Pain associated with dvt is often described as being a cramp or ache in the calf or thigh. Biplanar angiography of the mesenteric arteries remains the best method of diagnosing mesenteric vascular diseases, though duplex sonography of the mesenteric arteries appears to be a valuable screening tool. Treatment of mesenteric venous thrombosis springerlink. There are two such veins through which blood leaves the intestine. Signs and symptoms of mesenteric vein occlusion are very similar to those of acute mesenteric arterial occlusion. A 64yearold woman with a history of idiopathic portal hypertension presented at the emergency room with vomiting, increasing cramping abdominal pain, and lowgrade fever. Mvt is a clot that blocks blood flow in a mesenteric vein. Mesenteric venous thrombosis usually involves the superior mesenteric vein, with the danger of bowel infarction. Zakhour bj, dallis dj mesenteric venous thrombosis 1911 to 1984. Umpleby,1 in a discussion on a presentation of four patients, states that mvt is a rare condition accounting for 0.
While preparing a presentation on mesenteric venous thrombosis mvt recently we came across a blatant example of misquotation and requotation. Mesenteric venous thrombosis mvt was first described as a distinct cause of mesenteric ischemia by warren and eberhard in 1935 1. This technique, under appropriate circumstances, can be an appealing alternative to surgery. A rare case of isolated superior mesenteric venous thrombosis mvt after endoscopic variceal band ligation evl is reported. These authors reported a 34% mortality rate following intestinal resection for venous thrombosis. Less than 100 years ago in 1895, elliot 1 recognized intestinal gangrene secondary to mesenteric venous occlusion. Treatment of venous thrombosis at unusual sites springerlink. Superior mesenteric vein thrombosis radiology case. First differentiated from arterial causes of acute mesenteric ischemia 75 years ago, acute mesenteric venous thrombosis mvt is an uncommon disorder with nonspecific signs and symptoms, the. This study was designed to evaluate progress in diagnosis, management, and clinical outcome of mesenteric venous thrombosis mvt. Mesenteric venous thrombosis mvt is a serious condition.
The underlying cause is varied, and the prognosis depends on the precise pathologic findings. By 19, trotter 2 accumulated reports of 360 cases of mesenteric ischemia, 41% of which were mesenteric venous thrombosis. Mesenteric venous thrombosis accounts for less than 10% of cases. Percutaneous intervention is increasingly being used as an adjunct or alternative to surgical therapy for the treatment of acute, symptomatic, mesenteric venous thrombosis and noncavernous, chronic, portal vein thrombosis. Mesenteric vascular insufficiency mesenteric vascular insufficiency montgomery, robert a. Only 372 patients with mvt were reported from 1911 to 1984,37 and mvt accounted for only 6. Montgomery, md, phd assistant in surgery the johns hopkins university school of medicine baltimore, maryland anthony c. Nonlower extremity deep vein thrombosis emergency medicine. Ami as venous disease takes the form of mesenteric venous thrombosis mvt. Blunt, semiopaque indentations of the bowel lumen thumbprinting are indicative of mucosal edema, whereas gas in the wall of the bowel pneumatosis intestinalis or in the portal vein and free peritoneal air are characteristic of bowel infarction as a result of mesenteric venous thrombosis. Report of a young female with severe abdominal pain.
Proceedings alerting clinicians to suspect mesenteric venous thrombosis when patients present with severe abdominal pain, but findings on. Frontiers thrombosis of the abdominal veins in childhood. Decompression sickness dcs induced by extravascular and intravascular gas bubbles during decompression can present with varying manifestations, such as joint pain, numbness, cutaneous symptoms, and cardiopulmonary dysfunction. Acute mesenteric ischemia is a lifethreatening vascular emergency that requires early diagnosis and intervention to adequately restore mesenteric blood flow and to prevent bowel necrosis and patient death.
Venous causes of acute mesenteric ischemia are less common 5%15% of cases 4, 9 and are most often the result of a thrombosis of the superior mesenteric vein smv. Oct 26, 2014 once the diagnosis of mesenteric venous thrombosis mvt is made, treatment varies with the form of mvt acute, subacute, or chronic mvt. The operative relief of gangrene of intestine due to occlusion of the mesenteric vessels. Mesenteric venous thrombosis ian g harnik, lawrence j brandt. There are very few reported cases of patients presenting. Superior mesenteric vein thrombosis mimicking acute. An early diagnosis and thrombolytic and anticoagulant therapy are very important. Mesenteric venous thrombosis was recognized as a cause of intestinal gangrene more than a century ago by elliot,1 but warren and eberhard2 were the first to characterize mesenteric venous thrombosi. Guidance for the treatment of deep vein thrombosis and. Trombosis venosa mesenterica en mujeres transexuales. The condition stops the blood circulation of the intestine and can result in damage to the intestine. Mesenteric venous thrombosis although is an uncommon, it is a potential lethal cause of bowl ischemia.
