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Barbu LA, Mărgăritescu ND, Cercelaru L, Caragea DC, Vîlcea ID, Șurlin V, Mogoantă SȘ, Mogoș GFR, Vasile L, Țenea Cojan TȘ. Can Thrombosed Abdominal Aortic Dissecting Aneurysm Cause Mesenteric Artery Thrombosis and Ischemic Colitis?-A Case Report and a Review of Literature. J Clin Med 2025; 14:3092. [PMID: 40364123 PMCID: PMC12072285 DOI: 10.3390/jcm14093092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2025] [Revised: 04/27/2025] [Accepted: 04/28/2025] [Indexed: 05/15/2025] Open
Abstract
Background/Objectives: Ischemic colitis, typically caused by thrombosis or reduced blood flow in the inferior mesenteric artery, is the most common ischemic lesion at the colorectal level. This case contributes to existing knowledge by highlighting the rare co-occurrence of a thrombosed aortic aneurysm and ischemic colitis, pointing to a direct vascular etiology rather than a multifactorial or idiopathic cause. Methods: A thorough electronic search was conducted on PubMed to identify risk factors and etiological determinants of ischemic colitis. Results: We present the case of a 70-year-old male with diffuse abdominal pain and multiple cardiac comorbidities. A CT scan revealed aeroenteritis, aerocolia, fusiform aneurysmal dilation of the abdominal aorta (18 cm long, 7.3 cm in diameter, from below the renal arteries to the bifurcation), parietal thrombosis, a circulating lumen of 2.7 cm, and inferior mesenteric artery thrombosis. Intraoperatively, necrosis was found in the upper rectum, sigmoid colon, descending colon, and the middle third of the left transverse colon, with clear demarcation between healthy and necrotic tissue. A subtotal proctocolectomy with transverse colostomy was performed. Conclusions: This case highlights ischemic colitis as a vascular disorder, urging broader differential diagnosis when common causes are unclear. Timely imaging, a multidisciplinary approach, and attention to vascular risks are key to identifying rare causes like aneurysmal thrombosis. While thrombosed abdominal aortic aneurysms can cause mesenteric ischemia, their link to ischemic and ulcerative colitis is unique, emphasizing the importance of accurate risk assessment in treatment planning.
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Affiliation(s)
- Laurențiu Augustus Barbu
- Department of Surgery, Railway Clinical Hospital Craiova, University of Medicine and Pharmacy of Craiova, 2 Petru Rareş Street, 200349 Craiova, Romania; (L.A.B.); (G.F.R.M.); (T.Ș.Ț.C.)
| | - Nicolae-Dragoș Mărgăritescu
- Department of Surgery, Emergency County Hospital, University of Medicine and Pharmacy of Craiova, 2 Petru Rareş Street, 200349 Craiova, Romania; (I.-D.V.); (V.Ș.); (S.-Ș.M.); (L.V.)
| | - Liliana Cercelaru
- Department of Pathology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Daniel-Cosmin Caragea
- Departament of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Ionică-Daniel Vîlcea
- Department of Surgery, Emergency County Hospital, University of Medicine and Pharmacy of Craiova, 2 Petru Rareş Street, 200349 Craiova, Romania; (I.-D.V.); (V.Ș.); (S.-Ș.M.); (L.V.)
| | - Valeriu Șurlin
- Department of Surgery, Emergency County Hospital, University of Medicine and Pharmacy of Craiova, 2 Petru Rareş Street, 200349 Craiova, Romania; (I.-D.V.); (V.Ș.); (S.-Ș.M.); (L.V.)
| | - Stelian-Ștefaniță Mogoantă
- Department of Surgery, Emergency County Hospital, University of Medicine and Pharmacy of Craiova, 2 Petru Rareş Street, 200349 Craiova, Romania; (I.-D.V.); (V.Ș.); (S.-Ș.M.); (L.V.)
| | - Gabriel Florin Răzvan Mogoș
- Department of Surgery, Railway Clinical Hospital Craiova, University of Medicine and Pharmacy of Craiova, 2 Petru Rareş Street, 200349 Craiova, Romania; (L.A.B.); (G.F.R.M.); (T.Ș.Ț.C.)
| | - Liviu Vasile
- Department of Surgery, Emergency County Hospital, University of Medicine and Pharmacy of Craiova, 2 Petru Rareş Street, 200349 Craiova, Romania; (I.-D.V.); (V.Ș.); (S.-Ș.M.); (L.V.)
| | - Tiberiu Ștefăniță Țenea Cojan
- Department of Surgery, Railway Clinical Hospital Craiova, University of Medicine and Pharmacy of Craiova, 2 Petru Rareş Street, 200349 Craiova, Romania; (L.A.B.); (G.F.R.M.); (T.Ș.Ț.C.)
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Hosomi S, Oyama R, Isurugi C, Sato T, Baba T. Pregnancy Complicated by Extrahepatic Portal Vein Occlusion and Portal Vein Thrombosis: A Case Report. Cureus 2024; 16:e72457. [PMID: 39463911 PMCID: PMC11512749 DOI: 10.7759/cureus.72457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2024] [Indexed: 10/29/2024] Open
Abstract
We report the case of a 38-year-old woman with a history of extrahepatic portal vein obstruction (EHPVO) who became pregnant and developed portal vein thrombosis. She gave birth after intervention by gastroenterology and cardiology. She was referred to our department due to significant leg edema at eight weeks of gestation, and we noticed EHPVO, portal vein thrombosis, and left pulmonary arteriovenous fistula by contrast-enhanced CT. Therefore, subcutaneous heparin injections of 10,000 units/day were started as a preventive anticoagulant therapy. We performed an emergency cesarean section at 36 weeks of gestation. After surgery, the mother was administered a continuous heparin infusion. On the 11th day after surgery, the postoperative progress was good, so heparin was switched to oral warfarin, and the patient was discharged on the same day. During pregnancy, the risk of varicose vein rupture, hyperammonemia, and pulmonary hypertension increases due to an increase in circulating blood volume. This was a case in which careful perinatal management was performed in collaboration with other departments, resulting in a live birth.
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Affiliation(s)
- Shingo Hosomi
- Obstetrics and Gynecology, Iwate Medical University, Yahaba-cho, JPN
| | - Rie Oyama
- Obstetrics and Gynecology, Iwate Medical University, Yahaba-cho, JPN
| | - Chizuko Isurugi
- Obstetrics and Gynecology, Iwate Medical University, Yahaba-cho, JPN
| | - Takanori Sato
- Obstetrics and Gynecology, Iwate Medical University, Yahaba-cho, JPN
| | - Tsukasa Baba
- Obstetrics and Gynecology, Iwate Medical University, Yahaba-cho, JPN
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Abulfateh MK, Alghanem S. Acute Superior Mesenteric Thrombosis in a Young Adult With No Traditional Risk Factors: A Case Study. Cureus 2024; 16:e69364. [PMID: 39398737 PMCID: PMC11471293 DOI: 10.7759/cureus.69364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2024] [Indexed: 10/15/2024] Open
Abstract
This is a case report of acute superior mesenteric vein (SMV) thrombosis in a 24-year-old male with history of underlying psychiatric symptoms who had no traditional risk factors. The patient presented with abdominal pain, fever, and constipation. The patient's worsening symptoms led to an eventual diagnosis via computed tomography (CT) imaging. Management included anticoagulation therapy and multidisciplinary care. This case highlights the importance of considering SMV thrombosis in young adults and suggests a potential link between psychiatric conditions and thrombotic events, as evidenced by this patient's psychiatric history.
