Reviewer’s report
Title: 
Fibromuscular dysplasia of mesenteric arteries – a rare cause of multiple bowel resections: A case
report and literature review
Version: 
0 
Date: 
29 Dec 2020
Reviewer's report:
The paper is an interesting case of rare presentation of FMD causing bowel ischaemia with a prolonged
diagnostic odyssey due to the atypical disease. The paper would benefit from review from a native English
speaker or use of an academic editor service as there are a number of areas which would benefit from
clarity of expression and improvement in sentence structure and phraseology. The title purports the case to
be about multiple enterectomies (i.e. surgical small bowel resections) although only one small bowel
resection was undertaken so this title needs to be modified to reflect multiple bowel resections. 
The
abstract is quite long and would benefit from shortening to minimise duplication. The CT figures 1 and 2
should be annotated. There is an excessive number of figures, some of which really do not add to the case
report e.g. Figures 11-12 showing normal mucosa. The number of figures should be reduced to 3 - 4
figures. Some specific comments:
Page 1 Line 18 and Page 3 Line 54 - symptoms of the disease is unclear - is this all FMD or just
mesenteric FMD?
Page 3 lines 52 to 60 - need to reference clinical symptoms and enterectomies
Page 4 - the patient gave a history of mesenteric angina with post prandial pain - what investigations were
undertaken at the time of the initial presentation?
Page 4 Line 70 - what is an electronic colonoscopy? Is this a capsule endoscopy?
Page 4 Line 73 - size of spleen on USS only should be stated
Page 4 line 76 - the effect was poor - do they mean there was no or just limited clinical benefit?
Page 4 Line 81 - a palpable spleen would always suggest enlargement
Page 4 Line 81 - What were the values of HB, white cell counts and thrombocytopenia?
Page 4 Line 82-83 - normal reference ranges need to be added
Page 4 Line 84 - what is a "stimulation enhanced" CT - is this just contrast enhanced?
Page 5 Line 85 - "strengthened" is an incorrect term here
Page 5 Line 92 - the report suggests that she is steroid responsive - given this is a non-inflammatory
condition what is the presumed mechanism here?
Page 5 Line 100 - What type of FMD was the histology reported as?
Page 6 Line 107 - what was the indication for splenectomy?
Page 6 Line 117 - Medial type not medial involvement
Page 6 Line 118 - there is no endometrial type - do you mean intimal?
Page 6 Line 119 - of should be by
Page 6 Line 124 - define 'fairly rare'
Page 7 Line 134 - distributed mainly in intestinal wall. This sentence in contradicted by the previous
sentence stating that further vessel assessment wasn't undertaken. Was there any assessment made by
Doppler US or CT angio of renal or carotid vessels?
Page 6 Line 120 - "Vascular changes…" 
Is this for all types or only the last type mentioned?
Page 
7 Line 137 - It is important to emphasise on what basis this case was felt not to be due to the
mesenteric arteriovenous dysplasia mentioned (e.g. lack of venous involvement, histological features etc.)
Publons Reviewer Recognition
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reviewers. Please find the details of processing in Publons’ privacy policy
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No
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of this manuscript,
either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an organization that holds or has
applied for patents relating to the content of the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below. If your
reply is yes to any, please give details below.
I declare that I have no competing interests
Reviewer Publication Consent.
 I agree for my report to be made available under an Open Access
Creative Commons CC-BY License (
 http://creativecommons.org/licenses/by/4.0
) if this manuscript is
accepted for publication. Any comments that I do not wish to be included in the published report have
been included as confidential comments to the editor, which will not be published.
If you are not happy for us to publish this report, please contact the editorial office before completing
the review.
If you wish, you can include your name in your published report. Please note you must decide whether
to include your name at the start of the process and confirm this decision whenever prompted. If you
change your decision later, we will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name with my report. (default)
Is the study design appropriate to answer the research question (including the use of appropriate controls),
and are the conclusions supported by the evidence presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free from apparent
manipulation?
