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Portal vein thrombosis associated with ischemic colitis. Clin J Gastroenterol 2011; 4:147-150. [DOI: 10.1007/s12328-011-0214-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 02/07/2011] [Indexed: 10/18/2022]
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da Motta Leal Filho JM, Santos ACB, Carnevale FC, de Oliveira Sousa W, Grillo LSP, Cerri GG. Infusion of recombinant human tissue plasminogen activator through the superior mesenteric artery in the treatment of acute mesenteric venous thrombosis. Ann Vasc Surg 2011; 25:840.e1-4. [PMID: 21620665 DOI: 10.1016/j.avsg.2010.12.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 10/08/2010] [Accepted: 12/24/2010] [Indexed: 10/18/2022]
Abstract
Acute mesenteric venous thrombosis is an uncommon condition that is usually treated with systemic anticoagulation. Catheter-directed thrombolysis through the superior mesenteric artery may be a viable adjunct to treat this morbid condition. In the present article, we have described a case of superior mesenteric venous thrombosis treated with catheter-directed infusion of tissue plasminogen activator through the superior mesenteric artery.
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De Santis A, Moscatelli R, Catalano C, Iannetti A, Gigliotti F, Cristofari F, Trapani S, Attili AF. Systemic thrombolysis of portal vein thrombosis in cirrhotic patients: a pilot study. Dig Liver Dis 2010; 42:451-5. [PMID: 19819770 DOI: 10.1016/j.dld.2009.08.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 08/08/2009] [Accepted: 08/30/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND Portal vein thrombosis is a frequent complication in liver cirrhosis. Encouraging reports of systemic thrombolysis in non-cirrhotic patients suffering from acute portal vein thrombosis led us to start a pilot study on the efficacy and safety of systemic low dose recombinant tissue plasminogen activator (Actilyse, Boheringer Ingelheim, Florence, Italy). PATIENTS Nine cirrhotic patients (6 males and 3 females) with recent portal vein thrombosis were enrolled. Exclusion criteria were portal cavernomatosis, recent (30 days) surgery, active bleeding, hepatocellular carcinoma and cancer in other sites. METHODS All cases were treated for a maximum of 7 days by continuous i.v. infusion of 0.25mg/kg/die of r-tPA plus subcutaneous low molecular weight heparin. Efficacy was evaluated by colour doppler sonography monitoring and confirmed by contrast enhanced computerized tomography. RESULTS The combined r-tPA/LMWH treatment was well tolerated without clinically significant side effects. Complete resolution of thrombosis occurred in 4 cases, partial regression in 4 and none in 1. Retreatment of a complete recurrence in 1 patient was successful. Variceal pressure dropped from 30.7+/-4.5 mmHg to 21.2+/-6.6 mmHg (p=0.012). CONCLUSIONS Our preliminary data demonstrate that thrombolytic treatment of recent portal vein thrombosis with i.v. r-tPA and LMWH in patients with cirrhosis appears to be safe and effective and can significantly reduce pressure in oesophageal varices.
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Affiliation(s)
- Adriano De Santis
- GI Unit, Department of Clinical Medicine, University of Rome La Sapienza, Rome, Italy.
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Nakai M, Sato M, Sahara S, Kawai N, Kimura M, Maeda Y, Ibata Y, Higashi K. Transhepatic catheter-directed thrombolysis for portal vein thrombosis after partial splenic embolization in combination with balloon-occluded retrograde transvenous obliteration of splenorenal shunt. World J Gastroenterol 2006; 12:5071-4. [PMID: 16937510 PMCID: PMC4087417 DOI: 10.3748/wjg.v12.i31.5071] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 66-year-old woman underwent partial splenic embolization (PSE) for hypersplenism with idiopathic portal hypertension (IPH). One week later, contrast-enhanced CT revealed extensive portal vein thrombosis (PVT) and dilated portosystemic shunts. The PVT was not dissolved by the intravenous administration of urokinase. The right portal vein was canulated via the percutaneous transhepatic route under ultrasonic guidance and a 4 Fr. straight catheter was advanced into the portal vein through the thrombus. Transhepatic catheter-directed thrombolysis was performed to dissolve the PVT and a splenorenal shunt was concurrently occluded to increase portal blood flow, using balloon-occluded retrograde transvenous obliteration (BRTO) technique. Subsequent contrast-enhanced CT showed good patency of the portal vein and thrombosed splenorenal shunt. Transhepatic catheter-directed thrombolysis combined with BRTO is feasible and effective for PVT with portosystemic shunts.
