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Superior Mesenteric Vein Thrombosis

Deep Venou Thromb Sup Mes Vein


Presentation

  • The present case indicated abdominal inflammation or infection strongly related to the development and regression of mesenteric venous thrombosis.[ncbi.nlm.nih.gov]
Fever of Unknown Origin
  • J Clin Invest 31: 621-2 Resat O, Birgul M, Elif H, Ali M, Fehmi T (2003) Primary antiphospholipid syndrome: a cause of fever of unknown origin. Intern Med. 42: 358-361.[omicsonline.org]
Respiratory Distress
  • One patient with technical success died of acute respiratory distress syndrome 8 days after the procedure, whereas one patient with technical failure achieved clinical success. One patient experienced acute rethrombosis 8 days after the procedure.[ncbi.nlm.nih.gov]
Epigastric Tenderness
  • Clinical examination revealed epigastric tenderness, normal intestinal sounds with no other signs of intestinal obstruction. Fig ure 1.[pubs.sciepub.com]
Persistent Vomiting
  • Despite the medical treatment, his condition progressed to persistent vomiting. His past history showed no relevant medical conditions, he did not undergo any surgical procedures and did not have any similar complaint before.[pubs.sciepub.com]
Chronic Diarrhea
  • We present a case of a 56-year-old woman admitted with chronic diarrhea, who was found to have non-occlusive SMV thrombosis. A 56-year-old female presented to our hospital with complaints of fever and diarrhea.[oatext.com]
Vein Disorder
  • Disorders [ edit ] Thrombosis of the superior mesenteric vein is quite rare, but a significant cause of mesenteric ischemia and can be fatal.[en.wikipedia.org]
Hematuria
  • […] demonstrated on CT scan, were subjected to a thrombophilia screen consisting of Protein C, S, antithrombin levels, lupus anticoagulant, anticardiolipin antibodies, fibrinogen levels, factor VIII levels, factor V 'Leiden' gene mutation, and paroxysmal nocturnal hematuria[ncbi.nlm.nih.gov]
Dysmenorrhea
  • She had a history of dysmenorrhea for 15 years and was taking a combined hormonal contraceptive containing 0.02 mg ethinyl estradiol and 3 mg drospirenone for 19 months.[karger.com]

Workup

  • A hypercoagulable workup was normal. After continued anticoagulation therapy and supportive care, a duplex ultrasound 2 months after the event showed normal flow in both the superior mesenteric and portal veins.[ncbi.nlm.nih.gov]
  • Both patients completed a hypercoagulable workup; the female patient tested positive for protein S deficiency, while the male patient did not have a hypercoagulable predisposition.[sages.org]
  • Infectious workup including stool studies was unrevealing. She did not improve with empiric antibiotic therapy. A computerized tomography (CT) scan of the abdomen and pelvis showed decreased lymphadenopathy, and a new SMV thrombu s .[oatext.com]
  • A detailed outpatient workup revealed elevated serum homocysteine levels, but was negative for other causes of coagulopathy. She has been subsequently treated with vitamin B12, folate and warfarin.[westjem.com]
Hyperviscosity
  • It is also believed that splenectomy favors a hyperviscosity state due to thrombocytosis and postoperative leukocytosis since there is no splenic lysis of these cells [ 22 ] .[thejh.org]

Treatment

  • In 1 patient, the thrombi did not respond to the interventional treatment and resulted in intestinal necrosis, which required surgical treatment. In 3 patients with interventional treatment, thrombi re-formed 1, 3 and 4 mo after treatment.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis is good in this group of patients, with a mortality of only 7%, although bowel ischemia was noted in 21%.[ncbi.nlm.nih.gov]
  • It is very important to differentiate PVT from PVTT as the prognosis is different. PVTT progresses despite of long-term anticoagulation with poor prognosis.[thieme-connect.com]
  • Poor prognosis and limited therapeutic options in patients with Budd-Chiari syndrome and portal venous system thrombosis. Eur J Gastro Hepatol 1997 ; 9 : 485 –9. Sauvanet A , Panis Y, Valla D, et al .[gut.bmj.com]
  • […] variable) absent once infarcted (more common in arterial occlusion) hyperenhancement or target appearance prolonged enhancement pneumatosis intestinalis : due to transmural infarction dilated and fluid-filled lumen other changes ascites Treatment and prognosis[radiopaedia.org]

