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Juniku-Shkololli A, Gjikolli B, Hoti KD, Hyseni G, Kadrijaj F, Lahu F, Gjikolli D, Hyseni F, Musa J. A rare complication with superior mesenteric vein thrombosis after laparoscopic sleeve gastrectomy: A case report. Radiol Case Rep 2023; 18:3020-3025. [PMID: 37434619 PMCID: PMC10331020 DOI: 10.1016/j.radcr.2023.05.075] [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: 02/03/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 07/13/2023] Open
Abstract
Laparoscopic sleeve gastrectomy (LSG) has become a frequent procedure to reduce weight and morbid obesity. The procedure involves laparoscopic resection of more than 75% of the greater curvature of the stomach, resulting in early satiety and neuro-hormonal changes that collectively promote effective weight loss. We present a rare case of complication of superior mesenteric vein thrombosis (SMVT) and splenic vein after LSG, with consequent bowel ischemia that was treated with open laparotomy and appropriate anticoagulation therapy. A 56-year-old obese woman (BMI of 42.5 kg/m2), smoker for 30 years, presented to the emergency department with symptoms such as abdominal pain, fever, nausea and vomiting, 2 weeks after LSG intervention. Her white blood cell count was 15.5 (normal values: 3.8-10.4 × 103 /µL), while C- reactive protein level was 193 (normal values: 0.0-6.0 mg/L) and her D-Dimer level 4.69 (normal values: 0-0.50 mg/L). Abdominal CT with contrast showed a filling defect in the superior mesenteric and splenic vein, free perihepatic and Douglas pouch fluid, as well as small bowel thickening. An open laparotomy was performed and the necrotic segment of bowel of 80 cm was removed. The postoperative period went relatively well, despite the diarrhea that continued for the next 4 months after the intervention. The most common causes leading the development of this complication include: hypercoagulable state, dehydration, increased intra-abdominal pressure during the procedure and other secondary factors. The main symptom is abdominal pain, followed by nausea, vomiting, diarrhea and bleeding from the gastrointestinal tract. SMVT and SVT should be considered as a possible complication in patients with abdominal pain and increased inflammatory parameters after LSG. Early diagnosis through CT imaging and rapid anticoagulation therapy is considered to reduce further complications such as intestinal infarction and portal hypertension.
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Affiliation(s)
- Argjira Juniku-Shkololli
- Clinic of Gastroenterology, University of Pristina–University Clinical Centre of Kosovo, Pristina, Kosovo
| | - Bujar Gjikolli
- Clinic of Radiology, University of Pristina–University Clinical Centre of Kosovo, Pristina, Kosovo
- AAB College – Faculty of Radiology, Prishtina, Kosovo
| | - Kreshnike Dedushi Hoti
- Clinic of Radiology, University of Pristina–University Clinical Centre of Kosovo, Pristina, Kosovo
| | - Guri Hyseni
- Department of Pediatric Surgery, University of Pristina–University Clinical Centre of Kosovo, Pristina, Kosovo
| | - Fatbardh Kadrijaj
- Clinic of Gastroenterology, University of Pristina–University Clinical Centre of Kosovo, Pristina, Kosovo
| | - Flamur Lahu
- Clinic of Radiology, University of Pristina–University Clinical Centre of Kosovo, Pristina, Kosovo
| | - Dea Gjikolli
- AAB College – Faculty of Radiology, Prishtina, Kosovo
| | | | - Juna Musa
- Department of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, NY, USA
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Şen O, Kara S, Türkçapar AG. Porto-mesenteric vein thrombosis after laparoscopic sleeve gastrectomy. A case report. Int J Surg Case Rep 2021; 79:424-427. [PMID: 33524799 PMCID: PMC7851411 DOI: 10.1016/j.ijscr.2021.01.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/20/2021] [Accepted: 01/20/2021] [Indexed: 11/26/2022] Open
Abstract
Porta-mesenteric vein thrombosis (PMVT) is a serious complication that maybe seen after sleeve gastrectomy. Abdominal pain is the most significant symptom of PMVT. Some patients may develop life-threatening intestinal ischemic symptoms. Early diagnosis and anticoagulant therapy are very important.
İntroduction and importance Porta-mesenteric vein thrombosis (PMVT) is a rare but fatal complication in patients who are undergoing bariatric surgery. In this report, we present a rare case of a PMVT after laparoscopic sleeve gastrectomy (LSG). Case presentation A 52-year-old male patient with a body mass index of 42 kg/m2 was admitted to our clinic for morbid obesity. Standart LSG was performed with 5 trocar technique. 15 days after LSG, the patient admitted to the emergency department with complaints of abdominal pain, nausea and vomiting. The patient was dehydrated. His C-reactive protein level was 138 mg/L. Abdominal computerized tomography with contrast was performed and showed thickening of a part of small bowel wall in 10 cm length. Also, major trombosis were detected in the superior mesenteric vein branches and portal vein. The patient was hospitalized and 2 × 10,000 IU/1.0 mL high dosage low moleculer weight heparin (LMWH) therapy was initiated. The patient’s clinical signs recovered rapidly following treatment. Clinical discussion İn LSG, if the gastroepiploic venous arcus, which runs along the greater curvatura, and has a direct connection to the portal circulation is damaged, a local thrombus may form and move towards the portal system over time. Dehydration is another significant predisposing factor for PMVT. Some patients may develop life-threatening intestinal ischemia. Abdominal tomography with contrast plays a major role in diagnosis. Conclusion PMVT should be considered as a serious complication after LSG in patients with abdominal pain. With early diagnosis and anticoagulant therapy, patients’s clinical symptoms may improve quicly.
