Epidemiology, Risk and Prognostic Factors in Mesenteric Venous Thrombosis

Abstract

aortitis may contribute to the spectrum of aortic diseases, perhaps linking patients with Takayasu disease and the various subgroups of degenerative and genetically related TAAs. Epidemiology, Risk and Prognostic Factors in Mesenteric VenousThrombosis Acosta S, Alhadad A, Svensson P, et al. Br J Surg 2008;95:1245-1251 Conclusion: Mesenteric venous thrombosis (MVT) can be accurately diagnosed with portal venous-phase computed tomography (CT) scanning, and activated protein C resistance is associated with MVT.Summary: The authors used an inpatient and autopsy registry to identify patients at their hospital with MVT from 2000 to 2006. MVT was diagnosed in 51 patients. The diagnosis was made at autopsy in six patients. Patients aged 70 to 79 years had the highest incidence of MVT (11.3 per 100,000 person-years). Testing for activated protein C resistance was done in 29 patients, and 13 were positive. D-dimer levels were assessed in five patients, and all had elevated D-dimer. Multidetector row CT scans were done in the portal venous phase in 20 patients. The examination was positive in all 20 patients. There were 12 patients with surgery, with a median length of bowel resection of 0.6 m (range, 0.1-2.2 m). The 30-day mortality for the entire group was 20%. Increased mortality was associated with intestinal infarction (P ϭ .046), treatment on a nonsurgical ward (P ϭ .001), and lack of performance of CT scan (P ϭ .022). Long-term mortality was associated with presence of cancer, with a hazard ratio of 4.03 (95% CI, 1.03-15.85; P ϭ .046).Comment: MVT, at least symptomatic MVT, occurs infrequently. The diagnosis is difficult because symptoms are generally nonspecific. Mortality rates can be high. The authors' data are consistent with what one would suspect. CT scanning with a venous phase works well for diagnosis, and many of these patients will have a hypercoagulable state with, at least in this study, factor V Leiden mutation identified as the most prevalent abnormality. The study highlights the current standard of care for patients with possible MVT: a CT scan for diagnosis, anticoagulation for most patients, bowel resection for those with peritonitis, and an aggressive evaluation for hypercoagulable state with likely long-term anticoagulation. Long-term prognosis is largely related to the presence of malignancy.

The Management of Mesenteric Vein Thrombosis: A Single Institution Experience

“…[1] Acute thrombosis is associated with a bowel infarction in one-third of patients. [12] The primary aim of treatment must be to avoid the pathological process that leads to necrosis, and early diagnosis is required to avoid transmural gangrene, perforation, and peritonitis. [13] Following advances in radiologic imaging, as well as, increasing awareness of mesenteric venous thrombosis, early detection and medical treatment obviating surgical intervention became feasible.…”

“…Moreover, autopsy studies have determined that abdominal cancer is present in 22% of cases and hepatic cirrhosis is present in 17%. [12,16] Anticoagulant therapy for venous thromboembolism was first demonstrated by Barritt and Jordan in 1960. [17] Their randomized study reported that if patients do not receive anticoagulant therapy, approximately 25% experience fatal recurrences and another 25% experience non-fatal recurrences.…”

Pileflebitis asociada a apenaicitis aguda en una niña de 11 años

“…Dentro de los posibles focos, se menciona la apendicitis como la causa más frecuente, las enfermedades inflamatorias intestinales como la enfermedad de Crohn, infecciones del tracto biliar, pancreatitis aguda necrotizante, la sepsis tras la cirugía abdominal, diverticulitis y la septicemia generalizada [4][5][6][7][8][13][14][15] . Como condiciones predisponentes están las trombofilias, estados congestivos (cirrosis, insuficiencia cardíaca), cualquier tipo de neoplasia, situaciones que deben investigarse en forma dirigida 16,17 . En cuanto a las complicaciones, pueden producirse abscesos hepáticos que pueden requerir de tratamiento antibiótico asociado a su drenaje 5,13,18 .…”

Mesenteric Venous Thrombosis

“…2,[5][6][7] The proportion of patients with idiopathic cases decreases with more extensive evaluation. 8 Malignancies including myeloproliferative neoplasms are the most common form of prothrombotic disorders associated with MVT.…”