Soghomonyan N, Khachatryan H, Soghomonyan G, Fleming Q
Department of Vascular Surgery and Diabetic Foot, Yerevan Medical Center, Yerevan, Armenia.
Faculty of General Surgery, M. Heratsi State Medical University, Yerevan, Armenia.
Front Pharmacol. 2023 Sep 6;14:1246914. doi: 10.3389/fphar.2023.1246914. eCollection 2023.
Patients with venous thrombosis of splanchnic circulation represent a group of high risk with significant morbidity and mortality, if treatment is delayed. We present a patient with thrombosis of portal vein and its tributaries combined with deep venous thrombosis (DVT) of the lower extremities who was successfully treated with conservative management. This patient case highlights the importance of early empiric anti-inflammatory therapy along with systemic anticoagulation to reduce the intestinal inflammation and enteritis and break the vicious circuit resulting in secondary progressive thrombosis of the splanchnic veins, fluid shifts, and functional ileus. : A previously healthy 61-years-old female patient with no significant medical history was admitted with progressive upper abdominal pain, nausea and vomiting, low-grade fever, mild signs of ileus, and malaise. Imaging studies revealed portal venous dilation reaching ∼20 mm with near-total obliteration of the lumen by a thrombus. In addition, thrombosis of superior mesenteric and splenic veins with thrombophlebitis was found. Imaging studies also confirmed the presence of DVT of lower extremities including thrombus propagation into the iliac veins. An immediate therapy was started with parenteral antibiotics, anti-inflammatory medications, systemic anticoagulants, and intravenous fluid infusions to restore the circulating volume deficit and treat electrolyte disbalance. With such therapy, the patient's symptoms resolved within a month, and she was discharged from the hospital with full recovery. Heparin infusion was started to reach systemic anticoagulation. With resolution of symptoms, anticoagulation was continued with warfarin. We used non-steroidal anti-inflammatory drugs (NSAIDs) as a component in management of intestinal and systemic inflammation and multifocal thrombosis when the antiphospholipid syndrome was also on the list of differential diagnoses. : We present a previously asymptomatic patient with progressive portal venous thrombosis and ascending DVT. Early establishment of diagnosis and initiation of therapy with systemic anticoagulants, anti-inflammatory and antibacterial drugs helped to stop thrombus progression, prevent irreversible intestinal ischemia, and allow for re-canalization of the occluded veins. This case highlights the importance of early interventions to improve the treatment outcome.
内脏循环静脉血栓形成的患者若治疗延迟，是一组具有高发病率和死亡率的高危人群。我们报告了一例门静脉及其分支血栓形成合并下肢深静脉血栓形成（DVT）的患者，该患者通过保守治疗成功治愈。该病例强调了早期经验性抗炎治疗以及全身抗凝以减轻肠道炎症和肠炎，并打破导致内脏静脉继发性进行性血栓形成、液体转移和功能性肠梗阻的恶性循环的重要性。：一名既往健康、无重大病史的61岁女性患者因进行性上腹部疼痛、恶心、呕吐、低热、轻度肠梗阻体征和不适入院。影像学检查显示门静脉扩张至约20毫米，管腔几乎完全被血栓闭塞。此外，发现肠系膜上静脉和脾静脉血栓形成伴血栓性静脉炎。影像学检查还证实存在下肢DVT，包括血栓蔓延至髂静脉。立即开始采用肠外抗生素、抗炎药物、全身抗凝剂和静脉输液治疗，以恢复循环血容量不足并治疗电解质失衡。通过这种治疗，患者的症状在一个月内得到缓解，并完全康复出院。开始输注肝素以实现全身抗凝。随着症状缓解，继续使用华法林进行抗凝。当抗磷脂综合征也在鉴别诊断清单中时，我们使用非甾体抗炎药（NSAIDs）作为肠道和全身炎症以及多灶性血栓形成管理的一个组成部分。：我们报告了一例既往无症状的患者，患有进行性门静脉血栓形成和上行性DVT。早期诊断并开始使用全身抗凝剂、抗炎和抗菌药物治疗有助于阻止血栓进展，预防不可逆的肠道缺血，并使闭塞静脉再通。该病例强调了早期干预对改善治疗结果的重要性。
