Patients with this condition benefit from rapid diagnosis and expedient surgical therapy. Mesenteric venous thrombosis mvt is a rare but potentially lethal form of mesenteric ischemia. Clinical findings vague abdominal discomfort that evolves over 710 days. Only after other causes of a hypercoagulable state have been excluded can a patient be. Seventytwo patients were identified with a diagnosis of mvt. Seven of these 16 patients had previous deepvein thrombosis. Acute mesenteric venous thrombosis mvt is the rarest cause of acute mesenteric ischaemia, so thrombosis of a variant inferior mesenteric vein imv is especially uncommon in the setting of. Presented at the twentythird annual meeting of the southern association for vascular surgery, naples, fla, jan 2730, 1999. Mesenteric vein thrombosis an overview sciencedirect topics. Mesenteric venous thrombosis usually involves the superior mesenteric vein, with the danger of bowel infarction. Common etiologies of acute mesenteric ischemia ami include arterial embolus, mesenteric arterial thrombosis, aortic dissection, superior mesenteric andor portal venous thrombosis, and nonocclusive mesenteric ischemia. The causes of these thrombi are often unique to the venous.
Mesenteric vascular insufficiency, current problems in. Further evaluations revealed thrombosis in the mesenteric vein which leads to ischemia and gangrene of the small intestine. Argatroban, a direct thrombin inhibitor, may be a novel anticoagulant method in the therapy of asmvt. Symptoms are more likely with superior mesenteric vein thrombosis than portal venous thrombosis.
Repeated abdominal ct showed thrombosis of the superior mesenteric vein and fluid around the spleen figure 1. Report of a young female with severe abdominal pain. There are two such veins through which blood leaves the intestine. Mesenteric venous thrombosis is an insidious disease with a high mortality rate typically attributed to the long delay in diagnosis. Apr, 2014 over the last decade, jak 2 janus kinase 2 mutation has emerged as an accurate biomarker for diagnosis of myeloproliferative neoplasm, an important cause for mesenteric venous thrombosis. Nonetheless, pediatric hematologists and other subspecialists. Mvt accounts for 515% of all cases of mesenteric ischemia 1, 2. Mesenteric venous thrombosis mvt accounts for 515% of reported cases of acute mesenteric ischemia 1, 2. Mesenteric venous thrombosis mvt is a welldescribed cause of intestinal ischemia, accounting for approximately 15% of all mesenteric ischemia cases.
Anticoagulation is the treatment of choice for acute mesenteric venous thrombosis. Laparoscopic vertical sleeve gastrectomy lsg has become an. Over the last decade, jak 2 janus kinase 2 mutation has emerged as an accurate biomarker for diagnosis of myeloproliferative neoplasm, an important cause for mesenteric venous thrombosis. Mesenteric vein thrombosis mvt accounts for 5%15% of all mesenteric ischemic events and is classified as either primary or secondary. Knowledge on the natural history of mesenteric vein thrombosis mvt and of the efficacy and safety of longterm oral anticoagulant therapy oat in this setting is based on small uncontrolled series of patients with a limited followup. Thirtyfour 64% patients with acute mesenteric venous thrombosis. Nonlower extremity deep vein thrombosis emergency medicine. Mesenteric venous thrombosis mvt and its clinical expressions have become better defined as a result of improvements in both diagnostic imaging and our understanding of the various intestinal. Mesenteric venous thrombosis and small bowel ischemia. The newer imaging techniques allow earlier diagnosis. Venous thrombosis, however, is not limited to these locations and may involve the cerebral venous sinuses, renal veins, splanchnic veins, and ovarian veins.
Abdominal pain is one of the most common presenting complaints to the emergency department. A case of mesenteric venous thrombosis after endoscopic. Signs and symptoms of mesenteric vein occlusion are very similar to those of acute mesenteric arterial occlusion. Mesenteric venous thrombosis mvt is an uncommon cause of mesenteric ischemia accounting for 515% of the cases. Treatment of venous thrombosis at unusual sites springerlink. Acute mesenteric ischemia is included in the group of pathophysiologic processes that lead to necrosis of the intestine. All patients seen between 1983 and 1999 were enrolled into this retrospective study if recent portal or.
Mesenteric venous thrombectomy followed by liver transplantation 223. Mesenteric venous thrombosis was recognized as a cause of intestinal gangrene more than a century ago by elliot,1 but warren and eberhard2 were the first to characterize mesenteric venous thrombosi. Mesenteric venous thrombosis multimedia encyclopedia. Acute mesenteric ischemia ami is a syndrome caused by inadequate blood flow through the mesenteric vessels, resulting in ischemia and eventual gangrene of the bowel wall. Treatment of acute mesenteric venous thrombosis with transjugular intramesenteric urokinase infusion. First differentiated from arterial causes of acute mesenteric ischemia 75 years ago, acute mesenteric venous thrombosis mvt is an uncommon disorder with nonspecific signs and symptoms, the diagnosis of which requires a high index of suspicion. Mesenteric venous thrombosis after laparoscopic rouxeny.
