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1.
Rev. colomb. cir ; 39(3): 485-490, 2024-04-24. fig
Article in Spanish | LILACS | ID: biblio-1554170

ABSTRACT

Introducción. La embolia paradójica es un evento trombótico originado en la circulación venosa, que se manifiesta como embolismo arterial por medio de un defecto anatómico a nivel cardíaco o pulmonar. Se asocia principalmente a eventos cerebrovasculares, aunque se han encontrado casos de infarto agudo de miocardio, infarto renal y otros eventos isquémicos. Caso clínico. Paciente de 47 años, quien consultó por cuadro de dolor abdominal, que requirió manejo quirúrgico de urgencia, donde identificaron isquemia intestinal importante. Los estudios adicionales hallaron déficit de proteína S y persistencia de foramen oval permeable. Resultados. La presencia de trombosis arterial se conoce como trombosis de sitios inusuales y requiere de estudios para descartar trombofilias asociadas u otros estados protrombóticos. El déficit de proteína S es una trombofilia infrecuente, la cual se asocia en la vida adulta a eventos trombóticos de origen venoso. En presencia de defectos anatómicos, como un foramen oval permeable, puede progresar a embolia arterial, configurando un cuadro de embolismo paradójico. La estratificación de estos pacientes requiere imágenes que demuestran el defecto mencionado, así como el posible origen de los émbolos. El manejo se basa en anticoagulación plena, manejo de soporte, resolver las manifestaciones trombóticas existentes y un cierre temprano del defecto anatómico. Conclusiones. El embolismo paradójico debe sospecharse en caso de trombosis de sitios inusuales. Requiere de un estudio exhaustivo con imágenes y su manejo debe basarse en anticoagulación y cierre del defecto.


Introduction. Paradoxical embolism is a thrombotic event originating in the venous circulation, which manifests as arterial embolism through an anatomical cardiac or pulmonary defect. It is mainly associated with stroke, also presenting as acute myocardial infarction, renal infarction, and other ischemic events. Clinical case. A 47-year-old patient was admitted due to abdominal pain, which required emergency surgical management, finding significant intestinal ischemia. Additional studies found protein S deficiency and evidence of a patent foramen ovale. Discussion. Arterial thrombosis is known as unusual thrombosis; this situation requires to rule out associated thrombophilia or other prothrombotic diseases. Protein S deficiency is a rare thrombophilia, which in adults causes venous thrombosis. In the presence of anatomical defects, such as a patent foramen ovale, it can progress to arterial embolism, presenting a picture of paradoxical embolism. The study work of these patients requires imaging that demonstrates the aforementioned defect, as well as the possible origin of the emboli. Management is based on full anticoagulation, treatment of existing thrombotic manifestations, and management of the anatomical defect. Conclusions. Paradoxical embolism should be suspected in case of unusual thrombosis. It requires exhaustive studies based on imaging, and management should consist of anticoagulation and closure of the defect.


Subject(s)
Humans , Embolism and Thrombosis , Embolism, Paradoxical , Mesenteric Ischemia , Thrombophilia , Foramen Ovale, Patent , Laparotomy
2.
Medisan ; 27(1)feb. 2023. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1440570

ABSTRACT

Se describe el caso clínico de una paciente de 67 años de edad con varias comorbilidades, entre ellas la policitemia vera, quien acudió al Cuerpo de Guardia del Hospital Clinicoquirúrgico Universitario Dr. Ambrosio Grillo Portuondo de Santiago de Cuba por presentar síntomas y signos de un síndrome de abdomen agudo oclusivo. Se indicó intervención quirúrgica de urgencia, que permitió confirmar el diagnóstico presuntivo de afección vascular mesentérica de tipo trombótica. La inmediatez del tratamiento quirúrgico, la reversibilidad del daño vascular sin necesidad de procedimiento de resección intestinal y la administración efectiva de anticoagulantes permitieron una evolución favorable y sin complicaciones.


The case report of a 67 years patient with several comorbidities is described, among them polycythemia vera, who went to the emergency room of Ambrosio Grillo Portuondo University Clinical Surgical Hospital in Santiago de Cuba due to symptoms and signs of a syndrome of occlusive acute abdomen. An emergency surgical intervention was indicated, that confirmed the presumptive diagnosis of mesenteric vascular thrombosis. The immediacy of the surgical treatment, the reversibility of the vascular damage without necessity of intestinal resection procedure and the effective use of anticoagulants allowed a favorable clinical course without complications.


