Choudhary A M, Grayer D, Nelson A, Roberts I
Yale Affiliated Gastroenterology Program, Bridgeport Hospital, Connecticut 06610, USA.
J Clin Gastroenterol. 2000 Sep;31(2):179-82. doi: 10.1097/00004836-200009000-00021.
Mesenteric venous thrombosis (MVT), an uncommon but important clinical entity, is one possible cause of ischemia or infarction of the small intestine. Diagnosis of this condition is sometimes difficult and treatment is often delayed because patients usually present with nonspecific abdominal symptoms. The hallmark is pain that is out of proportion to the physical findings. We report two cases of MVT, where the patients initially presented with vague abdominal symptoms. Diagnosis was made on the basis of computed tomography of the abdomen showing thrombus within the superior mesenteric vein. A search for a precipitating condition revealed no evidence of a hypercoagulable state, myeloproliferative disorder, or malignancy. These cases illustrate well the nonspecific clinical presentation of MVT. A high index of suspicion, recognition of known risk factors, or a previous history of venous thrombosis coupled with a history of nonspecific abdominal symptoms should alert clinicians to the possibility of MVT. Early diagnosis and prompt anticoagulation are the mainstay of therapy unless there are signs of peritonitis that necessitate surgical resection of the infarcted bowel.
肠系膜静脉血栓形成（MVT）是一种少见但重要的临床病症，是小肠缺血或梗死的一个可能原因。这种疾病的诊断有时很困难，治疗常常延迟，因为患者通常表现为非特异性腹部症状。其特征是疼痛与体格检查结果不符。我们报告两例MVT患者，他们最初表现为模糊的腹部症状。根据腹部计算机断层扫描显示肠系膜上静脉内有血栓而做出诊断。对促发因素的检查未发现高凝状态、骨髓增殖性疾病或恶性肿瘤的证据。这些病例很好地说明了MVT的非特异性临床表现。高度的怀疑指数、对已知危险因素的认识、既往静脉血栓形成史以及非特异性腹部症状史应提醒临床医生注意MVT的可能性。早期诊断和及时抗凝是治疗的主要方法，除非有腹膜炎体征，需要手术切除梗死肠段。
