151
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Agrawal S, Dhiman RK. Hepatobiliary quiz-12 (2014). J Clin Exp Hepatol 2014; 4:376-9. [PMID: 25755586 PMCID: PMC4298632 DOI: 10.1016/j.jceh.2014.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
| | - Radha K. Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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152
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Yang S, Fan X, Ding W, Liu B, Meng J, Wang K, Wu X, Li J. D-dimer as an early marker of severity in patients with acute superior mesenteric venous thrombosis. Medicine (Baltimore) 2014; 93:e270. [PMID: 25546667 PMCID: PMC4602603 DOI: 10.1097/md.0000000000000270] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
No early serum marker of disease severity contributes to the treatment decision-making process of acute superior mesenteric venous thrombosis (ASMVT). This study aims to assess the value of serum D-dimer level in the first 3 days after admission as a severity marker of ASMVT patients. From May 2010 to June 2014, 50 consecutive patients of ASMVT were enrolled in this observational study. The serum D-dimer level was measured on a daily basis during the first 3 days after admission as well as other laboratory-testing parameters, clinical score, and outcome variables recorded during the same period. The maximum and mean D-dimer values were analyzed and compared with other potential markers for prediction of multiple-organ dysfunction syndrome (MODS) and short-bowel syndrome (SBS). The correlation of D-dimer level with other potential severity markers and inflammation parameters were also studied. Both maximum and mean D-dimer level during the first 3 days of admission were significantly higher in patients with several clinical variables such as death within 30 days, bowel resection, sepsis, abdominal compartment syndrome, MODS, and SBS. In addition, serum D-dimer level showed precise prediction for MODS and SBS, greater than L-lactate and intestinal-type fatty acid-binding protein (I-FABP). The D-dimer level was correlated well with L-lactate, I-FABP, and APACHE II score on the first 3 days of admission. Poor correlation of D-dimer level and inflammation parameters, white blood cell count, and C-reactive protein level, was detected. D-dimer level could be an effective, early, and specific serum marker indicating the clinical evolution and outcome of ASMVT.
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Affiliation(s)
- Shuofei Yang
- From the Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P.R. China
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153
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Allaix ME, Krane MK, Zoccali M, Umanskiy K, Hurst R, Fichera A. Postoperative portomesenteric venous thrombosis: lessons learned from 1,069 consecutive laparoscopic colorectal resections. World J Surg 2014; 38:976-84. [PMID: 24240673 DOI: 10.1007/s00268-013-2336-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Portomesenteric venous thrombosis (PVT) is a known complication after open and laparoscopic colorectal (LCR) surgery. Risk factors and the prognosis of PVT have been poorly described. METHODS This study is a retrospective analysis of a prospectively collected database. Patients with new-onset postoperative abdominal pain were evaluated with a computed tomography scan of the abdomen. Patients found to have PVT were analyzed. A multivariate analysis was performed to identify predictors of PVT. RESULTS A total of 1,069 patients undergoing LCR surgery for inflammatory bowel disease (IBD) or nonmetastatic cancer between June 2002 and June 2012 were included. Altogether, 37 (3.5 %) patients experienced symptomatic postoperative PVT. On univariate analysis, IBD (p < 0.001), ulcerative colitis (p = 0.016), preoperative therapy with steroids (p = 0.008), operative time ≥220 min (p = 0.004), total proctocolectomy (TPC) (p < 0.001), ileoanal pouch anastomosis (p = 0.006), and postoperative intraabdominal septic complications (p < 0.001) were found to be significant risk factors. By multivariate analysis, TPC (p = 0.026) and postoperative intraabdominal septic complications (p < 0.001) were independent predictors of PVT. In the PVT group, postoperative length of stay was longer (14.8 vs. 7.4 days, p < 0.001). Of the patients evaluated with a hematologic workup, 72.7 % were found to have a hypercoagulable condition. All patients were managed with oral anticoagulation for at least 6 months. No death or complications related to PVT occurred. CONCLUSIONS PVT is a potentially serious complication that is more likely to occur after TPC and in the presence of postoperative intraabdominal septic complications, particularly in patients with a coagulation disorder. Prompt diagnosis and treatment with oral anticoagulation are recommended to avoid long-term sequelae.
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Affiliation(s)
- Marco E Allaix
- Department of Surgery, University of Chicago Medical Center, MC 5095, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA,
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154
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Ma J, Yan Z, Luo J, Liu Q, Wang J, Qiu S. Rational classification of portal vein thrombosis and its clinical significance. PLoS One 2014; 9:e112501. [PMID: 25393320 PMCID: PMC4231054 DOI: 10.1371/journal.pone.0112501] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 10/19/2014] [Indexed: 02/07/2023] Open
Abstract
Portal vein thrombosis (PVT) is commonly classified into acute (symptom duration <60 days and absence of portal carvernoma and portal hypertension) and chronic types. However, the rationality of this classification has received little attention. In this study, 60 patients (40 men and 20 women) with PVT were examined using contrast-enhanced computed tomography (CT). The percentage of vein occlusion, including portal vein (PV) and superior mesenteric vein (SMV), was measured on CT image. Of 60 patients, 17 (28.3%) met the criterion of acute PVT. Symptoms occurred more frequently in patients with superior mesenteric vein thrombosis (SMVT) compared to those without SMVT (p<0.001). However, there was no significant difference in PV occlusion between patients with and without symptoms. The frequency of cavernous transformation was significantly higher in patients with complete PVT than those with partial PVT (p<0.001). Complications of portal hypertension were significantly associated with cirrhosis (p<0.001) rather than with the severity of PVT and presence of cavernoma. These results suggest that the severity of PVT is only associated with the formation of portal cavernoma but unrelated to the onset of symptoms and the development of portal hypertension. We classified PVT into complete and partial types, and each was subclassified into with and without portal cavernoma. In conclusion, neither symptom duration nor cavernous transformation can clearly distinguish between acute and chronic PVT. The new classification system can determine the pathological alterations of PVT, patency of portal vein and outcome of treatment in a longitudinal study.
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Affiliation(s)
- Jingqin Ma
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhiping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- * E-mail:
| | - Jianjun Luo
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qingxin Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianhua Wang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shijing Qiu
- Bone and Mineral Research Laboratory, Henry Ford Hospital, Detroit, Michigan, United States of America
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155
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Multidisciplinary stepwise management strategy for acute superior mesenteric venous thrombosis: an intestinal stroke center experience. Thromb Res 2014; 135:36-45. [PMID: 25466834 DOI: 10.1016/j.thromres.2014.10.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/16/2014] [Accepted: 10/14/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUD Acute superior mesenteric venous thrombosis (ASMVT) is an uncommon but catastrophic abdominal vascular emergency with high rate of intestinal failure and mortality. The retrospective pilot study was performed to assess the effect of a multidisciplinary stepwise management strategy on survival and mesenteric recanalization in an integrated intestinal stroke center (ISC). MATERIALS AND METHODS A modern management strategy performed by multidisciplinary specialists in ISC was evaluated among 43 ASMVT patients that were classified into central vs peripheral type, operative vs nonoperative, early vs late treated group from March 2009 to April 2013. Patients received specific medical therapy, endovascular treatment, damage-control surgery, selective second-look laparotomy, critical care management, and clinical nutrition support in a stepwise way. The demographics, etiology, imaging characteristics, treatment procedures, complications, clinical outcome, and 1-year follow-up data were analyzed and compared. Confounding factors of mortality were identified by univariate and ROC-curve analysis. A single-center experience of over 5years for this modern strategy was also reported. RESULTS The protocol of multidisciplinary stepwise management strategy was followed in all ASMVT patients successfully. The 30-day mortality and recanalization rate were 11.63% and 90.70%. Initial damage-control surgery was carried out in 46.51% patients, with selective second-look laparotomy in 23.26% patients. Endovascular thrombolysis was performed in 83.72% patients initially or postoperatively. Bowel resection was necessary in 18 patients with the length of 100.00 (47.50, 222.50) cm. The incidence of short-bowel syndrome was 13.95%. The rate and length of bowel resection, short-bowel syndrome rate were significantly lower in nonoperative and early-treated groups (P<0.05). During the follow-up survey, 1-year survival was 83.72%, with no additional death or re-thrombosis. CONCLUSION A multidisciplinary stepwise management strategy involving modern surgical and endovascular treatments that focus on early mesenteric recanalization and bowel viability salvage in a specialized ISC could significantly improve the clinical outcome of ASMVT patients.
