Hotoleanu C, Andercou O, Andercou A
Medical Clinic 2, UMF Iuliu Hatieganu, Cluj-Napoca, Romania.
Int Angiol. 2008 Dec;27(6):462-5.
Mesenteric venous thrombosis (MVT), an unusual location of deep venous thrombosis, occurs especially on a predisposing terrain. Recently, hyperhomocysteinemia has been shown to be associated with venous thrombosis, often recurrent and located in an uncommon site. Hyperhomocysteinemia is mainly due to genetic causes (mutations 677C>T and 1298A>C of methylenetetrahydrofolate reductase) and vitamins B deficiencies. MVT may present as acute, subacute or chronic form. The clinical supposition of mesenteric thrombosis is based on the discrepancy between the abdominal pain and the physical examination. The nonspecific character of the pain, mimicking peptic ulceration in some cases, and the possibility of an initial normal clinical examination may delay the diagnosis. The occurrence of the fever, rebound tenderness and guarding suggests progression to bowel infarction. MVT leads to peritonitis in 1/3 to 2/3 of cases. Laboratory blood tests are not helpful in confirming the diagnosis of venous thrombosis. Leukocytosis and metabolic acidosis are considered to be the most specific laboratory findings in patients with mesenteric ischemia. Abdominal computed tomography is the test of choice for the diagnosis. However, most of the cases are diagnosed during laparotomy or autopsy. Anticoagulant therapy administrated early increases the survival rate. Surgery is indicated in cases with bowel infarction or peritonitis.
肠系膜静脉血栓形成（MVT）是深静脉血栓形成的一种罕见部位，尤其发生在有易感因素的情况下。最近，高同型半胱氨酸血症已被证明与静脉血栓形成有关，通常为复发性且位于不常见部位。高同型半胱氨酸血症主要由遗传因素（亚甲基四氢叶酸还原酶的677C>T和1298A>C突变）和维生素B缺乏引起。MVT可表现为急性、亚急性或慢性形式。肠系膜血栓形成的临床推测基于腹痛与体格检查之间的差异。疼痛的非特异性特征，在某些情况下类似消化性溃疡，以及最初临床检查可能正常的可能性，可能会延迟诊断。发热、反跳痛和肌紧张的出现提示进展为肠梗死。MVT在1/3至2/3的病例中会导致腹膜炎。实验室血液检查对确诊静脉血栓形成并无帮助。白细胞增多和代谢性酸中毒被认为是肠系膜缺血患者最具特异性的实验室检查结果。腹部计算机断层扫描是诊断的首选检查。然而，大多数病例是在剖腹手术或尸检时确诊的。早期给予抗凝治疗可提高生存率。对于有肠梗死或腹膜炎的病例，需进行手术治疗。
