Paraskeva Panoraia, Akoh Jacob A
Department of Surgery, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth PL6 8DH, United Kingdom.
Department of Surgery, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth PL6 8DH, United Kingdom.
Int J Surg Case Rep. 2015;6C:118-21. doi: 10.1016/j.ijscr.2014.11.071. Epub 2014 Dec 2.
The increasing frequency of use of CT in patients with acute abdomen is likely to improve the diagnosis of rarely occurring conditions/causes such as superior mesenteric vein thrombosis (MVT). Despite its severe consequences, MVT often presents with nonspecific clinical features.
AD, a 64-year-old man was an emergency admission with vague abdominal discomfort of two weeks duration, acute upper abdominal pain, loose stools, fresh rectal bleeding and vomiting. A contrast enhanced abdominal CT showed thrombosis of the proximal portal vein and the entire length of the superior mesenteric vein (SMV) with small bowel ischaemia extending from the terminal ileum to the mid jejunal loops. Tests for paroxysmal nocturnal haemoglobinuria and Janus kinase 2 mutation yielded negative results. AD was readmitted seven months later with small bowel obstruction requiring segmental small bowel resection with end-to-end anastomosis. Abdominal CT had shown complete resolution of MVT but a small bowel stricture.
Thrombosis limited to mesenteric veins results in earlier and more frequent development of infarction compared to portal combined with mesenteric venous thrombosis. Most patients may be successfully treated with anti-coagulation therapy alone. However, surgery may be required to deal with intestinal infarction or late sequela of MVT.
This case demonstrates that MVT can be reversed by effective anticoagulation. However, the price paid for a mild to moderate effect on the bowel may be significant stricture later on. Patients escaping early bowel resection due to massive MVT leading to bowel infarction may still require resection later due to stricture.
在急腹症患者中，CT使用频率的增加可能会改善对诸如肠系膜上静脉血栓形成（MVT）等罕见病症/病因的诊断。尽管后果严重，但MVT通常表现出非特异性临床特征。
AD，一名64岁男性，因持续两周的腹部隐痛、急性上腹部疼痛、腹泻、直肠新鲜出血和呕吐而急诊入院。腹部增强CT显示门静脉近端和肠系膜上静脉（SMV）全长血栓形成，小肠缺血从回肠末端延伸至空肠中段肠袢。阵发性夜间血红蛋白尿和Janus激酶2突变检测结果为阴性。七个月后，AD因小肠梗阻再次入院，需要进行节段性小肠切除并端端吻合。腹部CT显示MVT已完全消退，但存在小肠狭窄。
与门静脉合并肠系膜静脉血栓形成相比，仅肠系膜静脉血栓形成导致梗死的发生更早且更频繁。大多数患者单独使用抗凝治疗可能成功。然而，可能需要手术来处理肠梗死或MVT的晚期后遗症。
本病例表明，有效的抗凝治疗可使MVT逆转。然而，对肠道产生轻度至中度影响的代价可能是后期出现明显狭窄。因大量MVT导致肠梗死而早期避免小肠切除的患者，后期仍可能因狭窄而需要切除。