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156
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Rottenstreich A, Khalaileh A, Elazary R. Sleeve gastrectomy and mesenteric venous thrombosis: report of 3 patients and review of the literature. Surg Obes Relat Dis 2014; 10:e57-61. [DOI: 10.1016/j.soard.2014.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 07/06/2014] [Accepted: 07/07/2014] [Indexed: 10/25/2022]
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157
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Kim MJ, Song HJ, Kim WK, Kim SH. Superior mesenteric vein thrombosis as an early presentation of myelodysplastic syndrome: a case report. Intest Res 2014; 12:157-61. [PMID: 25349584 PMCID: PMC4204708 DOI: 10.5217/ir.2014.12.2.157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 11/02/2013] [Accepted: 11/04/2013] [Indexed: 01/14/2023] Open
Abstract
Mesenteric venous thrombosis (MVT) is a serious condition due to its potential association with mesenteric ischemia and infarction of the small bowel. Symptoms of MVT are often vague, making accurate diagnosis and sufficient treatment difficult. However, increased awareness and new imaging modalities for this condition have improved outcomes for patients with MVT. Treatment includes anticoagulation, transcatheter therapy, and surgery. In the present report, we describe the case study of a 62-year-old woman with a presenting diagnosis of superior MVT, who was finally diagnosed with myelodysplastic syndrome. The superior MVT spontaneously dissolved after the patient underwent 6 months of systemic anticoagulation therapy. Invasive surgery or bowel resection was not required.
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Affiliation(s)
- Min Jung Kim
- Department of Surgery, Jeju National University School of Medicine, Jeju, Korea
| | - Hyun Joo Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Woo Kun Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Sun Hyung Kim
- Department of Laboratory Medicine, Jeju National University School of Medicine, Jeju, Korea
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158
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Elkrief L, Corcos O, Bruno O, Larroque B, Rautou PE, Zekrini K, Bretagnol F, Joly F, Francoz C, Bondjemah V, Cazals-Hatem D, Boudaoud L, De Raucourt E, Panis Y, Goria O, Hillaire S, Valla D, Plessier A. Type 2 diabetes mellitus as a risk factor for intestinal resection in patients with superior mesenteric vein thrombosis. Liver Int 2014; 34:1314-21. [PMID: 24237969 DOI: 10.1111/liv.12386] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 11/09/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Laure Elkrief
- Service d'Hépatologie, Hôpital Beaujon and INSERM U773, Clichy, France
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159
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Abdel-Aal AK, Ezzeldin IB, Hamed MF, Ibrahim RM, Berry M, Underwood ES, Saddekni S. Endovascular Treatment of Acute Portal Vein Thrombosis Using Ultrasound-Accelerated Catheter-Directed Thrombolysis. Vasc Endovascular Surg 2014; 48:460-465. [DOI: 10.1177/1538574414547087] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
We report a case of extensive acute portal vein thrombosis (PVT) presenting with severe diffuse abdominal pain and impending small bowel infarction. The patient was successfully treated with ultrasound-accelerated catheter-directed thrombolysis (EKOS endowave system; Covidien, Mansfield, Massachusetts), which resulted in prompt recanalization of his portal vein (PV) and its tributaries. The patient eventually had ischemic stricture that necessitated bowel resection. However, we believe that our technique was successful in rapidly restoring the patency of the PV and its tributaries, and therefore, avoiding a life-threatening complication of more extensive bowel infarction. To our knowledge, the use of ultrasound-accelerated thrombolysis in treatment of PVT has not been previously described in the literature.
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Affiliation(s)
| | - Islam B. Ezzeldin
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maysoon Farouk Hamed
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Max Berry
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edgar S. Underwood
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Souheil Saddekni
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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160
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Hmoud B, Singal AK, Kamath PS. Mesenteric venous thrombosis. J Clin Exp Hepatol 2014; 4:257-63. [PMID: 25755568 PMCID: PMC4284291 DOI: 10.1016/j.jceh.2014.03.052] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 03/13/2014] [Indexed: 12/12/2022] Open
Abstract
Mesenteric vein thrombosis is increasingly recognized as a cause of mesenteric ischemia. Acute thrombosis commonly presents with abdominal pain and chronic type with features of portal hypertension. Contrast enhanced CT scan of abdomen is quite accurate for diagnosing and differentiating two types of mesenteric venous thrombosis. Prothrombotic state, hematological malignancy, and local abdominal inflammatory conditions are common predisposing conditions. Over the last decade, JAK-2 (janus kinase 2) mutation has emerged as an accurate biomarker for diagnosis of myeloproliferative neoplasm, an important cause for mesenteric venous thrombosis. Anticoagulation is the treatment of choice for acute mesenteric venous thrombosis. Thrombolysis using systemic or transcatheter route is another option. Patients with peritoneal signs or refractory to initial measures require surgical exploration. Increasing recognition of mesenteric venous thrombosis and use of anticoagulation for treatment has resulted in reduction in the need for surgery with improvement in survival.
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Affiliation(s)
- Bashar Hmoud
- Department of Internal Medicine, UTMB, Galveston, TX, USA
| | - Ashwani K. Singal
- Division of Gastroenterology and Hepatology, UAB, Birmingham, AL, USA,Address for correspondence: Ashwani K. Singal, 1808, 7th Ave S BDB 351, Birmingham, AL, USA. Tel.: +1 205 975 5683; fax: +1 205 975 6363.
| | - Patrick S. Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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161
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Park BS, Park S, Jin K, Choi G, Park KM, Jo KM, Kim YW. Nephrotic syndrome complicated with portal, splenic, and superior mesenteric vein thrombosis. Kidney Res Clin Pract 2014; 33:161-4. [PMID: 26877968 PMCID: PMC4714169 DOI: 10.1016/j.krcp.2014.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/02/2014] [Accepted: 07/07/2014] [Indexed: 01/14/2023] Open
Abstract
Thromboembolism is a major complication of nephrotic syndrome. Renal vein thrombosis and deep vein thrombosis are relatively common, especially in membranous nephropathy. However, the incidence of portal vein and superior mesenteric vein (SMV) thrombosis in patients with nephrotic syndrome is very rare. To date, several cases of portal vein thrombosis treated by anticoagulation therapy, not by thrombolytic therapy, have been reported as a complication of nephrotic syndrome. Here, we report a case of portal, splenic, and SMV thrombosis in a patient with a relapsed steroid dependent minimal change disease who was treated successfully with anticoagulation and thrombolytic therapy using urokinase. Radiologic findings and his clinical conditions gradually improved. Six months later, a complete remission of the nephrotic syndrome was observed and the follow-up computed tomography scan showed the disappearance of all portal vein, splenic vein, and SMV thrombi.
