Acute Superior Mesenteric Vein Thrombosis Research Articles

MiR-138-5p ameliorates intestinal barrier disruption caused by acute superior mesenteric vein thrombosis injury by inhibiting the NLRP3/HMGB1 axis.

Acute superior mesenteric venous thrombosis (ASMVT) decreases junction-associated protein expression and intestinal epithelial cell numbers, leading to intestinal epithelial barrier disruption. Pyroptosis has also recently been found to be one of the important causes of mucosal barrier defects. However, the role and mechanism of pyroptosis in ASMVT are not fully understood. Differentially expressed microRNAs (miRNAs) in the intestinal tissues of ASMVT mice were detected by transcriptome sequencing (RNA-Seq). Gene expression levels were determined by RNA extraction and reverse transcription-quantitative PCR (RT-qPCR). Western blot and immunofluorescence staining analysis were used to analyze protein expression. H&E staining was used to observe the intestinal tissue structure. Cell Counting Kit-8 (CCK-8) and fluorescein isothiocyanate/propidine iodide (FITC/PI) were used to detect cell viability and apoptosis, respectively. Dual-luciferase reporter assays prove that miR-138-5p targets NLRP3. miR-138-5p expression was downregulated in ASMVT-induced intestinal tissues. Inhibition of miR-138-5p promoted NLRP3-related pyroptosis and destroyed tight junctions between IEC-6 cells, ameliorating ASMVT injury. miR-138-5p targeted to downregulate NLRP3. Knockdown of NLRP3 reversed the inhibition of proliferation, apoptosis, and pyroptosis and the decrease in tight junction proteins caused by suppression of miR-138-5p; however, this effect was later inhibited by overexpressing HMGB1. miR-138-5p inhibited pyroptosis, promoted intestinal epithelial tight junctions and alleviated ASMVT injury-induced intestinal barrier disruption via the NLRP3/HMGB1 axis.

Magnetic Resonance Angiography with Hour-Scale Duration after Single Low-Dose Administration of Biocompatible Gadolinium Oxide Nanoprobe.

Long-term contrast-enhanced angiography offers significant advantages in theranostics for diverse vascular diseases, particularly in terms of real-time dynamic monitoring during acute vascular events; However, achieving vascular imaging with a duration of hours through a single administration of low-dose contrast agent remains challenging. Herein, a hyaluronic acid-templated gadolinium oxide (HA@Gd2O3) nanoprobe-enhanced magnetic resonance angiography (MRA) is proposed to address this bottleneck issue for the first time. The HA@Gd2O3 nanoprobe synthesized from a facile one-pot biomineralization method owns ultrasmall size, good biocompatibility, optimal circulation half-life (≈149 min), and a relatively high T1 relaxivity (r1) under both clinical 3 T (8.215 mM-1s-1) and preclinical 9.4 T (4.023 mM-1s-1) equipment. The HA@Gd2O3 nanoprobe-enhanced MRA highlights major vessels readily with significantly improved contrast, extended imaging duration for at least 2 h, and ultrahigh resolution of 0.15mm under 9.4 T, while only requiring half clinical dosage of Gd. This technique can enable rapid diagnosis and real-time dynamic monitoring of vascular changes in a model of acute superior mesenteric vein thrombosis with only a single injection of nanoprobe. The HA@Gd2O3 nanoprobe-enhanced MRA provides a sophisticated approach for long-term (hour scale) vascular imaging with ultrahigh resolution and high contrast through single administration of low-dose contrast agent.