Subject(s)
Polycythemia Vera , Mesenteric Ischemia , Intestinal Obstruction , Thrombosis , Aged
3.
Acta cir. bras ; 38: e381323, 2023. graf
Article in English | LILACS, VETINDEX | ID: biblio-1439117

ABSTRACT

Purpose: Acute mesenteric ischemia (AMI) is a condition in pediatric surgery that ranges from intestine necrosis to death. Ischemic postconditioning (IPoC) methods were developed to reduce the damage caused by revascularization. This study aimed to evaluate the efficacy of these methods in an experimental weaning rat model. Methods: Thirty-two 21-day-old Wistar rats were allocated into four groups according to the surgical procedure performed: control, ischemia-reperfusion injury (IRI), local (LIPoC) and remote IPoC (RIPoC). At euthanasia, fragments of the intestine, liver, lungs, and kidneys were submitted to histological, histomorphometric, and molecular analyses. Results: In the duodenum, intestines, and kidneys histological alterations promoted by IRI were reversed by remote postconditioning method. In the distal ileum, the histomorphometric alterations could be reversed by the postconditioning methods with more evident effects promoted by the remote method. The molecular analysis found that the levels of expression of Bax (proapoptotic) and Bcl-XL (antiapoptotic) genes in the intestine were increased by IRI. These alterations were equally reversed by the postconditioning methods, with more evident effects of the remote method. Conclusions: IPoC methods positively reduced the damage caused by IRI in weaning rats.


Subject(s)
Animals , Rats , Reperfusion Injury , Rats, Wistar , Ischemic Postconditioning/veterinary , Mesenteric Ischemia/veterinary , Antioxidants
4.
Chinese Journal of Surgery ; (12): 493-497, 2023.
Article in Chinese | WPRIM | ID: wpr-985789

ABSTRACT

Objective: To investigate the factors influencing small intestinal ischemia in elderly patients with incarcerated hernia. Methods: The clinical data of 105 elderly patients admitted for surgical procedures of incarcerated hernia at Department of General Surgery, Huadong Hospital between January 2014 and December 2021 were retrospectively analyzed. There were 60 males and 45 females, aged (86.1±4.3) years (range: 80 to 96 years). They were divided into normal group (n=55) and ischemic group (n=50) according to intraoperative intestinal canal condition. The t test, χ2 test and Fisher's exact probability method were used for the univariate analysis of the factors that influence intestinal ischemia in patients, and Logistic regression was used for multifactorial analysis. Results: In all patients, 18 patients (17.1%) had irreversible intestinal ischemia with bowel resection. Six patients died within 30 days, 3 cases from severe abdominal infection, 2 cases from postoperative exacerbation of underlying cardiac disease, and 1 case from respiratory failure due to severe pulmonary infection. The results of the univariate analysis showed that there were differences in gender, history of intussusception, duration of previous hernia, white blood cell count, neutrophil percentage, C-reactive protein, type of incarcerated hernia, and preoperative intestinal obstruction between the two groups (all P<0.05). The Logistic regression results showed that the short time to the previous hernia (OR=0.892, 95%CI 0.872 to 0.962, P=0.003), high C-reactive protein (OR=1.022, 95%CI 1.007 to 1.037, P=0.003), non-indirect incarcerated hernia (OR=10.571, 95%CI 3.711 to 30.114, P<0.01) and preoperative intestinal obstruction (OR=6.438, 95%CI 1.762 to 23.522, P=0.005) were independent risk factors for the development of intestinal ischemia in elderly patients with incarcerated hernia. Conclusions: The short duration of the previous hernia, the high values of C-reactive proteins, the non-indirect incarcerated hernia, and the preoperative bowel obstruction are influencing factors for bowel ischemia in elderly patients with incarcerated hernia. A timely operation is necessary to reduce the incidence of intestinal necrosis and improve the prognosis.