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Affiliation(s)
- Maryam K Abulfateh
- Department of Emergency Medicine, Bahrain Defence Force, Royal Medical Services, Military Hospital, Riffa, BHR
| | - Salah Alghanem
- Department of Emergency Medicine, Bahrain Defence Force, Royal Medical Services, Military Hospital, Riffa, BHR
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Acosta-Mérida MA, Ortiz-López D, Suárez-Cabrera A, Pelloni M, Rahy-Martín AC, Bañolas-Suárez R, Marchena-Gómez J. Hypercoagulability status, operative mortality, and long-term survival in patients operated on for mesenteric venous thrombosis. J Vasc Surg Venous Lymphat Disord 2023; 11:731-740. [PMID: 36906102 DOI: 10.1016/j.jvsv.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 02/14/2023] [Accepted: 02/26/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE Mesenteric venous thrombosis (MVT) is a rare cause of acute surgical abdomen, with high mortality. The aim of this study was to analyze long-term outcomes and possible factors influencing its prognosis. METHODS All patients who underwent urgent surgery for MVT from 1990 to 2020 in our center were reviewed. Epidemiological, clinical, and surgical data; postoperative outcomes; origin of thrombosis; and long-term survival were analyzed. Patients were divided into two groups: primary MVT (hypercoagulability disorders or idiopathic MVT) and secondary MVT (underlying disease). RESULTS Fifty-five patients, 36 (65.5%) men and 19 (34.5%) women, mean age 66.7 years (standard deviation: ±18.0 years), underwent surgery for MVT. Arterial hypertension (63.6%) was the most prevalent comorbidity. Regarding the possible origin of MVT, 41 (74.5%) patients had primary MVT and 14 (25.5%) patients had secondary MVT. From these, 11 (20%) patients had hypercoagulable states, 7 (12.7%) had neoplasia, 4 (7.3%) had abdominal infection, 3 (5.5%) had liver cirrhosis, 1 (1.8%) patient had recurrent pulmonary thromboembolism, and 1 (1.8%) had deep venous thrombosis. Computed tomography was diagnostic of MVT in 87.9% of the cases. Intestinal resection was performed in 45 patients due to ischemia. Only 6 patients (10.9%) had no complication, 17 patients (30.9%) presented minor complications, and 32 patients (58.2%) presented severe complications according to the Clavien-Dindo classification. Operative mortality was 23.6%. In univariate analysis, comorbidity measured by the Charlson index (P = .019) and massive ischemia (P = .002) were related to operative mortality. The probability of being alive at 1, 3, and 5 years was 66.4%, 57.9%, and 51.0%, respectively. In univariate analysis of survival, age (P < .001), comorbidity (P < .001), and type of MVT (P = .003) were associated with a good prognosis. Age (P = .002; hazard ratio: 1.05, 95% confidence interval: 1.02-1.09) and comorbidity (P = .019; hazard ratio: 1.28, 95% confidence interval: 1.04-1.57) behaved as independent prognostic factors for survival. CONCLUSIONS Surgical MVT continues to show high lethality. Age and comorbidity according to the Charlson index correlate well with mortality risk. Primary MVT tends to have a better prognosis than secondary MVT.
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Affiliation(s)
- María Asunción Acosta-Mérida
- Servicio Cirugía General y Digestiva, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas, Las Palmas de Gran Canaria, Gran Canaria, Spain.
| | - David Ortiz-López
- Servicio Cirugía General y Digestiva, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas, Las Palmas de Gran Canaria, Gran Canaria, Spain
| | - Aurora Suárez-Cabrera
- Servicio Cirugía General y Digestiva, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas, Las Palmas de Gran Canaria, Gran Canaria, Spain
| | - María Pelloni
- Servicio Cirugía General y Digestiva, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas, Las Palmas de Gran Canaria, Gran Canaria, Spain
| | - Aída Cristina Rahy-Martín
- Servicio Cirugía General y Digestiva, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas, Las Palmas de Gran Canaria, Gran Canaria, Spain
| | - Raquel Bañolas-Suárez
- Servicio Cirugía General y Digestiva, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas, Las Palmas de Gran Canaria, Gran Canaria, Spain
| | - Joaquín Marchena-Gómez
- Servicio Cirugía General y Digestiva, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas, Las Palmas de Gran Canaria, Gran Canaria, Spain
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Tamme K, Reintam Blaser A, Laisaar KT, Mändul M, Kals J, Forbes A, Kiss O, Acosta S, Bjørck M, Starkopf J. Incidence and outcomes of acute mesenteric ischaemia: a systematic review and meta-analysis. BMJ Open 2022; 12:e062846. [PMID: 36283747 PMCID: PMC9608543 DOI: 10.1136/bmjopen-2022-062846] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To estimate the incidence of acute mesenteric ischaemia (AMI), proportions of its different forms and short-term and long-term mortality. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE (Ovid), Web of Science, Scopus and Cochrane Library were searched until 26 July 2022. ELIGIBILITY CRITERIA Studies reporting data on the incidence and outcomes of AMI in adult populations. DATA EXTRACTION AND SYNTHESIS Data extraction and quality assessment with modified Newcastle-Ottawa scale were performed using predeveloped standard forms. The outcomes were the incidence of AMI and its different forms in the general population and in patients admitted to hospital, and the mortality of AMI in its different forms. RESULTS From 3064 records, 335 full texts were reviewed and 163 included in the quantitative analysis. The mean incidence of AMI was 6.2 (95% CI 1.9 to 12.9) per 100 000 person years. On average 5.0 (95% CI 3.3 to 7.1) of 10 000 hospital admissions were due to AMI. Occlusive arterial AMI was the most common form constituting 68.6% (95% CI 63.7 to 73.2) of all AMI cases, with similar proportions of embolism and thrombosis.Overall short-term mortality (in-hospital or within 30 days) of AMI was 59.6% (95% CI 55.5 to 63.6), being 68.7% (95% CI 60.8 to 74.9) in patients treated before the year 2000 and 55.0% (95% CI 45.5 to 64.1) in patients treated from 2000 onwards (p<0.05). The mid/long-term mortality of AMI was 68.2% (95% CI 60.7 to 74.9). Mortality due to mesenteric venous thrombosis was 24.6% (95% CI 17.0 to 32.9) and of non-occlusive mesenteric ischaemia 58.4% (95% CI 48.6 to 67.7). The short-term mortality of revascularised occlusive arterial AMI was 33.9% (95% CI 30.7 to 37.4). CONCLUSIONS In adult patients, AMI is a rarely diagnosed condition with high mortality, although with improvement of treatment results over the last decades. Two thirds of AMI cases are of occlusive arterial origin with potential for better survival if revascularised. PROSPERO REGISTRATION NUMBER CRD42021247148.
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Affiliation(s)
- Kadri Tamme
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Anaesthesiology and Intensive Care Clinic, Tartu University Hospital, Tartu, Estonia
| | - Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Department of Intensive Care Medicine, Luzerner Kantonsspital, Luzern, Luzern, Switzerland
| | - Kaja-Triin Laisaar
- Department of Epidemiology and Biostatistics, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Merli Mändul
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Department of Statistics, Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia
| | - Jaak Kals
- Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Surgery Clinic, Tartu University Hospital, Tartu, Estonia
| | - Alastair Forbes
- Department of Internal Medicine, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Internal Medicine Clinic, Tartu University Hospital, Tartu, Estonia
| | - Olga Kiss
- Anaesthesiology and Intensive Care Clinic, Tartu University Hospital, Tartu, Estonia
| | - Stefan Acosta
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Martin Bjørck
- Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Joel Starkopf
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Anaesthesiology and Intensive Care Clinic, Tartu University Hospital, Tartu, Estonia
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6
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Conway AM, Carroccio A, Rosen RJ. Acute and Chronic Mesenteric Ischemia. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Swinson B, Waters PS, Webber L, Nathanson L, Cavallucci DJ, O'Rourke N, Bryant RD. Portal vein thrombosis following elective laparoscopic splenectomy: incidence and analysis of risk factors. Surg Endosc 2021; 36:3332-3339. [PMID: 34331132 DOI: 10.1007/s00464-021-08649-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/16/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Minimally invasive splenectomy is now well established for a wide range of pathologies. Portal vein thrombosis (PVT) is increasingly being recognised as a complication of splenectomy. The aim was to determine the incidence and risk factors for PVT after laparoscopic splenectomy. METHODS All cases of elective laparoscopic splenectomy performed from 1993 to 2020 were reviewed. Parameters recorded included demographics, diagnostic criterion and post-operative outcomes. Data were analysed using Minitab V18 with a p < 0.05 considered significant. RESULTS 210 patients (103 female, 107 male) underwent laparoscopic splenectomy (14 to 85 years). A major proportion of cases were performed for ITP (n = 77, p = 0.012) followed by lymphoma (n = 28), indeterminate lesions (n = 21) and myelofibrosis (n = 19). Ten patients developed symptomatic portal vein thrombosis (4.8%). Patients presented most commonly with pain and fever and diagnosis was confirmed by computed tomography (CT) or ultrasonography (USS). There were 10 conversions (4.8%) to open and two postoperative deaths, one from PVT and one from pneumonia. The remaining nine patients were successfully treated with anticoagulation. Of 19 patients with myelofibrosis, six patients developed PVT (p = 0.0002). Patients who developed PVT had significantly greater specimen weights (1773 g vs 348 g, p < 0.001). Forty-three patients had a specimen weight of 1 kg or greater, and of these 9 developed portal vein thrombosis (21%), versus one with PVT of 155 with a specimen weight of less than 1 kg (p < 0.0001). Myelofibrosis (p = 0.0039), specimen weight (p < 0.001) and mean platelet count (p = 0.0049) were predictive of PVT. CONCLUSION A high index of suspicion for this complication should be maintained and prompt treatment with anticoagulation. High-risk patients should be considered for prophylactic anticoagulation and routine imaging of the portal vein.