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Affiliation(s)
- Bong Soo Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sihyung Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Kyubok Jin
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Gibok Choi
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Kyeong Min Jo
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yang Wook Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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162
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Portomesenteric venous thrombosis following major colon and rectal surgery: incidence and risk factors. Surg Endosc 2014; 29:1071-9. [PMID: 25159636 DOI: 10.1007/s00464-014-3788-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 08/01/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Portomesenteric venous thrombosis (PMVT) is an uncommon complication of abdominal surgery. The objective of this study was to assess PMVT risk factor profiles and patient outcomes after colorectal surgery. METHODS A single center retrospective review of patients undergoing colorectal surgery was performed (2007-2012). PMVT was defined as thrombus within the portal, splenic, or superior mesenteric vein on computed tomography (CT). Inferior mesenteric vein thrombosis was excluded. Independent samples t test was used to compare data variables between PMVT and non-PMVT patients. Univariate and multivariate logistic regression analyses were used to assess PMVT risk factors. RESULTS There were 1,224 patients included (mean age 62 years, male = 566). Elective bowel resection was performed for colon carcinoma (n = 302), rectal carcinoma (n = 112), ulcerative colitis (n = 125), Crohn's disease (n = 78), polyps (n = 117), and diverticulitis (n = 215). Patients undergoing gynecological resections and emergent laparotomies were included (n = 275). Thirty-six patients (3%) were diagnosed with PMVT by CT: 17/36 on initial presentation and 19/36 by expert radiologist review. Patients with PMVT were younger (53 vs. 62 years, p = 0.001) with higher BMI (30.5 vs. 26.7, p < 0.001) and thrombocytosis (464 vs. 306, p < 0.001) compared to patients without PMVT. Univariate logistic regression identified younger age (p < 0.001), obesity (p < 0.001), ulcerative colitis (p < 0.001), thrombocytosis, (p < 0.001) and proctocolectomy as significant predictors of PMVT. Stepwise multivariate logistic regression identified that obesity (p < 0.001), thrombocytosis, (p < 0.001) and restorative proctocolectomy (p = 0.001) were still significant predictors. No patients in the PMVT group suffered bowel infarction and no related mortalities occurred. Thirty-day readmission rates were higher in the PMVT group (53% vs. 17%, p < 0.01). CONCLUSION BMI ≥ 30 kg/m(2), thrombocytosis, and restorative proctocolectomy were significant predictors of PMVT. Initial diagnostic studies showed a PMVT rate of 1.4%; however, after expert focused radiologic review, the actual rate was 3%. Thus, the diagnosis of PMVT is difficult and readmission after colorectal surgery should prompt its consideration.
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163
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Venkatesh P, Shaikh N, Malmstrom MF, Kumar VR, Nour B. Portal, superior mesenteric and splenic vein thrombosis secondary to hyperhomocysteinemia with pernicious anemia: a case report. J Med Case Rep 2014; 8:286. [PMID: 25155131 PMCID: PMC4154050 DOI: 10.1186/1752-1947-8-286] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 06/26/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Acute portomesenteric vein thrombosis is an uncommon but serious condition with potential sequelae, such as small-bowel gangrene and end-stage hepatic failure. It is known to be caused by various pro-thrombotic states, including hyperhomocysteinemia. We describe what is, to the best of our knowledge, the first reported case of concomitant thrombosis of portal, superior mesenteric and splenic veins due to hyperhomocysteinemia secondary to pernicious anemia and no other risk factors. CASE PRESENTATION A 60-year-old Indian man presented with epigastric pain, diarrhea and vomiting. An abdominal imaging scan showed that he had concomitant pernicious anemia and concomitant portal, superior mesenteric and splenic vein thrombosis. A work-up for the patient's hypercoagulable state revealed hyperhomocysteinemia, an undetectable vitamin B12 level and pernicious anemia with no other thrombophilic state. He developed infarction with perforation of the small bowel and subsequent septic shock with multi-organ dysfunction syndrome, and he ultimately died due to progressive hepatic failure. CONCLUSION This report demonstrates that pernicious anemia, on its own, can lead to hyperhomocysteinemia significant enough to lead to lethal multiple splanchnic vein thrombosis. Our case also underscores the need to (1) consider portomesenteric thrombosis in the differential diagnosis of epigastric abdominal pain, (2) perform a complete thrombotic work-up to elucidate metabolic abnormalities that could be contributing to a pro-thrombotic state and (3) initiate aggressive measures, including early consideration of multi-visceral transplantation, in order to avoid decompensation and a significant adverse outcome.
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Affiliation(s)
| | - Nissar Shaikh
- Weill Cornell Medical College in Qatar, Ar-Rayyan, Qatar.
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164
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Lee LYW, Aubrey-Jones H, Lacey R, De Silva A. Mesenteric vein thrombosis; not going with the flow. CASE REPORTS 2014; 2014:bcr-2013-202396. [DOI: 10.1136/bcr-2013-202396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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165
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Wichman HJ, Cwikiel W, Keussen I. Interventional treatment of mesenteric venous occlusion. Pol J Radiol 2014; 79:233-8. [PMID: 25089163 PMCID: PMC4117677 DOI: 10.12659/pjr.890990] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 05/08/2014] [Indexed: 12/26/2022] Open
Abstract
Background Mesenteric venous thrombus may be an incidental finding during imaging studies and asymptomatic patients are treated conservatively or with anticoagulant therapy only. Patients with symptomatic acute thrombosis causing bowel ischemia require urgent treatment, which frequently includes extensive surgery. Interventional treatment may be an alternative. Purpose: To present results of interventional treatment in patients with symptomatic occlusion of the mesenteric veins. Material/Methods Eight patients, four men and four women aged 24–74 years (mean 53 years) were treated due to symptomatic portomesenteric venous occlusion of thrombotic origin. Transhepatic (n=5), trans-splenic (n=2), and transjugular (n=4) accesses were used. Patients were treated with mechanical thrombus fragmentation (n=4), pharmacological thrombolysis (n=3) and stent placement (n=8). Additional transjugular intrahepatic portosystemic shunt (TIPS) was created to facilitate the outflow from the treated veins (n=4). Results The majority of the patients required combination of different treatment methods. Resolution of symptoms with initial clinical success was achieved in seven of the eight patients, and one patient died the day after the procedure due to sepsis. Two other patients had procedure-related complications; one of them required embolization. Two patients had documented long-term clinical success with patent stents and no symptoms at one year following intervention. Conclusions Endovascular treatment of portomesenteric occlusion in patients with acute symptomatology showed good short-term clinical success rate.
