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Vidal-Cañas S, Zuñiga-Jaramillo C, Artunduaga-Cañas E, Pérez-Garay V, Liscano Y. Mesenteric Ischemia in a Splenectomized Patient with Auto-Immune Hemolytic Anemia: Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1325. [PMID: 37512136 PMCID: PMC10385668 DOI: 10.3390/medicina59071325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/02/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023]
Abstract
Mesenteric ischemia is a serious complication that can occur after splenectomy for hemolytic anemia, potentially leading to lifelong intestinal problems such as ischemia and/or portal hypertension. We present the case of a 33-year-old man with a history of autoimmune hemolytic anemia and splenectomy who developed mesenteric ischemia. The patient experienced abdominal pain and diarrhea, and imaging studies revealed mesenteric vein thrombosis. Surgical intervention confirmed the diagnosis. This case significantly contributes to the existing literature by providing insights into the occurrence of mesenteric ischemia in younger individuals with predisposing factors, as well as its clinical presentation, diagnostic challenges, and severity. Moreover, it has implications for the future diagnosis and management of long-term mesenteric ischemia in patients who have undergone splenectomy for hemolytic anemia.
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Affiliation(s)
- Sinthia Vidal-Cañas
- Grupo de Investigación en Salud Integral (GISI), Departamento Facultad de Salud, Universidad Santiago de Cali, Cali 5183000, Colombia
| | - Cristian Zuñiga-Jaramillo
- Grupo de Investigación en Salud Integral (GISI), Departamento Facultad de Salud, Universidad Santiago de Cali, Cali 5183000, Colombia
| | - Esteban Artunduaga-Cañas
- Grupo de Investigación en Salud Integral (GISI), Departamento Facultad de Salud, Universidad Santiago de Cali, Cali 5183000, Colombia
| | - Valentina Pérez-Garay
- Grupo de Investigación en Salud Integral (GISI), Departamento Facultad de Salud, Universidad Santiago de Cali, Cali 5183000, Colombia
| | - Yamil Liscano
- Grupo de Investigación en Salud Integral (GISI), Departamento Facultad de Salud, Universidad Santiago de Cali, Cali 5183000, Colombia
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2
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Sapkota S, Shrestha S, Sharma S, Sapkota S, Solis LA, Kalla A. Fusobacterium bacteremia presenting with inferior mesenteric vein thrombosis. Clin Case Rep 2023; 11:e7617. [PMID: 37397578 PMCID: PMC10310899 DOI: 10.1002/ccr3.7617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 07/04/2023] Open
Abstract
Isolated mesenteric vein thrombosis associated with Fusobacterium is rare. Physicians should be aware regarding the association of Fusobacterium with thrombosis at various sites.
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Affiliation(s)
| | - Suraj Shrestha
- Maharajgunj Medical CampusInstitute of MedicineKathmanduNepal
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3
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Demelo-Rodríguez P, Ordieres-Ortega L, Oblitas CM. Mesenteric venous thrombosis. Med Clin (Barc) 2023; 160:400-406. [PMID: 36849315 DOI: 10.1016/j.medcli.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 02/27/2023]
Abstract
Mesenteric vein thrombosis (MVT) is a rare condition that can present acutely, subacutely, or chronically. MVT can be isolated or within a splanchnic thrombosis (spleno-porto-mesenteric). Symptomatic cases usually present as nonspecific abdominal pain, with or without signs of intestinal ischemia, and the diagnosis is usually made by imaging test (abdominal CT or MRI) in patients with high clinical suspicion. An early clinical-surgical approach is recommended to screen those patients with warning signs and who benefit from an exploratory laparotomy in addition to anticoagulant treatment, which is the cornerstone of medical treatment. MVT is usually associated with prothrombotic states, with hematological disorders (myeloproliferative syndromes and/or JAK2 gene mutations) being of special clinical relevance. On the other hand, the 5-year survival rate is 70-82% and early overall 30-day mortality from MVT can reach 20-32%.
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Affiliation(s)
- Pablo Demelo-Rodríguez
- Unidad de Enfermedad Tromboembólica Venosa, Departamento de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España; Facultad de Medicina, Universidad CEU San Pablo, Madrid, España.
| | - Lucía Ordieres-Ortega
- Unidad de Enfermedad Tromboembólica Venosa, Departamento de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Crhistian-Mario Oblitas
- Unidad de Enfermedad Tromboembólica Venosa, Departamento de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
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4
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Dunn R, Sahni N. 62-Year-Old Man With Abdominal Pain. Mayo Clin Proc 2023; 98:337-341. [PMID: 36737122 DOI: 10.1016/j.mayocp.2022.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Ryan Dunn
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Phoenix, AZ
| | - Nishant Sahni
- Advisor to resident and Consultant in Hospital Internal Medicine, Mayo Clinic, Phoenix, AZ.
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5
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Zhao JW, Cui XH, Zhao WY, Wang L, Xing L, Jiang XY, Gong X, Yu L. Acute mesenteric ischemia secondary to oral contraceptive-induced portomesenteric and splenic vein thrombosis: A case report. World J Clin Cases 2022; 10:10629-10637. [PMID: 36312508 PMCID: PMC9602218 DOI: 10.12998/wjcc.v10.i29.10629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/21/2022] [Accepted: 08/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Mesenteric ischemia represents an uncommon complication of splanchnic vein thrombosis, and it is less infrequently seen in young women using oral contraceptives. Diagnosis is often delayed in the emergency room; thus, surgical intervention may be inevitable and the absence of thrombus regression or collateral circulation may lead to further postoperative ischemia and a fatal outcome.
CASE SUMMARY We report a 28-year-old female patient on oral contraceptives who presented with acute abdominal pain. Her physical examination findings were not consistent with her symptoms of severe pain and abdominal distention. These findings and her abnormal blood tests raised suspicion of acute mesenteric ischemia (AMI) induced by splanchnic vein thrombosis. Contrast-enhanced abdominal computed tomography revealed ischemia of the small intestine with portomesenteric and splenic vein thrombosis (PMSVT). We treated the case promptly by anticoagulation after diagnosis. We then performed delayed segmental bowel resection after thrombus regression and established collateral circulation guided by collaboration with a multidisciplinary team. The patient had an uneventful postoperative course and was discharged 14 d after surgery and took rivaroxaban orally for 6 mo. In subsequent follow-up to date, the patient has not complained of any other discomfort.
CONCLUSION AMI induced by PMSVT should be considered in young women who are taking oral contraceptives and have acute abdominal pain. Prompt anticoagulation followed by surgery is an effective treatment strategy.
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Affiliation(s)
- Jin-Wei Zhao
- Department of Hepatopancreatobiliary Surgery of Second Hospital of Jilin University, State Key Laboratory for Zoonotic Diseases, Key Laboratory for Zoonosis Research of The Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun 130000, Jilin Province, China
| | - Xin-Hua Cui
- Department of Hepatopancreatobiliary Surgery of Second Hospital of Jilin University, State Key Laboratory for Zoonotic Diseases, Key Laboratory for Zoonosis Research of The Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun 130000, Jilin Province, China
| | - Wei-Yi Zhao
- Department of Hepatopancreatobiliary Surgery of Second Hospital of Jilin University, State Key Laboratory for Zoonotic Diseases, Key Laboratory for Zoonosis Research of The Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun 130000, Jilin Province, China
- Medical College of Yanbian University, Yanbian 133002, Jilin Province, China
| | - Lei Wang
- Department of Imaging Surgery of Second Hospital of Jilin University, Jilin University, Changchun 130000, Jilin Province, China
| | - Lin Xing
- Department of Hepatopancreatobiliary Surgery of Second Hospital of Jilin University, State Key Laboratory for Zoonotic Diseases, Key Laboratory for Zoonosis Research of The Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun 130000, Jilin Province, China
| | - Xue-Yuan Jiang
- Department of Hepatopancreatobiliary Surgery of Second Hospital of Jilin University, State Key Laboratory for Zoonotic Diseases, Key Laboratory for Zoonosis Research of The Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun 130000, Jilin Province, China
| | - Xue Gong
- Department of Imaging Surgery of Second Hospital of Jilin University, Jilin University, Changchun 130000, Jilin Province, China
| | - Lu Yu
- Department of Hepatopancreatobiliary Surgery of Second Hospital of Jilin University, State Key Laboratory for Zoonotic Diseases, Key Laboratory for Zoonosis Research of The Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun 130000, Jilin Province, China
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6
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Muacevic A, Adler JR. Acute Mesenteric Ischemia Secondary to Superior Mesenteric Vein Thrombosis. Cureus 2022; 14:e30819. [PMID: 36451637 PMCID: PMC9703029 DOI: 10.7759/cureus.30819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2022] [Indexed: 01/25/2023] Open
Abstract
The thrombosis of the superior mesenteric vein (SMV) can result in ischemia of the intestine. A 71-year-old male presented with pain in the abdomen and a black tarry stool. The findings from computed tomography (CT) with the contrast of the abdomen suggest the thrombosis of the SMV. Heparin was administered, followed by thrombectomy and stenting of the SMV. The patient reported no complications and was shifted from heparin to apixaban and then discharged after a five-day hospital stay.
