In this report, we present an Asian male patient who was 30 years old and admitted to the hospital due to pancreatitis. While undergoing a CT scan, an isolated mass was unexpectedly discovered in the patient\'s abdomen. The patient\'s abdominal pain, which was caused by pancreatitis, had resolved before he underwent surgical resection to remove the mass. Subsequently, the patient was diagnosed with Castleman disease based on pathology. Castleman disease occurring in the mesentery is exceptionally rare. Therefore, we have reviewed the essential information regarding Castleman disease and have found that the crucial part lies in the diagnosis and the consideration of distinct treatment strategies based on different types.

Essential to understanding disease spread in abdomen is to separate the peritoneum from the extraperitoneum. These areas have distinct anatomy with well-define separate pathways. The peritoneum is comprised of connected recesses that are potential spaces, normally not imaged except when containing excess fluid or air. Peritoneal recesses are formed by the opposing peritoneal surfaces and subdivided by the attachments of the ligaments and mesenteries to the parietal peritoneum. Disease flows within the recesses by changes in abdominal pressure. This forms a distinct spread pattern. The extraperitoneum is traditionally stratified by the renal fascia into the anterior and posterior pararenal spaces and the perirenal space. The fascia contains and directs spread from the contained organs with the compartments. Each space has a unique spread pattern defined by the containing fascia. The extraperitoneum is connected to the mesenteries and ligaments forming the subperitoneal space. This space interconnects the extraperitoneum with the mesenteries allowing for the normal continuum of blood vessels, lymphatics, and nerves but also forms the pathways for bidirectional spread of disease.

UNASSIGNED: Desmoid tumor (DT) is a rare locally aggressive but non-metastatic mesenchymal soft tissue neoplasm that predominantly occurs in the abdominal wall, abdominal cavity, and extremities. Its occurrence in the mesentery is relatively uncommon.
UNASSIGNED: This article reports two cases of desmoid tumor treated at the Department of Gastrointestinal Surgery, Weifang People\'s Hospital. The first case was a 59-year-old male patient who had previously undergone surgery for esophagogastric junction cancer. Postoperatively, he developed an intra-abdominal mass that rapidly increased in size within three months. The second case was a 60-year-old male patient who incidentally discovered a mass in the left lower abdomen. Both patients underwent surgical treatment, and the postoperative pathological diagnosis was mesenteric desmoid tumor.
UNASSIGNED: The treatment of desmoid tumor remains challenging. Simple surgical resection often yields unsatisfactory outcomes, and the efficacy of adjuvant radiotherapy and chemotherapy is also limited. Further research and clinical practice are necessary to improve diagnostic and therapeutic strategies, aiming to enhance patient survival and quality of life.

Small intestinal neuroendocrine tumours (SI-NETs) are the most common small intestinal tumours. A particularly challenging subset of these tumours is those that involve the superior mesenteric artery or vein for which the role and feasibility of surgery are often questioned. This systematic review aimed to identify and evaluate the management strategies used for these complex SI-NETs. The identified studies showed positive outcomes with surgery and multimodality therapy.

Mesenteric panniculitis (MP) is a benign condition characterized by chronic inflammation and fibrosis of adipose tissue mainly of the small bowel mesentery. MP is commonly detected incidentally on cross-sectional imaging of the abdomen and can be asymptomatic in up to nearly half of patients. The most frequent clinical symptom reported is abdominal pain, followed by bloating/distention, diarrhea, constipation, vomiting, anorexia, weight loss, fever, malaise, and nausea. On computed tomography, MP is seen as a mass-like area of increased fat attenuation within the small bowel mesentery, usually located in the left upper quadrant of the abdomen. This mass-like area envelops mesenteric vessels and displaces adjacent bowel segments. Lymph nodes are frequently seen within the area of mesenteric abnormality. One of the most common differential diagnoses of MP is lymphoma, and positron emission tomography/computed tomography may be performed if there is suspicion of a concurrent underlying malignancy. Because of the benign nature of MP, treatment decisions should be guided by severity of symptoms and presence of complications. First-line medical treatment is prednisone and tamoxifen. Surgery is reserved for cases of recurrent bowel obstruction. This article provides a review of MP, including its epidemiology, pathophysiology, clinical presentation, imaging findings, and treatment.

BACKGROUND: Approximately one third of patients with Acute Type A Aortic Dissection (ATAAD) present with pre-operative malperfusion syndromes (MPS). Of these, mesenteric malperfusion represents the greatest risk to patients with respect to increased short-term mortality. In select patients, it may be feasible to offer a staged approach by treating the mesenteric malperfusion first, optimizing the patient in the intensive care setting and then, following with a central aortic repair. The aim of this systematic review is to summarize cohort studies assessing the role of pre-operative interventions for mesenteric malperfusion.
METHODS: An electronic literature search of five databases was performed to identify all relevant studies providing studies examining short-term mortality on patients who underwent either endovascular or open revascularisation of mesenteric ischemia prior to central aortic repair. The primary outcome was all-cause, short-term mortality. Secondary outcomes were comparative mortality between a delayed repair vs. aortic repair first strategy, rates of postoperative laparotomy, bowel resection, and mortality following delayed aortic repair.
RESULTS: The search strategy identified 8 studies qualifying for inclusion, with a total of 180 patients who underwent delayed aortic surgery in the setting of mesenteric MPS. The weighted short-term mortality following a mesenteric revascularisation first, delayed aortic surgery strategy was 22.5%. This strategy was also associated with a significantly lower mortality than a central repair first strategy (OR 0.07, 95% CI 0.02-0.27), and a significantly lower rate of postoperative laparotomy/bowel resection (OR 0.05, 95% CI 0.02-0.14). If patients survive to receive central repair, the weighted short-term mortality postoperatively is low (2.1%).
CONCLUSIONS: A summary of this evidence reveals a lower short-term mortality in hemodynamically stable patients with mesenteric malperfusion, along with a reduction in postoperative laparotomy/bowel resections. Of those patients who survive to receive central repair, short-term mortality remains very low in the select group of hemodynamically stable patients. Further high-quality studies with randomized or propensity matched data are required to verify these results.