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Affiliation(s)
- Benjamin Swinson
- Department of Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Peadar S Waters
- Department of Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.
| | - Laurence Webber
- Department of Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Les Nathanson
- Department of Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,Department of Surgery, Wesley Hospital, Auchenflower, QLD, 4066, Australia
| | - David J Cavallucci
- Department of Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,Department of Surgery, Wesley Hospital, Auchenflower, QLD, 4066, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Nicholas O'Rourke
- Department of Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,Department of Surgery, Wesley Hospital, Auchenflower, QLD, 4066, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Richard D Bryant
- Department of Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,St Vincent's Northside Medical Centre, St Vincent's Private Hospital Northside, 627 Rode Road, Chermside, QLD, 4032, Australia
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Nakamoto H, Yokota R, Namba H, Yamada K, Hosoda M, Taguchi K. Effectiveness of Intraoperative Indocyanine Green Fluorescence-Navigated Surgery for Superior Mesenteric Vein Thrombosis that Developed During Treatment for Intravascular Lymphoma: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e929549. [PMID: 33927177 PMCID: PMC8097743 DOI: 10.12659/ajcr.929549] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Superior mesenteric vein thrombosis (SMVT) is a relatively rare form of acute abdominal disease; less than 0.1% of laparotomy surgeries are performed for SMVT. In the presence of severe intestinal ischemia or necrosis caused by SMVT, immediate surgical intervention is required. Macroscopic diagnosis of intestinal viability is sometimes difficult; its over-resection may carry the risk of short bowel syndrome. A near-infrared fluorescence imaging system with indocyanine green (ICG) has recently been developed for intraoperative, real-time evaluation of intestinal perfusion. This is the first report on the use of ICG fluorescence imaging during surgery for intestinal ischemia caused by venous thrombosis. CASE REPORT A 70-year-old man presented with a general feeling of weariness. On examination, he was diagnosed with intravascular large B cell lymphoma. R-CHOP therapy was initiated. On day 3 of initial R-CHOP therapy, the patient experienced sudden severe abdominal pain while in the hospital. Contrast-enhanced computed tomography revealed SMVT and loss of contrast effect in the small intestine. We diagnosed small bowel necrosis caused by SMVT, and exploratory laparotomy was performed, which revealed a continuous ischemia of 150 cm. Intraoperative ICG fluorescence imaging was utilized, and the color boundary was consistent with the ischemic area detected by visualization. The necrotic small intestine was excised and anastomosed. The patient was transferred to the hematology department on postoperative day 10 with no severe complications such as anastomotic leakage or re-thrombosis, and re-embolization was not observed 6 months later. CONCLUSIONS Venous thrombosis should be listed as a differential diagnosis when acute abdominal disease presents during chemotherapy for malignant lymphoma. ICG fluorescence imaging may be useful in the evaluation of intestinal blood flow for venous thrombosis.
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Affiliation(s)
- Hiroki Nakamoto
- Department of Surgery, Sunagawa City Medical Center, Sunagawa, Hokkaido, Japan
| | - Ryoichi Yokota
- Department of Surgery, Sunagawa City Medical Center, Sunagawa, Hokkaido, Japan
| | - Hiromasa Namba
- Department of Surgery, Sunagawa City Medical Center, Sunagawa, Hokkaido, Japan
| | - Kenji Yamada
- Department of Surgery, Sunagawa City Medical Center, Sunagawa, Hokkaido, Japan
| | - Mitsuchika Hosoda
- Department of Surgery, Sunagawa City Medical Center, Sunagawa, Hokkaido, Japan
| | - Koichi Taguchi
- Department of Surgery, Sunagawa City Medical Center, Sunagawa, Hokkaido, Japan
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Ahmad MSM, Iqbal MR, Refson JS. Acute mesenteric ischaemia due to superior mesenteric vein (SMV) thrombosis. BMJ Case Rep 2021; 14:14/4/e239110. [PMID: 33795268 DOI: 10.1136/bcr-2020-239110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 77-year-old male patient presented with a 5-day history of abdominal pain, coffee ground vomiting and blood-stained diarrhoea. CT scan of the abdomen and pelvis demonstrated a long segment thrombotic occlusion of the superior mesenteric vein (SMV) extending up to the proximal portion of the portal vein causing significant acute small bowel ischaemia. Patient's deteriorating clinical condition warranted surgical management. Successful surgical management required multidisciplinary teamwork between emergency, vascular surgeons, anaesthetists and intensivists. Emergency laparotomy revealed gangrene of an estimated 120 cm of small bowel segment starting from duodenojejunal junction and a long segment thrombotic occlusion of the SMV extending up to the portal confluence. Resection of gangrenous small bowel without anastomosis and thrombo-embolectomy of SMV along with laparostomy was done at the initial operation. Patient was admitted in the intensive care unit on systemic heparinisation through intravenous administration of unfractionated heparin. Second relook exploration was done after 48 hours followed by anastomosis of the small bowel and closure of the abdomen. Patient made a good recovery following anticoagulation therapy and was discharged on postoperative day 10.
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Affiliation(s)
- Muhammad Salah Muhammad Ahmad
- General Surgery, Princess Alexandra Hospital NHS Trust, Harlow, UK .,General Surgery, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
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Hiranuma W, Shimizu T, Takeda M, Matsuoka T, Minagawa T, Fukutomi T, Ohara M, Kawamoto S. A Case of Superior Mesenteric Venous Thrombosis Managed by Thrombectomy without Bowel Resection. Ann Vasc Dis 2020; 13:447-449. [PMID: 33391569 PMCID: PMC7758576 DOI: 10.3400/avd.cr.20-00119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We present a case of superior mesenteric venous thrombosis (SMVT) treated successfully with thrombectomy without bowel resection. A 73-year-old female was referred to our hospital with complaints of stomach ache. The patient was diagnosed with SMVT with impending bowel necrosis and underwent an emergency operation, after computed tomography (CT) revealed a thrombus in the superior mesenteric vein (SMV) extending to the splenic vein, ascites, and extremely edematous intestines. The intestines were not necrotic though highly congested. To avoid massive bowel resection, aggressive thrombectomy was performed. Postoperative CT confirmed resolved SMV and improved bowel edema. Prompt thrombectomy should be considered in such cases.
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Affiliation(s)
- Wakiko Hiranuma
- Department of Cardiovascular Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
| | - Takuya Shimizu
- Department of Cardiovascular Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
| | - Miki Takeda
- Department of Cardiovascular Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
| | - Takayuki Matsuoka
- Department of Cardiovascular Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
| | - Tadanori Minagawa
- Department of Cardiovascular Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
| | - Toshiaki Fukutomi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
| | - Masato Ohara
- Department of Surgery, Ishinomaki Red Cross Hospital, Ishinomaki, Miyagi, Japan
| | - Shunsuke Kawamoto
- Department of Cardiovascular Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
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Peripheral Photopenia on Whole-Body PET/CT Imaging With 18F-FDG in Patients With Compartment Syndrome and Mesenteric Venous Thrombosis. Clin Nucl Med 2020; 45:1007-1009. [PMID: 33031238 DOI: 10.1097/rlu.0000000000003315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
We present 2 cases that demonstrate photopenia in peripheral areas on whole-body PET/CT imaging with F-FDG as a sign of absent perfusion with severe short-term complications. The scan of the first patient shows photopenia in the right ankle and foot, resulting from compartment syndrome, caused by hemolytic group A streptococcus bacteremia with endocarditis and septic emboli, necessitating lower leg amputation. The scan of the second patient shows photopenia in the transverse colon, resulting from mesenteric venous thrombosis caused by polycythemia vera, leading to necrosis and perforation of the transverse colon, necessitating transverse and right hemicolectomy.
