Hatoum Ossama A, Spinelli Kristi S, Abu-Hajir Majed, Attila Tan, Franco Jose, Otterson Mary F, Telford Gordon L, Binion David G
Division of Cardiovascular Medicine, Froedtert Memorial Lutheran Hospital, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
J Clin Gastroenterol. 2005 Jan;39(1):27-31.
Mesenteric venous thrombosis (MVT) is a rare but potentially catastrophic clinical complication, which may lead to ischemia or infarction of the intestine and/or the emergence of portal hypertension. An association between inflammatory bowel disease (IBD) and MVT has previously been described, but clinical factors that may contribute to this complication in the setting of IBD are not well characterized. Diagnosis of MVT in IBD is difficult, as patients frequently present with nonspecific abdominal discomfort, which may delay diagnosis and initiation of treatment. We report 6 of 545 IBD patients at our center (1.1%) that developed MVT, and describe presentation, diagnostic approaches, treatment options, underlying contributing factors, and outcome. The diagnosis was determined with abdominal computed tomography (CT) in 5 of 6 cases. Clinical factors, which were thought to contribute to MVT, included underlying hypercoagulability, low-flow state, uncontrolled inflammation, perioperative time period, and prior surgical manipulation of the portal vein following orthotopic liver transplantation. There were no deaths as a result of MVT, although 1 patient developed severe portal hypertension and another experienced intestinal infarction requiring extensive resection. We conclude that MVT is an important clinical consideration in IBD patients, specifically during the perioperative setting, and diagnosis is facilitated with the use of CT scan.
肠系膜静脉血栓形成（MVT）是一种罕见但可能具有灾难性的临床并发症，可导致肠道缺血或梗死和/或门静脉高压的出现。先前已描述过炎症性肠病（IBD）与MVT之间的关联，但在IBD背景下可能导致这种并发症的临床因素尚未得到充分描述。IBD患者的MVT诊断困难，因为患者常表现为非特异性腹部不适，这可能会延迟诊断和治疗的开始。我们报告了我们中心545例IBD患者中有6例（1.1%）发生了MVT，并描述了其临床表现、诊断方法、治疗选择、潜在促成因素及结局。6例中有5例通过腹部计算机断层扫描（CT）确诊。被认为促成MVT的临床因素包括潜在的高凝状态、低血流状态、未控制的炎症、围手术期以及原位肝移植后门静脉的既往手术操作。尽管有1例患者出现严重门静脉高压，另1例发生肠梗死需要广泛切除，但没有患者因MVT死亡。我们得出结论，MVT是IBD患者重要的临床考量因素，尤其是在围手术期，CT扫描有助于诊断。
