Acute mesenteric, portal and inferior vena cava, venous thrombosis, anticoagulation (original) (raw)
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JPMA. The Journal of the Pakistan Medical Association, 2010
The prevalence and clinical spectrum of acute mesenteric venous thrombosis (AMVT) in Pakistan is largely unknown. The authors report two patients with acute mesenteric, portal and inferior vena cava venous thrombosis confirmed on CT imaging. The diagnoses were established within 24 hours of presentation and both patients were successfully treated with therapeutic heparin during hospital admission and continued on oral warfarin because of hypercoagulable state. The protocol that we currently use is evidence based and is leading to optimal outcome.
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.
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.
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.
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.
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.
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.
Superior mesenteric venous thrombosis presenting with hematemesis: a case report
The Annals of African Surgery, 2022
The superior mesenteric vein (SMV) is one of the two tributaries to the portal vein, which is the main prehepatic drainage channel of the splanchnic circulation. Venous thrombosis in the SMV is one of the rare causes of splanchnic ischemic syndrome. Clinical presentation is often vague abdominal symptoms. It seldom presents with hematemesis, which may further confound diagnosis, thereby increasing the risk of poor outcomes. This case highlights an otherwise healthy 31-year-old woman, who presenting at a tertiary hospital in Nairobi with a 2-day history of epigastric pain and copious hematemesis. She had been treated for Helicobacter pylori gastritis 2 months prior. Common differentials were considered. However, with normal esophagogastroduodenoscopy findings and darkcolored fluid sequestered in the upper gastrointestinal tract, mesenteric venous congestion with associated small bowel ischemia was suspected. Three-phase abdominal computed tomography angiogram confirmed proximal superior mesenteric venous thrombosis extending into the portal vein confluence. Associated small bowel necrosis was suspected, and surgery involving resection and primary ileo-jejunal anastomosis was performed. Post-operative 2-week parenteral nutrition and anticoagulation were administered. The patient was discharged after 3 weeks of hospitalization and remains in excellent condition.
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.