Yes
Reviewer’s report
Title: 
Fibromuscular dysplasia of mesenteric arteries – a rare cause of multiple bowel resections: A case
report and literature review
Version: 
0 
Date: 
29 Dec 2020
Reviewer's report:
The paper is an interesting case of rare presentation of FMD causing bowel ischaemia with a prolonged
diagnostic odyssey due to the atypical disease. The paper would benefit from review from a native English
speaker or use of an academic editor service as there are a number of areas which would benefit from
clarity of expression and improvement in sentence structure and phraseology. The title purports the case to
be about multiple enterectomies (i.e. surgical small bowel resections) although only one small bowel
resection was undertaken so this title needs to be modified to reflect multiple bowel resections. 
The
abstract is quite long and would benefit from shortening to minimise duplication. The CT figures 1 and 2
should be annotated. There is an excessive number of figures, some of which really do not add to the case
report e.g. Figures 11-12 showing normal mucosa. The number of figures should be reduced to 3 - 4
figures. Some specific comments:
Page 1 Line 18 and Page 3 Line 54 - symptoms of the disease is unclear - is this all FMD or just
mesenteric FMD?
Page 3 lines 52 to 60 - need to reference clinical symptoms and enterectomies
Page 4 - the patient gave a history of mesenteric angina with post prandial pain - what investigations were
undertaken at the time of the initial presentation?
Page 4 Line 70 - what is an electronic colonoscopy? Is this a capsule endoscopy?
Page 4 Line 73 - size of spleen on USS only should be stated
Page 4 line 76 - the effect was poor - do they mean there was no or just limited clinical benefit?
Page 4 Line 81 - a palpable spleen would always suggest enlargement
Page 4 Line 81 - What were the values of HB, white cell counts and thrombocytopenia?
Page 4 Line 82-83 - normal reference ranges need to be added
Page 4 Line 84 - what is a "stimulation enhanced" CT - is this just contrast enhanced?
Page 5 Line 85 - "strengthened" is an incorrect term here
Page 5 Line 92 - the report suggests that she is steroid responsive - given this is a non-inflammatory
condition what is the presumed mechanism here?
Page 5 Line 100 - What type of FMD was the histology reported as?
Page 6 Line 107 - what was the indication for splenectomy?
Page 6 Line 117 - Medial type not medial involvement
Page 6 Line 118 - there is no endometrial type - do you mean intimal?
Page 6 Line 119 - of should be by
Page 6 Line 124 - define 'fairly rare'
Page 7 Line 134 - distributed mainly in intestinal wall. This sentence in contradicted by the previous
sentence stating that further vessel assessment wasn't undertaken. Was there any assessment made by
Doppler US or CT angio of renal or carotid vessels?
Page 6 Line 120 - "Vascular changes…" 
Is this for all types or only the last type mentioned?
Page 
7 Line 137 - It is important to emphasise on what basis this case was felt not to be due to the
mesenteric arteriovenous dysplasia mentioned (e.g. lack of venous involvement, histological features etc.)
Publons Reviewer Recognition
. Springer Nature can send verification of this review directly to Publons
(a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on
the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted to Publons after the final
decision on the manuscript has been made. If you have already registered at Publons, they will notify you
of the receipt of this review and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to register in order for them to
be able to recognize your review on your new profile page. Publons may use the Review Data to generate
derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity
of such information. For example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help editors to identify candidate
reviewers. Please find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
No
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of this manuscript,
either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an organization that holds or has
applied for patents relating to the content of the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below. If your
reply is yes to any, please give details below.
I declare that I have no competing interests
Reviewer Publication Consent.
 I agree for my report to be made available under an Open Access
Creative Commons CC-BY License (
 http://creativecommons.org/licenses/by/4.0
) if this manuscript is
accepted for publication. Any comments that I do not wish to be included in the published report have
been included as confidential comments to the editor, which will not be published.
If you are not happy for us to publish this report, please contact the editorial office before completing
the review.
