MESENTERIC VENOUS THROMBOSIS - 11/09/11
Résumé |
Mesenteric venous thrombosis (MVT) is a rare but potentially lethal form of mesenteric ischemia. The presentation may vary from an entirely asymptomatic clinical scenario to intestinal infarction and shock. It was first described by Elliot 9 in 1895 as “thrombosis of the porto-mesenteric venous system,” which disallowed venous drainage from the gut leading to bowel infarction. Warren and Eberhard 29 in 1935 characterized MVT as a distinct clinical entity and emphasized its lethality. These authors reported a 34% mortality rate following intestinal resection for venous thrombosis. Fortunately, it comprises only 5% to 15% of all reported acute mesenteric ischemia cases in the modern literature.16 , 22 In a review by Abdu et al, 1 only 372 patients with MVT were identified in the literature from 1911 to 1984. In the Mayo Clinic series, only 72 patients with MVT were identified from 1972 to 1993.24 This group comprised 6.2% of the 1167 patients treated for mesenteric ischemia at the institution during the 22-year study period. Ottinger and Austen 22 found that MVT comprised only 0.006% of hospital admissions and less than 2% of autopsy cases. Kazmers 17 estimated that intestinal infarction due to MVT is encountered in less than 1 in 1000 laparotomies for acute abdomen.
Patients with MVT can be classified into acute and chronic presentations for treatment purposes. Acute MVT is defined as the process that exists in those patients with presenting symptoms of less than 4 weeks' duration. Those with symptoms greater than 4 weeks' duration, but without bowel infarction, or those with MVT diagnosed as incidental and clinically insignificant findings on abdominal imaging can be classified as having chronic MVT.
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Address reprint requests to Robert Y. Rhee, MD Section of Vascular Surgery A1011, University of Pittsburgh Medical Center 200 Lothrop Street Pittsburgh, PA 15213 |
Vol 77 - N° 2
P. 327-338 - avril 1997 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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