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Samanta J, Dhar J, Gupta P, Kochhar R. Venous Thrombosis in Acute Pancreatitis: What to and Not to Do? Dig Dis Sci 2024; 69:1537-1550. [PMID: 38600412 DOI: 10.1007/s10620-024-08418-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 03/26/2024] [Indexed: 04/12/2024]
Abstract
Acute pancreatitis is an acute inflammatory condition of the pancreas that has not only local but systemic effects as well. Venous thrombosis is one such complication which can give rise to thrombosis of the peripheral vasculature in the form of deep vein thrombosis, pulmonary embolism, and splanchnic vein thrombosis. The prevalence of these complications increases with the severity of the disease and adds to the adverse outcomes profile. With better imaging and awareness, more cases are being detected, although many at times it can be an incidental finding. However, it remains understudied and strangely, most of the guidelines on the management of acute pancreatitis are silent on this aspect. This review offers an overview of the incidence, pathophysiology, symptomatology, diagnostic work-up, and management of venous thrombosis that develops in AP.
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Affiliation(s)
- Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical College and Research, Chandigarh, India
| | - Jahnvi Dhar
- Department of Gastroenterology, Sohana Hospital, Mohali, Punjab, India
| | - Pankaj Gupta
- Department of Radiodiagnosis, Post Graduate Institute of Medical College and Research, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Post Graduate Institute of Medical College and Research, Chandigarh, India.
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Rempe M, Mentzel F, Pomykala KL, Haubold J, Nensa F, Kroeninger K, Egger J, Kleesiek J. k-strip: A novel segmentation algorithm in k-space for the application of skull stripping. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 243:107912. [PMID: 37981454 DOI: 10.1016/j.cmpb.2023.107912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND AND OBJECTIVE We present a novel deep learning-based skull stripping algorithm for magnetic resonance imaging (MRI) that works directly in the information rich complex valued k-space. METHODS Using four datasets from different institutions with a total of around 200,000 MRI slices, we show that our network can perform skull-stripping on the raw data of MRIs while preserving the phase information which no other skull stripping algorithm is able to work with. For two of the datasets, skull stripping performed by HD-BET (Brain Extraction Tool) in the image domain is used as the ground truth, whereas the third and fourth dataset comes with per-hand annotated brain segmentations. RESULTS All four datasets were very similar to the ground truth (DICE scores of 92 %-99 % and Hausdorff distances of under 5.5 pixel). Results on slices above the eye-region reach DICE scores of up to 99 %, whereas the accuracy drops in regions around the eyes and below, with partially blurred output. The output of k-Strip often has smoothed edges at the demarcation to the skull. Binary masks are created with an appropriate threshold. CONCLUSION With this proof-of-concept study, we were able to show the feasibility of working in the k-space frequency domain, preserving phase information, with consistent results. Besides preserving valuable information for further diagnostics, this approach makes an immediate anonymization of patient data possible, already before being transformed into the image domain. Future research should be dedicated to discovering additional ways the k-space can be used for innovative image analysis and further workflows.
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Affiliation(s)
- Moritz Rempe
- The Institute for AI in Medicine (IKIM), University Hospital Essen, Girardetstraße 2, Essen 45131, Germany; Otto-Hahn-Straße 4a, Department of Physics of the Technical University Dortmund, Dortmund 44227, Germany
| | - Florian Mentzel
- Otto-Hahn-Straße 4a, Department of Physics of the Technical University Dortmund, Dortmund 44227, Germany
| | - Kelsey L Pomykala
- The Institute for AI in Medicine (IKIM), University Hospital Essen, Girardetstraße 2, Essen 45131, Germany
| | - Johannes Haubold
- The Institute for AI in Medicine (IKIM), University Hospital Essen, Girardetstraße 2, Essen 45131, Germany
| | - Felix Nensa
- The Institute for AI in Medicine (IKIM), University Hospital Essen, Girardetstraße 2, Essen 45131, Germany
| | - Kevin Kroeninger
- Otto-Hahn-Straße 4a, Department of Physics of the Technical University Dortmund, Dortmund 44227, Germany
| | - Jan Egger
- The Institute for AI in Medicine (IKIM), University Hospital Essen, Girardetstraße 2, Essen 45131, Germany; The Computer Algorithms for Medicine Laboratory, Graz, Austria; The Institute of Computer Graphics and Vision, Inffeldgasse 16, Graz University of Technology, Graz 8010, Austria; Cancer Research Center Cologne Essen (CCCE), Hufelandstraße 55, University Medicine Essen, Essen 45147, Germany
| | - Jens Kleesiek
- The Institute for AI in Medicine (IKIM), University Hospital Essen, Girardetstraße 2, Essen 45131, Germany; Cancer Research Center Cologne Essen (CCCE), Hufelandstraße 55, University Medicine Essen, Essen 45147, Germany; Partner Site Essen, Hufelandstraße 55, German Cancer Consortium (DKTK), Essen 45147, Germany.
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Niang FG, Faye I, Ndong A, Diedhiou M, Niang I, Diop AD, Diop AN. Acute mesenteric ischemia: A case report. Radiol Case Rep 2024; 19:150-152. [PMID: 37954676 PMCID: PMC10632305 DOI: 10.1016/j.radcr.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 11/14/2023] Open
Abstract
Acute mesenteric ischemia is a rare life-threatening diagnostic and therapeutic emergency. Lack of clinical and biological specificity makes the diagnosis difficult. Imaging, particularly computed tomography can help confirm the diagnosis. An underlying cause is identified in about 30%-70% of cases and should always be sought. We report a case of a 51-year-old man with chronic alcoholic liver disease admitted to the emergency department for abdominal pain. Computed tomography showed mesenteric venous thrombosis with signs of small bowel ischemia and cirrhosis with portal hypertension. Through this observation, we describe the imaging aspects of mesenteric ischemia and emphasize the necessity of seeking underlying pathological condition.
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Affiliation(s)
- Fallou Galass Niang
- Department of Radiology, Saint-Louis Regional Hospital, Saint-Louis, Senegal
- Gaston Berger University (Saint-Louis - SENEGAL), Senegal
| | - Ibrahima Faye
- Department of Radiology, Saint-Louis Regional Hospital, Saint-Louis, Senegal
| | | | | | - Ibrahima Niang
- Department of Radiology, Fann University Hospital, Dakar, Senegal
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Susngi T, Shah J, Bhujade H, Jearth V, Singh AK, Mandavdhare HS, Sharma V, Gupta R, Rana S, Dutta U. Deep Venous Thrombosis in Acute Pancreatitis Is Associated with High Mortality: A Prospective Study. Dig Dis Sci 2023; 68:988-994. [PMID: 35867193 DOI: 10.1007/s10620-022-07617-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/04/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Incidence and risk factors for the development of extremity deep vein thrombosis (eDVT) in admitted patients of acute pancreatitis have been rarely explored. AIMS To identify the incidence of eDVT and to explore role of clinical scores for predicting eDVT in admitted patients of acute pancreatitis. METHODS We prospectively enrolled admitted patients of acute pancreatitis and performed a weekly eDVT screen for the duration of their admission. Well's score and Padua's score were also calculated weekly. The incidence of venous thrombosis (eDVT and splanchnic thrombosis based on contrast-enhanced CT scan abdomen) was noted, and the risk factors were determined using multivariate analysis. The correlation between Well's score, Padua's score, and development of DVT was calculated using Pearson's correlation. RESULTS Of the 102 patients of acute pancreatitis enrolled, 73.5% of patients had necrotizing pancreatitis. Total of 46 patients (45.1%) developed thrombosis: 43 patients had splanchnic vein thrombosis; 5 patients had eDVT; and 1 patient had pulmonary embolism. Patients with eDVT had higher BISAP score (2.6 ± 0.9 vs 1.7 ± 0.8; p = 0.039), requirement of mechanical ventilation (60% vs 8.2%; p = 0.008), and mortality (60% vs 12.4%; p = 0.022). Well's score of ≥ 2 had sensitivity and specificity of 80% and 96.9% for prediction of eDVT and it had better correlation with the development of eDVT compared to Pauda's score. CONCLUSION Incidence of DVT is 5% in patients with acute pancreatitis requiring admission. It is associated with higher disease severity and mortality. The Well's score is useful to predict the development of eDVT in routine clinical practice.
