A study of 25 patients on surgical management of acute mesenteric vascular thrombosis (original) (raw)
Related papers
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.
The Egyptian Journal of Hospital Medicine, 2013
Background and aim of the study: Mesenteric venous thrombosis has a global incidence of 10-15% of all cases of mesenteric ischemia; however reports from high altitude provinces of Saudi Arabia as Taif and Aseer recorded an incidence above 60%. The aim of this study is to record the incidence, pattern of presentation, risk factors; diagnostic tools and outcome of treatment in a single center (King Abdul Aziz Specialist Hospital) Taif, Saudi Arabia. Material and method: In this retrospective chart review study, we reviewed the records and data of all patients presented to King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia from January 2009 to January 2013 and their final diagnosis were proved to be acute mesenteric venous thrombosis. Traumatic, postoperative and non occlusive cases were excluded from the study. Results:Sixteen patients with final diagnosis of acute mesenteric venous thrombosis were included in this study, out of 26 patients (61.5%) presented and diagnosed as acute occlusive mesenteric ischemia. Males were more affected than females. The mean age of the patients was 55±13.4 years. The mean duration of symptoms was 4.9±1.4 days.The most common presenting symptoms were; abdominal pain followed by nausea, vomiting, anorexia, bloody diarrhea and fever. The most prevalent physical findings was tachycardia followed by ileus, 5 patients presented by marked peritoneal signs 3 of them were shocked. Multiple risk factors were detected in all patients. Laboratory findings were not conclusive and diagnosis was established by CT angiography in most of the patients. During operation, all patients were found to have a segment of infarction of the small intestine and in one of them the cecum was involved. Resection of the gangrenous parts was done for all patients. Second look operation was performed in 25% of patients. The total mortality was 18.75%. Conclusion: Acute mesenteric venous thrombosis is the most common cause of acute occlusive mesenteric ischemia in Taif province and this may be related to multiple risk factors. Being familiar with this disease is essential in making the correct diagnosis to be followed by prompt resuscitation with heparinization to be continued postoperatively to prevent recurrent thrombosis. Laparotomy should be performed as soon as metabolic and hemodynamic correction is done with resection of any infracted segment. A second look operation may be required. If these steps are followed strictly and without delay, the prognosis of mesenteric venous thrombosis is often favorable.
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
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.
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.
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.
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.
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.