Small Intestinal Stricture Complicating an Asymptomatic Superior Mesenteric Vein Thrombosis (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.
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
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
The Showa University Journal of Medical Sciences
We report a case of Superior Mesenteric Vein Thrombosis (SMVT) surgically treated by resection of the small intestine, and the development of an effective novel method for therapy of small intestinal stoma and nutrition after the operation. SMVT with thrombosis length of about 3 cm was diagnosed with computed tomography (CT) in a 59-year-old male experiencing acute abdominal pain. Initially, IVR for thrombolytic therapy was unsuccessfully conducted. Thus, we subsequently performed resection of small intestine displaying necrosis due to disorder of blood flow, which was 20 cm in length and located 20 cm distal to the Trize band, but did not anastomose in primary to avoid anastomotic leakage by re-thrombosis. We performed temporary gastrostomy for the drainage of intestinal juice, and jejunostomy with the stomas of the closed small intestinal ends to detect blood flow disorder. A nutritional tube was inserted into the anal stoma. This method is generally successful for collecting all the intestinal juice that damages skin, and providing high-calorie nutrition. Further, more this prevented dermatitis due to intestinal juice around the intestinal stoma. After ensuring no recurrence of re-thrombosis, the intestinal stoma was closed. A present, this patient is monitored as an outpatient. We propose that this operative method is applicable for the administration of stomas and surrounding skin in other diseases.
Mesenteric venous thrombosis with transmural intestinal infarction: A population-based study
Journal of Vascular Surgery, 2005
To determine the cause-specific mortality from and incidence of transmural intestinal infarction caused by mesenteric venous thrombosis (MVT) in a population-based study and to evaluate the findings at autopsy by evaluating autopsies and surgical procedures. Methods: All clinical (n ؍ 23,446) and forensic (n ؍ 7569) autopsies performed in the city of Malmö between 1970 and 1982 (population 264,000 to 230,000) were evaluated. The autopsy rate was 87%. The surgical procedures were performed in 1970, 1976, and 1982. Autopsy protocols coded for intestinal ischemia or mesenteric vessel occlusion, or both, were identified in a database. In all, 997 of 23,446 clinical and 9 of 7,569 forensic autopsy protocols were analyzed. A 3-year sample of the surgical procedures, comprising 21.3% (11,985 of 56,251) of all operations performed during the entire study period, was chosen to capture trends of diagnostic and surgical activity. In a nested case-control study within the clinical autopsy cohort, four MVT-free controls, matched for gender, age at death, and year of death were identified for each fatal MVT case to evaluate the clinical autopsy findings. Results: Four forensic and 23 clinical autopsies demonstrated MVT with intestinal infarction. Seven patients were operated on, of whom six survived. The cause-specific mortality ratio was 0.9:1000 autopsies. The incidence was 1.8/100,000 person years. At autopsy, portal vein thrombosis and systemic venous thromboembolism occurred in 2 of 3 and 1 of 2 of the cases, respectively. Obesity was an independent risk factor for fatal MVT (P .)120.؍ Conclusions: The estimated incidence of MVT with transmural intestinal infarction was 1.8/100,000 person years. Portal vein thrombosis, systemic venous thromboembolism and obesity were associated with fatal MVT. ( J Vasc Surg 2005;41: 59-63.)
Mesenteric vascular occlusion resulting in intestinal necrosis in children
Journal of Pediatric Surgery, 2000
The records of 4 patients who had necrotic bowel secondary to acute mesenteric vascular occlusion affecting various levels of mesenteric vasculature were reviewed to determine the clinical manifestations, diagnostic investigations, predisposing factors, complications, and outcome of mesenteric vascular thrombosis in children. Methods: The medical records of the patients (3 boys, 1 girl) treated between 1981 and 1996, inclusive, for bowel infarction secondary to mesenteric vascular thrombosis, were reviewed with regard to signs and symptoms, laboratory tests, radiological investigations, surgical findings, histopathologic examinations, and outcome. Results: The ages of the patients ranged between 1 and 14 years with a mean age of 8.2 years. Initial symptoms, present in all patients, were abdominal pain, abdominal distension, and tenderness. Laboratory and radiological findings including abdominal radiographs and abdominal ultrasonography were nondiagnostic. Selective superior mesenteric angiography showed complete obliteration of the superior mesenteric artery with absence of venous return in 1 case. Three patients with massive intestinal necrosis died of multiorgan failure or the complications of short bowel syndrome. Histological examination of the resected intestinal segments showed the typical findings of polyarteritis nodosa in 2 patients. One patient had a previous history of right femoral vein thrombosis, whereas 1 patient had no known underlying disorders predisposing vascular thrombosis. Conclusions: Mesenteric vascular occlusion is a rare but serious disease leading to death in children. The patients present with similar clinical signs, most frequent and important are acute abdominal pain, vomiting, and distension. Mesenteric vascular occlusion is a rare cause of acute abdomen in childhood, which requires urgent diagnosis and intervention. In suspected mesenteric vascular insufficiency, angiography should be performed followed by intraarterial thrombolytic infusion therapy in selected cases. When intestinal infarction is suspected, immediate surgical resection of compromised bowel is necessary with appropriate postoperative anticoagulation or treatment of any underlying disease.
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.