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Affiliation(s)
- Terence Susngi
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Jimil Shah
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vaneet Jearth
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Anupam K Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Harshal S Mandavdhare
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajesh Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Surinder Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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5
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Splanchnic vein thrombosis associated with myeloproliferative neoplasms. Thromb Res 2022; 218:8-16. [DOI: 10.1016/j.thromres.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/30/2022] [Accepted: 08/03/2022] [Indexed: 11/22/2022]
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Bhattarai AM, Bhattarai AM, Karki A, Baral S, Poudel S, Adhikari S. Superior mesenteric venous thrombosis in a 47 years old male with protein S deficiency: A case report. Ann Med Surg (Lond) 2022; 77:103719. [PMID: 35638063 PMCID: PMC9142700 DOI: 10.1016/j.amsu.2022.103719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/26/2022] [Accepted: 05/01/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Mesenteric venous thrombosis is due to blood clot in veins that drain blood from the intestine. It may lead to mesenteric ischemia. Protein S deficiency is one of the causes of superior mesenteric vein thrombosis. Case presentation A 47 years old male patient presented with pain in the abdomen. Contrast CECT shows filling defect in the superior mesenteric venous thrombosis. Coagulometer showed lower protein S activity than that of normal. Clinical discussion Proper diagnosis is needed for early detection so that proper intervention can be made on time. Anticoagulation and vitamin K antagonists are given. Conclusions Though rare, protein S deficiency should be considered a possible cause of mesenteric venous thrombosis. Mesenteric venous thrombosis is one of the causes of mesenteric ischemia which occurs as a result of local blood coagulation impairing the venous return of bowel. Protein C and S are vitamin K dependent glycoprotein deficiency of these proteins leads to thrombosis. CECT is the diagnostic modality for the proper diagnosis which should be done as early, so that proper intervention and treatment can be done in time. aPTT and PT/INR should monitored in time, to identify the risk factors so that lifetime medication can be started early.
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Affiliation(s)
- Ayush Mohan Bhattarai
- Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
- Corresponding author. Shree Birendra Hospital, 44600, Kathmandu, Nepal.
| | | | - Abinash Karki
- Department of Medicine, Shree Birendra Hospital, Chaunni, Kathmandu, Nepal
| | | | - Sabin Poudel
- Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
| | - Samikshya Adhikari
- Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
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Abstract
Patients with cirrhosis of the liver are at high risk of developing portal vein thrombosis (PVT), which has a complex, multifactorial cause. The condition may present with a myriad of symptoms and can occasionally cause severe complications. Contrast-enhanced computed tomography (CT) is the gold standard for the diagnosis of PVT. There are uncertainties regarding the effect on PVT and its treatment outcome in patients with cirrhosis. The main challenge for managing PVT in cirrhosis is analyzing the risk of hemorrhage compared to the risk of thrombus extension leading to complications. All current knowledge regarding non-tumor PVT in cirrhosis, including epidemiology, risk factors, classification, clinical presentation, diagnosis, impact on natural history, and treatment, is discussed in the present article.
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Key Words
- ACLF, acute-on-chronic liver failure
- BCS, Budd–Chiari syndrome
- DOACs, direct-acting oral anticoagulants
- EASL, European Association for the Study of the Liver
- HCC, hepatocellular carcinoma
- HVPG, hepatic venous pressure gradient
- INR, international normalized ratio
- JAK2, Janus Kinase 2
- LMWH, low molecular weight heparin
- LT, liver transplant
- MELD, Model for End-Stage Liver Disease
- MTHFR, methyltetrahydrofolate reductase
- NASH, non-alcoholic steatohepatitis
- NO, nitric oxide
- NSBBs, non-selective beta-blockers
- PV, portal vein
- PVT, Portal vein thrombosis
- RCT, randomized controlled trial
- SMA, superior mesenteric artery
- SMV, superior mesenteric vein
- SVT, splanchnic vein thrombosis
- TIPS, Transjugular intrahepatic portosystemic shunt
- UNOS, United Network for Organ Sharing
- VEGF, vascular endothelial growth factors
- VKAs, vitamin K antagonists
- VKORC1, vitamin K epoxide reductase complex 1
- anticoagulation
- cirrhosis
- eNOS, endothelial nitric oxide synthase
- non-tumoral portal vein thrombosis
- portal hypertension
- rTPA, recombinant tissue plasminogen activator
- transjugular intrahepatic portosystemic shunt
- vWF, von Willebrand factor
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Chou CK. CT manifestations of small bowel ischemia due to impaired venous drainage-with a correlation of pathologic findings. Indian J Radiol Imaging 2021; 26:342-351. [PMID: 27857460 PMCID: PMC5036332 DOI: 10.4103/0971-3026.190426] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acute abdominal pain may result from a wide variety of medical and surgical diseases. One of these diseases is small bowel ischemia, which may result in a catastrophic outcome if not recognized and treated promptly. Computed tomography (CT) by its faster image acquisition, thinner collimation, high resolution, and multiplanar reformatted images has become the most important imaging modality in evaluating the acute abdominal conditions. In this article, the author presents a description of the histology of the small bowel, pathophysiology of small bowel change, and a correlation of the pathologic and CT findings of the small bowel injuries due to impaired venous drainage. A convincing correlation of the microscopic mucosal condition with the enhancement pattern of the thickened small bowel wall on CT is useful in definitely describing the mucosal viability.
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Affiliation(s)
- Chung Kuao Chou
- Department of Radiology, Yuan's General Hospital, Kaohsiung, Taiwan, Republic of China
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Vekariya P, Daneti D, Senthamizhselvan K, Sureshkumar S, Mohan P. Acute Intestinal Obstruction as an Initial Presentation of Mesenteric Venous Thrombosis. Cureus 2021; 13:e15652. [PMID: 34277245 PMCID: PMC8281781 DOI: 10.7759/cureus.15652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/24/2022] Open
Abstract
Intestinal ischemia commonly occurs after arterial thrombosis or embolism. Thrombosis of the mesenteric vein accounts for less than 10% of cases of intestinal ischemia. Superior mesenteric vein thrombosis (SMVT) in its chronic form is less culpable to produce intestinal ischemia as it forms sufficient collateral drainage. Intestinal obstruction due to mesenteric venous thrombosis is rare, and so far, only 12 cases have been reported. The majority of them had a distinct episode of acute abdominal pain due to ischemia and later developed bowel stricture and intestinal obstruction. Here we report a case of a 44-year-old male who presented with intestinal obstruction as an initial presentation of SMVT. The patient required surgical resection and anastomosis, and he was started on anticoagulation therapy. This case report reiterates the fact that persistent low-grade mesenteric venous ischemia may lead to bowel stricture formation at a later stage. Therefore, etiological workup and early anticoagulant therapy can be useful to improve recurrence.
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Affiliation(s)
- Pradip Vekariya
- Medical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Dharanesh Daneti
- Medical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Kuppusamy Senthamizhselvan
- Medical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Sathasivam Sureshkumar
- General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Pazhanivel Mohan
- Medical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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10
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Ebrahimi N, Ng KS, Young CJ. Superior mesenteric vein thrombosis in a pregnant woman: Diagnostic and management challenge. ANZ J Surg 2021; 92:265-267. [PMID: 34060201 DOI: 10.1111/ans.16998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Nargus Ebrahimi
- Department of Colorectal Surgery, Discipline of Surgery, The University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kheng-Seong Ng
- Department of Colorectal Surgery, Discipline of Surgery, The University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Christopher J Young
- Department of Colorectal Surgery, Discipline of Surgery, The University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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Primignani M. Pancreatitis-related splanchnic vein thrombosis: What role, what warnings for anticoagulation therapy? J Dig Dis 2021; 22:122-125. [PMID: 33591597 DOI: 10.1111/1751-2980.12974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Massimo Primignani
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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12
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Practice guidance for diagnosis and treatment of pancreatitis-related splanchnic vein thrombosis (Shenyang, 2020). J Dig Dis 2021; 22:2-8. [PMID: 33215862 DOI: 10.1111/1751-2980.12962] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 12/11/2022]
Abstract
Splanchnic vein thrombosis is a severe complication of pancreatitis. To date, no consensus over the management of pancreatitis-related splanchnic vein thrombosis has been established. Based on the consensus of multidisciplinary experts, this practice guidance systematically reviewed the epidemiology, anatomy, pathophysiology, risk assessment and clinical presentations of splanchnic vein thrombosis, and formulated a diagnosis and treatment strategy for providing guidance in clinical practice for this disease.
