The Management of Mesenteric Vein Thrombosis: A Single Institution Experience (original) (raw)
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A study of 25 patients on surgical management of acute mesenteric vascular thrombosis
International Journal of Surgery Science, 2021
To study outcome of surgical management of acute mesenteric vascular thrombosis like Extent of disease Extent of resection Post-operative survival Patients and Methods: This study of 25 cases of diagnosed with acute mesenteric vascular thrombosis (MVT) from September 2016 to October 2018 in department of surgery, civil hospital Ahmadabad. Inclusion criteria: Patients with acute abdominal pain who is diagnosed as MVT in either on CT-scan or on exploration. Exclusion criteria: Patient with non-occlusive mesenteric ischemia that did not require laparotomy. Patient with only portal vein thrombosis. Results: Among 25 patients, 23 patients underwent exploratory laparotomy. Two patients were expired before surgery. In present study, maximum number of patients is in the age group 41-50 years. In 23 patients exploratory laparotomy was done based on their clinical feature with peritoneal signs with CECTabdomen pelvis finding. Mortality rate was 64% in my study while 9 (36%) patients are in follow-up, so early diagnosis and decision of intervention has saved 36% of patients. Conclusion: Mesenteric vascular thrombosis is one of the most lethal vascular disorders. So, this type of moribund conditions require urgent use of abdominal CT-Scan and increasing use of anti-coagulative medication improved the outcome in patients. This disease entity is lethal prompt decisions should be taken for patients survival.
International Journal of Surgery Case Reports
To present two cases of acute non-cirrhotic and non-malignant mesenteric vein thrombosis (MVT) treated with early transcatheter thrombectomy and thrombolysis with tissue plasminogen activator (tPA) and to review the literature on transcatheter thrombectomy and thrombolytic therapy of such condition. METHODS: Two cases of acute MVT treated with transhepatic transcatheter thrombectomy and thrombolysis in addition to systemic anticoagulation upon diagnosis are presented. In addition, a Pubmed literature search was undertaken using keywords acute mesenteric vein thrombosis, thrombolysis and thrombectomy. The inclusion criteria were studies examining the impacts of transcatheter thrombolysis and thrombectomy in the management of acute MVT. RESULTS: Early transcatheter thrombectomy and thrombolysis achieves technical success in both patients and result in nearly complete recanalization of the venous system, with no recurrent thrombosis to date in follow up. Both patients do not require extensive bowel resection despite extensive thrombus on presentation. However, both patients develop intra-abdominal bleeding requiring blood transfusion and embolization of the transcatheter tract. CONCLUSION: Catheter-directed first approach provides a minimal invasive approach for management of non-malignant and non-cirrhotic acute mesenteric thrombosis. It offers the benefits of rapid venous recanalization and avoid massing bowel resection despite extensive thrombosis. Subsequent progression into chronic MVT was also reduced. However, the procedure could lead to bleeding from puncture site and hence embolization of the catheter tract is advised during catheter removal.
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.
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.
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: 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.