Subject(s)
Male , Aged , Female , Humans , Retrospective Studies , C-Reactive Protein , Intestinal Obstruction/etiology , Hernia, Inguinal/surgery , Mesenteric Ischemia/surgery , Ischemia/surgery , Herniorrhaphy/adverse effects
5.
Int. j. med. surg. sci. (Print) ; 9(4): 1-5, Dec. 2022. ilus
Article in Spanish | LILACS | ID: biblio-1519478

ABSTRACT

Las complicaciones de la apendicitis aguda ha sido ampliamente descrita en la literatura; la trombosis venosa mesenterica es una manifestación poco común de esta patologia correspondiento a menos del 1 % de frecuencia, esto puede desorientar al cirujano general al coexistir en el cuadro de apendicitis aguda. Presentamos el caso de un paciente masculino de 58 años, con dolor abdominal de 5 días de evolución, con sintomatologia poco especifica para el diagnóstico concreto de apendicitis. Se realizó una tomografía computarizada de abdomen con hallazgos de apendicitis aguda y trombososis venosa mesenterica con un coágulo de 11.5 cm. Se hizó también apendicectomia abierta y se inició anticoagulación al egreso hospitalario.


The complications of acute appendicitis have been widely described in the literature; Mesenteric venous thrombosis is a rare manifestation of this pathology corresponding to less than 1% frequency, this can confuse the general surgeon as it coexists with acute appendicitis. We present the case of a 58-year-old male patient, with abdominal pain of 5 days of evolution, with symptoms that are not very specific for the specific diagnosis of appendicitis. Computed tomography of the abdomen was performed with findings of acute appendicitis and mesenteric venous thrombosis with a clot of 11.5 cm. An open appendectomy was performed and anticoagulation was started on hospital discharge.


Subject(s)
Humans , Male , Middle Aged , Appendicitis/complications , Thrombosis , Mesenteric Ischemia/etiology , Appendectomy , Appendicitis/surgery , Appendicitis/diagnostic imaging , Tomography, X-Ray Computed , Mesenteric Ischemia/drug therapy , Mesenteric Ischemia/diagnostic imaging , Anticoagulants/therapeutic use
6.
Rev. cuba. cir ; 61(3)sept. 2022.
Article in Spanish | LILACS, CUMED | ID: biblio-1441511

ABSTRACT

Introducción: La isquemia mesentérica aguda es la condición clínica que aparece cuando el flujo sanguíneo del territorio mesentérico resulta insuficiente para satisfacer los requerimientos del intestino. Objetivo: Caracterizar la morbilidad y mortalidad de los pacientes con isquemia mesentérica aguda. Métodos: Se realizó un estudio observacional, descriptivo, transversal, en el Servicio de cirugía del Hospital Universitario "Arnaldo Milián Castro" de Santa Clara, Villa Clara desde enero del 2016 hasta diciembre del 2020. La muestra quedó constituida por 119 pacientes que cumplieron los criterios de inclusión y exclusión. Resultados: De los 119 pacientes que presentaron isquemia mesentérica aguda, predominaron pacientes con factores de riesgo mayores de 65 años 97 (81,5 por ciento), femeninos 61 (51,3 por ciento), fumadores 52 (43,7 por ciento), con hipertensión arterial 84 (70,6 por ciento), cardiopatía isquémica 57 (47,9 por ciento), diabetes mellitus 31 (26,1 por ciento) y enfermedad arterial periférica 20 (16,8 por ciento). Predominó el tratamiento quirúrgico: la laparotomía exploratoria y cierre 55 (46,3 por ciento). Las complicaciones más frecuentes encontradas: el fallo múltiple de órganos 25 (25,7 por ciento) en los pacientes fallecidos. En los hallazgos necrológicos predominó la trombosis arterioesclerótica de la arteria mesentérica superior. Conclusiones: La isquemia mesentérica resulta frecuente en pacientes con factores de riesgo como son la edad mayor de 65 años, el sexo femenino, el hábito tóxico del tabaquismo y las enfermedades crónicas no transmisibles tales como la hipertensión arterial, cardiopatía isquémica y la diabetes mellitus. El tratamiento más realizado es el quirúrgico (la laparotomía y el cierre). En la mayoría de las necropsias realizadas la trombosis de la arteria mesentérica superior es el mayor hallazgo en los informes necrológicos(AU)


