Surgical treatment of mesenteric venous thrombosis

Introduction > Mesenteric venous thrombosis is a rare form of mesenteric ischemia that con be lethal when appropriate treatment is delayed. Case > A 61-year-old woman consulted with nonirradiating epigastric and left upper abdominal pain, nausea and vomiting, all of which had been increasing for 4 days. Two years earlier she hod hod phlebitis and a pulmonary embolism. Her white blood cell count was 15 300/mm(3). Abdominal computed tomography (CT) showed thrombosis of the superior mesenteric vein with no evidence of intestinal parietal ischemia. The patient received a full dose of heparin promptly and underwent selective intra-arterial thrombolysis. As her clinical condition deteriorated, an emergency laparotomy was performed to resect 1.5 meters of gangrenous jejunum. Full anticoagulation with heparin was resumed postoperatively and she was discharged is days after surgery. She continued taking oral anticoagulants. All results of a thorough laboratory work-up were negative. Discussion > The clinic presentation of acute mesenteric venous thrombosis is generally insidious. CT scanning is 0 reliable diagnostic method. The goal of initial treatment is to define the underlying cause of the patient's hypercoagulable state and to treat it appropriately. After achieving appropriate anticoagulation, patients should start long-term warfarin. Indications for surgery include signs of peritonitis, possible bowel infarction, and hemodynamic instability Once treated, patients with this condition hove a fairly good prognosis.