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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]

Partial portal vein thrombosis was also present on the initial CDU in 2 patients (40%), and nonocclusive splenic vein thrombosis was present in 1 (20%). [ingentaconnect.com]

[…] than three days of symptoms at presentation, and the presence of bowel ischemia. [westjem.com]

Immune System

  • Splenomegaly

    H igh risk patients are those who present hypercoagulopathy, hemolytic anemia, hypersplenism, hematologic malignancy and splenomegaly [ 25 ]. [thejh.org]

    Splenomegaly was present. https://doi.org/10.1371/journal.pone.0112501.g005 Discussion Acute and chronic PVT, as the name implies, are distinguished by the time of thrombus presence. [journals.plos.org]

    […] replacement therapy Pregnancy/postpartum state Nephrotic syndrome Inflammation Intra-abdominal Pancreatitis Inflammatory bowel disease Trauma Surgery (most commonly splenectomy) Infection Stasis Cirrhosis Congenital venous anomaly Heart failure Congestive splenomegaly [ahajournals.org]

Entire Body System

  • Anemia

    H igh risk patients are those who present hypercoagulopathy, hemolytic anemia, hypersplenism, hematologic malignancy and splenomegaly [ 25 ]. [thejh.org]

    […] pylori infections, retained gastric antrum, gastric outlet obstruction, renal failure, antral G cell syndromes, idiopathic gastroesophageal reflux or peptic ulcer disease, and physiological causes of hypergastrinemia (atrophic gastritis, pernicious anemia [orpha.net]

  • Multiple Organ Dysfunction Syndrome

    One patient in group 2 died of multiple organ dysfunction syndrome (at follow-up month 9). No patient in either group experienced thrombosis recurrence. [wjgnet.com]

  • Severe Pain

    SMV Thrombosis is a rare condition that can cause an array of symptoms, from severe pain to diarrhea [1]. [oatext.com]

Gastrointestinal

  • Constipation

    These patients presented with abdominal pain, constipation, and/or emesis approximately 12 days following surgery. [appliedradiology.com]

    Symptoms may include any of the following: Abdominal pain, which may get worse after eating and over time Bloating Constipation Bloody diarrhea Fever Septic shock Lower gastrointestinal bleeding Vomiting and nausea Blood thinners (most commonly heparin [medlineplus.gov]

    Weight loss Diarrhea Nausea and/or vomiting Flatulence Constipation Risk factors for mesenteric disease include: Family history of vascular disease Age (60 and older) Tobacco use High blood pressure High cholesterol Diagnosing mesenteric ischemia and [scripps.org]

Cardiovascular

  • Tachycardia

    Tenderness, distension, and diminished intestinal sounds were the prominent abdominal physical findings in this case and were often associated with tachycardia and hypotension. [ncbi.nlm.nih.gov]

    His vital signs were normal except for mild tachycardia. The abdominal pain was severe and seemed to be out of proportion to the physical findings. The abdomen was soft with predominantly midline tenderness and mild guarding. [accesssurgery.mhmedical.com]

    Electrocardiogram showed sinus tachycardia and echocardiography revealed borderline left ventricular hypertrophy with a minimal pericardial effusion. [joacc.com]

  • Vein Disorder

    veins veins from jejunum veins from ileum middle colic vein - drains the transverse colon right colic vein - drains the ascending colon ileocolic vein Disorders [ edit ] Thrombosis of the superior mesenteric vein is quite rare, but a significant cause [en.wikipedia.org]

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]

At that time thrombophilia workup was unremarkable except for JAK2 V617F mutation. Subsequent bone marrow studies showed no evidence of myeloproliferative disease (MPD). [accesssurgery.mhmedical.com]

Serum

  • Thrombocytosis

    Because of this, authors recommended administration of antiplatelet agents after splenectomy to all patients presenting severe thrombocytosis [ 13 ]. [thejh.org]

    […] following (>80% of patients with MVT are found to have predisposing conditions): Hypercoagulability [32] from protein C and S deficiency, [33, 34] antithrombin III deficiency, dysfibrinogenemia, abnormal plasminogen, polycythemia vera (most common), thrombocytosis [emedicine.medscape.com]

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]

Prognosis In the absence of liver metastases, the prognosis is favorable (10-year survival rate of 90-100%). Patients with liver metastases (65-75% of patients) have a 10-year survival rate of 20-40%. [orpha.net]

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]

Depending on local expertise, site-directed thrombolytic therapy may be used. 3 The duration of anticoagulation therapy depends on the suspected etiology of the thrombosis and may involve 6 to 12 months’ to life-long therapy. [cmaj.ca]

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]

In 80% of cases, an etiologic factor is found. The clinical presentation varies and the diagnosis is made based on imaging studies. The treatment involves anticoagulation alone or in combination with surgery. [lareferencia.info]

Epidemiology

Figure 2: N=57; Epidemiological distribution of the pathological fractures, traumatic fractures, and nonunion. [medcraveonline.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]

Epidemiology, risk and prognostic factors in mesenteric venous thrombosis. Br J Surg 2008;95:1245-51. 7. Lee SS, Ha HK, Park SH, Choi EK, Kim AY, Kim JC, et al. [jmgims.co.in]

In article CrossRef [4] Acosta, S., Alhadad, A., Svensson, P. and Ekberg, O, “Epidemiology, risk and prognostic factors in mesenteric venous thrombosis,” Br J Surg, 95. 1245-1251. 2008. [pubs.sciepub.com]

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]

The etiology and prevention of functional instability of the foot. J Bone Joint Surg Br 1965;47:678-85. 7. Stanitski CL. Common injuries in preadolescent and adolescent athletes. Recommendations for prevention. [go.gale.com]

In chronic MVT, anticoagulation may promote recanalization and prevents new thrombosis. [ahajournals.org]

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]

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