The successful report of total mesorectal excision (TME)/complete mesocolic excision (CME) has encouraged people to apply this concept beyond colorectal surgery. However, the negative results of the JCOG1001 trial denied the effect of complete resection of the \"mesogastrium\" including the greater omentum on the oncological survival of gastric cancer patients. People even believe that the mesentery is unique in the intestine, because they have a vague understanding of the structure of the mesentery. The discovery of proximal segment of the dorsal mesogastrium (PSDM) proved that the greater omentum is not the mesogastrium, and further revised the structure (definition) of the mesentery and revealed its container characteristics, i.e. the mesentery is an envelope-like structure, which is formed by the primary fascia (and serosa) that enclose the tissue/organ/system and its feeding structures, leading to and suspended on the posterior wall of the body. Breakdown of this structure leads to the simultaneous reduction of surgical and oncological effects of surgery. People quickly realized the universality of this structure and causality which cannot be matched by the existing theories of organ anatomy and vascular anatomy, so a new theory and surgical map- membrane anatomy began to form, which led to radical surgery upgraded from histological en bloc resection to anatomic en bloc resection.
结直肠外科全直肠系膜切除和完整结肠系膜切除的成功报道，推动了人们将这一理念应用到肠外区域，而JCOG1001试验的阴性结果，否认了基于大网膜切除的“胃系膜”完整切除对胃癌患者术后生存的作用。人们甚至以为系膜为肠道独有，其背后的原因是人们对系膜的结构认识模糊。胃背侧系膜近侧段的发现，证明了大网膜不是胃系膜，进而订正了系膜的结构（定义）和“载体”特征，即系膜是固有筋膜和浆膜，包绕着组织、器官、系统及其供养系统，通向和悬挂于体后壁的信封样结构，并揭示了打破该结构将导致手术的外科学和肿瘤学效果同步降低。据此人们很快意识到，这种结构和因果的普遍性，是已有的器官解剖和血管解剖理论无法解释的。于是，新的解剖理论和手术版图——“膜解剖”开始形成，使长期以来强调的“组织学整块切除”理念上升至解剖学整块切除的维度。.

Internal hernias are a worrying complication from laparoscopic Roux-en-Y gastric bypass (LRGB), with potential small bowel necrosis and obstruction. An electronic database search of Medline, Embase, and Pubmed was performed. All studies investigating the internal hernia rates in patients whose mesenteric defects were closed vs. not closed during LRGB were analysed. Odds ratios were calculated to assess the difference in internal hernia rate. A total of 14 studies totalling 20,553 patients undergoing LRGB were included. Internal hernia rate (220/12,445 (2%) closure vs. 509/8108 (6%) non-closure) and re-operation for small bowel obstruction (86/5437 (2%) closed vs. 300/3132 (10%) non-closure) were reduced when defects were closed. There was no difference observed when sutures were used to close the defects compared to clips/staples.

Diagnosing bowel and mesenteric trauma poses a significant challenge to radiologists. Although these injuries are relatively rare, immediate laparotomy may be indicated when they occur. Delayed diagnosis and treatment are associated with increased morbidity and mortality; therefore, timely and accurate management is essential. Additionally, employing strategies to differentiate between major injuries requiring surgical intervention and minor injuries considered manageable via non-operative management is important. Bowel and mesenteric injuries are among the most frequently overlooked injuries on trauma abdominal computed tomography (CT), with up to 40% of confirmed surgical bowel and mesenteric injuries not reported prior to operative treatment. This high percentage of falsely negative preoperative diagnoses may be due to several factors, including the relative rarity of these injuries, subtle and non-specific appearances on CT, and limited awareness of the injuries among radiologists. To improve the awareness and diagnosis of bowel and mesenteric injuries, this article provides an overview of the injuries most often encountered, imaging evaluation, CT appearances, and diagnostic pearls and pitfalls. Enhanced diagnostic imaging awareness will improve the preoperative diagnostic yield, which will save time, money, and lives.

An otherwise healthy 4-month-old girl presented to the community health service center because her abdomen was distended. Over the next 2 months, the girl\'s abdomen gradually became more distended. Her examination was notable for abdominal distention with a large, mobile, non-tender abdominal mass. Abdominal ultrasound images and subsequently obtained CT images showed a large, circumscribed cystic and solid mass. This led to the presumptive diagnosis of teratoma of the mesentery. The mass was completely resected during a laparotomy. The pathology, along with the surgical findings and imaging, led to the final diagnosis.