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7
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Medina-Perez R, Campbell DJ, Acosta Rullan JM, Gonzalez S. Partial Thrombosis of Inferior Mesenteric Vein With Thrombophlebitis. Cureus 2021; 13:e16900. [PMID: 34513473 PMCID: PMC8412061 DOI: 10.7759/cureus.16900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 11/27/2022] Open
Abstract
Inferior mesenteric vein thrombosis (IMVT) is a rare entity that can lead to a potentially lethal event unless recognized early in the disease. Although its prevalence is low, IMVT presents mainly in certain conditions such as in inflammatory processes like diverticulitis, arrhythmias, hypercoagulable states, connective tissue disorders, malignancy, or hereditary thrombophilias. Mesenteric venous thrombophlebitis is a condition in which a blood clot in a vein causes inflammation and pain. It can appear in an acute or subacute manner that leads to acute mesenteric ischemia. The case of a 58-year-old male without a significant past medical history who presented with suprapubic abdominal pain secondary to a partial IMVT of unknown etiology with accompanying thrombophlebitis is discussed here.
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Affiliation(s)
| | - Daniel J Campbell
- Internal Medicine, Aventura Hospital and Medical Center, Aventura, USA
| | | | - Sheyla Gonzalez
- Internal Medicine, Aventura Hospital and Medical Center, Miami, USA
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8
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Elnaggar M, Jandu JS, Beutler BD, Leong S, McCain R. Superior Mesenteric Vein Thrombosis in the Setting of Ileitis: Case Report and Literature Review. Cureus 2020; 12:e11107. [PMID: 33240703 PMCID: PMC7682540 DOI: 10.7759/cureus.11107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Acute mesenteric vein thrombosis represents a rare but potentially lethal thrombotic event. Its treatment involves prompt and aggressive anticoagulation therapy. In the perioperative setting, management of the underlying thrombus must be weighed carefully against the risk of bleeding. We describe a 57-year-old man who presented with abdominal pain and was found to have terminal ileitis with concomitant superior mesenteric vein thrombosis.
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9
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A systematic review of the management of acute superior mesenteric vein thrombosis in adults. JOURNAL OF PANCREATOLOGY 2020. [DOI: 10.1097/jp9.0000000000000051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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10
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Jiang M, Li CL, Pan CQ, Lv WZ, Ren YF, Cui XW, Dietrich CF. Nomogram for predicting transmural bowel infarction in patients with acute superior mesenteric venous thrombosis. World J Gastroenterol 2020; 26:3800-3813. [PMID: 32774059 PMCID: PMC7383843 DOI: 10.3748/wjg.v26.i26.3800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/23/2020] [Accepted: 06/04/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The prognosis of acute mesenteric ischemia (AMI) caused by superior mesenteric venous thrombosis (SMVT) remains undetermined and early detection of transmural bowel infarction (TBI) is crucial. The predisposition to develop TBI is of clinical concern, which can lead to fatal sepsis with hemodynamic instability and multi-organ failure. Early resection of necrotic bowel could improve the prognosis of AMI, however, accurate prediction of TBI remains a challenge for clinicians. When determining the eligibility for explorative laparotomy, the underlying risk factors for bowel infarction should be fully evaluated.
AIM To develop and externally validate a nomogram for prediction of TBI in patients with acute SMVT.
METHODS Consecutive data from 207 acute SMVT patients at the Wuhan Tongji Hospital and 89 patients at the Guangzhou Nanfang Hospital between July 2005 and December 2018 were included in this study. They were grouped as training and external validation cohort. The 207 cases (training cohort) from Tongji Hospital were divided into TBI and reversible intestinal ischemia groups based on the final therapeutic outcomes. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for TBI using the training data, and a nomogram was subsequently developed. The performance of the nomogram was evaluated with respect to discrimination, calibration, and clinical usefulness in the training and external validation cohort.
RESULTS Univariate and multivariate logistic regression analyses identified the following independent prognostic factors associated with TBI in the training cohort: The decreased bowel wall enhancement (OR = 6.37, P < 0.001), rebound tenderness (OR = 7.14, P < 0.001), serum lactate levels > 2 mmol/L (OR = 3.14, P = 0.009) and previous history of deep venous thrombosis (OR = 6.37, P < 0.001). Incorporating these four factors, the nomogram achieved good calibration in the training set [area under the receiver operator characteristic curve (AUC) 0.860; 95%CI: 0.771-0.925] and the external validation set (AUC 0.851; 95%CI: 0.796-0.897). The positive and negative predictive values (95%CIs) of the nomogram were calculated, resulting in positive predictive values of 54.55% (40.07%-68.29%) and 53.85% (43.66%-63.72%) and negative predictive values of 93.33% (82.14%-97.71%) and 92.24% (85.91%-95.86%) for the training and validation cohorts, respectively. Based on the nomogram, patients who had a Nomo-score of more than 90 were considered to have high risk for TBI. Decision curve analysis indicated that the nomogram was clinically useful.
CONCLUSION The nomogram achieved an optimal prediction of TBI in patients with AMI. Using the model, the risk for an individual patient inclined to TBI can be assessed, thus providing a rational therapeutic choice.
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Affiliation(s)
- Meng Jiang
- Sino-German Tongji-Caritas Research Center of Ultrasound in Medicine, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Chang-Li Li
- Department of Geratology, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan 430015, Hubei Province, China
| | - Chun-Qiu Pan
- Department of Emergency Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Wen-Zhi Lv
- Department of Artificial Intelligence, Julei Technology Company, Wuhan 430030, Hubei Province, China
| | - Yu-Fei Ren
- Department of Computer Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Xin-Wu Cui
- Sino-German Tongji-Caritas Research Center of Ultrasound in Medicine, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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11
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Di Bella A, Bruscino A, Alemanno G, Bergamini C, Prosperi P. Open abdomen management for massive intestinal infarction due to acute splanchnic venous thrombosis in a patient with protein S deficiency. A case report. Int J Surg Case Rep 2020; 72:122-126. [PMID: 32534415 PMCID: PMC7298329 DOI: 10.1016/j.ijscr.2020.05.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Acute mesenteric ischemia (AMI) refers to the sudden onset of intestinal hypoperfusion that can also result from splanchnic venous occlusion. The portomesenteric venous system (PMVS) is an unusual site of thrombosis in patients with protein S deficiency and its obstruction is a rare cause of AMI. Aim of this report is to illustrate a successful strategy in a case of massive small bowel infarction managed with an open abdomen (OA) approach. CASE PRESENTATION A 64 year-old woman presented to the emergency department with acute abdominal pain, rectal bleeding, diarrhea and vomiting. Contrast-enhanced computed tomography (CECT) showed small bowel ischemia and the complete occlusion of all the PMVS branches. Surgery was performed with an OA approach and anticoagulation was immediately begun. Further workup revealed isolated protein S deficiency and history of atrophic gastritis. Thromboprophylaxis with warfarin was started on discharge and no recurrence of thrombotic events was recorded during the one-year follow-up. DISCUSSION PMVS thrombosis related to protein S deficiency is a rare condition that can rapidly lead to an acute abdomen. CECT is the gold standard, because it detects splanchnic thrombosis and its possible complications, like bowel ischemia. In case of surgery, a planned second-look operation is the best strategy to assess bowel viability and possible ischemic progression. CONCLUSIONS OA management plays a fundamental role in case of resection for bowel ischemia. Patients with thrombosis at an uncommon site should be further investigated for prothrombotic states.
