Superior mesenteric venous thrombosis presenting with hematemesis: a case report (original) (raw)
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Management Of Bowel Ischemia Secondary To Mesenteric Vein Thrombosis: A Tight Rope Walk
The Internet Journal of Gastroenterology, 2010
Acute superior mesenteric vein (SMV) and portal vein (PV) thrombosis can be a complication of hypercoagulable, inflammatory, or infectious states. It can also occur as a complication of medical or surgical intervention. Management of mesenteric and portal vein thrombosis includes both operative and non-operative approaches. Operative interventions include thrombectomy with thrombolysis; this is often employed for patients who present with signs of peritoneal irritation. Nonoperative approaches can be either noninvasive or invasive. Treatment with anticoagulation has been shown to be efficacious, though its rate of recanalization is not as high as with intravascular infusion of thrombolytics. We here describe an interesting case report of a patient who developed ischemic bowel secondary to mesenteric vein thrombosis, who did not qualify for a surgical emergency and provided an interesting challenge in medical management until surgery finally took over the specific management.
Mesenteric Venous Thrombosis: Three Consecutive Cases
Kafkas Journal of Medical Sciences, 2020
Acute mesenteric venous thrombosis (MVT) has better prognosis than arterial thrombosis when the diagnosis is early. Newly developed radiological imaging are highly sensitive for of MVT; at the same time when early diagnosis is made, interventional radiology can apply aspiration thrombectomy or thrombolitics. We had presented three consecutive cases of MVT diagnosed in different clinical phases of thrombosis: first and third cases were diagnosed with intestinal necrosis, directly by laparotomy or laparoscopy and resection of the implicated segment was inevitable. Second patient was diagnosed at the phase of ischemia without necrosis, SMV was partially recanalised by the interventional radiologist with no reccurence of thrombosis for a period of 9 months.
Portal-venous gas unrelated to mesenteric ischemia
European Radiology, 2002
The aim of this study was to report on 8 patients with all different non-ischemic etiologies for portal-venous gas and to discuss this rare entity and its potentially misleading CT findings in context with a review of the literature. The CT examinations of eight patients who presented with intrahepatic portalvenous gas, unrelated to bowel ischemia or infarction, were reviewed and compared with their medical records with special emphasis on the pathogenesis and clinical impact of portal-venous gas caused by nonischemic conditions. The etiologies for portal-venous gas included: abdominal trauma (n=1); large gastric cancer (n=1); prior gastroscopic biopsy (n=1); prior hemicolectomy (n=1); graft-vs-host reaction (n=1); large paracolic abscess (n=1); mesenteric recurrence of ovarian cancer superinfected with clostridium septicum (n=1); and sepsis with Pseudomonas aeruginosa (n=1). The clinical outcome of all patients was determined by their underlying disease and not negatively influenced by the presence of portal-venous gas. Although the presence of portal-venous gas usually raises the suspicion of bowel ischemia and/or intestinal necrosis, this CT finding may be related to a variety of non-ischemic etiologies and pathogeneses as well. The knowledge about these conditions may help to avoid misinterpretation of CT findings, inappropriate clinical uncertainty and unnecessary surgery in certain cases.
Open Thrombectomy for Primary Acute Mesenterico-portal Venous Thrombosis – Should It Be Done?
Annals of Vascular Surgery, 2015
Mesentericoportal venous thrombosis (MVT) is a rare condition, accounting for 5e15% of acute mesenteric ischemia. Primary MVT is even rarer, with some reports quoting an incidence rate of 10e30% of reported cases. It presents a diagnostic challenge and is associated with a significant mortality rate, ranging from 13% to 50%. As it is an uncommon condition, the evidence in current literature regarding the treatment of MVT is limited. We discuss our surgical experience with a case of acute primary MVT that was managed with good clinical outcome and discuss the current evidence for the treatment of acute MVT. A 50-year-old Chinese lady with no significant past medical history presented with a 2-day history of abdominal pain and epigastric tenderness on examination. Computed tomography of her abdomen and pelvis showed evidence of extensive acute thrombi present in portal confluence extending into the superior mesenteric vein, associated with submucosal edema in some central jejunal loops. Despite systemic anticoagulation therapy with intravenous heparin, the patient deteriorated clinically, and decision was made for an exploratory laparotomy, small bowel resection, and open thrombectomy. Postoperative recovery was uneventful. She was discharged on postoperative day 13 with lifelong oral anticoagulation. In conclusion, we describe the successful management of a patient with extensive acute primary MVT where open thrombectomy was performed together with small bowel resection.
