Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis

AIM: To summarize our methods and experience with interventional treatment for symptomatic acute-sub-acute portal vein and superior mesenteric vein throm-bosis (PV-SMV) thrombosis. METHODS: Forty-six patients (30 males, 16 females, aged 17-68 years) with symptomatic acute-subacute portal and superior mesenteric vein thrombosis were ac-curately diagnosed with Doppler ultrasound scans, com-puted tomography and magnetic resonance imaging. They were treated with interventional therapy, including direct thrombolysis (26 cases through a transjugular intrahepatic portosystemic shunt; 6 through percutane-ous transhepatic portal vein cannulation) and indirect thrombolysis (10 through the femoral artery to superior mesenteric artery catheterization; 4 through the radial artery to superior mesenteric artery catheterization). RESULTS: The blood reperfusion of PV-SMV was achieved completely or partially in 34 patients 3-13 d after thrombolysis. In 11 patients there was no PV-SMV blood reperfusion but the number of collateral vessels increased signif icantly. Symptoms in these 45 patients were improved dramatically without severe operationalcomplications. In 1 patient, the thrombi did not respond to the interventional treatment and resulted in intestinal necrosis, which required surgical treatment. In 3 patients with interventional treatment, thrombi reformed 1, 3 and 4 mo after treatment. In these 3 patients, indirect PV-SMV thrombolysis was performed again and was successful. CONCLUSION: Interventional treatment, including direct or indirect PV-SMV thrombolysis, is a safe and effective method for patients with symptomatic acutesubacute PV-SMV thrombosis.

Mesenteric vein thrombosis following impregnation via in vitro fertilization-embryo transfer

Pregnancy is an acquired hypercoagulable state. Most patients with thrombosis that develops during pregnancy present with deep vein leg thrombosis and/or pulmonary embolism, whereas the development of mesenteric vein thrombosis(MVT) in pregnant patients is rare. We report a case of MVT in a 34-year-old woman who had achieved pregnancy via in vitro fertilization-embryo transfer(IVFET). At 7 wk of gestation, the patient was referred to us due to abdominal pain accompanied by vomiting and hematochezia, and she was diagnosed with superior MVT. Following resection of the gangrenous portion of the small intestine, anticoagulation therapy with unfractionated heparin and thrombolysis therapy via a catheter placed in the superior mesenteric artery were performed, and the patient underwent an artificial abortion. Oral estrogen had been administered for hormone replacement as part of the IVF-ET procedure, and additional precipitating factors related to thrombosis were not found. Pregnancy itself, in addition to the administered estrogen, may have caused MVT in this case. We believe that MVT should be included in the differential diagnosis of a pregnant patient who presents with an acute abdomen.

Acute appendicitis complicated by mesenteric vein thrombosis: A case report

BACKGROUND Acute appendicitis with mesenteric vein thrombosis(MVT)is an uncommon condition and usually lacks specific clinical manifestations,which leads to a high rate of misdiagnosis or delayed diagnosis,especially when it is accompanied by other abdominal diseases.Prompt and accurate recognition is vital for treatment and prognosis.CASE SUMMARY A 37-year-old woman had a history of acute metastatic right lower abdominal pain,nausea,and fever.A contrast-enhanced computed tomography(CT)scan showed a filling defect in the mesenteric vessels.The patient was diagnosed with acute appendicitis complicated by MVT and was treated with anticoagulation and intravenous antibiotics.The follow-up CT scan showed full resolution of the thrombosis and inflammation.CONCLUSION Clinical awareness is essential for recognizing MVT,especially when it is accompanied by other common acute abdominal diseases,such as acute appendicitis.Contrast-enhanced CT is helpful for the diagnosis of MVT and is recommended for patients with acute abdominal diseases.

Mesenteric venous thrombosis in a young adult:A case report and review of the literature

BACKGROUND Acute mesenteric vein thrombosis(MVT)accounts for only 2%–10%of all cases of acute mesenteric ischaemia,with an incidence rate of~0.1%in Europe and the United States.It represents<10%of mesenteric infarction cases and is seen predominantly in older adults.In younger individuals,MVT is uncommon,with 36%of cases having unidentified mechanisms and causes.CASE SUMMARY A 27-year-old man presented to the emergency department on February 29,2024,with a chief complaint of intermittent abdominal pain for 3 day.He was previously in good health.As the abdominal pain was not alleviated by conventional treatment,an abdominal computed tomography(CT)scan was performed,which showed increased density in the portal and mesenteric veins.Further imaging,including portal vein ultrasound,mesenteric CT angiography,and enhanced abdominal CT,revealed widespread thrombosis of the portal vein system(including the main portal vein,left and right branches,proximal mesenteric vein,and splenic vein).After 10 day of thrombectomy and anticoagulation therapy,the patient’s abdominal pain had improved significantly.Follow-up assessments indicated that portal venous blood flow had largely returned to normal.He was discharged on March 9,2024.During a follow-up exam 2 months later,repeat abdominal enhanced CT showed that the previously detected thrombi were no longer visible.CONCLUSION Clinicians should remain vigilant for acute MVT in young patients presenting with abdominal pain,to prevent misdiagnosis of this fatal condition.

Idiopathic acute superior mesenteric venous thrombosis after renal transplantation: A case report

BACKGROUND Acute superior mesenteric venous thrombosis(MVT)is a rare condition associated with a high mortality rate.The treatment strategy for MVT is clinically challenging due to its insidious onset and rapid development,especially when accompanied by kidney transplantation.CASE SUMMARY Here we present a rare case of acute MVT developed 3 years after renal transplantation.A 49-year-old patient was admitted with acute abdominal pain and diagnosed as MVT with intestinal necrosis.An emergency exploratory laparotomy was performed to remove the infarcted segment of the bowel.Immediate systemic anticoagulation was also initiated.During the treatment,the patient experienced bleeding,anastomotic leakage,and sepsis.However,after aggressive treatment was administered,all thrombi were completely resolved,and the patient recovered with his renal graft function unimpaired.CONCLUSION The present case suggests that accurate diagnosis and timely surgical treatment are important to improve the survival rate of MVT patients.Bleeding with anastomotic fistula needs to be treated with caution because of grafts.Also,previously published cases of mesenteric thrombosis after renal transplantation were reviewed.

Etiology and consequences of thrombosis in abdominal vessels

The thrombophilia which can be either congenital or acquired in adult life has major implications in the abdominal vessels. The resulting portal vein thrombosis, Budd-Chiari syndrome and mesenteric vein thrombosis have a variety of consequences ranging from acute abdomen to chronic hepatomegaly and even totally asymp- tomatic patient in whom the only finding is pancytopenia. The complications like esophageal varices, portal gastropathy, ascites, severe hypersplenism, liver failure requiring liver transplantation are well known. Interesting features of collateral venous circulation showing itself as pseudocholangiocarcinoma sign and its possible clinical reflection as cholestasis are also known from a long time. The management strategies for these complications of intraabdominal vessel thrombosis are not different from their counterpart which is cirrhotic portal hypertension, but the prognosis is unquestionably better in former cases. In this review we presented and discussed the abdominal venous thrombosis, etiology and the resulting clinical pictures. There are controversial issues both in nomenclature, and management including anticoagulation problems and follow up strategies. In light of the current knowledge, we discussed some controversial issues in literature and presented our experience and our proposals about this group of patients.