Trombosis segmentaria sigmoidea consecuente a neoplasia maligna de colon. A propósito de un caso interesante / Sigmoid segmental thrombosis consequent to colon malignant neoplasia. On the purpose of a case

RESUMEN Se presentó un caso de una paciente de 78 años de edad, procedente del municipio de Calimete, con antecedentes patológicos personales de infarto agudo miocárdico sin elevación del segmento ST e hipertensión arterial. Llegó a la Unidad de Cuidados Intensivos de Emergencia, de Colón con un estado toxico infeccioso severo. Fue intervenida quirúrgicamente con el diagnóstico presuntivo de una trombosis mesentérica. Se constató dicho diagnóstico complementario a una neoplasia maligna de colon sigmoides. Falleció producto a un shock séptico refractario a aminas. En la necropsia se reportaron hallazgos de interés.

ABSTRACT The authors present the case of a 78-years-old female patient from the municipality of Calimete, with personal pathological antecedents of acute myocardial infarct without ST segment elevation and arterial hypertension. She arrived to the Emergency Intensive Care Unit of Colon with a severe toxic-infectious status. She underwent a surgery with a presumptive mesenteric thrombosis. It was stated that diagnosis, complementary to a sigmoid colon malignant neoplasia. She died as a product of an amine-refractory septic shock. The autopsy showed findings of interest.

Isquemia mesentérica crónica, tratamiento quirúrgico: reporte de dos casos / Chronic mesenteric ischemia: report of two cases

Chronic mesenteric ischemia is uncommon and often not recognized by clinicians. We report two patients with the disease. A 61 years old female with a two years history of abdominal pain, diarrhea, anorexia and weight loss. A mesenteric arteriography showed a critical stenosis of the celiac artery. The patient was operated and a retrograde bypass from the iliac to the mesenteric artery was placed. Digestive symptoms ceased and the patient gained weight. A 49 years old smoker female, with a two years history of abdominal pain and weight loss, without diarrhea. A doppler ultrasonography of abdominal arteries showed a critical stenosis of the celiac artery. The angiography confirmed the stenosis and disclosed also a complete occlusion of the common hepatic artery. The patient was operated placing anterograde aortic-mesenteric and aortic- hepatic bypasses. During the follow up, the patient is in good conditions.

La isquemia mesentérica crónica es una enfermedad que pone en riesgo la vida, que puede provocar la muerte por inanición o infarto mesentérico. El diagnóstico se realiza tardíamente debido a la inespecificidad de sus síntomas. El método diagnóstico no invasivo de elección es la ecografía doppler, por el cual se determina la presencia de estenosis u oclusión de las arterias viscerales comprometidas. La arteriografía se utiliza para definir la anatomía de las lesiones y planificar la cirugía. El tratamiento de elección sigue siendo la revascularización. Presentamos dos pacientes tratadas en nuestro servicio con buenos resultados, las que presentaban historia de síntomas abdominales inespecíficos y baja de peso. En la primera paciente, con antecedentes de hipercolesterolemia, su estudio demostró ateromatosis calcica difusa de aorta abdominal, ilíacas comunes, tronco celíaco, renales y mesentérica superior; se le realizó bypass ilíaco-mesentérico superior. En la segunda paciente, con antecedentes de tabaquismo crónico, su estudio demostró lesiones críticas de tronco celíaco y arteria mesentérica superior e inferior, se le realizó bypass aorto-mesentérico superior y aorto-hepático común. En los controles, ambas pacientes presentan alza de peso sostenida y se mantienen asintomáticas.

A Case of Idiopathic Mesenteric Phlebosclerosis / 대한소화기학회지

Idiopathic mesenteric phlebosclerosis, rare disease entity causing chronic mesenteric ischemia is a member of non-thrombotic, non-inflammatory stenosis or occlusion of the mesenteric veins. The histologic hallmark is marked fibrous mural thickening and sclerosis of the vessel wall. It is frequently accompanied by calcification in the vessel wall. We report the case of a 61-year-old woman with idiopathic mesenteric phlebosclerosis. To our knowledge, this is the first case reported in Korea.