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Affiliation(s)
- Annamaria Di Bella
- Emergency Surgery Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
| | - Alessandro Bruscino
- Emergency Surgery Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
| | - Giovanni Alemanno
- Emergency Surgery Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
| | - Carlo Bergamini
- Emergency Surgery Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
| | - Paolo Prosperi
- Emergency Surgery Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
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12
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Wong CS, Cho G, Godfrey EM, Harper S. Portal pyaemia secondary to colonic perforation. BMJ Case Rep 2019; 12:12/4/e228400. [PMID: 30992283 DOI: 10.1136/bcr-2018-228400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Portal pyaemia or pylephlebitis is a form of septic (often suppurative) thrombophlebitis of the portal venous system. It may develop as a complication of intra-abdominal sepsis, such as diverticulitis or appendicitis. Patients typically present with a high fever that is sometimes accompanied by jaundice. We report a case of portal pyaemia associated with multiple liver abscesses and discuss the medical and surgical management of this condition.
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Affiliation(s)
- Chee Siong Wong
- Department of Hepatopancreaticobiliary Surgery, Cambridge University Hospital, Cambridge, Cambridgeshire, UK
| | - Gyuseong Cho
- Department of Hepatopancreaticobiliary Surgery, Cambridge University Hospital, Cambridge, Cambridgeshire, UK
| | - Edmund M Godfrey
- Department of Radiology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - Simon Harper
- Department of Hepatopancreaticobiliary Surgery, Cambridge University Hospital, Cambridge, Cambridgeshire, UK
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13
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Cho JW, Choi JJ, Um E, Jung SM, Shin YC, Jung SW, Kim JI, Choi PW, Heo TG, Lee MS, Jun H. Clinical Manifestations of Superior Mesenteric Venous Thrombosis in the Era of Computed Tomography. Vasc Specialist Int 2019; 34:83-87. [PMID: 30671416 PMCID: PMC6340699 DOI: 10.5758/vsi.2018.34.4.83] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/09/2018] [Accepted: 09/11/2018] [Indexed: 12/15/2022] Open
Abstract
Purpose Thrombosis of the portal vein, known as pylephlebitis, is a rare and fatal complication caused by intraperitoneal infections. The disease progression of superior mesenteric venous thrombosis (SMVT) is not severe. This study aimed to determine the clinical features, etiology, and prognosis of SMVT. Materials and Methods We retrospectively reviewed the medical records of 41 patients with SMVT from March 2000 to February 2017. We obtained a list of 305 patients through the International Classification of Disease-9 code system and selected 41 patients with SMVT with computed tomography. Data from the medical records included patient demographics, comorbidities, review of system, laboratory results, clinical courses, and treatment modalities. Results The causes of SMVT were found to be intraperitoneal inflammation in 27 patients (65.9%), malignancy in 7 patients (17.1%), and unknown in 7 patients (17.1%). Among the patients with intraperitoneal inflammation, 14 presented with appendicitis (51.9%), 7 with diverticulitis (25.9%), and 2 with ileus (7.4%). When comparing patients with and without small bowel resection, the differences in symptom duration, bowel enhancement and blood culture were significant (P=0.010, P=0.039, and P=0.028, respectively). Conclusion SMVT, caused by intraperitoneal inflammation, unlike portal vein thrombosis including pylephlebitis, shows mild prognosis. In addition, rapid symptom progression and positive blood culture can be the prognostic factors related to extensive bowel resection. Use of appropriate antibiotics and understanding of disease progression can help improve the outcomes of patients with SMVT.
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Affiliation(s)
- Joon Whoi Cho
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | | | - Eunhae Um
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sung Min Jung
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Yong Chan Shin
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sung-Won Jung
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jae Il Kim
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Pyong Wha Choi
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Tae Gil Heo
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Myung Soo Lee
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Heungman Jun
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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14
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Mesenteric venous thrombosis presenting as gastrointestinal bleeding, a challenging diagnosis. Am J Emerg Med 2018; 37:378.e1-378.e6. [PMID: 30503276 DOI: 10.1016/j.ajem.2018.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/05/2018] [Indexed: 01/16/2023] Open
Abstract
Acute mesenteric venous thrombosis (MVT) is an uncommon cause of intestinal ischemia and is associated with high morbidity and mortality. Patients with acute MVT often present with gastrointestinal (GI) bleeding and other unspecific findings making the diagnosis challenging. This condition requires emergent treatment. The high rates of misdiagnosis of these patients and subsequently the delay in proper and quick management put patients at increased risk of having a negative outcome. Physicians should suspect acute MVT in patients with GI bleed while also considering other factors such as, a past medical history of pro-thrombotic conditions, past surgical history of splenectomy, symptoms of nausea, vomiting, abdominal pain, physical exam findings of abdominal tenderness and abdominal distention and a laboratory workup indicating leukocytosis and an increased plasma lactic acid level. An increase in the yield of accurate diagnosis of acute MVT is possible if physicians in the ED accurately interpret all these findings. The authors herein present a case of acute MVT in a patient whose initial complaint was GI bleeding and provide a thorough review of the literature of cases of acute MVT presenting with GI bleed.
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15
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Post-traumatic superior mesenteric venous thrombosis with subsequent extension to the portal vein. Radiol Case Rep 2018; 14:151-155. [PMID: 30405866 PMCID: PMC6218702 DOI: 10.1016/j.radcr.2018.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/13/2018] [Accepted: 10/13/2018] [Indexed: 02/07/2023] Open
Abstract
Acute superior mesenteric vein thrombosis was first described in 1935 by Warren and Eberhardt. It is a potentially life-threatening condition, as it can lead to bowel ischemia and, ultimately, infarction. Its etiology may be primary or secondary to acquired prothrombotic conditions. Early recognition of mesenteric venous thrombosis is important, but can be challenging due to its nonspecific clinical presentation. Contrast-enhanced computed tomography is currently the gold standard for diagnosis. Systemic anticoagulation and surgical resection of the necrotic segment are the two main treatments. Here, we describe a case of acute post-traumatic superior mesenteric vein thrombosis, which was treated with systemic anticoagulation and resection of the ischemic bowel segment, with subsequent extension of the thrombosis to the portal vein.
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Osti NP, Sah DN, Bhandari RS. Successful medical management of acute mesenteric ischemia due to superior mesenteric and portal vein thrombosis in a 27-year-old man with protein S deficiency: a case report. J Med Case Rep 2017; 11:315. [PMID: 29117862 PMCID: PMC5679506 DOI: 10.1186/s13256-017-1463-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 09/18/2017] [Indexed: 12/28/2022] Open
Abstract
Background Acute mesenteric ischemia poses a diagnostic challenge due to nonspecific clinical clues and lack of awareness owing to its rarity. Ischemia due to mesenteric venous thrombosis has a good prognosis compared to arterial cause and can be managed conservatively with early diagnosis. The portomesenteric venous system is an unusual site of thrombosis in patients with protein S deficiency, and its thrombosis is an uncommon cause of acute mesenteric ischemia. Case presentation We present a case of a 27-year-old Mongolian man who presented with acute abdominal pain increasing in severity, and refractory to repeated attempts at treatment with a misdiagnosis of acute peptic ulcer disease. Contrast-enhanced computed tomography of his abdomen detected complete occlusion of the superior mesenteric vein, an extension of acute thrombus into the portal vein, and ischemic mid-jejunal loops. Early diagnosis and immediate anticoagulation with continuous intravenous infusion of unfractionated heparin prevented subsequent consequences. On further workup, our patient was diagnosed with isolated protein S deficiency. We started lifelong thromboprophylaxis with warfarin to prevent recurrence and our patient was asymptomatic on the latest follow-up 5 months after discharge. Conclusion Despite accurate detection of acute mesenteric ischemia by contrast-enhanced computed tomography, high index of suspicion is indispensable for its early diagnosis. Early diagnosis and immediate anticoagulation will prevent subsequent complications and need for surgical intervention. Young patients without known risk factors presenting with venous thrombosis in atypical sites should be investigated for prothrombotic diseases.