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Affiliation(s)
- Motoki Nakai
- Department of Radiology, Hidaka General Hospital, Gobo Shi, Wakayama 644-8655, Japan.
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Romano F, Caprotti R, Scaini A, Conti M, Scotti M, Colombo G, Uggeri F. Elective Laparoscopic Splenectomy and Thrombosis of the Spleno-portal Axis. Surg Laparosc Endosc Percutan Tech 2006; 16:4-7. [PMID: 16552370 DOI: 10.1097/01.sle.0000202187.80407.09] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Thrombosis of the portal system is a potentially life-threatening but otherwise underappreciated complication after splenectomy. Nonspecific and mild onset symptoms are the cause of delay in diagnosis, and the short hospital stay after laparoscopic approach could even contribute to the difficulty of early detection of this condition. The aim of this study was to verify if planned imaging controls are able to discover this complication leading to a prompt treatment. Thirty-eight patients (19 males and 19 females with a mean age of 24 years) who underwent laparoscopic splenectomy at our institution were studied to identify clinical signs of thrombosis of the portal venous system and eventually associated factors. All the patients were enrolled in a protocol of imaging surveillance using a doppler ultrasound method. Postoperative thrombosis of the spleno-portal axis occurred in 7 patients (18.9%) of the series. In 3 cases (8.1%) the thrombus extended from the splenic vein to occlude the portal axis. The complication was symptomatic in 4 cases (10.8%), whereas in 3 cases, the thrombosis was an ultrasonographic surprise in totally asymptomatic patients. Thrombosis occurred even as late as 2 months after splenectomy. Splenomegaly was the only significant factor predictive of thrombosis. Only those patients who had an early detection of portal or splenic vein thrombosis had a recanalization of the veins with anticoagulant therapy. Patients with splenomegaly who underwent laparoscopic splenectomy are at risk of thrombosis of the portal system and should undergo strict imaging surveillance and aggressive anticoagulation therapy.
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Affiliation(s)
- Fabrizio Romano
- Department of Surgery, San Gerardo Hospital, II University of Milan-Bicocca, Monza, Italy.
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Espeel B, Gérard C, Mansvelt B, Bertrand C, Vermonden J. [Extensive mesenteric venous thrombosis treatment by regional thrombolysis]. ACTA ACUST UNITED AC 2005; 24:274-7. [PMID: 15792561 DOI: 10.1016/j.annfar.2004.12.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2004] [Accepted: 12/13/2004] [Indexed: 12/11/2022]
Abstract
Two cases of mesenteric venous thrombosis with portal extension are reported. The first patient was treated right away by local intra-arterial thrombolysis, the second one benefited from local venous thrombolysis immediately after intestinal resection. No significant complication was observed.
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Affiliation(s)
- B Espeel
- Service de réanimation polyvalente, centre hospitalier Jolimont-Lobbes, hôpital de Jolimont, 159, rue Ferrer, 7100 Haine-Saint-Paul, Belgique.
