Dual Approach to Portal and Superior Mesenteric Vein Thrombosis in an Octogenarian Patient (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.
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.
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.
Hybrid Management of Acute Portal Vein Thrombosis Complicated by Mesenteric Ischemia
Journal of Endovascular Resuscitation and Trauma Management, 2022
Treatment for portal vein thrombosis complicated by mesenteric ischemia can be treated in the operating room following a hybrid approach. This allows for efficient care of the patient, avoids the need for transhepatic cannulation for obtaining a venogram and placing a thrombolysis catheter, and obviates the need to obtain percutaneous venous access.
The Management of Mesenteric Vein Thrombosis: A Single Institution Experience
Turkish Journal of Trauma and Emergency Surgery, 2013
Mesenteric vein thrombosis occurs rarely and is responsible for approximately 5-15% of all cases of acute mesenteric ischemia. The aim of this report was to discuss the management of mesenteric vein thrombosis based on our experience with 34 patients. METHODS In the present study, 34 patients who were admitted to our emergency surgery department between January 2007 and January 2010 with a diagnosis of acute mesenteric vein thrombosis were assessed retrospectively. Patients with peritoneal signs first underwent diagnostic laparoscopy to rule out perforation or bowel gangrene. We performed a second-look laparoscopy within 72 hours of the first operation. All patients were administered 100 mg/kg of the anticoagulant enoxaparin twice daily. In the 6th and 12th months of follow up, CT angiography was performed to evaluate recanalization of the veins. RESULTS CT angiography revealed superior mesenteric vein thrombosis in 25 (73%) patients, portal vein thrombosis in 24 (70%) patients, and splenic vein thrombosis in 12 (35%) patients. Eleven patients with peritoneal signs underwent diagnostic laparoscopy; eight of the patients underwent small bowel resection, anastomosis, and trocar insertion. During second-look laparoscopy, small bowel ischemia was found in two patients and re-resection was performed. CONCLUSION Early diagnosis with CT angiography, surgical and nonsurgical blood flow restoration, proper anticoagulation, and supportive intensive care are the cornerstones of successful treatment of mesenteric vein thrombosis.
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 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.)