Huťan Martin, Bartko Christian, Slyško Roman, Sekáč Jaroslav, Prochotský Augustín, Majeský Ivan, Skultéty Ján
IInd Surgical Department of Medical Faculty, Comenius University, Bratislava, Slovakia.
IInd Surgical Department of Medical Faculty, Comenius University, Bratislava, Slovakia.
Int J Surg Case Rep. 2014;5(10):765-8. doi: 10.1016/j.ijscr.2014.09.004. Epub 2014 Sep 10.
Pancreatoduodenectomy is an extensive procedure carrying risk of a number of postoperative complications. Of these the most common are surgical site infections (SSI), bleeding, delayed gastric emptying, and anastomotic leakage. However, the most serious complications are ones, that are rare, clinically hardly diagnosed, and if untreated, leading to the death of a patient. Among the latter complications is thrombosis of superior mesenteric vein. Its clinical signs are unspecific and diagnostics complicated. Treatment requires aggressive approach. If this is absent, intestinal necrosis with septic state, Multiple Organ Dysfunction Syndrome (MODS) and Multiple Organ Failure (MOF) lead to a death of a patient.
Authors present a case of a patient after pancreatoduodenectomy, complicated by the thrombosis of superior mesenteric vein. Patient was managed by resection of the necrotic bowel, venous decompression by venous bypass from superior mesenteric vein to the right ovarian vein, and open abdomen with negative pressure wound therapy (NPWT). Patient suffered severe abdominal sepsis with need for intensive organ support. Abdomen was definitely closed on fourth NPWT redress. Patient healed without any further complications, is well and was released to the ambulatory setting.
Superior mesenteric vein (VMS) thrombosis is a rare complication. It diagnosis requires high level of vigilance and once diagnosed, aggressive therapy is essential. Two goals of surgical treatment exist: resection of the necrotic bowel and facilitation of the blood outflow.
Mesenteroovarian anastomosis is one of the options in treatment of thrombosis of VMS if thrombectomy is not feasible.
胰十二指肠切除术是一项大型手术，存在多种术后并发症风险。其中最常见的是手术部位感染（SSI）、出血、胃排空延迟和吻合口漏。然而，最严重的并发症是那些罕见的、临床上难以诊断且若不治疗会导致患者死亡的并发症。后者包括肠系膜上静脉血栓形成。其临床症状不具特异性，诊断复杂。治疗需要积极的方法。若缺乏积极治疗，肠坏死伴脓毒症、多器官功能障碍综合征（MODS）和多器官衰竭（MOF）会导致患者死亡。
作者报告一例胰十二指肠切除术后并发肠系膜上静脉血栓形成的患者。患者接受了坏死肠段切除术、通过从肠系膜上静脉到右卵巢静脉的静脉搭桥进行静脉减压以及采用负压伤口治疗（NPWT）的开放腹腔处理。患者遭受严重的腹部脓毒症，需要强化器官支持。在第四次NPWT换药时腹腔最终关闭。患者康复，无任何进一步并发症，情况良好并出院。
肠系膜上静脉（VMS）血栓形成是一种罕见的并发症。其诊断需要高度警惕，一旦确诊，积极治疗至关重要。手术治疗有两个目标：切除坏死肠段和促进血液流出。
如果血栓切除术不可行，肠系膜-卵巢吻合术是治疗VMS血栓形成的选择之一。