Acute Mesenteric Ischaemia: A Case Series

Acute Mesenteric Ischaemia (AMI) is a group of disorders characterised by a sudden occlusion of blood supply to varing portions of the small intestine, eventually progressing to ischaemia and peritonitis. The present case series highlights a total of seven cases, three of which are classified as acute superior mesenteric artery thrombosis and four as acute superiormesenteric vein thrombosis. The typically symptoms reported were sudden onset of abdominal pain, distension, and melena (a late finding). Among the seven cases, four patients who received early intervention had favourable outcomes. All patients presented late with peritonitis symptoms, except for one patient. Emergency laparotomy was performed on all patients, except for one who underwent diagnostic laparoscopy. Therefore, although abdominal pain is an uncommon symptom, physicians need to exercise a high level of diligence. If left untreated, the overall mortality rate consistently exceeds 70-90%. This case series emphasises the importance of timely diagnosis, early intervention, and immediate postoperative heparinisation, which significantly decrease morbidity and mortality.

Primary antiphospholipid antibody syndrome presenting as acute superior mesenteric vein thrombosis

Antiphospholipid antibody syndrome (APS) is an autoantibody mediated thrombophilia characterised by recurrent arterial or venous thrombosis and/or pregnancy morbidity. APS presenting as thrombosis in mesenteric venous system is relatively uncommon (10%). Here, we present a case of primary APS presenting as acute superior mesenteric vein (SMV) thrombosis in a 38-year-old female. She was admitted with the complaints of abdominal pain and constipation for five days. Her abdomen was distended with sluggish bowel sounds. Her abdominal contrast enhanced computed tomography revealed thrombosis of SMV, splenic vein and portal vein. She was initially kept on conservative management and started on anticoagulants. Her coagulation work-up revealed that she was positive for anticardiolipin antibody and therefore, the diagnosis of APS was made. She was continued on conservative management and anticoagulants. On the tenth day of admission, after starting oral diet, she developed severe abdominal pain and abdominal signs of peritonitis. She was then taken up for emergency laparotomy. Intraoperatively; there was 100 cm of gangrenous ileal segment, about 60 cm from ileocecal junction and 160 cm from duodenojejunal flexure. The gangrenous ileal segment was resected and a double barrel ileostomy was constructed. She had an uneventful postoperative recovery and was started on lifelong anticoagulants.

A systematic review of the management of acute superior mesenteric vein thrombosis in adults

Abstract Background: Acute thrombosis of the superior mesenteric vein (SMV) is a rare but potentially catastrophic condition. Clinically separate from portal venous thrombosis due to a higher proportion of associated thrombophilic disorders and intestinal infarction, SMV thrombosis warrants a distinct approach to management. The aim of this review is to report the evidence for current practice. Methods: A systematic review was carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four clinical trials databases and 4 trial registries were searched. This search was not limited by language or study type, but was limited to an adult population (18 years and above). The search period was between January 1, 2000 and February 28, 2019. The review was registered in the PROSPERO database: CRD42018116825. Bias was assessed using the ROBINS-I tool. Results: A total of 7989 studies were identified, resulting in 19 observational studies being analyzed. Eighteen studies reported on anti-coagulation, 1 reported on anti-coagulation plus endovascular thrombectomy, 9 reported on thrombolysis, and 10 reported on the role of surgery. Bias assessment showed that confounding was a significant area of potential bias. This review has reported that the management of SMV thrombosis is centered around a patients’ perceived hemodynamic stability. If there is evidence of perforation or peritonism then surgical intervention is advocated. Otherwise, anti-coagulation or thrombolysis is preferred. Conclusions: The data reported were compared with, and added to, that presented by the European Society for Vascular Surgery 2017 guidelines. Overall the source data were heterogenous, with multiple sources of bias and statistical comparison was not achievable.

MISC 2. Clinical Significance of D-Dimer and Intestinal Fatty Acid-Binding Protein in Patients With Acute Superior Mesenteric Vein Thrombosis

MISC 2. Clinical Significance of D-Dimer and Intestinal Fatty Acid-Binding Protein in Patients With Acute Superior Mesenteric Vein Thrombosis

Acute superior mesenteric vein thrombosis with ischaemic bowel in Klinefelter syndrome.

Acute superior mesenteric vein thrombosis with ischaemic bowel in Klinefelter syndrome.

