Superior Mesenteric Venous Thrombosis Research Articles

Portal and superior mesenteric venous thrombosis treated with thrombolytic therapy via the superior mesenteric artery and vein

Portal and superior mesenteric venous thrombosis treated with thrombolytic therapy via the superior mesenteric artery and vein

Superior mesenteric venous thrombosis due to prothrombin 20210 g/a and mthfr c677t mutations: case report

Superior mesenteric venous thrombosis due to prothrombin 20210 g/a and mthfr c677t mutations: case report

Patterns of portal reconstruction for liver transplantation in patients with diffuse portal and superior mesenteric venous thrombosis

Patterns of portal reconstruction for liver transplantation in patients with diffuse portal and superior mesenteric venous thrombosis

Septic Thrombophlebitis with Superior Mesenteric Venous Thrombosis after Laparoscopic Appendectomy for Uncomplicated Acute Appendicitis

Septic Thrombophlebitis with Superior Mesenteric Venous Thrombosis after Laparoscopic Appendectomy for Uncomplicated Acute Appendicitis

Imaging diagnosis of portal vein stricture complicated with superior mesenteric venous thrombosis after liver transplantation

Portal vein stricture complicated with superior mesenteric venous thrombosis is rarely seen in clinical practice. On December 26, 2009, a 51-year-old male patient who had a liver transplantation history was admitted to The General Hospital of Chinese People's Armed Police Forces with the chief complaint of intermittent abdominal pain and diarrhea.A plain and enhanced CT scan showed that the portal vein was constrictive and thrombosis had formed in the main trunk of the superior mesenteric vein, and varicose veins were seen in surrounding tissues of the esophagus. Edema was observed at the end of the ileum and cecum. The results of colonoscopy showed inflammatory changes and varicose veins of the colon. The patient received medical treatment. The thrombosis was dissolved 9 days later, and all symptoms disappeared 12 days later. Key words: Superior mesenteric venous thrombosis; Portal vein stricture; Diagnosis

Acute symptomatic mesenteric venous thrombosis: treatment by catheter-directed thrombolysis with transjugular intrahepatic route

Objective: To assess the feasibility and effectiveness of transjugular intrahepatic route aspiration thrombectomy and catheter-directed thrombolytic therapy in patients with acute superior mesenteric venous thrombosis. Materials and methods: During a period of 8 years, 12 patients with acute thrombosis of the superior mesenteric vein (SMV) were treated by transjugular intrahepatic approach. The mean age was 41.2 years. After access to the portal system via the transjugular approach, the pigtail catheter fragmentation of the thrombus, local urokinase injection, and manual aspiration thrombectomy were used for treatment of the SMV thrombosis initially, followed by continuous thrombolytic therapy via an indwelling infusion catheter in the SMV, which was performed for 2 to 6 days (4.2 ± 1.8 days). The adequacy of anticoagulation was performed during treatment, throughout hospitalization, and after discharge. Results: Technical success was achieved in all 12 patients. Substantial clinical improvement was seen in these patients after the procedure. Minor complications at the jugular puncture site were observed in 4 patients, but the thrombolytic therapy was not interrupted. Contrast-enhanced computed tomography (CT) scan before discharge demonstrated nearly complete disappearance of SMV thrombosis in all patients. The 12 patients were discharged 5–10 days (7.6 ± 2.0) after admission. Mean duration of follow-up after hospital discharge was 37.7 months, and no recurrent episodes of SMV thrombosis developed during that time period. Conclusion: Catheter-directed thrombus aspiration, mechanical fragmentation, and local thrombolytic infusion via the transjugular intrahepatic route is a safe and effective therapy for the management of patients with acute symptomatic SMV thrombosis.

Clinical analysis of systemic lupus erythematosus with gastrointestinal manifestations

Our objective was to analyse the clinical characteristics of systemic lupus erythematosus (SLE) patients with gastrointestinal manifestations. Medical charts of 177 hospitalized SLE patients were systematically reviewed, including demographic data, clinical features, laboratory findings, and treatments, as well as outcomes. Thirty-nine cases (22.0%) had SLE-related gastrointestinal manifestations, and in 12 cases (30.8%), gastrointestinal manifestations occurred as the initial symptoms. Twenty-five cases (64.1%) had abdominal pain, 22 cases (56.4%) had nausea and vomiting, 12 cases (30.8%) had diarrhea, and gastrointestinal hemorrhage occurred in three cases (7.7%). Protein losing enteropathy and intestinal pseudo-obstruction were the most common identifiable gastrointestinal complications, though other reasons such as superior mesenteric venous thrombosis, pancreatitis, peritonitis, and liver impairment could also occur in SLE. The incidences of Raynaud's phenomenon and pyeloureterectasis were significantly higher in patients with gastrointestinal complications than those without (p < 0.05). Multivariable analysis indicated Raynaud's phenomenon, decreased C3, CH50, and anti-neutrophil cytoplasmic antibody positivity were independent predictors of gastrointestinal involvements (p < 0.05). Gastrointestinal complications are common, diverse, and could be the initial and major manifestations of lupus. SLE patients who had Raynaud's phenomenon, hypocomplementemia and positive anti-neutrophil cytoplasmic antibody were at increasing risk of developing gastrointestinal complication.

