Acute mesenteric ischaemia due to superior mesenteric vein (SMV) thrombosis

2021 ◽  
Vol 14 (4) ◽  
pp. e239110
Author(s):  
Muhammad Salah Muhammad Ahmad ◽  
Muhammad Rafaih Iqbal ◽  
Jonathan Simon Refson
Keyword(s):  
Small Bowel ◽  
Surgical Management ◽  
Superior Mesenteric Vein ◽  
Anticoagulation Therapy ◽  
Emergency Laparotomy ◽  
Bowel Ischaemia ◽  
Thrombotic Occlusion ◽  
Mesenteric Vein ◽  
Coffee Ground ◽  
History Of

A 77-year-old male patient presented with a 5-day history of abdominal pain, coffee ground vomiting and blood-stained diarrhoea. CT scan of the abdomen and pelvis demonstrated a long segment thrombotic occlusion of the superior mesenteric vein (SMV) extending up to the proximal portion of the portal vein causing significant acute small bowel ischaemia. Patient’s deteriorating clinical condition warranted surgical management. Successful surgical management required multidisciplinary teamwork between emergency, vascular surgeons, anaesthetists and intensivists. Emergency laparotomy revealed gangrene of an estimated 120 cm of small bowel segment starting from duodenojejunal junction and a long segment thrombotic occlusion of the SMV extending up to the portal confluence. Resection of gangrenous small bowel without anastomosis and thrombo-embolectomy of SMV along with laparostomy was done at the initial operation. Patient was admitted in the intensive care unit on systemic heparinisation through intravenous administration of unfractionated heparin. Second relook exploration was done after 48 hours followed by anastomosis of the small bowel and closure of the abdomen. Patient made a good recovery following anticoagulation therapy and was discharged on postoperative day 10.

Cocaine-induced mesenteric ischaemia requiring small bowel resection

2021 ◽  
Vol 14 (1) ◽  
pp. e238593
Author(s):  
Asya Veloso Costa ◽  
Asiya Zhunus ◽  
Rehana Hafeez ◽  
Arsh Gupta
Keyword(s):  
Small Bowel ◽  
Social History ◽  
Bowel Resection ◽  
Early Recognition ◽  
Small Bowel Resection ◽  
Emergency Laparotomy ◽  
Mesenteric Ischaemia ◽  
Bowel Ischaemia ◽  
Systemic Complications ◽  
Gastrointestinal Complications

Cocaine use causes profound vasoconstriction leading to various systemic complications. Gastrointestinal complications such as mesenteric ischaemia are difficult to recognise and may result in serious consequences if not treated promptly. We report on the case of a 47-year-old man presenting with mesenteric ischaemia on a background of acute on chronic cocaine consumption, where diagnosis was not evident until second presentation. He underwent an emergency laparotomy with small bowel resection and jejunostomy formation and made a good recovery with eventual reversal surgery. The literature on cocaine-induced bowel ischaemia shows significant variability in presentation and outcome. Laboratory investigations are non-specific, and early recognition is vital. Given the increasing recreational use of cocaine in the UK, it is imperative to have a high clinical index of suspicion for mesenteric ischaemia in patients presenting with non-specific abdominal pain, and to ensure a detailed social history covering recreational drug use is not forgotten.

scholarly journals Superior Mesenteric Vein Thrombosis Associated with Hormonal Contraceptive Use

2016 ◽  
Vol 10 (2) ◽  
pp. 264-268 ◽  
Author(s):  
Nobuatsu Koyama
Keyword(s):  
Superior Mesenteric Vein ◽  
Ethinyl Estradiol ◽  
Lower Abdominal Pain ◽  
Hormonal Contraceptive ◽  
Laboratory Evaluation ◽  
Mesenteric Vein Thrombosis ◽  
Mesenteric Vein ◽  
Vein Thrombosis ◽  
Superior Mesenteric Vein Thrombosis ◽  
History Of

A 44-year-old woman was admitted with a 7-day history of lower abdominal pain and nausea. Physical examination demonstrated tenderness in the lower abdomen without signs of peritonitis. There were no specific findings in the laboratory evaluation. She had a history of dysmenorrhea for 15 years and was taking a combined hormonal contraceptive containing 0.02 mg ethinyl estradiol and 3 mg drospirenone for 19 months. Contrast-enhanced computed tomography showed superior mesenteric vein thrombosis (SMVT). Systemic anticoagulant infusion was immediately administered and the symptoms disappeared within 2 days. The thrombus disappeared after 3 months. This case report suggests that early diagnosis of SMVT and immediate systemic anticoagulant therapy may reduce the rate of intestinal infarction.

