Thromboses veineuses mésentériques. Facteurs de risque, traitement et évolution. Analyse de 18 observations

Lefrançois, C.; Derlon, A.; Querrec, A. Le; Justum, Anne-Marie; Gautier, Philippe; Maurel, J.; Leroux, Yves; Lochu, T.; Sillard, B.; Deshayes, Jean-Luc; Delassus, Patrick; Bricard, H.

doi:10.1016/s0750-7658(05)80551-9

Cited by 14 publications

(6 citation statements)

References 27 publications

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“…[10][11][12][13][14][15][16][17][18][19][20][21][22] Isolated cases of recanalization with anticoagulation alone have also been described. 4,[23][24][25][26][27][28][29][30][31][32][33][34][35][36] However, because series of consecutive cases are scarce, 3,22,37 treatment of recent portal or mesenteric venous thrombosis has remained unsettled.…”

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confidence: 99%

Recent Portal or Mesenteric Venous Thrombosis: Increased Recognition and Frequent Recanalization on Anticoagulant Therapy

et al. 2000

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Characteristics and outcomes of recent portal or mesenteric venous thrombosis are ill-known. We intended to compare these features with those of patients with portal cavernoma, and also to assess the incidence of recanalization of recent thrombosis on anticoagulation therapy. All patients seen between 1983 and 1999 were enrolled into this retrospective study if recent portal or mesenteric venous thrombosis or portal cavernoma had been documented, and if cancer of the liver, pancreas, or bile duct, intrahepatic block including cirrhosis, and obstruction of the hepatic veins had been ruled out. The proportion of recent thrombosis was 7% in patients seen before 1990 and 56% after 1994 (P < .05). Patients with recent thrombosis (n ‫؍‬ 33) or cavernoma (n ‫؍‬ 108) did not differ with regard to age, sex ratio, or prevalence of prothrombotic states and of previous thrombotic events. In patients with recent thrombosis, septic pylephlebitis was more common and the incidence of gastrointestinal bleeding was lower (2.4 vs. 12.7/100 patient-years). Recanalization occurred in 25 of 27 patients given anticoagulation and 0 of 2 patients not given anticoagulation. The probability of recanalization was related to the extent of thrombosis (P ‫؍‬ .003). In conclusion, mesenteric or portal venous thrombosis is increasingly recognized at an early stage. The features differentiating recent thrombosis and cavernoma are related to silent onset precluding early recognition and therapy in the latter. Until recently, portal vein thrombosis was generally recognized at a stage of cavernomatous transformation with portal hypertension. 1,2 Therefore, manifestations, etiologic features, and outcomes of recent portal vein thrombosis have remained ill-known, although it has long been recognized that ischemic intestinal necrosis in the short term, and bleeding caused by portal hypertension in the long term, are dreadful complications. 3,4 The outcome might depend on early and sustained recanalization of the portal and mesenteric veins. There are anecdotal reports of recanalization after surgical thrombectomy 5-9 or after systemic or local thrombolysis. [10][11][12][13][14][15][16][17][18][19][20][21][22] Isolated cases of recanalization with anticoagulation alone have also been described. 4,[23][24][25][26][27][28][29][30][31][32][33][34][35][36] However, because series of consecutive cases are scarce, 3,22,37 treatment of recent portal or mesenteric venous thrombosis has remained unsettled.The aims of this study in patients with portal or mesenteric venous thrombosis were to compare the features of patients with recent thrombosis and cavernoma, respectively, and also to ascertain the frequency of recanalization in patients with recent thrombosis receiving only anticoagulation therapy. PATIENTS AND METHODSAll patients seen between 1983 and 1999 were enrolled into this retrospective study if recent portal or mesenteric venous thrombosis or portal cavernoma had been documented, and if cancer of the liver, pancreas, or bile duct, intrahepatic block ...

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confidence: 99%

Recent Portal or Mesenteric Venous Thrombosis: Increased Recognition and Frequent Recanalization on Anticoagulant Therapy

et al. 2000

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“…This deficit leads to a high risk of PV thrombosis, as it does in spontaneous PVT in adults. 42 In our experience, heparin administered to prevent arterial thrombosis in some patients did not prevent PVT. By comparing the large pediatric liver transplantation series in the literature (Table 3), two groups may be identified: teams in which aspirin, with or without dipyridamole, is used to prevent postoperative thrombosis, and teams in which antiaggregative agents are not used.…”

Section: Presentation Diagnosis and Treatmentmentioning

confidence: 64%

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1997

Liver Transpl

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“…This assessment is important because 20-35% of thrombosis results from primary causes [18]. The results should include local factors (intra-abdominal infection or malignancy), general factors (constitutional deficits in protein C, protein S and antithrombin III, a myeloproliferative disorder that can be latent) [19]. It was negative in both our cases, but in the first case, etiology was made after the introduction of heparin therapy that could skew the results.…”

Section: Discussionmentioning

confidence: 87%

“…It was negative in both our cases, but in the first case, etiology was made after the introduction of heparin therapy that could skew the results. Prognostic factors of these venous thromboses are early diagnosis, etiology, scope and speed of thrombosis installation and early treatment [16,19]. In case of active smoking and being on an oral anti-contraception treatment, their cessation must be affirmed to the patient when done.…”

Section: Discussionmentioning

confidence: 99%

Mesenteric Venous Thrombosis After Laparoscopic Sleeve Gastrectomy: Pathophysiology and Literature Review

Kassir

2014

J Curr Surg

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In the last 10 years, laparoscopic sleeve gastrectomy has become an increasingly popular surgical option for morbidly obese patients. Mesenteric venous thrombosis, as a complication of laparoscopic sleeve gastrectomy, has been rarely reported. We report two cases of thrombosis of the superior mesenteric vein after sleeve gastrectomy. It is confirmed by CT scan. Treatment is primarily medical. Three months later, the patients were asymptomatic still under antivitamin K. Thrombosis of the superior mesenteric vein after bariatric surgery is a diagnosis that one should know how to raise in front of any postoperative abdominal pain. The laparoscopic abdominal pressure (> 14 mm Hg), associated with a marked position in bariatric surgery, reduces the venous flow by 50% which may increase the risk of thrombosis. In addition, soft tissue trauma during surgery (manipulation of the small intestine during short gastric bypass or duodenal switch) releases tissue factors that could cause a mesenteric venous thrombosis in patients with a previously undiagnosed hypercoagulable state. The clinical signs of mesenteric venous ischemia are variable and nonspecific. The etiology of portal thrombosis must be done before the introduction of heparin therapy which is not always possible in emergency. An obese patient with a history of thrombosis should receive a complete etiology of these thromboses before bariatric surgery. Abnormal blood dirt, an active smoking fat woman having oral contraceptive, or a patient with a history of recurrent venous thrombosis may be a relative contraindication against a complex bariatric surgery with digestive bypass.

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Thromboses veineuses mésentériques. Facteurs de risque, traitement et évolution. Analyse de 18 observations

Cited by 14 publications

References 27 publications

Recent Portal or Mesenteric Venous Thrombosis: Increased Recognition and Frequent Recanalization on Anticoagulant Therapy

Recent Portal or Mesenteric Venous Thrombosis: Increased Recognition and Frequent Recanalization on Anticoagulant Therapy

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Mesenteric Venous Thrombosis After Laparoscopic Sleeve Gastrectomy: Pathophysiology and Literature Review

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