Case Of Mesenteric Vein Thrombosis Research Articles

S3926 A Case of Complicated Case of Mesenteric Vein Thrombosis

S3926 A Case of Complicated Case of Mesenteric Vein Thrombosis

Superior mesenteric vein thrombosis in a patient with primary focal segmental glomerulosclerosis

Abstract Introduction: Nephrotic syndrome creates a hypercoagulable state that predisposes patients to venous thromboembolism. Mesenteric vein thrombosis associated with minimal change disease and membranous nephropathy has rarely been reported. Few cases of mesenteric vein thrombosis have been reported in some types of nephrotic syndrome; however, isolated mesenteric vein thrombosis has not been previously reported in adults with nephrotic syndrome due to focal segmental glomerulosclerosis. Patient concern: A 19-year-old man with biopsy-proven primary focal segmental glomerulosclerosis was in partial disease remission when he presented with postprandial abdominal pain four months after starting prednisone therapy. Diagnosis: Abdominal computed tomography revealed subacute superior mesenteric vein thrombosis complicated by distal ileum ischemia. Intervention: The patient was treated with low-molecular-weight heparin and bridged with warfarin. Prednisone therapy was continued for the underlying nephrotic syndrome. Outcomes: The patient's symptoms improved with conservative management. He continued to be asymptomatic at subsequent follow-up visits, with no reported complications or medication side effects. Conclusion: This unique case of superior mesenteric vein thrombosis in an adult with nephrotic syndrome due to primary focal segmental glomerulosclerosis in partial remission diagnosed on computed tomography was treated conservatively with anticoagulation therapy. The findings in this case suggest that in patients with nephrotic syndrome, hypercoagulability may extend beyond the acute stage of the disease despite treatment.

A case of mesenteric vein thrombosis developed in the first trimester of pregnancy after in vitro fertilization and embryo transfer in a patient with antiphospholipid syndrome

Combined thrombophilia is known as a probable cause of recurrent in vitro fertilization (IVF) failures. The present clinical case demonstrates the importance of considering the possibility of inherited or acquired thrombophilia in patients under the preparation for IVF. Thromboses of rare locations (hepatic vein, splenic vein, mesenteric vein, ovarian vein, retinal vein, cerebral vein, portal vein, axillary and subclavian vein) are life-threatening conditions. Most often thrombosis of atypical location develops in patients with inherited hemostatic defects, e.g. genetic thrombophilia. Such thromboses can also result from acquired abnormalities of hemostasis, which include antiphospholipid syndrome, pregnancy-associated hypercoagulability, IVF, oral contraception, or ovarian hyper-stimulation within IVF procedures.

Treatment of mesenteric vein thrombosis with transjugular mechanical thrombectomy and subsequent simultaneous arterial and venous thrombolysis.

Mesenteric vein thrombosis may induce intestinal ischemia and gangrene. In severe cases, it is necessary to restore venous outflow from the small intestine rapidly. We describe a severe case of mesenteric vein thrombosis that was resolved successfully by mechanical thrombectomy from a transjugular approach followed by selective simultaneous venous and arterial thrombolysis via the superior mesenteric vein and artery. Inconclusion, the transjugular intrahepatic portosystemic approach was a feasible and safe access for mechanical thrombectomy and thrombolysis of the mesenteric vein in ourpatient.

Severe Thrombotic Events Associated with Dengue Fever, Brazil

Dengue fever has been a major problem in hospital settings in Brazil for the past 15 years. The main concern has been the severe forms, i.e., dengue hemorrhagic fever and dengue shock syndrome. Hemorrhagic events of different degrees have also been a major concern. We report five cases of large vein thrombotic events associated with the acute phase of dengue fever, including a previously non-reported case of mesenteric vein thrombosis. Complications such as these could have been overlooked in the diagnosis of dengue fever, given that the major concern is the hemorrhagic event.

A case of infarction of small bowel caused by thrombophilia secondary to hyperhomocysteinaemia