Introduction: Acute mesenteric ischemia is the clinical condition that appears when the blood flow of the mesenteric area becomes insufficient to meet intestinal requirements. Objective: To characterize the morbidity and mortality of patients with acute mesenteric ischemia. Methods: An observational, descriptive and cross-sectional study was carried out in the surgery service of Arnaldo Milián Castro University Hospital of Santa Clara City, Villa Clara Province, Cuba, from January 2016 to December 2020. The sample consisted of 119 patients who met the inclusion and exclusion criteria. Results: Of the 119 patients who presented acute mesenteric ischemia, patients with risk factors predominated: older than 65 years (97; 81.5 percent), female (61; 51.3 percent), smokers (52; 43.7 percent), with arterial hypertension (84; 70.6 percent), ischemic heart disease (57; 47.9 percent), diabetes mellitus (31; 26.1 percent), and peripheral arterial disease (20; 16.8 percent). Surgical management predominated: exploratory laparotomy and closure (55; 46.3 percent). The most frequent complications were multiple organ failure (25; 25.7 percent) in the deceased patients. Among the necropsy findings, arteriosclerotic thrombosis of the superior mesenteric artery predominated. Conclusions: Mesenteric ischemia is frequent in patients with risk factors such as age over 65 years, the female sex, the toxic habit of smoking; as well as chronic noncommunicable diseases such as arterial hypertension, ischemic heart disease and diabetes mellitus. The most commonly performed procedure is surgery (laparotomy and closure). In most of the performed necropsies, thrombosis of the superior mesenteric artery is the main finding according to the necrology reports(AU)


Subject(s)
Humans , Female , Aged , Mesenteric Ischemia/complications , Laparotomy/methods , Multiple Organ Failure/mortality , Epidemiology, Descriptive , Observational Study
7.
Rev. méd. Paraná ; 80(1): 1-2, jan. 2022.
Article in Portuguese | LILACS | ID: biblio-1381069

ABSTRACT

Obesity is a chronic disease that can lead to other serious health problems. In more severe cases, a therapeutic alternative is bariatric surgery. The aim of this study was to present a narrative review of anatomical aspects of superior mesenteric vein thrombosis after sleeve gastrectomy. A literature review on the subject was performed from 2011 to 2021, using the Periodicals CAPES and PubMed databases, using the following descriptors in English and Portuguese: sleeve, superior mesenteric vein and thrombosis. Among the results, 7 articles were selected that met the research purposes. In conclusion, the sleeve is an efficient procedure; however, it is necessary to consider the possibility of thrombosis of the superior mesenteric vein, and it is important to previously analyze the risk factors, as well as to consider the indication of the use of anticoagulants in the pre, trans and postoperative periods


A obesidade é doença crônica que pode acarretar outros graves problemas de saúde. Em casos mais severos, alternativa terapêutica é a realização de operação bariátrica. O objetivo deste trabalho foi apresentar revisão narrativa aspectos anatômicos da trombose da veia mesentérica superior após sleeve gástrico. Foi realizada análise de literatura sobre o tema no período de 2011 a 2021, utilizando-se das bases de dados Periódicos da CAPES e PubMed, empregando os seguintes descritores em inglês e português: sleeve, veia mesentérica superior e trombose. Dentre os resultados, foram selecionados 7 artigos que atendiam aos propósitos da pesquisa. Como conclusão, o sleeve é procedimento eficiente, contudo é preciso considerar a possibilidade de ocorrência da trombose da veia mesentérica superior, sendo de importância analisar previamente os fatores de risco, bem como cogitar a indicação do uso de anticoagulantes no período pré, trans e pós-operatório


Subject(s)
Humans , Thrombosis , Bariatric Surgery , Mesenteric Ischemia , Obesity , Digestive System
8.
J. vasc. bras ; 21: e20210013, 2022. graf
Article in Portuguese | LILACS | ID: biblio-1365068

ABSTRACT

Resumo A trombose de veia porta (TVP) é uma doença na qual ocorre trombose desde os ramos intra-hepáticos da veia porta, podendo se estender até a veia esplênica e/ou veia mesentérica superior, estando associada, na maioria das vezes, à cirrose hepática. A TVP não associada a cirrose é rara. O objetivo deste artigo foi relatar dois casos de TVP não associados à cirrose, que foram tratados com anticoagulação e tiveram evolução clínica satisfatória.


Abstract Portal vein thrombosis (PVT) is a disease in which thrombosis occurs from the intrahepatic branches of the portal vein, and may extend to the splenic vein and/or superior mesenteric vein. It is most often associated with liver cirrhosis. PVT not associated with cirrhosis is rare. The aim of this article is to report two cases of PVT in which it was not associated with cirrhosis. Both were treated with anticoagulation and clinical progress afterwards was good.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Portal Vein/pathology , Mesenteric Ischemia/therapy , Magnetic Resonance Angiography , Mesenteric Ischemia/diagnostic imaging , Computed Tomography Angiography , Anticoagulants/therapeutic use
9.
Salud(i)ciencia (Impresa) ; 25(3): 159-162, 2022. fot.
Article in Spanish | LILACS | ID: biblio-1436649