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Affiliation(s)
- Heather J Wichman
- Department of Radiology, Covenant Medical Center, Waterloo, IA, U.S.A
| | - Wojciech Cwikiel
- Department of Interventional Radiology, Skane University Hospital, Lund, Sweden
| | - Inger Keussen
- Department of Interventional Radiology, Skane University Hospital and Lund University Hospital, Lund, Sweden
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166
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Eilbert W, Hecht B, Zuiderveld L. Acute mesenteric venous thrombosis with a vaginal contraceptive ring. West J Emerg Med 2014; 15:395-7. [PMID: 25035742 PMCID: PMC4100842 DOI: 10.5811/westjem.2014.4.21364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/13/2014] [Accepted: 04/29/2014] [Indexed: 01/14/2023] Open
Abstract
Mesenteric venous thrombosis is a rare cause of abdominal pain, which if left untreated may result in bowel infarction, peritonitis and death. The majority of patients with this illness have a recognizable, predisposing prothrombotic condition. Oral contraceptives have been identified as a predisposing factor for mesenteric venous thrombosis in reproductive-aged women. In the last fifteen years new methods of hormonal birth control have been introduced, including a transdermal patch and an intravaginal ring. In this report, we describe a case of mesenteric venous thrombosis in a young woman caused by a vaginal contraceptive ring.
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Affiliation(s)
- Wesley Eilbert
- University of Illinois at Chicago, Department of Emergency Medicine, Chicago, Illinois
| | - Benjamin Hecht
- University of Illinois at Chicago, Department of Emergency Medicine, Chicago, Illinois
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167
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Acute Mesenteric Vein Thrombosis: Factors Associated With Evolution to Chronic Mesenteric Vein Thrombosis. AJR Am J Roentgenol 2014; 203:54-61. [DOI: 10.2214/ajr.13.11527] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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168
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Wassélius J, Sonesson B, Elf J, Ahlström M, Malina M, Dias N. Treatment of mesenteric vein thrombosis with transjugular mechanical thrombectomy and subsequent simultaneous arterial and venous thrombolysis. J Vasc Surg Venous Lymphat Disord 2014; 2:320-3. [DOI: 10.1016/j.jvsv.2013.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 08/30/2013] [Accepted: 09/11/2013] [Indexed: 01/14/2023]
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169
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Yang S, Liu B, Ding W, He C, Wu X, Li J. Acute superior mesenteric venous thrombosis: transcatheter thrombolysis and aspiration thrombectomy therapy by combined route of superior mesenteric vein and artery in eight patients. Cardiovasc Intervent Radiol 2014; 38:88-99. [PMID: 24934733 DOI: 10.1007/s00270-014-0896-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 03/24/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess the feasibility, effectiveness, and safety of catheter-directed thrombolysis and aspiration thrombectomy therapy by combined route of superior mesenteric vein and artery (SMV+SMA) for acute superior mesenteric venous thrombosis (ASMVT). METHODS This retrospective study reviewed eight ASMVT patients with transcatheter direct thrombolysis and aspiration thrombectomy therapy via SMV and indirect thrombolysis via SMA during a period of 14 months. The demographics, etiology, risk factors, therapeutic effect, complications, mortality, and follow-up of the study population were assessed. Anatomic and imaging classification of location and extent of thrombus at diagnosis and degree of thrombus lysis were described. RESULTS Technical success was achieved with substantial improvement in symptoms and thrombus resolution after thrombolytic therapy in all patients. The local urokinase infusion by SMA and SMV was performed for 5-7 (6.13 ± 0.83) and 7-15 (12 ± 2.51) days. Anticoagulation was performed catheter-directed and then orally throughout hospitalization and after discharge. Four patients required delayed localized bowel resection after thrombolytic therapy with no death. Thrombolytic therapy was not interrupted despite minor bleeding at the puncture site in two patients and sepsis in another two postoperatively. Nearly complete removal of thrombus was demonstrated by contrast-enhanced CT scan and portography before discharge. Patients were discharged in 10-27 (19.25 ± 4.89) days after admission. No recurrence developed during the follow-up of 10-13 (12.13 ± 0.99) months. CONCLUSIONS Catheter-directed thrombolytic and aspiration therapy via SMV+SMA is beneficial for ASMVT in avoiding patient death, efficient resolving thrombus, rapid improving symptoms, reversing extensive intestinal ischemia, averting bowel resection, or localizing infarcted bowel segment and preventing short bowel syndrome.
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Affiliation(s)
- Shuofei Yang
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, People's Republic of China,
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170
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L’ascite non liée à la cirrhose : physiopathologie, diagnostic et étiologies. Rev Med Interne 2014; 35:365-71. [DOI: 10.1016/j.revmed.2013.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 10/03/2013] [Accepted: 12/02/2013] [Indexed: 12/31/2022]
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171
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Yang SF, Liu BC, Ding WW, He CS, Wu XJ, Li JS. Initial transcatheter thrombolysis for acute superior mesenteric venous thrombosis. World J Gastroenterol 2014; 20:5483-5492. [PMID: 24833878 PMCID: PMC4017063 DOI: 10.3748/wjg.v20.i18.5483] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/15/2014] [Accepted: 02/20/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the optimal initial treatment modality for acute superior mesenteric vein thrombosis (ASMVT) in patients with circumscribed peritonitis.
METHODS: 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.
RESULTS: 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.
CONCLUSION: 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.
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172
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Al-Thani H, El-Mabrok J, El-Menyar A, Al-Sulaiti M, Tabeb AH, Hajaji K, Elgohary H, Asim M, Latifi R. Clinical Presentation and Outcome of Mesenteric Vein Thrombosis. Angiology 2014; 66:249-56. [DOI: 10.1177/0003319714531480] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Mesenteric venous thrombosis (MVT) is an uncommon event. We retrospectively analyzed data for patients who were admitted with MVT between June 2005 and May 2012 in Qatar. The study included 35 patients with a mean age of 45 ± 11 years. The risk of MVT was significantly high among males who smoked and females of Arab ethnicity. The main manifestations of MVT were abdominal distension and vomiting. The major etiological factors included deficiency in protein C and S, homocysteinemia, and prior abdominal surgery. Computed tomography (CT) findings were helpful in 80% of the patients. Bowel resection with primary anastomosis was performed in 25 (71%) patients. The overall mortality rate was 17%. High index of suspicion, detection of risk factors, CT imaging, and timely intervention are essential for better prognosis.
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Affiliation(s)
- Hassan Al-Thani
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | - Ayman El-Menyar
- Clinical Research, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
- Internal Medicine Department, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | | | | | - Khairi Hajaji
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Hesham Elgohary
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Mohammad Asim
- Clinical Research, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Rifat Latifi
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- Department of Surgery, Arizona University, Tucson, AZ, USA
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173
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Nagaraja R, Rao P, Kumaran V, Yadav A, Kapoor S, Varma V, Mehta N, Nundy S. Acute Mesenteric Ischaemia-An Indian Perspective. Indian J Surg 2014; 77:843-9. [PMID: 27011468 DOI: 10.1007/s12262-014-1034-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 01/08/2014] [Indexed: 12/13/2022] Open
Abstract
In Western countries, acute mesenteric ischaemia is commonly due to arterial occlusion and occurs in patients who are usually in their seventh decade. A venous cause for intestinal gangrene has been reported in only about 10 %. We examined whether this was so in India and compared the clinical features of patients with mesenteric arterial and venous ischaemia and relate these to their ultimate prognosis. We studied retrospectively, the records of all patients admitted or referred to the department with a diagnosis of acute mesenteric ischaemia between January 1997 and October 2012, noting their demographic details and mode of presentation, the results of preoperative imaging and blood investigations, the extent of bowel ischaemia, and the length of bowel that was resected at operation and their outcome. There were 117 patients, 85 males and 32 females whose median age was 53 years. Mesenteric venous thrombosis was seen in 56 patients (48 %) and mesenteric arterial occlusion in 61 (52 %). Forty six patients died (39 %); 15 with venous occlusion (27 %) and 31 with arterial occlusion (51 %). Compared to patients with arterial occlusion, the patients with venous obstruction were younger, had a longer duration of symptoms, were less frequently hypotensive at presentation, had higher platelet counts, had a shorter length of bowel resected, had fewer colonic resections and had a lower mortality. Other predictors of mortality on multivariate analysis were a longer duration of symptoms, lower serum albumin and higher creatinine levels at presentation and a shorter length of residual bowel. In India, acute mesenteric ischaemia in tertiary care centres is due to venous thrombosis in almost half of the patients who are at least a decade younger than those in the West. Significant predictors of mortality include low serum albumin and raised creatinine levels, a shorter residual bowel length and an arterial cause for mesenteric ischaemia.