Relative factors of transmural intestinal necrosis in acute superior mesenteric vein thrombosis

Objective: To examine the relative factors of transmural intestinal necrosis (TIN) during multidisciplinary stepwise management facilitating the decision making in patients with acute superior mesenteric vein thrombosis (ASMVT). Methods: Clinical data of patients with ASMVT admitted to Department of General Surgery, Jinling Hospital from January 2009 to June 2017 were reviewed retrospectively. There were 52 males and 37 females, aging (45.9 ± 12.6) years (range: 20 to 69 years). According to the postoperative pathological results and follow-up, the patients were divided into TIN group (n=31) and non-TIN group (n=58, including 18 cases of intestinal stricture). The related factors were compared between ASMVT patients with TIN and patients without TIN by univariate analysis using t test, U test and χ(2) test accordingly, and factors with statistically significance were subsequently submitted to binary Logistic regression analysis. The predictive value and cut-off point of factors were evaluated by receiver operator characteristic (ROC) curve and area under the curve. Results: In univariate analysis, smoking, hypertension, peritonitis, white blood cell count,haemoglobin, international normalized ratio, blood albumin, thrombosis of superior mesenteric branches vein, free intraperitoneal fluid, decrease of bowel wall enhancement and pneumatosis intestinalis were TIN risk factors (all P<0.05). According to the binary Logistic regression analysis, white blood cell count (OR=1.093, 95%CI: 1.010 to 1.182, P=0.027), thrombosis of the superior mesenteric branches vein (OR=11.519, 95%CI: 1.906 to 69.615, P=0.008), pneumatosis intestinalis (OR=11.140, 95%CI: 2.360 to 52.585, P=0.002) were independent relative factors of TIN in patients with AMI, and the area under the ROC curve of the above factors and predictive model was 0.759 (95%CI: 0.647 to 0.871), 0.745 (95%CI: 0.641 to 0.848), 0.737 (95%CI: 0.621 to 0.854), 0.909 (95%CI: 0.847 to 0.971), respectively. The cutoff value of white blood cell count was 18.1 × 10(9)/L. Conclusion: White blood cell levels, superior mesenteric vein branch thrombosis and pneumatosis intestinalis are independent predictors of TIN in ASMVT.

Computed tomography findings of mesenteric ischemia related to acute superior mesenteric vein thrombosis: A case report

Akut mezenterik iskemi (AMI), mezenterik damarlarin tikanmasi, vazospazm veya hipoperfuzyonun kan akisinda azalmaya neden oldugu bir durumdur. Tum AMI'nin yaklasik% 5-15'i mezenterik venoz tromboz (MVT) ile ilgilidir. MVT, ileri medikal teknolojilere ragmen yuksek olum oranina sahiptir. Bu nedenle, hastaligin prognozunda erken tani onemlidir. Kontrastli bilgisayarli tomografi (BT) ve BT anjiyografi erken tani icin en yararli radyolojik incelemelerdir. Radyolojik goruntuleri olan 55 yasindaki hastayi sunduk. Hastamiz bir hafta boyunca mevcut olan siddetli karin agrisi ile hastaneye basvurdu. MVT'yi distal portal kavsagina kadar superior mezenterik ven boyunca izledik. Hasta bir ay once baska bir hastanede peptik ulsere bagli olarak ust gastrointestinal sistem kanama oykusune sahipti. Nekroz nedeniyle pnomatozis intestinalis vardi, ileal duvarlar konsantrik kalin ve odem nedeniyle dusuktu. Segmental ileus bu olaya engel olmaksizin eslik ediyordu. Radyolojik olarak, MVT'nin neden oldugu AMI olarak degerlendirdik.