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Wu W, Liu J, Zhou Z. Preoperative Risk Factors for Short-Term Postoperative Mortality of Acute Mesenteric Ischemia after Laparotomy: A Systematic Review and Meta-Analysis. Emerg Med Int 2020; 2020:1382475. [PMID: 33083058 PMCID: PMC7556094 DOI: 10.1155/2020/1382475] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Our objective was to comprehensively present the evidence of preoperative risk factors for short-term postoperative mortality of acute mesenteric ischemia after laparotomy. METHODS PubMed, Embase, and Google Scholar were searched from January 2000 to January 2020. Studies evaluating the postoperative risk factors for short-term postoperative mortality of acute mesenteric ischemia after laparotomy were included. The outcome extracted were patients' demographics, medical history, and preoperative laboratory tests. RESULTS Twenty studies (5011 patients) met the inclusion criteria. Studies were of high quality, with a median Newcastle-Ottawa Scale Score of 7. Summary short-term postoperative mortality was 44.38% (range, 18.80%-67.80%). Across included studies, 49 potential risk factors were examined, at least two studies. Meta-analysis of predictors based on more than three studies identified the following preoperative risk factors for higher short-term postoperative mortality risk: old age (odds ratio [OR], 1.90, 95% confidence interval [CI], 1.57-2.30), arterial occlusive mesenteric ischemia versus mesenteric venous thrombosis (OR, 2.45, 95% CI 1.12-5.33), heart failure (OR 1.33, 95% CI 1.03-1.72), renal disorders (OR 1.61, 95% CI 1.24-2.07), and peripheral vascular disease (OR 1.38, 95% CI 1.00-1.91). Nonsurvivors were older (standardized mean difference [SMD], 0.32, 95% CI 0.24-0.40), had higher creatinine levels (SMD 0.50, 95% CI 0.25-0.75), and had lower platelet counts (SMD -0.32, 95% CI -0.50 to -0.14). CONCLUSION The short-term postoperative mortality of acute mesenteric ischemia who underwent laparotomy is still high. A better understanding of these risk factors may help in the early identification of high-risk patients, optimization of surgical procedure, and improvement of perioperative management.
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Affiliation(s)
- Wenhan Wu
- Institute of Digestive Surgery of Sichuan University, and Department of Gastrointestinal Surgery, West China Hospital, West China School of Medicine, Sichuan University, 610041 Chengdu, Sichuan, China
| | - Jianbo Liu
- Institute of Digestive Surgery of Sichuan University, and Department of Gastrointestinal Surgery, West China Hospital, West China School of Medicine, Sichuan University, 610041 Chengdu, Sichuan, China
| | - Zongguang Zhou
- Institute of Digestive Surgery of Sichuan University, and Department of Gastrointestinal Surgery, West China Hospital, West China School of Medicine, Sichuan University, 610041 Chengdu, Sichuan, China
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13
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A systematic review of the management of acute superior mesenteric vein thrombosis in adults. JOURNAL OF PANCREATOLOGY 2020. [DOI: 10.1097/jp9.0000000000000051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
OBJECTIVE. The purpose of this article is to provide an overview of the diagnostic and prognostic roles of CT in the management of acute mesenteric ischemia. CONCLUSION. Acute mesenteric ischemia is defined as inadequate blood supply to the gastrointestinal tract resulting in ischemic and inflammatory injury. The prognosis is poor without treatment. Contrast-enhanced CT has become the cornerstone of diagnosis to identify features of vascular disorders and of intestinal ischemic injury and to visualize bowel necrosis.
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Phyu WP, Tang HMS, Subhani Z. Upper gastrointestinal bleeding in superior mesenteric vein thrombosis. Clin Med (Lond) 2019; 19:507-508. [PMID: 31732593 DOI: 10.7861/clinmed.2019-0237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Superior mesenteric vein thrombosis (SMVT) is an uncommon disorder with non-specific signs and symptoms, where missed catastrophic consequences often follow secondary to disease progression. This case report highlights an unusual complication of SMVT and presented alongside with literature review.
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Affiliation(s)
| | - Hin Ming S Tang
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Zeeshan Subhani
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
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16
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Wong LCH, Lee KF, Lai PBS, Chong CCN. Superior mesenteric venous thrombophlebitis: A rare complication of a common disease. SURGICAL PRACTICE 2019. [DOI: 10.1111/1744-1633.12337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Leo Chun-Hei Wong
- Department of Surgery; Prince of Wales Hospital, The Chinese University of Hong Kong; Hong Kong
| | - Kit-Fai Lee
- Department of Surgery; Prince of Wales Hospital, The Chinese University of Hong Kong; Hong Kong
| | - Paul Bo-San Lai
- Department of Surgery; Prince of Wales Hospital, The Chinese University of Hong Kong; Hong Kong
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17
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Ito S, Endo A, Okada T, Yoshitomi H, Hyakudomi R, Tajima Y, Tanabe K. A Case of Left Ventricular Thrombus with Superior Mesenteric Vein Thrombosis Due to Atopic Dermatitis. Int Heart J 2018; 59:881-886. [PMID: 29877306 DOI: 10.1536/ihj.17-386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 55-year-old man was presented to the emergency room because of abdominal pain for 4 days. He had a history of atopic dermatitis. Left ventricular (LV) asynergy and thrombus was detected on echocardiography, and superior mesenteric vein thrombosis was detected by computed tomography. There are no reported cases of this combination of thrombi. We hypothesized that the reason for this complication is the combination of coagulation disorder due to atopic dermatitis, silent myocardial infarction, and exacerbation of the coagulation abnormality due to bacteremia, leading to superior mesenteric vein and LV thrombosis. Atopic dermatitis that has potential risk factors of thrombus with sepsis could provoke thrombophilic state. Atopic dermatitis is a common disease, but continuous medical care is essential.
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Affiliation(s)
- Shimpei Ito
- Division of Cardiology, Shimane University Faculty of Medicine
| | - Akihiro Endo
- Division of Cardiology, Shimane University Faculty of Medicine
| | - Taiji Okada
- Division of Cardiology, Shimane University Faculty of Medicine
| | | | - Ryoji Hyakudomi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine
| | - Kazuaki Tanabe
- Division of Cardiology, Shimane University Faculty of Medicine
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18
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Singh K, Khan G. Antiphospholipid syndrome presenting as acute mesenteric venous thrombosis involving a variant inferior mesenteric vein and successful treatment with rivaroxaban. BMJ Case Rep 2018; 2018:bcr-2017-223077. [DOI: 10.1136/bcr-2017-223077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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19
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Copin P, Zins M, Nuzzo A, Purcell Y, Beranger-Gibert S, Maggiori L, Corcos O, Vilgrain V, Ronot M. Acute mesenteric ischemia: A critical role for the radiologist. Diagn Interv Imaging 2018; 99:123-134. [DOI: 10.1016/j.diii.2018.01.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 01/16/2018] [Accepted: 01/18/2018] [Indexed: 12/13/2022]
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21
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Kim HK, Hwang D, Park S, Lee JM, Huh S. Treatment outcomes and risk factors for bowel infarction in patients with acute superior mesenteric venous thrombosis. J Vasc Surg Venous Lymphat Disord 2017; 5:638-646. [PMID: 28818214 DOI: 10.1016/j.jvsv.2017.04.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/10/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The prognosis of acute superior mesenteric venous thrombosis (SMVT) remains obscure. We aimed to investigate the treatment outcomes and possible risk factors for bowel infarction in these patients. METHODS We retrospectively included 66 patients with acute SMVT between January 2002 and June 2016. Each patient underwent contrast-enhanced computed tomography as part of the initial diagnosis. The standard protocol for management included a nonsurgical approach with early anticoagulation and selective exploration. For the analysis of the risk factors for bowel infarction, patients were divided into bowel resection (BR) and non-BR groups. Outcomes of interest were causes of SMVT, percentage of BR after nonsurgical treatment, and risk factors for BR. RESULTS Of 66 patients, 15 (23%) underwent BR; of these, 9 underwent urgent BR because of peritoneal signs and definite findings of bowel infarction on computed tomography scan, 4 underwent BR after failed anticoagulation, and 2 underwent BR because of delayed stricture. Clinically, vomiting (P = .003), abdominal distention (P = .003), rebound tenderness (P = .005), and leukocytosis (P = .001) were associated with BR. On radiologic examination, bowel wall thickening (P < .001), enhancement defects of the bowel wall (P < .001), and ascites (P = .007) were associated with BR. Twenty-seven (41%) patients presented with isolated SMVT, and the remaining patients demonstrated a coexisting portal vein (PV) thrombosis in addition to SMVT. All 15 BRs occurred in patients with combined PV thrombosis and SMVT (P < .001). Complete thrombosis of the superior mesenteric vein and PV was also associated with BR (P = .028 for superior mesenteric vein; P = .025 for PV). BR was performed in 1 (4%) of 24 patients with transient risk factors compared with 14 (33%) of 42 patients without transient risk factors (P = .006). Three patients (4.5%) died in the hospital. CONCLUSIONS In patients with acute SMVT, the extent of thrombus and etiology were associated with the severity of acute SMVT. Patients with transient risk factors and isolated SMVT tended to have a benign disease course. With early anticoagulation, acute SMVT does not seem to have the grave prognosis that is associated with arterial thrombosis.