ABSTRACT

Coronaviruses can cause respiratory, gastrointestinal, and central nervous system diseases in humans and animals, have the ability to adapt through mutations, and are programmed to modify host tropism. SARS-CoV-2 infection (COVID-19) has been shown to be a highly thrombogenic disease, generating deep vein thrombosis, pulmonary embolism and acute ischemia, in patients even without previous pathology. Coronaviruses can cross the species barrier and infect humans with unexpected consequences for public health. The transmission rate of SARS-CoV-2 is higher compared to that of closely related SARS-CoV infections. Key residues of the spike protein have a higher binding affinity for ACE2. These may be the reason for the higher transmission rate of SARS-CoV-2. COVID-19 has been shown in some patients to be a highly thrombogenic disease, both venous and arterial, generating deep vein thrombosis, pulmonary embolism and acute ischemia, both in patients without previous pathology as with them.There is molecular evidence of the state of hyper coagulability in COVID-19; the first observations were made by Wang, in 2020, when analyzing the levels of fibrinogen and D-dimer in patients with COVID-19 and finding elevated levels up to 75% above the laboratory controls. We present the case of a 62-year-old male with mild symptoms of COVID-19 and outpatient management, at the end of the clinical disease he presented an acute abdomen secondary to mesenteric ischemia, with good postoperative evolution.


Los coronavirus pueden causar enfermedades respiratorias, gastrointestinales y del sistema nervioso central en seres humanos y animales; tienen la capacidad para adaptarse por medio de mutaciones y son programados para modificar el tropismo del huésped. La infección por el SARS-CoV-2 (COVID-19) genera trombosis venosa profunda, embolismo pulmonar y cuadros de isquemia aguda, en pacientes sin afección previa. Los coronavirus infectan a los seres humanos con consecuencias inesperadas para la salud pública. La tasa de transmisión de la infección por el SARS-CoV-2 es más alta en comparación con las infecciones por SARS-CoV estrechamente relacionadas. Los residuos clave de la proteína espiga tienen mayor afinidad de unión por el receptor de la enzima convertidora de angiotensina (ECA2). Esta puede ser la razón de la mayor tasa de transmisión de SARS-CoV-2. La COVID-19 ha demostrado, en algunos pacientes, ser una enfermedad altamente trombogénica, tanto venosa como arterial, dado que genera trombosis venosa profunda, embolismo pulmonar y cuadros de isquemia aguda, tanto en pacientes sin afecciones previas como con ellas. Existe evidencia molecular del estado de hipercoagulabilidad en la COVID-19; las primeras observaciones fueron realizadas por Wang en 2020, al analizar los niveles de fibrinógeno y dímero-D en pacientes con COVID-19, y encontrar niveles elevados hasta 75% por arriba de los controles de laboratorio. Se presenta el caso de un paciente masculino de 62 años, con un cuadro leve de COVID-19 y abordaje ambulatorio; al término de la enfermedad clínica presentó abdomen agudo secundario a isquemia mesentérica, con buena evolución en el posoperatorio.


Subject(s)
Mesenteric Ischemia , Thrombosis , SARS-CoV-2 , COVID-19 , Abdomen, Acute , Ischemia
10.
Clin. biomed. res ; 42(2): 144-151, 2022.
Article in English | LILACS | ID: biblio-1391553

ABSTRACT

Introduction: Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by gas-filled cysts in the intestinal wall. Although rare, it may also involve other regions, such as the mesentery. PCI is classified as primary or secondary and is associated with multiple predisposing factors. It may be associated with either a benign condition or a potentially fatal condition, such as mesenteric ischemia. The objective of this study was to review the medical literature on the rare benign presentations of PCI, excluding cases associated with intestinal ischemia.Methods: We conducted a systematic literature review according to the PRISMA statement. We searched PubMed and LILACS databases for articles published between January 2015 and December 2020 using the following Medical Subject Headings: "pneumatosis cystoides intestinalis" and "pneumoperitoneum," "pneumatosis intestinalis," and "pneumoperitoneum" or "mesenteric pneumatosis."Results: We included 51 articles comprising 58 patients with PCI and pneumoperitoneum. Most patients were men, and mean patient age was 64.9 years. We identified an idiopathic etiology in 29.31% of cases, and the most common predisposing factor was immune dysfunction (29.31%). A total of 24.13% of patients were asymptomatic. The most commons symptoms were abdominal pain (43.10%), nausea and vomiting (41.37%), and abdominal distention (37.93%). Diagnostic surgery was conducted in 26 patients (44.82%). Only 1 patient underwent surgical treatment.Conclusions: PCI is a clinical condition that may have a benign etiology and not require surgery. Treatment of the benign etiology is conservative. Thus, life-threatening conditions should be excluded in all cases.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Pneumatosis Cystoides Intestinalis/diagnosis , Pneumoperitoneum/diagnosis , Mesenteric Ischemia/diagnosis , Pneumatosis Cystoides Intestinalis/therapy , Pneumoperitoneum/therapy , Risk Factors , Mesenteric Ischemia/therapy
13.
Acta cir. bras ; 36(9): e360903, 2021. tab, graf
Article in English | LILACS, VETINDEX | ID: biblio-1345025