Successful Treatment of Acute Superior Mesenteric Vein Thrombosis Caused by Infection Using the Ileocolic Vein as an Approach Site for Thrombectomy

Successful Treatment of Acute Superior Mesenteric Vein Thrombosis Caused by Infection Using the Ileocolic Vein as an Approach Site for Thrombectomy

Acute Superior Mesenteric Vein Thrombosis With Small Intestinal Ischemia

Acute superior mesenteric vein thrombosis results in sudden interruption of blood supply to a segment of small intestine leading to ischemia followed by intestinal infarction and necrosis of that segment. Immediate systemic anticoagulation and early surgical intervention are required to remove the infracted segment of bowel to prevent sepsis and death. The mesenteric ischemia due to thrombosis of superior mesenteric vein is a rare condition of the intestine, however intestinal infarction associated with it is even more uncommon. Systemic hypercoagulable state is usually present in most of these patients. I, report a case of 43 years old Caucasian male who presented to the emergency room with severe diffuse upper abdominal and back pains out of proportion of his abdominal findings associated with nausea and vomiting. Past history of deep vein thrombosis (DVT) of lower extremity in the patient and his sister was documented. Computed tomography of abdomen with intravenous contrast revealed superior mesenteric vein thrombosis and extension of thrombus into portal vein along with its segmental branches resulting in ischemia of distal small bowel. The patient was initially treated with systemic anticoagulation but due to lack of response to conservative management for 12 h the patient was taken to operating room and underwent resection of about 2 feet of ischemic distal small bowel with good post operative recovery. Acute superior mesenteric vein thrombosis associated with mesenteric ischemia requires prompt diagnosis, urgent medical and early surgical intervention to prevent sepsis, high morbidity and mortality. J Med Cases. 2018;9(9):293-295 doi: https://doi.org/10.14740/jmc3118w

A Case of Acute Superior Mesenteric Vein Thrombosis Treated with Thrombolysis through a Recanalized Umbilical Vein

A Case of Acute Superior Mesenteric Vein Thrombosis Treated with Thrombolysis through a Recanalized Umbilical Vein

One case of acute superior mesenteric vein thrombosis after cesarean section

One case of acute superior mesenteric vein thrombosis after cesarean section

Acute Superior Mesenteric Vein Thrombosis in a Patient with Primary Antiphospholipid Syndrome: A Case Report and Brief Review of the Literature

Acute superior mesenteric vein thrombosis is an uncommon but life threatening disease condition. In the setting of antiphospholipid syndrome, it is rare. This is a case of a 49 year old male who presented with a 2 day history of nausea, vomiting and abdominal pain. He had a previous history of deep vein thrombosis and pulmonary embolism about a year ago. Triple phase computed tomography confirmed superior mesenteric vein thrombosis. Lupus anticoagulant antibody was positive. He was initiated on heparin and then transitioned to warfarin. Given the finding of primary antiphospholipid syndrome, he is currently on lifelong anticoagulant therapy. Surgical resection, site directed thrombolysis and thrombectomy are other options of treatment for acute superior mesenteric vein thrombosis. With the diagnosis of acute superior mesenteric venous thrombosis, with or without any identifiable triggering factor, a search for hypercoagulable state is indicated. This will help determine the duration of anticoagulation therapy and prevent recurrent thrombosis. Acute Superior Mesenteric Vein Thrombosis in a Patient with Primary Antiphospholipid Syndrome: A Case Report and Brief Review of the Literature.

Superior Mesenteric Vein Thrombosis in a Patient Heterozygous for Factor V Leiden Mutation and With a History of Sleeve Gastrectomy

