Challenges in the management of mesenteric vein thrombosis

Abstract

Introduction: Mesenteric vein thrombosis (MVT) is uncommon. This emergency is rarely diagnosed early. High degree of suspicion is needed for diagnosis. Materials and Methods: Cases of pain abdomen, where the diagnosis of MVT was established either at laparotomy or by imaging were included retrospectively December 2004 to November 2010. Results: There were 16 cases with age range from 16 years to 51 years (median: 32 years). There were 13 males and 3 females. Six were diagnosed before bowel gangrene and could be managed with anti-coagulation alone. Ten of them had features of gangrenous bowel required bowel resection. After the resection, four underwent end to end anastomosis (one died, three leaked). Six had side to side anastomosis with 8-10 cm blind pouch on either end, were done to avoid ischemic transition zone anastomosis, and the abdomen was kept open with a transparent sheet cover to make it a continuous look laparostomy. The prothrombotic cause could be identified in eleven of the 13 cases tested. All are on oral anti-coagulant. One male became father after 12 years of marriage within 1-year of anti-coagulation. Conclusion: Mesenteric vascular thrombosis poses a diagnostic dilemma. Early anti-coagulation can avoid surgery. Gangrenous bowel resection with side to side anastomosis and continuous look laparostomy avoid multiple laparotomy.