Mesenteric vein thrombosis secondary to protein S deficiency

Mesenteric vein thrombosis is an uncommon condition. Diagnosis is often difficult because of the nonspecific clinical presentation and findings on routine laboratory and radiological evaluation. Endoscopy is usually unrevealing. An underlying hypercoagulable state is often present, but protein S deficiency has rarely been implicated. We describe a case in which chronic inferior mesenteric vein thrombosis, with remarkable endoscopic findings, occurred as the initial presentation of type I protein S deficiency.     

Mesenteric vein thrombosis treated successfully with ultrasound augmented thrombolysis

Mesenteric vein thrombosis is a potentially fatal condition that is associated with better outcomes with early diagnosis and intervention. A 32-year-old-man with Down syndrome presented with abdominal pain and was found to have extensive porto-splenomesenteric thrombosis with early bowel ischemia on computed tomography. He was treated successfully with ultrasound augmented thrombolysis. Ultrasound can improve efficiency of thrombolysis, decreasing the time required for thrombolysis by half, decrease thrombolytic dose and monitoring time and thus reduce overall costs and complications seen with long thrombolysis times.     

Mesenteric and portal vein thrombosis presenting as acute intestinal obstruction.

Acute bowel infarction is a major complication in patients with superior mesenteric vein and portal vein thrombosis. However, in some patients, sufficient collaterals can prevent acute bowel infraction. We present a case of mesenteric vein and portal vein thrombosis with intestinal obstruction due to acute bowel oedema and ischaemic adhesion without infarction or stenosis.     

Mesenteric vein thrombosis as presenting manifestation of hereditary protein S deficiency

Protein S deficiency is inherited as an autosomal dominant trait. Heterozygotes with a reduction of 50% in the plasma protein S concentration are at risk for the development of venous thromboembolism, often occurring at an early age without an apparent cause. In the majority of the patients thrombosis is restricted to the superficial or deep venous system of the legs. In this case report we describe the presence of mesenteric vein thrombosis in a 30-yr-old man with hereditary protein S deficiency. In his family protein S deficiency was also recognized in his mother, brother, and niece. Both his mother and brother had a history of thrombotic disease.     

Mesenteric venous thrombosis

First differentiated from arterial causes of acute mesenteric ischemia 75 years ago, acute mesenteric venous thrombosis (MVT) is an uncommon disorder with non-specific signs and symptoms, the diagnosis of which requires a high index of suspicion. The location, extent, and rapidity of thrombus formation determine whether intestinal infarction ensues. Etiologies, when identified, usually can be separated into local intra-abdominal factors and inherited or acquired hypercoagulable states. The diagnosis is most often made by contrast-enhanced computed tomography, though angiography and exploratory surgery still have important diagnostic as well as therapeutic roles. Anticoagulation prevents clot propagation and is associated with decreased recurrence and mortality. Thrombectomy and thrombolysis may preserve questionably viable bowel and should be considered under certain circumstances. Evidence of infarction mandates surgery and resection whenever feasible. Although its mortality rate has fallen over time, acute MVT remains a life-threatening condition requiring rapid diagnosis and aggressive management. Chronic MVT may manifest with complications of portal hypertension or may be diagnosed incidentally by noninvasive imaging. Management of chronic MVT is directed against variceal hemorrhage and includes anticoagulation when appropriate; mortality is largely dependent on the underlying risk factor.     

Mesenteric vein thrombosis: early CT and US diagnosis and conservative management

We report a case of isolated superior mesenteric vein thrombosis with acute ischemic bowel disease, diagnosed early by a screening ultrasound scan of the upper abdomen and definitively assessed by computed tomography and angiography. This report stresses the contribution of cross-sectional techniques in the early diagnosis and management of venous occlusive disease of the small bowel.     

Mesenteric vein thrombosis associated with primary cytomegalovirus infection: a case report.