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Affiliation(s)
- Ozan Şen
- Türkçapar Bariatrics, Obesity Center, Dikilitaş Mah. Ayazmadere cad, Yeşil Çimen sok no: 9, Beşiktaş, 34394, İstanbul, Turkey; Nişantaşı University, Department of Health Sciences, Maslak mah. Söğütözü sok. no: 20, Maslak 1453, Sarıyer, 34398, İstanbul, Turkey.
| | - Simay Kara
- Acibadem Fulya Hospital, Radiology Department, Hakkı yeten cad. Yeşilçimen sok. No: 23, 34349, İstanbul, Turkey
| | - Ahmet Gökhan Türkçapar
- Türkçapar Bariatrics, Obesity Center, Dikilitaş Mah. Ayazmadere cad, Yeşil Çimen sok no: 9, Beşiktaş, 34394, İstanbul, Turkey
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Portomesenteric Venous Thrombosis as a Complication of Laparoscopic Sleeve Gastrectomy: a Case Report and Review of the Literature. Indian J Surg 2019. [DOI: 10.1007/s12262-019-01976-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Valeriani E, Riva N, Di Nisio M, Ageno W. Splanchnic Vein Thrombosis: Current Perspectives. Vasc Health Risk Manag 2019; 15:449-461. [PMID: 31695400 PMCID: PMC6815215 DOI: 10.2147/vhrm.s197732] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/02/2019] [Indexed: 12/14/2022] Open
Abstract
Splanchnic vein thrombosis (SVT) including portal, mesenteric, splenic vein thrombosis and the Budd-Chiari syndrome, is a manifestation of unusual site venous thromboembolism. SVT presents with a lower incidence than deep vein thrombosis of the lower limbs and pulmonary embolism, with portal vein thrombosis and Budd-Chiari syndrome being respectively the most and the least common presentations of SVT. SVT is classified as provoked if secondary to a local or systemic risk factor, or unprovoked if the causative trigger cannot be identified. Diagnostic evaluation is often affected by the lack of specificity of clinical manifestations: the presence of one or more risk factors in a patient with a high clinical suspicion may suggest the execution of diagnostic tests. Doppler ultrasonography represents the first line diagnostic tool because of its accuracy and wide availability. Further investigations, such as computed tomography and magnetic resonance angiography, should be executed in case of suspected thrombosis of the mesenteric veins, suspicion of SVT-related complications, or to complete information after Doppler ultrasonography. Once SVT diagnosis is established, a careful patient evaluation should be performed in order to assess the risks and benefits of the anticoagulant therapy and to drive the optimal treatment intensity. Due to the low quality and large heterogeneity of published data, guidance documents and expert opinion could direct therapeutic decision, suggesting which patients to treat, which anticoagulant to use and the duration of treatment.
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Affiliation(s)
- Emanuele Valeriani
- Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti-Pescara, Italy
| | - Nicoletta Riva
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Marcello Di Nisio
- Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti-Pescara, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Yokota Y, Yoshioka T, Senoh M, Sunami K. Successful intravenous administration of argatroban in the management of heparin-resistant and surgery-resistant mesenteric vein thrombosis. BMJ Case Rep 2019; 12:12/8/e228427. [PMID: 31420420 PMCID: PMC6700539 DOI: 10.1136/bcr-2018-228427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
A 78-year-old woman visited the emergency department with complaints of progressively worsening abdominal pain for a week. Nausea and vomiting started at the time of the visit. An abdominal contrast-enhanced CT (CECT) revealed a filling defect of portal vein, splenic vein and superior mesenteric vein (SMV) which was diagnosed as portal vein and mesenteric venous thrombosis (MVT). Intravenous administration of unfractionated heparin was initiated. However, her symptoms did not improve, and she underwent surgical thrombectomy on the second day of hospitalisation. On the sixth day, CECT revealed the recurrence of thrombi in the portal vein, SMV and along the central venous catheters. We switched heparin to argatroban on the eighth day. After administering argatroban, CECT revealed that the thrombi had almost disappeared by the 40th day. In this case, argatroban was considered effective for heparin-resistant and surgery-resistant portal vein and MVT.
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Affiliation(s)
- Yuya Yokota
- Department of General Internal Medicine, Okayama Kyoritsu Hospital, Okayama, Japan
| | - Takashi Yoshioka
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan
| | - Mayumi Senoh
- Department of General Internal Medicine, Okayama Kyoritsu Hospital, Okayama, Japan
| | - Kazuharu Sunami
- Department of General Internal Medicine, Okayama Kyoritsu Hospital, Okayama, Japan
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Khripun AI, Shurygin SN, Mironkov AB, Pryamikov AD. [Venous acute disturbance of mesenteric circulation: diagnosis and treatment]. Khirurgiia (Mosk) 2017:95-102. [PMID: 29286040 DOI: 10.17116/hirurgia20171295-102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- A I Khripun
- Chair of surgery and endoscopy of the Department of advanced medical training of the N.I. Pirogov's Russian National Research Medical University, Moscow
| | - S N Shurygin
- Chair of surgery and endoscopy of the Department of advanced medical training of the N.I. Pirogov's Russian National Research Medical University, Moscow
| | - A B Mironkov
- Chair of surgery and endoscopy of the Department of advanced medical training of the N.I. Pirogov's Russian National Research Medical University, Moscow; V.M. Buyanov's City Clinical Hospital, Moscow, Russia
| | - A D Pryamikov
- Chair of surgery and endoscopy of the Department of advanced medical training of the N.I. Pirogov's Russian National Research Medical University, Moscow; V.M. Buyanov's City Clinical Hospital, Moscow, Russia
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7
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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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Pitta GBB, Pereira DA, Oliveira MDFQ, Guedes EA, Sampaio JA. Cateterismo de artéria mesentérica para tratamento de trombose de veia porta. J Vasc Bras 2017; 16:43-47. [PMID: 29930622 PMCID: PMC5829691 DOI: 10.1590/1677-5449.008416] [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: 10/27/2016] [Accepted: 02/01/2017] [Indexed: 12/01/2022] Open
Abstract
A trombose de veia porta é uma causa rara de abdome agudo vascular e está diretamente relacionada a trombofilias hereditárias ou adquiridas. O caso de um paciente de 60 anos, sexo masculino, com quadro clínico de isquemia mesentérica confirmada por exame de imagem é apresentado. Foi submetido a enterectomia e enteroanastomose e, após esplenoportografia que detectou trombose de veia porta, indicou-se tratamento medicamentoso com infusão contínua de ativador tecidual do plasminogênio recombinante (Alteplase) através de cateterismo seletivo da artéria mesentérica superior. Trata-se de um tratamento inovador. Obteve-se sucesso na recanalização do sistema porta. O paciente evoluiu com quadro de sepse abdominal, necessitando de assistência em terapia intensiva por 25 dias. Evoluiu bem e recebeu alta hospitalar com o uso de anticoagulante. O artigo apresenta uma breve revisão de literatura e discussão do caso clínico.
