Small intestinal stricture complicating superior mesenteric vein thrombosis. A study of three cases.

Eugène, C; Valla, Dominique; Wesenfelder, L; Fingerhut, Abe; Bergue, A; Merrer, Jade; Felsenheld, C; Moundji, A; Etienne, J

doi:10.1136/gut.37.2.292

Cited by 27 publications

(16 citation statements)

References 12 publications

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“…11 A few patients might suffer from delayed intestinal stenosis as a sequela of intestinal ischemia. 35 In patients treated at the stage of intestinal infarction with multiorgan dysfunction or failure, the outcome is poor; in these patients, the in-hospital mortality rate approaches 50%. 8 …”

Section: Outcomementioning

confidence: 99%

Nonmalignant portal vein thrombosis in adults

Condat

Valla

2006

Nat Rev Gastroenterol Hepatol

117

130

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Portal vein thrombosis (PVT) consists of two different entities: acute PVT and chronic PVT. Acute PVT usually presents as abdominal pain. When the thrombus extends to the mesenteric venous arches, intestinal infarction can occur. Chronic PVT is usually recognized after a fortuitous diagnosis of hypersplenism or portal hypertension, or when there are biliary symptoms related to portal cholangiopathy. Local risk factors for PVT, such as an abdominal inflammatory focus, can be identified in 30% of patients with acute PVT; 70% of patients with acute and chronic PVT have a general risk factor for PVT, most commonly myeloproliferative disease. Early initiation of anticoagulation therapy for acute PVT is associated with complete and partial success in 50% and 40% of patients, respectively. A minimum of 6 months' anticoagulation therapy is recommended for the treatment of acute PVT. For patients with either form of PVT, permanent anticoagulation therapy should be considered if they have a permanent risk factor. In patients with large varices, beta-adrenergic blockade or endoscopic therapy seems to prevent bleeding as a result of portal hypertension, even in patients on anticoagulation therapy. In patients with jaundice or recurrent biliary symptoms caused by cholangiopathy, insertion of a biliary endoprosthesis is the first treatment option. Overall, the long-term outcome for patients with PVT is good, but is jeopardized by cholangiopathy and transformation of underlying myeloproliferative disease into myelofibrosis or acute leukemia.

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Section: Outcomementioning

confidence: 99%

Nonmalignant portal vein thrombosis in adults

Condat

Valla

2006

Nat Rev Gastroenterol Hepatol

117

130

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“…Signs appear during the post-thrombotic course, and the main triad of symptoms, which indicates the appearance of chronic intestinal obstruction as a result of intestinal stenosis, mainly occurs several weeks after revascularization (it varies from several days to months) [6]. Ischemic intestinal stenosis does meet the diagnostic criteria of ischemic enteritis, which can also be related to limited thrombosis or embolism [19,20].…”

Section: Discussionmentioning

confidence: 99%

“…However, the chronic complication of delayed intestinal stricture secondary to AMVT, post-ischemic intestinal stenosis (PIIS), has rarely been reported [6,7]. In 1985, Witte et al rst reported the onset of mesenteric and portal vein thrombosis in a 71-year-old man, and the barium follow-up showed edema, spicules, thumb printing and poor distensibility of the distal ileum [8].…”

Section: Page 3/19mentioning

confidence: 99%

Clinical Profile, Response to therapy and outcomes of post-ischemic intestinal stenosis Secondary to Acute Mesenteric Venous Thrombosis: a retrospective case series study

Sun

Wang

Chu

et al. 2020

Preprint

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Background Acute mesenteric venous thrombosis (AMVT) can not only cause acute bowel infarction but result in post-ischemic intestinal stenosis (PIIS), which is rarely reported. Methods Consecutive patients diagnosed with PIIS secondary to AMVT (during the post-thrombotic course, confirmed segmental bowel stenosis) from January 2010 to June 2018 were enrolled. We evaluated the clinical profile, response to therapy, and outcomes of this complication managed at the intestinal stroke center in China. Clinical data are retrospectively analyzed and Wilcoxon signed-rank test was used to evaluate the efficiency of conservative treatment. Results 42 patients with PIIS secondary to AMVT were evaluated. 20 (5-150) days after discharge for AMVT, symptoms of PIIS appeared, and the interval between symptom onset and consultation was 29.5 (2-180) days. In addition, abdominal pain (90.5%), abdominal distension (76.2%), weight loss (71.4%), and nausea or vomiting (54.8%) were the common presentations. Hypoproteinemia was observed in 61.9% of patients, while leukocytosis, anemia and electrolyte disorders were present in 11.9%, 45.2% and 35.7% of patients, respectively. CT excluded thrombosis recurrence and revealed extensive collateral circulation or portal cavernous transformation in 83.3% of patients. Enterography was required only in 81.0% of patients, with positive findings in all patients, including complete obstruction (23.5%), intestinal stricture (64.7%), and extensive mucosal erosion (11.8%). Prompt conservative treatment achieved significantly increases of albumin and pre-albumin levels and correction of electrolyte disorders (all p < 0.05). However, only 4 (9.5%) patients improved after conservative therapy and laparotomy was required in other patients. A median length of 20 (2-100) cm of involved bowel was resected, mainly involving the jejunum (76.3%). Only 1 patient died due to uncontrolled transverse colon bleeding, and other patients’ postoperative courses were uneventful. Conclusion During the post-thrombotic course, clinicians should be aware of the possibility of PIIS in patients with symptoms of ileus and hypoproteinemia. Patients may respond to conservative therapy; however, the majority of patients warrant surgical resection.

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“…Ischemic bowel stenosis is one of the most frequent late sequelae of PMVT. [5][6][7][8] Once PMVT develops, it causes extensive bowel congestion and renders parts of the intestine vulnerable to thromboembolism or arterial spasm, resulting in bowel wall ischemia, which can cause multiple latent infarctions or persistent circulatory disturbance, despite successful conservative treatment. Because ischemic bowel stenosis is caused by latent infarctions or persistent circulatory disturbance, it can occur in multiple locations at the same time or serially.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic-assisted Resection for Jejunal Stenosis Following Extensive Portomesenteric Venous Thrombosis

Yokoyama

Ito

Sekioka

et al. 2014

CRSLS

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Introduction: Portomesenteric venous thrombosis (PMVT) is a rare and often fatal disease that is difficult to diagnose. The symptoms are nonspecific, and diagnosis and initial treatment tend to be delayed. The initial treatment strategy for PMVT has recently tended toward the use of conservative methods before surgical intervention, and most patients can be successfully treated in this way. In rare cases, however, bowel strictures may develop, owing to chronic ischemia.

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Small intestinal stricture complicating superior mesenteric vein thrombosis. A study of three cases.

Cited by 27 publications

References 12 publications

Nonmalignant portal vein thrombosis in adults

Nonmalignant portal vein thrombosis in adults

Clinical Profile, Response to therapy and outcomes of post-ischemic intestinal stenosis Secondary to Acute Mesenteric Venous Thrombosis: a retrospective case series study

Laparoscopic-assisted Resection for Jejunal Stenosis Following Extensive Portomesenteric Venous Thrombosis

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