Introduction: Acute mesenteric ischemia is deadly from 50% to 90% of cases due to poor understanding of the clinical picture of abdominal pain and the differential diagnosis when it is not suspected and partly because of an unacceptable delay in making the diagnosis. Clinical case: A 31-year-old female with generalized abdominal pain without peritoneal irritation accompanied by vomiting and loose bowel movements. Vital signs: BP 90/70 mmHg, HR 100/min, BF 20/min, Temperature 96.8°F. Laboratory test: Bh: Hto. 39.4, 42.6/103 leukocytes/uL, 89% neutrophils, 10% lymphocytes; QS: glucose
Mesenteric venous thrombosis: A changing clinical entity
Journal of Vascular Surgery, 2001
Objective: Mesenteric venous thrombosis (MVT) and its clinical spectrum have become better defined following improvements in diagnostic imaging. Historically, MVT has been described as a morbid clinical entity, but this may not necessarily be true. Often, an underlying disease process that predisposes a patient to MVT can be found and potentially treated. This study was designed to evaluate the diagnostics and management of MVT and to review long-term results of treatment. Patients: Thirty-one patients in whom MVT was diagnosed between 1985 and 1999 were retrospectively reviewed. Survivors were contacted for follow-up. There were 15 men and 16 women. Ages ranged from 22 to 80 years (mean, 49.1 years). Thirteen patients had documented hypercoagulability, 10 had a history of previous abdominal surgery, 6 had a prior thrombotic episode, and 4 had a history of cancer. MVT presented as abdominal pain (84%), diarrhea (42%), and nausea/vomiting (32%). Computed tomography (CT) was considered diagnostic in 18 (90%) of 20 patients who underwent the test. CT diagnosed MVT in 15 (100%) of 15 patients presenting with vague abdominal pain or diarrhea. Angiography demonstrated MVT in only five (55.5%) of nine patients. Results: Seven of 31 patients died within 30 days (< 30-day mortality rate, 23%). Twenty-two patients (72%) were initially treated with heparin. Nine patients were not heparinized: four of them died, and two were later given warfarin sodium (Coumadin). Of the 31 patients, only one received lytic therapy. Three patients became symptom free without anticoagulation. Ten patients (32%) underwent bowel resection. Overall, 19 (79%) of 24 survivors were treated with long-term warfarin therapy. Long-term follow-up was obtained in 24 patients (mean, 57.7 months). Twenty-one (88%) of 24 survived in follow-up. Conclusion: The diagnosis of MVT should be suspected when acute abdominal symptoms develop in patients with prior thrombotic episodes or a documented coagulopathy. CT scanning appears to be the primary diagnostic test of choice. Anticoagulation is recommended. If diagnosed and treated early, MVT is not likely to progress to gangrenous bowel. Recent mortality rates for MVT are lower than previously published, perhaps because of earlier diagnosis and aggressive treatment or possibly because we now readily diagnose a more benign form of the disease, which is due to widespread use of CT scanning.
Acute mesenteric ischemia revealing cirrhosis: about a clinical case
Gastroenterology & Hepatology: Open Access, 2020
Acute mesenteric ischemia (AMI) is a rare and serious medical and surgical emergency, the prognosis of which depends on the early diagnosis and appropriate treatment. It is caused by acute or chronic interruption of splanchno-mesenteric blood flow. This interruption may be due to embolism, thrombosis or intestinal hypoperfusion. We report a case of acute mesenteric ischemia in a young subject in a National Hospital and University Center of Benin. He was a 23-year-old man with no history of admitting a diffuse abdominal pain, excruciating, sudden onset of torsion and associated vomiting and stopping of materials and gases. Emergency laparotomy revealed acute mesenteric ischemia with ileal necrosis. Ileal resection with endo-ileal endo-ileal anastomosis was performed. Etiological research has revealed cirrhosis of undetermined cause. The postoperative course was marked by short bowel syndrome and ascitic decompensation of cirrhosis. Under symptomatic treatment, vitamin and iron supplementation and diuretic evolution was favorable.
Journal of Surgery, 2020
Ischemic bowel stenosis is an infrequent late complication of chronic ischemia in a patient with thrombosis of the Superior Mesenteric (SMV) and portal vein (PV) and there are only few cases reported. Abdominal Computed Tomography scan (CT scan) is the preferred radiologic test for this disease. Close follow-up of each patient is essential even after treatment for MSV thrombosis for an early diagnosis and treatment of this complication. We present a case of ischemic jejunal stenosis subsequent to SMV thrombosis and anticoagulant treatment, as well as a literature overview