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Villagrán R, Smith G, Rodriguez W, Flores C, Cariaga M, Araya S, Yañez M, Fuentes P, Linares J, Zapata A. Portomesenteric Vein Thrombosis After Laparoscopic Sleeve Gastrectomy: Incidence, Analysis and Follow-Up in 1236 Consecutive Cases. Obes Surg 2016; 26:2555-2561. [PMID: 27079191 PMCID: PMC5069330 DOI: 10.1007/s11695-016-2183-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Portomesenteric vein thrombosis (PMVT) is a rare but severe complication after laparoscopic bariatric surgery, with potentially serious consequences. We aimed to describe the incidence, clinical features, management, outcome, and midterm follow-up in patients with PMVT after laparoscopic sleeve gastrectomy (LSG). METHODS This retrospective and descriptive study included patients who underwent LSG between November 2009 and July 2015 and developed PMVT. The following data were analyzed: age, gender, body mass index (BMI), thrombosis risk factors, surgical technique, thromboembolic prophylaxis, primary surgery outcomes, clinical features, treatment, thrombophilia testing results, and follow-up findings, including imaging and endoscopic findings. RESULTS A total of 1236 patients underwent LSG, and 5 (0.4 %) developed PMVT. The mean age was 34.4 years, and 3 patients were women. The mean BMI was 38.5 kg/m2. Two patients had received hormonal contraceptive treatment. Four patients had a history of smoking. All of the patients received anticoagulant treatment, and none required surgery. The mean hospitalization duration was 7.6 days. Two patients showed complete recanalization. One patient showed portal cavernomatosis on delayed images. Two patients had a positive thrombophilia test. No portal hypertension endoscopic findings were observed. CONCLUSIONS PMVT is a rare complication, for which smoking was identified as a predominant risk factor. Early diagnosis and prompt anticoagulant therapy could lead to a dramatic decrease in the incidence of intestinal infarction, mortality, and extrahepatic portal hypertension in the near future. However, careful follow-up is necessary to evaluate the impact of PMVT on long-term patient outcomes.
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Affiliation(s)
- Rodrigo Villagrán
- Bariatric Surgery Department, Bupa Antofagasta Clinic, Matta 1868, 2nd floor, Antofagasta, Chile.
| | - Gabriela Smith
- Bariatric Surgery Department, Bupa Antofagasta Clinic, Matta 1868, 2nd floor, Antofagasta, Chile
| | - Walter Rodriguez
- Department of Radiology, Bupa Antofagasta Clinic, Antofagasta, Chile
| | - Carlos Flores
- Bariatric Surgery Department, Bupa Antofagasta Clinic, Matta 1868, 2nd floor, Antofagasta, Chile
| | - Mario Cariaga
- Bariatric Surgery Department, Bupa Antofagasta Clinic, Matta 1868, 2nd floor, Antofagasta, Chile
| | - Sofía Araya
- Bariatric Surgery Department, Bupa Antofagasta Clinic, Matta 1868, 2nd floor, Antofagasta, Chile
| | - Marisol Yañez
- Bariatric Surgery Department, Bupa Antofagasta Clinic, Matta 1868, 2nd floor, Antofagasta, Chile
| | - Paulina Fuentes
- Bariatric Surgery Department, Bupa Antofagasta Clinic, Matta 1868, 2nd floor, Antofagasta, Chile
- Faculty of Medicine and Dentistry, Antofagasta University, Antofagasta, Chile
| | - Jeannette Linares
- Endocrinology Department, Bupa Antofagasta Clinic, Antofagasta, Chile
- Faculty of Medicine and Dentistry, Antofagasta University, Antofagasta, Chile
| | - Antonio Zapata
- Endocrinology Department, Bupa Antofagasta Clinic, Antofagasta, Chile
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Tilsed JVT, Casamassima A, Kurihara H, Mariani D, Martinez I, Pereira J, Ponchietti L, Shamiyeh A, Al-Ayoubi F, Barco LAB, Ceolin M, D'Almeida AJG, Hilario S, Olavarria AL, Ozmen MM, Pinheiro LF, Poeze M, Triantos G, Fuentes FT, Sierra SU, Soreide K, Yanar H. ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg 2016; 42:253-70. [PMID: 26820988 PMCID: PMC4830881 DOI: 10.1007/s00068-016-0634-0] [Citation(s) in RCA: 176] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Acute mesenteric ischaemia (AMI) accounts for about 1:1000 acute hospital admissions. Untreated, AMI will cause mesenteric infarction, intestinal necrosis, an overwhelming inflammatory response and death. Early intervention can halt and reverse this process leading to a full recovery, but the diagnosis of AMI is difficult and failure to recognize AMI before intestinal necrosis has developed is responsible for the high mortality of the disease. Early diagnosis and prompt treatment are the goals of modern therapy, but there are no randomized controlled trials to guide treatment and the published literature contains a high ratio of reviews to original data. Much of that data comes from case reports and often small, retrospective series with no clearly defined treatment criteria. METHODS A study group of the European Society for Trauma and Emergency Surgery (ESTES) was formed in 2013 with the aim of developing guidelines for the management of AMI. A comprehensive literature search was performed using the Medical Subject Heading (MeSH) thesaurus keywords "mesenteric ischaemia", "bowel ischaemia" and "bowel infarction". The bibliographies of relevant articles were screened for additional publications. After an initial systematic review of the literature by the whole group, a steering group formulated questions using a modified Delphi process. The evidence was then reviewed to answer these questions, and recommendations formulated and agreed by the whole group. RESULTS The resultant recommendations are presented in this paper. CONCLUSIONS The aim of these guidelines is to provide recommendations for practice that will lead to improved outcomes for patients.
