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Acute mesenteric venous thrombosis (MVT) is a rare cause of adynamic intestinal obstruction (para... more Acute mesenteric venous thrombosis (MVT) is a rare cause of adynamic intestinal obstruction (paralytic ileus) that is associated with high mortality. A high index of suspicion is required to diagnose this condition. Contrast-enhanced CT scan is diagnostic. Management is usually complex and requires multidisciplinary approach, because MVT usually occurs in older patients with co-morbid disorders. Moreover, Heparin induced thrombocytopenia (HIT) can complicate heparin therapy which is the mainstay of medical management. Bowel ischaemia which may progress to infarction, gangrene and septicaemia is the main cause of morbidity and mortality. Hence, it is important to ensure intestinal viability, which may necessitate surgical resection that may be performed by laparotomy or laparoscopy. Additionally a second look laparotomy is sometimes indicated.
We present a case of MVT in a 67 year-old lady and review the published literature on this disorder. The lady was known diabetic hypertensive, as well as hepatitis C cirrhotic who also suffered from cardiac disease. We discuss the problems of diagnosis and management encountered in this patient within a clinical setting of a developing country. Despite a stormy postoperative course and intensive management, the patient survived with a good clinical outcome, and this has encouraged us to review the difficulties encountered in the diagnosis and management of this potentially fatal disorder.
Conclusion
MVT is a rare and fatal cause of small bowel obstruction. Its diagnosis requires a high level of suspicion. Early diagnosis and multidisciplinary management can largely improve its prognosis.
Acute mesenteric venous thrombosis (MVT) is a rare cause of adynamic intestinal obstruction (para... more Acute mesenteric venous thrombosis (MVT) is a rare cause of adynamic intestinal obstruction (paralytic ileus) that is associated with high mortality. A high index of suspicion is required to diagnose this condition. Contrast-enhanced CT scan is diagnostic. Management is usually complex and requires multidisciplinary approach, because MVT usually occurs in older patients with co-morbid disorders. Moreover, Heparin induced thrombocytopenia (HIT) can complicate heparin therapy which is the mainstay of medical management. Bowel ischaemia which may progress to infarction, gangrene and septicaemia is the main cause of morbidity and mortality. Hence, it is important to ensure intestinal viability, which may necessitate surgical resection that may be performed by laparotomy or laparoscopy. Additionally a second look laparotomy is sometimes indicated.
We present a case of MVT in a 67 year-old lady and review the published literature on this disorder. The lady was known diabetic hypertensive, as well as hepatitis C cirrhotic who also suffered from cardiac disease. We discuss the problems of diagnosis and management encountered in this patient within a clinical setting of a developing country. Despite a stormy postoperative course and intensive management, the patient survived with a good clinical outcome, and this has encouraged us to review the difficulties encountered in the diagnosis and management of this potentially fatal disorder.
Conclusion
MVT is a rare and fatal cause of small bowel obstruction. Its diagnosis requires a high level of suspicion. Early diagnosis and multidisciplinary management can largely improve its prognosis.