Acute Mesenteric Vein Thrombosis Research Articles

Recanalization of port-superior mesenteric vein thrombosis with long-term anticoagulant therapy after failed early anticoagulant therapy

BackgroundAnticoagulant therapy with heparin is the first-line treatment for acute mesenteric vein thrombosis and is effective in improving outcomes. Conversely, patients with failed early anticoagulant therapy occasionally develop bowel infarction requiring surgery. The efficacy of long-term anticoagulant therapy on recanalizing mesenteric vein thrombosis in patients with failed early anticoagulant therapy remains unclear. Herein, we report a patient who achieved recanalization of port-superior mesenteric vein thrombosis treated with anticoagulant therapy for 10 years after failed early anticoagulant therapy, followed by bowel resection.Case presentationA 38-year-old male patient visited an outpatient clinic due to acute exacerbation of abdominal pain that had persisted for a month. He was diagnosed with port-superior mesenteric vein thrombosis on contrast-enhanced computed tomography (CT) scan and was transferred to our institution. Although he presented with abdominal pain, his respiration and circulation were stable upon hospital arrival. Anticoagulant therapy with heparin was started, and the patient was admitted to the intensive care unit. However, the patient’s abdominal pain worsened, and he began to develop signs of peritonitis. Repeat CT scan revealed bowel infarction. Thus, the patient underwent bowel resection 6 h after admission. The initial surgery was completed with open abdomen management. Bowel anastomosis was performed on the second-look surgery on the first postoperative day. Finally, the abdomen was closed on the third postoperative day after confirming the absence of bowel ischemia progression. The patient had prolonged impaired bowel function with paralytic ileus, but was discharged on the 60th postoperative day. He was then diagnosed with protein C and S deficiency based on the tests performed. Anticoagulant therapy with warfarin was initiated. He also received anticoagulant therapy in the outpatient setting. The patient’s port-superior mesenteric vein thrombosis had improved gradually with warfarin during the follow-up period. At 10 years after surgery, total occlusion of the port-superior mesenteric vein was recanalized with improvement of the portal collateral vessels. In addition, no gastric or esophageal varices were observed.ConclusionsLong-term anticoagulation therapy could affect the recanalization of extensive thrombus in multiple segments in patients with mesenteric venous thrombosis.

Correlation between white blood cell count and intestinal resection in patients with acute mesenteric vein thrombosis

ObjectiveAcute mesenteric vein thrombosis (AMVT) is an acute abdominal disease with onset, rapid progression, and extensive intestinal necrosis that requires immediate surgical resection. The purpose of this study was to determine the risk factors for nosocomial intestinal resection in patients with AMVT.MethodsWe retrospectively analysed 64 patients with AMVT diagnosed by CTA at the Affiliated Hospital of Kunming University of Science and Technology from January 2013 to December 2021. We compared patients who underwent intestinal resection (42 patients) with those who did not undergo intestinal resection (22 patients). The area under the ROC curve was evaluated, and a forest map was drawn.ResultsAmong the 64 patients, 6 (9.38%) had a fever, 60 (93.75%) had abdominal pain, 9 (14.06%) had a history of diabetes, 8 (12.5%) had a history of deep vein thrombosis (DVT), and 25 (39.06%) had ascites suggested by B ultrasound or CT after admission. The mean age of all patients was 49.86 ± 16.25 years. The mean age of the patients in the enterectomy group was 47.71 ± 16.20 years. The mean age of the patients in the conservative treatment group (without enterectomy) was 53.95 ± 15.90 years. In the univariate analysis, there were statistically significant differences in leukocyte count (P = 0.003), neutrophil count (P = 0.001), AST (P = 0.048), total bilirubin (P = 0.047), fibrinogen (P = 0.022) and DD2 (P = 0.024) between the two groups. The multivariate logistic regression analysis showed that admission white blood cell count (OR = 1.153, 95% CI: 1.039–1.280, P = 0.007) was an independent risk factor for intestinal resection in patients with AMVT. The ROC curve showed that the white blood cell count (AUC = 0.759 95% CI: 0.620–0.897; P = 0.001; optimal threshold: 7.815; sensitivity: 0.881; specificity: 0.636) had good predictive value for emergency enterectomy for AMVT.ConclusionsAmong patients with AMVT, patients with a higher white blood cell count at admission were more likely to have intestinal necrosis and require emergency enterectomy. This study is helpful for clinicians to accurately determine whether emergency intestinal resection is needed in patients with AMVT after admission, prevent further intestinal necrosis, and improve the prognosis of patients.

