Incidence and risk factors of portomesenteric venous thrombosis after colorectal surgery for cancer in the elderly population

Abstract Background Although it is known that portomesenteric venous thrombosis (PMVT) is associated with total colectomy and proctocolectomy in young patients with inflammatory bowel disease, little is known about incidence and risk factors of PMVT among the elderly population undergoing colorectal surgery for cancer. Methods Data of elderly patients (> 70 years) undergoing surgery for colorectal cancer were retrospectively registered. The occurrence of PMVT was correlated with the patients’ characteristics and operative variables. Data collected included age, sex, obesity, ASA score, tumor degree, type of surgical resection, surgical approach (laparoscopic or open), and duration of surgery (from skin incision to the application of dressings). Results A total of 137 patients > 70 years who underwent surgery for colorectal cancer and developed an acute intraabdominal process with suggestive symptoms, needing a CT scan, were included. Three of these patients (2.1%) had portomesenteric venous thrombosis during the study period, which was proved with CT scan. There were no significant patients’ characteristics or operative variables between patients with or without the occurrence of PMVT after surgery. Of interest, only operative time was significantly higher in patients with PMVT after surgery (256 ± 40 vs 140 ± 41, p < 0.001). Conclusions PMVT as a cause of abdominal pain after colorectal surgery for cancer in the elderly population is uncommon. An index of suspicion for PMVT in an elderly postoperative colorectal cancer patient with sudden onset of abdominal pain must be maintained.

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Portomesenteric venous thrombosis in a postmenopausal female with testosterone implant: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02805-6 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Monica Zanconato Campitruz ◽

Luis T. Ortiz-Figueroa ◽

Edgardo Santiago

Keyword(s):

Risk Factors ◽

Abdominal Pain ◽

Case Report ◽

Hormone Replacement Therapy ◽

Venous Thrombosis ◽

Replacement Therapy ◽

Sexual Desire ◽

Hormone Replacement ◽

Vein Thrombosis ◽

Portomesenteric Venous Thrombosis

Abstract Background Acute portal vein thrombosis is a rare medical event usually seen in liver disease, but it can also occur due to any inherited or acquired procoagulable state that triggers venous occlusion. Hormonal therapies have been associated with an increased risk of prothrombotic states. This case report documents a portomesenteric venous thrombosis in a postmenopausal woman with testosterone implant for the treatment of hypoactive sexual desire and discusses the importance of identifying hypercoagulable risk factors before initiating hormone replacement therapy. We want to improve the awareness of an unusual medical complication associated with hormone replacement therapy and shed light on how testosterone implants could facilitate a thrombotic event related to other risk factors such as obesity and chronic hypoxic states, as well as the importance of differential diagnosis in the evaluation of postmenopausal women on testosterone replacement therapy presenting with acute abdominal pain. Case presentation A 55-year-old obese postmenopausal Hispanic female with medical history of chronic obstructive pulmonary disease presents with intractable abdominal pain, is found to have elevated hemoglobin and hematocrit, and an abdominopelvic computed tomography scan revealing portal and superior mesenteric vein thrombosis. Further evaluation excluded inherited and acquired thrombophilia but revealed elevated testosterone levels. The patient was treated with anticoagulation, which resulted in recanalization of the portal and superior mesenteric veins. Conclusion Supraphysiologic levels of testosterone caused by testosterone implants as a treatment of hypoactive sexual desire in postmenopausal women can contribute to thrombotic events in the presence of additional prothrombotic risk factors. Therefore, testosterone therapy should include a thorough risk assessment for prothrombotic states, be tailored to patients’ physiologic testosterone levels, and have close follow-up with testosterone level monitoring.

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A prospective cohort study of older colorectal cancer surgical patients: an association of post-operative clinical outcome with sarcopenia, frailty, and nutritional status [Protocol] (Preprint)

10.2196/preprints.16846 ◽

2019 ◽

Author(s):

Nia Humphry

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Nutritional Status ◽

Significant Proportion ◽

The Elderly ◽

Operative Risk ◽

Surgical Patients ◽

Clinical Frailty Scale ◽

Colorectal Cancer Surgery ◽

Colorectal Cancer Resection

UNSTRUCTURED Older patients account for a significant proportion of patients undergoing colorectal cancer surgery, and are vulnerable to a number of pre-operative risk factors that are not often present in younger patients. Three pre-operative risk factors more prevalent in the elderly are frailty, sarcopenia, and malnutrition. Whilst each of these has been studied in isolation, there is little information on the interplay between them in older surgical patients. One particular area of increasing interest is the use of urine metabolomics for objective evaluation of dietary profiles and malnutrition. Herein we describe the design, cohort, and standard operating procedures of a planned prospective study of older surgical patients undergoing colorectal cancer resection across multiple institutions in the United Kingdom. These procedures include serial frailty evaluations (Clinical Frailty Scale and Groningen Frailty Indicator), functional assessments (with hand grip strength and 4-metre walk test), muscle mass evaluations using computerized tomography morphometric analysis and evaluation of nutritional status using analysis of urinary dietary biomarkers. As these are all areas of common derangement in the elderly surgical population, prospectively studying them in concert will allow for analysis of their interplay as well as the development of predictive models for those at risk for commonly tracked surgical complications and outcomes.