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Affiliation(s)
- Hyung-Kee Kim
- Division of Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Deokbi Hwang
- Division of Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Sujin Park
- Division of Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Jong-Min Lee
- Department of Radiology, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Seung Huh
- Division of Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, South Korea.
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Wojciechowski AL, Bajwa RPS, Thatigotla B. Mesenteric venous thrombosis precipitated by foodborne gastrointestinal illness. Oxf Med Case Reports 2017; 2017:omx004. [PMID: 28473917 PMCID: PMC5410872 DOI: 10.1093/omcr/omx004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 01/20/2017] [Accepted: 02/11/2017] [Indexed: 11/28/2022] Open
Abstract
Foodborne illnesses are common and are usually considered as part of the differential diagnosis when a patient presents with gastrointestinal symptoms including nausea, vomiting, abdominal pain, diarrhea and fever. The majority of foodborne illness is transient and self-limited, while life threatening complications are rare. Here, we describe a case of a patient presenting with inflammatory diarrhea after consumption of undercooked seafood. She developed mesenteric and portal venous thrombosis and small bowel infarction requiring surgical intervention and resection of gangrenous small bowel. This is a rare presentation and outcome of common food poisoning. The case report is followed by a brief discussion of common foodborne illnesses and mesenteric venous thrombosis.
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Affiliation(s)
- Amy L. Wojciechowski
- Infectious Diseases Division, Niagara Falls Memorial Medical Center, Niagara Falls, NY, USA
| | - Rajinder PS Bajwa
- Infectious Diseases Division, Niagara Falls Memorial Medical Center, Niagara Falls, NY, USA
- Correspondence address. Niagara Falls Memorial Medical Center, 621 10th Street, Niagara Falls, NY 14304, USA. Tel: +1-7162784739; Fax: +1-7162784792; E-mail:
| | - Bala Thatigotla
- Infectious Diseases Division, Niagara Falls Memorial Medical Center, Niagara Falls, NY, USA
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23
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Wells D, Brackney A. Acute Portal Vein Thrombosis Diagnosed with Point-of-care Ultrasonography. Clin Pract Cases Emerg Med 2017; 1:50-52. [PMID: 29849431 PMCID: PMC5965441 DOI: 10.5811/cpcem.2016.11.32979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 11/22/2016] [Accepted: 11/28/2016] [Indexed: 12/17/2022] Open
Abstract
Abdominal pain is the most common presenting complaint to the emergency department (ED);1 however, acute portal vein thrombosis is an uncommon cause of abdominal pain. In the following case report, we present a patient who presented to the ED with symptoms of gastroenteritis but was ultimately diagnosed with acute portal vein thrombosis by point-of-care ultrasound (POCUS).
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Affiliation(s)
- Daniel Wells
- Henry Ford Medical Center - Fairlane, Department of Emergency Medicine, Dearborn, Michigan
| | - Abigail Brackney
- Beaumont Hospital - Royal Oak, Department of Emergency Medicine, Royal Oak, Michigan
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24
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Akingba AG, Mangalmurti CS, Mukherjee D. Surgical Management of Chronic Mesenteric Venous Thrombosis. Vasc Endovascular Surg 2016; 40:157-60. [PMID: 16598365 DOI: 10.1177/153857440604000211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Although mesenteric venous thrombosis is an uncommon disease, it is a diagnostic dilemma and if left untreated results in significant morbidity and mortality. The clinical presentation of mesenteric venous thrombosis (MVT) is varied and depends on the etiology. Prompt recognition and treatment is important as this may limit the progression of thrombosis. Even though medical management is the current mainstay of therapy, there have been reported cases of clinical improvement with operative management. The authors describe an improved outcome following mesenteric-systemic shunting in a symptomatic patient with acute-on-chronic MVT affecting the proximal superior mesenteric vein.
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Affiliation(s)
- A G Akingba
- Department of Surgery, Inova Fairfax Hospital, Falls Church, VA, USA.
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25
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Blumberg SN, Maldonado TS. Mesenteric venous thrombosis. J Vasc Surg Venous Lymphat Disord 2016; 4:501-7. [PMID: 27639007 DOI: 10.1016/j.jvsv.2016.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/20/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This review explores the current literature on the natural history, diagnosis, and management of mesenteric venous thrombosis (MVT) in the modern era. METHODS A review of the contemporary literature from 1997 to 2016 on MVT and its pathogenesis, diagnosis, and treatment was performed. RESULTS MVT is an insidious and lethal disease associated with acute mesenteric ischemia. The prevalence of MVT has increased sharply during the past two decades commensurate with an increase in radiographic imaging for abdominal complaints. The optimal treatment of and approach to MVT is controversial, given the poorly understood natural history of this rare disease. Both endovascular and open surgical strategies in addition to systemic anticoagulation have been used as adjuncts to treat MVT with limited success. Despite advances in treatment, mortality associated with MVT is still high. Furthermore, recent studies have shown that failure to recanalize the portomesenteric venous system leads to an increased risk for development of sequelae of portal hypertension. CONCLUSIONS MVT is a challenging disease to treat, given the difficulty in establishing a prompt initial diagnosis and the inability to reliably monitor patients for evidence of impending bowel infarction. Careful selection of patients for endovascular, open, or hybrid approaches is key to achieving improved outcomes. However, the paucity of prospective data and our evolving understanding of the natural history of MVT make consensus treatment strategies difficult to ascertain.
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Affiliation(s)
- Sheila N Blumberg
- Division of Vascular and Endovascular Surgery, NYU Langone Medical Center, New York, NY
| | - Thomas S Maldonado
- Division of Vascular and Endovascular Surgery, NYU Langone Medical Center, New York, NY.
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Hariharan M, Balasubramaniam R, Shetty SK, Yadavalli S, Ahetasham M, Devarapalli S. Uncommon Causes of Acute Abdominal Pain - A Pictorial Essay. J Clin Imaging Sci 2016; 6:4. [PMID: 27014500 PMCID: PMC4785781 DOI: 10.4103/2156-7514.177548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/06/2016] [Indexed: 11/09/2022] Open
Abstract
Acute abdomen is one of the most common clinical conditions requiring a radiological investigation. Ultrasound is the primary modality of choice which can diagnose some of the common causes of acute abdomen. However, sometimes the underlying cause for the pain is far more complicated than expected mandating a high degree of suspicion to suggest further investigation with contrast enhanced computed tomography or magnetic resonance imaging. Here, we have compiled a comprehensive series of selected cases to highlight the conditions which can be easily overlooked unless carefully sought for. This article also emphasizes the importance of multimodality approach to arrive at the final diagnosis with an increased overall diagnostic accuracy which in turn improves patient management and prognosis.