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Affiliation(s)
- Raghavendra Nagaraja
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India ; Department of Surgical Gastroenterology and Liver Transplantation, Manipal Hospital, Old Airport Road, Kodihalli, Bengaluru India
| | - Prashantha Rao
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Vinay Kumaran
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Amitabh Yadav
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Sorabh Kapoor
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Vibha Varma
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Naimish Mehta
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Samiran Nundy
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
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174
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Lee YB, Kim SM, Heo JS, Seok H, Shin IS, Eun YH, Kim DK. Idiopathic Splenic Vein Thrombosis Presenting as Splenic Infarction and Consequent Gastric Variceal Bleeding. J Lipid Atheroscler 2014. [DOI: 10.12997/jla.2014.3.2.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- You-Bin Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Heart, Stroke and Vascular Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Seok Heo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeri Seok
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In Seub Shin
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeong Hee Eun
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk-Kyung Kim
- Heart, Stroke and Vascular Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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175
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Bick BL, Acosta Cardenas AJ, Vege SS. 52-year-old man with acute midabdominal pain. Mayo Clin Proc 2014; 89:115-9. [PMID: 24388029 DOI: 10.1016/j.mayocp.2013.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 03/25/2013] [Accepted: 03/27/2013] [Indexed: 11/21/2022]
Affiliation(s)
- Benjamin L Bick
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
| | - Andres J Acosta Cardenas
- Fellow in Gastroenterology, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
| | - Santhi Swaroop Vege
- Adviser to resident and fellow and Consultant in Gastroenterology, Mayo Clinic, Rochester, MN.
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176
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Superior mesenteric venous thrombosis after laparoscopic exploration for small bowel obstruction. Case Rep Surg 2013; 2013:952383. [PMID: 24455391 PMCID: PMC3881378 DOI: 10.1155/2013/952383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 12/10/2013] [Indexed: 02/07/2023] Open
Abstract
Mesenteric venous thrombosis is a rare cause of intestinal ischemia which is potentially life-threatening because it can lead to intestinal infarction. Mesenteric venous thrombosis rarely develops after abdominal surgery and is usually associated with coagulation disorders. Associated symptoms are generally subtle or nonspecific, often resulting in delayed diagnosis. A 68-year-old woman underwent laparoscopic exploration for small bowel obstruction, secondary to adhesions. During the procedure, an intestinal perforation was identified and repaired. Postoperatively, the abdominal pain persisted and repeat exploration was undertaken. At repeat exploration, a perforation was identified in the small bowel with a surrounding abscess. After the second operation, the abdominal pain improved but anorexia persisted. Contrast enhanced abdominal computed tomography was performed which revealed superior mesenteric venous thrombosis. Anticoagulation therapy with heparin was started immediately and the thrombus resolved over the next 6 days. Although rare, this complication must be considered in patients after abdominal surgery with unexplained abdominal symptoms.
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177
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Acute portal vein thrombosis due to chronic relapsing pancreatitis: a fistula between a pancreatic pseudocyst and the splenic vein. Clin J Gastroenterol 2013; 7:52-7. [PMID: 26183509 DOI: 10.1007/s12328-013-0442-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 11/04/2013] [Indexed: 01/31/2023]
Abstract
Portal vein thrombosis (PVT) is a relatively common complication in patients with liver cirrhosis, but several other causes might play an important role in PVT pathogenesis. We present a case of alcoholic chronic pancreatitis complicated by acute extensive PVT. The patient was managed conservatively with danaparoid sodium at first, but the thrombosis gradually extended. We then tried radiological intervention using the direct transhepatic and transjugular intrahepatic postsystemic shunt approaches. Although we were able to successfully catheterize the percutaneous transhepatic portal vein (PTP), we could not achieve recanalization of the portal vein. Therefore, PTP catheterization and systemic intravenous infusion of urokinase and heparin was performed to prevent further progression of the thrombosis and cavernous transformation was finally achieved. Computed tomography (CT) and magnetic resonance cholangiopancreatography revealed a pancreatic stone which had possibly induced dilatation of the tail duct and formation of a pancreatic pseudocyst and caused intractable pancreatitis. We performed endoscopic retrograde cholangiopancreatography and placed a stent in the pancreatic duct, which completely cured the pancreatitis. Retrospectively, the previous CT with curved multi-planar reconstruction was reviewed and a fistula was detected between the pancreatic pseudocyst and splenic vein. We concluded that the etiology of the PVT was not only inflammatory extension from pancreatitis but also a fistula between the pancreatic duct and the splenic vein.
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178
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Endovascular management of porto-mesenteric venous thrombosis developing after trans-arterial occlusion of a superior mesenteric arteriovenous fistula. Indian J Gastroenterol 2013; 32:341-5. [PMID: 23475546 DOI: 10.1007/s12664-013-0312-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 02/03/2013] [Indexed: 02/04/2023]
Abstract
Porto-mesenteric venous thrombosis following a trans-arterial occlusion of a superior mesenteric arteriovenous fistula is a rare occurrence. We present a case of endovascular management of one such case treated pharmacomechanically with catheter-directed mesenteric thrombolysis and transjugular intrahepatic portosystemic shunt creation without long-term successful outcome.
