2017, Number 1
Acute abdominal pain due to portal and mesenteric venous thrombosis Case report
Trejo-Ávila ME, Arce-Liévano E, Cuendis-Velázquez A, Romero-Loera LS
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Language: Spanish
References: 7
Page: 23-27
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ABSTRACT
Background: Four common causes of mesenteric ischemia identified: arterial embolism, arterial thrombosis, non-occlusive pathologies and mesenteric venous thrombosis (MVT). MVT is an uncommon cause of acute abdominal pain and accounts for 1 in 1000 emergency surgical laparotomies for acute abdomen.Case Presentation: A 31 year old male, previously healthy, with 72 hour history of generalized abdominal pain on examination with signs of peritonitis. He underwent a computed tomographic (CT) scan of the abdomen and pelvis, which demonstrated thrombosis of the portal, splenic and superior mesenteric veins. A laparotomy was performed, we found jejunal necrosis and a bowel resection was required. Hematologic, oncologic and autoimmune studies were performed and all of them were negative.
Discussion: Venous thrombosis is almost always secondary to other pathologies. The principle ones are: hypercoagulability and occult neoplasia. The clinical presentation is non-specific. To make a diagnosis one can use: a Doppler ultrasound, a CT angiography, a magnetic resonance and a catheter angiography. The available treatments for acute mesenteric ischemia are: endovascular procedures, bypass surgery, anticoagulation and a laparotomy to treat visceral complications.
Conclusion: Even if this is an uncommon pathology, physicians need to be aware of pathophysiology, diagnosis and treatment of acute mesenteric ischemia.
REFERENCES
Russell CE, Wadhera RK, Piazza G. Mesenteric Venous Thrombosis. Circulation. 2015;131:1599-603. Figura 6. Laparotomía exploradora. Revisión de la afección y viabilidad intestinal. Figura 5. Laparotomía exploradora. Segmento de intestino delgado (yeyuno) necrosado, hemorragias en el mesenterio y trombos venosos mesentéricos.