A Case of Idiopathic Mesenteric Phlebosclerosis / 대한소화기학회지

Idiopathic mesenteric phlebosclerosis, rare disease entity causing chronic mesenteric ischemia is a member of non-thrombotic, non-inflammatory stenosis or occlusion of the mesenteric veins. The histologic hallmark is marked fibrous mural thickening and sclerosis of the vessel wall. It is frequently accompanied by calcification in the vessel wall. We report the case of a 61-year-old woman with idiopathic mesenteric phlebosclerosis. To our knowledge, this is the first case reported in Korea.

Superior mesenteric vein thrombosis complicating gangrenous appendicitis

Superior mesenteric vein [SMV] thrombosis is a condition of uncommon occurrence the diagnosis of which is challenging as the patient usually presents with nonspecific symptoms. Early diagnosis with computerized tomographic [CT] abdominal scan can prevent progression to mesenteric infarction. Herein, a case of SMV thrombosis secondary to gangrenous appendicitis is reported. Early intervention in the patient with full anticoagulation, helped to resolve the condition with no surgical intervention

Trombosis venosa mesentérica: manifestaciones clínicas, terapia y evolución / Mesenteric vein thrombosis: clinical manifestations, treatment and outcome

Background: Mesenteric vein thrombosis (MVT) is uncommon and accounts for 5-10percent of all mesenteric ischemic events. In 80percent of cases, an etiologic factor is found. The clinical presentation varies and the diagnosis is made based on imaging studies. The treatment involves anticoagulation alone or in combination with surgery. Aim: To describe the clinical characteristics of patients with MVT. Patients and methods: Retrospective and prospective review of all cases with MVT, treated between 1995-2001. The clinical presentation, imaging studies, treatment and outcome were evaluated. Results: 29 cases of MVT were reviewed (14 females, age 56 ± 15 years). Twenty two patients (76percent) had recognizable risk factors. The main symptoms were abdomianl pain (86percent) and vomiting (55percent). The diagnosis of acute mesenteric ischemia was suspected on admission only in 6 patients (21percent). Thirteen patients underwent transabdominal color Doppler ultrasonography and the diagnosis was confirmed for 11 of these (85percent). Twenty out of 24 patients (85percent) studied with computed tomography, had positive signs of MVT. Twenty one patients (72percent) recieved anticoagulation, 10 of whom also underwent surgery. Four patients (14percent) received surgical treatment alone. Four patients were not treated. Seven patients (24percent) died. Conclusions: MVT is difficult to identify. It is necessary to have a high degree of suspicion in patients who have risk factors. The diagnosis is made with imaging studies. The treatment consists of early anticoagulation and surgical intervention when indicated.