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179
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Nonneoplastic Diseases of the Small Intestine: Clinical, Pathophysiologic, and Imaging Characteristics. AJR Am J Roentgenol 2013; 201:W382-90. [DOI: 10.2214/ajr.12.8496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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180
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Okoli A. Additional information on mesenteric venous thrombosis. Mayo Clin Proc 2013; 88:902-3. [PMID: 23910420 DOI: 10.1016/j.mayocp.2013.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 05/21/2013] [Indexed: 12/15/2022]
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181
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Superior Mesenteric Vein Thrombosis After Laparoscopic Sleeve Gastrectomy. Surg Laparosc Endosc Percutan Tech 2013; 23:e162-3. [DOI: 10.1097/sle.0b013e31828b7fdb] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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182
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Sgourakis G, Papapanagiotou A, Kontovounisios C, Karamouzis MV, Lanitis S, Konstantinou C, Karaliotas C, Papavassiliou AG. The value of plasma neurotensin and cytokine measurement for the detection of bowel ischaemia in clinically doubtful cases: a prospective study. Exp Biol Med (Maywood) 2013; 238:874-80. [PMID: 23828592 DOI: 10.1177/1535370213494663] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The aim of this prospective study was to examine whether serum neurotensin, interleukin (IL)-6, and IL-8 are early predictor of bowel ischaemia especially in clinically equivocal cases. To this end, 56 patients were assigned to the following groups according to their disease: bowel ischaemia (group 1: n = 14), small bowel obstruction (group 2: n = 12), acute inflammation (group 3: n = 6), perforation (group 4: n = 8), and colorectal adenocarcinoma (group 5: n = 16). Fifteen healthy controls were assigned to group 6. Blood samples were obtained at enrollment, all measurements were done blindly, and all patients underwent surgery. Pretreatment doubtful diagnosis comprised of ileus, mild abdominal pain, and indeterminate imaging. Blood urea nitrogen, lactic acidosis, diagnostic workup, and IL-6 were predictors of diagnosis in univariate analysis. In multivariate analysis, IL-6 (P < 0.001) and diagnostic workup (P < 0.01) were independent predictors of the definite diagnosis. Neurotensin and IL-8 did not differentiate among groups. Considering clinically doubtful cases, IL-6 perfectly differentiates mesenteric ischaemia (of infarction/embolic/occlusive aetiology) from the rest of the indeterminate pathologies. The optimum cut-off point for IL-6 was 27.66 pg/mL. The value of serum IL-6 (27.66 pg/mL) had sensitivity = 1 and specificity = 1. In conclusion, plasma IL-6 measurement on admission might be an additional diagnostic tool that can predict bowel ischaemia in doubtful clinical situations.
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Affiliation(s)
- George Sgourakis
- Second Surgical Department and Surgical Oncology Unit of Red Cross Hospital, 11526 Athens, Greece
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183
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Chen TY, Lin YY, Chen YL, Hsu CW, Tsai SH. Initial presentation of mesenteric venous thrombosis mimicking acute duodenitis: A true gastrointestinal vascular emergency. J Acute Med 2013. [DOI: 10.1016/j.jacme.2013.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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184
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Fonseca AL, Cleary MA, Cholewczynski W, Sumpio BE, Atweh NA. Omental vein catheter thrombolysis for acute porto-mesenteric vein thrombosis. Ann Vasc Surg 2013; 27:497.e1-4. [PMID: 23566871 DOI: 10.1016/j.avsg.2012.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 09/25/2012] [Indexed: 01/16/2023]
Abstract
Mesenteric venous thrombosis (MVT) is an uncommon clinical condition with potential high morbidity. We report here a patient who presented with acute-onset MVT and bowel infarction, which was successfully ameliorated with intramesenteric vein thrombolytic therapy.
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Affiliation(s)
- Annabelle L Fonseca
- Department of Surgery, Yale University School of Medicine, New Haven, CT 06511, USA.
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185
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De novo portal vein thrombosis in virus-related cirrhosis: predictive factors and long-term outcomes. Am J Gastroenterol 2013; 108:568-74. [PMID: 23381015 DOI: 10.1038/ajg.2012.452] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The objective of this study is to investigate predictive factors and long-term outcomes of de novo portal vein thrombosis (PVT) in cirrhosis. METHODS The incidence and factors predictive of PVT (diagnosed by Doppler ultrasound) and prognosis were examined in 150 patients with virus-related cirrhosis but without PVT at baseline. RESULTS PVT developed in 28% of patients (42/150), with cumulative incidence of 12.8%, 20%, and 38.7% at 1, 5, and 8-10 years, respectively. The baseline flow volume in the largest collateral vessel was an independent risk factor for thrombosis (hazard ratio, 3.922; 95% confidence intervals, 3.697-4.415; P<0.0001). The cumulative incidence of PVT at 1, 5, and 10 years was significantly higher in patients with the largest collateral vessel velocity >10 cm/s (19.1%, 27%, and 78.4%, respectively) compared with those with velocity ≤10 cm/s (8.6%, 16.3%, and 24.7%, respectively, P=0.0303), and higher in patients with volume >400 ml/min (27.4%, 36.5%, and 74.6%, respectively) compared with those with volume ≤400 ml/min (10.6%, 16.2%, and 28.8%, respectively, P=0.0075). The natural course of thrombosis was improvement in 47.6%, unchanged in 45.2%, and worsened in 7.2%. The diameter and flow volume in the largest collateral vessel at the time of thrombus detection were significantly smaller in the improved patients than the others. The cumulative survival rate was similar between the thrombosis group and non-thrombosis group. CONCLUSIONS Development of collateral vessels was a significant predictive factor for the occurrence of PVT in virus-induced cirrhosis. Spontaneous resolution or unchanged appearance was the most common outcome of thrombosis, which had little influence on prognosis.
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186
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El Barni R, El Kharras A, Lahkim M, Fihri JF, Mejdane A, Bouchama R, Achour A. [Superior mesenteric vein thrombosis complicating an unrecognized appendicitis]. Pan Afr Med J 2013; 14:12. [PMID: 23504278 PMCID: PMC3597861 DOI: 10.11604/pamj.2013.14.12.2263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 01/06/2013] [Indexed: 11/23/2022] Open
Abstract
La thrombose veineuse mésentérique supérieure (TVMS) peut se présenter selon un mode aigu, subaigu ou chronique. Réputée rare, elle peut être primitive ou secondaire. Les étiologies chirurgicales les plus fréquemment identifiées de TVMS sont la diverticulite colique et l'appendicite aiguë. Les auteurs ont jugé utile de rapporter une observation de TVMS compliquant une appendicite refroidie par les antibiotiques, tout en insistant sur la latence clinique de telle pathologie rendant son diagnostic et son traitement plus difficile.
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Affiliation(s)
- Rachid El Barni
- Service de chirurgie générale, Hôpital Militaire Avicenne Marrakech, Morocco
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187
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Duran R, Denys AL, Letovanec I, Meuli RA, Schmidt S. Multidetector CT features of mesenteric vein thrombosis. Radiographics 2013; 32:1503-22. [PMID: 22977032 DOI: 10.1148/rg.325115100] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Mesenteric vein thrombosis (MVT) accounts for 5%-15% of all mesenteric ischemic events and is classified as either primary or secondary. Primary MVT is idiopathic, whereas secondary MVT can result from a variety of underlying diseases and risk factors, including primary hypercoagulable states or prothrombotic disorders, myeloproliferative neoplasms, cancer (most frequently of the pancreas or liver), diverse inflammatory conditions, recent surgery, portal hypertension, and miscellaneous causes such as oral contraceptives or pregnancy. Clinical symptoms of MVT are rather nonspecific and are mainly characterized by abdominal pain. The mortality rate for MVT remains high, since even now the diagnosis is often delayed. Multidetector computed tomography (CT) is the modality of choice in this context. Although venous bowel ischemia occurs only infrequently with MVT, radiologists should be familiar with its multidetector CT features. Familiarity with the possible causes of MVT, the underlying pathogenic mechanisms associated with MVT, and the correlation between multidetector CT features and these pathogenic mechanisms is necessary to optimize medical management and improve patient care.