Apr 10, 2020 a diagnosis of mesenteric venous thrombosis mvt is usually confirmed during laparotomy or autopsy. Abdominal pain represents the most common manifestation of mvt and is present in approximately 75% to 90% of patients. The thrombosis is extending from the splenoportal venous confluence to the main tributaries of superior mesenteric vein. The diagnosis is often delayed, and cases traditionally have been identified either at laparotomy or at autopsy. Chronic mesenteric ischemia, also known as intestinal angina, is most often due to arterial atherosclerotic disease. Thieme ejournals thrombosis and haemostasis abstract. Fortunately, it comprises only 5% to 15% of all reported acute mesenteric ischemia cases in the modern literature.
The current study aimed to identify risk factors of intestinal necrosis in in patients with mvt to predict the onset of patients. Acute mesenteric ischemia and duodenal ulcer perforation. The venous clot results in vascular stagnation, ultimately resulting in inadequate tissue oxygenation. Each of the categories in the clinical curriculum is assumed to include the diagnosis and management of the. We report a case of a patient, without any specific. Abdu razakhour bjdallis dj mesenteric venous thrombosis. Use of transjugular intrahepatic portosystemic shunts during lytic therapy of extensive portal splenic and mesenteric venous thrombosis.
Sudden death due to mesenteric vein thrombosis in a. Mvt accounts for 515% of all cases of mesenteric ischemia 1,2. Mesenteric venous thrombosis after laparoscopic sleeve. Mesenteric venous thrombosis mvt is a rare but potentially lethal form of mesenteric ischemia. Acute mesenteric ischemia ami is a syndrome caused by inadequate blood flow through the mesenteric vessels, resulting in ischemia and eventual gangrene of the bowel wall. Multidetector ct features of mesenteric vein thrombosis.
Patients characteristics and risk factors of in were assessed. Fiftythree patients had acute and 19 had chronic mesenteric venous thrombosis. The newer imaging techniques allow earlier diagnosis. Mesenteric venous thrombectomy followed by liver transplantation 223. Mesenteric venous thrombosis is a dangerous, somewhat uncommon abdominal catastrophe that has received little attention. Thirtyfour 64% patients with acute mesenteric venous thrombosis. Mesenteric venous thrombosis journal of vascular surgery. In comparison with arterial occlusive disease, which is much more frequent, venous occlusive disease makes up a much smaller percentage 1015% of mesenteric ischemia. A case of mesenteric venous thrombosis after endoscopic. However, mesenteric venous thrombosis mvt is a rare complication of dcs.
Mvt must be distinguished from arterial and nonocclusive types of mesenteric ischemia, and accounts for 5% to 15% of all cases of mesenteric ischemia. Acute mesenteric ischaemia and duodenal perforation are surgical emergencies with serious consequences. Apr, 2014 mesenteric venous thrombosis mvt is an uncommon cause of mesenteric ischemia accounting for 515% of the cases. Mesenteric venous thrombosis, techniques in vascular and. Mesenteric ischemiaa complex disease requiring an interdisciplinary approach. Idiopathic mesenteric venous thrombosis is a rare entity. Although relatively rare, it is a potentially lifethreatening condition. Abdominal pain is one of the most common presenting complaints to the emergency department. While mortality rates are low, a significant proportion of affected children may suffer longterm morbidity. Additionally, given the infrequency of these thrombi, there is lack of stringent research data and evidencebased treatment guidelines.
Deep vein thrombosis should be suspected in any patient who presents with unexplained extremity swelling, pain, warmth or erythema. Acute superior mesenteric venous thrombosis asmvt is an intractable disease with poor prognosis. Mesenteric venous thrombosis mvt is an uncommon cause of mesenteric ischemia accounting for 515% of the cases. Acute mesenteric venous thrombosis mvt is the rarest cause of acute mesenteric ischaemia, so thrombosis of a variant inferior mesenteric vein imv is especially uncommon in the setting of. The turkish journal of trauma and emergency surgery tjtes is an official publication of the turkish association of trauma and emergency surgery. Treatment of acute superior mesenteric vein thrombosis with. The location, extent, and rapidity of thrombus formation determine whether intestinal infarction. Mesenteric vein thrombosis almost always involves the distal small intestine superior mesenteric venous drainage and rarely involves the colon inferior mesenteric venous drainage. Argatroban, a direct thrombin inhibitor, may be a novel anticoagulant method in the therapy of asmvt. Treatment of acute superior mesenteric vein thrombosis with percutaneous techniques. Mesenteric venous thrombosis represents an important cause to consider in patients with acute abdominal pain. Laparoscopic vertical sleeve gastrectomy lsg has become an alternative bariatric procedure in select patients 3.
