Editing Mesentery (section)

==Clinical significance==
Clarifications of the mesenteric anatomy have facilitated a clearer understanding of diseases involving the mesentery, examples of which include [[malrotation]] and [[Crohn's disease]] (CD). In CD, the mesentery is frequently thickened, rendering [[hemostasis]] challenging. In addition, fat wrapping—creeping fat—involves extension of mesenteric fat over the circumference of contiguous gastrointestinal tract, and this may indicate increased mesothelial plasticity. The relationship between mesenteric derangements and mucosal manifestations in CD points to a pathobiological overlap; some authors say that CD is mainly a mesenteric disorder that secondarily affects the GIT and systemic circulation.<ref>{{cite journal |vauthors=Sahebally SM, Burke JP, Chang KH, Kiernan MG, O'Connell PR, Coffey JC |title=Circulating fibrocytes and Crohn's disease |journal=The British Journal of Surgery |volume=100 |issue=12 |pages=1549–56 |date=November 2013  |pmid=24264775 |doi=10.1002/bjs.9302|doi-access=free }}</ref>

[[Thrombosis]] of the [[superior mesenteric vein]] can cause [[mesenteric ischemia]] also known as ''ischemic bowel''. Mesenteric ischemia can also result from the formation of a [[volvulus]], a twisted loop of the small intestine that when it wraps around itself and also encloses the mesentery too tightly can cause [[ischemia]].<ref name=NIH2013>{{cite web|title=Anatomic Problems of the Lower GI Tract|url=https://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/anatomic-colon/Pages/facts.aspx#Volvulus|website=NIDDK|access-date=3 August 2016|date=July 2013|archive-date=28 July 2016|archive-url=https://web.archive.org/web/20160728003747/https://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/anatomic-colon/Pages/facts.aspx#Volvulus|url-status=dead}}</ref>

The rationalization of mesenteric and peritoneal fold anatomy permits the surgeon to differentiate both from intraperitoneal adhesions—also called congenital adhesions. These are highly variable among patients and occur in several locations. Congenital adhesions occur between the lateral aspect of the peritoneum overlying the mobile component of the mesosigmoid and the parietal peritoneum in the left iliac fossa. During the lateral to the medial approach of mobilizing of the mesosigmoid, these must be divided first before the peritoneum proper can be accessed. Similarly, focal adhesions occur between the undersurface of the greater omentum and the cephalad aspect of the transverse mesocolon. These can be accessed after dividing the peritoneal fold that links the greater omentum and transverse colon. Adhesions here must be divided to separate the greater omentum off the transverse mesocolon, thus allowing access to the lesser sac proper.<ref name="Coffey"/><ref name="Sehgal"/>

=== Surgery ===
While the total mesorectal excision (TME) operation has become the surgical gold standard for the management of rectal cancer, this is not so for colon cancer.<ref name="Coffey"/><ref name="Sehgal">{{cite journal|last1=Sehgal|first1=R|last2=Coffey|first2=JC|title=The development of consensus for complete mesocolic excision (CME) should commence with standardisation of anatomy and related terminology.|journal=International Journal of Colorectal Disease|date=June 2014|volume=29|issue=6|pages=763–4|doi=10.1007/s00384-014-1852-8|pmid=24676507|s2cid=10393183}}</ref>
Recently, the surgical principles underpinning TME in rectal cancer have been extrapolated to colonic surgery.<ref>{{cite journal |vauthors=West NP, Morris EJ, Rotimi O, Cairns A, Finan PJ, Quirke P |title=Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study |journal=The Lancet Oncology |volume=9 |issue=9 |pages=857–65 |date=September 2008  |pmid=18667357 |doi=10.1016/S1470-2045(08)70181-5}}</ref><ref>{{cite journal  |vauthors=Søndenaa K, Quirke P, Hohenberger W, etal |title=The rationale behind complete mesocolic excision (CME) and a central vascular ligation for colon cancer in open and laparoscopic surgery : proceedings of a consensus conference |journal=International Journal of Colorectal Disease |volume=29 |issue=4 |pages=419–28 |date=April 2014  |pmid=24477788 |doi=10.1007/s00384-013-1818-2|s2cid=6464670 }}</ref> Total or complete mesocolic excision (CME), use planar surgery and extensive mesenterectomy (high tie) to minimise breach of the mesentery and maximise lymph nodes yield. Application of this T/CME reduces local five-year recurrence rates in colon cancer from 6.5% to 3.6%, while cancer-related five-year survival rates in patients resected for cure increased from 82.1% to 89.1%.<ref name=":11">{{cite journal |vauthors=Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S |title=Standardized surgery for colonic cancer: complete mesocolic excision and central ligation – technical notes and outcome |journal=Colorectal Disease |volume=11 |issue=4 |pages=354–64; discussion 364–5 |date=May 2009  |pmid=19016817 |doi=10.1111/j.1463-1318.2008.01735.x|s2cid=24215331 }}</ref>

=== Radiology ===
Recent radiologic appraisals of the mesenteric organ have been conducted in the context of the contemporary understanding of mesenteric organ anatomy. When this organ is divided into non-flexural and flexural regions, these can readily be differentiated in most patients on CT imaging. Clarification of the radiological appearance of the human mesentery resonates with the suggestions of Dodds and enables a clearer conceptualization of mesenteric derangements in disease states.<ref name=":4" /> This is of immediate relevance in the spread of cancer from colon cancer and perforated diverticular disease, and in pancreatitis where fluid collections in the lesser sac dissect the mesocolon from the retroperitoneum and thereby extend distally within the latter.<ref>{{cite journal |vauthors=Koo BC, Chinogureyi A, Shaw AS |title=Imaging acute pancreatitis |journal=The British Journal of Radiology |volume=83 |issue=986 |pages=104–12 |date=February 2010  |pmid=20139261 |pmc=3473535 |doi=10.1259/bjr/13359269}}</ref>