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Dakak AG, Mahgoub MK, Jalkhi TA, Mohammed MA, Alkassar A, Amirrad M. Isolated superior mesenteric vein thrombosis in an adult with nephrotic syndrome due to minimal change disease: a case report. J Med Case Rep 2025; 19:149. [PMID: 40170178 PMCID: PMC11963653 DOI: 10.1186/s13256-025-05130-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Accepted: 02/07/2025] [Indexed: 04/03/2025] Open
Abstract
BACKGROUND Nephrotic syndrome, a condition that induces a hypercoagulable state, poses a significant risk of thromboembolism, a potentially life-threatening complication. While venous thromboembolism in nephrotic syndrome typically manifests as pulmonary emboli, deep vein thrombosis, and renal vein thrombosis, mesenteric vein thrombosis is a rare occurrence. The rarity is further accentuated when it occurs in patients with minimal change disease, with only a handful of cases reported in the literature. CASE PRESENTATION The patient is a 25-year-old Syrian male, previously in good health, presenting with severe abdominal pain and vomiting that had persisted for 6 days. Investigations revealed hypoalbuminemia with nephrotic range proteinuria. Computed tomography scan of the abdomen and pelvis with contrast showed superior mesenteric vein thrombosis. Renal biopsy revealed minimal change disease. The patient was mainly treated with a therapeutic dose of enoxaparin, followed by apixaban. He also received oral prednisolone, a short course of cyclosporine, and furosemide. With the appropriate treatment, the patient's symptoms gradually improved and he was discharged. This successful management of a rare complication in a nephrotic syndrome patient demonstrates the potential for positive outcomes in such cases. CONCLUSIONS This unique case underscores the importance of early recognition and appropriate management of thromboembolic events in nephrotic syndrome. By presenting this case, we aim to alert clinicians to the possibility of mesenteric venous thrombosis, a rare but potentially serious complication. Such reports are crucial in informing more effective clinical decision-making and improving outcomes for nephrotic syndrome patients.
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Affiliation(s)
| | | | | | | | | | - Maryam Amirrad
- College of Medicine, Ajman University, P.O. Box 346, Ajman, UAE
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2
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Lorenz J, Kwak DH, Martin L, Kesselman A, Hofmann LV, Yu Q, Youssef S, Ciolek P, Ahmed O. Endovascular Management of Noncirrhotic Acute Portomesenteric Venous Thrombosis. J Vasc Interv Radiol 2025; 36:17-30. [PMID: 39389231 DOI: 10.1016/j.jvir.2024.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 09/16/2024] [Accepted: 09/28/2024] [Indexed: 10/12/2024] Open
Abstract
Acute portomesenteric venous thrombosis (PVT) is a rare but potentially life-threatening condition in individuals without cirrhosis. Initial management typically involves anticoagulation therapy, but the optimal approach to interventional treatment remains a topic of ongoing research. This article explores both traditional and emerging endovascular techniques, providing an overview of the existing evidence supporting their use. Additionally, it delves into the significance of acute PVT in the context of contemporary pathologies, notably coronavirus disease 2019 infection, vaccine-induced immune thrombotic thrombocytopenia, and liver transplantation.
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Affiliation(s)
- Jonathan Lorenz
- Section of Interventional Radiology, Department of Radiology, the University of Chicago Medical Center, Chicago, Illinois
| | - Daniel H Kwak
- Section of Interventional Radiology, Department of Radiology, the University of Chicago Medical Center, Chicago, Illinois.
| | - Lynne Martin
- Division of Interventional Radiology, Department of Radiology, Stanford University Medical Center, Stanford, California
| | - Andrew Kesselman
- Division of Interventional Radiology, Department of Radiology, Stanford University Medical Center, Stanford, California
| | - Lawrence V Hofmann
- Division of Interventional Radiology, Department of Radiology, Stanford University Medical Center, Stanford, California
| | - Qian Yu
- Section of Interventional Radiology, Department of Radiology, the University of Chicago Medical Center, Chicago, Illinois
| | - Salma Youssef
- University College Dublin School of Medicine, Belfield, Dublin, Ireland
| | - Paul Ciolek
- Chicago Medical School of Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Osman Ahmed
- Section of Interventional Radiology, Department of Radiology, the University of Chicago Medical Center, Chicago, Illinois
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3
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Cohen O, Caiano LM, Levy-Mendelovich S. Cancer-associated splanchnic vein thrombosis: Clinical implications and management considerations. Thromb Res 2024; 234:75-85. [PMID: 38183815 DOI: 10.1016/j.thromres.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024]
Abstract
Splanchnic vein thrombosis (SVT), a thrombosis which involves the portal, mesenteric, and splenic veins, and the Budd-Chiari syndrome, represents an uncommon type of venous thromboembolism (VTE). Like with deep vein thrombosis of the lower extremities and pulmonary embolism, ample evidence suggests a significant association between SVT and cancer, particularly intra-abdominal solid malignancies (e.g. hepatobiliary and pancreatic cancers) and myeloproliferative neoplasms (MPN). Clinical symptoms of SVT in cancer patients can be ambiguous, and frequently attributed to the primary cancer itself. Alternatively, SVT may be asymptomatic and detected incidentally during cancer staging or follow-up evaluations. SVT can also precede the diagnosis of cancer and has been associated with poorer outcomes in patients with liver or pancreatic cancers. Therefore, an unprovoked SVT warrants a thorough evaluation for an underlying malignancy or MPN. Cancer-associated SVT carries a high risk of VTE extension, recurrence and bleeding. Extended anticoagulant treatment is often required in the absence of a high bleeding risk. Guidelines suggest treatment with either low molecular weight heparin (LMWH) or direct oral anticoagulants (DOACs), although available data on the safety and effectiveness of DOACs in these patients is limited. This comprehensive review outlines the epidemiology, pathogenesis, risk factors, and diagnosis of cancer-associated SVT and underscores the importance of comprehensive patient evaluation and evidence-based management.
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Affiliation(s)
- Omri Cohen
- National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel-Hashomer, Israel; School of Medicine, Tel Aviv University, Israel; Department of Medicine and Surgery, University of Insubria, Varese, Italy.
| | - Lucia Maria Caiano
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Sarina Levy-Mendelovich
- National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel-Hashomer, Israel; School of Medicine, Tel Aviv University, Israel
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4
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Sato R, Horiguchi S, Otsuka M. A Rare Case of Severe Colitis Associated With a Pancreatic Neuroendocrine Tumor. Gastroenterology 2024; 166:e13-e16. [PMID: 37495180 DOI: 10.1053/j.gastro.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Ryosuke Sato
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| | - Shigeru Horiguchi
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan.
| | - Motoyuki Otsuka
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
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5
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Beleva EA. Splanchnic Vein Thrombosis in Myelofibrosis-An Underappreciated Hallmark of Disease Phenotype. Int J Mol Sci 2023; 24:15717. [PMID: 37958701 PMCID: PMC10649007 DOI: 10.3390/ijms242115717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Splanchnic vein thrombosis (SVT) encompasses thrombosis in the vessels of the splanchnic basin and has a relatively rare occurrence with a reported frequency in the general population of 1-2%. An episode of seemingly unprovoked SVT almost always triggers a diagnostic work-up for a Philadelphia chromosome-negative myeloproliferative neoplasm (MPN), since atypical site thrombosis is a hallmark of MPN-associated thrombophilia. Primary myelofibrosis (PMF) is a rare MPN with an estimated incidence between 0.1 and 1/100,000 per year. Although prothrombotic tendency in PMF is not envisioned as a subject of specific therapeutic management, unlike other MPNs, such as polycythemia vera (PV) and essential thrombocythemia (ET), thrombotic risk and SVT prevalence in PMF may be comparably high. Additionally, unlike PV and ET, SVT development in PMF may depend more on procoagulant mechanisms involving endothelium than on blood cell activation. Emerging results from registry data also suggest that PMF patients with SVT may exhibit lower risk and better prognosis, thus highlighting the need for better thrombotic risk stratification and identifying a subset of patients with potential benefit from antithrombotic prophylaxis. This review highlights specific epidemiological, pathogenetic, and clinical features pertinent to SVT in myelofibrosis.