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Affiliation(s)
- Rafael Duran
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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188
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Abstract
The prevalence of mesenteric venous thrombosis has increased over the past 2 decades with the routine use of contrast-enhanced computed tomography (CT) in patients presenting with abdominal pain and those with portal hypertension. Concurrent with increasing recognition, routine and frequent use of anticoagulation has reduced the need for surgical intervention and improved outcome in these patients. Acute thrombosis often presents with abdominal pain, whereas chronic disease manifests either as an incidental finding on CT or with features of portal hypertension. Contrast-enhanced CT diagnoses about 90% of cases. The presence of collateral circulation and cavernoma around a chronically thrombosed vein differentiates chronic from acute disease. The superior mesenteric vein is often involved, whereas involvement of the inferior mesenteric vein is rare. Associated portal venous thrombosis can be seen if the disease originates in the major veins instead of the small vena rectae. Thrombophilia and local abdominal inflammatory conditions are common causes. Management is aimed at preventing bowel infarction and recurrent thrombosis. Anticoagulation, the mainstay of management, has also been safely used in patients with cirrhosis and portal hypertension. This review discusses the pathogenesis of thrombosis of mesenteric veins, the diagnosis and differentiation from arterial ischemia, the emergence of the JAK2 (Janus kinase 2) sequence variation as a marker of thrombophilia and myelodysplastic neoplasms, and new anticoagulants. Algorithms for the management of acute and chronic mesenteric venous thrombosis are provided to help readers understand and remember the approach to the management of acute and chronic mesenteric venous thrombosis.
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Affiliation(s)
- Ashwani K Singal
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
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189
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Speranskaya A, Nicolau J, Olivares J, Pascual S, González De Cabo M, Masmiquel L. Mesenteric vein thrombosis after laparoscopic sleeve gastrectomy. Clin Obes 2013; 3:56-8. [PMID: 25586392 DOI: 10.1111/cob.12012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 03/07/2013] [Accepted: 03/11/2013] [Indexed: 12/25/2022]
Abstract
Mesenteric vein thrombosis is a rare complication of bariatric laparoscopic surgery. We report a case of a 47-year-old man with obesity who had mesenteric vein thrombosis 14 days after laparoscopic sleeve gastrectomy. He was treated with heparin anticoagulation with a good therapeutic response. This case and literature review illustrate that mesenteric vein thrombosis has to be included in the differential diagnosis of abdominal pain after a bariatric procedure and listed formally as a complication of bariatric surgery.
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Affiliation(s)
- A Speranskaya
- Endocrinology, Hospital Son Llatzer, Palma de Mallorca, Spain
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190
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Lorenz JM, Bennett S, Patel J, Van Ha TG, Funaki B. Combined Pharmacomechanical Thrombolysis of Complete Portomesenteric Thrombosis in a Liver Transplant Recipient. Cardiovasc Intervent Radiol 2013; 37:262-6. [DOI: 10.1007/s00270-013-0568-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 12/30/2012] [Indexed: 11/28/2022]
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191
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Handa P, Crowther M, Douketis JD. Portal vein thrombosis: a clinician-oriented and practical review. Clin Appl Thromb Hemost 2013; 20:498-506. [PMID: 23364162 DOI: 10.1177/1076029612473515] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
With advances in modern imaging techniques, portal vein thrombosis (PVT) is being increasingly diagnosed. It has a wide ranging clinical spectrum from being an asymptomatic state to a potentially life-threatening situation. It is not unusual to find it as an incidental finding in the abdominal imagings done for other reasons. It is commonly associated with cirrhosis and abdominal malignancies and also has a strong association with prothrombotic disorders. It is often difficult for the clinicians to decide whether PVT is acute or chronic. This poses great challenges to its management strategies that include anticoagulants, thrombolysis, and surgical options. Timely diagnosis and appropriate management have great bearings on its outcomes of morbidity and mortality. In this clinician-oriented review, we have provided a concise review of clinical aspects of PVT and discussed various management strategies while addressing the common questions that come to a physician's mind dealing with such a patient.
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Affiliation(s)
- Pankaj Handa
- Department of Medicine, McMaster University and St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Mark Crowther
- Department of Medicine, McMaster University and St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - James D Douketis
- Department of Medicine, McMaster University and St Joseph's Healthcare, Hamilton, Ontario, Canada
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192
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Lee SS, Park SH. Computed Tomography Evaluation of Gastrointestinal Bleeding and Acute Mesenteric Ischemia. Radiol Clin North Am 2013. [DOI: 10.1016/j.rcl.2012.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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193
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Hoekstra J, Seijo S, Rautou PE, Ducarme G, Boudaoud L, Luton D, Alijotas-Reig J, Casellas-Caro M, Condat B, Bresser E, Thabut D, Larroque B, Gárcia-Pagán JC, Janssen HLA, Valla DC, Plessier A. Pregnancy in women with portal vein thrombosis: results of a multicentric European study on maternal and fetal management and outcome. J Hepatol 2012; 57:1214-9. [PMID: 22885716 DOI: 10.1016/j.jhep.2012.07.034] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 07/16/2012] [Accepted: 07/26/2012] [Indexed: 12/04/2022]
Abstract
BACKGROUND & AIMS Women of childbearing age account for approximately 25% of patients with non-cirrhotic portal vein thrombosis (PVT). We aimed at assessing maternal and fetal outcome in pregnant women with known PVT. METHODS We performed a retrospective analysis of the files of women with chronic PVT in three European referral centers between 1986 and 2010. RESULTS Forty-five pregnancies, 28 (62%) treated with low molecular weight heparin, occurred in 24 women. Nine (20%) were lost before gestation week 20. Preterm birth occurred in 38% of deliveries: there were 3 births at week 24-25, 7 at week 32-36, and 26 after week 37. A term birth with a healthy infant occurred in 58% of pregnancies. Cesarean section was used in 53% of deliveries. Two women developed HELLP syndrome. A favorable outcome happened in 64% of pregnancies. Pregnancies with an unfavorable outcome were associated with a higher platelet count at diagnosis. Bleeding from esophageal varices occurred in 3 patients during pregnancy, all without adequate primary prophylaxis. Genital or parietal bleeding occurred postpartum in 4 patients, only one being on anticoagulation therapy. Thrombotic events occurred in 2 patients, none related to lower limbs or mesenteric veins. There were no maternal deaths. CONCLUSIONS In pregnant PVT patients treated with anticoagulation on an individual basis, the rate of miscarriage and preterm birth appears to be increased. However, fetal and maternal outcomes are favorable for most pregnancies reaching gestation week 20. High platelet counts appear to increase the risk for unfavorable outcome. Pregnancy should not be contraindicated in stable PVT patients.
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Affiliation(s)
- J Hoekstra
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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194
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Szabóné Révész E. [Acute mesenteric ischemia: analysis of cases over a ten-years period (2001-2010)]. Orv Hetil 2012; 153:1424-32. [PMID: 22951410 DOI: 10.1556/oh.2012.29444] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
UNLABELLED Acute mesenteric ischemia is a rare disorder; it occurs on average of 0.4% of acute surgery cases. Its diagnosis is often difficult because of the poor symptoms, and mortality of the patients is still as high as 70-90%. AIMS The aims of the study were to assess the importance of time factor that may influence the outcome and to find out whether it is possible to decrease the high mortality rate in this disease. METHOD Among patients admitted to Saint Pantaleon Hospital in Hungary between January 2001 and December 2010, patients whose surgery or autopsy findings confirmed intestinal necrosis were analyzed. A total of 114 patients with acute mesenteric ischemia were included in the study. RESULTS 55% of the patients had typical symptoms. 43.8% of the patients underwent surgery and among these patients the mortality rate was 70% despite surgical intervention. The survival rate was 72.3% when surgery was performed within less than 12 hours after the onset of symptoms, but only 20% of patients survived when surgery was delayed between 24 and 48 hours after the onset of symptoms. CONCLUSION With early diagnosis and intervention, patients with acute mesenteric ischemia may have a better a chance to survive.