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Affiliation(s)
- J V T Tilsed
- Surgery Health Care Group, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK.
| | - A Casamassima
- Emergency Department, Istituto Clinico Città Studi, Milan, Italy
| | - H Kurihara
- Emergency Surgery and Trauma Unit, Humanitas Research Hospital, Rozzano, Italy
| | - D Mariani
- Department of General Surgery, Ospedale di Legnano, Milan, Italy
| | - I Martinez
- Servicio de Cirugía General y Digestiva, Hospital Universitario de Torrevieja, Torrevieja, Spain
| | - J Pereira
- Surgery 1-Tondela-Viseu Hospital Centre, Viseu, Portugal
| | - L Ponchietti
- Department of Surgery, Milton Keynes Hospital NHS Foundation Trust, Milton Keynes, UK
| | - A Shamiyeh
- 2nd Surgical Department, Kepler University Clinic Linz, Linz, Austria
| | - F Al-Ayoubi
- Division of Trauma and Acute Care Surgery, Mafraq Hospital, Abu Dhabi, United Arab Emirates
| | - L A B Barco
- Department of Angiology and Vacular Surgery, University Hospital of Torrevieja, Torrevieja, Spain
| | - M Ceolin
- Emergency Surgery and Trauma Unit, Humanitas Research Hospital, Rozzano, Italy
| | - A J G D'Almeida
- Department of General Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - S Hilario
- 2nd Surgical Department, Santo André Hospital, Leiria, Portugal
| | - A L Olavarria
- Servicio de Cirugía General y Digestiva, Hospital Galdakao Usansolo, Vizcaya, Spain
| | - M M Ozmen
- Department of Surgery, Medical School, Hacettepe University, 06100, Ankara, Turkey
| | - L F Pinheiro
- General Surgery Department, Hospital São Teotónio, Viseu, Portugal
| | - M Poeze
- Department of Surgery/Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - G Triantos
- Department of General Surgery, Rhodes General Hospital, Rhodes, Greece
| | - F T Fuentes
- General Surgery 2 and Emergency Surgery, University General Hospital Gregorio Marañón, Madrid, Spain
| | - S U Sierra
- Department of Surgery, Galdakao-Usansolo Hospital, Galdakao, Vizcaya, Spain
| | - K Soreide
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - H Yanar
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Çapa, Istanbul, Turkey
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11
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Nakajima Y, Takahashi A, Kanno Y, Gunji N, Imaizumi H, Hayashi M, Okai K, Abe K, Watanabe H, Ohira H. Paralytic Ileus due to Superior Mesenteric Venous Thrombosis after Transarterial Injection for Hepatocellular Carcinoma. Intern Med 2016; 55:37-42. [PMID: 26726083 DOI: 10.2169/internalmedicine.55.5907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 69-year-old man was admitted to hospital with abdominal pain. In the four years prior to his presentation, he had undergone repeated transarterial chemoembolizations and injections for hepatocellular carcinoma. He underwent his 8th transcatheter arterial therapy one month prior to admission. Abdominal X-rays and contrast-enhanced computed tomography showed large amounts of small intestinal gas and venous thrombosis from the portal vein to the superior mesenteric vein, respectively. The thrombosis was reduced after anticoagulation therapy (heparin, antithrombin III, danaparoid sodium and warfarin). This is the first case report of paralytic ileus due to superior mesenteric venous thrombosis after transcatheter arterial therapy for hepatocellular carcinoma with an arterioportal shunt.
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Affiliation(s)
- Yuki Nakajima
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Japan
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12
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Liu K, Meng J, Yang S, Liu B, Ding W, Wu X, Li J. Transcatheter thrombolysis combined with damage control surgery for treatment of acute mesenteric venous thrombosis associated with bowel necrosis: a retrospective study. World J Emerg Surg 2015; 10:50. [PMID: 26516342 PMCID: PMC4625718 DOI: 10.1186/s13017-015-0045-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 10/21/2015] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE This study aims to evaluate the clinical outcomes of transcatheter thrombolysis in acute superior mesenteric venous thrombosis (ASMVT) associated with bowel necrosis. METHODS A retrospective study of six patients with ASMVT treated with catheter-directed thrombectomy/thrombolysis and damage control surgery at Jinling Hospital (Nanjing, China) between 2010 and 2013 was conducted. Demographics, past medical history, risk factors, therapeutic methods and effects, mortality, and follow-up of the study population were assessed. RESULTS Five of six patients underwent arteriovenous combined thrombolysis, while one patient underwent arterial thrombolysis. All patients required damage control surgery, and four of these patients underwent temporary abdominal closure. All patients survived and were free of recurrence. CONCLUSIONS Transcatheter thrombectomy/thrombolysis and damage control surgery could help avoid extensive bowel resection, prevent short bowel syndrome and reduce mortality for critically ill patients with acute mesenteric venous thrombosis associated with bowel necrosis.
