Transhepatic fibrinolysis of mesenteric and portal vein thrombosis in a patient with ulcerative colitis: a case report (original) (raw)
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Blood Coagulation & Fibrinolysis, 2007
Portal or/and mesenteric vein thrombosis is a rare condition with high mortality in an acute form. Therapy of thrombosis is not well defined, although there are some general guidelines that differ according to disease onset and clinical presentation. In acute thrombosis with bowel infarction, surgical resection with possible thrombolysis is advised. The best therapy for the subacute form is not known and the approach differs between centers. For chronic disease, prolonged anticoagulant therapy is recommended. Thrombolysis is well recognized in the treatment of acute ischemic coronary or cerebral diseases. Success of treatment is better if therapy is introduced within a few hours after symptoms have begun. We describe a 25-year-old patient with the subacute form of extensive portal, mesenteric and ileocolic vein thrombosis in the setting of underlying liver cirrhosis due to autoimmune disease. An aggressive therapeutic approach is advised, especially in patients who will eventually undergo liver transplantation, since portal and/or mesenteric vein thrombosis is relative contraindication for liver transplantation in the majority of transplant centers. Blood Coagul Fibrinolysis 18:581-583 ß 2007 Lippincott Williams & Wilkins.
International Journal of Surgery Case Reports, 2018
INTRODUCTION AND CASE PRESENTATION: Acute portal and superior mesenteric vein thrombosis(SMV) is a rare but potentially lethal condition that is often characterized by generalized and non-specific symptoms. A high index of suspicion is warranted for early diagnosis and management. We present a case of 54 year old male who presented with generalized abdominal pain which was later accompanied by hemodynamic instability and radiological diagnosis of portal vein and superior mesenteric vein thrombosis. DISCUSSION: The management of SMV can be divided into medical and surgical therapy. Patients who have clear signs of peritonitis will require emergent surgery. Interventions for life-threatening portal vein thrombosis are limited and poorly described in the literature. CONCLUSION: We report a case of extensive portal vein thrombosis(PVT) advancing proximally to involve the superior mesenteric vein. Rapid portal vein patency and improved hepatic function was achieved with the direct use of tissue plasminogen activator infusion via operatively placed middle colic vein catheter.
A Patient with Ulcerative Colitis Complicated by Systemic Vein Thrombosis
Case Reports in Gastroenterology, 2018
Crohn's disease and ulcerative colitis (UC) patients have an increased risk for thromboembolic complications, the most common of them are deep venous thrombosis and pulmonary embolism. Other locations and genetic mutations of coagulation factors are not so common in these patients. Here we present a case of a young woman with exacerbation of previously diagnosed mild UC complicated by multiple thrombotic incidents due to MTHFR gene mutation.
Mesenteric venous thrombosis in inflammatory bowel disease
American Journal of Gastroenterology, 2003
Mesenteric venous thrombosis (MVT) is a rare but potentially catastrophic clinical complication, which may lead to ischemia or infarction of the intestine and/or the emergence of portal hypertension. An association between inflammatory bowel disease (IBD) and MVT has previously been described, but clinical factors that may contribute to this complication in the setting of IBD are not well characterized. Diagnosis of MVT in IBD is difficult, as patients frequently present with nonspecific abdominal discomfort, which may delay diagnosis and initiation of treatment. We report 6 of 545 IBD patients at our center (1.1%) that developed MVT, and describe presentation, diagnostic approaches, treatment options, underlying contributing factors, and outcome. The diagnosis was determined with abdominal computed tomography (CT) in 5 of 6 cases. Clinical factors, which were thought to contribute to MVT, included underlying hypercoagulability, low-flow state, uncontrolled inflammation, perioperative time period, and prior surgical manipulation of the portal vein following orthotopic liver transplantation. There were no deaths as a result of MVT, although 1 patient developed severe portal hypertension and another experienced intestinal infarction requiring extensive resection. We conclude that MVT is an important clinical consideration in IBD patients, specifically during the perioperative setting, and diagnosis is facilitated with the use of CT scan.
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.
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.
Surgery Today, 2006
bowel resection and thrombolytic infusion via a jejunal vein. Case Report A 52-year-old woman who had been taking warfarin for 4 years because of previous portal vein thrombosis presented with acute abdominal pain. Evaluation of hypercoagulablity revealed decreased protein C activity to 20% (70%-140%) and decreased protein S activity to 56% (70%-123%). The patient stated that she had stopped taking warfarin 6 months earlier. Physical examination revealed a distended abdomen with diminished bowel sounds and rebound tenderness. Laboratory analysis detected an elevated WBC count, and normal prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT) levels, and blood chemistry. Computed tomography (CT) showed thrombosis of the SMV with a thickened small bowel wall (Fig. 1). Heparin treatment was initiated with a bolus dose of 5000 U followed by a continuous infusion of 1000 U/h. Surgical exploration identified free peritoneal fluid, a thickened small bowel, and edematous mesentery with hard and thrombosed jejunal veins. We resected a 20-cm jejunal segment, which was infarcted, and performed end-to-end anastomosis. A peripheral jejunal vein was isolated and cut down. A central venous catheter with side holes was inserted and positioned at the confluence of the SMV and splenic vein under fluoroscopic guidance. Angiography through the catheter showed a tortuous and dilated splenic vein, but no image of the SMV and PV (Fig. 2). The other end of the catheter was brought through the abdominal wall, and a temporary abdominal closure was done in preparation for the planned second-look operation. Mesenteric thrombolysis was carried out with a bolus infusion of 1 500 000 U streptokinase just after the Abstract Mesenteric venous thrombosis (MVT) is a catastrophic form of mesenteric vascular occlusion. In the absence of peritoneal signs, anticoagulation therapy should be started immediately. For selected patients, thrombolysis through the superior mesenteric artery (SMA), jugular vein, or portal vein via a transhepatic route might be successful; however, exploratory laparotomy is mandatory when peritoneal signs develop. We report a case of acute MVT associated with protein C and S deficiency, treated successfully by limited bowel resection and simultaneous thrombolytic infusion, given via an operatively placed mesenteric vein catheter.
Introduction: Inflammatory bowel diseases (IBD) are a group of affections characterized by a chronic inflammation of the mucosae of the digestive tract and primarily include Crohn's Disease (CD) and Ulcerative Colitis (UC). Although much has already been studied, aetiology and pathomechanisms are still unclear. IBD patients are at risk of many complications including the risk of thromboembolic events. Thrombotic complications in this kind of patients have already been recognised and demonstrated although further considerations have to be made regarding the incidence of such kind of events.