Acute mesenteric ischemia

Acute mesenteric ischemia [AMI] is a morbid condition with a difficult diagnosis and a high rate of complications, which is associated with a high mortality rate. For the evaluation of the hospital results of diagnosis and treatment of acute mesenteric ischemia we reviewed our experience. The clinical data of 24 patients diagnosed with acute mesenteric ischemia between 2001 and 2004 were reviewed, assessed and hospital results analyzed. The dominant population were males [83%] whereas females were only [17%]. The median age was 61.5, and cases increased with age. Smoking had been studied as a causative factor for acute mesenteric ischemia. 18 patients in the study were regular smokers [75%]. 22 patients [92%] had previous medical or surgical problems, and the most frequent were respectively heart disease [62%], recent surgical procedures [26%], DM [13%], CVA [11%], and previous digestive problems [11%]. 11 patients [46%] had previous thrombosis events. 6 patients [25%] had recent stress [acute illness] associated with mesenteric ischemia. The most common symptoms and signs were respectively: abdominal pain [91%], nausea and vomiting [79%], intestinal obstrucion [58%], gastrointestinal bleeding [33%]. The Median time of pain was 45.6 h, and the most frequent duration was 24 h and less. Abdominal distension was the the most frequent sign [71%], followed by peritoneal irritation [58%]. On ECG series at the time of admission an Atrial Fibration was found in 33% of cases, heart ischemia signs in 66, 67% of cases, enlargment of heart in 17.5%, and arrhythmias in 17.5%. 11 patient [45%] had problems of the chest at the time of admission, and [96%] had cardiopulmonary problems. laboratory findings were non-specific, and the most important signs were:- increased WBC, and the mean value was 18604 mm3-decreased blood PH, and the mean value was 7.2. -the other findings were not helpful in diagnosing acute mesenteric ischemia. Abdominal scanning by AXR and U/S were not helpful and showed some non-specific finding. Angiography was not performed for any cases. CT scan was performed in 6 cases of those had high suspision of acute mesenteric ischemia, 3 of them were diagnosed [and included in this study], it showed specific signs [embolism] in 2 patients [8%], nothing in one case [4%]. The predictive value, sensitivity, and specificity were 67%, 67%, 67%, respectively. All patients underwent open surgery [100%] without any case of laparoscopic, and the indications were: explorative laparotomy [7 cases] 29%, intestinal obstruction [2 cases] 8%, peritoneal irritation [14 cases] 59%, fecal fistula after previous surgery [1 case] 4%. The surgery was performed after admision 31 h as a mean. Surgery showed that there is one or more foci of gangrenous lesions in all patient [100%], these lesions were supplied by SMA in 23 cases [96%], and 1 case was supplied by IMA. and the median leangth of its was 282 cm. Selected procedure to the gangrenous intestine was done in 21 cases [87%], which was colointestinal resection with primary anastomosis in 19 cases and with stoma in 2 cases, while only 2 patient [8%]underwent revascularization procedures [thromboembolectomy] Secound operation was done in 3 cases [12.5%], the indication was fecal fistula [2 cases] and intestinal obstruction [1 case]. The cause of occlusion was determined by clinical and imaging study and the results: 19 cases [79%] were arterial occlusion [14 cases [58%] embolism, and 5 cases [21%] thrombosis], 3 cases [13%] were mesenteric venous thrombosis, and 2 cases [8%] were non-occlusive mesenteric ischemia [NOMI]. Mortality associated with surgery was 14 cases [58%], and higher mortality rate occured in:-Mesenteric venous thrombosis patients [67% of this group], arterial thrombosis [60%], and embolism [5 7%]-At the group of late surgery-The patient at advanced age-Patients having recent heart or chest problems. Most cases of death were at the first 24 h after operation, and less by the time. Multiorgan failure [MOF] was the most frequent cause of death in this group of patients [71.5%], then hemorrhagic shock [2 1%], then heart failure [7%]. Complications occurred in 14 cases of total amount of patient [58%], and in 8 of surviving patients [80%]. -The complications in survived cases were: wound infection in [2], sepsis in [3], gastrointestinal bleeding in [1], short bowel syndrome in [2], bowel obstruction in[1], faecal fistula in [I], multiorgan failure in 2. Total Parenteral nutrition [TPN] was necessary in 60% of survived patients

Dímero D e isquemia intestinal aguda: un nuevo marcador en plasma? / D-dimer (plasmatic marker) in acute intestinal ischemia

Antecedentes: La isquemia intestinal tiene una mortalidad mayor al 70 por ciento. Su diagnóstico es un desafío. No existe estudio de certeza para determinar su presencia. El Dímero D (DD) es un marcador de fibrinolisis. Se aplica en el diagnóstico de la trombosis venosa profunda y el tromboembolismo pulmonar. Su nivel plasmático elevado indicaría la presencia de isquemia intestinal aguda (IIA) por enfermedad trombólica. Objetivo: Determinar el valor diagnóstico del DD en la IIA de cualquier etiología. Lugar de aplicación: Hospital Privado de la Comunidad. Diseño: Longitudinal, consecutivo, prospectivo no randomizado. Período: 2001-2002. Población: Determinación de DD en 26 pacientes con diagnóstico presuntivo de IIA. Métodos: Se analizaron la sensibilidad (S), especificidad (E), valor predictivo negativo (VPN) y positivo (VPP) del DD para determinar la IIA (Epidat 2,1). Resultados: Se comprobó la ausencia de isquemia intestinal en 6 casos, en todos ellos el DD fue negativo. En los 4 casos tratados médicamente no se pudo certificar isquemia, asimismo el DD fue negativo. Dichos pacientes evolucionaron favorablemente sin necesidad de cirugía. En 15 de los 16 casos con certeza de isquemia el DD fue positivo. La S del DD para diagnosticar isquemia fue de 93,3 por ciento - VPN 87,5 por ciento - E y VPP, 100 por ciento (Alfa=0,05)