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Affiliation(s)
- N P Osti
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
| | - D N Sah
- Department of GI Surgery, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - R S Bhandari
- Department of GI Surgery, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Lim KH, Jang J, Yoon HY, Park J. Acute superior mesenteric vein thrombosis associated with abdominal trauma: A rare case report and literature review. Medicine (Baltimore) 2017; 96:e8863. [PMID: 29382004 PMCID: PMC5709003 DOI: 10.1097/md.0000000000008863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Acute mesenteric vein thrombosis (MVT) is defined as new-onset thrombosis of the mesenteric vein without evidence of collateralization, finally resulting in extensive intestinal infarction. MVT may be idiopathic or be caused by conditions responsible for thrombophilia and acquired risk factors. To date, there have been few reports of MVT after trauma. Herein we describe our experiences treating three patients with MVT. PATIENT CONCERNS Case 1 was a 44-year-old man with transverse colon mesenteric hematoma after blunt abdominal trauma. Case 2 was a 55-year-old man with jejunal transection after a traffic accident. Case 3 was a 26-year-old man presented with multiple abdominal stab bowel injury. DIAGNOSES A 1-week follow-up abdominal computed tomography scan showed superior mesenteric vein thrombosis in all of three patients. INTERVENTIONS All patients were treated with anticoagulant for 3 or 6 months. OUTCOMES MVTs were completely resolved without any complications. LESSONS If early diagnosis and treatment could be available, anticoagulation alone might be adequate for the treatment of SMVT associated with trauma. Early anticoagulation in patients with acute SMVT may avoid the grave prognosis observed in patients with arterial thrombosis.
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Kim HK, Hwang D, Park S, Lee JM, Huh S. Treatment outcomes and risk factors for bowel infarction in patients with acute superior mesenteric venous thrombosis. J Vasc Surg Venous Lymphat Disord 2017; 5:638-646. [PMID: 28818214 DOI: 10.1016/j.jvsv.2017.04.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/10/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The prognosis of acute superior mesenteric venous thrombosis (SMVT) remains obscure. We aimed to investigate the treatment outcomes and possible risk factors for bowel infarction in these patients. METHODS We retrospectively included 66 patients with acute SMVT between January 2002 and June 2016. Each patient underwent contrast-enhanced computed tomography as part of the initial diagnosis. The standard protocol for management included a nonsurgical approach with early anticoagulation and selective exploration. For the analysis of the risk factors for bowel infarction, patients were divided into bowel resection (BR) and non-BR groups. Outcomes of interest were causes of SMVT, percentage of BR after nonsurgical treatment, and risk factors for BR. RESULTS Of 66 patients, 15 (23%) underwent BR; of these, 9 underwent urgent BR because of peritoneal signs and definite findings of bowel infarction on computed tomography scan, 4 underwent BR after failed anticoagulation, and 2 underwent BR because of delayed stricture. Clinically, vomiting (P = .003), abdominal distention (P = .003), rebound tenderness (P = .005), and leukocytosis (P = .001) were associated with BR. On radiologic examination, bowel wall thickening (P < .001), enhancement defects of the bowel wall (P < .001), and ascites (P = .007) were associated with BR. Twenty-seven (41%) patients presented with isolated SMVT, and the remaining patients demonstrated a coexisting portal vein (PV) thrombosis in addition to SMVT. All 15 BRs occurred in patients with combined PV thrombosis and SMVT (P < .001). Complete thrombosis of the superior mesenteric vein and PV was also associated with BR (P = .028 for superior mesenteric vein; P = .025 for PV). BR was performed in 1 (4%) of 24 patients with transient risk factors compared with 14 (33%) of 42 patients without transient risk factors (P = .006). Three patients (4.5%) died in the hospital. CONCLUSIONS In patients with acute SMVT, the extent of thrombus and etiology were associated with the severity of acute SMVT. Patients with transient risk factors and isolated SMVT tended to have a benign disease course. With early anticoagulation, acute SMVT does not seem to have the grave prognosis that is associated with arterial thrombosis.
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Affiliation(s)
- Hyung-Kee Kim
- Division of Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Deokbi Hwang
- Division of Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Sujin Park
- Division of Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Jong-Min Lee
- Department of Radiology, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Seung Huh
- Division of Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, South Korea.
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Zeng Q, Fu QN, Li FH, Wang XH, Liu H, Zhao Y. Early initiation of argatroban therapy in the management of acute superior mesenteric venous thrombosis. Exp Ther Med 2017; 13:1526-1534. [PMID: 28413504 DOI: 10.3892/etm.2017.4103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 11/21/2016] [Indexed: 12/18/2022] Open
Abstract
Acute superior mesenteric venous thrombosis (ASMVT) is an intractable disease with poor prognosis. Argatroban, a direct thrombin inhibitor, may be a novel anticoagulant method in the therapy of ASMVT. The aim of the present study was to assess the efficacy and safety of early argatroban therapy in ASMVT patients. The current retrospective study reviewed a consecutive series of ASMVT patients receiving early argatroban therapy during hospitalization between March 2013 and April 2014, with 18 ASMVT patients included in the study. Of these, 16 patients without hepatic dysfunction underwent anticoagulant therapy with argatroban with a mean dose of 1.57±0.34 µg/kg/min and a mean duration of 12.2±3.7 days, while their activated partial thromboplastin time (aPTT) was elevated to 1.95±0.26 times the baseline value. In addition, 2 hepatic dysfunction patients received therapy with a dose of 0.41 µg/kg/min and 0.46 µg/kg/min, and with aPTT of 1.68 and 1.62 times the baseline value, respectively. Overall, 94% (n=17) of the patients presented clinical improvement, while 88% (n=16) of patients presented partially or completely dissolved thrombus in contrast-enhanced computed tomography images. The incidence of surgery and bowel resection was 6% (excluding 1 case with intestinal necrosis detected on admission). Furthermore, 11% (n=2) of patients experienced a bleeding episode, however no major bleeding or mortality occurred during hospitalization. During the follow-up, the mortality and the recurrence rate were 6% and 11%, respectively. In conclusion, early initiation of argatroban treatment may be an effective and safe therapy in ASMVT, manifesting efficient resolution of the thrombus, rapid improvement of symptoms, low incidence of bowel resection and bleeding complication, and low mortality rate.
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Affiliation(s)
- Qiu Zeng
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Qi-Ning Fu
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Feng-He Li
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Xue-Hu Wang
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Hong Liu
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Yu Zhao
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
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Lole Harris BH, Walsh JL, Nazir SA. Super-mesenteric-vein-expia-thrombosis, the clinical sequelae can be quite atrocious. Int J Adolesc Med Health 2016; 28:445-449. [PMID: 26356359 DOI: 10.1515/ijamh-2015-0040] [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] [Received: 05/06/2015] [Accepted: 07/02/2015] [Indexed: 01/16/2023]
Abstract
Superior mesenteric vein (SMV) thrombosis is a rare, potentially life-threatening complication of intra-abdominal infection. Here we present a case of massive SMV thrombosis secondary to appendicitis in a 13-year-old boy. He presented with vague abdominal pain and associated symptoms, persistently elevated serum inflammatory markers and a pyrexia of unknown origin. Sonography proved inconclusive, and a definitive diagnosis was made by abdominal contrast-enhanced computed tomography. He was treated with antibiotics and anticoagulation before interval elective laparoscopic appendectomy. The non-specific nature of the presenting symptoms makes SMV thrombosis an important differential to consider when dealing with such patients.