Introduction: Superior mesenteric vein thrombosis (SMVT) presents as abdominal pain in the acute setting. Associations with thrombophilia’s as well as intra-abdominal laprascopic surgeries have been described in the literature. In spite of the known predisposition to thrombosis in this patient population no specific hypercoaguability screening is recommended by the Society of American Gastrointestinal and Endoscopic Surgeons for patients who will be undergoing laparoscopic bariatric surgery. We present a case of 46-year-old male who developed acute SMVT two years after laparoscopic sleeve gastrectomy, and was subsequently found to be heterozygous for a Factor V Leiden (FVL) mutation. Case Report: A 46-year-old male presented with complaints of epigastric pain, radiating to his back for approximately 2 days. The pain was described as crampy in nature and worsened by food. The patient denied any nausea, vomiting, or change in his bowel function. The patient had undergone a vertical laparoscopic sleeve gastrectomy two years earlier. Laboratory workup including amylase and lipase were found to be normal. CT scan of the abdomen and pelvis with contrast showed a SMVT. There was no arterial occlusion or extension of the venous thrombus. Heparin infusion was started and the patient was transitioned to oral Coumadin therapy. Subsequent hypercoaguable workup for antithrombin III, protein-C and S and anticardiolipin were all negative. However, the patient was found to be FVL heterozygous, and on repeat questioning reported familial history of the disorder. Conclusion: SMVT in patients who have undergone laprascopic surgery generally occurs in the acute postoperative setting and in association with pneumoperitoneum induced hemodynamic changes, hypercapnia induced mesenteric vasoconstriction, and coagulation impairment. Our case is unique in that the patient was 2 years removed from his sleeve gastrectomy before developing a SMVT. Our patient was found on subsequent hypercoaguable work-up to be heterozygous for FVL mutation. Local inflammatory processes and thrombophilia’s are known risk factors for the development of SMVT, with one retrospective case review finding a prothrombotic defect in 75% of patients, 25% of which were heterozygous for a FVL mutation. Although case reports have been written linking both bariatric surgery and thrombophilia’s to SMVT, our case is unique in the duration of time that passed before our patient presented with his thrombosis. Our case raises the question of while it may not be financially feasible to screen all patients undergoing surgery, should there be special consideration for patients with a familial history of thrombophilia’s given their risk of development of SMVT.

Initial transcatheter thrombolysis for acute superior mesenteric venous thrombosis.

To determine the optimal initial treatment modality for acute superior mesenteric vein thrombosis (ASMVT) in patients with circumscribed peritonitis. A retrospective review was made of the Vascular Surgery Department's medical records to identify adult patients (≥ 18 years old) presenting with circumscribed peritonitis and diagnosed with ASMVT by imaging or endoscopic examination. Patients were selected from the time period between October 2009 and October 2012 to assess the overall performance of a new first-line treatment policy implemented in May 2011 for patients with circumscribed peritonitis, which recommends transcatheter thrombolysis with local anticoagulation and endovascular mechanical thrombectomy. Of the 25 patients selected for study inclusion, 12 had undergone emergency surgical exploration (group 1) and 13 had undergone the initial catheter-directed thrombolysis (group 2). Data extracted from each patient's records for statistical analyses included method of diagnosis, symptoms, etiology and risk factors, thrombus location, initial management, morbidity, mortality, duration and total cost of hospitalization (in Renminbi, RMB), secondary operation, total length of bowel resection, duration of and findings in follow-up, and death/survival. The two treatment groups showed similar rates of morbidity, 30-d mortality, and 1-year survival, as well as similar demographic characteristics, etiology or risk factors, computed tomography characteristics, symptoms, findings of blood testing at admission, complications, secondary operations, and follow-up outcomes. In contrast, the patients who received the initial non-operative treatment of transcatheter thrombolysis had significantly shorter durations of admission to symptom elimination (group 1: 18.25 ± 7.69 d vs group 2: 7.23 ± 2.42 d) and hospital stay (43.00 ± 13.77 d vs 20.46 ± 6.59 d), and early enteral or oral nutrition restoration (20.50 ± 5.13 d vs 8.92 ± 1.89 d), as well as significantly less total length of bowel resection (170.83 ± 61.27 cm vs 29.23 ± 50.24 cm) and lower total cost (200020.4 ± 91505.62 RMB vs 72785.6 ± 21828.16 RMB) (P < 0.05 for all). Statistical analyses suggested that initial transcatheter thrombolysis is correlated with quicker resolution of the thrombus, earlier improvement of symptoms, stimulation of collateral vessel development, reversal of intestinal ischemia, receipt of localizing bowel resection to prevent short bowel syndrome, shorter hospitalization, and lower overall cost of treatment. For ASMVT patients with circumscribed peritonitis, early diagnosis is key to survival, and non-operative transcatheter thrombolysis is feasible and effective as an initial treatment.