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Affiliation(s)
- Elina A. Beleva
- Clinic of Hematology, Military Medical Academy, 1606 Sofia, Bulgaria;
- QSAR and Molecular Modelling, Institute of Biophysics and Biomedical Engineering, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria
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6
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Schmidt SA, Beer M, Vogele D. [Update: Small bowel diseases in computed tomography and magnetic resonance imaging]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00117-023-01139-2. [PMID: 37016034 DOI: 10.1007/s00117-023-01139-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 04/06/2023]
Abstract
CLINICAL/METHODICAL ISSUE Radiological procedures play a crucial role in the diagnosis of small bowel disease. Due to a broad and quite nonspecific spectrum of symptoms, clinical evaluation is often difficult, and endoscopic procedures require significant manpower, are time-consuming and expensive. In contrast, radiologic imaging can provide important information about morphologic and functional variations of the small bowel and help to identify various disease entities, such as inflammation, tumors, vascular problems, and obstruction. STANDARD RADIOLOGICAL METHODS The most common radiological modalities in small bowel diagnostics include ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and fluoroscopy. Each of these modalities has its own advantages and limitations, and the choice of imaging modality depends on clinical symptoms and suspected diagnosis in addition to availability. METHODOLOGICAL INNOVATIONS In recent years, significant progress has been made, especially in cross-sectional imaging modalities, as a result of new and further technical developments. PERFORMANCE These range from increasing detail resolution to functional and molecular imaging techniques that go far beyond simple morphology. In addition, information technology (IT) applications, which include artificial intelligence and radiomics, are assuming an increasing role. ACHIEVEMENTS Many of the methods mentioned are still in early stages and need to be further developed for daily practice, but some have already found their way into clinical routine. PRACTICAL RECOMMENDATIONS The aim of this work is to provide a review of the most important disease entities of the small intestine, including new and innovative diagnostic approaches.
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Affiliation(s)
- Stefan Andreas Schmidt
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
| | - Meinrad Beer
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - Daniel Vogele
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
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7
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Demelo-Rodríguez P, Ordieres-Ortega L, Oblitas CM. Mesenteric venous thrombosis. Med Clin (Barc) 2023; 160:400-406. [PMID: 36849315 DOI: 10.1016/j.medcli.2023.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 02/27/2023]
Abstract
Mesenteric vein thrombosis (MVT) is a rare condition that can present acutely, subacutely, or chronically. MVT can be isolated or within a splanchnic thrombosis (spleno-porto-mesenteric). Symptomatic cases usually present as nonspecific abdominal pain, with or without signs of intestinal ischemia, and the diagnosis is usually made by imaging test (abdominal CT or MRI) in patients with high clinical suspicion. An early clinical-surgical approach is recommended to screen those patients with warning signs and who benefit from an exploratory laparotomy in addition to anticoagulant treatment, which is the cornerstone of medical treatment. MVT is usually associated with prothrombotic states, with hematological disorders (myeloproliferative syndromes and/or JAK2 gene mutations) being of special clinical relevance. On the other hand, the 5-year survival rate is 70-82% and early overall 30-day mortality from MVT can reach 20-32%.
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Affiliation(s)
- Pablo Demelo-Rodríguez
- Unidad de Enfermedad Tromboembólica Venosa, Departamento de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España; Facultad de Medicina, Universidad CEU San Pablo, Madrid, España.
| | - Lucía Ordieres-Ortega
- Unidad de Enfermedad Tromboembólica Venosa, Departamento de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Crhistian-Mario Oblitas
- Unidad de Enfermedad Tromboembólica Venosa, Departamento de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
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Brenner DM, Brandt LJ, Fenster M, Hamilton MJ, Kamboj AK, Oxentenko AS, Wang B, Chey WD. Rare, Overlooked, or Underappreciated Causes of Recurrent Abdominal Pain: A Primer for Gastroenterologists. Clin Gastroenterol Hepatol 2023; 21:264-279. [PMID: 36180010 DOI: 10.1016/j.cgh.2022.09.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 01/28/2023]
Abstract
Recurrent abdominal pain is a common reason for repeated visits to outpatient clinics and emergency departments, reflecting a substantial unmet need for timely and accurate diagnosis. A lack of awareness of some of the rarer causes of recurrent abdominal pain may impede diagnosis and delay effective management. This article identifies some of the key rare but diagnosable causes that are frequently missed by gastroenterologists and provides expert recommendations to support recognition, diagnosis, and management with the ultimate aim of improving patient outcomes.
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Affiliation(s)
- Darren M Brenner
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Lawrence J Brandt
- Division of Gastroenterology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Marc Fenster
- Division of Gastroenterology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Matthew J Hamilton
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts
| | - Amrit K Kamboj
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Amy S Oxentenko
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona
| | - Bruce Wang
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - William D Chey
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
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9
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Lin B, Zhang YP, Xue LY, Ye Y, Tang Y, Yang CS, Luo JW, Gao MZ, Fang ZT. A clinical analysis of intestinal mucosal necrosis and exfoliation induced by superior mesenteric vein thrombosis: A case report. Front Surg 2023; 9:988195. [PMID: 36700010 PMCID: PMC9870673 DOI: 10.3389/fsurg.2022.988195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/07/2022] [Indexed: 01/11/2023] Open
Abstract
Background Superior mesenteric vein (SMV) thrombosis is a rare intestinal ischemic disease. The clinical manifestations of patients differ, and most experience gastrointestinal symptoms. Case summary A 45-year-old female patient presented with persistent abdominal pain and abnormal vaginal bleeding for 7 days. A physical examination revealed significant abdominal tenderness with positive rebound tenderness. A laboratory examination revealed a white blood cell count of 27 × 109/l, hemoglobin level of 52 g/L, and D-dimer of 4.54 mg/l. Enhanced computed tomography revealed a thickening and swelling of the jejunum and ileum in the left upper quadrant and portal vein. Filling defects in the main lumen and branch lumen suggested the possibility of portal vein and superior mesenteric vein thrombosis. Symptoms improved after treatment with low-molecular-weight heparin and warfarin. One month later, the patient developed occasional dull pain in the left lower quadrant, with long strips of discharge. An electronic colonoscopy revealed avascular necrosis and tissue exfoliation of the intestinal mucosa. After the continuation of warfarin therapy, the abdominal pain resolved. Five months later, the patient experienced recurrent abdominal pain and vomiting. A physical examination revealed a blood pressure of 75/49 mm Hg. An incomplete ileus with the portal and superior mesenteric vein thrombosis was diagnosed, partial jejunectomy and gastrointestinal bypass anastomosis were performed, and warfarin was continued postoperatively. Conclusion The intestinal mucosal shedding observed, in this case, was caused by SMV thrombosis, which enriched the clinical manifestations of the disease and provided a new basis for the clinical diagnosis of SMV thrombosis.
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Affiliation(s)
- Bin Lin
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Yan-ping Zhang
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Lin-ying Xue
- Department of Geriatrics, Fujian Provincial Geriatric Hospital, Fuzhou, China
| | - Ying Ye
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Yi Tang
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China,Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, China
| | - Chang Shun Yang
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Jie-wei Luo
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China,Correspondence: Jie-wei Luo Mei-zhu Gao Zhu-ting Fang
| | - Mei-zhu Gao
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China,Department of Nephrology, Fujian Provincial Hospital, Fuzhou, China,Correspondence: Jie-wei Luo Mei-zhu Gao Zhu-ting Fang
| | - Zhu-ting Fang
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China,Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, China,Correspondence: Jie-wei Luo Mei-zhu Gao Zhu-ting Fang
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10
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Wang L, Guo X, Bai Z, Yin Y, Xu S, Pan J, Mancuso A, Noronha Ferreira C, Qi X. Impact of Asymptomatic Superior Mesenteric Vein Thrombosis on the Outcomes of Patients with Liver Cirrhosis. Thromb Haemost 2022; 122:2019-2029. [PMID: 36179738 DOI: 10.1055/s-0042-1756648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND The impact of asymptomatic superior mesenteric vein (SMV) thrombosis on the outcomes of cirrhotic patients remains uncertain. METHODS Nonmalignant cirrhotic patients who were consecutively admitted between December 2014 and September 2021 and underwent contrast-enhanced computed tomography/magnetic resonance imaging scans were screened. Portal venous system thrombosis (PVST) was identified. Death and hepatic decompensation were the outcomes of interest. Nelson-Aalen cumulative risk curve analysis and competing risk regression analysis were performed to evaluate the impact of asymptomatic SMV thrombosis and portal vein thrombosis (PVT) on the outcomes. RESULTS Overall, 475 patients were included, of whom 67 (14.1%) had asymptomatic SMV thrombosis, 95 (20%) had PVT, and 344 (72.4%) did not have any PVST. Nelson-Aalen cumulative risk curve analyses showed that the cumulative incidences of death (p = 0.653) and hepatic decompensation (p = 0.630) were not significantly different between patients with asymptomatic SMV thrombosis and those without PVST, but the cumulative incidences of death (p = 0.021) and hepatic decompensation (p = 0.004) were significantly higher in patients with PVT than those without PVST. Competing risk regression analyses demonstrated that asymptomatic SMV thrombosis was not a significant risk factor for death (subdistribution hazard ratio [sHR] = 0.89, p = 0.65) or hepatic decompensation (sHR = 1.09, p = 0.63), but PVT was a significant risk factor for death (sHR = 1.56, p = 0.02) and hepatic decompensation (sHR = 1.50, p = 0.006). These statistical results remained in competing risk regression analyses after adjusting for age, sex, and Child-Pugh score. CONCLUSION Asymptomatic SMV thrombosis may not influence the outcomes of cirrhotic patients. The timing of intervention for asymptomatic SMV thrombosis in liver cirrhosis should be further explored.