Dear Editor: Patients with coronary heart disease, stroke, peripheral arterial occlusive disease or venous thrombosis show a higher prevalence of hyperhomocysteinaemia (HHCY), between 20% and 50%. The meta-analysis of Homocysteine Studies Collaboration underlines the connection between HHCY and degenerative vascular disease. For a homocysteine (HCY) increase of 5 μmol/l, the odds ratio for ischemic heart disease was calculated to be 1.32, for venous thrombosis 1.60, and 1.59 for stroke. Bostom et al. demonstrate that starting from a plasma concentration threshold of 10 μmol/l, the vascular risk progressively increases following a linear dose-response relationship. We report a case of mesenteric vein thrombosis (MVT) with segmental transmural intestinal infarction of small bowel secondary to HHCY associated with portal vein thrombosis (PVT) at 1 month from the infarct onset. A 45-year-old man was admitted for diffuse colicky abdominal pain dating back to the previous 8 days. The pain progressively worsened particularly in the lower abdominal quadrants and became continuous at admission time. The patient was affected by mild hypertension which was not on medication. The clinical history was characterized by a splenectomy performed 2 months before for a voluminous splenic organized hematoma due to a motorcycle accident. Before splenectomy the patient underwent a MR and a CT scan, which did not show any alteration in the extrahepatic portal system. Moreover, since at discharge the platelet count was within normal limits, the patient was not treated with antiplatelet agents (dipyridamole, aspirin), but only with low-molecular-weight heparin (LMWH), that he carried out until the 30th post-operative day from splenectomy. On examination, the abdomen was tender and guarded. Plain abdominal film showed some small air-fluid levels and the abdominal ultrasonography revealed significant intraperitoneal fluid and no alteration of other abdominal organs, with no evidence of PVT. Laboratory tests showed a neutrophilic hyperleukocytosis. Because of the clinical, radiological, and laboratory findings, we decided for an emergency laparotomy. Intraoperatively, 28 cm of nonviable infarcted small bowel distal to the mid-jejunum with thickened mesentery was detected. No mechanical factors or strangulation were identified. The infarcted segment was resected but bowel continuity was not restored because of the severe intestinal conditions. Therefore, a terminal ileostomy was performed. The histological report showed an acute hemorrhagic necrosis of the intestinal loop involved. Immediately after the surgical approach, the patient was put on infusion, broad-spectrum antibiotics, and anticoagulant therapy with LMWH. The intraoperative findings and the patient’s young age, associated with the lack of anamnestic cardiovascular or thrombotic risk factors, suggested us to test the patient for coagulation disorders. The screening for primary thrombophilia was only significant for a raised serum HCY of 37 μmol/l. In the review by Herrmann et al., this value is classified as intermediary HHCY and it consists of heterozygous mutations of enzymes or severe vitamin Int J Colorectal Dis (2009) 24:1471–1473 DOI 10.1007/s00384-009-0729-8

プロテインＳ欠乏症による上腸間膜静脈血栓症の１例

症例は39歳の男性で, 下血と腹痛を主訴に来院し急性腸炎の診断で入院した. 入院時白血球数13,100/mm3と上昇していたが, その他血液検査ならびに腹部CTでは特に異常を認めなかった. 数日間の絶食補液にて症状はいったん軽快するも, 再度下血, 腹痛ならびに腹膜刺激症状が出現した. 第11病日の造影CTで腹水と小腸壁の著明な肥厚, 上腸間膜静脈血栓を認め, 開腹手術を施行した. 開腹時血性腹水大量, 空腸約35cm, 回腸約25cmが壊死に陥り, 回腸で穿孔を認めた. 回腸, 空腸部分切除術を施行した. 病理組織検査にて腸間膜静脈内に新鮮および陳旧性血栓が多発し, 腸管壁の全層性出血性壊死を認めた. 血液凝固検査でプロテインS抗原が24.2%, 活性値11%と低値を示し, プロテインS欠乏症が本症例の原因と考えられた. プロテインS欠乏症に起因する腸間膜静脈血栓症は非常にまれであり, 文献的考察を加えて報告した.

Trombosis venosa mesentérica: manifestaciones clínicas, terapia y evolución

Mesenteric vein thrombosis (MVT) is uncommon and accounts for 5-10% of all mesenteric ischemic events. In 80% of cases, an etiologic factor is found. The clinical presentation varies and the diagnosis is made based on imaging studies. The treatment involves anticoagulation alone or in combination with surgery. To describe the clinical characteristics of patients with MVT. Retrospective and prospective review of all cases with MVT, treated between 1995-2001. The clinical presentation, imaging studies, treatment and outcome were evaluated. 29 cases of MVT were reviewed (14 females, age 56 +/- 15 years). Twenty two patients (76%) had recognizable risk factors. The main symptoms were abdominal pain (86%) and vomiting (55%). The diagnosis of acute mesenteric ischemia was suspected on admission only in 6 patients (21%). Thirteen patients underwent transabdominal color Doppler ultrasonography and the diagnosis was confirmed for 11 of these (85%). Twenty out of 24 patients (85%) studied with computed tomography, had positive signs of MVT. Twenty one patients (72%) received anticoagulation, 10 of whom also underwent surgery. Four patients (14%) received surgical treatment alone. Four patients were not treated. Seven patients (24%) died. MVT is difficult to identify. It is necessary to have a high degree of suspicion in patients who have risk factors. The diagnosis is made with imaging studies. The treatment consists of early anticoagulation and surgical intervention when indicated.

プロテインS欠乏症に起因した腸間膜静脈血栓症の1手術例

We report a case of mesenteric vein thrombosis. A 44-year-old man referred to our hospital for abdominal pain, melena, and fever after deep vein thrombosis was found to have a palpable dilated intestine with localized peritonitis. Colonospopy showed congestive necrosis of the sigmoid colon, necessitating emergency laparotomy. Operative findings showed inferior mesenteric vein thrombosis with congestion from the descending colon to rectosigmoid and congestive necrosis of the sigmoid colon. Resection from the transverse colon to rectosigmoid with colostomy was done. Although the patient was treated with heparin, superior mesenteric vein thrombosis occurred on postoperative day 46. Interventional radiology using urokinase and heparin prevented necrosis of the small intestine but the ischemic jejunal stricture had to be resected. Laboratory examination showed coagulation disorder of the lower level of protein S. This mesenteric vein thrombosis is thought to be based on protein S deficiency.

Uterine leiomyoma as a rare cause of acute abdomen and intestinal gangrene

A rare case of mesenteric vein thrombosis and small intestinal gangrene caused by a pedunculated fundal uterine fibroid is presented. The causative mechanism and management are discussed. (Am J Obstet Gynecol 1998;179:830-1.)