Surgical and Endovascular Treatment of Severe Complications Secondary to Noncirrhotic Portal Hypertension: Experience of 56 Cases

Major complications of noncirrhotic portal hypertension (NCPH) include bleeding esophagogastric varices, hypersplenism, ascites, and bowel ischemia under acute circumstances. The aim of this article is to determine the outcomes of surgical and endovascular treatments for severe complications from NCPH. From January 2000 to June 2011, 56 patients with symptomatic NCPH underwent open surgery or endovascular thrombolysis. The medical records were retrospectively reviewed. Of the 56 patients, there were 39 males and 17 females. The mean age was 21 years, ranging from 2 to 54 years. Forty-one of them were diagnosed to have prehepatic portal vein obstruction (PHPVO), 9 had Budd-Chiari syndrome (BCS), and 6 had noncirrhotic portal fibrosis (NCPF). All patients were symptomatic from 5 days to 14 years (mean 25 months). Portosystemic shunt (PSS) was primarily performed in 49 patients. Shunts were as follows: 35 mesocaval; 7 splenorenal; 4 portocaval; 2 paraumbilical-jugular; and 1 portal to right atrial. Esophagogastric devascularization was performed in 3 patients, but was converted to mesocaval shunt later in 2. The remaining 4 patients with acute superior mesenteric vein (SMV) and portal vein thrombosis were treated with endovascular catheter-directed thrombolysis. Warfarin was prescribed to all the patients for at least 6 months. Mean follow-up was 57 months, ranging from 2 to 125 months. The outcomes, focusing on 30-day mortality, recurrent bleeding, and hypersplenism, were recorded. In the 49 patients undergoing primary PSS, the shunts remained patent and there was no recurrent variceal bleeding during the follow-up. All 3 patients with esophagogastric devascularization had recurrent variceal bleeding at 8, 13, and 24 months postoperatively. Two of them were converted to mesocaval shunt, and 1 died before redo operation. Thrombolysis in all 4 patients with acute SMV and portal thrombosis was technically successful. Three of the 4 survived without complications and 1 died from small bowel infarction due to recurrent thrombosis 40 days later. In the 47 patients with hypersplenism, mean platelet counts increased from 43×10(9)/L to 239×10(9)/L 2 weeks after surgery. Ascites in 30 of the 31 patients disappeared within 2 months after PSS. There was no postoperative encephalopathy, and perioperative 30-day mortality was 0%. PSS can be employed to treat bleeding esophagogastric varices and severe hypersplenism secondary to NCPH. Post-PSS encephalopathy is less of a concern in NCPH patients with normal liver function. Endovascular catheter-directed thrombolysis via superior mesenteric artery is a useful alternative treatment for acute portal and/or mesenteric venous thrombosis.

Transradial approach for transcatheter selective superior mesenteric artery urokinase infusion therapy in patients with acute extensive portal and superior mesenteric vein thrombosis