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Affiliation(s)
- Le Wang
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, China Medical University, Shenyang, China
| | - Xiaozhong Guo
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, China Medical University, Shenyang, China
| | - Zhaohui Bai
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, Shenyang Pharmaceutical University, Shenyang, China
| | - Yue Yin
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Shixue Xu
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, China Medical University, Shenyang, China
| | - Jiahui Pan
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, Shenyang Pharmaceutical University, Shenyang, China
| | - Andrea Mancuso
- Medicina Interna 1, Azienda di Rilievo Nazionale ad Alta Specializzazione Civico, Di Cristina-Benfratelli, Palermo, Italy
| | - Carlos Noronha Ferreira
- Serviço De Gastrenterologia e Hepatologia, Hospital De Santa Maria-Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Xingshun Qi
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, China Medical University, Shenyang, China
- Postgraduate College, Shenyang Pharmaceutical University, Shenyang, China
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Inferior Mesenteric Vein Thrombosis Resulting in Pylephlebitis in a Patient With Inflammatory Bowel Disease. ACG Case Rep J 2022; 9:e00903. [DOI: 10.14309/crj.0000000000000903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 09/05/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
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12
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Lin CH, Yang CJ, Tsai YD, Yang CW, Ke HY, Chou HK. Young Man with Epigastric Pain. Ann Emerg Med 2022; 80:e25-e26. [PMID: 35995526 DOI: 10.1016/j.annemergmed.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Cheng-Han Lin
- Department of Emergency Medicine, Tri-Service General Hospital SongShan branch, National Defense Medical Center, Taipei, Taiwan; Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Jen Yang
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Da Tsai
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Wei Yang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hung-Yen Ke
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hua-Kang Chou
- Department of Internal Medicine, Tri-Service General Hospital SongShan branch, National Defense Medical Center, Taipei, Taiwan
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13
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Darshit D, Srikant S, Kibanda D, Michael O. Outcomes of bowel resection following non-mechanical intestinal obstruction due to mesenteric vein thrombosis in Uganda: A case series. Int J Surg Case Rep 2022; 98:107542. [PMID: 36027826 PMCID: PMC9424601 DOI: 10.1016/j.ijscr.2022.107542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction and importance Mesenteric venous thrombosis (MVT) is one of the common occlusive causes of compromised bowel perfusion. Contrast-enhanced CT angiography is the diagnostic imaging study of choice for MVT. In-hospital mortality following acute mesenteric infarction is 63 %. Surgical resection may be life saving for patients with peritoneal signs or refractory to conservative management. Case presentation We consecutively included records of five patients from Lubaga Hospital with intestinal obstruction who underwent bowel resection following intraoperatively confirmed acute mesenteric ischemia between May 2017 and November 2021. Three of the patients were female. Patients were between 21 and 45 years. One patient had comorbid conditions and an identifiable underlying etiology of polycythemia for MVT. Duration of symptoms ranged from 1 to 11 days. All patients underwent open laparotomy, the length of bowel resection ranged from 77 cm to 600 cm (mean length of 337 cm). Two patients developed short bowel syndrome (SBS) and one patient developed intestinal fistula. There was one in-hospital death due to multi-organ failure. Clinical discussion Morbidity and mortality are associated with delay to diagnose the condition. Revascularization is the primary goal, resection of all non-viable regions and preservation of viable bowel. Mortality is commonly related to multi-organ failure. Advanced intensive care and parenteral nutrition have improved survival rates over the years. 2-year and 5-year survival rates have been reported to be 70 % and 50 %. Conclusion Good outcomes are still possible for post-operatively optimized patients despite the high mortality and morbidity associated with bowel resection following extensive mesenteric thrombosis.
Despite high morbidity and mortality of mesenteric thrombosis, good outcomes are possible in optimized patients. Short bowel syndrome and fistulae are a major course of morbidity in massive bowel resected patients. Surgery is indicated for patients with peritoneal signs and those refractory to conservative management.
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14
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Sudden and unexpected deaths due to non-traumatic abdominal disorders: A forensic perspective. J Forensic Leg Med 2022; 89:102355. [PMID: 35512523 DOI: 10.1016/j.jflm.2022.102355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/08/2022] [Accepted: 04/23/2022] [Indexed: 12/22/2022]
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15
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Yang F, Guo XC, Rao XL, Sun L, Xu L. Acute appendicitis complicated by mesenteric vein thrombosis: A case report. World J Clin Cases 2021; 9:11400-11405. [PMID: 35071571 PMCID: PMC8717517 DOI: 10.12998/wjcc.v9.i36.11400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 06/29/2021] [Accepted: 11/18/2021] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Fan Yang
- Department of General Surgery, Peking University First Hospital, Beijing 100034, Beijing Province, China
| | - Xiao-Chao Guo
- Department of Radiology, Peking University First Hospital, Beijing 100034, Beijing Province, China
| | - Xiao-Long Rao
- Endoscopy Center, Peking University First Hospital, Beijing 100034, Beijing Province, China
| | - Lie Sun
- Department of General Surgery, Peking University First Hospital, Beijing 100034, Beijing Province, China
| | - Ling Xu
- Breast Disease Center, Peking University First Hospital, Beijing 100034, Beijing Province, China
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16
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Sharma S, Henkin S, Young MN. Renovascular Disease and Mesenteric Vascular Disease. Cardiol Clin 2021; 39:527-537. [PMID: 34686265 DOI: 10.1016/j.ccl.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Renal artery stenosis is caused by atherosclerosis and fibromuscular dysplasia and is associated with ischemic nephropathy, renovascular hypertension, and accelerated cardiovascular disease. Routine screening for renal artery stenosis is not recommended but is reasonable in patients who have rapid onset of hypertension, resistant hypertension, progressive renal insufficiency, recurrent pulmonary edema, or repeat admissions for heart failure. Acute mesenteric ischemia is caused by arterial embolism or thrombosis, mesenteric venous thrombosis, or nonocclusive mesenteric ischemia, whereas chronic mesenteric ischemia is most often caused by arterial obstruction. This article reviews the epidemiology, pathophysiology, diagnosis, and management of these two conditions.
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Affiliation(s)
- Swapna Sharma
- The Elliot Hospital, 1 Elliot Way, Manchester, NH 03103, USA
| | - Stanislav Henkin
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Michael N Young
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
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17
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Ju C, Li X, Gadani S, Kapoor B, Partovi S. Portal Vein Thrombosis: Diagnosis and Endovascular Management. ROFO-FORTSCHR RONTG 2021; 194:169-180. [PMID: 34649289 DOI: 10.1055/a-1642-0990] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Portal vein thrombosis (PVT) is a rare but severe entity that can cause clinically significant sequela such as worsening portal hypertension or mesenteric ischemia. Those cases refractory to medical management may be referred for endovascular intervention. Several technical considerations have been described in the literature, but a cohesive comparison of these multiple techniques is lacking. METHODS The purpose of this article is to review the diagnosis and endovascular management of PVT, including areas in which further research is warranted. RESULTS Cases of PVT can be readily diagnosed using ultrasound, computed tomography, or magnetic resonance imaging. Treatment often begins with systemic anticoagulation and endovascular interventions may be used in selected cases. Determining the optimal approach to accessing the portal venous system depends on the underlying disease and chronicity of the thrombus and the degree of occlusion. Once access to the portal venous system is established, catheter-directed therapy may be performed to achieve recanalization. CONCLUSION Despite the heterogeneity in patient presentation, cases of PVT can be readily diagnosed across several imaging modalities. Strategizing interventional approaches involves evaluation of the underlying disease and the chronicity of the thrombus. KEY POINTS · This review will enable interventionalists to establish a framework for treating portal vein thrombosis by identifying patient risk factors and thrombus characteristics that determine patient management.. · The unique risks and benefits for transhepatic, transsplenic, and transmesenteric approaches for establishing portal venous access will be discussed.. · Advantages and complications of thrombolysis, thrombectomy, and transjugular intrahepatic portosystemic shunt creation for treating portal vein thrombosis will be reviewed in detail based on our extensive institutional experience.. CITATION FORMAT · Ju C, Li X, Gadani S et al. Portal Vein Thrombosis: Diagnosis and Endovascular Management. Fortschr Röntgenstr 2021; DOI: 10.1055/a-1642-0990.
