Surgical management of portal and mesenteric vein thrombosis. A case report

10.17605/OSF.IO/5E2PV

Perzabal Avilez CT, Lopez Jaime CA, Ruiz Cereceres Sj, Soto Posada AK, Zapata Arredondo TG, Acosta García AG. Surgical management of portal and mesenteric vein thrombosis. A case report. Am J Med Surg. January 2022; 6(3). 1-5

BACKGROUND: Mesenteric venous thrombosis (MTV) is defined as thrombosis within the superior or inferior mesenteric vein. MTV was first reported by Elliot in 1895 when he operated an intestinal infarction case.

This is a 51-year-old male with generalized abdominal pain, nausea, vomiting, and diarrheal evacuations, with abdominal distension. On physical examination with tachycardia, fever, tachypnea, distended abdomen, painful on generalized palpation and tympanic on percussion in mesogastrium.

A contrasted abdominal tomography is requested with evidence of  thickened jejunum, intestinal pneumatosis, and a hyperdense image in the portal vein with. A exploratory laparotomy is performed performing a 90 cm resection of the small intestine with a side to side anastomosis with endoGIA stapler and manual examination of the portal vein is performed without evidence of thrombus inside.

The patient with a satisfactory evolution, channeling and evacuating on the fourth day, for which the progressive liquid diet is started and discharged to continue external consultation follow-up.

MTV is a relatively rare condition more common in males and individual 40 to 60 years old. The incidence is low with 2.7 per 100,000 cases per year.

Prothrombotic states and primary hypercoagulable states are the most common causes of secondary mesenteric venous thrombosis. Combined mesenteric and portal venous thrombosis are more often associated with non-systemic pathologies, such as local abdominal inflammatory conditions.

Mortality rates from MVT remain high and are largely a result of failure to diagnose and to treat in a timely fashion.

 

KEY WORDS: blood coagulation disorders; gastrointestinal tract; mesentery; venous thrombosis; exploratory laparotomy