Abdishakur Abdihakim Elmi, Hussein Said Mohamed
General Surgery Department, Somali Sudanese Specialized Hospital, Mogadishu, Somalia.
General Surgery Department, Somali Sudanese Specialized Hospital, Mogadishu, Somalia.
Int J Surg Case Rep. 2024 Jul;120:109872. doi: 10.1016/j.ijscr.2024.109872. Epub 2024 Jun 7.
The most frequent location of thrombosis development in acute mesenteric venous thrombosis is the superior mesenteric vein. It is an uncommon but potentially fatal condition. Patients with underlying medical conditions that interfere with the Virchow Triad hypercoagulability, stasis, and endothelial injury are more likely to experience it.
A 37-year-old female reported to our emergency department with a 5-day history of severe abdominal discomfort, vomiting, and constipation, as well as two episodes of bleeding per rectum. The patient had a clean medical history, no HTN, no diabetes, no chronic medication, no history of contraceptive pill use or non-steroid anti-inflammatory drug use, no history of chronic disease or operation. Patient was directly transferred to the intensive care unit for additional evaluation and preoperative stabilization.
A patient with acute mesenteric venous thrombosis and possible intestinal damage is the case we've presented. Upon presentation patient was unstable, we assessed her condition and transferred to the intensive care unit for stabilization and pre-operative preparation. She didn't respond to conservative management and we had to operate, we highly emphasize how crucial it is for early intervention in these type of conditions. Acute mesenteric venous thrombosis is a complicated case due to its nonspecific symptoms, it requires a multidisciplinary team approach between internal medicine and surgical team to plan for the most appropriate treatment strategy suitable for each patient as all options are associated with significant risks. Multiple options are available for the management of mesenteric venous thrombosis. In patients with peritoneal signs to suggestive bowel infarction or perforation or those who failed to progress with conservative management, operative intervention may be necessary. Other options include anticoagulation therapy, local or systemic thrombolysis, interventional or surgical thrombectomy.
Acute mesenteric venous thrombosis is a complex situation that calls for a multidisciplinary team approach between the surgical and internal medicine departments to determine the best course of action for each patient, as there are major risks involved with each alternative. If peritonism is present, it is preferable to assess and resuscitate as soon as possible and to proceed with surgery.
急性肠系膜静脉血栓形成最常发生于肠系膜上静脉。这是一种罕见但可能致命的疾病。患有影响维氏三联征（高凝状态、血流淤滞和内皮损伤）的基础疾病的患者更易发生此病。
一名37岁女性因严重腹部不适、呕吐、便秘5天，以及两次直肠出血到我院急诊科就诊。该患者既往病史无异常，无高血压、无糖尿病、无长期用药史、无避孕药或非甾体抗炎药使用史、无慢性病或手术史。患者被直接转入重症监护病房进行进一步评估和术前稳定治疗。
我们呈现的病例是一名患有急性肠系膜静脉血栓形成且可能伴有肠损伤的患者。就诊时患者情况不稳定，我们评估了她的病情并将其转入重症监护病房进行稳定治疗和术前准备。她对保守治疗无反应，我们不得不进行手术，我们高度强调在这类疾病中早期干预的重要性。急性肠系膜静脉血栓形成是一个复杂病例，因其症状不具特异性，需要内科和外科团队采取多学科协作方法，为每位患者制定最合适的治疗策略，因为所有治疗方案都有重大风险。肠系膜静脉血栓形成的治疗有多种选择。对于有提示肠梗死或穿孔的腹膜体征的患者，或保守治疗无效的患者，可能需要进行手术干预。其他选择包括抗凝治疗、局部或全身溶栓、介入或手术取栓。
急性肠系膜静脉血栓形成是一种复杂情况，需要外科和内科部门采取多学科团队方法，为每位患者确定最佳行动方案，因为每种选择都有重大风险。如果出现腹膜炎，最好尽快进行评估和复苏并进行手术。