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Israrahmed A, Yadav RR, Yadav G, Alpana, Helavar RV, Rai P, Jain MK, Gupta A. Systematic reporting of computed tomography enterography/enteroclysis as an aid to reduce diagnostic dilemma when differentiating between intestinal tuberculosis and Crohn's disease: A prospective study at a tertiary care hospital. JGH OPEN 2020; 5:180-189. [PMID: 33553653 PMCID: PMC7857287 DOI: 10.1002/jgh3.12478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/25/2020] [Accepted: 12/05/2020] [Indexed: 02/05/2023]
Abstract
Background and Aim Crohn's disease (CD) and intestinal tuberculosis (ITB) have similar symptomatology and overlapping features on imaging, endoscopy, and histopathology. It is important to differentiate ITB from CD to initiate correct medical management. This prospective study aimed to characterize imaging features on computed tomography enteroclysis/enterography (CTE) that help in differentiating ITB from CD. Methods A total of 300 consecutive patients who underwent CTE with the suspicion of small bowel diseases were evaluated. CTE findings were documented on a detailed "CTE case record form" and were correlated with other investigations like endoscopy, histopathological and microbiological examination, and improvement on empirical therapy to arrive at a final diagnosis. Only confirmed cases of ITB/CD were included for further analysis. Results Final diagnoses revealed that 61 patients had ITB, 24 had CD, 90 patients had a final diagnosis not related to ITB/CD, and 125 had no bowel-related diseases. The sensitivity of CTE (ITB vs CD, 90.2 vs 91.6%) was higher than the sensitivity of ileocolonoscopy (ITB vs CD, 87 vs 83.3%). A homogenous pattern of bowel wall thickening and confluent bowel involvement were significantly more common in ITB. Stratified bowel wall thickening with mucosal hyperenhancement, skip lesions in the bowel, and a comb sign were significantly more common in CD. Stratified bowel wall enhancement with an intervening layer of fat was specifically (P < 0.001) seen in patients with CD, and necrotic (P = 0.002) and calcified (P = 0.055) lymph nodes were specifically seen in patients with ITB. Conclusion We propose a systematic approach to the radiological differentiation of ITB from CD.
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Affiliation(s)
- Amrin Israrahmed
- Department of Radiodiagnosis Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow India
| | - Rajanikant R Yadav
- Department of Radiodiagnosis Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow India
| | - Geeta Yadav
- Department of Pathology Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow India.,Department of Pathology King George's Medical University Lucknow India
| | - Alpana
- Department of Radiodiagnosis Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow India
| | - Rajesh V Helavar
- Department of Radiodiagnosis Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow India.,Department of Radiology Columbia Asia Hospitals Bengaluru India
| | - Praveer Rai
- Department of Gastroenterology Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow India
| | - Manoj Kumar Jain
- Department of Pathology Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow India
| | - Archna Gupta
- Department of Radiodiagnosis Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow India
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Shokralla SY, Amin FG. Non-traumatic abdominal pain: assessment of diagnostic value of MDCT enterography in small bowel diseases—a retrospective study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00274-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Abstract
Background
Because of its unique anatomy, overlap of its loops, and its continuous peristaltic motion, imaging of the small bowel is a big challenge. Non-traumatic abdominal pain of small bowel origin includes a spectrum of medical and surgical conditions ranging from minor to life-threatening conditions. Accurate diagnosis of these diseases is essential to reduce morbidity and mortality. The aim of our study is to assess the role of MDCT enterography in evaluation and diagnosis of different small bowel causes of non-traumatic abdominal pain.
Results
Data analysis of 47 patients’ files included in this study revealed a high diagnostic accuracy of MDCTE in diagnosing variable small bowel-related pathologies that were confirmed histopathologically.
Conclusion
MDCTE can be used as a reliable diagnostic imaging modality for the detection of small bowel diseases. However, operative data and tissue biopsy are still the confirmatory methods for diagnosis.
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Karaosmanoglu AD, Uysal A, Akata D, Ozmen MN, Karcaaltincaba M. Role of imaging in visceral vascular emergencies. Insights Imaging 2020; 11:112. [PMID: 33057847 PMCID: PMC7561664 DOI: 10.1186/s13244-020-00913-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023] Open
Abstract
Differential diagnosis in non-traumatic acute abdomen is broad and unrelated diseases may simulate each other from a clinical perspective. Despite the fact that they are not as common, acute abdominal pain due to diseases related to visceral vessels may be life-threating if not detected and treated promptly. Thrombosis, dissection, and aneurysm in the abdominal visceral arteries or thrombosis in visceral veins may cause acute abdominal pain. Imaging with appropriate protocoling plays a fundamental role in both early diagnosis and determination of the treatment approach in these cases where early treatment can be life-saving. Computed tomography (CT) appears to be the most effective modality for the diagnosis as it provides high detail images in a very short time. Patient cooperation is also a less concern as compared to magnetic resonance imaging (MRI). As the imaging findings may sometimes be really subtle, diagnosis may be difficult especially to inexperienced imagers. Correct protocoling is also very critical to detect arterial abnormalities as visceral arterial abnormalities may not be detectable in portal phase only abdominal CT scans. In this article, we aimed to increase awareness among imaging specialists to these not very common causes of acute abdomen.
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Affiliation(s)
| | - Aycan Uysal
- Department of Radiology, Gulhane Training and Research Hospital, 06010, Ankara, Turkey
| | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
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Acute mesenteric ischemia: A review of the main imaging techniques and signs. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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17
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Isquemia mesentérica aguda: Revisión de las principales técnicas y signos radiológicos. RADIOLOGIA 2020; 62:336-348. [DOI: 10.1016/j.rx.2020.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 01/15/2020] [Accepted: 02/11/2020] [Indexed: 12/11/2022]
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Inoue A, Nitta N, Ota S, Takaki K, Imai Y, Misaki S, Iwai T, Sonoda A, Mukaisho KI, Murata K. MR Imaging-based Evaluation of Mesenteric Ischemia Caused by Strangulated Small Bowel Obstruction and Mesenteric Venous Occlusion: An Experimental Study Using Rabbits. Magn Reson Med Sci 2020; 19:125-134. [PMID: 31061268 PMCID: PMC7232033 DOI: 10.2463/mrms.mp.2019-0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE This study assessed the MRI findings of strangulated small bowel obstruction (SBO) and mesenteric venous occlusion (MVO) in a rabbit model using 3T MRI. MATERIALS AND METHODS Twenty rabbits were included in this study. The strangulated SBO and MVO models were generated via surgical procedures in nine rabbits, and sham surgery was performed in two rabbits. The success of generating the models was confirmed via angiographic, macroscopic, and microscopic findings after the surgical procedure. MRI was performed before and 30 min after inducing mesenteric ischemia. T1-weighted images (T1WIs), T2-weighted images (T2WIs), and fat-suppressed T2WIs (FS-T2WIs) were obtained using the BLADE technique, and fat-suppressed T1WIs (FS-T1WIs) were obtained. The signal intensities of the affected bowel before and after the surgical procedures were visually categorized as high, iso, and low intense compared with the findings for the normal bowel wall on all sequences. Bowel wall thickness was measured, and the signal intensity ratio (SI ratio) was calculated using the signal intensities of the bowel wall and psoas muscle. RESULTS Angiographic, macroscopic, and microscopic findings confirmed that all surgical procedures were successful. The ischemic bowel wall was thicker than the normal bowel. The bowel wall was thicker in the MVO model (3.17 ± 0.55 mm) than in the strangulated SBO model (2.26 ± 0.46 mm). The signal intensity and SI ratio of the bowel wall were significantly higher after the procedure than before the procedure on all sequences in both models. The mesentery adjacent to the ischemic bowel loop exhibited a high signal intensity in all animals on FS-T2WIs. CONCLUSION Non-contrast MRI can be used to evaluate mesenteric ischemia caused by strangulated SBO and MVO. FS-T2WIs represented the best modality for depicting the high signal intensity in the bowel wall and mesentery caused by ischemia.
