Surgical treatment of mesenteric venous thrombosis

Mesenteric venous thrombosis is a rare form of mesenteric ischemia that can be lethal when appropriate treatment is delayed. A 61-year-old woman consulted with nonirradiating epigastric and left upper abdominal pain, nausea and vomiting, all of which had been increasing for 4 days. Two years earlier...

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Bibliographic Details
Published in:La Presse médicale (1983) 2007-06, Vol.36 (6 Pt 1), p.878-880
Main Authors: Abboud, Bassam, Jaoude, Joe Bou, Sleilaty, Ghassan, Slaba, Sami
Format: Article
Language:fre
Subjects:
Anticoagulants - therapeutic use
Female
Humans
Mesenteric Veins - diagnostic imaging
Mesenteric Veins - surgery
Middle Aged
Phlebitis
Pulmonary Embolism
Thrombosis - diagnostic imaging
Thrombosis - surgery
Tomography, X-Ray Computed
Treatment Outcome
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Summary:Mesenteric venous thrombosis is a rare form of mesenteric ischemia that can be lethal when appropriate treatment is delayed. A 61-year-old woman consulted with nonirradiating epigastric and left upper abdominal pain, nausea and vomiting, all of which had been increasing for 4 days. Two years earlier, she had had phlebitis and a pulmonary embolism. Her white blood cell count was 15,300/mm3. Abdominal computed tomography (CT) showed thrombosis of the superior mesenteric vein with no evidence of intestinal parietal ischemia. The patient received a full dose of heparin promptly and underwent selective intra-arterial thrombolysis. As her clinical condition deteriorated, an emergency laparotomy was performed to resect 1.5 meters of gangrenous jejunum. Full anticoagulation with heparin was resumed postoperatively, and she was discharged 15 days after surgery. She continued taking oral anticoagulants. All results of a thorough laboratory work-up were negative. The clinic presentation of acute mesenteric venous thrombosis is generally insidious. CT scanning is a reliable diagnostic method. The goal of initial treatment is to define the underlying cause of the patient's hypercoagulable state and to treat it appropriately. After achieving appropriate anticoagulation, patients should start long-term warfarin. Indications for surgery include signs of peritonitis, possible bowel infarction, and hemodynamic instability. Once treated, patients with this condition have a fairly good prognosis.
ISSN:0755-4982
DOI:10.1016/j.lpm.2007.03.006