Salim S, Ekberg O, Elf J, Zarrouk M, Gottsäter A, Acosta S
Department of Clinical Sciences, Lund University, Malmö, Sweden.
Department of Translational Medicine, Division of Medical Radiology, Lund University, Malmö, Sweden.
Emerg Radiol. 2018 Aug;25(4):407-413. doi: 10.1007/s10140-018-1601-3. Epub 2018 Mar 28.
The main aim of this study was to evaluate the association of computed tomography (CT) findings at admission and bowel resection rate in patients with mesenteric venous thrombosis (MVT). It was hypothesized that abnormal intestinal findings on CT were associated with a higher bowel resection rate.
Retrospective study of MVT patients treated between 2004 and 2017. CT images at admission and at follow-up were scrutinized according to a predefined protocol. Successful recanalization was defined as partial or complete recanalization of the portomesenteric venous thrombosis at the latest CT follow-up (n = 70).
We studied 102 patients (median age 58 years, 61 men). Lifelong anticoagulation was initiated in 64 patients, and bowel resection rate was 17%. No referral letter indicated suspicion of MVT, whereas three indicated suspected intestinal ischemia. Previous venous thromboembolism was associated with increased bowel resection rate (p = 0.049). No patient with acute pancreatitis (n = 17) underwent bowel resection (p = 0.068). The presence of mesenteric oedema (p = 0.014), small bowel wall oedema (p < 0.001), small bowel dilatation (p = 0.005), and ascites (p = 0.021) were associated with increased bowel resection rate. Small bowel wall oedema remained as an independent risk factor associated with bowel resection (OR 15.8 [95% CI 3.2-77.2]). Successful thrombus recanalization was achieved in 66% of patients.
The presence of abnormal intestinal findings secondary to MVT confers an excess risk of need of bowel resection due to infarction. Responsible physicians should therefore scrutinize the CT images at diagnosis together with the radiologist to better tailor clinical surveillance.
本研究的主要目的是评估肠系膜静脉血栓形成（MVT）患者入院时的计算机断层扫描（CT）表现与肠切除率之间的关联。研究假设是CT上的肠道异常表现与更高的肠切除率相关。
对2004年至2017年期间接受治疗的MVT患者进行回顾性研究。根据预定义方案仔细检查入院时和随访时的CT图像。成功再通定义为在最新的CT随访时门静脉肠系膜静脉血栓形成部分或完全再通（n = 70）。
我们研究了102例患者（中位年龄58岁，男性61例）。64例患者开始接受终身抗凝治疗，肠切除率为17%。没有转诊信提示怀疑MVT，而有3例提示怀疑肠缺血。既往静脉血栓栓塞与肠切除率增加相关（p = 0.049）。没有急性胰腺炎患者（n = 17）接受肠切除（p = 0.068）。肠系膜水肿（p = 0.014）、小肠壁水肿（p < 0.001）、小肠扩张（p = 0.005）和腹水（p = 0.021）与肠切除率增加相关。小肠壁水肿仍然是与肠切除相关的独立危险因素（OR 15.8 [95% CI 3.2 - 77.2]）。66%的患者实现了血栓成功再通。
MVT继发的肠道异常表现会增加因梗死而需要进行肠切除的额外风险。因此，负责的医生应在诊断时与放射科医生一起仔细检查CT图像，以更好地调整临床监测。