scholarly journals Incarcerated Lumbar Hernia Complicated by Retroperitoneal Pseudoaneurysm 50 Years after Resection and Radiation Therapy of a Sarcoma

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Oluwatobi Onafowokan ◽  
Dabanjan Bandyopadhyay ◽  
Dale Johnson ◽  
Hugo J. R. Bonatti
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Ct Scan ◽  
Late Complication ◽  
Abdominal Hernia ◽  
Emergency Laparotomy ◽  
Incisional Hernias ◽  
History Of ◽  
The Right

Background. Lumbar hernias are rare abdominal hernias. Surgery is the only treatment option but remains challenging. Posterior incisional hernias are even rarer especially with incarceration of intra-abdominal contents.Case Presentation. A 68-year old female presented with a 3-day history of worsening acute abdominal pain and distension, with multiple episodes of emesis. A CT scan indicated a large incarcerated posterolateral abdominal hernia. The patient had a history of resection of a sarcoma on her back as a child and also received chemotherapy and radiation. During emergency laparoscopy, a hemorrhagic small bowel segment incarcerated in the hernia was reduced and resected, and the distended small bowel was decompressed. An elective hernia repair was scheduled. After temporary clinical improvement, the patient again developed abdominal pain, distention, and emesis. During emergency laparotomy, a large hematoma in the right flank was found and partially evacuated. The right colon was mobilized out of the hernia and the duodenum was kocherized. A20×20cm BIO-A mesh was placed on top of the Gerota fascia and cranially tucked under liver segment VI. Anteriorly, the mesh was fixated with absorbable tacks. The duodenum and colon were placed into the mesh pocket. A postoperative CT scan identified a 2 cm pseudoaneurysm of a side branch of a lumbar artery, and the bleeding source was embolized. The postoperative course was complicated byClostridium difficile-associated colitis, but ultimately, the patient recovered fully. At 6-month follow-up, there was no evidence for a recurrent hernia.Discussion. There is a paucity of literature concerning lumbar incisional hernias. Repair with bioabsorbable mesh seems feasible, but longer follow-up is necessary as the mesh was placed in an unusual fashion due to the retroperitoneal hematoma. The exact cause of the hemorrhage is unclear and may have been caused during the initial incarceration, during surgery, or may be a late complication of her previous radiation.

Anatomy of the Superior Mesenteric Vein With Special Reference to the Surgical Management of First-order Branch Involvement at Pancreaticoduodenectomy

2008 ◽  
Vol 248 (6) ◽  
pp. 1098-1102 ◽  
Author(s):  
Matthew H. G. Katz ◽  
Jason B. Fleming ◽  
Peter W. T. Pisters ◽  
Jeffrey E. Lee ◽  
Douglas B. Evans
Keyword(s):  
Special Reference ◽  
Surgical Management ◽  
Superior Mesenteric Vein ◽  
First Order ◽  
Mesenteric Vein ◽  
Order Branch

scholarly journals Imaging, superior mesenteric vein (SMV) sign and bowel ischaemia

QJM ◽  
2017 ◽  
Vol 110 (9) ◽  
pp. 605-605 ◽  
Author(s):  
Hiroki Matsuura ◽  
Hironori Kurokawa
Keyword(s):  
Superior Mesenteric Vein ◽  
Bowel Ischaemia ◽  
Mesenteric Vein

scholarly journals Laparosacopic management with combination of fatty meal and methylen-blu for chylous leak after a left para-aortic paraganglioma excision

2020 ◽  
Vol 2020 (12) ◽  
Author(s):  
Curzio Cupellini ◽  
Giovanni Alemanno ◽  
Andrea Bottari ◽  
Annamaria Di Bella ◽  
Alessandro Bruscino ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Superior Mesenteric Vein ◽  
Young Female ◽  
Fatty Meal ◽  
Laparoscopic Exploration ◽  
Orogastric Tube ◽  
Mesenteric Vein ◽  
Methylen Blue ◽  
History Of ◽  
Acrylic Glue

Abstract We report a case of chylous leak recognized post-operatively after abdominal surgery for left para-aortic paraganglioma in a young female with a history of open botallo’s duct. Conservative measures failed to control the leak and the patient is not eligible for sclerotisation. Laparoscopic exploration with intralipidand methylen blue injection through an orogastric tube revealed the leaking area near the superior mesenteric vein behind the Traitz, and this was ligated with non-asorbable suture and placement of acrylic glue. The patient was discharged the 7th post-operative day after removal of the drainage which appeared to supply <100 cc of serum material. Outpatient control was successful and the patient is actually in good conditions.

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