Acute Thrombosis of the Splanchnic Veins

Abstract

The consequence of an acute thrombosis in the splanchnic veins on the viability of the intestine has not been well defined in the literature. Spontaneous recovery or total necrosis of the bowel have both been described. We treated seven patients with thrombosis of the splanchnic veins and adopted a surgical approach in three patients with extended and complete thrombosis of the superior mesenteric vein, portal vein, and splenic vein, while four patients with partial thrombosis of the superior mesenteric vein or protal vein recovered with conservative treatment. A 22-year literature review has identified 64 cases of acute thrombosis in the splanchnic veins, with complete information regarding the location and extent of the thrombosis, the treatment, and the outcome. Different anatomical patterns of thrombosis with mortality rates varying between 0% and 76% seem to be related to the extent and completeness of venous obstruction.

A young adult with a fulminant Staphylococcus aureus infection and multiple thrombi

“…Splanchnic vein thrombosis often occurs in patient with cirrhosis, inflammatory disorders in the abdomen, abdominal trauma and hypercoagulable states. 7,8 Our patient did not appear to have any other contributing factors beyond her acute staphylococcal infection. However, it is possible that she had an underlying hypercoagulable disorder such as antiphospholipid syndrome, which was triggered by ankle trauma and cellulitis and contributed, to her clinical course.…”

The implications for patients undergoing splenectomy: postsurgery risk management

“…Thus, patients with total splenic vein thrombosis are thought to have a poor prognosis and may be at greater risk of developing clinical symptoms compared with patients with other PSVT. 51 In fact, PSVT may be asymptomatic or may resolve spontaneously, depending on the extent of the thrombus. Isolated splenic stump or partial intrahepatic PVT can be asymptomatic.…”

Portal vein thrombosis

“…Allo stato attuale non è chiaro quando sottoporre un paziente alla terapia anticoagulante o a trombolisi, né esistono dei trial randomizzati che indichino se una terapia è più efficace dell'altra, anche se studi retrospettivi di pazienti con PVT acuta hanno mostrato una percentuale di ricanalizzazione superiore con trombolisi rispetto alla terapia conservativa 29 e la trombolisi è risultata essere efficace anche quando la terapia con eparina non aveva prodotto dei risultati 34 . Oltre alla terapia medica sono state utilizzate anche tecniche chirurgiche invasive come la trombectomia chirurgica 35 . In caso di pazienti instabili emodinamicamente e/o in presenza di infarto intestinale la soluzione chirurgica con resezione del tratto intestinale infartuato rappresenta il trattamento di scelta.…”