**7.5 Superior mesenteric artery aneurysm**

Most commonly found within the first 5 cm of the artery,, these aneurysms are particularly dangerous because complications such as aneurysm rupture, acute thrombosis, or distal embolization may jeopardize the entire small bowel.

Superior Mesenteric Artery Aneurysm associated with an infectious etiology in the majority of cases (Mycotic aneurysms). The majority of Superior Mesenteric Artery Aneurysms are symptomatic at initial evaluation. Treatment of Superior Mesenteric Artery Aneurysms should be considered regardless of size or symptomatology because of the high mortality risk associated with potential rupture. treatment must be individualized and based on the etiology, size, and anatomic location of the lesion; co-morbid conditions of the patient; and the potential morbidity of the proposed procedure (41, 42).

#### **8. References**

244 New Advances in the Basic and Clinical Gastroenterology

fibrodysplasia, trauma, infection, biliary diseases and percutaneous or endoscopic

Symptoms can include epigastric or right upper quadrant pain and subsequent gastrointestinal hemorrhage and jaundice. Treatment options depend to a large extent on the anatomic location and morphology of the Hepatic Artery Aneurysms, underlying

In contrast to Splenic Artery Aneurysms are Celiac Artery Aneurysms more commonly found in men. The causes are medial degeneration or atherosclerotic disease. Less common causes include trauma, collagen vascular disease, arterial dissection, anomalous splanchnic circulation, and mycotic aneurysms. Open surgical options included aneurysmectomy,

Most commonly found within the first 5 cm of the artery,, these aneurysms are particularly dangerous because complications such as aneurysm rupture, acute thrombosis, or distal

Superior Mesenteric Artery Aneurysm associated with an infectious etiology in the majority of cases (Mycotic aneurysms). The majority of Superior Mesenteric Artery Aneurysms are symptomatic at initial evaluation. Treatment of Superior Mesenteric Artery Aneurysms should be considered regardless of size or symptomatology because of the high mortality risk associated with potential rupture. treatment must be individualized and based on the etiology, size, and anatomic location of the lesion; co-morbid conditions of the patient; and

procedures, polyarteritis nodosa, and congenital disorders.

Fig. 7. Splenic Artery Aneurysm (intraoperative photograph)

etiology, and status of the end organ (36, 37, 38, 39).

**7.4 Celiac artery aneurysms** 

aneurysmorrhaphy, and ligation (40).

**7.5 Superior mesenteric artery aneurysm** 

embolization may jeopardize the entire small bowel.

the potential morbidity of the proposed procedure (41, 42).


**12** 

*USA* 

Andrew S. Freiberg

*Pennsylvania State University*

**A Case Based Approach to** 

**Severe Microcytic Anemia in Children** 

Clinicians are traditionally taught that the differential diagnosis of microcytic anemia is limited to a very few causes, with iron deficiency anemia on top of that list. While this may be true, the specific etiology of these causes and specifically the exact cause of the iron deficiency in each case is of clinical importance, as treatment of the anemia is very different for each cause. Just as the most common reason for severe microcytic anemia at any age is iron deficiency, the most common reasons for that deficiency at any age involve the gastrointestinal tract. The gastrointestinal tract is both the site of iron uptake and the most common site of blood loss. Thus, the gastrointestinal specialist plays a key role in diagnosing and managing microcytic anemia and must understand the various etiologies of microcytic anemia that are likely or possible in the population seen, including those cases that do not have a GI cause. In this chapter we will explain in a case based format the proper workup of the child and adolescent with microcytic anemia, emphasizing the role of the GI

tract in the mechanism and of the GI specialist in the diagnosis and management.

pathologic processes and is not considered a disease in itself.

Anemia refers to a hemoglobin (Hgb) or hematocrit (Hct) level lower than adult range or the age-adjusted range for healthy children. Normal values also vary depending on the gender and race of the patient. Since the main physiological role of red blood cells (RBCs) is to deliver oxygen to tissues, anemia is a condition where the body's metabolic demands for oxygen may not be adequately achieved. The condition is usually secondary to various

The causes for anemia can be broadly categorized into three pathological processes: decreased or ineffective erythropoiesis, increased hemolysis, and blood loss. However, cases where anemia is multifatorial in origin can exist. Anemia can also be further classified as microcytic, normocytic or macrocytic, referring to the mean corpuscular volume (MCV) which measures RBCs size, ranging from small, normal and large, respectively. This chapter will focus on microcytic anemia in children. The cases and information given are applicable to the general practitioner, but are aimed specifically at the pediatric gastroenterologist, focusing specifically on *severe* anemias that are *severely* microcytic, because these are the cases that impact the gastroenterologist most. An effort will be made to clarify much of the

commonly thought but vague and misleading information about this condition.

**1. Introduction** 

**2. Overview of anemia** 

treatment with continuous intravenous high-dose prostaglandin E1. Ann Surg 2007; 246:229-235.