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Affiliation(s)
- Akitoshi Inoue
- Department of Radiology, Shiga University of Medical Science
| | - Norihisa Nitta
- Department of Radiology, Shiga University of Medical Science
| | - Shinichi Ota
- Department of Radiology, Shiga University of Medical Science
| | - Kai Takaki
- Department of Radiology, Shiga University of Medical Science
| | - Yugo Imai
- Department of Radiology, Shiga University of Medical Science
| | - Sayaka Misaki
- Department of Radiology, Shiga University of Medical Science
| | - Takayasu Iwai
- Department of Radiology, Shiga University of Medical Science
| | - Akinaga Sonoda
- Department of Radiology, Shiga University of Medical Science
| | - Ken-Ichi Mukaisho
- Division of Molecular and Diagnostic Pathology, Shiga University of Medical Science
| | - Kiyoshi Murata
- Department of Radiology, Shiga University of Medical Science
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Madubogwu C. Acute inferior mesenteric venous thrombosis in a child. NIGERIAN JOURNAL OF MEDICINE 2020. [DOI: 10.4103/njm.njm_100_20] [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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20
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Motiaa Y, Ouassou Z, Moumou H, El Otmani W. Association of multiple splanchnic venous thrombosis and left renal venous thrombosis, a rare complication of pancreatitis: a case report. J Med Case Rep 2019; 13:171. [PMID: 31159864 PMCID: PMC6547583 DOI: 10.1186/s13256-019-2053-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 03/15/2019] [Indexed: 12/17/2022] Open
Abstract
Background Vascular complications of acute pancreatitis are common. Splanchnic thrombosis accounts for 11% of these complications, whereas extrasplanchnic thrombosis remains a rare entity. These complications are associated with high morbidity and mortality. Diagnosis is established on the basis of clinical and radiological evaluation, especially computed tomography. Renal vein thrombosis has been reported previously, but only in association with thrombosis of the inferior vena cava. To our knowledge, renal vein thrombosis without inferior vena cava thrombosis has never been reported in the literature. We report a case of a woman who developed acute pancreatitis complicated with splanchnic thrombosis and renal vein thrombosis with a patent inferior vena cava. Case presentation A 48-year-old Moroccan woman with no significant past medical history presented to our emergency department with worsening epigastric pain and vomiting. Her physical examination was notable only for moderate epigastric tenderness. She was apyrexic and had no jaundice or any features of liver failure. An initial computed tomographic scan showed Balthazar grade C pancreatitis with multiple splanchnic thromboses involving the portal vein, superior mesenteric vein, and left renal vein and enteromesenteric venous infarct with no signs of bowel perforation. The inferior vena cava was patent. Therapeutic anticoagulation and analgesia were started with resumption of enteral feeding 72 h later. The result of a thrombophilia screen was negative. Two months later, the patient was admitted to the intensive care unit with acute liver failure. Computed tomography of the abdomen showed worsening ischemic liver lesions and no signs of bowel perforation. Biochemical analysis showed acute hepatitis with hepatocellular insufficiency. The clinical evolution was unfavorable, and the patient died 48 h later. Conclusions Association of splanchnic and renal vein thrombosis without inferior vena cava thrombosis as a complication of acute pancreatitis has never been reported before. There are no specific aspects of management of this complication; therapeutic anticoagulation and symptomatic treatment are the main measures used owing to the lack of available organs for liver transplant. The prognosis depends on the consequences of splanchnic thrombosis and their complications. Electronic supplementary material The online version of this article (10.1186/s13256-019-2053-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Youssef Motiaa
- Intensive Care Unit, Hassan I Hospital, Tiznit, Morocco. .,Department of Anesthesiology and Intensive Care, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco.
| | - Zakaria Ouassou
- Department of Anesthesiology and Intensive Care, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
| | - Houda Moumou
- Department of Radiology, Hassan I Hospital, Tiznit, Morocco
| | - Wafae El Otmani
- Department of Anesthesiology and Intensive Care, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco.,Cardiac ICU, Mohamed V Military Hospital, Rabat, Morocco
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21
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Viscuse PV, Bartlett DJ, Foley TA, Michelena HI. Post-ischaemic exuberant left ventricular mass: thrombus vs. tumour-case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 2:yty077. [PMID: 31020155 PMCID: PMC6177049 DOI: 10.1093/ehjcr/yty077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 06/27/2018] [Indexed: 11/16/2022]
Abstract
Background We present a case that illustrates the diagnostic challenge of differentiating thrombus from tumour when confronted with a large left ventricular (LV) cardiac mass. Case Summary A 43-year-old Caucasian woman polysubstance-abuser presented to a regional hospital with an ST-elevation myocardial infarction and underwent aspiration-thrombectomy and successful circumflex artery bare metal stenting. She was noted to have an exuberant LV mass on transthoracic echocardiogram the following day and transferred to our care. Transthoracic echocardiogram, transoesophageal echocardiogram, and cardiac magnetic resonance imaging were performed in an attempt to characterize the mass with conflicting findings for either thrombus or tumour. The mass was surgically excised and final pathology indicated a fibrin-rich thrombus. Discussion The association of the mass with an infarcted area of the left ventricle supported the diagnosis of thrombus. However, due to the size and some imaging features a myxoma could not be completely ruled out. Atypical presentations of thrombus can be difficult to differentiate from cardiac tumours.
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Affiliation(s)
- Paul V Viscuse
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - David J Bartlett
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Thomas A Foley
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
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Mesenteric venous thrombosis presenting as gastrointestinal bleeding, a challenging diagnosis. Am J Emerg Med 2018; 37:378.e1-378.e6. [PMID: 30503276 DOI: 10.1016/j.ajem.2018.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/05/2018] [Indexed: 01/16/2023] Open
Abstract
Acute mesenteric venous thrombosis (MVT) is an uncommon cause of intestinal ischemia and is associated with high morbidity and mortality. Patients with acute MVT often present with gastrointestinal (GI) bleeding and other unspecific findings making the diagnosis challenging. This condition requires emergent treatment. The high rates of misdiagnosis of these patients and subsequently the delay in proper and quick management put patients at increased risk of having a negative outcome. Physicians should suspect acute MVT in patients with GI bleed while also considering other factors such as, a past medical history of pro-thrombotic conditions, past surgical history of splenectomy, symptoms of nausea, vomiting, abdominal pain, physical exam findings of abdominal tenderness and abdominal distention and a laboratory workup indicating leukocytosis and an increased plasma lactic acid level. An increase in the yield of accurate diagnosis of acute MVT is possible if physicians in the ED accurately interpret all these findings. The authors herein present a case of acute MVT in a patient whose initial complaint was GI bleeding and provide a thorough review of the literature of cases of acute MVT presenting with GI bleed.
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23
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Zhang S, Lai R, Gao X, Zhao Y, Zhao Y, Wu J, Guo Z. Ischemic colitis caused by polycythemia vera: A case report and literature review. Exp Ther Med 2018; 16:3663-3667. [PMID: 30233723 DOI: 10.3892/etm.2018.6638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 08/10/2018] [Indexed: 02/07/2023] Open
Abstract
Polycythemia vera (PV) is a chronic myeloproliferative disorder originating from hematopoietic stem cells and complicated by thrombosis and bleeding. This report describes a case of ischemic colitis (IC) caused by PV and includes a review of the relevant literature. The patient was a 59-year-old male with a history of PV who presented with abdominal pain and hematochezia. Colonoscopy and histopathological examination results indicated suspected ischemic bowel disease. Following experimental anticoagulant therapy for 7 days, the patient no longer experienced abdominal pain and hematochezia had resolved. Colonoscopy review showed no obvious anomalies 1 month later. These data demonstrated that PV is an uncommon cause of IC.
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Affiliation(s)
- Shasha Zhang
- Department of Rheumatology and Immunology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Ruixue Lai
- Department of Rheumatology and Immunology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Xueqing Gao
- Department of Rheumatology and Immunology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Yufei Zhao
- Department of Rheumatology and Immunology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Yue Zhao
- Department of Gastroenterology and Hepatology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Jianhua Wu
- Animal Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Zhanjun Guo
- Department of Rheumatology and Immunology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
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Jha RC, Khera SS, Kalaria AD. Portal Vein Thrombosis: Imaging the Spectrum of Disease With an Emphasis on MRI Features. AJR Am J Roentgenol 2018; 211:14-24. [DOI: 10.2214/ajr.18.19548] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Reena C. Jha
- Department of Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Rd, NW, Lombardi, G-184, Washington, DC 20007
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25
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Abstract
RATIONALE Superior mesenteric venous thrombosis (SMVT) is a rare condition that carries high mortality. Very few cases have been reported of SMVT, complicating acute appendicitis. Early recognition requires a high index of suspicion and is crucial in successful treatment of such a life-threatening condition. PATIENT CONCERNS A 33-year-old male presents with a 4-day history of right lower abdominal pain, nausea and subjective fever. CT scan showed acute appendicitis and a central filling defect in the superior mesenteric vein. DIAGNOSES Acute appendicitis complicated by SMVT. INTERVENTIONS Intravenous antibiotics, appendectomy, and anticoagulation. OUTCOMES Repeat CT scan showed successful resolution of the SMVT at a 3-month follow up. LESSONS Clinical awareness and high index of suspicion are essential to diagnose and manage SMVT, a serious complication of acute appendicitis.
