Clinical Analysis Of39Cases Of Mesenteric Venous Thrombosis

ObjectiveTo study the etiology, clinical manifestation, early diagnosis and management of mesenteric venous thrombosis.MethodsThirty-nine cases of mesenteric venous thrombosis admitted to the second affiliated hospital of Zhejiang University School of Medicine (from2006to2015) were reviewed retrospectively.ResultsThirty-nine cases were reviewed, including27males and12females, with the mean age of54.8±14.3years. Twenty cases had history of abdominal operation (13cases with splenectomy),14cases had cirrhosis,6cases had local inflammatory factors,6cases had history of deep vein thrombosis, and2cases with abdominal trauma. Post-chemotherapy of lymphoma, systemic lupus erythematosus, and Budd-Chiari syndrome were identified in1case, respectively. There are three cases without objective etiologic factors. Abdominal pain (82.1%) were the most common presentation, followed by nausea and vomiting (35.9%), hematemesis and melena (28.2%), abdominal distension (23.1%). Incidental imaging finding also accounted for2.6%. According to the presentation and clinical manifestation of mesenteric venous thrombosis,74.4%of the cases were acute or sub-acute and the left were chronic. All the patients were diagnosed by CT、CTA、MRA、Doppler ultrasound or surgery.30.8% were simple mesenteric venous thrombosis,53.8%were portal-mesenteric venous thrombosis, and15.4%were portal-spleno-mesenteric venous thrombosis. After admission,31cases received anticoagulation treatment with low-molecular-weight heparin and warfarin, of which10cases simultaneously got thrombolytic therapy with urokinase. Surgery was applied in9cases, including7cases of intestinal resection (because of bowel infarction) and2cases of splenectomy along with pericardial devascularization (because of uncontrolled bleeding of esophageal varices). Four deaths were recorded, including3patients with surgery, with the total and post-operation mortality of10.3%and33.3%, respectively.ConclusionsMost cases of mesenteric venous thrombosis were presented with abdominal pain and no specific manifestation could be detected. Enhancement-computed tomography is the most useful diagnostic modality. Anticoagulation should be the initial treatment of mesenteric venous thrombosis, but no consensus has been achieved for the use of anticoagulants in cirrhotic patients. Surgery is required for the cases with bowel infarction and enterobrosis, despite the high mortality. Identify mesenteric venous thrombosis in early stage and initiate anticoagulation promptly, preventing the extension of thrombus and bowel infarction, are the best ways to improve the prognosis of those patients.