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Affiliation(s)
- Kai Liu
- Medical School of Nanjing University, Nanjing, 210002 Jiangsu Province P. R. China
| | - Jiaxiang Meng
- Medical School of Nanjing University, Nanjing, 210002 Jiangsu Province P. R. China
| | - Shuofei Yang
- Medical School of Nanjing University, Nanjing, 210002 Jiangsu Province P. R. China
| | - Baochen Liu
- Medical School of Nanjing University, Nanjing, 210002 Jiangsu Province P. R. China
| | - Weiwei Ding
- Research Institute of General Surgery, Jinling Hospital, 305 East Zhongshan Road, 210002 Nanjing, Jiangsu China
| | - Xingjiang Wu
- Research Institute of General Surgery, Jinling Hospital, 305 East Zhongshan Road, 210002 Nanjing, Jiangsu China
| | - Jieshou Li
- Research Institute of General Surgery, Jinling Hospital, 305 East Zhongshan Road, 210002 Nanjing, Jiangsu China
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Multidisciplinary stepwise management strategy for acute superior mesenteric venous thrombosis: an intestinal stroke center experience. Thromb Res 2014; 135:36-45. [PMID: 25466834 DOI: 10.1016/j.thromres.2014.10.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/16/2014] [Accepted: 10/14/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUD Acute superior mesenteric venous thrombosis (ASMVT) is an uncommon but catastrophic abdominal vascular emergency with high rate of intestinal failure and mortality. The retrospective pilot study was performed to assess the effect of a multidisciplinary stepwise management strategy on survival and mesenteric recanalization in an integrated intestinal stroke center (ISC). MATERIALS AND METHODS A modern management strategy performed by multidisciplinary specialists in ISC was evaluated among 43 ASMVT patients that were classified into central vs peripheral type, operative vs nonoperative, early vs late treated group from March 2009 to April 2013. Patients received specific medical therapy, endovascular treatment, damage-control surgery, selective second-look laparotomy, critical care management, and clinical nutrition support in a stepwise way. The demographics, etiology, imaging characteristics, treatment procedures, complications, clinical outcome, and 1-year follow-up data were analyzed and compared. Confounding factors of mortality were identified by univariate and ROC-curve analysis. A single-center experience of over 5years for this modern strategy was also reported. RESULTS The protocol of multidisciplinary stepwise management strategy was followed in all ASMVT patients successfully. The 30-day mortality and recanalization rate were 11.63% and 90.70%. Initial damage-control surgery was carried out in 46.51% patients, with selective second-look laparotomy in 23.26% patients. Endovascular thrombolysis was performed in 83.72% patients initially or postoperatively. Bowel resection was necessary in 18 patients with the length of 100.00 (47.50, 222.50) cm. The incidence of short-bowel syndrome was 13.95%. The rate and length of bowel resection, short-bowel syndrome rate were significantly lower in nonoperative and early-treated groups (P<0.05). During the follow-up survey, 1-year survival was 83.72%, with no additional death or re-thrombosis. CONCLUSION A multidisciplinary stepwise management strategy involving modern surgical and endovascular treatments that focus on early mesenteric recanalization and bowel viability salvage in a specialized ISC could significantly improve the clinical outcome of ASMVT patients.
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Rottenstreich A, Khalaileh A, Elazary R. Sleeve gastrectomy and mesenteric venous thrombosis: report of 3 patients and review of the literature. Surg Obes Relat Dis 2014; 10:e57-61. [DOI: 10.1016/j.soard.2014.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 07/06/2014] [Accepted: 07/07/2014] [Indexed: 10/25/2022]
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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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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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Werner KT, Sando S, Carey EJ, Vargas HE, Byrne TJ, Douglas DD, Harrison ME, Rakela J, Aqel BA. Portal vein thrombosis in patients with end stage liver disease awaiting liver transplantation: outcome of anticoagulation. Dig Dis Sci 2013; 58:1776-80. [PMID: 23314858 DOI: 10.1007/s10620-012-2548-y] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 12/24/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND The prevalence of portal vein thrombosis (PVT) increases with the severity of liver disease. Development of PVT is often accompanied by increased rate of morbidity and mortality and may affect patient candidacy for liver transplant. There is limited data regarding the role of anticoagulation therapy in patients with PVT and liver cirrhosis. OBJECTIVES The aims of this study were to describe the prevalence of hypercoagulable disorders in patients with liver cirrhosis and PVT, and to describe the outcome of anticoagulation in patients with liver cirrhosis and PVT. METHODS A retrospective chart review was conducted of patients with liver cirrhosis awaiting liver transplant who were diagnosed with PVT between January 2005 and November 2011. RESULTS During the study period, 537 patients were evaluated for liver transplant. Sixty-nine (13 %) patients were diagnosed with portal vein thrombosis. Chronic hepatitis C was the cause of liver disease in 24/69 (35 %) patients, and hepatocellular carcinoma was present in 39 % of patients. In 22 patients screened for hypercoagulable disorders, hypercoagulable disorder was diagnosed in one patient (5 %). Twenty-eight (28/69) patients were treated during the study period with warfarin: PVT resolved in 11/28 (39 %), no change in 5/28 (18 %), and 12/28 (43 %) patients showed partial resolution of thrombus. Eight patients received liver transplant while on anticoagulation, and operative notes confirmed patency of PV in all eight patients. CONCLUSIONS PVT is frequently seen in patients with end stage liver disease with prevalence of 13 %. Hypercoagulable disorder was detected in 5 % of the patients screened. Careful use of anticoagulation is safe and effective in patients with PVT.