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Affiliation(s)
- AbdAllah Gad
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Odessa, Texas
- Department of Biostatistics and Cancer Epidemiology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Zakaria Hindi
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Odessa, Texas
| | - Talal Zahoor
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Odessa, Texas
| | - Rémy Zock À Zock
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Odessa, Texas
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26
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Mier-Hicks A, Raj M, Do RK, Yu KH, Lowery MA, Varghese A, O'Reilly EM. Incidence, Management, and Implications of Visceral Thrombosis in Pancreatic Ductal Adenocarcinoma. Clin Colorectal Cancer 2018; 17:121-128. [PMID: 29477452 PMCID: PMC7382360 DOI: 10.1016/j.clcc.2018.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 01/22/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Visceral or splanchnic thrombosis is defined as thrombi within the hepatoportal venous system, including portal (PV), mesenteric (MV), and splenic vein (SV), as well as thrombi in renal or gonadal veins. There are limited data to evaluate the prognostic significance, incidence, and clinical management of visceral thromboses in patients with pancreatic ductal adenocarcinoma (PDAC). PATIENTS AND METHODS We conducted an analysis of 95 patients treated at Memorial Sloan Kettering Cancer Center with PDAC who had a visceral thrombosis. RESULTS A total of 153 visceral thromboses (VsT) were identified in 95 patients (n = 51, 54% woman). A total of 36 patients (37%) had locally advanced disease, and n = 59 (62%) had metastatic disease. Systemic therapies received included FOLFIRINOX (n = 57, 60%) and GC/PTX (n = 27, 28%). All VsT events were incidentally detected. Overall survival of cohort was 12.3 months (range, 10.2-14.4 months). Visceral thrombosis incidence in the cohort was as follows: portal vein (PV) (45%), MV (26%), SV (17%), and gonadal veins (8%). Time to develop first VsT was 4.3 months (range, 3-5.6 months), and time to death from VsT development was 1.87 months (range, 0.8-2.8 months). Forty-five patients (47%) developed a second VsT. Sixty percent had a Khorana risk score of > 3. Thirty-nine patients (41%) were treated with short-term anticoagulation (AC) (< 1 month) (low-molecular-weight heparin, n = 34). Forty-five patients (47%) were treated with long-term AC (> 1 month) (low-molecular-weight heparin, n = 32; 23 were transitioned to an oral anticoagulant). Twenty-two patients (23%) were not treated with AC. Eight patients (8%) had a bleeding complication from AC. Portal vein thrombosis had the shortest overall survival at 3.6 months (range, 2.3-4.8 months). CONCLUSION In PDAC, VsT can frequently present as an incidental finding on routine abdominal imaging. The most common location is PV, followed by MV and SV. We observed that AC is underutilized in this setting despite a low bleeding complication rate. PV was associated with the least overall survival of the VsT. Future large prospective studies should explore the role of AC and value in this setting.
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Affiliation(s)
| | - Michael Raj
- Department of Diagnostic Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Richard Kinh Do
- Department of Diagnostic Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kenneth H Yu
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Maeve A Lowery
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anna Varghese
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eileen M O'Reilly
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medicine, New York, NY.
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27
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Fidelman N, AbuRahma AF, Cash BD, Kapoor BS, Knuttinen MG, Minocha J, Rochon PJ, Shaw CM, Ray CE, Lorenz JM. ACR Appropriateness Criteria ® Radiologic Management of Mesenteric Ischemia. J Am Coll Radiol 2018; 14:S266-S271. [PMID: 28473083 DOI: 10.1016/j.jacr.2017.02.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 12/29/2022]
Abstract
Mesenteric vascular insufficiency is a serious medical condition that may lead to bowel infarction, morbidity, and mortality that may approach 50%. Recommended therapy for acute mesenteric ischemia includes aspiration embolectomy, transcatheter thrombolysis, and angioplasty with or without stenting for the treatment of underlying arterial stenosis. Nonocclusive mesenteric ischemia may respond to transarterial infusion of vasodilators such as nitroglycerin, papaverine, glucagon, and prostaglandin E1. Recommended therapy for chronic mesenteric ischemia includes angioplasty with or without stent placement and, if an endovascular approach is not possible, surgical bypass or endarterectomy. The diagnosis of median arcuate ligament syndrome is controversial, but surgical release may be appropriate depending on the clinical situation. Venous mesenteric ischemia may respond to systemic anticoagulation alone. Transhepatic or transjugular superior mesenteric vein catheterization and thrombolytic infusion can be offered depending on the severity of symptoms, condition of the patient, and response to systemic anticoagulation. Adjunct transjugular intrahepatic portosystemic shunt creation can be considered for outflow improvement. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Nicholas Fidelman
- Principal Author, University of California San Francisco, San Francisco, California.
| | - Ali F AbuRahma
- West Virginia University, Charleston, West Virginia; Society of Vascular Surgery
| | - Brooks D Cash
- University of South Alabama, Mobile, Alabama; American Gastroenterological Association
| | | | | | - Jeet Minocha
- University of California San Diego, San Diego, California
| | - Paul J Rochon
- University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Colette M Shaw
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Charles E Ray
- Specialty Chair, University of Illinois Hospital and Health Science System, Chicago, Illinois
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28
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Riva N, Ageno W. Approach to thrombosis at unusual sites: Splanchnic and cerebral vein thrombosis. Vasc Med 2017; 22:529-540. [PMID: 29202678 DOI: 10.1177/1358863x17734057] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Splanchnic vein thrombosis (SVT) and cerebral vein thrombosis (CVT) are two manifestations of unusual site venous thromboembolism (VTE). SVT includes thrombosis in the portal, mesenteric or splenic veins, and the Budd-Chiari syndrome. CVT encompasses thrombosis of the dural venous sinuses and thrombosis of the cerebral veins. Unusual site VTE often represents a diagnostic and therapeutic challenge because of the heterogeneity in clinical presentation, the limited evidence available in the literature on the acute and long-term prognosis of these diseases, and the lack of large randomized controlled trials evaluating different treatment options. This narrative review describes the approach to patients with SVT or CVT by examining the diagnostic process, the assessment of potential risk factors and the appropriate anticoagulant treatment.
