Type 2 diabetes mellitus as a risk factor for intestinal resection in patients with superior mesenteric vein thrombosis.
OBJECTIVE
The most serious complication of acute mesenteric vein thrombosis (MVT) is acute intestinal ischaemia requiring intestinal resection or causing death. Risk factors for this complication are unknown. To identify risk factors for severe intestinal ischaemia leading to intestinal resection in patients with acute MVT.


METHODS
We retrospectively analysed consecutive patients seen between 2002 and 2012 with acute MVT in 2 specialized units. Patients with cirrhosis were excluded. We compared patients who required intestinal resection to patients who did not.


RESULTS
Among 57 patients, a local risk factor was identified in 14 (24%) patients, oral contraceptive use in 16 (29%), and at least one or more other systemic prothrombotic condition in 25 (44%). Five (9%) patients had diabetes mellitus (DM), 33 (58%) had overweight or obesity, 9 (18%) had hypertriglyceridemia and 10 (19%) had arterial hypertension. Eleven patients (19%) underwent intestinal resection. DM was significantly associated with intestinal resection (P = 0.02) while local factors or prothrombotic conditions were not. Computed tomography (CT) scans performed at diagnosis found that occlusion of second order radicles of the superior mesenteric vein was more frequently observed in patients who underwent intestinal resection (P = 0.009).


CONCLUSIONS
In acute MVT, patients with underlying DM have an increased risk of requiring intestinal resection. Neither local factors nor systemic prothrombotic conditions are associated with intestinal resection. When CT scan shows the preservation of second order radicles of the superior mesenteric vein, the risk of severe resection is low.
Service d'Hépatologie, Hôpital Beaujon and INSERM U773, Clichy, France.
Laure
L
Elkrief
Olivier
O
Corcos
Onorina
O
Bruno
Beatrice
B
Larroque
Pierre-Emmanuel
PE
Rautou
Kamal
K
Zekrini
Frédéric
F
Bretagnol
Francisca
F
Joly
Claire
C
Francoz
Vanessa
V
Bondjemah
Dominique
D
Cazals-Hatem
Larbi
L
Boudaoud
Emmanuelle
E
De Raucourt
Yves
Y
Panis
Odile
O
Goria
Sophie
S
Hillaire
Dominique
D
Valla
Aurélie
A
Plessier
D000925:Anticoagulants / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007422:Intestines / Q000473:pathology / Q000601:surgery*; D007511:Ischemia / Q000453:epidemiology / Q000209:etiology / Q000473:pathology* / Q000601:surgery*; D008297:Male; D065666:Mesenteric Ischemia / Q000150:complications* / Q000000981:diagnostic imaging; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed
D000925:Anticoagulants
Portal vein thrombosis; acute mesenteric ischaemia; computed tomography; diabetes mellitus; mesenteric venous thrombosis