Once thought to be separate components, the new model of a contiguous mesentery could lead to new medical laboratory tools for diagnosing and treating digestive diseases such as Crohn’s and colorectal cancer

For more than a century, pathology professionals have treated the network of tissue folds surrounding the human digestive system, known as the mesentery, as separate entities. However, new research  indicates the mesentery is in fact a single, continuous organ and therefore reverses that thinking. This could impact the way pathologists and medical laboratories currently perform diagnostics and testing of digestive diseases.

Dr. J. Calvin Coffey, Professor of Surgery at the University of Limerick, Ireland, and Dr. Peter O’Leary, PhD, MBBS, of the Royal College of Surgeons in Ireland (RCSI), published their findings in The Lancet Gastroenterology and Hepatology.

“This organ is far from fragmented and complex. It is simply one continuous structure,” said Coffey in an article posted on the University of Limerick’s website. “During the initial research, we noticed in particular that the mesentery, which connects the gut to the body, was one continuous organ. Up to that it was regarded as fragmented—present here, absent elsewhere—and a very complex structure. The anatomic description that had been laid down over 100 years of anatomy was incorrect,” he concluded.

Understanding Function to Identify Abnormal Function

While Dr. Coffey’s research has uncovered differences in the anatomy and structure from previously accepted standards, more research is needed to determine the function of the mesentery. In the published research, Coffey notes, “The next step is the function. If you understand the function you can identify abnormal function, and then you have disease. Put them all together and you have the field of mesenteric science … the basis for a whole new area of science. This is relevant universally as it affects all of us.”

Dr. J. Calvin Coffey (above left), Professor of Surgery at the University of Limerick, and Dr. Peter O’Leary (above right), Royal College of Surgeons in Ireland, published research in The Lancet Gastroenterology and Hepatology journal that claims the mesentery is a single, contiguous organ and not separate entities within the human body as has traditionally been believed. Their findings could lead to a plethora of new clinical laboratory tests and procedures for the pathologic diagnosis and treatment of digestive diseases. (Photo copyright: Irish America/Irish Melanoma Forum.) UL Surgeon Receives International Award For Outstanding Contribution to the Science of Surgery  Professor Calvin Coffey Receives Prestigious James IV Fellowship Award Professor Calvin Coffey (Chair of Surgery, Graduate Entry Medical School, University of Limerick and Consultant General & Colorectal Surgeon, Limerick University Hospital) has been selected to receive a James IV Fellowship from the James IV Association of Surgeons  . This Fellowship is awarded to candidates who have made outstanding contributions to the art and science of surgery.    Each year surgeons are selected from around the world to receive this prestigious Fellowship. In the coming months, Professor Coffey will travel to clinical sites in North America, Korea, and across Europe to present his experiences of novel techniques and innovation in minimally invasive colorectal cancer surgery.   Professor Coffey acknowledged the importance of the award saying;  “This fellowship is a key piece in the jigsaw as we continue to develop educational programmes at the highest level possible for undergraduate students and postgraduate surgical trainees”.   Professor Colum Dunne, Graduate Entry Medical School at University of Limerick, added “Professor Coffey and his surgical colleagues at each of the clinical sites affiliated with UL have created an effective and enjoyable learning experience for GEMS students.  We welcome the opportunity to disseminate the knowledge generated by these teams in surgical teaching and research, and like all learning organisations look forward to implementing new approaches that may result from this fellowship”.     The James IV Association of Surgeons, Inc. was founded in 1957 by three distinguished surgeons from England, Scotland and the United States so that surgeons from around the world could be brought together to exchange ideas and techniques regarding surgery. The aim of the Ass

Dr. J. Calvin Coffey (above left), Professor of Surgery at the University of Limerick, and Dr. Peter O’Leary (above right), Royal College of Surgeons in Ireland, published research in The Lancet Gastroenterology and Hepatology journal that claims the mesentery is a single, contiguous organ and not separate entities within the human body as has traditionally been believed. Their findings could lead to a plethora of new clinical laboratory tests and procedures for the pathologic diagnosis and treatment of digestive diseases. (Photo copyright: Irish America/Irish Melanoma Forum.)

Research published in the March 2016 issue of World Journal of Gastrointestinal Oncology highlights how study of the mesenteric organ already improved patient outcomes and 5-year survival rates for colorectal cancer. Research authors attribute research into the anatomical form of the mesenteric organ to increased ability for surgeons to perform complete mesocolic excision (CME) and total mesorectum excision (TME) procedures.

It is already known that the mesentery carries lymphatic fluid and blood between the intestine and the surrounding body. As abnormal functions and diseases are uncovered, pathology and clinical laboratories will likely see an increase in samples and diagnostic tests related to the new organ.

In the published research, Dr. Coffey notes, “Increasing data point to the occurrence of cellular mesenteropathies. The concept of cellular mesenteropathies is supported by findings in sclerosing mesenteritis and adhesion formation. With increasing investigation of the histological basis of the mesentery in health and disease, further examples of this disease subtype are likely to emerge.”

Other diseases and disorders Coffey believes the mesentery might help to highlight include:

Crohn’s Disease;

Diabetes;

• Obesity;

Metabolic syndrome; and

Atherosclerosis.

The Potential of Mesenteric Diagnostics for Clinical Laboratories

As the known form of the mesentery continues to improve, the ability to collect diagnostic samples, and standardize non-invasive and minimally invasive means of observation, will improve as well. Coffey’s research notes, “Endoscopic mesenteric sampling aims to provide clinically relevant data in an array of abdominal and non-abdominal disorders and will be addressed in studies. It is anticipated that these data will culminate in the development of non-invasive mesenteric-based therapies [i.e., mesenteric pharmacotherapeutics], which might obviate surgical intervention.”

Medical laboratories will play a major role in much of this process, both in analyzing samples to help determine normal functions and conditions, and in identifying abnormalities. Coffey believes that the discovery will be of particular value to pathologists saying, “Pathology will benefit from [enhanced] comprehensive understanding in an array of abdominal and non-abdominal conditions.”

However, he also highlights that the new data on the structure of the mesentery raises as many questions as it answers. First, he says that anatomical and other features need further study. He then points out that the functional unit of the mesentery is still unknown and might lead to important insights into the role the mesentery plays at hematological, immunological, and other levels.

As these insights occur, pathologists, clinical laboratories, and other providers of diagnostic testing, will likely see a new wave of tests to further improve diagnosis and shape the future of treatments across a variety of diseases.

—Jon Stone

Related Information:

Irish Surgeon Identifies Emerging Area of Medical Science

The Mesentery: Structure, Function, and Role in Disease

Complete Mesocolic Excision: Lessons from Anatomy Translating to Better Oncologic Outcome

Historical Development of Mesenteric Anatomy Provides a Universally Applicable Anatomic Paradigm for Complete/Total Mesocolic Excision 

The Mesocolon: A Prospective Observational Study 

The Mesentery: A ‘New’ Organ You Didn’t Know You Had 

The Human Body May Have a New Organ—the Mesentery 

It’s Official: A Brand-New Human Organ Has Been Classified