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Vannelli A, Fiore F, Del Conte C, Rivolta U, Corsi C. Pylethrombosis Associated with Gastric Cancer in Moschcowitz's Disease: Successful Management with Anticoagulant. Report of a Case. TUMORI JOURNAL 2004; 90:259-61. [PMID: 15237595 DOI: 10.1177/030089160409000220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Portal vein thrombosis secondary to gastric cancer has been rarely reported. The main difficulty is represented by the correct differential diagnosis between benign and malignant thrombus and therefore by its treatment. In this report we describe a 62-year-old woman with Moschcowitz's disease who developed pylethrombosis and gastric cancer. Preoperative examination confirmed the relationship between the portal vein thrombosis and Moschcowitz's disease. She underwent an aggressive surgical procedure for the gastric cancer and conservative treatment of the thrombosis with subcutaneus administration of 8000 IU/day of low molecular weight heparin (LMWH) at the time of diagnosis, interrupted eight hours before surgery and resumed eight hours after with 4000 IU/day. At discharge LMWH treatment was replaced with oral sodium warfarin home treatment to keep the international normalized ratio range between 2 and 3. Regression of the thrombosis with low molecular weight heparin was confirmed by computed tomography. The patient survived more than two years. We believe that patients with gastric cancer complicated by benign partial portal vein thrombosis could gain particular benefit from adjuvant anticoagulant treatment, so that the surgical approach can be limited to gastric cancer.
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Henao EA, Bohannon WT, Silva MB. Treatment of portal venous thrombosis with selective superior mesenteric artery infusion of recombinant tissue plasminogen activator. J Vasc Surg 2004; 38:1411-5. [PMID: 14681650 DOI: 10.1016/s0741-5214(03)01052-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Portal and mesenteric venous thrombosis is an uncommon condition that is usually treated with systemic anticoagulation. Catheter-directed thrombolysis via the superior mesenteric artery may be a viable adjunct to treatment of this potentially morbid condition. We present a case of portal and mesenteric venous thrombosis treated with systemic anticoagulation and catheter-directed infusion of tissue plasminogen activator via the superior mesenteric artery.
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Affiliation(s)
- E A Henao
- Division of Vascular Surgery, Texas Tech University Health Sciences Center, 3601 4th Street, Lubbock, TX 79430-8312, USA
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Brink JS, Brown AK, Palmer BA, Moir C, Rodeberg DR. Portal vein thrombosis after laparoscopy-assisted splenectomy and cholecystectomy. J Pediatr Surg 2003; 38:644-7. [PMID: 12677588 DOI: 10.1053/jpsu.2003.50144] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A 12-year-old girl underwent laparoscopy-assisted splenectomy and cholecystectomy with removal of her spleen through a small Pfannenstiel incision. She had an unremarkable postoperative course but returned 16 days later because of increasing right-sided abdominal pain. The pain was constant, sharp, and stabbing without radiation. Abdominal examination showed diffuse right upper quadrant and epigastric tenderness without peritoneal irritation. Laboratory test results included white blood cell count, 14.4 x 10(9)/mm3; hemoglobin, 8.5 g/dL; platelets, 1,483,000; and normal values for lipase, amylase, aspartate transaminase, and alanine transaminase. Evaluation with ultrasonography and vessel Doppler studies showed an occlusive thrombus throughout the portal and splenic veins. The patient underwent intravenous heparin anticoagulation therapy. Her symptoms resolved completely over the next 2 days. The patient is currently receiving warfarin and anagrelide as an outpatient (international normalized ratio, 2). There were no long-term complications caused by portal vein thrombosis. This is the first reported case of portal vein thrombosis after laparoscopic splenectomy in the pediatric population.