Acute superior mesenteric venous thrombosis with advanced gastric cancer: a case report

Although the advanced stages of neoplasms have a risk of superior mesenteric venous thrombosis (MVT), an initial clinical diagnosis of MVT is sometimes difficult and it can be treated as a cancer-related pain using NSAIDs and/or opioids.We herein present a case of palliative stage of cancer with acute MVT, which was successfully treated with immediate anticoagulant therapy. We believe this case provides an important clinical lesson, which is that we should remember that MVT is one of the potential causes of abdominal pain with cancer patients and the thrombosis can be easily identified by US and CT.

Postoperative acute superior mesenteric venous thrombosis after cardiac surgery in a patient with anti-phospholipid syndrome

Fig. 1. A 45-year-old female was admitted with chest pain and dyspnoea for 2 days. She had a medical history of anti-phospholipid syndrome. Coronary angiogram showed total occlusion of left circumflex artery (A). Moreover, severe ischaemic mitral regurgitation without papillary muscle rupture was found on echocardiography (ECG showing regular sinus rhythm) (B). Preoperative computerised tomography (CT) scan showed no abnormal findings of abdominal visceral and vascular structures (C-1 and C-2). After myocardial revascularisation and mitral valvuloplasty, extubation was performed with minimal inotropic support (dopamine 9 mg/kg/min) 8 h later. However, mild LLQ abdominal discomfort was developed on postoperative 1 day. CA, coeliac axis; ECG, electrocardiography; LLQ, left lower quadrant; SMA, superior mesenteric artery.

Transradial Approach for Transcatheter Selective Superior Mesenteric Artery Urokinase Infusion Therapy in Patients with Acute Extensive Portal and Superior Mesenteric Vein Thrombosis

The purpose of this investigation was to assess the feasibility and effectiveness of transradial approach for transcatheter superior mesenteric artery (SMA) urokinase infusion therapy in patients with acute extensive portal and superior mesenteric venous thrombosis. During a period of 7 years, 16 patients with acute extensive thrombosis of the portal (PV) and superior mesenteric veins (SMV) were treated by transcatheter selective SMA urokinase infusion therapy by way of the radial artery. The mean age of the patients was 39.5 years. Through the radial sheath, a 5F Cobra catheter was inserted into the SMA, and continuous infusion of urokinase was performed for 5-11 days (7.1 +/- 2.5 days). Adequate anticoagulation was given during treatment, throughout hospitalization, and after discharge. Technical success was achieved in all 16 patients. Substantial clinical improvement was seen in these 16 patients after the procedure. Minor complications at the radial puncture site were observed in 5 patients, but trans-SMA infusion therapy was not interrupted. Follow-up computed tomography scan before discharge demonstrated nearly complete disappearance of PV-SMV thrombosis in 9 patients and partial recanalization of PV-SMV thrombosis in 7 patients. The 16 patients were discharged 9-19 days (12 +/- 6.0 days) after admission. Mean duration of follow-up after hospital discharge was 44 +/- 18.5 months, and no recurrent episodes of PV-SMV thrombosis developed during that time period. Transradial approach for transcatheter selective SMA urokinase infusion therapy in addition to anticoagulation is a safe and effective therapy for the management of patients with acute extensive PV-SMV thrombosis.

Establishment of animal model of superior mesenteric vein-portal vein thrombosis

Objective To assess the feasibility of interventional techniques in the establishment of animal model of superior mesenteric vein-portal vein (SMV-PV) thrombosis. Methods Nine miniature pigs were involved in the study including one for preliminary experiment. After general anesthesia, a balloon catheter was placed in the main trunk of PV to block the portal flow and then thrombin or autologous blood clot was injected to the SMV. Venography was performed to confirm the thrombosis 30 minutes later. Changes in the imaging before and after the thrombosis were observed. Pigs died during the experiment were anatomized to analyze the causes, and pathological examination was performed when necessary. Results The model of SMV-PV thrombosis was successfully established in all the pigs. One pig died of diffuse intravascular coagulation 10 minutes after model establishment in the preliminary experiment. Two pigs died of hepatorrhexis and over dose of anesthetics respec-tively 3 hours after model establishment, and the rest 6 pigs were fed for 14 days. Conclusion Interventional techniques are effective in the establishment of SMV-PV thrombosis model. Key words: Portal vein thrombosis; Superior mesenteric venous thrombosis; Animal model

