The Management of Mesenteric Vein Thrombosis: A Single Institution Experience

Yanar, Fatih; Ağcaoğlu, Orhan; Gök, Ali Fuat Kaan; Sarıcı, İnanç Şamil; Özçınar, Beyza; Aksakal, Nihat; Güloğlu, Recep; Günay, Kayıhan; Aksoy, Murat; Özkurt, Enver; Kurtoğlu, Mehmet

doi:10.5505/tjtes.2013.47542

Cited by 12 publications

(18 citation statements)

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“…1,7 Thrombosis of the mesenteric vein is responsible for 5-15% of cases of mesenteric ischemia. 7,13,19 Initially, there is ischemia of the mucosa, which causes diffuse peritonitis as it progresses to transmural infarction. 10 Ultrasonography is considered the first line for diagnosis of disorders in the portal vein system, although it was not used in this case because of the acute abdomen presentation.…”

Section: Discussionmentioning

confidence: 99%

“…2 Splenoportography provides better images of size of thrombus, site, and compromised blood flow, offering diagnostic sensitivity of 90%. 19 The procedure is conducted in two phases: first contrast is injected into the superior mesenteric artery and the arterial territory is examined, then a venous phase is conducted and any venous obstruction and intraluminal thrombi are recorded. 11 In the case described here, the obstruction was located at the confluence of the splenic and superior mesenteric veins (Figure 2) and it was this involvement that caused mesenteric ischemia, which is the principal complication of acute PVT.…”

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confidence: 99%

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Cateterismo de artéria mesentérica para tratamento de trombose de veia porta

et al. 2017

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Portal vein thrombosis is a rare vascular cause of acute abdomen and it is directly related to hereditary or acquired thrombophilias. This article presents the case of a 60-year-old male patient, with clinical signs of mesenteric ischemia that was confirmed by imaging examination. He underwent enterectomy and enteroanastomosis and, after detection of portal vein thrombosis by splenoportography, he was prescribed drug-based treatment with continuous infusion of recombinant tissue plasminogen activator (Alteplase) via selective catheterization of the superior mesenteric artery. This is a treatment innovation. The portal system was successfully recanalized. However, the patient developed abdominal sepsis and required intensive care for 25 days. His clinical status improved and he was discharged with a prescription for oral anticoagulant. This article presents a brief review of the literature and a discussion of portal vein thrombosis.Keywords: portal vein; thrombosis; thrombophilia; mesenteric ischemia; acute abdomen. ResumoA trombose de veia porta é uma causa rara de abdome agudo vascular e está diretamente relacionada a trombofilias hereditárias ou adquiridas. O caso de um paciente de 60 anos, sexo masculino, com quadro clínico de isquemia mesentérica confirmada por exame de imagem é apresentado. Foi submetido a enterectomia e enteroanastomose e, após esplenoportografia que detectou trombose de veia

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Cateterismo de artéria mesentérica para tratamento de trombose de veia porta

et al. 2017

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“…18 In a study by Yanar et al, only 11 patients (32%) with peritonitis underwent surgical intervention and 23 patients (68%) underwent conservative treatment. 11 In another study 21 patients (100%) underwent surgical treatment and 85% underwent intestinal resection and anastomosis. 24 Our results are comparable to what is reported by Abu Daff et al that 21 patients (70%) underwent surgical exploration, and 95% of them underwent bowel resection.…”

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confidence: 99%

“…Other series documented that patients with MVT can receive anticoagulation for 6 months or more, depending on the causes and the underlying risk factors of the disease. 11,23,26 Mesenteric vein thrombosis has a high rate of recurrence during the first month after presentation and diagnosis. 11 In the current study, three patients had recurrence of MVT, shortly after one month of discharge, due to non-compliance to the oral anticoagulant treatment.…”

