Portal and Superior Mesenteric Venous Thrombosis Treated with Urokinase Infusion via Superior Mesenteric Artery / 대한소화기학회지

Portal and mesenteric venous thrombosis is an uncommon disease, but clinically important, because it accounts for 5% to 15% of acute mesenteric ischemia. The diagnosis is often delayed because the conditions are nonspecific abdominal symptoms. In addition, when this occurs in young individual without any known predisposing factor, the diagnosis may become even more difficult. The treatment of mesenteric venous thrombosis involves anticoagulation therapy alone or in combination with surgery. The addition of thrombolytic therapy to the treatment of portal and mesenteric venous thrombosis may enhance the clearance of thrombus and hasten the clinical improvements. We present a case of mesenteric venous thrombosis treated with catheter-directed infusion of urokinase via the superior mesenteric artery and systemic anticoagulation.

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.

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

Trombose de veia mesentérica superior e anticoagulante lúpico / Thrombosis of the upper mesenteric vein and lupus anticoagulant

Relata-se o caso de uma paciente de 47 anos de idade que procurou o serviço de cirurgia do Hospital de Base - FAMERP (SP) com queixas de dor abdominal em cólica na regiao hipogástrica, náuseas, vômitos e diarréia nao sanguinolenta há um dia. No exame físico encontrava-se taquicárdica, hipotensao e com dor à descompressao brusca do abdome em regiao hipogástrica. Foi submetida a laparotomia exploradora com diagnóstico de trombose de vei mesentérica superior. Constatou-se a positividade para o anticoagulante lúpico com ausência de anticorpos anticardiolipinas, proteína S e C e antitrombina III. Realizou-se a anticoagulaçao com heparina e mesmo na vigência desta apresentou progressao do quadro trombótico com necessidade de novas ressecçoes. Chama-se atençao para a necessidade de se investigar as causas trombogênicas em pacientes com trombose da veia mesentérica superior.

Importância dos radicais livres derivados do oxigênio na fisiopatologia das afecçöes isquêmicas intestinais / Importance of oxygen-free radicals in the pathophysiology of intestinal ischemic lesions

O presente trabalho experimental teve como finalidade estudar a participaçäo dos radicais livres derivados de oxigênio na fisiopatologia das lesöes isquêmicas intestinais. Utilizaram-se 40 cobaias subdivididas em quatro grupos. Três deles eram compostos por oito animais e o Grupo I, controle, era formado por 16 cobaias. No Grupo II aplicaram-se ligaduras segmentares definitivas do mesentério do intestino delgado e no Grupo III foi instituída isquemia, seguida pelo restabelecimento da perfusäo sangüínea intestinal. Comprovou-se, através do uso dos sais de tetrazólio, que houve intensa liberaçäo de radicais livres derivados do oxigênio nos segmentos reperfundidos. Os exames histológicos evidenciaram dano tecidual, principalmente no Grupo III, em que ocorreu a reperfusäo. Por fim, no Grupo IV, administrou-se previamente ao período de reperfusäo, um inativador dos radicais livres derivados do oxigênio. Esta substância, o alopurinol, exerceu um efeito protetor sobre a mucosa, evitando o aparecimento das lesöes histopatológicas evidenciadas nos Grupos II e III. Os resultados obtidos consubstanciaram a proposiçäo do uso deste inativador como recurso profilático e método terapêutico nas afecçöes vasculares isquêmicas intestinais