Acute mesenteric thrombosis in a pregnant woman with Factor V Leiden mutation with a history of in vitro fertilization and embryo transfer: case report and literature review

To report the case of a patient diagnosed with acute mesenteric vein thrombosis (AMVT) associated with Factor V Leiden mutation and a history of in vitro fertilization and embryo transfer and review the literature on risk factors and treatments performed for AMVT. We reported the case of a 37-year-old pregnant woman. A bibliographic search was carried out in Medline/PubMed and LILACS, filtering by type of language (English and Spanish). Primary cohort studies, cases and controls, case reports and case series were included, which addressed the risk factors associated with the development of acute mesenteric thrombosis during pregnancy and treatments performed. The search identified cases and control studies, case reports and case series related to mesenteric ischemia, pregnancy and in vitro fertilization. The literature reported that the main factors associated with mesenteric ischemia are pregnancy itself, genetic factors, drugs, protein C and protein S deficiency and idiopathic causes. SMV thrombosis is a life-threatening and very rarely seen condition that emerges in pregnancies. The literature suggests that, during gestation, the factors associated with the development of acute mesenteric thrombosis are hypercoagulability induced by pregnancy, the administration of oral estrogen during IVF-ET, and other precipitating factors. More studies are required to better understand the possible additional factors and build better optimal treatment algorithms.

Diagnosis and Management of Acute and Chronic Portomesenteric Venous Thrombosis

AbstractThrombosis of the portal and mesenteric veins is relatively uncommon. Thrombosis can be acute or chronic. Management is dictated by symptoms on clinical presentation. Acute symptomatic mesenteric vein thrombosis may require aggressive endovascular intervention with mechanical thrombectomy, thromboaspiration, infusion of thrombolytic drugs, TIPS creation or surgery. Chronic, symptomatic portal and mesenteric vein thrombosis usually requires recanalization of occluded segments and stent placement. The three main catheterization techniques for access into the portal venous system are: transhepatic, transjugular and trans-splenic. Evidence-based therapeutic strategies for acute and chronic portal and mesenteric vein thrombosis have not been established. There are no prospective comparative studies to support superiority of any given technique in the management of these conditions. The purpose of this review is to present an overview of the etiology, physiopathology, clinical presentation, and management of acute and chronic portal and mesenteric vein thrombosis.

ACUTE SUPERIOR MESENTERIC VESSEL THROMBOSIS CAUSING BOWEL ISCHEMIA – A 5 CASE SERIES

Background: Acute mesenteric ischemia consists of the sudden, partial or complete, interruption of the blood ow in superior or inferior mesenteric vessels that result in intestinal ischemia. The incidence was exponentially increasing with age and no difference has been observed between sexes. Aim: The Aim of this case series was to highlight clinical presentation, the difculty in diagnosis and importance of early intervention and the prognosis of superior mesenteric vessel thrombosis with bowel ischemia. This article presented a case series of intestinal infarction through obstruction of superior mesenteric vessels – three cases of acute mesenteric artery thrombosis, two case of acute mesenteric vein thrombosis. Materials and methods: The materials for this case series was collected from patients diagnosed and admitted as acute superior mesenteric vessel thrombosis in various surgical units in Department of General Surgery, Govt. Kilpauk Medical College & Hospital & Govt Royapettah Hospital,Chennai. All 5 cases have been analyzed for this study during period of 18 months from March 2020 to Augest 2021. All Cases with superior mesenteric vessels thrombosis were included.No exclusion criteria. Results: This case series consisted of 5 cases, three cases of acute mesenteric artery thrombosis and two case of acute mesenteric vein thrombosis. In this case series, superior mesenteric artery thrombosis was more common with male preponderance. 4 out of 5 cases were male in which Superior mesenteric artery was more common when compared to vein thrombosis. Out of 5 cases, 2 cases were asymptomatic with mild abdominal discomfort. Most common complaints of 5 cases were sudden onset of abdominal pain with or without vomiting. Abdominal distension/ Constipation were not seen in all cases. Out of 5 cases, 2post- operative stay and no complications after surgery. 2 cases developed postop complications.1 case had deceased because of late presentation. Conclusion: The diagnosis of AMI is difcult and mostly delayed resulting in irreversible bowel ischemia which requires emergency intervention. Mortality and morbidity for AMI remains high, and in patients requiring extensive bowel resection the survival rate was low. As AMI mostly affects the elderly population physicians have to be aware of the possibility of this condition when facing the elderly patient even with mild sudden onset of abdominal pain complaints. An interdisciplinary collaboration is must, since patients are not initially evaluated by surgeons.