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Affiliation(s)
- Connie Ju
- Radiology, University of California Los Angeles Health System, Los Angeles, United States
| | - Xin Li
- Radiology, University of Pennsylvania Health System, Philadelphia, United States
| | - Sameer Gadani
- Interventional Radiology, Cleveland Clinic Foundation, Cleveland, United States
| | - Baljendra Kapoor
- Interventional Radiology, Cleveland Clinic Foundation, Cleveland, United States
| | - Sasan Partovi
- Interventional Radiology, Cleveland Clinic Foundation, Cleveland, United States
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18
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Okobi OE, Dawkins B, Saoji J, Nyabera K, Metellus D, Hapshy V, Osueni A, Gunawardene IA, Dorcé-Medard J. Recurrent Acute Pancreatitis and Superior Mesenteric Venous Thrombosis - Cause or Course. Cureus 2021; 13:e18558. [PMID: 34765342 PMCID: PMC8575324 DOI: 10.7759/cureus.18558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/05/2022] Open
Abstract
The management of pancreatitis can be daunting, especially when associated with other comorbidities. These complexities in management are conflicting in the presence of comorbidities with a similar presentation, such as abdominal pain. Acute pancreatitis (AP) has been associated with mesenteric thrombosis but less commonly with superior mesenteric vein thrombosis (SMVT) as a causal or complicating dilemma. This case report describes the careful intrigues and overlaps in presentation. Furthermore, this paper presents a dilemma in that contrast-enhanced computed tomography (CT) may not be recommended in the early stage of diagnosis of AP according to the 2013 American College of Gastroenterology (ACG) guideline, but SMVT, which can be fatal, sometimes, complicates AP, and contrast-enhanced CT is important in its diagnosis. This paper attempts to address this dilemma. Managing these two potentially fatal pathologies requires promptness and thoughtfulness in averting a deadly outcome. Because SMVT is fatal, in this paper, we reiterate the use of contrast-enhanced CT in the early stages of the management of AP. Fatal complications from AP should not be missed. Although contrast-enhanced CT is not recommended in the early stages of diagnosis of AP in the ACG guideline, fatal complications such as SMVT can be avoided.
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Affiliation(s)
- Okelue E Okobi
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Bryan Dawkins
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Janaki Saoji
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Kevin Nyabera
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | | | - Vera Hapshy
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Azeberoje Osueni
- Nephrology, Brookdale University Hospital Medical Center, New York, USA
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19
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Umbrello M, Brena N, Vercelli R, Foa RA, Femia M, Rossi U, Podda GM, Cortellaro F, Muttini S. Successful treatment of acute spleno-porto-mesenteric vein thrombosis after ChAdOx1 nCoV-19 vaccine. A case report. J Crit Care 2021; 65:72-75. [PMID: 34111682 PMCID: PMC9735233 DOI: 10.1016/j.jcrc.2021.05.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/17/2021] [Accepted: 05/31/2021] [Indexed: 12/14/2022]
Abstract
Several cases of deep venous thrombosis in people who had recently received Vaxzevria (previously known as COVID-19 Vaccine AstraZeneca) have recently been reported, mainly presenting as cerebral vein/cerebral venous sinus thrombosis. This syndrome has been termed "vaccine-induced immune thrombotic thrombocytopenia (VITT)". Acute spleno-porto-mesenteric vein thrombosis is an uncommon but serious condition with potential sequelae, such as small-bowel gangrene and end-stage liver failure. We describe a case of concomitant thrombosis of portal, superior mesenteric and splenic veins in a young female patient with no other risk factors who received Vaxzevria (previously ChAdOx1 nCoV-19 vaccine, AstraZeneca) 17 days before. The diagnostic workup and the successful endovascular treatment and systemic anticoagulation management is reported.
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Affiliation(s)
- Michele Umbrello
- SC Anestesia e Rianimazione II, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo – Polo Universitario, Milano, Italy,Corresponding author at: U.O. Anestesia e Rianimazione II, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo – Polo Universitario, Via Pio II, 3, 20153 Milano, Italy
| | - Nicola Brena
- SC Pronto Soccorso e Degenza Breve, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo – Polo Universitario, Milano, Italy
| | - Ruggero Vercelli
- SC Radiologia I, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo – Polo Universitario, Milano, Italy
| | - Riccardo Alessandro Foa
- SC Radiologia I, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo – Polo Universitario, Milano, Italy
| | - Marco Femia
- SC Radiologia I, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo – Polo Universitario, Milano, Italy
| | - Umberto Rossi
- SSD UO a Direzione Universitaria di Radiologia Vascolare ed Interventistica, Ospedale Galliera, Genova, Italy
| | - Gian Marco Podda
- SC Medicina Generale II, Ospedale Paolo, ASST Santi Paolo e Carlo – Polo Universitario, Milano, Italy
| | - Francesca Cortellaro
- SC Pronto Soccorso e Degenza Breve, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo – Polo Universitario, Milano, Italy
| | - Stefano Muttini
- SC Anestesia e Rianimazione II, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo – Polo Universitario, Milano, Italy
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20
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Lee HA, Kim SE, Jung DW, Byeon JR, Choe AR, Tae CH, Moon CM, Jung HK, Shim KN, Jung SA. Small Bowel Necrosis Associated with Catastrophic Antiphospholipid Syndrome: A Case Report. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 77:294-299. [PMID: 34158449 DOI: 10.4166/kjg.2021.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/17/2021] [Accepted: 04/12/2021] [Indexed: 11/03/2022]
Abstract
Catastrophic antiphospholipid syndrome is a highly fatal condition characterized by widespread thromboembolism subsequent to a triggering factor (e.g., infection, trauma, and neoplasia) in antiphospholipid antibody-positive patients. This paper reports a case of a 29-year-old male without the underlying disease who developed extensive mesenteric thromboembolism and jejunal necrosis during the treatment for acute enteritis. The patient's condition was improved with low-molecular-weight heparin and an intravenous Ig treatment with emergency surgery. The serum antiphospholipid (anticardiolipin IgM) and lupus anticoagulant antibody tests showed positive results. Acute infectious enterocolitis is generally considered a mild disease. On the other hand, aggressive evaluation and treatment should be considered if the clinical conditions do not improve and deteriorate rapidly despite appropriate antibiotic treatment because of the possibility of acute immunological complications, such as catastrophic antiphospholipid syndrome.