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Diagnosis and management challenges of acute mesenteric venous thrombosis in patients with liver cirrhosis: a single institution's experience

et al. 2017

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Background: Acute mesenteric venous thrombosis (MVT) is a dreadful complication of liver cirrhosis that requires prompt diagnosis and aggressive management for better outcome. The aim of this work was to study the diagnostic tools and the optimal management of acute MVT in patients with liver cirrhosis.Methods: It was a retrospective study including 40 patients with liver cirrhosis who were admitted to the surgical emergency and were eventually diagnosed as acute MVT between May 2011 to September 2016. The preoperative clinicopathological data, operative data and postoperative follow up were recorded.Results: Forty patients had acute MVT. Twenty five patients (62.5%) had prolonged prothrombin time, 18 patients (45%) had thrombocytopenia and 22 patients (55%) had low protein C. triphasic CT scan was the main diagnostic image in 28 patients, with sensitivity 100% and accuracy 96.9% in detection of intestinal infarction. Ten patients (25%) underwent conservative treatment with anticoagulant, while 30 patients (75%) were surgically explored and 28 patients of them had gangrenous bowel loops and underwent primary resection and anastomosis. Three patients underwent second look operation. Three patients had recurrent symptoms after 1 month of the first presentation. The overall 30- and 90-day mortality was 27.5% and 37.5% respectively.Conclusions: Cirrhotic patients may have hypercoagulable state and the usual laboratory tests don’t accurately assess the coagulation status in these patient. Acute MVT in cirrhotic patients has a high early morbidity and mortality that needs early diagnosis and urgent management with selective surgical intervention and proper anticoagulant.

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“…Heparin inhibits further thrombogenesis and prevents additional clot accumulation with particular caution to the possibility of GI bleeding. Conversion to oral warfarin with suitable dose adjustment is always indicated and should be continued for at least 6 mo [21,42] . Recent knowledge has generated a multidisciplinary surgical management of AMI.…”

Section: Diagnostic Modalitiesmentioning

confidence: 99%

Mesenteric ischemia: Pathogenesis and challenging diagnostic and therapeutic modalities

Mastoraki¹

2016

WJGP

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Mesenteric ischemia (MI) is an uncommon medical condition with high mortality rates. ΜΙ includes inadequate blood supply, inflammatory injury and eventually necrosis of the bowel wall. The disease can be divided into acute and chronic MI (CMI), with the first being subdivided into four categories. Therefore, acute MI (AMI) can occur as a result of arterial embolism, arterial thrombosis, mesenteric venous thrombosis and nonocclusive causes. Bowel damage is in proportion to the mesenteric blood flow decrease and may vary from minimum lesions, due to reversible ischemia, to transmural injury, with subsequent necrosis and perforation. CMI is associated to diffuse atherosclerotic disease in more than 95% of cases, with all major mesenteric arteries presenting stenosis or occlusion. Because of a lack of specific signs or due to its sometime quiet presentation, this condition is frequently diagnosed only at an advanced stage. Computed tomography (CT) imaging and CT angiography contribute to differential diagnosis and management of AMI. Angiography is also the criterion standard for CMI, with mesenteric duplex ultrasonography and magnetic resonance angiography also being of great importance. Therapeutic approach of MI includes both medical and surgical treatment. Surgical procedures include restoration of the blood flow with arteriotomy, endarterectomy or anterograde bypass, while resection of necrotic bowel is always implemented. The aim of this review was to evaluate the results of surgical treatment for MI and to present the recent literature in order to provide an update on the current concepts of surgical management of the disease. Mesh words selected include MI, diagnostic approach and therapeutic management.

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The Management of Mesenteric Vein Thrombosis: A Single Institution Experience

Cited by 12 publications

References 29 publications

Cateterismo de artéria mesentérica para tratamento de trombose de veia porta

Cateterismo de artéria mesentérica para tratamento de trombose de veia porta

Diagnosis and management challenges of acute mesenteric venous thrombosis in patients with liver cirrhosis: a single institution's experience

Mesenteric ischemia: Pathogenesis and challenging diagnostic and therapeutic modalities

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