S2586 MY OCP Is Out of Control!—A Case of Acute Portal and Mesenteric Vein Thrombosis After One Week of OCP Use

S2586 MY OCP Is Out of Control!—A Case of Acute Portal and Mesenteric Vein Thrombosis After One Week of OCP Use

Acute Intestinal Ischemia and Mesenteric Vein Thrombosis with Mortality During Pregnancy

Objective: We present a case of acute intestinal ischemia and mesenteric venosus thrombosis in a first trimester pregnant woman with surgical treatment. Case presentation and intervention: Our case was a 23-year-old multigravid woman at 8 weeks gestation. She presented to Ataturk University Research Hospital with complaints of abdominal distention, nausea, vomiting and constipation. The first day after admission, complained of more intense vomiting, abdominal distenrion and pain. An emergency laparotomy was performed. The part of jejenum, entire ileum, part of the ascending colon were necrosis, and thrombosis was discovered in the mesenteric venosus. The necrotic intestine was resected and a end-to-end colo-jejunal anostomosis was perormed. Postoperative, the patient was started on anticoagulants and antibiotherapy in intensive care. Unfortunately, the patient died on the second day after the operation. Conclusion: Mesenteric ischemia and MVT in pregnancy is a rare, but important cause of intestinal ischemia. When a pregnant patient presents with an acute abdomen, mesenteric ischemia and MVT should be included in the differential diagnosis.

Thrombectomy and Thrombolysis by Catheter Through Right Gastroepiploic Vein of Acute Superior Mesenteric Venous Thrombosis with Peritoneal Signs

Thrombectomy and Thrombolysis by Catheter Through Right Gastroepiploic Vein of Acute Superior Mesenteric Venous Thrombosis with Peritoneal Signs

Percutaneous Pharmaco-Mechanical Thrombectomy of Acute Symptomatic Superior Mesenteric Vein Thrombosis

PurposeTo evaluate the safety and the efficacy of percutaneous pharmaco-mechanical thrombectomy (PPMT) of acute superior mesenteric vein (SMV) thrombosis.MethodsA database of patients treated between 2011 and 2018 with acute venous mesenteric ischemia (VMI) was reviewed. VMI was diagnosed in the presence of SMV thrombosis and CT evidence of jejunal thickening. All patients presented with mild to moderate peritonism, which allowed surgery to be postponed. Initial treatment consisted of heparinization. PPMT was indicated in case of worsening abdominal pain despite anticoagulation and was performed via a transjugular or transhepatic approach, using a rotational aspiration thrombectomy catheter, followed by transcatheter thrombolysis. Clinical success was defined as symptoms resolution. Technical success was defined as patency of > 50% of SMV at venography and resolution of jejunal thickening. Patients were discharged on lifelong oral anticoagulation (INR 2.5–3.5). Follow-ups were performed using CT and color Doppler ultrasound.ResultsPopulation consisted of eight males, aged 37–81 (mean 56.5 years). Causes for thrombosis were investigated. Urokinase infusion time ranged from 48 to 72 h (3,840,000–5,760,000 IU). Clinical and technical success was obtained in all cases. One patient experienced bleeding from the superior epigastric artery and was treated with embolization. One patient died of multi-organ failure after 35 days, despite resolution of SMV thrombosis. In no case was surgery required after PPMT; mean hospitalization was 14.1 days (9–24). Mean follow-up of remaining seven patients was 37.7 months (12–84 months).ConclusionPPMT of acute SMV thrombosis seems safe and effective, with an 87.5% long-term survival rate and a 12.5% major complication rate.