Superior mesenteric vein thrombosis complicating appendicular masses

Mesenteric vein thrombosis [MVT] is rare. Its diagnosis is usually difficult and delayed. Herein, we report 2 patients who developed MVT as a complication of an appendicular mass. One of them had appendectomy and developed fever 10 days postoperatively. The other was treated conservatively. An abdominal computerized tomography [CT] scan with intravenous contrast was helpful in diagnosing the superior MVT in both patients, which were not suspected. Intravenous contrast should be used when performing CT of an appendicular mass. Special interest should be directed at studying the superior mesenteric vein. Early diagnosis of our patients helped to start early medical treatment with anticoagulation

Dolor abdominal atípico en paciente con estenosis crítica de arteria mesentérica superior: resolución con angioplastía / Atypical abdominal pain in a patient with critical upper mesenteric artery stenosis: resolution with angioplasty

Se presenta el caso de una paciente con dolor abdominal, de carácter atípico. Tras amplio estudio, se realizó angiografía que demostró estenosis crítica en origen de arteria mesentérica. Se procedió a instalar stent, con óptimo flujo posterior. Este caso ilustra la efectividad y seguridad de la angioplastía con stent en el tratamiento de la isquemia mesentérica crónica y su creciente aplicación, antes reservada sólo a casos de alto riesgo quirúrgico

Importancia de la determinación del ácido láctico peritoneal en el diagnóstico de oclusión vascular mesentérica / Importance of the peritoneal lactic acid determination in the mesenteric vascular occlusion diagnostic

En este estudio se evalúa la importancia diagnóstica de ácido láctico peritoneal en el diagnóstico de oclusión vascular mesentérica. Se seleccionaron a 15 pacientes sometidos a laparotomía por abdomen agudo quirúrgico, determinandose las concentraciones séricas de ácido láctico y de líquido peritoneal al momento de la intevención. 5 pacientes correspondieron a oclusión vascular mesentérica y 10 a abdomen agudo no vasculo-oclusivo. Se observaron concentraciones séricas de ácido láctico en los pacientes con isquemia intestinal de 61,53 ± 85,12 mg/dl y en los pacientes con abdomen agudo no vasculo-oclusivo de 16,33 ± 10,84 mg/dl (p: 0,33>0,05). No se observó en ambos grupos una diferencia estadísticamente significativa en las concentraciones en líquido peritoneal de glóbulos rojos (p: 0,45>0,05), glóbulos blancos (p: 0,69>0,05), glicemia (p: 0,11>0,05), proteínas totales (p: 0,16>0,05), bilirrubina total (p: 0,48>0,05) y una diferencia estadísticamente significativa en las concentraciones de ácido láctico peritoneal (p:0,0118<0,05). Estos hallazgos sugieren que la determinación de ácido láctico peritoneal es de ayuda diagnóstica en la evaluación del paciente con oclusión vascular mesentérica y en su evolución postoperatoria

Isquemia mesentérica aguda / Acute mesenteric ischemia

La isquemia mesentérica aguda aún no es considerada en muestro medio dentro de las hipótesis diagnósticas de un paciente con un cuadro abdominal agudo, además la reticencia de muchos colegas para indicar estudio angiográfico o la falta de disponibilidad inmediata de éste, es otro punto en contra. Lo anteriormente expuesto determina la diferencia entre isquemia e infarto intestinal y no permite modificar sustancialmente el resultado final del paciente

Lesión obstructiva de arteria mesentérica superior / Obstructive lesion of superior mesenteric artery: case report

Se presenta un caso de lesión obstructiva de la arteria mesentérica superior, que se presentó como un abdomen agudo, requirió un completo estudio diagnóstico y dos intervenciones quirúrgicas. Se discute la escasa literatura disponible

Medical Quiz acute mesenteric ischaemia

A 62 years old Bahraini man was admitted through the surgical clinic with recurrent attacks os central abdominal pain of several month's duration. He gave a history of ischaemic heart disease but was not on regular treatment. Previous echocardiography had shown impaired systolic left ventricular function with global hypokinesia. On the second day of his admission he developed a cold left lower limb. Clinical examination revealed an absent pulse from dorsalis pedis and posterior tibial arteries that was confirmed by duplex ultrasound. Following a femoral angiography [Fig. 1] he underwent a successful femoral embolectomy. On the first postoperative day he complained of severe central abdominal pain and became hypotensive and tachycardiac