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21
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Blumberg SN, Maldonado TS. Mesenteric venous thrombosis. J Vasc Surg Venous Lymphat Disord 2016; 4:501-7. [PMID: 27639007 DOI: 10.1016/j.jvsv.2016.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/20/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This review explores the current literature on the natural history, diagnosis, and management of mesenteric venous thrombosis (MVT) in the modern era. METHODS A review of the contemporary literature from 1997 to 2016 on MVT and its pathogenesis, diagnosis, and treatment was performed. RESULTS MVT is an insidious and lethal disease associated with acute mesenteric ischemia. The prevalence of MVT has increased sharply during the past two decades commensurate with an increase in radiographic imaging for abdominal complaints. The optimal treatment of and approach to MVT is controversial, given the poorly understood natural history of this rare disease. Both endovascular and open surgical strategies in addition to systemic anticoagulation have been used as adjuncts to treat MVT with limited success. Despite advances in treatment, mortality associated with MVT is still high. Furthermore, recent studies have shown that failure to recanalize the portomesenteric venous system leads to an increased risk for development of sequelae of portal hypertension. CONCLUSIONS MVT is a challenging disease to treat, given the difficulty in establishing a prompt initial diagnosis and the inability to reliably monitor patients for evidence of impending bowel infarction. Careful selection of patients for endovascular, open, or hybrid approaches is key to achieving improved outcomes. However, the paucity of prospective data and our evolving understanding of the natural history of MVT make consensus treatment strategies difficult to ascertain.
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Affiliation(s)
- Sheila N Blumberg
- Division of Vascular and Endovascular Surgery, NYU Langone Medical Center, New York, NY
| | - Thomas S Maldonado
- Division of Vascular and Endovascular Surgery, NYU Langone Medical Center, New York, NY.
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22
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Maldonado TS, Blumberg SN, Sheth SU, Perreault G, Sadek M, Berland T, Adelman MA, Rockman CB. Mesenteric vein thrombosis can be safely treated with anticoagulation but is associated with significant sequelae of portal hypertension. J Vasc Surg Venous Lymphat Disord 2016; 4:400-6. [PMID: 27638992 DOI: 10.1016/j.jvsv.2016.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 05/08/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Mesenteric venous thrombosis (MVT) is a relatively uncommon but potentially lethal condition associated with bowel ischemia and infarction. The natural history and long-term outcomes are poorly understood and under-reported. METHODS A single-institution retrospective review of noncirrhotic patients diagnosed with MVT from 1999 to 2015 was performed using International Classification of Diseases, Ninth Revision and radiology codes. Patients were excluded if no radiographic imaging was available for review. Eighty patients were identified for analysis. Demographic, clinical, and radiographic data on presentation and at long-term follow-up were collected. Long-term sequelae of portal venous hypertension were defined as esophageal varices, portal vein cavernous transformation, splenomegaly, or hepatic atrophy, as seen on follow-up imaging. RESULTS There were 80 patients (57.5% male; mean age, 57.9 ± 15.6 years) identified; 83.3% were symptomatic, and 80% presented with abdominal pain. Median follow-up was 480 days (range, 1-6183 days). Follow-up radiographic and clinical data were available for 50 patients (62.5%). The underlying causes of MVT included cancer (41.5%), an inflammatory process (25.9%), the postoperative state (20.7%), and idiopathic cases (18.8%). Pancreatic cancer was the most common associated malignant neoplasm (53%), followed by colon cancer (15%). Twenty patients (26%) had prior or concurrent lower extremity deep venous thromboses. Most patients (68.4%) were treated with anticoagulation; the rest were treated expectantly. Ten (12.5%) had bleeding complications related to anticoagulation, including one death from intracranial hemorrhage. Four patients underwent intervention (three pharmacomechanical thrombolysis and one thrombectomy). One patient died of intestinal ischemia. Two patients had recurrent MVT, both on discontinuing anticoagulation. Long-term imaging sequelae of portal hypertension were noted in 25 of 50 patients (50%) who had follow-up imaging available. Patients with long-term sequelae had lower recanalization rates (36.8% vs 65%; P = .079) and significantly higher rates of complete as opposed to partial thrombosis at the initial event (73% vs 43.3%; P < .005). Long-term sequelae were unrelated to the initial cause or treatment with anticoagulation (P = NS). CONCLUSIONS Most cases of MVT are associated with malignant disease or an inflammatory process, such as pancreatitis. A diagnosis of malignant disease in the setting of MVT has poor prognosis, with a 5-year survival of only 25%. MVT can be effectively treated with anticoagulation in the majority of cases. Operative or endovascular intervention is rarely needed but important to consider in patients with signs of severe ischemia or impending bowel infarction. There is a significant incidence of radiographically noted long-term sequelae from MVT related to portal venous hypertension, especially in cases of initial complete thrombosis of the mesenteric vein.
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Affiliation(s)
| | - Sheila N Blumberg
- Division of Vascular Surgery, NYU Langone Medical Center, New York, NY
| | - Sharvil U Sheth
- Division of Vascular Surgery, NYU Langone Medical Center, New York, NY
| | - Gabriel Perreault
- Division of Vascular Surgery, NYU Langone Medical Center, New York, NY
| | - Mikel Sadek
- Division of Vascular Surgery, NYU Langone Medical Center, New York, NY
| | - Todd Berland
- Division of Vascular Surgery, NYU Langone Medical Center, New York, NY
| | - Mark A Adelman
- Division of Vascular Surgery, NYU Langone Medical Center, New York, NY
| | - Caron B Rockman
- Division of Vascular Surgery, NYU Langone Medical Center, New York, NY
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Affiliation(s)
- Cori E Russell
- From Department of Medicine (C.E.R., R.K.W.) and Cardiovascular Division, Department of Medicine (G.P.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Rishi K Wadhera
- From Department of Medicine (C.E.R., R.K.W.) and Cardiovascular Division, Department of Medicine (G.P.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Gregory Piazza
- From Department of Medicine (C.E.R., R.K.W.) and Cardiovascular Division, Department of Medicine (G.P.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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24
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Paraskeva P, Akoh JA. Small bowel stricture as a late sequela of superior mesenteric vein thrombosis. Int J Surg Case Rep 2014; 6C:118-21. [PMID: 25544479 PMCID: PMC4334991 DOI: 10.1016/j.ijscr.2014.11.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/21/2014] [Accepted: 11/21/2014] [Indexed: 12/14/2022] Open
Abstract
64-year-old man admitted with abdominal pain and rectal bleeding found to have thrombosis of portal and superior mesenteric veins on abdominal CT. Managed conservatively but returned seven months later with obstruction requiring segmental small bowel resection. Case demonstrates that mesenteric vein thrombosis can be reversed by effective anticoagulation. Patients escaping early bowel resection due to bowel infarction may still require resection later due to stricture.
Introduction The increasing frequency of use of CT in patients with acute abdomen is likely to improve the diagnosis of rarely occurring conditions/causes such as superior mesenteric vein thrombosis (MVT). Despite its severe consequences, MVT often presents with nonspecific clinical features. Presentation of case AD, a 64-year-old man was an emergency admission with vague abdominal discomfort of two weeks duration, acute upper abdominal pain, loose stools, fresh rectal bleeding and vomiting. A contrast enhanced abdominal CT showed thrombosis of the proximal portal vein and the entire length of the superior mesenteric vein (SMV) with small bowel ischaemia extending from the terminal ileum to the mid jejunal loops. Tests for paroxysmal nocturnal haemoglobinuria and Janus kinase 2 mutation yielded negative results. AD was readmitted seven months later with small bowel obstruction requiring segmental small bowel resection with end-to-end anastomosis. Abdominal CT had shown complete resolution of MVT but a small bowel stricture. Discussion Thrombosis limited to mesenteric veins results in earlier and more frequent development of infarction compared to portal combined with mesenteric venous thrombosis. Most patients may be successfully treated with anti-coagulation therapy alone. However, surgery may be required to deal with intestinal infarction or late sequela of MVT. Conclusion This case demonstrates that MVT can be reversed by effective anticoagulation. However, the price paid for a mild to moderate effect on the bowel may be significant stricture later on. Patients escaping early bowel resection due to massive MVT leading to bowel infarction may still require resection later due to stricture.
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Affiliation(s)
- Panoraia Paraskeva
- Department of Surgery, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth PL6 8DH, United Kingdom
| | - Jacob A Akoh
- Department of Surgery, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth PL6 8DH, United Kingdom.