Portomesenteric Venous Thrombosis After Laparoscopic Surgery

Portomesenteric venous thrombosis (PVT) is an uncommon but potentially lethal condition reported after several laparoscopic procedures. Its presentation, treatment, and outcomes remain poorly understood, and possible etiologic factors include venous stasis from increased intra-abdominal pressure, intraoperative manipulation, or damage to the splanchnic endothelium and systemic thrombophilic states. Systematic literature review. Academic research. We summarized the clinical presentation and outcomes of PVT after laparoscopic surgery other than splenectomy in 18 subjects and reviewed the treatment strategies. Systematic review of the literature on PVT after laparoscopic procedures other than splenectomy. Eighteen cases of PVT following laparoscopic procedures were identified after Roux-en-Y gastric bypass (n = 7), Nissen fundoplication (n = 5), partial colectomy (n = 3), cholecystectomy (n = 2), and appendectomy (n = 1). The mean patient age was 42 years (age range, 20-74 years). Systemic predispositions toward venous thrombosis were identified in 11 patients. Clinical symptoms consisted primarily of abdominal pain manifested, on average, 14 days (range, 3-42 days) after surgery. Thrombus location varied, but 8 patients had a combination of portal and superior mesenteric venous thrombosis. Sixteen patients were treated with anticoagulation therapy. Ten patients underwent major interventions, including exploratory laparotomy in 6 patients and thrombolytic therapy in 4 patients. Six patients had complications, and 2 patients died. Portomesenteric venous thrombosis following laparoscopic surgery usually manifests as nonspecific abdominal pain. Computed tomography can readily provide the diagnosis and demonstrate the extent of the disease. Treatment should be individualized based on the extent of thrombosis and the presence of bowel ischemia but should include anticoagulation therapy. Venous stasis from increased intra-abdominal pressure, intraoperative manipulation of splanchnic vasculature, and systemic thrombophilic states likely converges to produce this potentially lethal condition.

Nursing experience of acute and subacute SMV-PV thrombosis treated by interventional radiological techniques

Objective To conduct the nursing cooperation of interventional procedures among twenty-one patients with acute and subacute SMV and PV thrombosis.Methods The interventional procedures included transjugular intrahepatic portosystemic shunt (TIPS) approach in 12 cases and transcatheter superior mesenteric arterial (SMA) thrombolysis with urokinass in 9 patients.Before the procedures,everything should be prepared.Results To cooperate with doctor, nursses should observe the patients carefully.The technical success was achieved in 19 cases.No complications related to the procedure occurred.12 cases were treated throush TIPS approach.and the angiography showed that thrombosis was cleared mostly among 11 of them.In addition, the portal vein system had blood flow pass.and the clinical symptoms were relieved.1 case had biood flow in SMV-PV,but died of celiac abscess and of multiple organ dysfunction.9 cases were treated by transeatheter SMA Thromblysis,the symptoms were gradually ameliorated in 8 patients'and inefficacy in 1 patient.Condusions The interventional techniques are safe and effective in the treatment of acute and subacute SMV-PV thrombosis.Special nursing of nurses in catheterization room is the guarantee of successful therapy. Key words: Portal vein thrombosis; Superior mesenteric venous thrombosis; Thrombolysis; Interventional therapy; Nursing

Chronic Superior Mesenteric Venous Thrombosis Revealed by Diabetic Ketonuria and Bacteremia

We report a patient with superior mesenteric venous thrombosis presenting as diabetic ketonuria and bacteremia. The patient was a 65-year-old man with a history of diabetes mellitus, and was admitted to our hospital due to high fever. Tests revealed diabetic ketonuria and Bacteroides fragilis bacteremia. Abdominal computed tomographic scan and Doppler sonography revealed an old thrombus in the superior mesenteric vein with good flow through collateral vessels, causing the patient to have an absence of abdominal symptoms. There was no evidence of hereditary thrombophilia. The thrombus was secondary to a combination of comorbidities, including dehydration, hyperosmolarity, and diabetes mellitus.

