Dr. Alejandro Díaz Girón Gidi

Mesentery Excision in Crohn's Disease: Why? When? How?

The mesenteric organ is a single structural entity spanning the gut from duodenojejunal flexure to mesorectum. At the ileocolic level, the small intestinal mesentery continues to the right colon as the right mesocolon. A substantial mesenteric tissue mass occurs at the ileocaecal level. Anatomically, the mesentery is divisible into vascular and avascular regions. Current data indicate that local responses are mainly immunologic in nature whereas systemic changes occur in the fibrinolytic, coagulation, and inflammatory cascades. The mesentery also plays a directly protective role not unlike that of the omentum, that is, ‘the policeman’ of the peritoneum. As part of a phlegmon, it walls off and contains intraperitoneal pathology. This prevents the host mounting a generalized systemic inflammatory response to intraperitoneal disease. Mesenteric mes- othelium contributes major reparative activities such as postoperative reconstitution of mesothelial contiguity.