Estenosis segmentaria de intestino delgado luego de trombosis de vena mesentérica superior: caso clínico / Segmental short bowel stenosis after a superior mesenteric vein thrombosis: report of 1 case

We report a 24 years old female with a superior mesenteric and portal vein thrombosis due to an antithrombin III factor deficiency, associated to oral contraceptive use and smoking. She presented with severe abdominal pain and the diagnosis was reached after surgery with a CT scan. The patient was treated with intravenous heparin and oral anticoagulation, with a good clinical and doppler endosonographic response. One month after the onset, she developed an intestinal occlusion caused by two concentric jejunal stenoses, measuring 2 and 0.7 cm in length and demonstrated with a barium jejunogram. A 35 cm intestinal resection was done and the patient recovered uneventfully. The pathological study showed granulation tissue on both stenotic zones with an ulcer near to the distal stricture, that reached the internal muscularis propria, with subserosal fibrosis. The development of segmental stenosis is a rare complication superior mesenteric vein thrombosis, that must be bore in mind

Isquemia intestinal aguda de origen mesentérico / Acute mesenteric ischemia

Se analizan 29 pacientes con diagnóstico de isquemia mesentérica aguda. El dolor abdominal agudo, intenso y persistente, fue el motivo de consulta en todos los casos. Los signos humorales como leucocitos, hemoconcentración e hiperlactacidemia, no son específicos. La arteriografía selectiva de la arteria mesentérica superior permite el diagnóstico y el tratamiento de la isquemia mesentérica extensa, lo que nos llevó a efectuar la revascularización en cuatro de nuestros casos. Las tácticas quirúrgicas empleadas fueron: revascularización y/o resección intestinal. La amyoría de los pacientes desarrollaron complicaciones graves como: shock perioperatorio en 10 casos, sepsis en 10, dehiscencia anastomática en 5, evisceración en 2 y síndrome de malabsorción en uno. La mortalidad alcanzó a 20 pacientes, 69 por ciento, en un gran porcentaje de casos antes de la primer semana de postoperatorio. No falleció ningún revascularizado, mientras que un revascularizado y resecado falleció (50 por ciento), la mortalidad de la resección fue de 13 casos (68 por ciento) y murieron los 6 pacientes a los que sólo se les efectuó una laparotomía exploratoria. El criterio diagnóstico fundado en la "sospecha clínica" y la arteriografía a partir del cual se puede efectuar un tratamiento enérgico y oportuno, puede mejorar de manera importante el pronóstico de esta enfermedad

Hallazgos tomográficos en la isquemia intestinal / Tomographic findings in the intestinal ischemia

La isquemia mesentérica es una entidad grave, que presenta signos clínicos poco significativos. Antes de la era tomográfica su diagnóstico era presuntivo y el estudio angiográfico confirmatorio. Actualmente con los signos tomográficos se logra realizar un diagnóstico preciso. A fin de ilustrar con casos confirmados los signos tomográficos característicos que se desarrollan en la isquemia intestinal se revisaron 2.800 tomografías de abdomen desde 1993 hasta la fecha, hallándose 11 casos de isquemia intestinal confirmados con la evolución clínica y quirúrgica, dos de ellos con anatomía patológica. Se concluye que la TC es un método fidedigno para diagnosticar y/o confirmar los signos de isquemia intestinal

Anticorpo antifosfolipídio e trombose mesentérica: relato de caso / Antiphospolidid antibody and mesenteric thrombosis: case report

Os autores apresentam o caso de um paciente do sexo masculino, 36 anos de idade, com história de dor abdominal aguda, pela qual foi submetido à laparotomia exploradora, onde realizou-se o diagnóstico de trombose da veia mesentérica superior. O paciente era previamente hígido e na investigaçäo da causa trombogênica a pesquisa de anticorpos antifosfolipídios foi positiva para anticorpos anticardiolipina IgG e IgM. Ressalta-se a importância em investigar as causas trombogênicas e entre elas os anticorpos antifosfolipídios.