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Affiliation(s)
- K T Werner
- Division of Gastroenterology and Hepatology, Mayo Clinic, E Mayo Blvd. 5777, Phoenix, AZ 85054, USA
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İnan M, Sarıoğlu T, Serhat TH. Portomesenteric venous thrombosis as a rare cause of acute abdomen in a young patient: What should be the process of diagnosis and management? ULUSAL CERRAHI DERGISI 2013; 29:84-7. [PMID: 25931853 DOI: 10.5152/ucd.2013.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 04/03/2012] [Indexed: 12/29/2022]
Abstract
This report aimed to discuss indications for radiological evaluation, laboratory investigation for thrombophilic risk factors, and the duration of anticoagulation therapy in porto-mesenteric venous thrombosis, based on a young patient who presented with acute abdomen and ascites. We investigated the acquired and genetic thrombophilic risk factors and the diagnostic process. Abdominal CT and Doppler US were found to be useful radiological tools in both diagnosis and follow-up of portomesenteric thrombosis. The investigated thrombophilic factors, PT G20210A, MTHFR C677T and MTHFR A1298C, were positive for heterozygous mutations and high levels of lupus anticoagulant and factor VIII were detected. Rapid ascites resolution and an improvement in abdominal pain after meals were observed following anticoagulation. Follow-up examination after six months showed that the portomesenteric thrombosis had completely resolved. Evaluation by CT is recommended for patients with acute abdomen and ascites, especially if ultrasonography failed to show any specific pathology. Several acquired or genetic thrombophilic factors were identified in a patient in whom local precipitating factors were absent. For patients with genetic thrombophilic risk factors and thrombosis at an uncommon site in the body, lifelong treatment with anticoagulants is recommended.
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Affiliation(s)
- Mehmet İnan
- Department of General Surgery, Mağusa Medical Center, Gazimagusa, Turkish Republic of Northern Cyprus
| | - Tansel Sarıoğlu
- Department of Radiology, Mağusa Medical Center, Gazimagusa, Turkish Republic of Northern Cyprus
| | - Tülay Hakkı Serhat
- Department of Radiology, Mağusa Medical Center, Gazimagusa, Turkish Republic of Northern Cyprus
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Hall TC, Garcea G, Metcalfe M, Bilku D, Dennison AR. Management of acute non-cirrhotic and non-malignant portal vein thrombosis: a systematic review. World J Surg 2012; 35:2510-20. [PMID: 21882035 DOI: 10.1007/s00268-011-1198-0] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND No definitive evidence exists regarding the treatment of acute portal vein thrombosis (PVT). Treatment modalities described include conservative management, anticoagulation, thrombolysis, and thrombectomy. This review examines the impact of such treatment, its outcomes, and the complications resulting from the resultant portal hypertension. METHODS A Medline literature search was undertaken using the keywords portal vein thrombosis, anticoagulation, thrombolysis, and thrombectomy. The primary end point was portal vein recanalization. Secondary outcome measures were morbidity and the development of portal hypertension and its sequelae, including variceal bleeding. Data from articles relating to PVT in the context of cirrhosis, malignancy, or liver transplant were excluded. RESULTS Early systemic anticoagulation results in complete portal vein recanalization in 38.3% of cases and partial recanalization in 14.0% of cases. Spontaneous recanalization without treatment can only be expected in up to 16.7% of patients. Frequently this is only when associated with self-limiting underlying pathology and/or minimal thrombus extension. Thrombolysis can be associated with major complications in up to 60% of patients. CONCLUSIONS The natural history of acute PVT is poorly described. Spontaneous resolution of acute portal vein thrombosis is uncommon. Early anticoagulation results in a satisfactory rate of recanalization with minimal procedure-associated morbidity. Thrombolysis should be used with caution and only considered if the disease is progressive and signs of mesenteric ischemia are present. Further well-designed trials with precise outcome reporting are needed to improve our understanding of the disease.
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Affiliation(s)
- T C Hall
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, Leicester, LE5 4PW, UK.
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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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Bellanger DE, Hargroder AG, Greenway FL. Mesenteric venous thrombosis after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2010; 6:109-11. [DOI: 10.1016/j.soard.2009.08.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 08/08/2009] [Indexed: 12/19/2022]
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Cytomegalovirus-associated superior mesenteric vein thrombosis treated with systemic and in-situ thrombolysis. Eur J Gastroenterol Hepatol 2009; 21:587-92. [PMID: 19373975 DOI: 10.1097/meg.0b013e3283196b15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A 56-year-old patient, first diagnosed with an acute cytomegalovirus infection, presented with progressive abdominal pain because of a superior mesenteric vein thrombosis for which he was treated with systemic thrombolysis and heparin in continuous infusion. As this therapy did not have the intended success after 5 days, an interventional radiological procedure was performed with local thrombolysis in the superior mesenteric artery resulting in recanalisation of the vein. Oral anticoagulation was initiated and continued for a period of 6 months. Mesenteric venous thrombosis is a relatively uncommon cause of mesenteric ischemia that can be associated with severe morbidity and significant mortality. With noninvasive techniques, it is possible to establish a diagnosis in the majority of the cases. The importance of an early diagnosis and therapy - not only with anticoagulation, but also thrombolysis in selected cases - is shown with this case and review of the literature.
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Abstract
This guideline has been approved by the American Association for the Study of Liver Diseases (AASLD) and represents the position of the association.