Un caso de trombosis venosa parcial del segmento terminal de la vena mesentérica superior en un paciente con hepatopatía crónica


 Introducción: La isquemia intestinal tiene diversas causas y presentaciones que se pueden clasificar como agudas o crónicas. También se subdividen en causas arteriales, venosas y no oclusivas. La oclusión venosa mesentérica predomina en aproximadamente el 10% de los casos de isquemia intestinal. Las trombosis venosas están muy relacionadas a problemas de coagulabilidad, así como otras enfermedades como síndrome de anticuerpos antifosfolípidos, policitemia vera, síndrome de hepatopatía crónica o incluso al uso de anticonceptivos o al estado de hipercoagulabilidad en embarazos. 
 Caso: Paciente masculino de 52 años que se presenta con una hepatopatía crónica e hipertensión portal, hepatoesplenomegalia y con dolor abdominal insidioso que lo hace consultar con un especialista gastroenterólogo, el cual le solicita realizarse un ultrasonido abdominal. El paciente se presenta en ayunas y en el examen se le encuentra un hígado con aumento de la ecogenicidad, con superficie hepática micronodular, sin nódulos ni masas, sin dilatación de vías biliares intra o extrahepáticas y con vena porta y venas suprahepáticas permeables con calibre y aspecto normal teniendo al doppler color flujo normal. Vesícula biliar sin litiasis. Páncreas con morfología y con aspecto normal sin embargo inferior y medial a la cabeza pancreática se aprecia un área hipoecoica tubular, heterogénea y de bordes irregulares. 
 Discusión: La circulación venosa también se puede ver comprometida en la estrangulación del intestino como lo observado en volvulus, intusucepción o en obstrucción en asa. 
 La trombosis de la vena mesentérica aguda más comúnmente ocurre cuando existen condiciones patológicas como estados de hipercoagubilidad o neoplasias proliferativas causando trombosis de ramas venosas pequeñas con la consecuente reducción drástica del retorno venoso y formación de vasos colaterales. Varios métodos de imágenes están disponibles para su diagnóstico actualmente, cada cual tiene sus ventajas y desventajas. Entre estos está el ultrasonido convencional de alta resolución, ultrasonido doppler color, tomografía axial computada multicorte realizada con medio de contraste I.V, los cuales fueron utilizados en este caso. También se puede utilizar como gran aporte Resonancia Magnética (angioresonancia con gadolonio), que en este caso no se utilizó, ya que estaba claro el diagnóstico y por limitaciones económicas. Como otra opción, se puede realizar una angiografía digital del sistema arterial y venoso mesentérico, pero este procedimiento está reservado para casos de diagnóstico complicado con las técnicas no invasivas. 
 Conclusión: Por la información revisada y el catastrófico pronóstico de la enfermedad se deben hacer los mayores esfuerzos para pensar en esta entidad en pacientes con dolor abdominal y poseedores de factores de riesgo y así explotar más las posibilidades diagnósticas que pueden brindar la Tomografía Axial Computada, el ultrasonido convencional y el ultrasonido Doppler a color.