Superior mesenteric venous thrombosis as a cause of right-side colonic varices: CT and endoscopic findings

Superior mesenteric venous thrombosis as a cause of right-side colonic varices: CT and endoscopic findings

Septic thrombophlebitis of the superior mesenteric vein and multiple liver abscesses in a patient with Crohn's disease at onset

BackgroundPortal-mesenteric vein thrombosis, pylephlebitis and liver abscesses are rare complications of inflammatory bowel disease (IBD). The purpose of this case report is to relate an unusual presentation of CD in order to show how conservative treatment could be an appropriate option as a bridge to the surgery, in patients with septic thrombophlebitis and multiple liver abscesses with CD.Case presentationWe report a case of a 25-year-old man with Crohn's disease (CD) who developed a superior mesenteric venous thrombosis, multiple liver abscesses and pylephlebitis, diagnosed through abdominal ultrasound and an abdominal computed tomography (CT) scan. The patient was successfully treated with conservative treatment consisting of intravenous antibiotics, subcutaneous anticoagulation and percutaneous catheter drainage of liver abscesses.ConclusionWe reported an unnusual case of pylephlebitis in CD. Until now this association has not been reported in adult patients at onset. We hypothesise that the infection developed as a result of mucosal disease and predisposed by corticoid therapy. Adequated management was discussed.

MRI of portal vein and superior mesenteric venous thrombosis with intestinal ischemia

目的 分析门静脉(PV)和肠系膜上静脉(SMV)血栓形成的MRI特征及其诊断价值.方法 搜集经手术与病理证实的PV和SMV血栓形成患者12例,全部行MR T1WI、T2WI、抑脂T2、血管成像及钆喷替酸葡甲胺(Gd-DTPA)3期动态增强扫描.结果 直接征象为血管内血栓信号(12例),表现为T1WI和T2WI显示PV和SMV流空信号消失.3例急性期血栓T1WI为低或等信号,T2WI为高信号;8例亚急性期血栓T1WI及T2WI均为高信号;1例慢性期血栓T1WI为混杂信号,T2WI为低信号;增强扫描静脉期PV、SMV管腔内无对比剂充盈,PV周围呈轨道样增强,其内无强化的低信号血栓.间接征象包括肠腔扩张积液(10例)、肠管积血(6例)、肠壁增厚(12例)、肠黏膜水肿(11例)、薄纸样肠壁(1例)、缆绳征(11例)、肠系膜积液(2例)、肠壁积气(3例)、腹腔积液(12例)、PV海绵样变(3例)、肝脏异常灌注(6例).结论 MRI是诊断PV和SMV血栓形成并肠道缺血敏感有效的方法,MR多序列、多轴面成像及增强扫描对病变的显示、定位、范围及血栓的分期等有重要作用。

Thrombose aiguë de la veine mésentérique supérieure. Étude rétrospective de neuf cas

Aim of the study To determine diagnostic modalities and both immediate and long-term treatment of superior mesenteric venous thrombosis. Patients and methods Retrospective study from 1997 to 2004 in two institutions concerning patients with superior mesenteric vein thrombosis. Results Nine patients (all males, mean age = 55 years), were included. Abdominal pain (100%), vomiting (44%), and bowel activity disorders (44%) were the most common symptoms. A personal or familial thrombosis history was present in 67% of patients. A genetic predisposing factor of thrombosis was present in 78% of patients. The diagnosis was established with CT-scan in 8 cases with a mean delay of 8 days. Treatment was exclusively medical in 33% of patients and included surgery in 67%. All operated patients underwent resection for bowel infarction and only one had immediate anastomosis. All enterostomies were subsequently closed. No patient died. Conclusion Diagnosis of superior mesenteric vein thrombosis is frequently delayed and relies on CT-scan with intravenous contrast. Prognosis is globally favourable but depends on early application of anticoagulation therapy. In case of surgery, bowel-sparing resection is indicated and enterostomies are often needed. Genetic disorders predisposing to thrombosis are very frequent, that may indicate prolonged even definitive anticoagulation therapy.

Eight Cases of Superior Mesenteric Venous Thrombosis

Eight Cases of Superior Mesenteric Venous Thrombosis

Superior mesenteric venous thrombosis.

Superior mesenteric venous occlusion may be difficult to recognize, but is important as it carries a better prognosis than superior mesenteric arterial occlusion, an may be amenable to surgical treatment. Three cases of primary superior mesenteric venous occlusion are described. The diagnosis was unsuspected until discovered at laparotomy. Non-viable bowel was present in all cases and in two cases thrombosed veins were apparent in the mesentery. The lesion was localized in distribution, and generous bowel resection with primary anastomosis was performed. Recovery was uncomplicated in all cases. When the thrombosis appears well localized, generous resection with primary anastomosis seems a suitable alternative to resection and exteriorization or conservative treatment with a second-look procedure.