Improved diagnosis and treatment of mesenteric obstructive arterial disease and its complications have occurred. Mesenteric vascular insufficiency, current problems in. 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. The operative relief of gangrene of intestine due to occlusion of the mesenteric vessels. Mesenteric venous thrombosis is an insidious disease with a high mortality rate typically attributed to the long delay in diagnosis. The role of secondlook procedure in improving survival time for patients with mesenteric venous thrombosis. By 19, trotter 2 accumulated reports of 360 cases of mesenteric ischemia, 41% of which were mesenteric venous thrombosis. Oncel m, kurt n, remzi fh, sensu ss, vural s, gezen cf, et al. Mvt must be distinguished from arterial and nonocclusive types of mesenteric ischemia, and accounts for 5% to 15% of all cases of mesenteric ischemia. Less than 100 years ago in 1895, elliot 1 recognized intestinal gangrene secondary to mesenteric venous occlusion. Dallis, dj portal and mesenteric venous thrombosis as a complication of endoscopic sclerotherapy.
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. Thirtyfour 64% patients with acute mesenteric venous thrombosis underwent a surgical procedure. A diagnosis of mesenteric venous thrombosis mvt is usually confirmed during laparotomy or autopsy. Antonio beniviene was the first to describe mesenteric ischemia as early as the 15th. Under normal conditions, microthrombi tiny aggregates of red cells, platelets and fibrin are continually formed and lysed within the venous circulatory system. The risk of acute mesenteric venous thrombosis increases in patients with hypercoagulable states e. Abdominal pain represents the most common manifestation of mvt and is present in approximately 75% to 90% of patients. Treatment of superior mesenteric and portal vein thrombosis with direct thrombolytic infusion via an operatively placed mesenteric. The newer imaging techniques allow earlier diagnosis. Apr, 2014 mesenteric venous thrombosis mvt is an uncommon cause of mesenteric ischemia accounting for 515% of the cases.
Abdu ra, zakhour bj, dallis dj 1987 mesenteric venous thrombosis 1911 to 1984. Acute mesenteric ischemia ami is a potentially fatal vascular emergency with overall mortality of 60% to 80%, 15 and its reported incidence is increasing. Mesenteric venous thrombosis ian g harnik, lawrence j. Abdu ra, zakhour bj, dallis dj mesenteric venous thrombosis 1911 to 1984. Mesenteric venous thrombosis mvt is a rare but potentially lethal form of mesenteric ischemia. Case records of the massachusetts general hospital. Grendell jh, mcquaid kr, eds current diagnosis and treatment in. The turkish journal of trauma and emergency surgery tjtes is an official publication of the turkish association of trauma and emergency surgery. It was first described by elliot 9 in 1895 as thrombosis of the portomesenteric venous system, which disallowed venous drainage from the gut leading to bowel infarction. Acute mesenteric ischemia is included in the group of pathophysiologic processes that lead to necrosis of the intestine. Mesenteric venous thrombosis is a dangerous, somewhat uncommon abdominal catastrophe that has received little attention. Mesenteric vascular insufficiency mesenteric vascular insufficiency montgomery, robert a. This study was designed to evaluate progress in diagnosis, management, and clinical outcome of mesenteric venous thrombosis mvt.
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. 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. Only 372 patients with mvt were reported from 1911 to 1984,37 and mvt accounted for only 6. First described by elliot 1 in 1895 and characterized as a clinical entity by warren and eberhard 2 in 1935, mvt makes up 5% to 15% of all acute mesenteric ischemia. Oct 26, 2014 once the diagnosis of mesenteric venous thrombosis mvt is made, treatment varies with the form of mvt acute, subacute, or chronic mvt. Mesenteric venous thrombosis mvt is an uncommon cause of mesenteric ischemia accounting for 515% of the cases. Mesenteric venous thrombosis mvt is an uncommon event. Thieme ejournals thrombosis and haemostasis abstract. Venbrux, md associate professor of radiology associate director, cardiovascular diagnostic. The survival rate has not improved substantially during the past 70 years, and the major reason is the. Nonlower extremity deep vein thrombosis emergency medicine. Mesenteric fat infiltration at diagnosis was more frequent in the chronic mesenteric venous thrombosis signs group than in the complete recovery group p 0.