To evaluate the feasibility and efficacy of urokinase infusion therapy via a transradial approach for transcatheter superior mesenteric artery (SMA) in patients with acute extensive portal and superior mesenteric venous thrombosis. During a period of 8 years, 47 patients with acute extensive thrombosis of portal vein (PV) and superior mesenteric veins (SMV) received urokinase infusion therapy by transcatheter selective SMA via radial artery. Their mean age was 44 ± 13 years (range: 19 - 65). Through radial sheath, a 5F catheter was placed into SMA and subsequently the infusion of urokinase was given for 5 - 11 days (mean: 7.1 ± 2.5). Adequate anticoagulation was initiated during treatment, throughout hospitalization and post-discharge. Follow-up contrast-enhanced computed tomography (CT) was performed in each patient every 3 days and before the removal of infusion catheter. Termination of urokinase infusion therapy was decided on the basis of clinical and radiographic findings. Technical success was achieved in all patients. Two patients had worsening abdominal pain, developed the signs of peritonitis at 24 hours after interventional treatment and underwent eventual laparotomy with the resection of necrotic bowel. Substantial clinical improvement was observed in 45 (95.7%) of them after the procedure. Minor complications at the radial puncture site were observed in 7 patients (14.9%) and infusion therapy continued. Follow-up CT scans at pre-discharge demonstrated a nearly complete disappearance of PV-SMV thrombosis in 29 patients (64.4%) and partial recanalization of PV-SMV thrombosis in 16 patients (35.6%). They were discharged at 9 - 20 days (mean: 12 ± 6) post-admission. The mean post-discharge duration of follow-up was 48 ± 20 months. Recurrent episodes of PV and SMV thrombosis were observed in 2 (4.4%) patients at 6 months and 5 years respectively post-discharge and they were treated successfully with urokinase infusion. The transcatheter SMA urokinase infusion therapy via a transradial approach for plus anticoagulation is both safe and effective for the management of patients with acute extensive PV-SMV thrombosis.

Damage control surgery for acute mesenteric ischemia

To examine the outcome of damage control surgery (DCS) in patients with acute mesenteric ischemia (AMI). Clinical data of 15 consecutive AMI cases treated with DCS from May 2001 to March 2009 at the Research Institute of General Surgery, Jinling Hospital were retrospectively analyzed. Eleven patients had acute superior mesenteric vein thrombosis (MVT) on admission, and 4 suffered from acute mesenteric arterial embolism/thrombosis (MAE/MAT). The staged damage control approach included immediate resection of the involved bowel (but no attempts to restore gastrointestinal continuity), open thrombectomy, transfer of the patients to ICU for resuscitation, and thrombolysis prior to the planned definitive reconstructive procedure. Of 15 patients, 10 (66.7%) survived. The mean remnant small bowel length was (209.0+/-53.8) cm (120 to 280 cm). None of the survived patients was parenteral nutrition-dependent. Of the 5 deaths, 2 died of recurrence of thrombosis and necrosis of the remaining bowel,1 of massive gastrointestinal bleeding. One patient abandoned treatment intra-operatively, and another with total small bowel resection abandoned treatment postoperatively. Damage control approach improves the survival of patients with AMI. Thrombectomy and thrombolysis are necessary for AMI management to prevent progression or further development of the thrombosis.

Interventional radiological technique for acute and subacute superior mesenteric vein-portal vein thrombosis

目的 评价介入技术治疗急性和亚急性肠系膜上静脉(superior mesenteric vein,SMV)-门静脉(portal vein,PV)血栓形成的疗效.方法 对21例急性和亚急性SMV-PV血栓形成患者进行介入治疗.选择经颈静脉途径经肝穿刺门静脉[即通过经颈静脉肝内门脉系统分流术(transjugular intrahepatic portosystemic shunt approach,TIPS途径)]介入治疗(12例)和经导管肠系膜上动脉(superior mesenteric artery,SMA)溶栓治疗(9例).结果 治疗成功19例,无严重并发症.11例经TIPS途径治疗的患者于治疗结束时造影显示大部分血栓被清除,门静脉系统有血流通过,临床症状缓解.1例虽然SMV-PV恢复血流,但12d后死于腹腔脓肿、MODS.经导管SMA内溶栓治疗9例,术后症状逐渐改善8例,无效1例.结论 经TIPS途径介入技术和经导管SMA溶栓是治疗急性和亚急性SMV-PV血栓形成的有效方法。