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Affiliation(s)
- Mahesh Hariharan
- Department of Radiology and Imaging, Dr. B R Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India
| | - Rajan Balasubramaniam
- Department of Radiology and Imaging, Dr. B R Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India
| | - Sharath Kumar Shetty
- Department of Radiology and Imaging, Sapthagiri Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India
| | - Shanthala Yadavalli
- Department of Radiology and Imaging, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Mohammed Ahetasham
- Department of Radiology and Imaging, Dr. B R Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India
| | - Sravya Devarapalli
- Department of Radiology and Imaging, Dr. B R Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India
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Affiliation(s)
- Daniel G Clair
- From the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (D.G.C.) and the Department of Vascular Surgery, Heart and Vascular Institute, Cleveland Clinic (D.G.C., J.M.B.) - both in Cleveland
| | - Jocelyn M Beach
- From the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (D.G.C.) and the Department of Vascular Surgery, Heart and Vascular Institute, Cleveland Clinic (D.G.C., J.M.B.) - both in Cleveland
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Choudhry AJ, Baghdadi YMK, Amr MA, Alzghari MJ, Jenkins DH, Zielinski MD. Pylephlebitis: a Review of 95 Cases. J Gastrointest Surg 2016; 20:656-61. [PMID: 26160320 PMCID: PMC4882085 DOI: 10.1007/s11605-015-2875-3] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/08/2015] [Indexed: 02/06/2023]
Abstract
Pylephlebitis, or suppurative thrombophlebitis of the portal mesenteric venous system occurring in the setting of abdominal inflammatory processes, is a rare but deadly disease commonly associated with diverticulitis. We review our institutional experience in the management of patients with this condition. A retrospective review of medical records from 2002 to 2012 was performed. Patients with a portal mesenteric vein thrombosis (PMVT) within 30 days of an intra-abdominal inflammatory process were identified and evaluated. Ninety-five patients were included. The mean patient age at presentation was 57 years (range, 24-88). The most common associated processes were pancreatitis (31 %), followed by diverticulitis (19 %). Bacteremia was noted in 34 (44 %) patients. The most common organism cultured was Streptococcus viridans. Antibiotic and anticoagulation therapy was given in 86 (91 %) and 78 (82 %) patients, respectively. Overall, we report an 11 % mortality rate. Albeit rare, pylephlebitis most commonly was manifested in the setting of pancreatitis. Treatment should be individualized to culture results and extent of thrombosis. If diagnosed early and managed appropriately, a favorable outcome is possible.
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Affiliation(s)
| | | | | | | | | | - Martin D. Zielinski
- Department of Surgery, Mayo Clinic, Rochester, MN, USA,Division of Trauma, Critical Care, and General Surgery, Rochester, MN, USA
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Abstract
Acute mesenteric ischemia (AMI) is a rare disease that most commonly affects the elderly. The vague symptoms often lead to delayed diagnosis and consequent high mortality. Physical exam and laboratory findings lack the sensitivity and specificity to exclude AMI, but computed tomography angiography can rapidly and accurately confirm the diagnosis. Survival improves with prompt restoration of perfusion and resection of nonviable bowel. Advances in imaging, operative techniques, and critical care have led to a steady decline in overall mortality; however, long-term survival is limited because of the comorbidities in this patient group.
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Affiliation(s)
- Thomas W Carver
- Division of Trauma and Critical Care, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
| | - Ravi S Vora
- Division of Digestive Diseases, Emory University, 615 Michael Street, Suite 201, Atlanta, GA 30322, USA
| | - Amit Taneja
- Division of Pulmonary and Critical Care Medicine, The Medical College of Wisconsin, Suite E 5200, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA
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Plotnik AN, Hebroni F, McWilliams J. Chronic portomesenteic venous thrombosis complicated by a high flow arteriovenous malformation presenting with gastrointestinal bleeding. J Med Imaging Radiat Oncol 2016; 60:88-91. [DOI: 10.1111/1754-9485.12308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 02/27/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Adam N. Plotnik
- Department of Radiology; David Geffen School of Medicine; University of California; Los Angeles California USA
| | - Frank Hebroni
- Department of Radiology; David Geffen School of Medicine; University of California; Los Angeles California USA
| | - Justin McWilliams
- Department of Radiology; David Geffen School of Medicine; University of California; Los Angeles California USA
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Raman SP, Fishman EK. Computed Tomography Angiography of the Small Bowel and Mesentery. Radiol Clin North Am 2016; 54:87-100. [DOI: 10.1016/j.rcl.2015.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Imaging Diagnosis of Splanchnic Venous Thrombosis. Gastroenterol Res Pract 2015; 2015:101029. [PMID: 26600801 PMCID: PMC4620257 DOI: 10.1155/2015/101029] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/22/2015] [Indexed: 12/15/2022] Open
Abstract
Splanchnic vein thrombosis (SVT) is a broad term that includes Budd-Chiari syndrome and occlusion of veins that constitute the portal venous system. Due to the common risk factors involved in the pathogenesis of these clinically distinct disorders, concurrent involvement of two different regions is quite common. In acute and subacute SVT, the symptoms may overlap with a variety of other abdominal emergencies while in chronic SVT, the extent of portal hypertension and its attendant complications determine the clinical course. As a result, clinical diagnosis is often difficult and is frequently reliant on imaging. Tremendous improvements in vascular imaging in recent years have ensured that this once rare entity is being increasingly detected. Treatment of acute SVT requires immediate anticoagulation. Transcatheter thrombolysis or transjugular intrahepatic portosystemic shunt is used in the event of clinical deterioration. In cases with peritonitis, immediate laparotomy and bowel resection may be required for irreversible bowel ischemia. In chronic SVT, the underlying cause should be identified and treated. The imaging manifestations of the clinical syndromes resulting from SVT are comprehensively discussed here along with a brief review of the relevant clinical features and therapeutic approach.
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Wijaya R, Ng JH, See AH, Kum SW. Open Thrombectomy for Primary Acute Mesentericoportal Venous Thrombosis—Should It Be Done? Ann Vasc Surg 2015; 29:1454.e21-5. [DOI: 10.1016/j.avsg.2015.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 04/03/2015] [Accepted: 05/01/2015] [Indexed: 12/26/2022]
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Abstract
PURPOSE OF REVIEW Diagnosis of acute mesenteric ischemia in the early stages is now possible with modern computed tomography (CT), using intravenous contrast enhancement and imaging in the arterial and/or portal venous phase. The availability of CT around the clock means that more patients with acute mesenteric ischemia may be treated with urgent intestinal revascularization. RECENT FINDINGS The establishment of a hybrid operation room is most important to be able to perform explorative laparotomy for evaluation of the extent of mesenteric ischemia and successful intestinal revascularization. Endovascular recanalization and stenting has become an important alternative, especially in patients with both acute and chronic thrombotic superior mesenteric artery (SMA) occlusion. Aspiration embolectomy, thrombolysis and open surgical embolectomy, followed by on-table angiography, are the treatment options for embolic SMA occlusion. Endovascular therapy may be an option in the few patients with mesenteric venous thrombosis who do not respond to anticoagulation therapy. The concept of damage-control surgery is recommended after intestinal revascularization. SUMMARY Intestinal revascularization in patients with arterial occlusive mesenteric ischemia reduces bowel morbidity and mortality. Observational studies report that both endovascular and open vascular therapy options are effective, but endovascular technique may be preferred in these often elderly and fragile patients.
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Yang S, Fan X, Ding W, Liu B, Meng J, Xu D, He C, Yu W, Wu X, Li J. Multidisciplinary stepwise management strategy for acute superior mesenteric venous thrombosis: an intestinal stroke center experience. Thromb Res 2015; 135:36-45. [PMID: 25466834 DOI: 10.1016/j.thromres.2014.10.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/16/2014] [Accepted: 10/14/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUD Acute superior mesenteric venous thrombosis (ASMVT) is an uncommon but catastrophic abdominal vascular emergency with high rate of intestinal failure and mortality. The retrospective pilot study was performed to assess the effect of a multidisciplinary stepwise management strategy on survival and mesenteric recanalization in an integrated intestinal stroke center (ISC). MATERIALS AND METHODS A modern management strategy performed by multidisciplinary specialists in ISC was evaluated among 43 ASMVT patients that were classified into central vs peripheral type, operative vs nonoperative, early vs late treated group from March 2009 to April 2013. Patients received specific medical therapy, endovascular treatment, damage-control surgery, selective second-look laparotomy, critical care management, and clinical nutrition support in a stepwise way. The demographics, etiology, imaging characteristics, treatment procedures, complications, clinical outcome, and 1-year follow-up data were analyzed and compared. Confounding factors of mortality were identified by univariate and ROC-curve analysis. A single-center experience of over 5years for this modern strategy was also reported. RESULTS The protocol of multidisciplinary stepwise management strategy was followed in all ASMVT patients successfully. The 30-day mortality and recanalization rate were 11.63% and 90.70%. Initial damage-control surgery was carried out in 46.51% patients, with selective second-look laparotomy in 23.26% patients. Endovascular thrombolysis was performed in 83.72% patients initially or postoperatively. Bowel resection was necessary in 18 patients with the length of 100.00 (47.50, 222.50) cm. The incidence of short-bowel syndrome was 13.95%. The rate and length of bowel resection, short-bowel syndrome rate were significantly lower in nonoperative and early-treated groups (P<0.05). During the follow-up survey, 1-year survival was 83.72%, with no additional death or re-thrombosis. CONCLUSION A multidisciplinary stepwise management strategy involving modern surgical and endovascular treatments that focus on early mesenteric recanalization and bowel viability salvage in a specialized ISC could significantly improve the clinical outcome of ASMVT patients.