The risk of acute mesenteric venous thrombosis increases in patients with hypercoagulable states e. Treatment of acute mesenteric venous thrombosis with transjugular intramesenteric urokinase infusion. However, there are many diseases that can lead to mvt. Mesenteric vein thrombosis is increasingly recognized as a cause of mesenteric ischemia. Knowledge on the natural history of mesenteric vein thrombosis mvt and of the efficacy and safety of longterm oral anticoagulant therapy oat in this setting is based on small uncontrolled series of patients with a limited followup. As with acute arterial mesenteric ischemia, acute mvt is a. Mesenteric vascular insufficiency, current problems in. The causes of these thrombi are often unique to the venous. Acute mesenteric ischemia is a lifethreatening vascular emergency that. Venbrux, md associate professor of radiology associate director, cardiovascular diagnostic. Treatment of acute superior mesenteric vein thrombosis. There is evidence of filling defect in the superior mesenteric vein and its tributaries due to an isodense material within the lumen of the veins suggestive of acute superior mesenteric vein thrombosis. Clinical curriculum and educational objectives for vascular surgery developed by the association of program directors in vascular surgery james m.
Omai may be further subdivided into acute mesenteric arterial embolism amae and acute mesenteric arterial thrombosis amat. Acute mesenteric venous thrombosis presented most frequently as abdominal pain 83%, anorexia 53%, and diarrhea 43%. Idiopathic superior mesenteric vein thrombosis smvt is defined as a thrombosis of the superior mesenteric vein without any other related disease or etiologic factor. Studies shows that acute mesenteric venous thrombosis has better prognosis than acute arterial mesenteric ischemia. Because this is such a bizarre number we would have dismissed it as a. It can be either acute presenting commonly with abdominal pain or chronic presenting with features of portal hypertension. Our practice has performed 800 lsg procedures for weight loss, with 3 cases. Patients presenting with acute mesenteric ischaemia alone face a high mortality rate as high as 60% whereas those presenting with peptic ulcer perforation the mortality rates range from 614%. Mar 26, 2020 ami as arterial disease may be subdivided into nonocclusive mesenteric ischemia nomi and occlusive mesenteric arterial ischemia omai. Predictive risk factors of intestinal necrosis in patients. Mesenteric venous thrombosis, mesenteric ischemia, mesenteric vascular occlusion, abdominal pain abstract mesenteric ischemia is a rare disease with a high rate of mortality because of the nonspecific symptoms which leads to. The anatomic site of involvement in acute mesenteric venous thrombosis is most often ileum 64 to 83 percent or jejunum 50 to 81 percent, followed by colon. Mesenteric venous thrombosis mvt is an uncommon cause of. A diagnosis of mesenteric venous thrombosis mvt is usually confirmed during laparotomy or autopsy.
Antonio beniviene was the first to describe mesenteric ischemia as early as the 15th. The outcome of mesenteric venous thrombosis is related to early recognition and treatment. The literature is filled with randomized controlled trial data to guide most steps in managing patients with deep venous thrombosis of the extremities or pulmonary embolism. Health, general abdominal pain diagnosis blood vessels mesentery bloodvessels thrombophlebitis case studies warfarin health aspects. Improved diagnosis and treatment of mesenteric obstructive arterial disease and its complications have occurred. Mesenteric venous thrombosis multimedia encyclopedia.
Mesenteric venous thrombosis ian g harnik, lawrence j. Acute mesenteric venous thrombosis mvt is the rarest cause of acute mesenteric ischaemia, so thrombosis of a variant inferior mesenteric vein. The presentation may vary from an entirely asymptomatic clinical scenario to intestinal infarction and shock. Only after other causes of a hypercoagulable state have been excluded can a patient be. Venous thrombosis, however, is not limited to these locations and may involve the cerebral venous sinuses, renal veins, splanchnic veins, and ovarian veins. Article information, pdf download for mesenteric venous thrombosis. Angiography diagnosed acute mesenteric venous thrombosis in five 72% of seven patients. Mesenteric vein thrombosis an overview sciencedirect topics. First differentiated from arterial causes of acute mesenteric ischemia 75 years ago, acute mesenteric venous thrombosis mvt is an uncommon disorder with nonspecific signs and symptoms, the diagnosis of which requires a high index of suspicion.
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