In the past few years several studies have supported an interplay between cytomegalovirus infections and a prothrombotic state. We describe a case of primary cytomegalovirus infection in an immunocompetent adult that was complicated with mesenteric vein thrombosis. Transient protein C deficiency, lupus anticoagulant and activated protein C resistance were found, in combination with a heterozygous prothrombin G20210A mutation. We discuss the possible mechanisms of cytomegalovirus-related venous thrombosis.     

Internal jugular vein thrombosis after cervical traction

A clinically and roentgenographically typical case of internal jugular vein thrombosis is presented in a patient having undergone repeated sessions of Glisson traction for neck and backache. In this mode of therapy, axial traction is applied to the neck by attaching a weight, via a pulley, to a construction of straps encompassing the head. This particular trauma to the neck has not previously been described to be associated with spontaneous internal jugular vein thrombosis.     

Femoral vein thrombosis after right-sided electrophysiological procedures

Purpose

Electrophysiological studies and radiofrequency catheter ablations require single or multiple sheath placements through femoral vein cannulation. The objective of this study was to determine the incidence, predictors, and outcomes of deep vein thrombosis (DVT) following such procedures.

Methods and results

We prospectively enrolled 220 consecutive patients with a median age of 70 [60–79]?years. The median duration of the procedures from insertion to removal of sheaths was 45 [30–75]?min. At least two sheaths were inserted in 158 (72 %) of the cases. Duplex ultrasonography evaluation of the lower leg veins was performed 6 h after the procedure and revealed common femoral vein thrombosis in 11 (5 %) patients. All thrombi were partial and none was complete. Thrombi were mobile in four patients and extended to the external iliac vein in three patients. None of the patients presented with clinical signs of DVT or pulmonary embolism. Anticoagulation was prescribed for 2–4 weeks and a follow-up duplex ultrasonography obtained in the first seven patients revealed complete resolution of thrombi in all cases. On multivariate analysis, two predictors of thrombosis occurrence were identified: a greater sum of sheath diameters (odds ratio, 1.41 [95 % confidence interval, 1.25–1.60] per 1-French increase; p?<?0.001) and a longer procedural duration (odds ratio, 1.02 [95 % confidence interval, 1.00–1.04] per 1-min increase; p?=?0.04).

Conclusions

Asymptomatic femoral DVT occur in 5 % of electrophysiological studies and right-heart radiofrequency catheter ablations, particularly when large sheaths are inserted for a longer period. The role of anticoagulation in this clinical setting warrants further evaluation.     

永久起搏器植入术后致锁骨下静脉血栓的治疗

植入永久起搏器是治疗严重缓慢心律失常最有效的方法，我院1997年8月至2003年8月间成功植入起搏器283例，术后并发锁骨下静脉血栓形成8例(2．8％)，经有效治疗全部治愈，现报告如下。     

腹腔镜袖状胃切除术后并发门肠系膜静脉血栓形成一例报告

目的报告一个罕见的腹腔镜袖状胃切除术（LSG）术后并发门肠系膜静脉血栓形成（PMVT）病例。 方法患者，女性，32岁，体重105 kg，身高1.65 m，身体质量指数（BMI）：38.5 kg/m²。因"代谢综合征"入暨南大学附属第一医院，于2021年3月29日行LSG手术。手术过程顺利，术后第3 d出院。术后第7 d出现上腹部持续性腹痛，无伴恶心呕吐、发热就诊，查体患者处于脱水状态，腹部CT提示考虑门静脉、脾静脉、肠系膜上静脉多发血栓形成。诊断为：门肠系膜静脉血栓形成。遂予以静脉补液，皮下注射依诺肝素钠注射液抗凝治疗。 结果经治疗后患者症状体征明显改善。复查上腹部CT提示原门静脉及脾静脉内低密度影基本吸收。遂予以出院，嘱出院后继续口服抗凝药（利伐沙班）治疗6个月以预防PMVT慢性并发症的发生。 结论随着腹腔镜减重手术数量的不断增加，术后门肠系膜静脉血栓形成的发病率可能会增加。对于术后出现非特异性腹痛的患者，需要警惕PMVT的发生。早发现早治疗对PMVT的预后至关重要。