Hybrid Therapy Consisting of Bowel Resection and Fluoroscopic-Assisted Balloon Thrombectomy for Small Bowel Infarction Caused by Acute Mesenteric Venous Thrombosis

Xu, Rongwei; Tang, Linna; Wang, Xianming; Zhang, Tao; Zhou, Zhengtong; Wang, Ming-Hai; Qin, Shengxue; Zhang, Shuguang

doi:10.1016/j.avsg.2018.12.081

Cited by 2 publications

(6 citation statements)

References 11 publications

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“…This allows for observing the evolution of ischemia, avoiding unnecessary laparotomies, and the effect of the nonsurgical therapies [18]. Treatment of MVT depends on the stage of presentation; the options include anticoagulation therapies, local or systemic thrombolysis and interventional or surgical thrombectomy [8]. When bowel infarction is present, resection is mandatory [1].…”

Section: Discussionmentioning

confidence: 99%

“…A mesenteric venous thrombosis is a deep venous thrombosis that occurs due to coagulation problems interfering with bowel venous return [4][5][6][7]. It represents 0-16% of all cases of intestinal infarction and 5-15% without mechanical obstruction [8]. Although it is rare, it is potentially deadly with a mortality rate of 20-30% [8,9].…”

Section: Introductionmentioning

confidence: 99%

“…It represents 0-16% of all cases of intestinal infarction and 5-15% without mechanical obstruction [8]. Although it is rare, it is potentially deadly with a mortality rate of 20-30% [8,9]. Life-threatening risks include infarction, following the thrombosis.…”

Section: Introductionmentioning

confidence: 99%

“…When bowel ischemia is suspected, surgeons might choose between operative management or conservative treatment with anticoagulation [8]. Exploratory laparotomy in acute stages is often complicated due to undefined borders between the ischemic bowel and the viable bowel.…”

Section: Introductionmentioning

confidence: 99%

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Asymptomatic Intestinal Ischemia Secondary to Thrombosis of the Spleno-Mesenteric Portal Axis: Usefulness of Laparoscopic Approach for Diagnosis and Therapeutical Decisions—Case Report and Review of the Literature

Gianazza,

Morabito,

Inversini

et al. 2024

Emergency Care and Medicine

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Mesenteric Venous Thrombosis (MVT) is a rare but often lethal form of ischemia. The diagnosis may be difficult for the clinician due to its mild symptoms with a great discrepancy between the pain suffered by the patients and the clinical observation. The non-specificity of the laboratory tests and the challenge in computed tomography (CT) scan in distinguishing when an ischemia is occurring lead to the risk of an unrecognized diagnosis, especially considering that an early onset of treatment is largely fundamental for better outcomes. Also, the choice between the surgical approach and the anticoagulation may be a pitfall for the clinicians. The treatment choice requires a multidisciplinary approach. Emergency exploration by laparoscopy allows clinicians to reach the correct diagnosis and the real-time assessment of the intestinal infarction extension, playing a double diagnostic and therapeutic role in those doubtful and tricky cases. Here, a 77-year-old male with a completely asymptomatic bowel ischemia secondary to a Mesenteric Venous Thrombosis was submitted to a laparoscopic approach.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Asymptomatic Intestinal Ischemia Secondary to Thrombosis of the Spleno-Mesenteric Portal Axis: Usefulness of Laparoscopic Approach for Diagnosis and Therapeutical Decisions—Case Report and Review of the Literature

Gianazza,

Morabito,

Inversini

et al. 2024

Emergency Care and Medicine

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“…3c). Combining endovascular therapy with open surgery (hybrid approach) has been described in a modern series of nine patients (15), where bowel resection was followed by fluoroscopic-guided balloon thrombectomy after surgical exposure of the superior mesenteric vein, ending up with completion control venography. In a reported series of 31 surgically treated patients in 1997, 11 underwent open surgical thrombectomy, of which 5 received additional treatment with continuous local thrombolysis with high-dose recombinant tissue plasminogen activator for 2–3 days (16) (Fig.…”

Section: Non-operative Therapymentioning

confidence: 99%

Management of Acute Mesenteric Venous Thrombosis: A Systematic Review of Contemporary Studies

Acosta

Salim

2020

Scand J Surg

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Background and Aims: Acute mesenteric venous thrombosis accounts for up to 20% of all patients with acute mesenteric ischemia in high-income countries. Acute mesenteric venous thrombosis is nowadays relatively more often diagnosed with intravenous contrast-enhanced computed tomography in the portal phase than at explorative laparotomy No high-quality comparative studies between anticoagulation alone, endovascular therapy, or surgery exists. The aim of the present systematic review was to offer a contemporary overview on management. Materials and Methods: Eleven relevant published original studies with series of at least ten patients were retrieved from a Pub Med search between 2015 and 2020 using the Medical Subject Heading term “mesenteric venous thrombosis.” Results: When MVT is diagnosed early, immediate anticoagulation with either unfractionated heparin or subcutaneous low-molecular-weight heparin should commence. Surgeons need to be aware of the importance to scrutinize the computed tomography images themselves for assessment of secondary intestinal abnormalities to mesenteric venous thrombosis and the risk of bowel resection and worse prognosis. Progression toward peritonitis is an indication for explorative laparotomy and assessment of bowel viability. Frank transmural small bowel necrosis should be resected and bowel anastomosis may be delayed for several days until second look. Meanwhile, intravenous full-dose unfractionated heparin should be given at the end of the first operation. Postoperative major intra-abdominal or gastrointestinal bleeding occurs rarely, but the heparin effect can instantaneously be reversed by protamine sulfate. Patients who do not improve during conservative therapy with anticoagulation alone but without developing peritonitis may be subjected to endovascular therapy in expert centers. When the patient’s intestinal function has recovered, with or without bowel resection, switch from parenteral unfractionated heparin or low-molecular-weight heparin therapy to oral anticoagulation can be performed. There is a trend that direct oral anticoagulants are increasingly used instead of vitamin K antagonists. Up to now, direct oral anticoagulants have been shown to be equally effective with the same rate of bleeding complications. Patients with no strong permanent trigger factor for mesenteric venous thrombosis such as intra-abdominal cancer should undergo blood screening for inherited and acquired thrombophilia. Conclusion: Early diagnosis with emergency computed tomography with intravenous contrast-enhancement and imaging in the portal phase and anticoagulation therapy is necessary to be able to have a succesful non-operative succesful course.

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Hybrid Therapy Consisting of Bowel Resection and Fluoroscopic-Assisted Balloon Thrombectomy for Small Bowel Infarction Caused by Acute Mesenteric Venous Thrombosis

Cited by 2 publications

References 11 publications

Asymptomatic Intestinal Ischemia Secondary to Thrombosis of the Spleno-Mesenteric Portal Axis: Usefulness of Laparoscopic Approach for Diagnosis and Therapeutical Decisions—Case Report and Review of the Literature

Asymptomatic Intestinal Ischemia Secondary to Thrombosis of the Spleno-Mesenteric Portal Axis: Usefulness of Laparoscopic Approach for Diagnosis and Therapeutical Decisions—Case Report and Review of the Literature

Management of Acute Mesenteric Venous Thrombosis: A Systematic Review of Contemporary Studies

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