A Novel Surgical Method for the Postoperative Treatment of Superior Mesenteric Vein Thrombosis: Report of a Case (original) (raw)
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Small Intestinal Stricture Complicating an Asymptomatic Superior Mesenteric Vein Thrombosis
American Journal of Medical Case Reports, 2014
Ischemic stricture of the small intestine is a rare complication of mesenteric vein thrombosis. We report a case of small intestine stricture that complicated an asymptomatic superior mesenteric vein thrombosis. This diagnosis was challenging owing to the silent course of the primary cause; the superior mesenteric vein thrombosis and the rarity of the ischemic stricture of the small intestine as a complication. The patient underwent resectionanastomosis and passed an uneventful postoperative course. We concluded that a high suspicion level should be maintained during dealing with the cases of intestinal obstruction due to small intestine stricture as mesenteric ischemia could be the underlying cause.
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
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.
Hybrid Management of Acute Portal Vein Thrombosis Complicated by Mesenteric Ischemia
Journal of endovascular resuscitation and trauma management, 2022
Acute portal vein thrombosis complicated by mesenteric ischemia requires emergent treatment to address the compromised bowel as well as the portal vein thrombus. We report a novel hybrid approach to managing this disease process. The procedure we discuss entails exploratory laparotomy and small bowel resection by the acute care emergency surgery team. Following this, the vascular surgery team performs a portal venogram through a branch mesenteric vein accessed through the laparotomy incision and then places a thrombolysis catheter. This technique and approach allows us to provide initial management efficiently and effectively under one operation.
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.
Dual Approach to Portal and Superior Mesenteric Vein Thrombosis in an Octogenarian Patient
Gerontology & Geriatrics Studies
Mesenteric venous thrombosis (MVT) is an uncommon catastrophic form of mesenteric vascular occlusion. This clinical entity is associated with severe and potentially lethal complications. It accounts for 5-15% of the acute causes of mesenteric ischemia and up to 20% of all cases of intestinal infarction. In the literature, successful non-operative treatment options of MVT such as thrombolytic infusion via the superior mesenteric artery (SMA) or directly into the portal (PV) or superior mesenteric veins (SMV) via the transjugular or transhepatic routes have been shown. However; only a limited number of reports has pointed out thrombolysis by using a jejunal mesenteric vein. Here, the case of a patient with acute PVT and MVT, having a history of oral contraceptive usage who was treated successfully with limited bowel resection and thrombolytic infusion via a jejunal vein, is reported.
Small Bowel Perforation Secondary to Portal Vein Thrombosis
Cureus
Portal vein thrombosis (PVT) is a heterogeneous entity often described as either an acute or chronic occlusion of the portal vein or its tributaries. The clinical presentation is highly variable, and it often mimics other more common causes of abdominal pain. In most patients, imaging studies such as doppler ultrasound, computed tomography, or magnetic resonance imaging are adequate for diagnosis. Occasionally imaging studies may be inadequate, and the diagnosis may not be made until complications such as bowel necrosis and perforation have occurred. We present a case of a morbidly obese 45-year-old female who was initially treated for suspected small bowel enteritis and discharged home on several occasions after nonspecific findings on abdominal imaging were seen and interval improvement in symptoms occurred with intravenous fluids and antibiotics. She then presented with worsening symptoms and was found on abdominal imaging to have a large fluid collection in the peritoneal cavity requiring exploratory laparotomy with peritoneal washout and partial small bowel resection due to perforation. She was diagnosed with PVT with mesenteric extension after samples of the resected mesentery were evaluated in the pathology laboratory. Her treatment included a prolonged course of antibiotics, total parenteral nutrition, and anticoagulation.
Liver Transplantation and Surgery, 1998
Mesenteric vein thrombosis (MVT) is a rare cause of intestinal ischemia. Because of its nonspecific symptoms, diagnosis is often delayed. We describe a patient with liver cirrhosis who developed acute MVT while waiting for liver transplantation. Surgical intervention carried a high risk because of her underlying cirrhosis. Mesenteric venous thrombectomy and thrombolysis were performed with an AngioJet (Possis Medical, Min-neapolis, MN) thrombectomy device and streptokinase infusion through transjugular route. The patient subsequently received an orthotopic liver transplant. We also present a review of the literature about the occurrence and treatment options for MVT.