Clinical Manifestations of Superior Mesenteric Venous Thrombosis in the Era of Computed Tomography

Cho, Joon Whoi; Choi, Jae Jeong; Um, Eunhae; Jung, Sung Min; Shin, Yong Chan; Kim, Jae Il; Choi, Pyong Wha; Heo, Tae Gil; Lee, Myung Soo; Jun, Heungman

doi:10.5758/vsi.2018.34.4.83

Cited by 10 publications

(18 citation statements)

References 16 publications

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“…Four series ( 21 , 22 , 25 , 27 ) reported endovascular procedures, ranging from 6.7% to 72.1% of the included number of patients in respective study. The four series ( 19 – 22 ) that diagnosed all patients by CT/initial imaging had all a low 30-day mortality rate, ranging from 1.2% to 4.9%. One series included 15 asymptomatic and 65 symptomatic MVT patients, and demographic and outcome data were presented on all MVT patients with available data ( 22 ).…”

Section: Resultsmentioning

confidence: 99%

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Management of Acute Mesenteric Venous Thrombosis: A Systematic Review of Contemporary Studies

Acosta

Salim

2020

Scand J Surg

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Background and Aims: Acute mesenteric venous thrombosis accounts for up to 20% of all patients with acute mesenteric ischemia in high-income countries. Acute mesenteric venous thrombosis is nowadays relatively more often diagnosed with intravenous contrast-enhanced computed tomography in the portal phase than at explorative laparotomy No high-quality comparative studies between anticoagulation alone, endovascular therapy, or surgery exists. The aim of the present systematic review was to offer a contemporary overview on management. Materials and Methods: Eleven relevant published original studies with series of at least ten patients were retrieved from a Pub Med search between 2015 and 2020 using the Medical Subject Heading term “mesenteric venous thrombosis.” Results: When MVT is diagnosed early, immediate anticoagulation with either unfractionated heparin or subcutaneous low-molecular-weight heparin should commence. Surgeons need to be aware of the importance to scrutinize the computed tomography images themselves for assessment of secondary intestinal abnormalities to mesenteric venous thrombosis and the risk of bowel resection and worse prognosis. Progression toward peritonitis is an indication for explorative laparotomy and assessment of bowel viability. Frank transmural small bowel necrosis should be resected and bowel anastomosis may be delayed for several days until second look. Meanwhile, intravenous full-dose unfractionated heparin should be given at the end of the first operation. Postoperative major intra-abdominal or gastrointestinal bleeding occurs rarely, but the heparin effect can instantaneously be reversed by protamine sulfate. Patients who do not improve during conservative therapy with anticoagulation alone but without developing peritonitis may be subjected to endovascular therapy in expert centers. When the patient’s intestinal function has recovered, with or without bowel resection, switch from parenteral unfractionated heparin or low-molecular-weight heparin therapy to oral anticoagulation can be performed. There is a trend that direct oral anticoagulants are increasingly used instead of vitamin K antagonists. Up to now, direct oral anticoagulants have been shown to be equally effective with the same rate of bleeding complications. Patients with no strong permanent trigger factor for mesenteric venous thrombosis such as intra-abdominal cancer should undergo blood screening for inherited and acquired thrombophilia. Conclusion: Early diagnosis with emergency computed tomography with intravenous contrast-enhancement and imaging in the portal phase and anticoagulation therapy is necessary to be able to have a succesful non-operative succesful course.

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Section: Resultsmentioning

confidence: 99%

“…Eleven studies (evidence level C) were retrieved ( 18 – 28 ), of which seven were from East Asian countries ( Table 1 ). The total number of patients was 604, 207 females and 397 males.…”

Section: Resultsmentioning

confidence: 99%

Management of Acute Mesenteric Venous Thrombosis: A Systematic Review of Contemporary Studies

Acosta

Salim

2020

Scand J Surg

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“…The etiology of MVT can be identified in about 75% of patients, with the use of oral contraceptives accounting for 9% to 18% of MVT in young women ( 1 ). The main causes of MVT are reportedly intraperitoneal inflammation (65.9%), malignancy (17.1%), and unknown causes (17.1%) ( 7 ). Among patients with intraperitoneal inflammation, the most common causes are appendicitis (51.9%), diverticulitis (25.9%), and ileus (7.4%) ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