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Affiliation(s)
- Hyun Ae Lee
- Department of Internal Medicine, Ewha Womans University, College of Medicine, Seoul, Korea
| | - Seong-Eun Kim
- Department of Internal Medicine, Ewha Womans University, College of Medicine, Seoul, Korea
| | - Do Woung Jung
- Department of Internal Medicine, Ewha Womans University, College of Medicine, Seoul, Korea
| | - Ju Ran Byeon
- Department of Internal Medicine, Ewha Womans University, College of Medicine, Seoul, Korea
| | - A Reum Choe
- Department of Internal Medicine, Ewha Womans University, College of Medicine, Seoul, Korea
| | - Chung Hyun Tae
- Department of Internal Medicine, Ewha Womans University, College of Medicine, Seoul, Korea
| | - Chang Mo Moon
- Department of Internal Medicine, Ewha Womans University, College of Medicine, Seoul, Korea
| | - Hye Kyung Jung
- Department of Internal Medicine, Ewha Womans University, College of Medicine, Seoul, Korea
| | - Ki Nam Shim
- Department of Internal Medicine, Ewha Womans University, College of Medicine, Seoul, Korea
| | - Sung Ae Jung
- Department of Internal Medicine, Ewha Womans University, College of Medicine, Seoul, Korea
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21
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Feldman ZM, Wang LJ, Chou EL, Latz CA, Sumpio BJ, Eagleton MJ, Conrad MF. Venous mesenteric ischemia carries high procedural burden and elevated mortality in patients with severe presentation. J Vasc Surg Venous Lymphat Disord 2021; 9:1479-1487. [PMID: 33741519 DOI: 10.1016/j.jvsv.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/04/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Venous mesenteric ischemia (VMI) presents with variable severity resulting in a spectrum of outcomes. This study sought to characterize the natural history of VMI and identify drivers of intervention and adverse outcomes. METHODS All patients who presented to our institution with acute and subacute VMI between 1993 and 2016 were identified. Images were reviewed to determine thrombosis location and charts were reviewed to identify clinical factors and outcomes. Univariate analysis was performed for demographics, comorbidities, and presenting characteristics, with primary outcomes of intervention, readmission, and 30-day mortality. A survival analysis was performed with log-rank difference testing for demographics, comorbidities, and presenting characteristics. RESULTS We identified 103 patients with acute and subacute VMI. The locations of the thrombosis included the superior mesenteric vein (SMV) (31.1%); SMV and portal vein (35.9%); SMV, portal, and splenic veins (15.5%); and other combinations of portomesenteric veins (17.4%), without correlation between the location and outcomes. Most patients were male (60.6%), 22.3% were actively smoking, and the median Charlson comorbidity score was 4 (interquartile range, 2-7). The mean patient age was 61.3 years. More than one-half had a known hypercoagulability (52.4%), 22.3% had prior bowel resection, and 8.7% had prior mesenteric venous intervention, including transjugular intrahepatic portosystemic shunt procedures. Thirty-five patients underwent 83 procedures during their hospitalization, and 23 patients underwent surgical intervention specifically. Prior mesenteric venous procedure, abdominal tenderness, and lactatemia of more than 1.5 mmol/L were associated with an increased need for surgical intervention (P < .05). Patients with leukocytosis of greater than 10K/μL had increased surgical intervention (P = .10), although without statistical significance. However, symptoms for less than 2 weeks (P < .05) were associated with decreased surgical intervention. The 30-day mortality was low in this cohort (6.8%), but was increased in patients requiring intervention (11.4%). For those undergoing procedures, a shorter time to intervention was associated with an improved 30-day mortality (8.7% for procedures on hospital days 0-1 vs 16.7% for hospital day 2 or later; P = .01). Abdominal tenderness and lactatemia were associated with increased 30-day mortality (6.8% vs 3.6% [P < .01] and 16.0% vs 3.8% [P = .03], respectively). A Kaplan-Meier survival analysis revealed a median survival of 7.1 years, with a 1-year survival rate of 74.9%, a 3-year survival rate of 67.1%, and a 5-year survival rate of 57.9%. Negative predictors of survival included a higher Charlson comorbidity index (hazard ratio, 3.7; P < .01) and malignancy (hazard ratio, 3.1; P < .01). CONCLUSIONS The 30-day mortality of VMT is low, but more than one-third of patients required an intervention beyond anticoagulation. Comorbidity, a prior mesenteric vessel or intestinal operation, and presentation with tenderness or relevant laboratory abnormalities portend worse outcomes. Early intervention is associated with improved outcomes.
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Affiliation(s)
- Zach M Feldman
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass.
| | | | - Elizabeth L Chou
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Christopher A Latz
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Brandon J Sumpio
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Matthew J Eagleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Mark F Conrad
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
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22
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Zhao H, Meng Y, Zhang P, Zhang Q, Wang F, Li Y. Predictors and risk factors for intestinal necrosis in patients with mesenteric ischemia. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:337. [PMID: 33708964 PMCID: PMC7944323 DOI: 10.21037/atm-20-8154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Mesenteric ischemia results in blood flow that is insufficient to meet metabolic demands and subsequent dysfunction of visceral organs, including arterial obstruction and venous thrombosis. Sustained mesenteric ischemia exhausts the ability of capillaries to provide oxygen and initiate an inflammatory reaction, and eventually leads to intestinal mucosal necrosis, a serious and potentially life-threatening condition. Therefore, it is essential that the predictors and risk factors for intestinal necrosis in patients with mesenteric thrombus are explored. Methods This study retrospectively enrolled 41 patients with mesenteric ischemia (including mesenteric vein embolism, mesenteric artery thrombosis, and portal vein thrombosis) who were admitted to the Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital between May 2016 and October 2019; of the patients, 18 were further diagnosed with intestinal necrosis. Comparisons of symptoms, computed tomography angiography (CTA) features, and laboratory examination results were performed between mesenteric ischemia patients with and without intestinal necrosis. Results White blood cell count showed an excellent predictive ability for intestinal necrosis in patients with mesenteric ischemia, with an area under the receiver operating characteristic (ROC) curve of 0.772 (P=0.009). The four CTA features [pneumatosis (P=0.016), intestinal swelling (P=0.006), ascitic fluid (P<0.001), and decreased intestinal wall enhancement (P=0.004)] differed significantly between patients with and without intestinal necrosis. Peritonitis showed a strong association with intestinal necrosis (P=0.006) in the univariate analysis, and multivariate analysis further showed their association [odds ratio (OR): 8.53; 95%CI: 1.46-49.81; P=0.017]. Conclusions White blood cell count is a potential predictor of intestinal necrosis. Peritonitis is a possible risk factor for intestinal necrosis in patients with mesenteric ischemia. A multi-center prospective study with a larger sample size needs to be performed to further investigate these findings.
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Affiliation(s)
- Hongwei Zhao
- Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yiting Meng
- Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Peng Zhang
- Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Qian Zhang
- Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Feng Wang
- Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yuanxin Li
- Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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23
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Naymagon L, Tremblay D, Zubizarreta N, Moshier E, Naymagon S, Mascarenhas J, Schiano T. The Natural History, Treatments, and Outcomes of Portal Vein Thrombosis in Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis 2021; 27:215-223. [PMID: 32185400 PMCID: PMC8427727 DOI: 10.1093/ibd/izaa053] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Portal vein thrombosis (PVT) is a poorly described complication of inflammatory bowel disease (IBD). We sought to better characterize presentations, compare treatments, and assess outcomes in IBD-related PVT. METHODS We conducted a retrospective investigation of IBD-related PVT at our institution. Multivariable Cox proportional hazards modeling was used to estimate adjusted hazard ratios across treatments. RESULTS Sixty-three patients with IBD-related PVT (26 with Crohn disease, 37 with ulcerative colitis) were followed for a median 21 months (interquartile ratio [IQR] = 9-52). Major risk factors included intra-abdominal surgery (60%), IBD flare (33%), and intra-abdominal infection (13%). Primary hematologic thrombophilias were rare and did not impact management. Presentations were generally nonspecific, and diagnosis was incidental. Ninety-two percent of patients (58/63) received anticoagulation (AC), including 23 who received direct oral anticoagulants (DOACs), 22 who received warfarin, and 13 who received enoxaparin. All anticoagulated patients started AC within 3 days of diagnosis. Complete radiographic resolution (CRR) of PVT occurred in 71% of patients. We found that DOACs were associated with higher CRR rates (22/23; 96%) relative to warfarin (12/22; 55%): the hazard ratio of DOACs to warfarin was 4.04 (1.83-8.93; P = 0.0006)). Patients receiving DOACs required shorter courses of AC (median 3.9 months; IQR = 2.7-6.1) than those receiving warfarin (median 8.5 months; IQR = 3.9-NA; P = 0.0190). Incidence of gut ischemia (n = 3), symptomatic portal hypertension (n = 3), major bleeding (n = 4), and death (n = 2) were rare, and no patients receiving DOACs experienced these adverse outcomes. CONCLUSIONS We show that early and aggressive use of AC can lead to excellent outcomes in IBD-associated PVT and that DOACs are associated with particularly favorable outcomes in this setting.
