Mesenteric and Portal Vein Thrombosis: Treated with Early Initiation of Anticoagulation

Joh, Jin Hyun; Kim, D.-I.

doi:10.1016/j.ejvs.2004.10.005

Cited by 51 publications

(54 citation statements)

References 20 publications

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“…Ascites is found in 60% of patients with portomesenteric thrombosis (7). Therefore, in patients with significant increases of abdominal pain in the post-prandial period, detection of ascites with clinical examination or ultrasonography portomesenteric thrombosis should be considered even if they are young.…”

Section: Discussionmentioning

confidence: 99%

Portomesenteric venous thrombosis as a rare cause of acute abdomen in a young patient: What should be the process of diagnosis and management?

İnan

Sarıoğlu²,

Serhat³

2013

UCD

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Portomesenteric venous thrombosis as a rare cause of acute abdomen in a young patient: What should be the process of diagnosis and management?This report aimed to discuss indications for radiological evaluation, laboratory investigation for thrombophilic risk factors, and the duration of anticoagulation therapy in porto-mesenteric venous thrombosis, based on a young patient who presented with acute abdomen and ascites. We investigated the acquired and genetic thrombophilic risk factors and the diagnostic process. Abdominal CT and Doppler US were found to be useful radiological tools in both diagnosis and follow-up of portomesenteric thrombosis. The investigated thrombophilic factors, PT G20210A, MTHFR C677T and MTHFR A1298C, were positive for heterozygous mutations and high levels of lupus anticoagulant and factor VIII were detected. Rapid ascites resolution and an improvement in abdominal pain after meals were observed following anticoagulation. Follow-up examination after six months showed that the portomesenteric thrombosis had completely resolved. Evaluation by CT is recommended for patients with acute abdomen and ascites, especially if ultrasonography failed to show any specific pathology. Several acquired or genetic thrombophilic factors were identified in a patient in whom local precipitating factors were absent. For patients with genetic thrombophilic risk factors and thrombosis at an uncommon site in the body, lifelong treatment with anticoagulants is recommended. Key Words: Portomesenteric venous thrombosis, anticoagulation, acute abdomen INTRODUCTIONPortomesenteric venous thrombosis is an uncommon disease, difficult to diagnose and leading to mortality. Clinical suspicion is crucial in diagnosis (1-3). Congenital or acquired prothrombotic disorders, other thrombophilic factors or local factors play a role in etiology. Typically, a combination of multiple factors is detected (4). Abdominal Doppler ultrasonography (U.S.) for portal venous thrombosis and portal venous phase of contrast-enhanced tomography (CT) for mesenteric thrombosis are valuable methods for accurate diagnosis and follow-up (5). A case is discussed below, who presented with right lower quadrant pain and free fluid and incidentally diagnosed with portomesenteric thrombosis, in terms of diagnosis, screening of thrombophilic risk factors and duration of treatment. CASE PRESENTATIONA 24-year-old woman presented to our clinics with persistent abdominal pain. She was evaluated on the previous day at another clinic with similar complaints, her laboratory tests and abdominal US did not reveal any pathologies and the patient departed from that clinic on her request. Her pain increased overnight and she developed nausea and vomiting following oral intake.On physical examination, bowel sounds were decreased and the right lower quadrant was tender. She was tachycardic 100/min heart rate with an arterial blood pressure of 110/80 mmHg. On U.S. free fluid was detected in the right lower quadrant, right paracolic area and in the pouch of Douglas, the ...

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Section: Discussionmentioning

confidence: 99%

Portomesenteric venous thrombosis as a rare cause of acute abdomen in a young patient: What should be the process of diagnosis and management?

İnan

Sarıoğlu²,

Serhat³

2013

UCD

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“…7,13,19 Initially, there is ischemia of the mucosa, which causes diffuse peritonitis as it progresses to transmural infarction. 10 Ultrasonography is considered the first line for diagnosis of disorders in the portal vein system, although it was not used in this case because of the acute abdomen presentation. It offers specificity and sensitivity greater than 80%, which improve if Doppler imaging is employed.…”

Section: Discussionmentioning

confidence: 99%

Cateterismo de artéria mesentérica para tratamento de trombose de veia porta

et al. 2017

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Portal vein thrombosis is a rare vascular cause of acute abdomen and it is directly related to hereditary or acquired thrombophilias. This article presents the case of a 60-year-old male patient, with clinical signs of mesenteric ischemia that was confirmed by imaging examination. He underwent enterectomy and enteroanastomosis and, after detection of portal vein thrombosis by splenoportography, he was prescribed drug-based treatment with continuous infusion of recombinant tissue plasminogen activator (Alteplase) via selective catheterization of the superior mesenteric artery. This is a treatment innovation. The portal system was successfully recanalized. However, the patient developed abdominal sepsis and required intensive care for 25 days. His clinical status improved and he was discharged with a prescription for oral anticoagulant. This article presents a brief review of the literature and a discussion of portal vein thrombosis.Keywords: portal vein; thrombosis; thrombophilia; mesenteric ischemia; acute abdomen. ResumoA trombose de veia porta é uma causa rara de abdome agudo vascular e está diretamente relacionada a trombofilias hereditárias ou adquiridas. O caso de um paciente de 60 anos, sexo masculino, com quadro clínico de isquemia mesentérica confirmada por exame de imagem é apresentado. Foi submetido a enterectomia e enteroanastomose e, após esplenoportografia que detectou trombose de veia

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“…Thus, it is not rare for SMVT to be first diagnosed in an advanced state with findings such as intestinal necrosis, which warrant surgical intervention (25,32). Anticoagulant therapy is effective in patients who receive an early diagnosis (33). Reports have described the efficacy of danaparoid sodium in addition to traditional urokinase and tissue plasminogen activator in patients with SMVT or PVT (34)(35)(36).…”

Section: Discussionmentioning

confidence: 99%

Paralytic Ileus due to Superior Mesenteric Venous Thrombosis after Transarterial Injection for Hepatocellular Carcinoma

et al. 2016

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A 69-year-old man was admitted to hospital with abdominal pain. In the four years prior to his presentation, he had undergone repeated transarterial chemoembolizations and injections for hepatocellular carcinoma. He underwent his 8th transcatheter arterial therapy one month prior to admission. Abdominal X-rays and contrast-enhanced computed tomography showed large amounts of small intestinal gas and venous thrombosis from the portal vein to the superior mesenteric vein, respectively. The thrombosis was reduced after anticoagulation therapy (heparin, antithrombin III, danaparoid sodium and warfarin). This is the first case report of paralytic ileus due to superior mesenteric venous thrombosis after transcatheter arterial therapy for hepatocellular carcinoma with an arterioportal shunt.

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Mesenteric and Portal Vein Thrombosis: Treated with Early Initiation of Anticoagulation

Abstract: The early initiation of anticoagulation in patients of SMVT combined with PVT could minimise the serious complication such as peritonitis due to bowel necrosis required immediate exploratory laparotomy.

Cited by 51 publications

References 20 publications

Portomesenteric venous thrombosis as a rare cause of acute abdomen in a young patient: What should be the process of diagnosis and management?

Portomesenteric venous thrombosis as a rare cause of acute abdomen in a young patient: What should be the process of diagnosis and management?

Cateterismo de artéria mesentérica para tratamento de trombose de veia porta

Paralytic Ileus due to Superior Mesenteric Venous Thrombosis after Transarterial Injection for Hepatocellular Carcinoma

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