Department of Radio-Diagnosis, All India Institute of Medical Sciences, Patna 801 507, India.
Department of G.I. Surgery, All India Institute of Medical Sciences, Patna 801 507, India.
Indian J Gastroenterol. 2021 Feb;40(1):82-87. doi: 10.1007/s12664-020-01123-x. Epub 2021 Jan 6.
Ischemic jejunal stricture due to mesenteric vein thrombosis (MVT) rarely occurs in patients with extrahepatic portal vein obstruction (EHPVO). This is because the thrombus often occludes only a short segment of superior mesenteric vein adjacent to splenoportal confluence, facilitating development of collateral veins that protect bowel from ischemia. However, ischemic strictures can develop when the thrombus involves jejunal veins, venous arcades or vasa recta. We report three patients with EHPVO, who developed jejunal strictures due to MVT. They presented with symptoms of proximal bowel obstruction. Two of these patients had evidence of recurrent deep vein thrombosis (DVT), suggesting possibility of an underlying prothrombotic state. One of them had completely occluded bilateral iliac veins and inferior vena cava following DVT, 10 years ago. At the same time, he was identified as having a portal cavernoma. Contrast-enhanced computed tomography showed portal cavernoma together with MVT in all the patients. The thrombus was identified in the jejunal veins in two patients and in the entire superior mesenteric vein up to splenic vein in one patient. All three patients were found to have a tight concentric stricture involving a long length of proximal jejunum. Two patients required urgent surgical intervention and one died.
肠系膜静脉血栓形成（MVT）导致的缺血性空肠狭窄在肝外门静脉阻塞（EHPVO）患者中很少见。这是因为血栓通常仅阻塞邻近脾门静脉汇合处的肠系膜上静脉的一小段，从而有利于保护肠免于缺血的侧支静脉的发展。然而，当血栓累及空肠静脉、静脉弓或直静脉时，可能会发生缺血性狭窄。我们报告了 3 例 EHPVO 患者，他们因 MVT 导致空肠狭窄。这些患者表现为近端肠阻塞的症状。其中 2 例有复发性深静脉血栓形成（DVT）的证据，提示可能存在潜在的血栓形成倾向。其中 1 例在 DVT 10 年前出现双侧髂静脉和下腔静脉完全闭塞，同时被诊断为门静脉海绵样变。增强 CT 显示所有患者均存在门静脉海绵样变和 MVT。2 例患者的血栓位于空肠静脉内，1 例患者的血栓位于整个肠系膜上静脉至脾静脉。这 3 例患者均发现存在涉及近端空肠长段的紧密同心狭窄。2 例患者需要紧急手术干预，其中 1 例死亡。