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Affiliation(s)
- Leonard Naymagon
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Douglas Tremblay
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nicole Zubizarreta
- Department of Population Health Science and Policy/Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Erin Moshier
- Department of Population Health Science and Policy/Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Steven Naymagon
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John Mascarenhas
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thomas Schiano
- Division of Liver Diseases, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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24
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Knight CG, Heitmann PT, McDonald CR. Clostridium cadaveris bacteraemia with associated superior mesenteric vein thrombus. ANZ J Surg 2021; 91:E531-E532. [PMID: 33417738 DOI: 10.1111/ans.16538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/06/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Casey G Knight
- Colorectal Surgery Unit, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Paul T Heitmann
- Colorectal Surgery Unit, Lyell McEwin Hospital, Adelaide, South Australia, Australia
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25
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Nainani V, Oo J, Ban EJ. Superior mesenteric vein thrombus as a complication of acute appendicitis. ANZ J Surg 2020; 91:1631-1632. [PMID: 33368952 DOI: 10.1111/ans.16513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/20/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Viveka Nainani
- Department of Hepatopancreatobiliary Surgery, Alfred Health, Melbourne, Victoria, Australia
| | - June Oo
- Department of Hepatopancreatobiliary Surgery, Alfred Health, Melbourne, Victoria, Australia
| | - Ee Jun Ban
- Department of Hepatopancreatobiliary Surgery, Alfred Health, Melbourne, Victoria, Australia
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26
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Jiang M, Li CL, Pan CQ, Lv WZ, Ren YF, Cui XW, Dietrich CF. Nomogram for predicting transmural bowel infarction in patients with acute superior mesenteric venous thrombosis. World J Gastroenterol 2020; 26:3800-3813. [PMID: 32774059 PMCID: PMC7383843 DOI: 10.3748/wjg.v26.i26.3800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/23/2020] [Accepted: 06/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The prognosis of acute mesenteric ischemia (AMI) caused by superior mesenteric venous thrombosis (SMVT) remains undetermined and early detection of transmural bowel infarction (TBI) is crucial. The predisposition to develop TBI is of clinical concern, which can lead to fatal sepsis with hemodynamic instability and multi-organ failure. Early resection of necrotic bowel could improve the prognosis of AMI, however, accurate prediction of TBI remains a challenge for clinicians. When determining the eligibility for explorative laparotomy, the underlying risk factors for bowel infarction should be fully evaluated. AIM To develop and externally validate a nomogram for prediction of TBI in patients with acute SMVT. METHODS Consecutive data from 207 acute SMVT patients at the Wuhan Tongji Hospital and 89 patients at the Guangzhou Nanfang Hospital between July 2005 and December 2018 were included in this study. They were grouped as training and external validation cohort. The 207 cases (training cohort) from Tongji Hospital were divided into TBI and reversible intestinal ischemia groups based on the final therapeutic outcomes. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for TBI using the training data, and a nomogram was subsequently developed. The performance of the nomogram was evaluated with respect to discrimination, calibration, and clinical usefulness in the training and external validation cohort. RESULTS Univariate and multivariate logistic regression analyses identified the following independent prognostic factors associated with TBI in the training cohort: The decreased bowel wall enhancement (OR = 6.37, P < 0.001), rebound tenderness (OR = 7.14, P < 0.001), serum lactate levels > 2 mmol/L (OR = 3.14, P = 0.009) and previous history of deep venous thrombosis (OR = 6.37, P < 0.001). Incorporating these four factors, the nomogram achieved good calibration in the training set [area under the receiver operator characteristic curve (AUC) 0.860; 95%CI: 0.771-0.925] and the external validation set (AUC 0.851; 95%CI: 0.796-0.897). The positive and negative predictive values (95%CIs) of the nomogram were calculated, resulting in positive predictive values of 54.55% (40.07%-68.29%) and 53.85% (43.66%-63.72%) and negative predictive values of 93.33% (82.14%-97.71%) and 92.24% (85.91%-95.86%) for the training and validation cohorts, respectively. Based on the nomogram, patients who had a Nomo-score of more than 90 were considered to have high risk for TBI. Decision curve analysis indicated that the nomogram was clinically useful. CONCLUSION The nomogram achieved an optimal prediction of TBI in patients with AMI. Using the model, the risk for an individual patient inclined to TBI can be assessed, thus providing a rational therapeutic choice.
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Affiliation(s)
- Meng Jiang
- Sino-German Tongji-Caritas Research Center of Ultrasound in Medicine, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Chang-Li Li
- Department of Geratology, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan 430015, Hubei Province, China
| | - Chun-Qiu Pan
- Department of Emergency Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Wen-Zhi Lv
- Department of Artificial Intelligence, Julei Technology Company, Wuhan 430030, Hubei Province, China
| | - Yu-Fei Ren
- Department of Computer Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Xin-Wu Cui
- Sino-German Tongji-Caritas Research Center of Ultrasound in Medicine, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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Sun SL, Wang XY, Chu CN, Liu BC, Li QR, Ding WW. Predictors of irreversible intestinal resection in patients with acute mesenteric venous thrombosis. World J Gastroenterol 2020; 26:3625-3637. [PMID: 32742131 PMCID: PMC7366062 DOI: 10.3748/wjg.v26.i25.3625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/26/2020] [Accepted: 06/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute mesenteric venous thrombosis (AMVT) can cause a poor prognosis. Prompt transcatheter thrombolysis (TT) can achieve early mesenteric revascularization. However, irreversible intestinal ischemia still occurs and the mechanism is still unclear. AIM To evaluate the clinical outcomes of and to identify predictive factors for irreversible intestinal ischemia requiring surgical resection in AMVT patients treated by TT. METHODS The records of consecutive patients with AMVT treated by TT from January 2010 to October 2017 were retrospectively analyzed. We compared patients who required resection of irreversible intestinal ischemia to patients who did not require. RESULTS Among 58 patients, prompt TT was carried out 28.5 h after admission. A total of 42 (72.4%) patients underwent arteriovenous combined thrombolysis, and 16 (27.6%) underwent arterial thrombolysis alone. The overall 30-d mortality rate was 8.6%. Irreversible intestinal ischemia was indicated in 32 (55.2%) patients, who had a higher 30-d mortality and a longer in-hospital stay than patients without resection. The significant independent predictors of irreversible intestinal ischemia were Acute Physiology and Chronic Health Evaluation (APACHE) II score (odds ratio = 2.368, 95% confidence interval: 1.047-5.357, P = 0.038) and leukocytosis (odds ratio = 2.058, 95% confidence interval: 1.085-3.903, P = 0.027). Using the receiver operating characteristic curve, the cutoff values of the APACHE II score and leukocytosis for predicting the onset of irreversible intestinal ischemia were calculated to be 8.5 and 12 × 109/L, respectively. CONCLUSION Prompt TT could achieve a favorable outcome in AMVT patients. High APACHE II score and leukocytosis can significantly predict the occurrence of irreversible intestinal ischemia. Therefore, close monitoring of these factors may help with the early identification of patients with irreversible intestinal ischemia, in whom ultimately surgical resection is required, before the initiation of TT.
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Affiliation(s)
- Shi-Long Sun
- Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Xin-Yu Wang
- Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Cheng-Nan Chu
- Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Bao-Chen Liu
- Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Qiu-Rong Li
- Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Wei-Wei Ding
- Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
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Abstract
MR angiography is a flexible imaging technique enabling morphologic assessment of mesenteric arterial and venous vasculature. Conventional gadolinium-based contrast media and ferumoxytol are used as contrast agents. Ferumoxytol, an intravenous iron replacement therapy approved by the US Food and Drug Administration for iron deficiency anemia, is an effective and well tolerated blood pool contrast agent. The addition of 4D flow MR imaging enables a functional assessment of the arterial and venous vasculature; when coupled with a meal challenge, the severity of mesenteric arterial stenosis is well appreciated. Noncontrast MR angiographic techniques are useful for evaluating suspected mesenteric ischemia.
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Bailey KE, Tranovich MJ. Portal Venous Thrombosis Associated with Use of Etonogestrel/ethinyl Estradiol Vaginal Ring. Clin Pract Cases Emerg Med 2020; 4:263-266. [PMID: 32426689 PMCID: PMC7220020 DOI: 10.5811/cpcem.2020.1.44654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/30/2019] [Accepted: 01/01/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Portal venous thrombosis is a life-threatening cause of abdominal pain. In younger patients, heritable thrombophilias, pregnancy, tobacco use, and oral contraceptives are associated. Case Report A 26-year-old woman prescribed contraceptive vaginal ring presented with abdominal pain and was diagnosed with an extensive portal venous thrombosis. Management included heparin and later an oral anticoagulant with good short-term outcome. Discussion Women using hormonal contraception are approximately four times more likely to develop thromboembolism. Risk of thromboembolism is similar between users of intravaginal and oral contraceptives. Conclusion Portal venous thrombosis must be considered in women presenting with abdominal pain who are prescribed hormonal contraceptives, including intravaginal forms.