ABSTRACT

ABSTRACT Purpose: To evaluate if the perconditioning affects the antioxidant capacity in mesenteric ischemia and reperfusion injury. Methods: Twenty-one Wistar rats were assigned into three groups, as follows: Sham, IR and rPER. The animals were subjected to mesenteric ischemia for 30 min. rPER consisted of three cycles of 5-min hindlimb ischemia followed by 5 min hindlimb perfusion at the same time to mesenteric ischemic period. After 5 minutes, blood and 5 cm of terminal ileum were harvested for thiobarbituric acid reactive substances (TBARS) and Trolox equivalent antioxidant capacity (TEAC) measurement. Results: rPER technique was able to reduce intestinal tissue TBARS levels (p<0.0001), but no statistic difference was observed in blood levels between groups, although it was verified similar results in rPER and Sham group. rPER technique also enhanced TEAC levels in both blood (p = 0.0314) and intestinal tissue (p = 0.0139), compared to IR group. Conclusions: rPER appears as the most promising technique to avoid IR injury. This technique reduced TBARS levels in blood and intestinal tissue and promoted the maintenance of antioxidant defense in mesenteric acute injury.


Subject(s)
Reperfusion Injury/prevention & control , Mesenteric Ischemia , Rats, Wistar , Ischemia , Antioxidants
14.
Rev. colomb. radiol ; 32(3): 5622-5624, sept. 2021.
Article in English, Spanish | LILACS | ID: biblio-1427558

ABSTRACT

La trombosis venosa mesentérica (TVM) representa el 5 %-15 % de las isquemias mesentéricas. Es una patología infrecuente y puede ocurrir de manera espontánea o en su mayoría estar relacionada con factores predisponentes protrombóticos. Tiene un abordaje diagnóstico complicado por su inespecificidad clínica y baja prevalencia, lo cual disminuye su sospecha; sin embargo, es de suma importancia reconocer esta patología en el contexto de un abdomen agudo por su alta mortalidad. El diagnóstico se realiza mediante la angiotomografía computarizada (ATC) y su desenlace estará determinado por un rápido diagnóstico y un tratamiento efectivo. La localización de un trombo en la vena mesentérica inferior (VMI) es muy infrecuente. Este hecho motiva la presentación de este caso, un paciente masculino, adulto mayor, con antecedente de alcoholismo, cardiopatía dilatada y fibrilación auricular en manejo con anticoagulante, quien presenta signos de irritación peritoneal y hallazgo imagenológico de trombosis en distintas ramas de las venas mesentéricas


Mesenteric venous thrombosis (MVT) represents 5-15% of mesenteric ischemia. It is an infrequent pathology and can occur spontaneously or mostly be related to predisposing pro-thrombotic factors. It has a complicated diagnostic approach due to its clinical non specificity and low prevalence that reduce its suspicion; however, it is extremely important to recognize this pathology in the context of an acute abdomen due to its high mortality. The approach is performed through the use computed tomography angiography (CTA) and the outcome will be determined by the rapid diagnosis and effective treatment. The location of a thrombus at the level of the inferior mesenteric vein (IMV) is very rare, which is why a case report will be presented of an elderly male patient with a history of alcoholism, dilated heart disease and atrial fibrillation under treatment with anticoagulant. The patient has signs of peritoneal irritation and imaging finding of thrombosis in different branches of the mesenteric veins.