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Affiliation(s)
- Nicoletta Riva
- 1 Department of Pathology, University of Malta, Msida, Malta
| | - Walter Ageno
- 2 Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Martín-Llahí M, Albillos A, Bañares R, Berzigotti A, García-Criado MÁ, Genescà J, Hernández-Gea V, Llop-Herrera E, Masnou-Ridaura H, Mateo J, Navascués CA, Puente Á, Romero-Gutiérrez M, Simón-Talero M, Téllez L, Turon F, Villanueva C, Zarrabeitia R, García-Pagán JC. Enfermedades vasculares del hígado. Guías Clínicas de la Sociedad Catalana de Digestología y de la Asociación Española para el Estudio del Hígado. GASTROENTEROLOGIA Y HEPATOLOGIA 2017; 40:538-580. [DOI: 10.1016/j.gastrohep.2017.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 03/29/2017] [Indexed: 12/11/2022]
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Cox M, Epelman M, Chandra T, Meyers AB, Johnson CM, Podberesky DJ. Non–Catheter-related Venous Thromboembolism in Children: Imaging Review from Head to Toe. Radiographics 2017; 37:1753-1774. [DOI: 10.1148/rg.2017170036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Mougnyan Cox
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
| | - Monica Epelman
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
| | - Tushar Chandra
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
| | - Arthur B. Meyers
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
| | - Craig M. Johnson
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
| | - Daniel J. Podberesky
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
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de'Angelis N, Abdalla S, Lizzi V, Esposito F, Genova P, Roy L, Galacteros F, Luciani A, Brunetti F. Incidence and predictors of portal and splenic vein thrombosis after pure laparoscopic splenectomy. Surgery 2017; 162:1219-1230. [PMID: 28919051 DOI: 10.1016/j.surg.2017.07.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/09/2017] [Accepted: 07/21/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Optimal modalities for diagnosis, treatment, and surveillance of portal or splenic vein thrombosis have not yet been defined. The present retrospective study aimed to investigate the role of computed tomography performed systematically before and after laparoscopic splenectomy to assess the incidence of portal or splenic vein thrombosis, predictors, and outcomes. METHODS Computed tomography scans were obtained from 170 patients undergoing elective laparoscopic splenectomy between 2005 and 2015. Pre- and postoperative splenic vein diameter was measured at the splenoportal junction and at a distance of 2, 4, 6 cm from it. Univariate and multivariate analyses were used to identify portal or splenic vein thrombosis risk factors and predictors of treatment outcome. RESULTS Overall, 68.2% of patients had benign hematologic diseases; 64.1% showed splenomegaly. Portal or splenic vein thrombosis occurred in 53.5% of patients (91/170), of whom 49.5% were asymptomatic. Preoperative splenic vein diameter measurements at 2, 4, and 6 cm from the splenoportal junction were significantly greater in portal or splenic vein thrombosis patients than in no-portal or splenic vein thrombosis patients. Patients with splenic vein diameter ≥8 mm at all measured sites had a greater risk of developing portal or splenic vein thrombosis (P = .009; odds ratio, 2.57; 95% confidence interval, 1.26-5.23). The majority of thromboses involved the distal splenic vein (45.1%, 41/91), and 41.7% of patients had thromboses located in multiple sites. Fully 71.4% showed complete resolution of portal or splenic vein thrombosis. Thrombus location at a single site predicted a favorable treatment outcome (P < .0001). CONCLUSION Portal or splenic vein thrombosis is a frequent complication of splenectomy that occurs asymptomatically in half of cases. Computed tomography could have an important role in identifying patients at risk of developing portal or splenic vein thrombosis as well as in predicting portal or splenic vein thrombosis resolution.
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Affiliation(s)
- Nicola de'Angelis
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
| | - Solafah Abdalla
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
| | - Vincenzo Lizzi
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
| | - Francesco Esposito
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
| | - Pietro Genova
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
| | - Lydia Roy
- Department of Hematology, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
| | - Frédéric Galacteros
- Department of Internal Medicine, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
| | - Alain Luciani
- Department of Radiology, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
| | - Francesco Brunetti
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France.
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Riva N, Ageno W. Clinical manifestations and imaging tools in the diagnosis of splanchnic and cerebral vein thromboses. Thromb Res 2017; 163:252-259. [PMID: 28673473 DOI: 10.1016/j.thromres.2017.06.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/14/2017] [Accepted: 06/25/2017] [Indexed: 12/19/2022]
Abstract
Splanchnic vein thrombosis (SVT) and cerebral vein thrombosis (CVT) are uncommon manifestation of venous thromboembolism (VTE), occurring less frequently than deep vein thrombosis of the lower extremities and pulmonary embolism. SVT encompasses portal vein thrombosis, mesenteric vein thrombosis, splenic vein thrombosis and the Budd-Chiari syndrome. It is therefore a heterogeneous disease, with differences in clinical manifestations according to the site of thrombosis. CVT includes thrombosis of the cortical or deep cerebral veins and thrombosis of the major dural venous sinuses. Clinical presentation is variable, with a wide spectrum of signs and symptoms that can mimic other cerebral diseases. There are no clinical algorithms or specific laboratory tests that can guide in the identification of SVT and CVT; therefore, the diagnosis relies exclusively on imaging tests. Conventional angiography once was the gold standard for the diagnosis of SVT and CVT, but it is rarely used nowadays. Abdominal ultrasound (US), computed tomography (CT) and magnetic resonance (MR) with angiography are currently used for the diagnosis of SVT; while cerebral CT and MR with angiography are currently used for the diagnosis of CVT. These imaging tests have different sensitivities/specificities and different advantages/disadvantages that should be kept into consideration when choosing the appropriate imaging test based on the suspected site of thrombosis. This narrative review summarizes the clinical and diagnostic approach to SVT and CVT.
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Affiliation(s)
- Nicoletta Riva
- Department of Pathology, University of Malta, Msida, Malta
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy.
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Fernández-Pacheco BC, López-Tomassetti Fernández E, Fernández-SanMillán D. Hepatic encephalopathy after sleeve gastrectomy: a hypothesis of its development. Surg Obes Relat Dis 2017; 13:1449-1450. [PMID: 28552740 DOI: 10.1016/j.soard.2017.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 04/15/2017] [Accepted: 04/18/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Borja Camacho Fernández-Pacheco
- Complejo Hospitalario Universitario Insular-Materno Infantil, Avenida Marítima del Sur, Las Palmas, Spain; Department of Gastrointestinal Surgery, Insular University of Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | - Eudaldo López-Tomassetti Fernández
- Complejo Hospitalario Universitario Insular-Materno Infantil, Avenida Marítima del Sur, Las Palmas, Spain; Department of Gastrointestinal Surgery, Insular University of Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - David Fernández-SanMillán
- Complejo Hospitalario Universitario Insular-Materno Infantil, Avenida Marítima del Sur, Las Palmas, Spain; Department of Gastrointestinal Surgery, Insular University of Gran Canaria, Las Palmas de Gran Canaria, Spain
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Hepatic Issues and Complications Associated With Inflammatory Bowel Disease: A Clinical Report From the NASPGHAN Inflammatory Bowel Disease and Hepatology Committees. J Pediatr Gastroenterol Nutr 2017; 64:639-652. [PMID: 27984347 DOI: 10.1097/mpg.0000000000001492] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatobiliary disorders are common in patients with inflammatory bowel disease (IBD), and persistent abnormal liver function tests are found in approximately 20% to 30% of individuals with IBD. In most cases, the cause of these elevations will fall into 1 of 3 main categories. They can be as a result of extraintestinal manifestations of the disease process, related to medication toxicity, or the result of an underlying primary hepatic disorder unrelated to IBD. This latter possibility is beyond the scope of this review article, but does need to be considered in anyone with elevated liver function tests. This review is provided as a clinical summary of some of the major hepatic issues that may occur in patients with IBD.
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What is the optimal treatment of superior mesenteric vein/portal vein thrombosis after bariatric surgery? Is SMA-directed t-PA the answer? Surg Obes Relat Dis 2017; 13:533-537. [DOI: 10.1016/j.soard.2016.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/15/2016] [Accepted: 11/17/2016] [Indexed: 12/22/2022]
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Vascular imaging of the mesenteric vasculature. Best Pract Res Clin Gastroenterol 2017; 31:3-14. [PMID: 28395786 DOI: 10.1016/j.bpg.2016.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 10/31/2016] [Accepted: 12/17/2016] [Indexed: 01/31/2023]
Abstract
Imaging of the mesenteric vasculature is crucial in diagnosing vascular disease of the gastro-intestinal tract such as acute or chronic mesenteric ischemia caused by arterial stenosis, embolism or thrombosis, mesenteric vein thrombosis and mesenteric aneurysm or dissection. The reference standard for imaging of the mesenteric vasculature is digital subtraction angiography. However, modalities as duplex ultrasonography, computed tomography angiography and magnetic resonance angiography are developing rapidly and may provide accurate imaging non-invasively. This review provides an up-to-date overview of the anatomic resolution, clinical application, emerging techniques and future perspectives of these four radiological modalities for imaging of the mesenteric vasculature.
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Pitta GBB, Pereira DA, Oliveira MDFQ, Guedes EA, Sampaio JA. Cateterismo de artéria mesentérica para tratamento de trombose de veia porta. J Vasc Bras 2017; 16:43-47. [PMID: 29930622 PMCID: PMC5829691 DOI: 10.1590/1677-5449.008416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/01/2017] [Indexed: 12/01/2022] Open
Abstract
A trombose de veia porta é uma causa rara de abdome agudo vascular e está diretamente relacionada a trombofilias hereditárias ou adquiridas. O caso de um paciente de 60 anos, sexo masculino, com quadro clínico de isquemia mesentérica confirmada por exame de imagem é apresentado. Foi submetido a enterectomia e enteroanastomose e, após esplenoportografia que detectou trombose de veia porta, indicou-se tratamento medicamentoso com infusão contínua de ativador tecidual do plasminogênio recombinante (Alteplase) através de cateterismo seletivo da artéria mesentérica superior. Trata-se de um tratamento inovador. Obteve-se sucesso na recanalização do sistema porta. O paciente evoluiu com quadro de sepse abdominal, necessitando de assistência em terapia intensiva por 25 dias. Evoluiu bem e recebeu alta hospitalar com o uso de anticoagulante. O artigo apresenta uma breve revisão de literatura e discussão do caso clínico.
