Davies Mark, Satyadas Thomas, Akle Charles A
University Department of Surgery, Royal Free and University College Medical School, London, UK.
Ann R Coll Surg Engl. 2002 May;84(3):177-80.
A previously fit 37-year-old man developed superior mesenteric venous thrombosis after undergoing a laparoscopic Nissen fundoplication. Despite receiving thrombo-embolic prophylaxis on postoperative day 16, he presented with a gradual onset of vague, but severe, umbilical and epigastric pains. Laboratory tests, abdominal ultrasound scan and gastroscopy were all unremarkable. Contrast enhanced abdominal spiral computerised tomography (CT) revealed a partial occlusion of the superior mesenteric and portal vein due to a thrombus; abnormal flow was confirmed on colour Doppler ultrasound. A predisposing hyper-coagulable condition was excluded. The patient responded rapidly to expectant management and a repeat spiral CT scan, 3 weeks after the initial presentation, demonstrated complete re-canalisation of the vessel. Although rare, superior mesenteric venous thrombosis is probably underdiagnosed due to the vague nature of the symptoms, the lack of clinical signs, a low index of suspicion on the part of the clinician, and then subsequent failure to request the optimal investigation--namely contrast enhanced abdominal spiral CT scan. We discuss the possible mechanisms by which laparoscopic surgery may increase the risks of developing superior mesenteric venous thrombosis, the pitfalls in diagnosis and treatment options.
一名既往健康的37岁男性在接受腹腔镜下尼森胃底折叠术后发生肠系膜上静脉血栓形成。尽管在术后第16天接受了血栓栓塞预防措施，但他仍逐渐出现模糊但严重的脐部和上腹部疼痛。实验室检查、腹部超声扫描和胃镜检查均无异常。腹部螺旋计算机断层扫描（CT）增强扫描显示，由于血栓形成，肠系膜上静脉和门静脉部分闭塞；彩色多普勒超声证实血流异常。排除了易患的高凝状态。患者对保守治疗反应迅速，初次就诊3周后重复螺旋CT扫描显示血管完全再通。尽管肠系膜上静脉血栓形成罕见，但可能因症状模糊、缺乏临床体征、临床医生怀疑指数低以及随后未要求进行最佳检查（即腹部螺旋CT增强扫描）而未被充分诊断。我们讨论了腹腔镜手术可能增加肠系膜上静脉血栓形成风险的潜在机制、诊断中的陷阱以及治疗选择。