What is the pathophysiology of mesenteric venous thrombosis mvt. In the mayo clinic series, only 72 patients with mvt were identified from 1972 to 1993. Read mesenteric vascular insufficiency, current problems in surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. The risk of acute mesenteric venous thrombosis increases in patients with hypercoagulable states e. Mar 26, 2020 acute mesenteric ischemia ami is a syndrome caused by inadequate blood flow through the mesenteric vessels, resulting in ischemia and eventual gangrene of the bowel wall. Mvt may also occur after ligation of the splenic vein for a splenectomy or ligation of the portal vein or the superior mesenteric vein as part of damage control.
Idiopathic superior mesenteric vein thrombosis smvt is defined as a thrombosis of the superior mesenteric vein without any other related disease or etiologic factor. She was diagnosed to have superior mesenteric vein thrombosis. This pathology is an uncommon type of intestinal ischemia associated with significant mortality and morbidity because of. Multidetector ct features of mesenteric vein thrombosis. The objective was to study the factors associated with mortality in mesenteric venous thrombosis mvt.
Broadly, ami may be classified as either arterial or venous. Mesenteric and portal vein thrombosis in a young patient. An abdominal angiogram demonstrated thrombosis of the superior mesenteric vein as well as diffuse venous collaterals, consistent with subacute mesenteric venous thrombosis figure 2. Treatment of acute superior mesenteric vein thrombosis with. Improved diagnosis and treatment of mesenteric obstructive arterial disease and its complications have occurred. Subscription of members of the belgian society of radiology are included in.
Although relatively rare, it is a potentially lifethreatening condition. The presentation may vary from an entirely asymptomatic clinical scenario to intestinal infarction and shock. Aetiology idiopathic up to 50%, hypercoagulability e. What is the pathophysiology of acute mesenteric arterial. Hereditary protein c deficiency presenting as venous mesenteric. Venous causes of acute mesenteric ischemia are less common 5%15% of cases 4, 9 and are most often the result of a thrombosis of the superior mesenteric vein smv. Twelve patients had progressive abdominal pain, three had gastrointestinal bleeding, and one had general malaise. Most cases of acute mesenteric venous thrombosis evolve toward the chronic form with vein stenosis or occlusion and development of collateral veins. The location, extent, and rapidity of thrombus formation determine whether intestinal infarction. Acute mesenteric ischemia is a potentially dangerous vascular pathology with a total mortality of 6080 % and its constant increase by 15 % per year. Treatment of acute superior mesenteric vein thrombosis. The literature is filled with randomized controlled trial data to guide most steps in managing patients with deep venous thrombosis of the extremities or pulmonary embolism.
Portomesenteric vein thrombosis pmvt is a rare cause of mesenteric and bowel ischemia. This study was designed to evaluate progress in diagnosis, management, and clinical outcome of mesenteric venous thrombosis mvt. Fiftythree patients had acute and 19 had chronic mesenteric venous thrombosis. Acute mesenteric ischemia ami is a potentially fatal vascular emergency with overall mortality of 60% to 80%, 15 and its reported incidence is increasing. Rather, it is an often fatal complication of underlying venous thrombosis.
Superior mesenteric vein thrombosis mimicking acute. Proceedings alerting clinicians to suspect mesenteric venous thrombosis when patients present with. Mesenteric venous thrombosis, techniques in vascular and. Find out how were doing our part to confront this crisis. Location, length of mesenteric venous thrombosis, transverse diameter of the vein, and mesenteric fat infiltration at diagnosis are determinant factors for mesenteric venous thrombosis evolution. Pdf mesenteric venous thrombosis is a rare but potentially fatal. A 64yearold woman with a history of idiopathic portal hypertension presented at the emergency room with vomiting, increasing cramping abdominal pain. It is most commonly seen in the elderly and may be categorized as acute or chronic mesenteric ischemia.
Mesenteric venous thrombosis can occur without gangrenous bowel. Frontiers thrombosis of the abdominal veins in childhood. Mesenteric venous thrombosis definition of mesenteric. Mesenteric cysts and mesenteric venous thrombosis leading.
Mvt is a clot that blocks blood flow in a mesenteric vein. Blunt, semiopaque indentations of the bowel lumen thumbprinting are indicative of mucosal edema, whereas gas in the wall of the bowel pneumatosis intestinalis or in the portal vein and free peritoneal air are characteristic of bowel infarction as a result of mesenteric venous thrombosis. Mesenteric venous thrombosis mvt is an uncommon form of mesenteric. Acute superior mesenteric venous thrombosis asmvt is an intractable disease with poor prognosis. Mesenteric and portal vein thrombosis in a young patient with protein s deficiency treated with urokinase via the superior mesenteric artery. Historically, the etiology of the thrombus was unknown in most patients. Trombosis venosa mesenterica en mujeres transexuales.