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Affiliation(s)
- Shuofei Yang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Department of Vascular Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Integrated Intestinal Stroke Center, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China.
| | - Xinxin Fan
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Department of Vascular Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Integrated Intestinal Stroke Center, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China.
| | - Weiwei Ding
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Department of Vascular Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Department of Gastroenterology, Inflammatory Bowel Diseases, Nutritional Support and Intestinal Transplantation, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Integrated Intestinal Stroke Center, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China.
| | - Baochen Liu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Department of Vascular Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Integrated Intestinal Stroke Center, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China.
| | - Jiaxiang Meng
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Department of Vascular Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Integrated Intestinal Stroke Center, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China.
| | - Dandan Xu
- Department of Gastroenterology Nursing and ostomy care, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Integrated Intestinal Stroke Center, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China.
| | - Changsheng He
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Department of Vascular Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Department of Radiology and Intervention Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Integrated Intestinal Stroke Center, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China.
| | - Wenkui Yu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Surgical Intensive Care Unit, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Integrated Intestinal Stroke Center, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China.
| | - Xingjiang Wu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Department of Vascular Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Department of Radiology and Intervention Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Integrated Intestinal Stroke Center, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China.
| | - Jieshou Li
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Department of Gastroenterology, Inflammatory Bowel Diseases, Nutritional Support and Intestinal Transplantation, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Surgical Intensive Care Unit, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Integrated Intestinal Stroke Center, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China.
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Rottenstreich A, Khalaileh A, Elazary R. Sleeve gastrectomy and mesenteric venous thrombosis: report of 3 patients and review of the literature. Surg Obes Relat Dis 2014; 10:e57-61. [DOI: 10.1016/j.soard.2014.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 07/06/2014] [Accepted: 07/07/2014] [Indexed: 10/25/2022]
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Elkrief L, Corcos O, Bruno O, Larroque B, Rautou PE, Zekrini K, Bretagnol F, Joly F, Francoz C, Bondjemah V, Cazals-Hatem D, Boudaoud L, De Raucourt E, Panis Y, Goria O, Hillaire S, Valla D, Plessier A. Type 2 diabetes mellitus as a risk factor for intestinal resection in patients with superior mesenteric vein thrombosis. Liver Int 2014; 34:1314-21. [PMID: 24237969 DOI: 10.1111/liv.12386] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 11/09/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS The most serious complication of acute mesenteric vein thrombosis (MVT) is acute intestinal ischaemia requiring intestinal resection or causing death. Risk factors for this complication are unknown. To identify risk factors for severe intestinal ischaemia leading to intestinal resection in patients with acute MVT. METHODS We retrospectively analysed consecutive patients seen between 2002 and 2012 with acute MVT in 2 specialized units. Patients with cirrhosis were excluded. We compared patients who required intestinal resection to patients who did not. RESULTS Among 57 patients, a local risk factor was identified in 14 (24%) patients, oral contraceptive use in 16 (29%), and at least one or more other systemic prothrombotic condition in 25 (44%). Five (9%) patients had diabetes mellitus (DM), 33 (58%) had overweight or obesity, 9 (18%) had hypertriglyceridemia and 10 (19%) had arterial hypertension. Eleven patients (19%) underwent intestinal resection. DM was significantly associated with intestinal resection (P = 0.02) while local factors or prothrombotic conditions were not. Computed tomography (CT) scans performed at diagnosis found that occlusion of second order radicles of the superior mesenteric vein was more frequently observed in patients who underwent intestinal resection (P = 0.009). CONCLUSIONS In acute MVT, patients with underlying DM have an increased risk of requiring intestinal resection. Neither local factors nor systemic prothrombotic conditions are associated with intestinal resection. When CT scan shows the preservation of second order radicles of the superior mesenteric vein, the risk of severe resection is low.
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Affiliation(s)
- Laure Elkrief
- Service d'Hépatologie, Hôpital Beaujon and INSERM U773, Clichy, France
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Hmoud B, Singal AK, Kamath PS. Mesenteric venous thrombosis. J Clin Exp Hepatol 2014; 4:257-63. [PMID: 25755568 PMCID: PMC4284291 DOI: 10.1016/j.jceh.2014.03.052] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 03/13/2014] [Indexed: 12/12/2022] Open
Abstract
Mesenteric vein thrombosis is increasingly recognized as a cause of mesenteric ischemia. Acute thrombosis commonly presents with abdominal pain and chronic type with features of portal hypertension. Contrast enhanced CT scan of abdomen is quite accurate for diagnosing and differentiating two types of mesenteric venous thrombosis. Prothrombotic state, hematological malignancy, and local abdominal inflammatory conditions are common predisposing conditions. Over the last decade, JAK-2 (janus kinase 2) mutation has emerged as an accurate biomarker for diagnosis of myeloproliferative neoplasm, an important cause for mesenteric venous thrombosis. Anticoagulation is the treatment of choice for acute mesenteric venous thrombosis. Thrombolysis using systemic or transcatheter route is another option. Patients with peritoneal signs or refractory to initial measures require surgical exploration. Increasing recognition of mesenteric venous thrombosis and use of anticoagulation for treatment has resulted in reduction in the need for surgery with improvement in survival.
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Affiliation(s)
- Bashar Hmoud
- Department of Internal Medicine, UTMB, Galveston, TX, USA
| | - Ashwani K. Singal
- Division of Gastroenterology and Hepatology, UAB, Birmingham, AL, USA,Address for correspondence: Ashwani K. Singal, 1808, 7th Ave S BDB 351, Birmingham, AL, USA. Tel.: +1 205 975 5683; fax: +1 205 975 6363.
| | - Patrick S. Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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Portomesenteric venous thrombosis following major colon and rectal surgery: incidence and risk factors. Surg Endosc 2014; 29:1071-9. [PMID: 25159636 DOI: 10.1007/s00464-014-3788-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 08/01/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Portomesenteric venous thrombosis (PMVT) is an uncommon complication of abdominal surgery. The objective of this study was to assess PMVT risk factor profiles and patient outcomes after colorectal surgery. METHODS A single center retrospective review of patients undergoing colorectal surgery was performed (2007-2012). PMVT was defined as thrombus within the portal, splenic, or superior mesenteric vein on computed tomography (CT). Inferior mesenteric vein thrombosis was excluded. Independent samples t test was used to compare data variables between PMVT and non-PMVT patients. Univariate and multivariate logistic regression analyses were used to assess PMVT risk factors. RESULTS There were 1,224 patients included (mean age 62 years, male = 566). Elective bowel resection was performed for colon carcinoma (n = 302), rectal carcinoma (n = 112), ulcerative colitis (n = 125), Crohn's disease (n = 78), polyps (n = 117), and diverticulitis (n = 215). Patients undergoing gynecological resections and emergent laparotomies were included (n = 275). Thirty-six patients (3%) were diagnosed with PMVT by CT: 17/36 on initial presentation and 19/36 by expert radiologist review. Patients with PMVT were younger (53 vs. 62 years, p = 0.001) with higher BMI (30.5 vs. 26.7, p < 0.001) and thrombocytosis (464 vs. 306, p < 0.001) compared to patients without PMVT. Univariate logistic regression identified younger age (p < 0.001), obesity (p < 0.001), ulcerative colitis (p < 0.001), thrombocytosis, (p < 0.001) and proctocolectomy as significant predictors of PMVT. Stepwise multivariate logistic regression identified that obesity (p < 0.001), thrombocytosis, (p < 0.001) and restorative proctocolectomy (p = 0.001) were still significant predictors. No patients in the PMVT group suffered bowel infarction and no related mortalities occurred. Thirty-day readmission rates were higher in the PMVT group (53% vs. 17%, p < 0.01). CONCLUSION BMI ≥ 30 kg/m(2), thrombocytosis, and restorative proctocolectomy were significant predictors of PMVT. Initial diagnostic studies showed a PMVT rate of 1.4%; however, after expert focused radiologic review, the actual rate was 3%. Thus, the diagnosis of PMVT is difficult and readmission after colorectal surgery should prompt its consideration.