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Affiliation(s)
- Laurie D. DeLeve
- Division of Gastrointestinal and Liver Diseases and the Research Center for Liver Diseases, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Dominique-Charles Valla
- Service d’Hépatologie, Hôpital Beaujon, Université Denis-Diderot-Paris 7, and Institut National de la Santé et de la Recherche Médicale U773, Clichy, France
| | - Guadalupe Garcia-Tsao
- Digestive Disease Section, Yale University School of Medicine and Veterans Administration–Connecticut Healthcare System, New Haven, CT
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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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Dobrinja C, Trevisan G, Petronio B, Liguori G. Idiopathic mesenteric venous thrombosis: report of a case. ACTA ACUST UNITED AC 2008; 33:96-100. [PMID: 18396003 DOI: 10.1016/j.jmv.2008.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Accepted: 02/19/2008] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Idiopathic mesenteric venous thrombosis is a rare entity. An early diagnosis and thrombolytic and anticoagulant therapy are very important. PATIENT AND METHODS We report a case of a patient, without any specific known risk factor, with small intestinal ischemia secondary to superior mesenteric vein thrombosis (SMVT). RESULTS In our case, only a computed tomography (CT) abdominal scan permitted the diagnosis of SMVT. The patient was successfully treated by resection of the infarcted bowel with primary anastomosis and immediate postoperative anticoagulation. CONCLUSIONS Diagnosis of intestinal ischemia from mesenteric venous thrombosis (MVT) is often delayed because the symptoms are nonspecific. Moreover, when there is not any known predisposing factor, the diagnosis may become even more difficult with significant morbidity and mortality. CT abdominal scan done early in case of nonspecific abdominal pain, since the patients had a previous history of venous thrombosis, may not require a surgical treatment of MVT.
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Affiliation(s)
- C Dobrinja
- Department of General and Thoracic Surgery, Division of Clinical Surgery, Hospital of Cattinara, Università degli Studi di Trieste, Strada di Fiume 447, Trieste, Italy.
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Hirmerova J, Jana H, Liska V, Vaclav L, Mirka H, Hynek M, Chudacek Z, Zdenek C, Treska V, Vladislav T. Portal and mesenteric vein thromboses in a patient with prothrombin G20210 mutation, elevated lipoprotein (a), and high factor VIII. Clin Appl Thromb Hemost 2007; 14:481-5. [PMID: 18160613 DOI: 10.1177/1076029607308392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
A 65-year-old man was examined for abdominal pain. Portal and mesenteric vein thromboses were described by ultrasound and computed tomography. No local cause was found. The patient had a positive history of venous thromboembolism. Thrombophilia workup revealed prothrombin G20210A mutation (heterozygous), C677T mutation of methylenetetrahydrofolate reductase gene (homozygous), elevated level of lipoprotein (a), and high level of coagulation factor VIII. Anticoagulation was started and planned for a long-term duration. The etiology of portal vein thrombosis is often multifactorial, with various combinations of systemic factors (inherited or acquired prothrombotic conditions) and local precipitating factors (inflammation, injury to the portal venous system, cancer of the abdominal organs, cirrhosis). The reported prevalence of hypercoagulable states in patients with portal vein thrombosis has been very heterogeneous so far. Some authors support a role of the prothrombin G20210A mutation. In the reported patient, this mutation was revealed in a combination with other hypercoagulable states.
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Affiliation(s)
- Jana Hirmerova
- 2nd Department of Internal Medicine, University Hospital, Charles University, Pilsen-Bory, Dr. E. Benese 13, Pilsen, Czech Republic.
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Lin HYH, Lin ZY, Shih PMC, Chuang WL. Acute pancreatitis complicated with transient portal venous thrombosis in one patient with hepatocellular carcinoma and cirrhosis. Kaohsiung J Med Sci 2007; 23:254-8. [PMID: 17525008 DOI: 10.1016/s1607-551x(09)70406-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Portal venous thrombosis (PVT) is a condition associated with high morbidity. The etiologies of PVT include intra-abdominal inflammation or infection, surgical intervention, abdominal malignancies such as hepatocellular carcinoma (HCC) and pancreatic carcinoma, or abnormality in coagulation caused by various reasons such as liver cirrhosis. Management of PVT should be based on its etiology and the condition of the patient. We describe a cirrhotic patient with HCC who suffered from acute pancreatitis. PVT in the main trunk was detected at admission due to the episode of acute pancreatitis. The etiology of thrombosis was considered to be inflammation around the main portal trunk caused by pancreatitis rather than cirrhosis or HCC. We did not instigate any management for the thrombosis. Acute pancreatitis was relieved after conservative treatment. Follow-up imaging study performed 46 days after detection of thrombosis showed spontaneous complete resolution of the thrombus. Our experience may provide useful information for the management of such patients.