“…The main causes of MVT are reportedly intraperitoneal inflammation (65.9%), malignancy (17.1%), and unknown causes (17.1%) ( 7 ). Among patients with intraperitoneal inflammation, the most common causes are appendicitis (51.9%), diverticulitis (25.9%), and ileus (7.4%) ( 7 ). Laboratory tests for thrombophilia include inherited factors (e.g.…”

Section: Discussionmentioning

confidence: 99%

Successful Nonsurgical Treatment of Acute Peritonitis Caused by a Large Thrombosis of the Superior Mesenteric Vein in a 25-year-old Woman

Ueda

Kawai²,

Shokoku³

et al. 2020

Intern. Med.

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Superior mesenteric venous thrombosis (SMVT), which results from various etiologies, including coagulation disorders, can be diagnosed early using advanced imaging technology. However, few reports have described the nonsurgical treatment of acute peritonitis caused by SMVT. We encountered a young woman whose history included abdominal pain and daily oral contraceptives and who presented with acute peritonitis caused by SMVT. We administered nonsurgical treatment that included thrombolysis and anticoagulation for the peritonitis (without mesenteric ischemia as confirmed by contrast-enhanced computed tomography). In addition, we showed the importance of investigating persistent risk factors for thromboembolism in young patients to determine the duration of anticoagulation.

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“…9 Although not consistent amongst all studies, the identification of intestinal wall oedema, decreased bowel enhancement, small bowel dilatation and ascites were all associated with increased risk of intestinal infarction and/or resection. [10][11][12] Therefore, the combination of intestinal wall oedema and ascites in patients with acute PVT and ongoing abdominal pain likely identifies a high risk group in whom optimal management has yet to be established.…”

Section: Introductionmentioning

confidence: 99%

A stepwise thrombolysis regimen in the management of acute portal vein thrombosis in patients with evidence of intestinal ischaemia

Benmassaoud

Alrubaiy

et al. 2019

Aliment Pharmacol Ther

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Summary Background Anticoagulation alone in acute, extensive portomesenteric vein thrombosis (PVT) does not always result in spontaneous clot lysis, and leaves the patient at risk of complications including intestinal infarction and portal hypertension. Aim To develop a new standard of care for patients with acute PVT and evidence of intestinal ischaemia. Methods We present a case series of patients with acute PVT and evidence of intestinal ischaemia plus ongoing symptoms despite initial systemic anticoagulation, who were treated with a thrombolysis protocol between 2014 and 2019. This stepwise protocol initially uses low‐dose systemic alteplase, and in patients with ongoing abdominal pain, and no evidence of radiological improvement, is followed by local clot dissolution therapy (CDT) through a TIPSS. Outcomes and safety were assessed. Results Twenty‐two patients were included. The mean age was 44.6 (standard deviation [SD] 16.0) years, and 64% had an identifiable prothrombotic risk factor. All patients had intestinal wall oedema and 77% had complete occlusion of all portomesenteric veins. Systemic thrombolysis was started 18.7 (SD 11.2) days after the onset of symptoms. 55% of patients underwent TIPSS insertion for CDT. At the end of treatment, symptoms resolved in 91% of patients and recanalisation in 86%. Only one patient required resection for intestinal ischaemia, and there were no deaths. Major complications occurred in two patients (9%). Conclusions Our stepwise protocol is effective, resulting in good recanalisation rates. It can be commenced early while organising transfer to a centre capable of performing local CDT.

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Clinical Manifestations of Superior Mesenteric Venous Thrombosis in the Era of Computed Tomography

Cited by 10 publications

References 16 publications

Management of Acute Mesenteric Venous Thrombosis: A Systematic Review of Contemporary Studies

Management of Acute Mesenteric Venous Thrombosis: A Systematic Review of Contemporary Studies

Successful Nonsurgical Treatment of Acute Peritonitis Caused by a Large Thrombosis of the Superior Mesenteric Vein in a 25-year-old Woman

A stepwise thrombolysis regimen in the management of acute portal vein thrombosis in patients with evidence of intestinal ischaemia

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