Totsi Albion, Chalkidou Eirini, Dinas Sotirios, Symeonidou Elissavet, Papavasileiou Christos
Surgery, Papageorgiou General Hospital, Thessaloniki, GRC.
General Surgery, Princess Royal University Hospital, London, GBR.
Cureus. 2025 Aug 24;17(8):e90892. doi: 10.7759/cureus.90892. eCollection 2025 Aug.
Acute mesenteric venous thrombosis (MVT) is a life-threatening emergency, as delayed treatment may result in bowel ischemia and high mortality. Diagnosis is often challenging due to non-specific symptoms, and management may be conservative or surgical. We report the case of a 52-year-old man who presented to the emergency department with abdominal pain and diarrhea. Although abdominal computed tomography (CT) did not confirm MVT, persistent clinical suspicion and the presence of metabolic acidosis prompted an exploratory laparotomy. Intraoperatively, extensive intestinal ischemia was identified, and given the patient's hemodynamic instability, damage control surgery was performed, including resection of necrotic bowel, temporary stoma formation, and temporary abdominal closure using the "sandwich" technique. After stabilization in the ICU, a second-look operation allowed for jejunocolic anastomosis, stoma reversal, and definitive abdominal closure. A postoperative venous-phase CT scan confirmed MVT. The patient was discharged after 13 days on anticoagulation, with subsequent diagnosis of Factor V Leiden thrombophilia. This case underscores the importance of maintaining high clinical suspicion for MVT despite inconclusive imaging, as timely surgical intervention can be life-saving.
急性肠系膜静脉血栓形成（MVT）是一种危及生命的急症，因为治疗延迟可能导致肠缺血和高死亡率。由于症状不具特异性，诊断往往具有挑战性，治疗方式可能是保守治疗或手术治疗。我们报告一例52岁男性患者，该患者因腹痛和腹泻就诊于急诊科。尽管腹部计算机断层扫描（CT）未确诊MVT，但持续的临床怀疑以及代谢性酸中毒的存在促使进行了剖腹探查术。术中发现广泛的肠缺血，鉴于患者血流动力学不稳定，实施了损伤控制手术，包括切除坏死肠段、临时造口术以及采用“三明治”技术进行临时腹壁关闭。在重症监护病房（ICU）病情稳定后，二次探查手术进行了空肠结肠吻合术、造口还纳术以及确定性腹壁关闭。术后静脉期CT扫描确诊为MVT。患者在抗凝治疗13天后出院，随后被诊断为凝血因子V莱顿易栓症。该病例强调了尽管影像学检查结果不明确，但仍需对MVT保持高度临床怀疑的重要性，因为及时的手术干预可能挽救生命。