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Multidetector Computed Tomography Evaluation of Mesenteric Venous Thrombosis Following Laparoscopic Bariatric Surgery. J Comput Assist Tomogr 2017; 41:56-60. [DOI: 10.1097/rct.0000000000000473] [Citation(s) in RCA: 7] [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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Takeda A, Hayashi S, Teranishi Y, Imoto S, Nakamura H. Portomesenteric Vein Thrombosis After Excision of Parasitic Peritoneal Myomas. J Minim Invasive Gynecol 2016; 24:501-505. [PMID: 27939898 DOI: 10.1016/j.jmig.2016.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 11/26/2016] [Accepted: 11/30/2016] [Indexed: 12/16/2022]
Abstract
An enlargement of multiple asymptomatic pelvic masses was detected during a regular checkup of a 39-year-old woman. Twelve years earlier, she had undergone laparoscopic-assisted myomectomy, at which time an uncontained manual extraction of a posterior intramural myoma was performed. This was followed by 2 uneventful cesarean deliveries after spontaneous conceptions. Diagnostic imaging revealed at least 3 abdominal masses, 1 of which received its major blood supply from the inferior mesenteric artery. Gasless single-port laparoscopic excision of the peritoneal masses, was performed along with laparoscopic-assisted vaginal hysterectomy and bilateral salpingo- oophorectomy. The masses were histopathologically diagnosed as parasitic peritoneal myomas. The patient's immediate postoperative course was uneventful; however, on day 6 after surgery, she complained of severe periumbilical abdominal pain and vomiting. Anticoagulant therapy was initiated after hematologic examination revealed an elevated D-dimer level and dynamic computed tomography angiography showed portomesenteric vein thrombosis. Vaginal stump bleeding, which occurred 17 days after the initiation of anticoagulant therapy, was managed conservatively, and there was no recurrence of venous thrombosis in the year after surgery. To avoid significant morbidities and potential mortality when parasitic peritoneal myomas with aberrant neovascularization are excised, attention should be given to the perioperative development of venous thromboembolic events in rare locations.
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Affiliation(s)
- Akihiro Takeda
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan.
| | - Shotaro Hayashi
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Yoshie Teranishi
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Sanae Imoto
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Hiromi Nakamura
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
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Belnap L, Rodgers GM, Cottam D, Zaveri H, Drury C, Surve A. Portal vein thrombosis after laparoscopic sleeve gastrectomy: presentation and management. Surg Obes Relat Dis 2016; 12:1787-1794. [DOI: 10.1016/j.soard.2016.03.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/02/2016] [Accepted: 03/04/2016] [Indexed: 11/26/2022]
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Chen G, Wei S, Zou Z, Sun J, Tang G, Chen J, Zhou S. A case report of simultaneous orthotopic liver transplantation and jejunectomy. BMC Surg 2016; 16:67. [PMID: 27659187 PMCID: PMC5034575 DOI: 10.1186/s12893-016-0184-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 09/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Liver transplantation (LT) accompanied by jejunectomy to treat patients with acute or chronic hepatic cirrhosis with thrombosis in the portal system is extremely rare. CASE PRESENTATION A 47-year-old man presented with hematemesis and melena, and a diagnosis of decompensated cirrhosis, chronic portal vein thrombosis (PVT) and secondary gastro-esophageal variceal hemorrhage was made. Coagulants were administered, but portal vein thrombi occurred rapidly, and gastrointestinal bleeding recurred shortly thereafter. The patient underwent LT, phlebothrombectomy and a partial jejunectomy. His recovery from a fistula was uneventful, and follow-up visits over 70 months were unremarkable. CONCLUSION Liver transplantation and partial jejunectomy is a feasible and effective surgical option for select patients with end-stage liver disease accompanied by acute portal venous thrombosis.
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Affiliation(s)
- Guoyong Chen
- Center of Hepatopancreaticobiliary Surgery, Henan Provincial People’s Hospital, Zhengzhou, Henan 450003 China
| | - Sidong Wei
- Center of Hepatopancreaticobiliary Surgery, Henan Provincial People’s Hospital, Zhengzhou, Henan 450003 China
| | - Zhongwu Zou
- Hubei Vocational-Technical College School of Medicine, Xiaogan, 432000 China
| | - Jianjun Sun
- Center of Hepatopancreaticobiliary Surgery, Henan Provincial People’s Hospital, Zhengzhou, Henan 450003 China
| | - Gaofeng Tang
- Center of Hepatopancreaticobiliary Surgery, Henan Provincial People’s Hospital, Zhengzhou, Henan 450003 China
| | - Jianbin Chen
- Center of Hepatopancreaticobiliary Surgery, Henan Provincial People’s Hospital, Zhengzhou, Henan 450003 China
| | - Shaotang Zhou
- Center of Hepatopancreaticobiliary Surgery and Liver transplantation, 100 Xisihuang Middle Road, Fengtai District, Beijing, 100039 China
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Rottenstreich A, Elazary R, Kalish Y. Abdominal thrombotic complications following bariatric surgery. Surg Obes Relat Dis 2016; 13:78-84. [PMID: 27444858 DOI: 10.1016/j.soard.2016.05.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/13/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Thrombotic events involving the portal-splenic-mesenteric venous system (PSMVT) are rare but potentially lethal after bariatric surgery. OBJECTIVES To investigate the incidence, clinical presentation, management, and outcome of thrombotic events after bariatric surgery. SETTING Two university hospitals. METHODS A retrospective review of individuals who underwent bariatric surgery between January 2006 and December 2015. RESULTS Overall, 4386 patients underwent bariatric surgery (laparoscopic sleeve gastrectomy [LSG; n = 2886], laparoscopic Roux-en-Y gastric bypass [n = 762], laparoscopic adjustable gastric banding [n = 668], and biliopancreatic diversion [n = 70]). Mechanical (thigh-length pneumatic compression stockings) and pharmacologic thromboprophylaxis (40 mg enoxaparin daily, starting 12 hours after surgery until discharge) was provided for all patients. A minority of patients (n = 543, 12.4%) also received an extended course of enoxaparin for 1-4 weeks after discharge. We observed 16 cases of PSMVT, all after LSG, with an incidence of .55% (16/2886). Twelve additional patients experienced deep vein thrombosis and 6 had pulmonary embolism. Follow-up imaging indicated complete resolution in all cases, with no sequelae, recurrent thrombosis, or mortality. The overall thrombosis rate was significantly lower in patients who received an extended course of anticoagulation after LSG (P = .01) and after any type of bariatric surgery (P = .02). CONCLUSIONS PSMVT was found to occur uncommonly after LSG. Prompt diagnosis and anticoagulation therapy led to favorable outcomes in most cases. Significantly lower rates of thrombosis were found in patients who received an extended course of anticoagulation. We support its use for at least 1 week after discharge.
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Affiliation(s)
- Amihai Rottenstreich
- Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ram Elazary
- Surgery Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yosef Kalish
- Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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Hariharan M, Balasubramaniam R, Shetty SK, Yadavalli S, Ahetasham M, Devarapalli S. Uncommon Causes of Acute Abdominal Pain - A Pictorial Essay. J Clin Imaging Sci 2016; 6:4. [PMID: 27014500 PMCID: PMC4785781 DOI: 10.4103/2156-7514.177548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/06/2016] [Indexed: 11/09/2022] Open
Abstract
Acute abdomen is one of the most common clinical conditions requiring a radiological investigation. Ultrasound is the primary modality of choice which can diagnose some of the common causes of acute abdomen. However, sometimes the underlying cause for the pain is far more complicated than expected mandating a high degree of suspicion to suggest further investigation with contrast enhanced computed tomography or magnetic resonance imaging. Here, we have compiled a comprehensive series of selected cases to highlight the conditions which can be easily overlooked unless carefully sought for. This article also emphasizes the importance of multimodality approach to arrive at the final diagnosis with an increased overall diagnostic accuracy which in turn improves patient management and prognosis.
