Small Bowel Perforation Secondary to Portal Vein Thrombosis (original) (raw)

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.

Portal vein thrombosis (PVT): A study of 20 non-irrhotic cases

Swiss medical weekly: official journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology

Portal and mesenteric venous thrombosis (PVT) is an uncommon disease with serious consequences if not discovered early in order to prevent complications such as variceal bleeding and intestinal ischaemia. The objective of this study was to describe the clinical presentation and outcome of patients with PVT with a view to early diagnosis and treatment of this disease. The study was restricted to patients with PVT not caused by underlying liver cirrhosis. To analyse important clinical characteristics of this entity we performed a retrospective study of 20 non-cirrhotic patients seen in our hospital from February 1998 to March 2003. The main clinical symptom was abdominal pain (13 patients, 86%), sometimes in combination with diarrhoea and vomiting (5 patients, 33%), nausea and anorexia (3 patients). Laboratory signs were non-specific and diagnosis was usually by computed tomography (19 patients, 95%). Causative factors included prothrombotic states (9 patients, 45%) and/or local facto...

Abdominal Pain: An Ominous Sign of Portal Vein Thrombosis—Case Series

OALib

Portal vein thrombosis (PVT) is a disease in which thrombosis occurs from the intrahepatic branches of the portal vein and may extend to the splenic vein and/or superior mesenteric vein. It is most often associated with liver cirrhosis. PVT not associated with cirrhosis is rare. The aim of this case series of portal vein thrombosis is to give importance that even though PVT is a rare cause of abdominal pain, timely diagnosis, and appropriate management is vital due to its lethal complications such as mesenteric ischemia and mesenteric infarction and late complication like portal hypertension.

Portal vein thrombosis as a rare cause of abdominal pain: When should we think?

Turkish Journal of Surgery, 2015

Extrahepatic portal vein thrombosis (PVT) is a rare condition that is characterized by the presence of thrombus within any segment of the portal vein, including the right and left intrahepatic branches. It may also extend to the splenic or superior mesenteric veins. Portal vein thrombosis may be related to cirrhosis or liver malignancy as well as to local inflammatory conditions in the abdomen and genetic or acquired thrombophilic diseases. Currently, PVT is being increasingly diagnosed due to advances in modern imaging techniques. The clinical presentation has a wide range, from an asymptomatic lesion to a potentially life-threatening situation. In this study, we present three patients with PVT. The diagnosis was made by radiologic and clinical findings. In the first patient, genetic testing revealed factor V Leiden mutation as the cause of PVT. The second patient was diagnosed with lupus anticoagulant syndrome as the cause of PVT. Portal vein thrombosis was associated with intra abdominal infection due to anastomotic leakage in the third patient. Two patients were successfully treated with anticoagulant therapy. This report emphasizes that even though PVT is a rare cause of abdominal pain, timely diagnosis and appropriate management is vital due to its lethal complications such as mesenteric ischemia and mesenteric infarct.

Mesenteric venous thrombosis in inflammatory bowel disease

American Journal of Gastroenterology, 2003

Mesenteric venous thrombosis (MVT) is a rare but potentially catastrophic clinical complication, which may lead to ischemia or infarction of the intestine and/or the emergence of portal hypertension. An association between inflammatory bowel disease (IBD) and MVT has previously been described, but clinical factors that may contribute to this complication in the setting of IBD are not well characterized. Diagnosis of MVT in IBD is difficult, as patients frequently present with nonspecific abdominal discomfort, which may delay diagnosis and initiation of treatment. We report 6 of 545 IBD patients at our center (1.1%) that developed MVT, and describe presentation, diagnostic approaches, treatment options, underlying contributing factors, and outcome. The diagnosis was determined with abdominal computed tomography (CT) in 5 of 6 cases. Clinical factors, which were thought to contribute to MVT, included underlying hypercoagulability, low-flow state, uncontrolled inflammation, perioperative time period, and prior surgical manipulation of the portal vein following orthotopic liver transplantation. There were no deaths as a result of MVT, although 1 patient developed severe portal hypertension and another experienced intestinal infarction requiring extensive resection. We conclude that MVT is an important clinical consideration in IBD patients, specifically during the perioperative setting, and diagnosis is facilitated with the use of CT scan.

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.

Portal vein thrombosis as a rare cause of abdominal pain: When to consider?

2017

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.

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.

Small Bowel Perforation Secondary to Portal Vein Thrombosis (original) (raw)

Related papers