3:09 PM Abstract No. 362 Percutaneous transhepatic catheter-directed thrombolysis for the treatment of acute portal and mesenteric vein thrombosis

To evaluate our institutional outcomes following catheter-directed thrombolysis (CDT) for the treatment of acute portal and mesenteric vein thrombosis (PVT). A retrospective chart review of all patients with PVT treated with CDT over a ten-year period was performed. Thrombus was quantified using the Yerdel Classification pre- and post-thrombolysis. Demographics, risk factors for PVT, symptoms, clinical and technical success rates, and complications were analyzed. Subgroup analyses were performed comparing cirrhotic and non-cirrhotic patients. Twenty-eight patients (mean age 50.6 years) were treated with CDT, including 8 cirrhotic patients. Major risk factors included recent surgery, cirrhosis, and malignancy. Presenting symptoms were abdominal pain and nausea. Immediate clinical and technical success rates were 82.1% and 89.3%, respectively. Median Yerdel score significantly decreased in all groups, but more dramatically in the non-cirrhotic population (3.5 vs. 1, p = 0.034). Pain significantly decreased from a median score of 7 (IQR 4-9.5) pretreatment to 0 (IQR 0-3.25) posttreatment. Two procedure related patient deaths occurred, 1 bleed in a heparinized patient (aPTT >200) 5 days postprocedure, and multi-organ failure in a patient with a thrombosed SMV stent placed post Whipple. Additional complications included self-limited SMV extravasation post angioplasty, rapid ventricular response requiring antiarrhythmic medications, blood loss requiring transfusion, and vomiting requiring a nasogastric tube. There was a trend towards a lower complication rate in the cirrhotic population (25% vs. 55%). Nineteen patients had long-term follow-up (median 10.8 mo IQR: 4.9-18.7 mo) with 78.9% stable or decreased thrombus and 21.1% re-thrombosis. CDT for acute portal and mesenteric vein thrombosis has a good success rate with long-term partial and complete patency up to 79%, however continues to have a modest rate of significant complications. Given these findings, further investigation with a medically managed control group is warranted.

Abstract No. 659 - Approach to the endovascular management of acute portal and mesenteric vein thrombosis

Abstract No. 659 - Approach to the endovascular management of acute portal and mesenteric vein thrombosis

PWE-092 Systemic tpa for acute splanchnic vein thrombosis: Abstract PWE-092 Table 1

<h3>Introduction</h3> Acute portal mesenteric vein thrombosis, when extensive, is associated with catastrophic complications of gut infarction, short bowel syndrome, PN dependence and death. The absence of a satisfactory therapeutic regimen has prompted the recommendation for alternative therapies (Hepatology 2010;51:210–218). Based on the safety profile of prolonged low dose tPA in children with extensive deep vein thrombosis, we have developed a ward-based TPA protocol to be used in patients with acute splanchnic vein thrombosis and symptoms/radiological signs of gut ischaemia. This treatment algorithm was approved by RFH DTC. <h3>Method</h3> Alteplase is commenced at a dose of 0.05 mg/kg/hr in patients with acute splanchnic vein thrombosis, after informed consent and an MDT decision involving surgery/radiology/hepatology. The standard contraindications to tPA apply. Monitoring involves 12 hrly FBC, clotting, fibrinogen. Thromboelastography/ROTEM were included as exploratory investigations. t-PA may be continued for 72 h. Contrast enhanced CT is performed at 48 h, or earlier if clinically indicated. TIPS is indicated if thrombus/symptoms persist at 72 h. <h3>Results</h3> To-date, 6 patients have been treated with this regimen. Aetiology of thrombosis was Chiari malformation (1) previously undiagnosed JAK2+ve MPD (2) local sepsis (1) and unknown (2) (see Table 1). Three patients had complete radiologic normalisation of their splanchnic circulation, 2 of whom also required TIPS due to persistent PVT. Two patients re-permeated their SMV with complete resolution of clinical symptoms and radiological signs of gut ischaemia, but with persistent PV thrombus. One patient did not have a radiological response, although their pain resolved. No patient required surgery for gut ischaemia. All patients survived and were discharged with normal enteric function. Two patients had their infusion interrupted; one for an arterial line puncture site bleed, and one for worsening gut symptoms (infusion re-started). <h3>Conclusion</h3> This early experience suggests that systemic tPA in patients with acute PMVT and symptoms/signs of gut ischaemia can be used to achieve resolution of thrombus and symptoms and avoid catastrophic complications of gut infarction. We propose that tPA is of value in a multi-modality approach to the management of acute splanchnic vein thrombosis. <h3>Disclosure of interest</h3> None Declared.