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Affiliation(s)
- Jeromy S Brink
- Division of Pediatric Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA
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Franciosi C, Romano F, Caprotti R, Giardino A, Piacentini G, Visintini G, Uggeri F. Splenoportal thrombosis as a complication after laparoscopic splenectomy. J Laparoendosc Adv Surg Tech A 2003; 12:273-6. [PMID: 12269496 DOI: 10.1089/109264202760268069] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Laparoscopic splenectomy is performed with increasing acceptance for hematologic disorders, with low complication rates reported. Splenoportal thrombosis following splenectomy is a rare complication, anecdotally reported after laparoscopic procedures. We here describe a case of thrombosis of the spleno-mesenteric-portal axis 14 days after a laparoscopic splenectomy using Ligasure. Abdominal ultrasound scans and Doppler examination allowed us to diagnose this event, and an angio-MR scan performed afterward confirmed the diagnosis. Heparin therapy was promptly begun. The patient was then switched to oral anticoagulant therapy, with resolution of the clinical features. The patient was discharged after 1 week of anticoagulant therapy with a stable Doppler ultrasound pattern. Early diagnosis and prompt initiation of anticoagulant therapy associated with careful surgical technique may reduce the risk of this life-threatening complication.
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Affiliation(s)
- Claudio Franciosi
- Department of General Surgery, San Gerardo Hospital, II University of Milan-Bicocca, Milan, Italy
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Condat B, Pessione F, Helene Denninger M, Hillaire S, Valla D. Recent portal or mesenteric venous thrombosis: increased recognition and frequent recanalization on anticoagulant therapy. Hepatology 2000; 32:466-70. [PMID: 10960436 DOI: 10.1053/jhep.2000.16597] [Citation(s) in RCA: 360] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Characteristics and outcomes of recent portal or mesenteric venous thrombosis are ill-known. We intended to compare these features with those of patients with portal cavernoma, and also to assess the incidence of recanalization of recent thrombosis on anticoagulation therapy. All patients seen between 1983 and 1999 were enrolled into this retrospective study if recent portal or mesenteric venous thrombosis or portal cavernoma had been documented, and if cancer of the liver, pancreas, or bile duct, intrahepatic block including cirrhosis, and obstruction of the hepatic veins had been ruled out. The proportion of recent thrombosis was 7% in patients seen before 1990 and 56% after 1994 (P <.05). Patients with recent thrombosis (n = 33) or cavernoma (n = 108) did not differ with regard to age, sex ratio, or prevalence of prothrombotic states and of previous thrombotic events. In patients with recent thrombosis, septic pylephlebitis was more common and the incidence of gastrointestinal bleeding was lower (2.4 vs. 12.7/100 patient-years). Recanalization occurred in 25 of 27 patients given anticoagulation and 0 of 2 patients not given anticoagulation. The probability of recanalization was related to the extent of thrombosis (P =.003). In conclusion, mesenteric or portal venous thrombosis is increasingly recognized at an early stage. The features differentiating recent thrombosis and cavernoma are related to silent onset precluding early recognition and therapy in the latter. Frequent association with prothrombotic states and frequent recanalization on anticoagulation support the recommendation of early anticoagulation therapy in all patients with recent portal vein thrombosis.
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Affiliation(s)
- B Condat
- Service d'hépatologie et INSERM U481, Fédération médico-chirurgicale d'hépato-gastroentérologie, Assistance Publique-Hôpitaux de Paris, France
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Abstract
Splenectomy was one of the most common operations in abdominal surgery. During the past decade, an increased rate of late complications, especially septic and thromboembolic complications occurring after splenectomy, have been reported. The septic complications are well documented. The risk is related to the indication of splenectomy, and is less than 1% in adults without immunodeficiency. However, these overwhelming postsplenectomy infections are associated with a high mortality rate, about 50%. The best treatment of these infections is preventive measures which are based on vaccination and education of asplenic patients. The thromboembolic complications are rare, little studied, and specific preventive procedures have not been implemented.
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Affiliation(s)
- S Benoist
- Service de chirurgie viscérale et digestive, Hôpital Lariboisière, Paris, France
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Guckelberger O, Bechstein W, Langrehr JM, Kratschmer B, Settmacher U, Neuhaus R, Neuhaus P, Loeffel J, Haenninen EL, Venz S, Vogl T. Successful recanalization of late portal vein thrombosis after liver transplantation using systemic low-dose recombinant tissue plasminogen activator. Transpl Int 1999. [DOI: 10.1111/j.1432-2277.1999.tb01213.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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