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Kim MJ, Song HJ, Kim WK, Kim SH. Superior mesenteric vein thrombosis as an early presentation of myelodysplastic syndrome: a case report. Intest Res 2014; 12:157-61. [PMID: 25349584 PMCID: PMC4204708 DOI: 10.5217/ir.2014.12.2.157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 11/02/2013] [Accepted: 11/04/2013] [Indexed: 01/14/2023] Open
Abstract
Mesenteric venous thrombosis (MVT) is a serious condition due to its potential association with mesenteric ischemia and infarction of the small bowel. Symptoms of MVT are often vague, making accurate diagnosis and sufficient treatment difficult. However, increased awareness and new imaging modalities for this condition have improved outcomes for patients with MVT. Treatment includes anticoagulation, transcatheter therapy, and surgery. In the present report, we describe the case study of a 62-year-old woman with a presenting diagnosis of superior MVT, who was finally diagnosed with myelodysplastic syndrome. The superior MVT spontaneously dissolved after the patient underwent 6 months of systemic anticoagulation therapy. Invasive surgery or bowel resection was not required.
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Affiliation(s)
- Min Jung Kim
- Department of Surgery, Jeju National University School of Medicine, Jeju, Korea
| | - Hyun Joo Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Woo Kun Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Sun Hyung Kim
- Department of Laboratory Medicine, Jeju National University School of Medicine, Jeju, Korea
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Hmoud B, Singal AK, Kamath PS. Mesenteric venous thrombosis. J Clin Exp Hepatol 2014; 4:257-63. [PMID: 25755568 PMCID: PMC4284291 DOI: 10.1016/j.jceh.2014.03.052] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 03/13/2014] [Indexed: 12/12/2022] Open
Abstract
Mesenteric vein thrombosis is increasingly recognized as a cause of mesenteric ischemia. Acute thrombosis commonly presents with abdominal pain and chronic type with features of portal hypertension. Contrast enhanced CT scan of abdomen is quite accurate for diagnosing and differentiating two types of mesenteric venous thrombosis. Prothrombotic state, hematological malignancy, and local abdominal inflammatory conditions are common predisposing conditions. Over the last decade, JAK-2 (janus kinase 2) mutation has emerged as an accurate biomarker for diagnosis of myeloproliferative neoplasm, an important cause for mesenteric venous thrombosis. Anticoagulation is the treatment of choice for acute mesenteric venous thrombosis. Thrombolysis using systemic or transcatheter route is another option. Patients with peritoneal signs or refractory to initial measures require surgical exploration. Increasing recognition of mesenteric venous thrombosis and use of anticoagulation for treatment has resulted in reduction in the need for surgery with improvement in survival.
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Affiliation(s)
- Bashar Hmoud
- Department of Internal Medicine, UTMB, Galveston, TX, USA
| | - Ashwani K. Singal
- Division of Gastroenterology and Hepatology, UAB, Birmingham, AL, USA,Address for correspondence: Ashwani K. Singal, 1808, 7th Ave S BDB 351, Birmingham, AL, USA. Tel.: +1 205 975 5683; fax: +1 205 975 6363.
| | - Patrick S. Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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Eilbert W, Hecht B, Zuiderveld L. Acute mesenteric venous thrombosis with a vaginal contraceptive ring. West J Emerg Med 2014; 15:395-7. [PMID: 25035742 PMCID: PMC4100842 DOI: 10.5811/westjem.2014.4.21364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/13/2014] [Accepted: 04/29/2014] [Indexed: 01/14/2023] Open
Abstract
Mesenteric venous thrombosis is a rare cause of abdominal pain, which if left untreated may result in bowel infarction, peritonitis and death. The majority of patients with this illness have a recognizable, predisposing prothrombotic condition. Oral contraceptives have been identified as a predisposing factor for mesenteric venous thrombosis in reproductive-aged women. In the last fifteen years new methods of hormonal birth control have been introduced, including a transdermal patch and an intravaginal ring. In this report, we describe a case of mesenteric venous thrombosis in a young woman caused by a vaginal contraceptive ring.
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Affiliation(s)
- Wesley Eilbert
- University of Illinois at Chicago, Department of Emergency Medicine, Chicago, Illinois
| | - Benjamin Hecht
- University of Illinois at Chicago, Department of Emergency Medicine, Chicago, Illinois
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Wassélius J, Sonesson B, Elf J, Ahlström M, Malina M, Dias N. Treatment of mesenteric vein thrombosis with transjugular mechanical thrombectomy and subsequent simultaneous arterial and venous thrombolysis. J Vasc Surg Venous Lymphat Disord 2014; 2:320-3. [DOI: 10.1016/j.jvsv.2013.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 08/30/2013] [Accepted: 09/11/2013] [Indexed: 01/14/2023]
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29
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Transcatheter thrombolysis centered stepwise management strategy for acute superior mesenteric venous thrombosis. Int J Surg 2014; 12:442-51. [DOI: 10.1016/j.ijsu.2014.03.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 03/23/2014] [Indexed: 02/07/2023]
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30
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Li J, Hu X, Zhang Q, Cao H, Liu C, Wang J, Zhang J, Xin S. Activated protein C resistance associated with lupus anticoagulants is a high risk in acute mesenteric venous thrombosis. J Vasc Surg Venous Lymphat Disord 2014; 2:155-9. [PMID: 26993180 DOI: 10.1016/j.jvsv.2013.10.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 09/12/2013] [Accepted: 10/27/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Acute mesenteric venous thrombosis (AMVT) is one of those diseases that cannot be diagnosed by specific symptoms and signs. A high misdiagnosis rate makes AMVT a final diagnosis established by exploratory laparotomy or forensic examinations earlier, during the period when computed tomography was not as efficient as it is now. The main motivation of our research was to improve the diagnosis and treatment by finding the relationship among activated protein C (APC) resistance, antiphospholipid antibodies, and AMVT in the Chinese Han population. METHODS APC resistance was tested by activated partial thromboplastin time method in 70 AMVT patients and 75 healthy adult volunteers that excluded hypercoagulable states. Factor V Leiden mutation was analyzed by polymerase chain reaction with restriction fragment length polymorphism. Anticardiolipin antibodies (aCLs) were tested by enzyme-linked immunosorbent assay. A sensitive activated partial thromboplastin time-lupus anticoagulant (LA) test was used according to the guidelines. RESULTS Only two samples had factor V Leiden mutation and were excluded. Twenty-one (30.9%) of the 68 AMVT patients had APC resistance. The rate of aCLs positive in AMVT group (13.2%) was significantly increased compared with control group (1.33%; P = .014). The LA-positive rate is significantly different between the AMVT and control group. Among LA-positive patients, the number of APC resistance was much higher than LA-negative patients (P = .000), but aCLs do not have an increased predisposition to APC resistance (P = .85). CONCLUSIONS APC resistance associated with LAs is a high risk in AMVT. The way aCL may affect the process of AMVT is not the same as with LA.
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Affiliation(s)
- Jun Li
- First Affiliated Hospital, China Medical University, Department of Surgery, Shenyang, China
| | - Xinhua Hu
- First Affiliated Hospital, China Medical University, Department of Surgery, Shenyang, China.
| | - Qiang Zhang
- First Affiliated Hospital, China Medical University, Department of Surgery, Shenyang, China
| | - Hui Cao
- First Affiliated Hospital, China Medical University, Department of Surgery, Shenyang, China
| | - Chengwei Liu
- First Affiliated Hospital of Jiamusi University, First Department of General Surgery, Jiamusi, China
| | - Junpeng Wang
- First Affiliated Hospital, China Medical University, Department of Surgery, Shenyang, China
| | - Jian Zhang
- First Affiliated Hospital, China Medical University, Department of Surgery, Shenyang, China
| | - Shijie Xin
- First Affiliated Hospital, China Medical University, Department of Surgery, Shenyang, China
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Kim HK, Chun JM, Huh S. Anticoagulation and delayed bowel resection in the management of mesenteric venous thrombosis. World J Gastroenterol 2013; 19:5025-5028. [PMID: 23946612 PMCID: PMC3740437 DOI: 10.3748/wjg.v19.i30.5025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 05/20/2013] [Accepted: 06/19/2013] [Indexed: 02/06/2023] Open
Abstract
Acute mesenteric venous thrombosis is potentially lethal because it can result in mesenteric ischemia and, ultimately, bowel infarction requiring surgical intervention. Systemic anticoagulation for the prevention of thrombus propagation is a well-recognized treatment modality and the current mainstay therapy for patients with acute mesenteric venous thrombosis. However, the decision between prompt surgical exploration vs conservative treatment with anticoagulation is somewhat difficult in patients with suspected bowel ischemia. Here we describe a patient with acute mesenteric venous thrombosis who presented with bowel ischemia and was treated with anticoagulation and delayed short-segment bowel resection.