Thieme ejournals thrombosis and haemostasis abstract. A diagnosis of mesenteric venous thrombosis mvt is usually confirmed during laparotomy or autopsy. The turkish journal of trauma and emergency surgery tjtes is an official publication of the turkish association of trauma and emergency surgery. Biplanar angiography of the mesenteric arteries remains the best method of diagnosing mesenteric vascular diseases, though duplex sonography of the mesenteric arteries appears to be a valuable screening tool. This disease is common in the sixth and seventh decades of. N2 the prevalence of mesenteric venous thrombosis has increased over the past 2 decades with the routine use of contrastenhanced computed tomography ct in patients presenting with abdominal pain and those with portal hypertension. Mesenteric venous thrombosis mvt was first described as a distinct cause of mesenteric ischemia by warren and eberhard in 1935 1. Primary mvt is idiopathic, whereas secondary mvt can result from a variety of underlying diseases and risk factors, including primary hypercoagulable states or prothrombotic disorders, myeloproliferative neoplasms, cancer most frequently of the pancreas or. Treatment of acute superior mesenteric vein thrombosis with percutaneous techniques. Bioline international official site site updated regularly. Chronic mesenteric ischemia, also known as intestinal angina, is most often due to arterial atherosclerotic disease. It is important to diagnose accurately and in a timely fashion important as mortality is in the order of 2030%. Under normal conditions, microthrombi tiny aggregates of red cells, platelets and fibrin are continually formed and lysed within the venous circulatory system.
The anatomic site of involvement in acute mesenteric venous thrombosis is most often ileum 64 to 83 percent or jejunum 50 to 81 percent, followed by colon. Her past medical history and drug history was negative, except she was taking levonorgestrel and cyproterone acetate for a 5 months period. Use of transjugular intrahepatic portosystemic shunts during lytic therapy of extensive portal splenic and mesenteric venous thrombosis. This is the first report of the coexistence of mesenteric cysts and mesenteric vein thrombosis during gestation.
Mesenteric venous thrombosis is more common in the sixth and seventh decades of life. Pulmonary thromboembolism is not a disease in and of itself. Data on 99 of these patients were obtained from autopsy reports and were not included in the study. It can be either acute presenting commonly with abdominal pain or chronic presenting with features of portal hypertension. Subscribers information the jbrbtr is published 6 times a year. With the improved sophistication in testing for hypercoagulable states, the underlying cause can now be. Apr 10, 2020 a diagnosis of mesenteric venous thrombosis mvt is usually confirmed during laparotomy or autopsy. The diagnosis is often delayed, and cases traditionally have been identified either at laparotomy or at autopsy. Only after other causes of a hypercoagulable state have.
Thrombolysis using systemic or transcatheter route is another option. Abdominal venous thrombosis is a rare form of venous thromboembolic disease in children. The initial 34% mortality rate reported by warren and eberhard 3 in 1935 remains relatively unchanged. Symptoms typically do not develop until two of the three arteries usually the celiac artery and the sma. Mesenteric venous thrombosis represents an important cause to consider in patients with acute abdominal pain. Additionally, given the infrequency of these thrombi, there is lack of stringent research data and evidencebased treatment guidelines. Mesenteric venous thrombosis after laparoscopic sleeve. A rare case of isolated superior mesenteric venous thrombosis mvt after endoscopic variceal band ligation evl is reported. Mesenteric vein thrombosis almost always involves the distal small intestine superior mesenteric venous drainage and rarely involves the colon inferior mesenteric venous drainage.
Mesenteric venous thrombosis ian g harnik, lawrence j. Mesenteric venous thromendothelin serum concentrations and preser bosis. After negative routine gastrointestinal and hepatobiliary evaluation, 11 patients underwent an infusion. While mortality rates are low, a significant proportion of affected children may suffer longterm morbidity.
In addition, mesenteric vein thrombosis is a rare and lifethreatening condition in pregnancy and needs immediate treatment because it can lead to intestinal necrotic ischemia. Percutaneous intervention is increasingly being used as an adjunct or alternative to surgical therapy for the treatment of acute, symptomatic, mesenteric venous thrombosis and noncavernous, chronic, portal vein thrombosis. A case report on superior mesenteric vein thrombosis. Acute mesenteric ischemia is a lifethreatening vascular emergency that requires early diagnosis and intervention to adequately restore mesenteric blood flow and to prevent bowel necrosis and patient death. Abdominal pain represents the most common manifestation of mvt and is present in approximately 75% to 90% of patients.
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