Portal Vein Thrombosis after Laparoscopic Colectomy: Thrombolytic Therapy via the Superior Mesenteric Vein

Poultsides, George A.; Lewis, W Cannon; Feld, Robert S.; Walters, David; Cherry, David; Ruby, Steven T.

doi:10.1177/000313480507101013

Cited by 25 publications

(8 citation statements)

References 23 publications

(28 reference statements)

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“…54 Pain out of proportion to physical findings should raise the clinical suggestion of PVT. 42,49 Routine blood tests are typically not helpful in the diagnosis of acute PVT. Leukocytosis and mild elevations in liver function tests may be present, whereas metabolic acidosis is a typical late finding suggestive of bowel infarction.…”

Section: Commentmentioning

confidence: 99%

Portomesenteric Venous Thrombosis After Laparoscopic Surgery

et al. 2009

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Portomesenteric venous thrombosis following laparoscopic surgery usually manifests as nonspecific abdominal pain. Computed tomography can readily provide the diagnosis and demonstrate the extent of the disease. Treatment should be individualized based on the extent of thrombosis and the presence of bowel ischemia but should include anticoagulation therapy. Venous stasis from increased intra-abdominal pressure, intraoperative manipulation of splanchnic vasculature, and systemic thrombophilic states likely converges to produce this potentially lethal condition.

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Section: Commentmentioning

confidence: 99%

Portomesenteric Venous Thrombosis After Laparoscopic Surgery

et al. 2009

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“…The intraabdominal inflammatory conditions leading to sepsis that cause PVT include pancreatitis, cholecystitis, cholangitis, appendicitis, liver abscess and local injury to portal venous axis following splenectomy including laparoscopic splenectomy, laparoscopic colectomy, abdominal trauma, portocaval shunts & other intraabdominal surgical procedures in association with the above acquired or inherited prothrombotic conditions 26–30 . PVT may also occur after ablative therapy for HCC and fine needle aspiration of pancreatic mass 31–33 …”

Section: Aetiologymentioning

confidence: 99%

Review article: the modern management of portal vein thrombosis

Chawla

Duseja

Dhiman

2009

Aliment Pharmacol Ther

139

133

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Summary Background Portal vein thrombosis (PVT) is an important cause of portal hypertension. It may occur as such with or without associated cirrhosis and hepatocellular carcinoma. Information on its management is scanty. Aim To provide an update on the modern management of portal vein thrombosis. Information on portal vein thrombosis in patients with and without cirrhosis and hepatocellular carcinoma is also updated. Methods A pubmed search was performed to identify the literature using search items portal vein thrombosis‐aetiology and treatment and portal vein thrombosis in cirrhosis and hepatocellular carcinoma. Results Portal vein thrombosis occurs because of local inflammatory conditions in the abdomen and prothrombotic factors. Acute portal vein thrombosis is usually symptomatic when associated with cirrhosis and/or superior mesenteric vein thrombosis. Anticoagulation should be given for 3–6 months if detected early. If prothrombotic factors are identified, anticoagulation should be given lifelong. Chronic portal vein thrombosis usually presents with well tolerated upper gastrointestinal bleed. It is diagnosed by imaging, which demonstrates a portal cavernoma in place of a portal vein. Anticoagulation does not have a definite role, but bleeds can be treated with endotherapy or shunt surgery. Rarely liver transplantation may be considered. Conclusion Role of anticoagulation in chronic portal vein thrombosis needs to be further studied.

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“…One of the proposed causative factors for PMVT is the development of splanchnic vessels thrombosis, but its underlying mechanism remains unclear [ 11 , 18 ]. Kotzampassi et al [ 19 ] suggested that a sustained pressure of 14 mmHg of carbon dioxide could affect the mucosal blood flow in an experimental animal model.…”

Section: Discussionmentioning

confidence: 99%

“…An earlier study demonstrated an inverse relationship between intraperitoneal pressure and the portal blood flow because an increase in intra-abdominal pressure beyond 14 mmHg is enough to reduce the portal venous flow by 50% [ 8 ]. It is not the direct pressure alone that might pre-dispose to thrombus formation; carbon dioxide causes sympathetic vasoconstriction through the release of vasopressors, which eventually reduces venous blood flow and increases the risk of thrombosis [ 11 , 18 ]. In addition, the prolonged reverse-Trendelenburg position is considered as another possible explanation for the development of portal vein thrombosis [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Portomesenteric Vein Thrombosis After Laparoscopic Sleeve Gastrectomy: 3 Case Reports and a Literature Review

et al. 2016

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Case seriesPatient: Male, 27 • Female, 46 • Male, 46Final Diagnosis: —Symptoms: Vague abdominal pain • severe nausea • vomiting • fever and diffuse abdominal tendernesMedication: —Clinical Procedure: —Specialty: —Objective:Rare co-existance of disease or pathologyBackground:Porto-mesenteric venous thrombosis (PMVT) is an infrequent but severe surgical complication developing in patients who underwent laparoscopic bariatric surgery (sleeve gastrectomy). Herein, we describe the clinical presentation, management, and outcome of 3 rare cases of PMVT after laparoscopic sleeve gastrectomy (LSG), successfully treated at our center.Case Report:All patients developed PMVT post-LSG and presented with diffused abdominal pain, nausea, and vomiting. Computed tomography (CT) of the abdomen confirmed the diagnosis of portal vein thrombosis. Two patients were treated conservatively with anticoagulation and thrombolytic therapy and the third patient required operative intervention with bowel resection.Conclusions:PMVT is a rare presentation after LSG, which requires early diagnosis and management. Conservative management through anticoagulants and thrombolytic therapy is quite effective and, if indicated, should always be considered as the primary treatment option.

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Portal Vein Thrombosis after Laparoscopic Colectomy: Thrombolytic Therapy via the Superior Mesenteric Vein

Cited by 25 publications

References 23 publications

Portomesenteric Venous Thrombosis After Laparoscopic Surgery

Portomesenteric Venous Thrombosis After Laparoscopic Surgery

Review article: the modern management of portal vein thrombosis

Portomesenteric Vein Thrombosis After Laparoscopic Sleeve Gastrectomy: 3 Case Reports and a Literature Review

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