If you wish, you can include your name in your published report. Please note you must decide whether
to include your name at the start of the process and confirm this decision whenever prompted. If you
change your decision later, we will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name with my report. (default)
Is the study design appropriate to answer the research question (including the use of appropriate controls),
and are the conclusions supported by the evidence presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free from apparent
manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
Fibromuscular dysplasia of mesenteric arteries – a rare cause of multiple bowel resections: A case
report and literature review
Version: 
0 
Date: 
29 Dec 2020
Reviewer's report:
The paper is an interesting case of rare presentation of FMD causing bowel ischaemia with a prolonged
diagnostic odyssey due to the atypical disease. The paper would benefit from review from a native English
speaker or use of an academic editor service as there are a number of areas which would benefit from
clarity of expression and improvement in sentence structure and phraseology. The title purports the case to
be about multiple enterectomies (i.e. surgical small bowel resections) although only one small bowel
resection was undertaken so this title needs to be modified to reflect multiple bowel resections. 
The
abstract is quite long and would benefit from shortening to minimise duplication. The CT figures 1 and 2
should be annotated. There is an excessive number of figures, some of which really do not add to the case
report e.g. Figures 11-12 showing normal mucosa. The number of figures should be reduced to 3 - 4
figures. Some specific comments:
Page 1 Line 18 and Page 3 Line 54 - symptoms of the disease is unclear - is this all FMD or just
mesenteric FMD?
Page 3 lines 52 to 60 - need to reference clinical symptoms and enterectomies
Page 4 - the patient gave a history of mesenteric angina with post prandial pain - what investigations were
undertaken at the time of the initial presentation?
Page 4 Line 70 - what is an electronic colonoscopy? Is this a capsule endoscopy?
Page 4 Line 73 - size of spleen on USS only should be stated
Page 4 line 76 - the effect was poor - do they mean there was no or just limited clinical benefit?
Page 4 Line 81 - a palpable spleen would always suggest enlargement
Page 4 Line 81 - What were the values of HB, white cell counts and thrombocytopenia?
Page 4 Line 82-83 - normal reference ranges need to be added
Page 4 Line 84 - what is a "stimulation enhanced" CT - is this just contrast enhanced?
Page 5 Line 85 - "strengthened" is an incorrect term here
Page 5 Line 92 - the report suggests that she is steroid responsive - given this is a non-inflammatory
condition what is the presumed mechanism here?
Page 5 Line 100 - What type of FMD was the histology reported as?
Page 6 Line 107 - what was the indication for splenectomy?
Page 6 Line 117 - Medial type not medial involvement
Page 6 Line 118 - there is no endometrial type - do you mean intimal?
Page 6 Line 119 - of should be by
Page 6 Line 124 - define 'fairly rare'
Page 7 Line 134 - distributed mainly in intestinal wall. This sentence in contradicted by the previous
sentence stating that further vessel assessment wasn't undertaken. Was there any assessment made by
Doppler US or CT angio of renal or carotid vessels?
Page 6 Line 120 - "Vascular changes…" 
Is this for all types or only the last type mentioned?
Page 
7 Line 137 - It is important to emphasise on what basis this case was felt not to be due to the
mesenteric arteriovenous dysplasia mentioned (e.g. lack of venous involvement, histological features etc.)
Publons Reviewer Recognition
. Springer Nature can send verification of this review directly to Publons
(a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on
the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted to Publons after the final
decision on the manuscript has been made. If you have already registered at Publons, they will notify you
of the receipt of this review and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to register in order for them to
be able to recognize your review on your new profile page. Publons may use the Review Data to generate
derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity
of such information. For example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help editors to identify candidate
reviewers. Please find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
No
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of this manuscript,
either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an organization that holds or has
applied for patents relating to the content of the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below. If your
reply is yes to any, please give details below.
I declare that I have no competing interests
Reviewer Publication Consent.
 I agree for my report to be made available under an Open Access
Creative Commons CC-BY License (
 http://creativecommons.org/licenses/by/4.0
) if this manuscript is
accepted for publication. Any comments that I do not wish to be included in the published report have
been included as confidential comments to the editor, which will not be published.
If you are not happy for us to publish this report, please contact the editorial office before completing
the review.
If you wish, you can include your name in your published report. Please note you must decide whether
to include your name at the start of the process and confirm this decision whenever prompted. If you
change your decision later, we will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name with my report. (default)
Is the study design appropriate to answer the research question (including the use of appropriate controls),
and are the conclusions supported by the evidence presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free from apparent
manipulation?
Yes
assistant