Acute superior mesenteric venous thrombosis asmvt is an intractable disease with poor prognosis. Acute splanchnic or mesenteric venous thrombosis is a rare disease accounting for approximately 10% of all abdominal ischemic events. Data on 99 of these patients were obtained from autopsy reports and were not included in the study. Mesenteric vein thrombosis an overview sciencedirect topics. In comparison with arterial occlusive disease, which is much more frequent, venous occlusive disease makes up a much smaller percentage 1015% of mesenteric ischemia. Mesenteric venous thrombosis ian g harnik, lawrence j brandt. The splanchnic venous system represents all intestinal veins which drain ultimately into the portal circulation. Argatroban, a direct thrombin inhibitor, may be a novel anticoagulant method in the therapy of asmvt. Mesenteric venous thrombosis is a rare but lethal form of mesenteric ischemia. Rhee ry, gloviczki p, mendonca ct, petterson tm, serry rd, sarr. 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. Most cases of acute mesenteric venous thrombosis evolve toward the chronic form with vein stenosis or occlusion and development of collateral veins. Mesenteric venous thrombosis mvt is a rare but potentially lethal form of. Mesenteric venous thrombosis is a rare but potentially fatal complication associated with laparoscopy which has now become common practice and gold standard for many procedures in general surgery.
There are only few scattered case reports in the literature describing this postoperative thrombotic event. Rhee ry, gloviczki p, mendonca ct, petterson tm, serry rd, sarr mg et al. Mesenteric vein thrombosis almost always involves the distal small intestine superior mesenteric venous drainage and rarely involves the colon inferior mesenteric venous drainage. Documented experience in the east african region is. Trombosis venosa mesenterica en mujeres transexuales. Once the diagnosis of mesenteric venous thrombosis mvt is made, treatment varies with the form of mvt acute, subacute, or chronic mvt. The presentation may vary from an entirely asymptomatic clinical scenario to intestinal infarction and shock. As with acute arterial mesenteric ischemia, acute mvt is a. 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.
Use of transjugular intrahepatic portosystemic shunts during lytic therapy of extensive portal splenic and mesenteric venous thrombosis. 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. Mesenteric vascular disease is a relatively rare disease. Treatment of acute superior mesenteric vein thrombosis.
Treatment of mesenteric venous thrombosis springerlink. 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. Acute mesenteric ischemia is a lifethreatening vascular emergency that requires early. Treatment of acute mesenteric venous thrombosis with transjugular intramesenteric urokinase infusion.
Diagnosis before frank thrombosis and gangrene is a challenge. Apr 10, 2020 a diagnosis of mesenteric venous thrombosis mvt is usually confirmed during laparotomy or autopsy. Treatment of acute superior mesenteric vein thrombosis with. Pulmonary thromboembolism is not a disease in and of itself.
Abdu razakhour bjdallis dj mesenteric venous thrombosis. 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. It can be either acute presenting commonly with abdominal pain or chronic presenting with features of portal hypertension. Rather, it is an often fatal complication of underlying venous thrombosis.
Mesenteric venous thrombosis accounts for 5 to 15 percent of all mesenteric ischemic events 3 and usually involves the superior mesenteric vein. Mesenteric venous thrombosis with transmural intestinal infarction. First differentiated from arterial causes of acute mesenteric ischemia 75 years. Fiftythree patients had acute and 19 had chronic mesenteric venous thrombosis. Mesenteric venous thrombosis mvt is an uncommon but often lethal form of intestinal ischemia. Only after other causes of a hypercoagulable state have been excluded can a patient be. Patients with this condition benefit from rapid diagnosis and expedient surgical therapy. We retrospectively analyzed data for patients who were admitted with mvt between june 2005 and. This disease is common in the sixth and seventh decades of. Bioline international official site site updated regularly.
47 98 867 22 94 357 890 1438 734 437 1181 1437 695 1261 403 527 1089 410 577 529 1077 782 1203 1396 459 8 1078 707 95 477 1035 445