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Affiliation(s)
- Katelynn E Bailey
- Charleston Area Medical Center, Department of Emergency Medicine, Charleston, West Virginia
| | - Michael J Tranovich
- Allegheny Health Network, Department of Emergency Medicine, Canonsburg, Pennsylvania
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Liu K, Liu S, Li L, Wang S, Fan X, Wu X, Shi G, Zong H. Evaluation of Endovascular Therapy Combined with Bowel Resection Treatment on Patients with Acute Mesenteric Venous Thrombosis. Ann Vasc Surg 2020; 65:72-81. [DOI: 10.1016/j.avsg.2019.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 10/20/2019] [Accepted: 11/09/2019] [Indexed: 02/07/2023]
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Andraska E, Haga L, Reitz K, Li X, Ramos R, Avgerinos E, Singh M, Eslami M, Makaroun M, Chaer R. Acute superior mesenteric venous thrombosis results in high rates of readmission and morbidity. J Vasc Surg Venous Lymphat Disord 2020; 8:748-755. [PMID: 32139329 DOI: 10.1016/j.jvsv.2020.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/13/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Superior mesenteric venous thrombosis (MVT) is a poorly understood clinical entity, and as such, outcomes are poorly described. This study aimed to identify predictors of bowel ischemia after MVT and to compare outcomes for patients treated medically (group 1) with those for patients treated with bowel resection (group 2). METHODS This was a retrospective, single-institution study capturing all patients diagnosed with symptomatic acute MVT on computed tomography imaging from 2008 to 2018. Demographics, comorbidities, imaging, laboratory values, and treatment were included. Predictors of bowel resection were analyzed by univariate and multivariate statistics. Outcomes including mortality, readmissions for abdominal pain, and chronic mesenteric venous congestion were compared using χ2 test. RESULTS There were 121 patients included in the study; 98 patients were treated medically (group 1), 19 patients were treated with bowel resection (group 2), and 4 patients were treated with endovascular recanalization (group 3). Group 1 and group 2 were compared directly. Patients requiring bowel resection tended to have higher body mass index (P = .051) and a hypercoagulable disorder (P = .003). Patients who required bowel resection were more likely to present with lactic acidosis (P < .001) and leukocytosis (P < .001) with bowel wall thickening on scan (P < .001). On multivariable analysis, a genetic thrombophilia was a strong predictor of bowel ischemia (odds ratio, 3.81; 95% confidence interval, 1.12-12.37). One-year mortality and readmission rates did not differ between groups. However, readmission rates for abdominal pain were high for both groups (group 1, 44.90%; group 2, 57.89%; P = .317), and a significant proportion of patients exhibited chronic mesenteric venous congestion on repeated scan (group 1, 42.86%; group 2, 47.37%; P = .104). CONCLUSIONS A genetic hypercoagulable disorder is a predictor of bowel ischemia due to MVT. Regardless of treatment, outcomes after MVT are morbid, with high rates of readmission for abdominal pain. An alternative approach to treat these patients is needed, given the poor outcomes with current strategies.
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Affiliation(s)
- Elizabeth Andraska
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Lindsey Haga
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Katherine Reitz
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Xiaoyi Li
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Rafael Ramos
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Efthymios Avgerinos
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Michael Singh
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Mohammad Eslami
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Michel Makaroun
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Rabih Chaer
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
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Toyota S, Nagata S, Yoshino S, Kono S, Kawanami S, Maeda S, Kuramitsu E, Ichimannda M, Nagamatsu S, Kai S, Fukuyama Y, Orita H, Korenaga D. Mesenteric venous thrombosis as a rare complication of decompression sickness. Surg Case Rep 2020; 6:24. [PMID: 31950288 PMCID: PMC6965534 DOI: 10.1186/s40792-020-0780-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/02/2020] [Indexed: 12/24/2022] Open
Abstract
Background Decompression sickness (DCS) induced by extravascular and intravascular gas bubbles during decompression can present with varying manifestations, such as joint pain, numbness, cutaneous symptoms, and cardiopulmonary dysfunction. However, mesenteric venous thrombosis (MVT) is a rare complication of DCS. To the best of our knowledge, only a few cases have been reported, and surgical cases of MVT secondary to DCS have not yet been reported. Case presentation A 59-year-old man who was a fisherman and recreational diver dived to a depth of 100 feet. After diving, he noted abdominal and postcervical pain and visited a community hospital. Computed tomography (CT) revealed a large amount of intravenous gas, so he was diagnosed with DCS. He was then transferred to a previous hospital, where hyperbaric oxygen therapy (HBOT) was performed. HBOT reduced the amount of venous gas, but his abdominal pain worsened, so he was transferred to our hospital. CT showed pneumatosis cystoides intestinalis. Because of the possibility of intestinal necrosis, a laparoscopic examination was performed, which revealed necrosis of the transverse colon. We therefore performed a transverse colon resection. He was discharged 36 days after the surgery and followed an uneventful postoperative course. Conclusions DCS is likely to cause MVT. If intestinal necrosis is suspected, a laparoscopic examination may be useful for determining the diagnosis and treatment. MVT should be included as a differential diagnosis of abdominal pain that persists after HBOT.
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Affiliation(s)
- Satoshi Toyota
- Department of Surgery, Nakatsu Municipal Hospital, 173 Shimoikenaga, Nakatsu, Oita, 871-8511, Japan.
| | - Shigeyuki Nagata
- Department of Surgery, Nakatsu Municipal Hospital, 173 Shimoikenaga, Nakatsu, Oita, 871-8511, Japan
| | - Shinichiro Yoshino
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Sota Kono
- Department of Surgery, Nakatsu Municipal Hospital, 173 Shimoikenaga, Nakatsu, Oita, 871-8511, Japan
| | - Syogo Kawanami
- Department of Surgery, Nakatsu Municipal Hospital, 173 Shimoikenaga, Nakatsu, Oita, 871-8511, Japan
| | - Syohei Maeda
- Department of Surgery, Nakatsu Municipal Hospital, 173 Shimoikenaga, Nakatsu, Oita, 871-8511, Japan
| | - Erina Kuramitsu
- Department of Surgery, Nakatsu Municipal Hospital, 173 Shimoikenaga, Nakatsu, Oita, 871-8511, Japan
| | - Michihiro Ichimannda
- Department of Surgery, Nakatsu Municipal Hospital, 173 Shimoikenaga, Nakatsu, Oita, 871-8511, Japan
| | - Satoko Nagamatsu
- Department of Surgery, Nakatsu Municipal Hospital, 173 Shimoikenaga, Nakatsu, Oita, 871-8511, Japan
| | - Seiichiro Kai
- Department of Surgery, Nakatsu Municipal Hospital, 173 Shimoikenaga, Nakatsu, Oita, 871-8511, Japan
| | - Yasuro Fukuyama
- Department of Surgery, Nakatsu Municipal Hospital, 173 Shimoikenaga, Nakatsu, Oita, 871-8511, Japan
| | - Hiroyuki Orita
- Department of Surgery, Nakatsu Municipal Hospital, 173 Shimoikenaga, Nakatsu, Oita, 871-8511, Japan
| | - Daisuke Korenaga
- Department of Surgery, Nakatsu Municipal Hospital, 173 Shimoikenaga, Nakatsu, Oita, 871-8511, Japan
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Madubogwu C. Acute inferior mesenteric venous thrombosis in a child. NIGERIAN JOURNAL OF MEDICINE 2020. [DOI: 10.4103/njm.njm_100_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Gao Z, Yin L, Pan Y, Chen B. Treatment of Superior Mesenteric Vein Thrombus by Catheter-Directed Thrombolysis. Ann Vasc Surg 2019; 65:286.e9-286.e13. [PMID: 31743781 DOI: 10.1016/j.avsg.2019.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 10/31/2019] [Accepted: 11/09/2019] [Indexed: 02/07/2023]
Abstract
Contrast-enhanced computed tomography (CT) greatly improves the diagnosis of superior mesenteric vein (SMV) thrombosis, which presents as the unspecific symptom of abdominal pain. Prothrombotic states or thrombophilia and local intra-abdominal infections are major causes of SMV thrombosis. A 37-year-old Chinese woman was diagnosed with SMV and portal vein thrombosis. The patient was initially given 40 mg of heparin sodium every 12 hr and 80,0000 U/day of urokinase using superior mesenteric artery angiography. The abdominal pain was not relieved after treatment. The patient then underwent open surgery, where an ileal branch of the SMV was punctured, a 4F sheath was introduced into the vein toward the portal vein, and a 20-cm Unifuse catheter was placed inside the thrombus for further thrombolysis. Both heparin sodium and urokinase were infused through catheter-directed thrombolysis. The patient's symptoms then gradually resolved.