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Affiliation(s)
- Mahesh Hariharan
- Department of Radiology and Imaging, Dr. B R Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India
| | - Rajan Balasubramaniam
- Department of Radiology and Imaging, Dr. B R Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India
| | - Sharath Kumar Shetty
- Department of Radiology and Imaging, Sapthagiri Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India
| | - Shanthala Yadavalli
- Department of Radiology and Imaging, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Mohammed Ahetasham
- Department of Radiology and Imaging, Dr. B R Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India
| | - Sravya Devarapalli
- Department of Radiology and Imaging, Dr. B R Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India
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Dhatt HS, Behr SC, Miracle A, Wang ZJ, Yeh BM. Radiological Evaluation of Bowel Ischemia. Radiol Clin North Am 2016; 53:1241-54. [PMID: 26526436 DOI: 10.1016/j.rcl.2015.06.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intestinal ischemia, which refers to insufficient blood flow to the bowel, is a potentially catastrophic entity that may require emergent intervention or surgery in the acute setting. Although the clinical signs and symptoms of intestinal ischemia are nonspecific, computed tomography (CT) findings can be highly suggestive in the correct clinical setting. In our article, we review the CT diagnosis of arterial, venous, and nonocclusive intestinal ischemia. We discuss the vascular anatomy, pathophysiology of intestinal ischemia, CT techniques for optimal imaging, key and ancillary radiological findings, and differential diagnosis.
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Affiliation(s)
- Harpreet S Dhatt
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0628, USA
| | - Spencer C Behr
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0628, USA
| | - Aaron Miracle
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0628, USA
| | - Zhen Jane Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0628, USA
| | - Benjamin M Yeh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0628, USA.
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Chamarthy MR, Anderson ME, Pillai AK, Kalva SP. Thrombolysis and Transjugular Intrahepatic Portosystemic Shunt Creation for Acute and Subacute Portal Vein Thrombosis. Tech Vasc Interv Radiol 2016; 19:42-51. [PMID: 26997088 DOI: 10.1053/j.tvir.2016.01.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Catheter-based interventional therapy offers a safe and effective option for treatment of symptomatic portomesenteric venous thrombosis refractory to medical therapy. Various techniques and approaches have been described for thrombolysis and thrombectomy and re-establishing the portal venous flow for select populations. Early diagnosis and prompt treatment based on clinical presentation, imaging, and underlying anatomy are necessary to prevent long-term complications. This article describes various catheter-based approaches for treatment of acute and subacute portal vein thrombosis.
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Affiliation(s)
- Murthy R Chamarthy
- Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Matthew E Anderson
- Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Anil K Pillai
- Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Sanjeeva P Kalva
- Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX.
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46
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47
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Imaging Diagnosis of Splanchnic Venous Thrombosis. Gastroenterol Res Pract 2015; 2015:101029. [PMID: 26600801 PMCID: PMC4620257 DOI: 10.1155/2015/101029] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/22/2015] [Indexed: 12/15/2022] Open
Abstract
Splanchnic vein thrombosis (SVT) is a broad term that includes Budd-Chiari syndrome and occlusion of veins that constitute the portal venous system. Due to the common risk factors involved in the pathogenesis of these clinically distinct disorders, concurrent involvement of two different regions is quite common. In acute and subacute SVT, the symptoms may overlap with a variety of other abdominal emergencies while in chronic SVT, the extent of portal hypertension and its attendant complications determine the clinical course. As a result, clinical diagnosis is often difficult and is frequently reliant on imaging. Tremendous improvements in vascular imaging in recent years have ensured that this once rare entity is being increasingly detected. Treatment of acute SVT requires immediate anticoagulation. Transcatheter thrombolysis or transjugular intrahepatic portosystemic shunt is used in the event of clinical deterioration. In cases with peritonitis, immediate laparotomy and bowel resection may be required for irreversible bowel ischemia. In chronic SVT, the underlying cause should be identified and treated. The imaging manifestations of the clinical syndromes resulting from SVT are comprehensively discussed here along with a brief review of the relevant clinical features and therapeutic approach.
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48
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Manouchehri N, Kaneva P, Séguin C, Artho GP, Feldman LS. Screening for thrombophilia does not identify patients at risk of portal or splenic vein thrombosis following laparoscopic splenectomy. Surg Endosc 2015; 30:2119-26. [PMID: 26307597 DOI: 10.1007/s00464-015-4476-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 07/28/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Portal and/or splenic vein thrombosis (PSVT) is a potentially lethal complication of splenectomy for hematologic disease. Known risk factors for PSVT include malignancy and splenomegaly. While these patients are believed to be hypercoagulable, the specific mechanism is unclear. The aim of this study is to evaluate whether specific acquired prothrombotic risk factors contribute to the development of PSVT following laparoscopic splenectomy (LS). METHODS Consecutive patients undergoing LS were prospectively studied between 2005 and 2013. Preoperatively, patients were screened for prothrombotic states and surveillance duplex ultrasonography was performed between 1 week and 1 month postoperatively to assess for PSVT. The association between baseline prothrombotic disorders and PSVT was explored using descriptive statistics. RESULTS Sixty-eight patients were included in the analysis, and 17 (25 %) of these developed PSVT. There were no differences in patients with and without PSVT with respect to age, body mass index, gender or surgical time. Preoperative spleen size, as determined by diagnostic imaging, and intraoperative blood transfusion were associated with PSVT. Seven of 9 patients (78 %) with massive splenomegaly (>20 cm) developed PSVT compared with 4 of 13 patients (31 %) with moderate splenomegaly (15-20 cm) and 6 of 45 patients (13 %) without (p < 0.001). Abnormalities in baseline prothrombotic screening tests were common, with 52 patients (75 %) demonstrating at least one; however, none were associated with the development of PSVT. CONCLUSION In patients scheduled for LS, screening for prothrombotic states is not useful to identify patients at risk of development of PSVT. Preoperative spleen size and blood transfusion were predictive of PSVT formation.
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Affiliation(s)
- Namdar Manouchehri
- Division of General Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave, L9-300, Montreal, QC, H3G 1A4, Canada
| | - Pepa Kaneva
- Division of General Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave, L9-300, Montreal, QC, H3G 1A4, Canada
| | - Chantal Séguin
- Department of Medicine, Division of Hematology, McGill University Health Centre, Montreal, QC, Canada
| | - Giovanni P Artho
- Department of Diagnostic Radiology, McGill University Health Centre, Montreal, QC, Canada
| | - Liane S Feldman
- Division of General Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave, L9-300, Montreal, QC, H3G 1A4, Canada.
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Abstract
Background In contrast to an acute occlusion of the visceral arteries, which is the most important differential diagnosis for an occlusion of the portal venous system and which poses a highly dangerous situation ending in gangrene of the bowel wall, the symptoms of an acute occlusion of the portal venous system are quite unspecific. To rule out an acute arterial occlusion, diagnostic evaluation has to be carried out quickly in order to decide on the necessity of therapeutic steps concerning a recanalization of the occluded vessels. Only few therapeutic options are available to recanalize and remodel the portal venous system, depending on the underlying disease, the age of the occlusion, its extension, and the effect on the bowel wall, stomach, spleen, and abdominal wall. Moreover, the efficacy of recanalization procedures mainly depends on the formation and number of collateral venous blood supply, its degree, and the anatomic structure. Possible complications of portal hypertension like varices, gastrointestinal vasculopathy, ascites, and splenomegaly also influence the success of recanalization procedures. Only in cases of acute thrombotic occlusion systemic lytic therapy promises to be successful. Therefore, other options such as transjugular intrahepatic recanalization, e.g. by means of the TIPS (transjugular intrahepatic portosystemic shunt) procedure, have to be evaluated. Methods Review of the literature. Results Noninvasive methods such as ultrasound (US), computed tomography, and especially magnetic resonance imaging (MRI) allow the evaluation of therapeutic options as well as their success, the feasibility of technical procedures, the detection of possible risks, and a calculation of risks and benefits. Conclusion In order to arrive at the correct therapeutic decision, a combination of MRI and US methods combined with color Doppler guarantee the most efficient diagnostic results in cases with acute or chronic occlusions of the portal venous system.
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Affiliation(s)
- Karlheinz Hauenstein
- Institute of Diagnostic and Interventional Radiology, University Medicine Rostock, Rostock, Germany
| | - Yan Li
- Institute of Diagnostic and Interventional Radiology, University Medicine Rostock, Rostock, Germany
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Megally HI, Elmalah HEM, Seifeldein GS, Abbas NA, Elamin HA. The diagnostic role of MDCT enterography in small bowel lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2014.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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