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195
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Maruyama H, Ishibashi H, Takahashi M, Shimada T, Kamesaki H, Yokosuka O. Prediction of the therapeutic effects of anticoagulation for recent portal vein thrombosis: a novel approach with contrast-enhanced ultrasound. ACTA ACUST UNITED AC 2012; 37:431-8. [PMID: 21904887 DOI: 10.1007/s00261-011-9795-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine whether intra-thrombus enhancement on contrast-enhanced sonograms can predict the recanalization by anticoagulation for recent portal thrombosis. METHODS This prospective study included 10 patients with a recent portal thrombosis and 20 controls (10 cirrhosis patients and 10 healthy subjects, all without thrombosis). The diagnosis of thrombosis was based on clinical and ultrasound findings. Pre-anticoagulation intra-thrombus enhancement on the contrast-enhanced sonogram was examined with respect to the post-anticoagulation results or portal enhancement in controls. RESULTS Complete recanalization was obtained in 4 patients with positive intra-thrombus enhancement. However, in 4 other patients who had a thrombosis showing positive enhancement concurrent with one showing negative enhancement, anticoagulation recanalized the former and failed to recanalize the latter. Mean onset time of contrast enhancement measured from the beginning of hepatic arterial enhancement was significantly longer in the thrombus (6.6 ± 4.3 s, 3-16 s) than in the portal vein of controls (cirrhosis, 4.3 ± 1.4 s, 2-8 s, P = 0.0035; healthy subjects, 2.4 ± 0.6 s, 1-3 s, P < 0.0001). Anticoagulation failed to achieve recanalization in 2 patients with negative intra-thrombus enhancement. Sensitivity and specificity of contrast enhancement for the prediction of post-treatment recanalization was 100%. CONCLUSIONS Intra-thrombus positive enhancement demonstrated on contrast-enhanced sonograms has promise as a successful predictor of recanalization for the recent portal thrombosis.
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Affiliation(s)
- Hitoshi Maruyama
- Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, Inohana, Chuou-ku, Japan.
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196
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The role of portal vein thrombosis in the clinical course of inflammatory bowel diseases: report on three cases and review of the literature. Gastroenterol Res Pract 2012; 2012:916428. [PMID: 23093957 PMCID: PMC3475311 DOI: 10.1155/2012/916428] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 09/01/2012] [Indexed: 12/13/2022] Open
Abstract
Inflammatory bowel diseases are associated with an increased risk of vascular complications. The most important are arterial and venous thromboembolisms, which are considered as specific extraintestinal manifestations of inflammatory bowel diseases. Among venous thromboembolism events, portal vein thrombosis has been described in inflammatory bowel diseases. We report three cases of portal vein thrombosis occurring in patients with active inflammatory bowel disease. In two of them, hepatic abscess was present. Furthermore, we performed a systematic review based on the clinical literature published on this topic.
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197
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Tait C, Baglin T, Watson H, Laffan M, Makris M, Perry D, Keeling D. Guidelines on the investigation and management of venous thrombosis at unusual sites. Br J Haematol 2012; 159:28-38. [PMID: 22881455 DOI: 10.1111/j.1365-2141.2012.09249.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 06/25/2012] [Indexed: 12/13/2022]
Affiliation(s)
- Campbell Tait
- Department of Haematology, Glasgow Royal Infirmary, Glasgow, UK
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198
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Catheter-directed continuous thrombolysis following aspiration thrombectomy via the ileocolic route for acute portal venous thrombosis: report of two cases. Surg Today 2012; 43:1310-5. [DOI: 10.1007/s00595-012-0343-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 05/17/2012] [Indexed: 12/17/2022]
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199
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Park JH, Jeong SH, Kwag SJ, Park TJ, Jeong CY, Ju YT, Jung EJ, Hong SC, Choi SK, Ha WS, Lee YJ. Identification of Prognostic Factors for In-Hospital Mortality in Acute Mesenteric Ischemia. Vasc Specialist Int 2012. [DOI: 10.5758/kjves.2012.28.3.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Ji Ho Park
- Department of Surgery, Gyeongsang National University, Post-graduate School of Medicine, Jinju, Korea
| | - Sang Ho Jeong
- Department of Surgery, Gyeongsang National University, Post-graduate School of Medicine, Jinju, Korea
| | - Seung Jin Kwag
- Department of Surgery, Gyeongsang National University, Post-graduate School of Medicine, Jinju, Korea
| | - Tae Jin Park
- Department of Surgery, Gyeongsang National University, Post-graduate School of Medicine, Jinju, Korea
| | - Chi Young Jeong
- Department of Surgery, Gyeongsang National University, Post-graduate School of Medicine, Jinju, Korea
| | - Young Tae Ju
- Department of Surgery, Gyeongsang National University, Post-graduate School of Medicine, Jinju, Korea
| | - Eun Jung Jung
- Department of Surgery, Gyeongsang National University, Post-graduate School of Medicine, Jinju, Korea
| | - Soon Chan Hong
- Department of Surgery, Gyeongsang National University, Post-graduate School of Medicine, Jinju, Korea
| | - Sang Kyung Choi
- Department of Surgery, Gyeongsang National University, Post-graduate School of Medicine, Jinju, Korea
| | - Woo Song Ha
- Department of Surgery, Gyeongsang National University, Post-graduate School of Medicine, Jinju, Korea
| | - Young Joon Lee
- Department of Surgery, Gyeongsang National University, Post-graduate School of Medicine, Jinju, Korea
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200
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De Stefano V, Martinelli I. Abdominal thromboses of splanchnic, renal and ovarian veins. Best Pract Res Clin Haematol 2012; 25:253-64. [PMID: 22959542 DOI: 10.1016/j.beha.2012.07.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Thromboses of abdominal veins outside the iliac-caval axis are rare but clinically relevant. Early deaths after splanchnic vein thrombosis occur in 5-30% of cases. Sequelae can be liver failure or bowel infarction after splanchnic vein thrombosis, renal insufficiency after renal vein thrombosis, ovarian infarction after ovarian vein thrombosis. Local cancer or infections are rare in Budd-Chiari syndrome, and common for other sites. Inherited thrombophilia is detected in 30-50% of patients. Myeloproliferative neoplasms are the main cause of splanchnic vein thrombosis: 20-50% of patients have an overt myeloproliferative neoplasm and/or carry the molecular marker JAK2 V617F. Renal vein thrombosis is closely related to nephrotic syndrome; finally, ovarian vein thrombosis can complicate puerperium. Heparin is used for acute treatment, sometimes in conjunction with systemic or local thrombolysis. Vitamin K-antagonists are recommended for 3-6 months, and long-term in patients with Budd-Chiari syndrome, unprovoked splanchnic vein thrombosis, or renal vein thrombosis with a permanent prothrombotic state such as nephrotic syndrome.
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Affiliation(s)
- Valerio De Stefano
- Institute of Hematology, Catholic University, Largo Gemelli, Rome, Italy.
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