Subject(s)
Mesenteric Ischemia , Venous Thrombosis , Computed Tomography Angiography , Mesenteric Veins
15.
J. vasc. bras ; 20: e20200105, 2021. tab, graf
Article in English | LILACS | ID: biblio-1154760

ABSTRACT

Abstract The purpose of this article is to report the case of a 53-year-old black man, with no previous comorbidities, who presented 48 days after a confirmed diagnosis of COVID-19, complaining of an initially insidious epigastric pain that had progressed to severe pain radiating to the interscapular vertebral region, with hyporexia and episodes of projectile vomiting, with no nausea or fever. Laboratory tests revealed no signs of acute infection or pancreatic injury. Abdominal computed tomography showed dilated, fluid-filled small bowel loops with thickened walls. After clinical treatment, the patient developed persistent abdominal pain. An exploratory laparotomy was performed, finding two sites of small bowel stenosis, with no extrinsic cause, and signs of local ischemia and considerable distension of jejunal and ileal loops. After enterectomy and side-to-side enteroanastomosis, the patient recovered satisfactorily and was discharged with a prescription for oral anticoagulants for outpatient use.


Resumo O objetivo deste artigo é relatar o caso de um homem de 53 anos de idade, negro, sem comorbidades prévias, com diagnóstico confirmado de COVID-19 há 48 dias anteriores ao início do quadro de dor epigástrica insidiosa, que evoluiu para dor de forte intensidade que irradiava para região interescapulovertebral, associada a hiporexia e episódios de vômitos em jato, sem náuseas ou febre. Os exames laboratoriais não apresentavam sinais de infecção aguda ou lesão pancreática. A tomografia computadorizada do abdome mostrou alças do intestino delgado dilatadas, cheias de líquido e com paredes espessas. Após terapia de suporte, o paciente evoluiu com dor abdominal persistente. Foi realizada laparotomia exploratória, na qual foram encontrados dois sítios de estenose no intestino delgado sem causa extrínseca, ao lado de sinais de isquemia local e distensão importante das alças jejunais e ileais. Após enterectomia e enteroanastomose primária látero-lateral, o paciente evoluiu de forma satisfatória e recebeu alta hospitalar com prescrição de anticoagulantes orais para uso ambulatorial.


Subject(s)
Humans , Male , Middle Aged , Mesenteric Ischemia/complications , Mesenteric Ischemia/therapy , COVID-19/complications , Constriction, Pathologic , Mesenteric Ischemia/diagnosis , Intestine, Small/physiopathology , Laparotomy , Anticoagulants
16.
Rev. gastroenterol. Perú ; 40(3): 270-273, Jul-Sep 2020. graf
Article in Spanish | LILACS | ID: biblio-1144675

ABSTRACT

RESUMEN Las várices del intestino delgado, usualmente, están relacionadas con hipertensión portal. Las várices ectópicas secundarias a trombosis crónica aislada de la vena mesentérica superior son muy infrecuentes. El sangrado digestivo secundario a éstas representa un reto diagnóstico, dada la baja prevalencia y sospecha clínica, y terapéutico por la escasa evidencia científica existente con respecto a las opciones de tratamiento. Presentamos el caso de un hombre de 56 años, con sangrado digestivo secundario a várices yeyunales por trombosis crónica de la vena mesentérica superior, asociada a trombofilia; diagnosticadas mediante video cápsula endoscópica (VCE) y enterografía por tomografía (entero TC), sin posibilidades de manejo endoscópico ni radiológico dado el compromiso extenso, intervenido quirúrgicamente con éxito.


ABSTRACT Small bowel varices are usually associated with portal hypertension. Ectopic varices caused by isolated chronic superior mesenteric vein thrombosis are exceedingly rare. Gastrointestinal bleeding secondary to these represents a diagnostic challenge, given the low prevalence and clinical suspicion, and therapeutic dilemma due to the limited scientific evidence available regarding treatment options. We present the case of a 56-year-old man with gastrointestinal bleeding from jejunal varices due to chronic superior mesenteric vein thrombosis, associated with thrombophilia; diagnosed by video capsule endoscopic (VCE) and computed tomography enterography (CTE), with no possibility of endoscopic or radiological management given the extensive involvement, who underwent successful surgery.


