title: Open Thrombectomy for Primary Acute Mesentericoportal Venous Thrombosis--Should It Be Done?
abstract: Mesentericoportal venous thrombosis (MVT) is a rare condition, accounting for 5-15% of acute mesenteric ischemia. Primary MVT is even rarer, with some reports quoting an incidence rate of 10-30% of reported cases. It presents a diagnostic challenge and is associated with a significant mortality rate, ranging from 13% to 50%. As it is an uncommon condition, the evidence in current literature regarding the treatment of MVT is limited. We discuss our surgical experience with a case of acute primary MVT that was managed with good clinical outcome and discuss the current evidence for the treatment of acute MVT. A 50-year-old Chinese lady with no significant past medical history presented with a 2-day history of abdominal pain and epigastric tenderness on examination. Computed tomography of her abdomen and pelvis showed evidence of extensive acute thrombi present in portal confluence extending into the superior mesenteric vein, associated with submucosal edema in some central jejunal loops. Despite systemic anticoagulation therapy with intravenous heparin, the patient deteriorated clinically, and decision was made for an exploratory laparotomy, small bowel resection, and open thrombectomy. Postoperative recovery was uneventful. She was discharged on postoperative day 13 with lifelong oral anticoagulation. In conclusion, we describe the successful management of a patient with extensive acute primary MVT where open thrombectomy was performed together with small bowel resection.
authors.affiliation: Department of General Surgery, Changi General Hospital, Singapore. Electronic address: ramesh_wijaya@cgh.com.sg.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Wijaya
authors.affiliation: Department of Otolaryngology, Singapore General Hospital, Singapore.
authors.forename: Jia Hui
authors.initials: JH
authors.lastname: Ng
authors.affiliation: Department of General Surgery, Changi General Hospital, Singapore.
authors.forename: Amanda H
authors.initials: AH
authors.lastname: See
authors.affiliation: Department of General Surgery, Changi General Hospital, Singapore.
authors.forename: Steven W
authors.initials: SW
authors.lastname: Kum
mesh_terms: D000208:Acute Disease; D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D065666:Mesenteric Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008641:Mesenteric Vascular Occlusion / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008642:Mesenteric Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013152:Splanchnic Circulation; D017131:Thrombectomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000925:Anticoagulants