Etiology

  • OBJECTIVE: Our purpose was to examine the clinical presentation, imaging appearance, etiology, and clinical outcome in patients who had acute thrombosis of the superior mesenteric vein with radiologically occult cause.[ncbi.nlm.nih.gov]
  • While mesenteric arterial thrombosis results from arrhythmia and cardiac etiologies, mesenteric venous thrombosis is overwhelmingly associated with hypercoagulable states, stasis and local factors which lead to vessel wall injury [3].[oatext.com]
  • Etiology The majority of cases are considered secondary to an identifiable underlying condition, including 1-3 : hypercoagulable states malignancy polycythemia vera protein C deficiency protein S deficiency antithrombin III deficiency recent abdominal[radiopaedia.org]
  • Although the diagnosis of the cause of the small intestinal obstruction did not affect the line of treatment selection as surgery was the optimal option, the diagnosis of the SMVT as the underlying etiology drew the attention to the importance of the[pubs.sciepub.com]

Epidemiology

  • Figure 2: N 57; Epidemiological distribution of the pathological fractures, traumatic fractures, and nonunion.[medcraveonline.com]
  • ., Svensson, P. and Ekberg, O, “Epidemiology, risk and prognostic factors in mesenteric venous thrombosis,” Br J Surg, 95. 1245-1251. 2008.[pubs.sciepub.com]
  • Epidemiology, risk and prognostic factors in mesenteric venous thrombosis. Br J Surg. 2008;95:1245–51. [ PubMed ] 8. Zhang J, Duan ZQ, Song QB, et al.[westjem.com]
  • Pneumatosis Intestinalis Predictive Evaluation Study (PIPES): A multicenter epidemiologic study of the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2013; 75 (1): 15-23[ DOI ][ PubMed ] 2. Galandiuk S, Fazio VW.[colorectalresearch.com]
  • Summary Epidemiology Annual incidence is estimated at 1-2 cases per million. The condition is slightly more common in females than males (sex ratio of 1.3:1). Clinical description ZES is usually diagnosed in the fifth decade of life.[orpha.net]
Sex distribution
Age distribution

Pathophysiology

  • While MVT has been established in hypercoagulable states and local-abdominal processes (splenectomy, pancreatitis, diverticulitis), its incidence and pathophysiology in the setting of laparoscopic bariatric surgery alone is relatively unknown and rarely[sages.org]
  • Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 118. Cloud A, Dussel JN, Webster-Lake C, Indes J. Mesenteric ischemia. In: Yeo CJ, ed.[medlineplus.gov]
  • Two large series demonstrated that chronic MVT accounts for 24% to 40% of total cases of MVT. 3 Risk Factors and Pathophysiology Risk Factors MVT often results from a combination of hypercoagulability, endothelial injury, and stasis, any of which may[ahajournals.org]
  • Portal vein thrombosis in adults: pathophysiology, pathogenesis and management. J Hepatol. 2000; 32 :865 – 71. 4. Rosendaal FR. Venous thrombosis: a multicausal disease. Lancet. 1999; 353 :1167 – 73. 5. Fried M, Van Ganse W, Van Avermaet S.[tropicalgastro.com]
  • Pathophysiology Three phases of ischaemic colitis have been described ( Phases of ischaemic colitis ). Clinical presentation The clinical features depend on the phase of the disease.[surgwiki.com]

Prevention

  • We report a case of a young adult man with SMVT due to a hypercoagulable state (protein S deficiency), in whom an early diagnosis and appropriate anticoagulant treatment prevented any further extension of the thrombotic process and limited the hemorrhagic[ncbi.nlm.nih.gov]
  • Although these collaterals are capable of preventing hemorrhagic infarction, it is not adequate to prevent segmental chronic intestinal ischemia that in turn leads to chronic inflammation and scarring of the small intestine musculature [ 1 ].[pubs.sciepub.com]
  • This will help prevent recurrent thrombosis. Treatment of Acute mesenteric vein thrombosis involves bowel rest, anticoagulation to limit the extension of thrombosis and monitoring for any clinical deterioration.[omicsonline.org]
  • Our case highlights the importance of having a high index of suspicion for this disease entity, as early diagnosis and treatment may prevent the devastating sequelae associated with prolonged thrombosis.[oatext.com]

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