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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2010 December;23(6):235-40
How to manage acute mesenteric and portal vein thrombosis
Seung M-K., Roh Y-N., Kim Y-W., Kim D-I.
Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Aim. Acute mesenteric vein thrombosis (MVT) and portal vein thrombosis (PVT) are associated with high rates of morbidity and mortality due in part to the difficulty to diagnostic them and the operative challenges. The initial treatment for MVT and PVT is controversial. Some authors have proposed a surgical approach, whereas others have advocated medical therapy (anticoagulation). In this study, we analyzed and compared the results obtained with surgical and medical treatments to determine the best initial management for this disease.
Methods. We retrospectively reviewed the hospital records and clinical data of 10 patients who were treated for MVT and PVT. Each patient was assessed for the diagnosis, initial management (laparotomy or anticoagulation), the morbidity and mortality and the duration of hospitalization.
Results. All of the patients were initially treated with unfractionated heparin. The mean hospital stay was 20 days. One patient underwent emergency laparotomy with bowel resection, while two patients developed stricture during the follow-up period that necessitated resection and anastomosis of the bowel. The other seven patients underwent anticoagulation therapy only. During the follow-up period, all the patients were checked by computed tomography (CT). Five patients showed improvement, four patients showed no change and one patient showed worsened MVT and PVT. Nine patients showed cavernous transformation of the venous system along the mesenteric vein and portal vein on CT. There was no mortality.
Conclusion. Nonoperative management for acute MVT and PVT is feasible when the bowel infarction has not led to transmural necrosis and bowel perforation. The morbidity, mortality and long-term outcomes were similar for the cases of surgical and nonoperative management. A nonoperative approach, when indicated, avoids resection of the macroscopically infarcted small bowel in cases that are potentially reversible with anticoagulation alone.