Subject(s)
Humans , Male , Middle Aged , Varicose Veins/etiology , Mesenteric Ischemia/complications , Gastrointestinal Hemorrhage/etiology , Jejunum/blood supply
17.
Rev. Asoc. Méd. Argent ; 133(1): 21-24, mar. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1097699

ABSTRACT

La isquemia mesentérica aguda (IMA) es consecuencia de la oclusión de la arteria mesentérica superior (AMS) por trombosis o embolia, y es considerada la más letal del síndrome de abdomen agudo. Se presenta el caso de paciente femenina de 69 años con clínica difusa y confirmación diagnóstica radiológica, El objetivo de este caso clínico es proporcionar una revisión bibliográfica actual del tema y facilitar la adecuada actuación ante este problema de salud de amplio compromiso sistémico, y de aparición no tan infrecuente. (AU)


Acute mesenteric ischemia (IMA) is a consequence of occlusion of the superior mesenteric artery (AMS) by thrombosis or embolism; and it is considered the most lethal of acute abdomen syndrome. The case of a 69 years old female patient with diffuse clinic and radiological diagnostic confirmation is presented. The objective of this clinical case is to provide a current bibliographic review of the topic and facilitate adequate action in the face of this health problem with a broad systemic commitment, and with no appearance so infrequent. (AU)


Subject(s)
Humans , Female , Aged , Mesenteric Artery, Superior/diagnostic imaging , Mesenteric Ischemia/diagnostic imaging , Mesenteric Vascular Occlusion/complications , Acute Disease , Mesenteric Artery, Superior/surgery , Multidetector Computed Tomography , Mesenteric Ischemia/etiology , Mesenteric Ischemia/therapy
18.
Prensa méd. argent ; 106(2): 83-90, 20200000. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1369323

ABSTRACT

La isquemia mesentérica aguda (IMA) es consecuencia de la oclusión de la arteria mesentérica superior (AMS) por trombosis o embolia, es considerada como la más letal del síndrome de abdomen agudo. Se presenta el caso de paciente femenina de 69 años con clínica difusa y confirmación diagnóstica radiológica, El objetivo de este caso clínico es proporcionar una revisión bibliográfica actual del tema y facilitar la adecuada actuación ante este problema de salud de amplio compromiso sistémico, de aparición no tan infrecuente.


Acute mesenteric ischemia (IMA) is a consequence of occlusion of the superior mesenteric artery (AMS) by thrombosis or embolism, it is considered the most lethal of acute abdomen syndrome. The case of a 69-year-old female patient with diffuse clinic and radiological diagnostic confirmation is presented. The objective of this clinical case is to provide a current bibliographic review of the topic and facilitate adequate action in the face of this health problem with a broad systemic commitment, with no appearance. so infrequent.


Subject(s)
Humans , Female , Aged , Prognosis , Critical Care , Mesenteric Ischemia/surgery , Mesenteric Ischemia/mortality , Mesenteric Ischemia/therapy , Abdomen, Acute/surgery
19.
Rev. colomb. cir ; 35(4): 675-681, 2020. fig, tab
Article in Spanish | LILACS | ID: biblio-1147980

ABSTRACT

En este artículo se revisan los aspectos más importantes de la epidemiología, fisiopatología, abordaje diagnóstico y terapéutico de la trombosis del sistema venoso portal y mesentérico, para finalizar discutiendo la experiencia clínica de un caso a la luz de la literatura relevante. Esta complicación es usualmente relacionada con afecciones sistémicas y hepáticas, pero rara vez se presenta aislada y relacionada con el trauma. En ausencia de tratamiento adecuado durante la etapa aguda, la trombosis puede evolucionar hacia el infarto intestinal y la muerte del paciente. En casos crónicos, se ha asociado con la degeneración del sistema venoso portal hacia cambios por hipertensión portal crónica


This article reviews the epidemiology, pathophysiology, diagnostic and therapeutic approach of the portal and mesenteric venous system thrombosis, with a clinical case discussion considering the relevant literature. This complication is usually related to systemic and hepatic conditions, but rarely occurs isolated and related to trauma. In the absence of adequate treatment during the acute stage, thrombosis can progress to intestinal infarction and death. In chronic cases, it has been associated with degeneration of the portal venous system into changes due to chronic portal hypertension


Subject(s)
Humans , Abdominal Injuries , Portal System , Venous Thrombosis , Mesenteric Ischemia
20.
In. Machado Rodríguez, Fernando; Liñares, Norberto; Gorrasi, José; Terra Collares, Eduardo Daniel. Manejo del paciente en la emergencia: patología y cirugía de urgencia para emergencistas. Montevideo, Cuadrado, 2020. p.181-187.
Monography in Spanish | LILACS, UY-BNMED, BNUY | ID: biblio-1343001
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