtment of Surgery, University
of Limerick Hospital Group, Raheen, Dooradoyle, Limerick, Ireland
Sara Gaines Department of Surgery, University of Chicago, Chicago, IL, USA
Siddhartha Guru Department of Medicine, Advocate Lutheran General Hos pital,
Park Ridge, IL, USA
Saad Hashmi Department of Internal Medicine, Advocate Lutheran General
Hospital, Park Ridge, IL, USA
Paul T. Hernandez Department of Surgery, Division of Colon and Rectal Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA,
USA
Ryan T. Hoff Department of Medicine, Advocate Lutheran General Hospital, Park
Ridge, IL, USA
Richard A. Jacobson Department of Surgery, Rush University Medical Center,
Chicago, IL, USA
J. Joshua Smith Department of Colorectal Surgery, Memorial Sloan Kettering
Cancer Center, New York, NY, USA
Deborah S. Keller Division of Colon and Rectal Surgery, NewYork-Presbyterian,
Columbia University Medical Center, New York, NY, USA
Robert C. Keskey Department of Surgery, University of Chicago, Chicago, IL,
USA
Hermann Kessler Digestive Disease and Surgery Institute, Department of
Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
Ahmed Khattab Department of Internal Medicine, Division of Gastroenterology,
Advocate Lutheran General Hospital, Park Ridge, IL, USA
Miranda G. Kiernan School of Medicine and Centre for Interventions in Infection, Inflammation and Immunity, University of Limerick, Castleroy, Limerick,
Ireland
School of Medicine and Department of Surgery, University of Limerick Hospital
Group, Raheen, Dooradoyle, Limerick, Ireland

Contributors xix
David H. Kruchko Department of Medicine, Advocate Lutheran General
Hospital, Park Ridge, IL, USA
Chloe Lee Department of Internal Medicine, Advocate Lutheran General Hospital,
Park Ridge, IL, USA
Craig A. Messick Department of Surgical Oncology, The University of Texas MD
Anderson Cancer Center, Houston, TX, USA
Assad Munis Department of Medicine, Advocate Lutheran General Hospital, Park
Ridge, IL, USA
Vincent Obias Department of Colorectal Surgery, George Washington University
Medical Faculty Associates, Washington, DC, US
Peter O’Leary School of Medicine and Department of Surgery , University of
Limerick Hospital Group, Raheen, Dooradoyle, Limerick, Ireland
Emily Papazian Department of Surgery, University of Chicago, Chicago, IL,
USA
Salvatore Parascandola Department of Colorectal Surgery, George Washington
University Medical Faculty Associates, Washington, DC, US
Amir Patel Department of Gastroenterology and Hepatology, Medical College of
Wisconsin/Froedtert Hospital, Milwaukee, WI, USA
Jeffrey Prochot Department of Internal Medicine, Advocate Lutheran General
Hospital, Park Ridge, IL, USA
Cindy G. Pulido Department of Medicine, Advocate Lutheran General Hospital,
Park Ridge, IL, USA
Felipe Quezada-Díaz Department of Colorectal Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Joseph V. Sakran Division of Acute Care Surgery and Adult Trauma Services,
Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
Dorsa Samsami Department of Internal Medicine, Advocate Lutheran General
Hospital, Park Ridge, IL, USA
Nicole M. Saur Department of Surgery, Division of Colon and Rectal Surgery,
University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
Rishabh Sehgal Department of Colorectal Surgery, University Hospital Limerick,
Limerick, Ireland
Natasha Shah Department of Gastroenterology, Advocate Lutheran General
Hospital, Park Ridge, IL, USA
Sherief Shawki Department of Colon and Rectal Surgery, Cleveland Clinic,
Cleveland, OH, USA

xx Contributors
Khaja M. Siraj Department of Internal Medicine, NorthShore Medical Group,
Evanston, IL, USA
Scott Sorensen The University of Chicago, Chicago, IL, USA
Winson Jianhong Tan Department of Colorectal Surgery, Memorial Sloan Ket-
tering Cancer Center, New York, NY, USA
Nyi Nyi Tun Department of Internal Medicine, Miami Valley Hospital, Dayton,
OH, USA
Jasper B. van Praag Department of Surgery, University Medical Center
Groningen, Groningen, The Netherlands
Dara Walsh School of Medicine and Department of Surgery, University of
Limerick Hospital Group, Raheen, Dooradoyle, Limerick, Ireland
Steven D. Wexner Department of Colon and Rectal Surgery, Cleveland Clinic
Florida, Weston, IL, USA
Ashley J. Williamson Department of Surgery, University of Chicago, Chicago,
IL, USA
Joshua H. Wolf Department of Surgery, LifeBridge Health, Baltimore, MD, USA
Evan G. Wong Division of Acute Care Surgery and Adult Trauma Services,
Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
Thomas Q. Xu Department of Surgery, Rush University Medical Center, Chicago,
IL, USA

Part I
General

Redefining the Mesentery as an Organ
J. Calvin Coffey and Peter O’Leary
Definition of the Mesentery
The mesentery is defined as the collection of tissues that maintains all abdominal
digestive organs in position and in continuity with other systems. This definition
differs considerably from the classic definition which describes the mesentery as a
double fold of peritoneum that maintains the intestine in position.
Once the shape of the mesentery was clarified it became apparent that it was
continuous, substantive, and important from a functional perspective. It was also
noted that it could be readily differentiated from structures with which it was
continuous. Further studies demonstrated that mesenteric continuity applied from
the oesophago-gastric to anorectal junction. In turn, it was observed that all
abdominal digestive organs are continuous with the mesentery.
These findings indicated that the mesentery has an essential function. In the
embryo, it serves as an incubator for digestive organs, providing a platform on which
they can develop. In the adult it also has an essential function in maintaining the
organization of the digestive system as well as its connectivity with all other systems.
These observations led our group to suggest that it be designated an organ in
itself.
1
Historic Development of the Understanding of the Mesentery
As our current understanding of the mesentery differs considerably from that
depicted in the classic model, it is important to describe how our current understanding of the mesentery developed. Renaissance anatomists visually depicted a
J. C. Coffey (&) P. O’Leary
School of Medicine and Department of Surgery, University of Limerick Hospital Group,
Raheen, Dooradoyle, Limerick, Ireland
e-mail: calvin.coffey@ul.ie
© Springer Nature Switzerland AG 2021
E. D. Ehrenpreis et al. (eds.), The Mesenteric Organ in Health and Disease,
https://doi.org/10.1007/978-3-030-71963-0_1
3
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