Acute mesenteric vein thrombosis: factors associated with evolution to chronic mesenteric vein thrombosis.

Acute mesenteric venous thrombosis signs at MDCT are well described, but the literature lacks studies assessing their evolution. We aimed to describe the radiologic evolution of isolated acute mesenteric venous thrombosis and associated prognostic factors. Patients with isolated acute mesenteric venous thrombosis with follow-up for a minimum of 1 month with MDCT were selected. Images at the acute phase and on follow-up were reviewed in consensus reading. For acute mesenteric venous thrombosis, we searched for low-attenuated intraluminal filling defect. For chronic mesenteric venous thrombosis, we searched for vessel stenosis or occlusion associated with collateral mesenteric veins. Treatment, thrombosis risk factor, symptoms, location, and length and diameter of mesenteric venous thrombosis were reported and correlated with evolution over time. Twenty patients (nine women and 11 men; mean age, 52 years) were selected. Four patients recovered without radiologic sequelae, and 16 developed chronic mesenteric venous thrombosis signs. Anticoagulation did not influence recovery (p = 1). Patients with recovery compared with patients with chronic mesenteric venous thrombosis showed more frequent central lesions (p = 0.03). At diagnosis, the thrombosed segment was shorter and larger in the complete radiologic recovery group compared with the chronic mesenteric venous thrombosis signs group: mean length (± SD) 6.25 ± 3.21 cm and 12.81 ± 5.96 cm, respectively (p = 0.01); mean transverse diameter 1.82 ± 0.42 cm and 1.12 ± 0.34 cm, respectively (p = 0.01). Mesenteric fat infiltration at diagnosis was more frequent in the chronic mesenteric venous thrombosis signs group than in the complete recovery group (p = 0.03). Most cases of acute mesenteric venous thrombosis evolve toward the chronic form with vein stenosis or occlusion and development of collateral veins. Location, length of mesenteric venous thrombosis, transverse diameter of the vein, and mesenteric fat infiltration at diagnosis are determinant factors for mesenteric venous thrombosis evolution.

Type 2 diabetes mellitus as a risk factor for intestinal resection in patients with superior mesenteric vein thrombosis

The most serious complication of acute mesenteric vein thrombosis (MVT) is acute intestinal ischaemia requiring intestinal resection or causing death. Risk factors for this complication are unknown. To identify risk factors for severe intestinal ischaemia leading to intestinal resection in patients with acute MVT. We retrospectively analysed consecutive patients seen between 2002 and 2012 with acute MVT in 2 specialized units. Patients with cirrhosis were excluded. We compared patients who required intestinal resection to patients who did not. Among 57 patients, a local risk factor was identified in 14 (24%) patients, oral contraceptive use in 16 (29%), and at least one or more other systemic prothrombotic condition in 25 (44%). Five (9%) patients had diabetes mellitus (DM), 33 (58%) had overweight or obesity, 9 (18%) had hypertriglyceridemia and 10 (19%) had arterial hypertension. Eleven patients (19%) underwent intestinal resection. DM was significantly associated with intestinal resection (P = 0.02) while local factors or prothrombotic conditions were not. Computed tomography (CT) scans performed at diagnosis found that occlusion of second order radicles of the superior mesenteric vein was more frequently observed in patients who underwent intestinal resection (P = 0.009). In acute MVT, patients with underlying DM have an increased risk of requiring intestinal resection. Neither local factors nor systemic prothrombotic conditions are associated with intestinal resection. When CT scan shows the preservation of second order radicles of the superior mesenteric vein, the risk of severe resection is low.