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Fonseca AL, Cleary MA, Cholewczynski W, Sumpio BE, Atweh NA. Omental vein catheter thrombolysis for acute porto-mesenteric vein thrombosis. Ann Vasc Surg 2013; 27:497.e1-4. [PMID: 23566871 DOI: 10.1016/j.avsg.2012.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 09/25/2012] [Indexed: 01/16/2023]
Abstract
Mesenteric venous thrombosis (MVT) is an uncommon clinical condition with potential high morbidity. We report here a patient who presented with acute-onset MVT and bowel infarction, which was successfully ameliorated with intramesenteric vein thrombolytic therapy.
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Affiliation(s)
- Annabelle L Fonseca
- Department of Surgery, Yale University School of Medicine, New Haven, CT 06511, USA.
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Abstract
The prevalence of mesenteric venous thrombosis has increased over the past 2 decades with the routine use of contrast-enhanced computed tomography (CT) in patients presenting with abdominal pain and those with portal hypertension. Concurrent with increasing recognition, routine and frequent use of anticoagulation has reduced the need for surgical intervention and improved outcome in these patients. Acute thrombosis often presents with abdominal pain, whereas chronic disease manifests either as an incidental finding on CT or with features of portal hypertension. Contrast-enhanced CT diagnoses about 90% of cases. The presence of collateral circulation and cavernoma around a chronically thrombosed vein differentiates chronic from acute disease. The superior mesenteric vein is often involved, whereas involvement of the inferior mesenteric vein is rare. Associated portal venous thrombosis can be seen if the disease originates in the major veins instead of the small vena rectae. Thrombophilia and local abdominal inflammatory conditions are common causes. Management is aimed at preventing bowel infarction and recurrent thrombosis. Anticoagulation, the mainstay of management, has also been safely used in patients with cirrhosis and portal hypertension. This review discusses the pathogenesis of thrombosis of mesenteric veins, the diagnosis and differentiation from arterial ischemia, the emergence of the JAK2 (Janus kinase 2) sequence variation as a marker of thrombophilia and myelodysplastic neoplasms, and new anticoagulants. Algorithms for the management of acute and chronic mesenteric venous thrombosis are provided to help readers understand and remember the approach to the management of acute and chronic mesenteric venous thrombosis.
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Affiliation(s)
- Ashwani K Singal
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
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Kobilica N, Skalicky M, Milotič F, Flis V. Non-Cirrhotic and Non-Malignant Acute Extrahepatic Portal Vein Thrombosis (PVT): Short- and Long-Term Results. J Int Med Res 2011; 39:1090-8. [DOI: 10.1177/147323001103900344] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
This observational cohort study reports the short- and long-term clinical outcomes of 31 patients admitted for acute non-malignant, non-cirrhotic portal vein thrombosis (PVT) over a 10-year period. Patients had a mean age of 43 years at admission and a mean duration of follow-up of 84 months. All patients were initially treated with anticoagulants. Complete recanalization occurred within 30 days after admission in 18 patients (58%), partially in nine patients (29%), and failed in four patients (13%). During follow-up, 10 patients (32%) had at least one episode of gastrointestinal bleeding. The probability of remaining bleed-free was 0.93 at 24 months and 0.61 at 48 months. Fundal varices were not controlled by endoscopic sclerotherapy, so all four patients underwent portosystemic shunt construction. To date, there has been no mortality. In conclusion, using a combination of different treatment options reduces the risk of death and late complications in patients with non-malignant, non-cirrhotic PVT.
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Affiliation(s)
- N Kobilica
- Department of Vascular Surgery, University Clinical Centre Maribor, Maribor, Slovenia
| | - M Skalicky
- Department of Gastroenterology, University Clinical Centre Maribor, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - F Milotič
- Department of Vascular Surgery, University Clinical Centre Maribor, Maribor, Slovenia
| | - V Flis
- Department of Vascular Surgery, University Clinical Centre Maribor, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
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Abstract
First differentiated from arterial causes of acute mesenteric ischemia 75 years ago, acute mesenteric venous thrombosis (MVT) is an uncommon disorder with non-specific signs and symptoms, the diagnosis of which requires a high index of suspicion. The location, extent, and rapidity of thrombus formation determine whether intestinal infarction ensues. Etiologies, when identified, usually can be separated into local intra-abdominal factors and inherited or acquired hypercoagulable states. The diagnosis is most often made by contrast-enhanced computed tomography, though angiography and exploratory surgery still have important diagnostic as well as therapeutic roles. Anticoagulation prevents clot propagation and is associated with decreased recurrence and mortality. Thrombectomy and thrombolysis may preserve questionably viable bowel and should be considered under certain circumstances. Evidence of infarction mandates surgery and resection whenever feasible. Although its mortality rate has fallen over time, acute MVT remains a life-threatening condition requiring rapid diagnosis and aggressive management. Chronic MVT may manifest with complications of portal hypertension or may be diagnosed incidentally by noninvasive imaging. Management of chronic MVT is directed against variceal hemorrhage and includes anticoagulation when appropriate; mortality is largely dependent on the underlying risk factor.
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Affiliation(s)
- Ian G Harnik
- Montefiore Medical Center, Bronx, NY 10467, USA.
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Tang ZH, Qiang JW, Feng XY, Li RK, Sun RX, Ye XG. Acute mesenteric ischemia induced by ligation of porcine superior mesenteric vein: multidetector CT evaluations. Acad Radiol 2010; 17:1146-52. [PMID: 20646939 DOI: 10.1016/j.acra.2010.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 04/21/2010] [Accepted: 04/21/2010] [Indexed: 01/16/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate multidetector computed tomography (MDCT) for detecting the early changes and dynamic evolution of acute mesenteric ischemia (AMI) induced by the ligation of superior mesenteric vein (SMV) in an experimental porcine model. MATERIALS AND METHODS Twelve pigs were randomly assigned to three experimental groups, and one control group with three pigs in each group. After laparotomy, the SMV was separated and ligated in nine pigs and separated without ligation in three controls. MDCT pre- and postcontrast with arterial, venous, and delayed phase scans, and CT angiography reconstructions of mesenteric vessels were carried out at preoperation, 6 hours, 12 hours, and 18 hours after ligation. The findings of mesenteric vessels, bowel, abdominal cavity at pre- and postoperation, and dynamic evolution were correlated with pathology. RESULTS AMI-induced pathological changes were identified in all nine experimental pigs. MDCT angiography clearly delineated main trunk of the SMV, peripheral major and minor tributaries up to brushy vasa recta, and the location and shape of ligations. The early ischemic findings were bowel wall thickening, mesenteric edema, ascites, and pronounced bowel enhancement. Superior mesenteric artery and its major branches appeared spasm with poor filling and delayed and prolonged visualization. SMV and its tributaries were poorly delineated with delayed opacification. We also saw thinning of bowel wall, dilatating bowel with fluid, aggravating mesenteric edema and ascites, and poor enhanced bowel over time. CONCLUSION MDCT detects early changes of mesenteric ischemia and its evolution after ligation of porcine SMV, and may find application in early diagnosis of human venous occlusive AMI.