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Affiliation(s)
- Zhiwei Gao
- Department of Vascular Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China
| | - Libo Yin
- Department of Vascular Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China
| | - Yifeng Pan
- Department of Vascular Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China
| | - Bing Chen
- Department of Vascular Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China.
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Abstract
CLINICAL ISSUE Vascular abnormalities are a rare cause of an acute abdomen. They include arterial bleeding and ischemia, the latter being either in the arterial or venous system. The most common cause of an acute ischemic abdomen is acute mesenteric ischemia caused by a thromboembolic occlusion of the superior mesenteric artery, followed by thrombotic occlusion of the portal vein, the mesenteric vein as well as the hepatic veins and the suprahepatic part of the inferior vena cava. In the case of an acute abdomen due to internal bleeding, all abdominal arteries can be the source but most common are ruptures of aortic aneurysms and inflammatory-driven bleeding from the superior mesenteric artery. PRACTICAL RECOMMENDATIONS Due to the high mortality, vascular causes should be diagnosed as soon as possible. For this purpose, computed tomography (CT) has evolved into the preferred tool due to its high availability and speed. To differentiate various vascular causes of an acute abdomen, it is important to incorporate a CT protocol without contrast media as well as contrast-enhanced series in arterial and venous phases. Conventional angiography has been replaced by CT for the diagnosis of vascular pathologies causing an acute abdomen; however, it plays an increasing role in the treatment of these pathologies.
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Affiliation(s)
- R E Schernthaner
- Klinische Abteilung für Kardiovaskuläre und Interventionelle Radiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - C Loewe
- Klinische Abteilung für Kardiovaskuläre und Interventionelle Radiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
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Cho JW, Choi JJ, Um E, Jung SM, Shin YC, Jung SW, Kim JI, Choi PW, Heo TG, Lee MS, Jun H. Clinical Manifestations of Superior Mesenteric Venous Thrombosis in the Era of Computed Tomography. Vasc Specialist Int 2019; 34:83-87. [PMID: 30671416 PMCID: PMC6340699 DOI: 10.5758/vsi.2018.34.4.83] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/09/2018] [Accepted: 09/11/2018] [Indexed: 12/15/2022] Open
Abstract
Purpose Thrombosis of the portal vein, known as pylephlebitis, is a rare and fatal complication caused by intraperitoneal infections. The disease progression of superior mesenteric venous thrombosis (SMVT) is not severe. This study aimed to determine the clinical features, etiology, and prognosis of SMVT. Materials and Methods We retrospectively reviewed the medical records of 41 patients with SMVT from March 2000 to February 2017. We obtained a list of 305 patients through the International Classification of Disease-9 code system and selected 41 patients with SMVT with computed tomography. Data from the medical records included patient demographics, comorbidities, review of system, laboratory results, clinical courses, and treatment modalities. Results The causes of SMVT were found to be intraperitoneal inflammation in 27 patients (65.9%), malignancy in 7 patients (17.1%), and unknown in 7 patients (17.1%). Among the patients with intraperitoneal inflammation, 14 presented with appendicitis (51.9%), 7 with diverticulitis (25.9%), and 2 with ileus (7.4%). When comparing patients with and without small bowel resection, the differences in symptom duration, bowel enhancement and blood culture were significant (P=0.010, P=0.039, and P=0.028, respectively). Conclusion SMVT, caused by intraperitoneal inflammation, unlike portal vein thrombosis including pylephlebitis, shows mild prognosis. In addition, rapid symptom progression and positive blood culture can be the prognostic factors related to extensive bowel resection. Use of appropriate antibiotics and understanding of disease progression can help improve the outcomes of patients with SMVT.
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Affiliation(s)
- Joon Whoi Cho
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | | | - Eunhae Um
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sung Min Jung
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Yong Chan Shin
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sung-Won Jung
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jae Il Kim
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Pyong Wha Choi
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Tae Gil Heo
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Myung Soo Lee
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Heungman Jun
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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Salim S, Ekberg O, Elf J, Zarrouk M, Gottsäter A, Acosta S. Evaluation of direct oral anticoagulants and vitamin K antagonists in mesenteric venous thrombosis. Phlebology 2018; 34:171-178. [PMID: 29848218 DOI: 10.1177/0268355518779517] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIM Mesenteric venous thrombosis is a rare lethal disease. The main aim of the present study was to evaluate clinical efficacy and safety of direct oral anticoagulants and vitamin K antagonists in mesenteric venous thrombosis patients. METHODS Retrospective study of 102 mesenteric venous thrombosis patients treated between 2004 and 2017 at a center with a conservative medical first approach. Median clinical follow-up was 4 years. RESULTS Computed tomography showed successful recanalization of thrombosis in 71% of patients on vitamin K antagonists and 69% of patients on direct oral anticoagulants ( p = 0.88). Overall major and esophageal variceal bleeding rate was 14.7% and 2.9%, respectively. No difference in major bleeding ( p = 0.54) was found between vitamin K antagonists and direct oral anticoagulants. No mesenteric venous thrombosis recurrence occurred during follow-up, and one venous thromboembolism occurred after cessation of anticoagulation. CONCLUSION Anticoagulation with direct oral anticoagulants and vitamin K antagonists was efficient in patients with mesenteric venous thrombosis. Bleeding complications was a concern during treatment in both groups.
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Affiliation(s)
- Saman Salim
- 1 Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Olle Ekberg
- 2 Department of Translational Medicine, Division of Medical Radiology, Lund University, Malmö, Sweden
| | - Johan Elf
- 1 Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.,3 Vascular Centre, Department of Cardio-Thoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - Moncef Zarrouk
- 1 Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.,3 Vascular Centre, Department of Cardio-Thoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - Anders Gottsäter
- 1 Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.,3 Vascular Centre, Department of Cardio-Thoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - Stefan Acosta
- 1 Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.,3 Vascular Centre, Department of Cardio-Thoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
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Singh K, Khan G. Antiphospholipid syndrome presenting as acute mesenteric venous thrombosis involving a variant inferior mesenteric vein and successful treatment with rivaroxaban. BMJ Case Rep 2018; 2018:bcr-2017-223077. [DOI: 10.1136/bcr-2017-223077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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40
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Khripun AI, Shurygin SN, Mironkov AB, Pryamikov AD. [Venous acute disturbance of mesenteric circulation: diagnosis and treatment]. Khirurgiia (Mosk) 2017:95-102. [PMID: 29286040 DOI: 10.17116/hirurgia20171295-102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- A I Khripun
- Chair of surgery and endoscopy of the Department of advanced medical training of the N.I. Pirogov's Russian National Research Medical University, Moscow
| | - S N Shurygin
- Chair of surgery and endoscopy of the Department of advanced medical training of the N.I. Pirogov's Russian National Research Medical University, Moscow
| | - A B Mironkov
- Chair of surgery and endoscopy of the Department of advanced medical training of the N.I. Pirogov's Russian National Research Medical University, Moscow; V.M. Buyanov's City Clinical Hospital, Moscow, Russia
| | - A D Pryamikov
- Chair of surgery and endoscopy of the Department of advanced medical training of the N.I. Pirogov's Russian National Research Medical University, Moscow; V.M. Buyanov's City Clinical Hospital, Moscow, Russia
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Kai L, Jiaxiang M, Xinxin F, Baochen L, Weiwei D, Xingjiang W, Shuofei Y, Jieshou L. Establishment of mesenteric venous thrombosis in a porcine model using a transhepatic endovascular approach. Thromb Res 2015; 136:1179-1184. [DOI: 10.1016/j.thromres.2015.10.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/02/2015] [Accepted: 10/15/2015] [Indexed: 01/16/2023]
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