Educational Exhibit Abstract No. 346 - Optimizing access in the treatment of acute portal vein thrombosis: a pictorial review of different methods of obtaining access to the portal venous system for the purpose of lytic therapy with emphasis on the advantages and disadvantages of each technique

Learning Objectives To describe the indications for thrombolytic therapy in the setting of acute, symptomatic portal vein thrombosis. To depict the different approaches to gaining access in the setting of acute portal vein thrombosis, as well as describe the pros and cons of each method. To provide useful hints in order to prevent common pitfalls. Background Portal vein thrombosis is a cause of significant morbidity amongst patients with endstage liver disease/hepatocellular carcinoma. Treatment in the acute, symptomatic setting may help to prevent life-threatening complications resulting from portal hypertension including variceal bleeding and mesenteric ischemia. Treatment may also help to prevent cavernous transformation of the portal vein, which can hinder transplant eligibility. Clinical Findings/Procedure Details The exhibit will include a pictorial review of cases describing different methods of obtaining access in the setting of acute portal vein thrombosis. Methods of access will include percutaneous routes as well as access via TIPS and DIPS placement. Cases will be followed by a description of the advantages and disadvantages of each method as well as a few helpful hints for troubleshooting based on the experience of multiple IRs at our academic institution. Conclusion and/or Teaching Points The use of thrombolytic therapy for the treatment of acute portal vein thrombosis can be associated with a high complication rate given the morbidity associated with endstage liver disease. This makes choosing the optimal access strategy for each individual patient extremely important in order to minimize complications and increase the likelihood of successful treatment. By familiarizing oneself with the pros and cons of each method, the IR can correctly choose the optimum route for access and hopefully avoid serious complications. Reference 1. Hollingshead M et al. Transcatheter Thrombolytic Therapy for Acute Mesenteric and Portal Vein Thrombosis. JVIR 2005: 16: 651-661.

The Management of Mesenteric Vein Thrombosis: A Single Institution Experience

Mesenteric vein thrombosis occurs rarely and is responsible for approximately 5-15% of all cases of acute mesenteric ischemia. The aim of this report was to discuss the management of mesenteric vein thrombosis based on our experience with 34 patients. In the present study, 34 patients who were admitted to our emergency surgery department between January 2007 and January 2010 with a diagnosis of acute mesenteric vein thrombosis were assessed retrospectively. Patients with peritoneal signs first underwent diagnostic laparoscopy to rule out perforation or bowel gangrene. We performed a second-look laparoscopy within 72 hours of the first operation. All patients were administered 100 mg/kg of the anticoagulant enoxaparin twice daily. In the 6th and 12th months of follow up, CT angiography was performed to evaluate recanalization of the veins. CT angiography revealed superior mesenteric vein thrombosis in 25 (73%) patients, portal vein thrombosis in 24 (70%) patients, and splenic vein thrombosis in 12 (35%) patients. Eleven patients with peritoneal signs underwent diagnostic laparoscopy; eight of the patients underwent small bowel resection, anastomosis, and trocar insertion. During second-look laparoscopy, small bowel ischemia was found in two patients and re-resection was performed. Early diagnosis with CT angiography, surgical and non-surgical blood flow restoration, proper anticoagulation, and supportive intensive care are the cornerstones of successful treatment of mesenteric vein thrombosis.

Effectiveness of endovascular thrombolysis in acute mesenteric vein thrombosis

Background Mesenteric vein thrombosis (MVT) is a rare, often lethal, entity that accounts for approximately 10-15% of all cases of mesenteric ischemia [1,2]. Current indications for surgery in patients with acute MVT include signs of peritonitis, bowel infarction and hemodynamic instability. In all other cases, long-lasting anticoagulation is the strategy of choice [3,4], patients with MVT have a fairly good prognosis and long-term outcomes once appropriate anticoagulation is achieved [4,5]. At variance with the slow onset of recanalization that takes place during anticoagulation, thrombolysis leads to a rapid re-opening of a vessel, with immediate tissue reperfusion [4].

Endovascular Thrombolysis in Acute Mesenteric Vein Thrombosis: A 3-year follow-up with the rate of short and long-term sequaelae in 32 patients

Endovascular Thrombolysis in Acute Mesenteric Vein Thrombosis: A 3-year follow-up with the rate of short and long-term sequaelae in 32 patients

Acute mesenteric vein thrombosis after laparoscopic gastric sleeve surgery for morbid obesity

Acute mesenteric vein thrombosis after laparoscopic gastric sleeve surgery for morbid obesity