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He JA, Hu XH, Fan YY, Yang J, Zhang ZS, Liu CW, Yang DH, Zhang J, Xin SJ, Zhang Q, Duan ZQ. Hyperhomocysteinaemia, low folate concentrations and methylene tetrahydrofolate reductase C677T mutation in acute mesenteric venous thrombosis. Eur J Vasc Endovasc Surg 2009; 39:508-13. [PMID: 19846322 DOI: 10.1016/j.ejvs.2009.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Accepted: 09/20/2009] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Acute mesenteric venous thrombosis (AMVT) was first reported by Fagge and was recognised as a distinct clinical entity by Warreen in 1935. However, its pathogenesis is still unclear. Elevated plasma levels of homocysteine (Hcy) are associated with an increased risk of deep vein thrombosis. This case-control study examines the potential association among hyperhomocysteinaemia (hyper-Hcy), low serum folate and vitamin B(12) levels and the common C677T mutation of the MTHFR gene in patients with AMVT. MATERIALS AND METHODS Sixty-three patients with AMVT and 75 sex- and age-matched healthy controls were recruited, and their plasma Hcy, folate and vitamin B(12) levels were measured by high performance liquid chromatography (HPLC) and immunological assays. The polymorphism of MTHFR C677T was detected by PCR-RFLP. RESULTS The mean plasma Hcy levels were significantly higher in patients with AVMT compared with controls (23.5 standard deviation (S.D.) 8.8 vs. 12.6+/-6.6micromoll(-1), P<0.01). The fasting Hcy correlated negatively with folate (AMVT: r=-0.42, P<0.01; CONTROL r=-0.40, P<0.01). The frequency of homozygous (TT) genotype in MTHFR C677T mutation was significantly higher in patients with AMVT than that in control subjects (33% vs. 17%; chi square (chi(2))=6.31, P<0.05; odds ratio (OR)=2.80; 95% confidence interval (CI): 1.25-6.25). Compared with the control subjects, the mean serum vitamin B(12) levels were lower in patients, but it was not statistically significant (365+/-88pmoll(-1) vs. 408+/-108pmoll(-1), P>0.05). CONCLUSIONS Hyper-Hcy and low serum folate levels were associated with an increased risk of AMVT. The homozygous (TT) genotype of MTHFR gene mutation may be a crucial hereditary risk factor in the development of AMVT for a Chinese population.
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Affiliation(s)
- J A He
- Department of General Surgery, First Affiliated Hospital, China Medical University, Shenyang, PR China
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Alvi AR, Khan S, Niazi SK, Ghulam M, Bibi S. Acute mesenteric venous thrombosis: improved outcome with early diagnosis and prompt anticoagulation therapy. Int J Surg 2009; 7:210-3. [PMID: 19332155 DOI: 10.1016/j.ijsu.2009.03.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 02/23/2009] [Accepted: 03/07/2009] [Indexed: 12/17/2022]
Abstract
AIM To analyze the clinical spectrum of acute mesenteric venous thrombosis (AMVT), to assess the factors affecting the outcome and to determine the optimal management of this disease. METHODS We retrospectively reviewed the case records of 20 patients with acute mesenteric venous thrombosis confirmed on CT imaging or on laparotomy over a 23 year period. Patients were divided into two groups according to the duration of symptoms: group I with symptoms for up to 3 days duration and group II with symptoms for more than 3 days. RESULTS The mean age was 50.55 year, with 15 male and five female patients. In all patients the diagnosis were confirmed on CT imaging preoperatively except two patients when the diagnosis was established on exploratory laparotomy in the period before 1998. There were six patients in group I and 14 in group II. Five patients underwent an operation and one received a non-operative treatment in group I. Three patients underwent laparotomy and 11 received non-operative treatment in group II (P-value 0.01, Fisher's exact test). There were three and one mortality in groups I (n=6) and II (n=14) respectively (P-value 0.061, Fisher's exact test). Most patients received preoperative therapeutic anticoagulation. Two patients in group II who underwent exploratory laparotomy, neither did receive preoperative anticoagulation. Both patients died in the postoperative period. Eighteen patients were investigated for thrombophilia. Eleven patients had one (n=6) or more (n=5) identifiable hypercoagulable state, these included protein S deficiency (n=1), both protein C and S deficiency (n=5), polycythemia (n=2), factor V Leiden deficiency (n=1) and malignancy (n=2). None had antithrombin III deficiency, hyperhomocystine urea and contraceptive pill intake. There were no statistical differences between thrombophilic and non-thrombophilic patients regarding duration of symptoms, indications for laparotomy and 30 days mortality rate. CONCLUSIONS Patients with AMVT of rapid onset (<3 days duration) had poor outcome and more patients required laparotomy because of extensive thrombosis leading to bowel gangrene and peritonitis. Early diagnosis with CT scanning, prompt treatment with anticoagulation in all patients, surgical treatment in cases of peritonitis or failure of medical treatment can contain the mortality rate in these patients.
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Affiliation(s)
- A Rehman Alvi
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
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39
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Findings in multi-detector row CT with portal phase enhancement in patients with mesenteric venous thrombosis. Emerg Radiol 2009; 16:477-82. [DOI: 10.1007/s10140-009-0807-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 03/06/2009] [Indexed: 12/23/2022]
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40
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Usefulness of Computed Tomography in Differentiating Transmural Infarction from Nontransmural Ischemia of the Small Intestine in Patients With Acute Mesenteric Venous Thrombosis. J Comput Assist Tomogr 2008; 32:730-7. [DOI: 10.1097/rct.0b013e318159f135] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Castel H, Reimund JM. [Clinical case: a mesenteric vein thrombosis]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2006; 30:1395-7. [PMID: 17211339 DOI: 10.1016/s0399-8320(06)73561-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Hélène Castel
- Service d'Hépato-Gastro-Entérologie et Nutrition, Centre Hospitalier Universitaire de Caen
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Wolff M, Schäfer N, Schepke M, Hirner A. Akute und chronische Thrombosen des Pfortadersystems. GEFÄSSCHIRURGIE 2006. [DOI: 10.1007/s00772-006-0462-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Sauerland S, Agresta F, Bergamaschi R, Borzellino G, Budzynski A, Champault G, Fingerhut A, Isla A, Johansson M, Lundorff P, Navez B, Saad S, Neugebauer EAM. Laparoscopy for abdominal emergencies. Surg Endosc 2005; 20:14-29. [PMID: 16247571 DOI: 10.1007/s00464-005-0564-0] [Citation(s) in RCA: 227] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Accepted: 07/12/2005] [Indexed: 01/10/2023]
Abstract
BACKGROUND Emergency laparoscopic exploration can be used to identify the causative pathology of acute abdominal pain. Laparoscopic surgery also allows treatment of many intraabdominal disorders. This report was prepared to describe the effectiveness of laparoscopic surgery compared to laparotomy or nonoperative treatment. METHODS A panel of European experts in abdominal and gynecological surgery was assembled and participated in a consensus conference using Delphi methods. The aim was to develop evidence-based recommendations for the most common diseases that may cause acute abdominal pain. RECOMMENDATIONS Laparoscopic surgery was found to be clearly superior for patients with a presumable diagnosis of perforated peptic ulcer, acute cholecystitis, appendicitis, or pelvic inflammatory disease. In the emergency setting, laparoscopy is of unclear or limited value if adhesive bowel obstruction, acute diverticulitis, nonbiliary pancreatitis, hernia incarceration, or mesenteric ischemia are suspected. In stable patients with acute abdominal pain, noninvasive diagnostics should be fully exhausted before considering explorative surgery. However, diagnostic laparoscopy may be useful if no diagnosis can be found by conventional diagnostics. More clinical data are needed on the use of laparoscopy after blunt or penetrating trauma of the abdomen. CONCLUSIONS Due to diagnostic and therapeutic advantages, laparoscopic surgery is useful for the majority of conditions underlying acute abdominal pain, but noninvasive diagnostic aids should be exhausted first. Depending on symptom severity, laparoscopy should be advocated if routine diagnostic procedures have failed to yield results.
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Affiliation(s)
- S Sauerland
- Institute for Research in Operative Medicine, University of Witten/Herdecke, Ostmerheimer Strasse 200, D 51109, Cologne, Germany
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Ramos-Gallo M, Vaquero-Lorenzo F, Vallina-Vázquez M, Álvarez-Fernández L. Trombosis venosa mesentérica aguda como causa de isquemia. ANGIOLOGIA 2005. [DOI: 10.1016/s0003-3170(05)74925-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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