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Affiliation(s)
- Hugo You-Hsien Lin
- Division of Hepatobiliary Medicine, Department of Internal Medicine, Kaohsiung Medical University, Taiwan
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Bagnobianchi A, Ordóñez A, Miñano A, Sánchez I, Cano H, Del Rey ML, Hernández-Espinosa D, González-Conejero R, Corral J. A novel mutation in the antithrombin gene (insT 7429–30) causes superior mesenteric vein thrombosis. Thromb Res 2007; 119:793-6. [PMID: 16839598 DOI: 10.1016/j.thromres.2006.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Revised: 05/31/2006] [Accepted: 06/02/2006] [Indexed: 10/24/2022]
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Orr DW, Harrison PM, Devlin J, Karani JB, Kane PA, Heaton ND, O'Grady JG, Heneghan MA. Chronic mesenteric venous thrombosis: evaluation and determinants of survival during long-term follow-up. Clin Gastroenterol Hepatol 2007; 5:80-6. [PMID: 17142105 DOI: 10.1016/j.cgh.2006.09.030] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The natural history of chronic portomesenteric (PM) and portosplenomesenteric (PSM) venous thrombosis is defined poorly. Therapeutic options are limited, and are directed at the prevention of variceal bleeding and the control of abdominal pain related to gastrointestinal hyperemia. METHODS Patients with extensive PM and PSM thrombosis were reviewed retrospectively to evaluate the efficacy of medical therapy and to determine which clinical variables had prognostic significance regarding long-term survival. RESULTS Sixty patients, with a median age at diagnosis of 44 years (range, 18-68 y), were assessed. The median follow-up period was 3.5 years (range, 0.2-32.0 y). The overall survival rate was 73.3%, with 1- and 5-year survival rates of 81.6%, and 78.3%, respectively. One- and 5-year survival rates, excluding patients who died from malignancy-related causes, were 85.7% and 82.1%, respectively. Factors associated with improved survival included treatment with beta-blockers (P = .02; odds ratio [OR], .09; 95% confidence interval [CI], 0.01-0.70) and anticoagulation (P = .005; OR, 0.01; 95% CI, <0.01 to 0.26). Eighteen patients in total were anticoagulated, including 8 patients who had variceal bleeding, all of whom underwent endoscopic band ligation of esophageal varices before anticoagulation. By using Cox regression analysis, variables associated with reduced survival were the presence of ascites (P = .001; OR, 42.6; 95% CI, 5.03-360), and hyperbilirubinemia (P = .01; OR, 13.8; 95% CI, 1.9-100) at presentation. Six patients died of variceal hemorrhage. CONCLUSIONS Patients with chronic PM and PSM venous thrombosis without underlying malignancy have an acceptable long-term survival. Treatment with beta-blockers and anticoagulation appears to improve outcome.
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Affiliation(s)
- David W Orr
- Institute of Liver Studies, King's College Hospital, Denmark Hill, London, England
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MESH Headings
- Acute Disease
- Adult
- Anticoagulants/therapeutic use
- Biopsy
- Carcinoma, Hepatocellular/complications
- Carcinoma, Hepatocellular/diagnosis
- Carcinoma, Hepatocellular/pathology
- Colonoscopy
- Hemangioma, Cavernous/diagnosis
- Hemangioma, Cavernous/diagnostic imaging
- Hemangioma, Cavernous/etiology
- Hemangioma, Cavernous/therapy
- Humans
- Liver/pathology
- Liver Cirrhosis/complications
- Liver Neoplasms/complications
- Liver Neoplasms/diagnosis
- Liver Neoplasms/pathology
- Liver Transplantation
- Mesenteric Vascular Occlusion/diagnostic imaging
- Mesenteric Veins
- Portal Vein/pathology
- Portal Vein/physiopathology
- Portasystemic Shunt, Transjugular Intrahepatic
- Prognosis
- Retrospective Studies
- Tomography, Spiral Computed
- Tomography, X-Ray Computed
- Vascular Neoplasms/diagnosis
- Vascular Neoplasms/diagnostic imaging
- Vascular Neoplasms/etiology
- Vascular Neoplasms/therapy
- Venous Thrombosis/complications
- Venous Thrombosis/diagnosis
- Venous Thrombosis/diagnostic imaging
- Venous Thrombosis/drug therapy
- Venous Thrombosis/etiology
- Venous Thrombosis/pathology
- Venous Thrombosis/physiopathology
- Venous Thrombosis/surgery
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Affiliation(s)
- Bertrand Condat
- Service d'Hépatogastroentérologie, Hôpital Saint Camille, Bry-sur-Marne.
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Condat B, Valla D. Nonmalignant portal vein thrombosis in adults. NATURE CLINICAL PRACTICE. GASTROENTEROLOGY & HEPATOLOGY 2006; 3:505-15. [PMID: 16951667 DOI: 10.1038/ncpgasthep0577] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2005] [Accepted: 06/28/2006] [Indexed: 02/06/2023]
Abstract
Portal vein thrombosis (PVT) consists of two different entities: acute PVT and chronic PVT. Acute PVT usually presents as abdominal pain. When the thrombus extends to the mesenteric venous arches, intestinal infarction can occur. Chronic PVT is usually recognized after a fortuitous diagnosis of hypersplenism or portal hypertension, or when there are biliary symptoms related to portal cholangiopathy. Local risk factors for PVT, such as an abdominal inflammatory focus, can be identified in 30% of patients with acute PVT; 70% of patients with acute and chronic PVT have a general risk factor for PVT, most commonly myeloproliferative disease. Early initiation of anticoagulation therapy for acute PVT is associated with complete and partial success in 50% and 40% of patients, respectively. A minimum of 6 months' anticoagulation therapy is recommended for the treatment of acute PVT. For patients with either form of PVT, permanent anticoagulation therapy should be considered if they have a permanent risk factor. In patients with large varices, beta-adrenergic blockade or endoscopic therapy seems to prevent bleeding as a result of portal hypertension, even in patients on anticoagulation therapy. In patients with jaundice or recurrent biliary symptoms caused by cholangiopathy, insertion of a biliary endoprosthesis is the first treatment option. Overall, the long-term outcome for patients with PVT is good, but is jeopardized by cholangiopathy and transformation of underlying myeloproliferative disease into myelofibrosis or acute leukemia.
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Affiliation(s)
- Bertrand Condat
- Service d'Hépatologie, Hôpital Beaujon, 100 Boulevard du Général-Leclerc, 92118 Clichy Cedex, France
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Famularo G, Minisola G, Nicotra GC, Simone CD. Mesenteric and portal vein thrombosis associated with hyperhomocysteinemia and heterozygosity for factor V Leiden mutation. World J Gastroenterol 2006; 11:7700-1. [PMID: 16437705 PMCID: PMC4727217 DOI: 10.3748/wjg.v11.i48.7700] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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