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Lee LYW, Aubrey-Jones H, Lacey R, De Silva A. Mesenteric vein thrombosis; not going with the flow. CASE REPORTS 2014; 2014:bcr-2013-202396. [DOI: 10.1136/bcr-2013-202396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Eilbert W, Hecht B, Zuiderveld L. Acute mesenteric venous thrombosis with a vaginal contraceptive ring. West J Emerg Med 2014; 15:395-7. [PMID: 25035742 PMCID: PMC4100842 DOI: 10.5811/westjem.2014.4.21364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/13/2014] [Accepted: 04/29/2014] [Indexed: 01/14/2023] Open
Abstract
Mesenteric venous thrombosis is a rare cause of abdominal pain, which if left untreated may result in bowel infarction, peritonitis and death. The majority of patients with this illness have a recognizable, predisposing prothrombotic condition. Oral contraceptives have been identified as a predisposing factor for mesenteric venous thrombosis in reproductive-aged women. In the last fifteen years new methods of hormonal birth control have been introduced, including a transdermal patch and an intravaginal ring. In this report, we describe a case of mesenteric venous thrombosis in a young woman caused by a vaginal contraceptive ring.
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Affiliation(s)
- Wesley Eilbert
- University of Illinois at Chicago, Department of Emergency Medicine, Chicago, Illinois
| | - Benjamin Hecht
- University of Illinois at Chicago, Department of Emergency Medicine, Chicago, Illinois
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Transcatheter thrombolysis centered stepwise management strategy for acute superior mesenteric venous thrombosis. Int J Surg 2014; 12:442-51. [DOI: 10.1016/j.ijsu.2014.03.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 03/23/2014] [Indexed: 02/07/2023]
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Kim HK, Chun JM, Huh S. Anticoagulation and delayed bowel resection in the management of mesenteric venous thrombosis. World J Gastroenterol 2013; 19:5025-5028. [PMID: 23946612 PMCID: PMC3740437 DOI: 10.3748/wjg.v19.i30.5025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 05/20/2013] [Accepted: 06/19/2013] [Indexed: 02/06/2023] Open
Abstract
Acute mesenteric venous thrombosis is potentially lethal because it can result in mesenteric ischemia and, ultimately, bowel infarction requiring surgical intervention. Systemic anticoagulation for the prevention of thrombus propagation is a well-recognized treatment modality and the current mainstay therapy for patients with acute mesenteric venous thrombosis. However, the decision between prompt surgical exploration vs conservative treatment with anticoagulation is somewhat difficult in patients with suspected bowel ischemia. Here we describe a patient with acute mesenteric venous thrombosis who presented with bowel ischemia and was treated with anticoagulation and delayed short-segment bowel resection.
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Trombosis venosa mesentérica asociada a obstrucción intestinal por fitobezoar. Cir Esp 2013; 91:461-3. [DOI: 10.1016/j.ciresp.2012.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 02/14/2012] [Indexed: 11/20/2022]
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Abstract
This article reviews the presentation, diagnosis, evaluation, and treatment of the various forms of mesenteric ischemia, including acute and chronic ischemia. In addition, nonocclusive mesenteric ischemia and median arcuate ligament compressive syndrome are covered. The goals are to provide a structured and evidence-based framework for the evaluation and management of patients with these intestinal ischemia syndromes. Special attention is given to avoiding typical pitfalls in the diagnostic and treatment pathways. Operative techniques are also briefly discussed, including an evidence-based review of newer endovascular techniques.
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El Barni R, El Kharras A, Lahkim M, Fihri JF, Mejdane A, Bouchama R, Achour A. [Superior mesenteric vein thrombosis complicating an unrecognized appendicitis]. Pan Afr Med J 2013; 14:12. [PMID: 23504278 PMCID: PMC3597861 DOI: 10.11604/pamj.2013.14.12.2263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 01/06/2013] [Indexed: 11/23/2022] Open
Abstract
La thrombose veineuse mésentérique supérieure (TVMS) peut se présenter selon un mode aigu, subaigu ou chronique. Réputée rare, elle peut être primitive ou secondaire. Les étiologies chirurgicales les plus fréquemment identifiées de TVMS sont la diverticulite colique et l'appendicite aiguë. Les auteurs ont jugé utile de rapporter une observation de TVMS compliquant une appendicite refroidie par les antibiotiques, tout en insistant sur la latence clinique de telle pathologie rendant son diagnostic et son traitement plus difficile.
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Affiliation(s)
- Rachid El Barni
- Service de chirurgie générale, Hôpital Militaire Avicenne Marrakech, Morocco
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Duran R, Denys AL, Letovanec I, Meuli RA, Schmidt S. Multidetector CT features of mesenteric vein thrombosis. Radiographics 2013; 32:1503-22. [PMID: 22977032 DOI: 10.1148/rg.325115100] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Mesenteric vein thrombosis (MVT) accounts for 5%-15% of all mesenteric ischemic events and is classified as either primary or secondary. Primary MVT is idiopathic, whereas secondary MVT can result from a variety of underlying diseases and risk factors, including primary hypercoagulable states or prothrombotic disorders, myeloproliferative neoplasms, cancer (most frequently of the pancreas or liver), diverse inflammatory conditions, recent surgery, portal hypertension, and miscellaneous causes such as oral contraceptives or pregnancy. Clinical symptoms of MVT are rather nonspecific and are mainly characterized by abdominal pain. The mortality rate for MVT remains high, since even now the diagnosis is often delayed. Multidetector computed tomography (CT) is the modality of choice in this context. Although venous bowel ischemia occurs only infrequently with MVT, radiologists should be familiar with its multidetector CT features. Familiarity with the possible causes of MVT, the underlying pathogenic mechanisms associated with MVT, and the correlation between multidetector CT features and these pathogenic mechanisms is necessary to optimize medical management and improve patient care.
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Affiliation(s)
- Rafael Duran
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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İnan M, Sarıoğlu T, Serhat TH. Portomesenteric venous thrombosis as a rare cause of acute abdomen in a young patient: What should be the process of diagnosis and management? ULUSAL CERRAHI DERGISI 2013; 29:84-7. [PMID: 25931853 DOI: 10.5152/ucd.2013.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 04/03/2012] [Indexed: 12/29/2022]
Abstract
This report aimed to discuss indications for radiological evaluation, laboratory investigation for thrombophilic risk factors, and the duration of anticoagulation therapy in porto-mesenteric venous thrombosis, based on a young patient who presented with acute abdomen and ascites. We investigated the acquired and genetic thrombophilic risk factors and the diagnostic process. Abdominal CT and Doppler US were found to be useful radiological tools in both diagnosis and follow-up of portomesenteric thrombosis. The investigated thrombophilic factors, PT G20210A, MTHFR C677T and MTHFR A1298C, were positive for heterozygous mutations and high levels of lupus anticoagulant and factor VIII were detected. Rapid ascites resolution and an improvement in abdominal pain after meals were observed following anticoagulation. Follow-up examination after six months showed that the portomesenteric thrombosis had completely resolved. Evaluation by CT is recommended for patients with acute abdomen and ascites, especially if ultrasonography failed to show any specific pathology. Several acquired or genetic thrombophilic factors were identified in a patient in whom local precipitating factors were absent. For patients with genetic thrombophilic risk factors and thrombosis at an uncommon site in the body, lifelong treatment with anticoagulants is recommended.
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Affiliation(s)
- Mehmet İnan
- Department of General Surgery, Mağusa Medical Center, Gazimagusa, Turkish Republic of Northern Cyprus
| | - Tansel Sarıoğlu
- Department of Radiology, Mağusa Medical Center, Gazimagusa, Turkish Republic of Northern Cyprus
| | - Tülay Hakkı Serhat
- Department of Radiology, Mağusa Medical Center, Gazimagusa, Turkish Republic of Northern Cyprus
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Abstract
Atherosclerotic vascular disease involving the mesenteric arteries occurs frequently in the elderly population. Although the prevalence of ischemic bowel disease is difficult to determine, acute mesenteric ischemia (AMI) has been reported to cause in 1 in 1000 hospital admissions, whereas chronic mesenteric ischemia (CMI) is estimated to affect 1 in 100,000 individuals. Mesenteric ischemia generally manifests in its chronic form as postprandial abdominal pain resulting in significant weight loss, and in its acute form as an abrupt development of abdominal pain, lower gastrointestinal bleeding, and subsequent intestinal necrosis. This article discusses the cause, clinical manifestations, diagnosis, and management of AMI and CMI.
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