Peters T G, Lewis J D, Flip D J, Morris L
Ann Surg. 1977 Feb;185(2):229-31. doi: 10.1097/00000658-197702000-00017.
The most commonly recognized cause of mesenteric venous thrombosis following splenectomy is hypercoagulation secondary to reactive thrombocytosis. A case is reviewed in which hypercoagulation followed splenectomy for idiopathic thrombocytopenic purpura (ITP) in spite of persistent thrombocytopenia. Episodic mesenteric venous occlusion occurred due to antithrombin III deficiency. This hypercoagulable state may be the cause of primary acute mesenteric venous occlusive disease. Symptoms and signs suggesting thrombosis in the portal circulation demand immediate coagulation studies since even in the thrombocytopenic patient thrombotic proglems can occur. Surgical intervention is the treatment of choice for segmental small bowel ischemia; warfarin therapy is indicated when there is evidence of antithrombin III deficiency.
脾切除术后肠系膜静脉血栓形成最常见的公认原因是反应性血小板增多继发的高凝状态。本文回顾了一例尽管存在持续性血小板减少，但因特发性血小板减少性紫癜（ITP）行脾切除术后发生高凝状态的病例。由于抗凝血酶III缺乏，出现了间歇性肠系膜静脉闭塞。这种高凝状态可能是原发性急性肠系膜静脉闭塞性疾病的病因。提示门静脉循环血栓形成的症状和体征需要立即进行凝血研究，因为即使是血小板减少的患者也可能出现血栓问题。手术干预是节段性小肠缺血的首选治疗方法；当有抗凝血酶III缺乏的证据时，应使用华法林治疗。