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Prevalence of Depression in the Elderly Population of Manisa and Related Risk Factors

The Turkish Journal of Geriatrics ◽

10.31086/tjgeri.2018.65 ◽

2018 ◽

Vol 21 (4) ◽

Cited By ~ 1

Author(s):

Beyhan Cengiz

Keyword(s):

Risk Factors ◽

Elderly Population ◽

The Elderly ◽

Related Risk ◽

Prevalence Of Depression

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Transversal and longitudinal studies of risk factors for coronary heart disease in the elderly population of Sa˜o Paulo

Atherosclerosis ◽

10.1016/0021-9150(94)93071-6 ◽

1994 ◽

Vol 109 (1-2) ◽

pp. 15

Author(s):

M.S. Cendoroglo ◽

T.L.R. Martinez ◽

L.E.S. Almeida Pinto ◽

F.R. Gonçalves ◽

T.E.C. Rosa ◽

...

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Heart Disease ◽

Longitudinal Studies ◽

Elderly Population ◽

The Elderly

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Isolated intestinal polyarteritis nodosa in an elderly patient

BMJ Case Reports ◽

10.1136/bcr-2020-241431 ◽

2021 ◽

Vol 14 (3) ◽

pp. e241431

Author(s):

Ariana González-Meléndez ◽

Eduardo J Medina-Parrilla ◽

Román Vélez ◽

Luis M Vilá

Keyword(s):

Abdominal Pain ◽

Polyarteritis Nodosa ◽

Elderly Population ◽

Systemic Vasculitis ◽

Exploratory Laparotomy ◽

The Elderly ◽

High Dose ◽

Systemic Involvement ◽

Intestinal Pseudo Obstruction ◽

Single Organ

Polyarteritis nodosa (PAN) is a necrotising systemic vasculitis involving medium-sized and small-sized vessels. PAN limited to a single organ is rare, particularly in the elderly population. Herein, we present a 73-year-old-woman who developed severe abdominal pain. Mesenteric angiography showed multifocal areas of segmental dilation and narrowing of the superior mesenteric, ileocolic and right colonic arteries. Exploratory laparotomy revealed multiple areas of necrosis of the jejunum for which resection was performed. Histopathological exam disclosed mesenteric vasculitis with fibrinoid necrosis of the arterial wall with leucocytic infiltrates and haemorrhages consistent with PAN. She was started on high-dose corticosteroids with an initial good response. However, 6 months later, she developed intestinal pseudo-obstruction for which oral cyclophosphamide was started. After 5 months of cyclophosphamide therapy, she remained stable without further relapses. Our case suggests that PAN should be considered in elderly patients presenting with abdominal pain even in the absence of systemic involvement.

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Prevalence of Cardiovascular Risk Factors in the Elderly Population of Alentejo

Handbook of Research on Health Systems and Organizations for an Aging Society - Advances in Human Services and Public Health ◽

10.4018/978-1-5225-9818-3.ch014 ◽

2020 ◽

pp. 185-195

Author(s):

Maria do Céu Mendes Pinto Marques ◽

Ana Filipa Pereira Vaz ◽

Ana Sofia Emídio Cardoso Leite ◽

Cláudia Sofia Araújo ◽

Cláudia Roque Condeço ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Elderly Population ◽

Research Question ◽

National Level ◽

The Elderly ◽

Regional Level ◽

Age Group ◽

Prevalence Studies

The objective of this chapter is to identify cardiovascular risk factors in the elderly and their prevalence in the elderly population of Alentejo. The research question was elaborated according to the PI[C]OD methodology. The prevalence studies included allow the authors to identify the risk factors with the greatest impact on cardiovascular diseases, with the analysis of at least one of the factors (hypertension, diabetes, smoking, obesity, hypercholesterolemia, alcoholism, and sedentary lifestyle) and their prevalence in the elderly from the region of Alentejo. The results present the prevalence of cardiovascular risk factors, mainly at the national level, compared to those at the regional level, with a small number of exclusive studies in the Alentejo region, while simultaneously disaggregating the results by age group. From the data obtained, it can be concluded that the prevalence of risk factors is generally increased in the elderly population and, consequently, in Alentejo, because it is a region in the interior of the country that is predominantly rural and very old.

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Admission deep venous thrombosis of lower extremity after intertrochanteric fracture in the elderly: a retrospective cohort study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02092-9 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Jinzeng Zuo ◽

Yongcheng Hu

Keyword(s):

Risk Factors ◽

Elderly Patients ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Intertrochanteric Fracture ◽

Lower Extremities ◽

The Elderly ◽

Intertrochanteric Fractures ◽

Targeted Interventions ◽

Laboratory Test Results

Abstract Objective The purpose of this study was to investigate the incidence, location, and related factors of deep venous thrombosis (DVT) of the bilateral lower extremities after intertrochanteric fractures in the elderly. Methods Retrospective analysis was performed on the elderly patients with intertrochanteric fracture who were admitted from January 2017 to December 2019. At admission, patients receive routine ultrasound Doppler scanning of bilateral lower extremities to detect DVT; those with DVT were assigned to the case group and those without DVT to the control group. Patient data on demographics, comorbidities, injury-related data, and laboratory test results at admission were extracted. Logistic regression analyses were conducted to identify the independent risk factors associated with DVT. Results Five hundred seventy-eight patients were included, among whom 116 (20.1%) had DVT. Among those with DV, 70.7% (82/116) had DVT of the distal type, 24 (29.6%) had DVT of the proximal type, and 10 (10.4%) had mixed DVT. In 76.7% (89/116) of patients, DVT occurred in the fractured extremity, 9.5% (11/116) in the bilateral and 13.8% (16/116) in the non-fractured extremity. Multivariate analyses identified obesity, delay to admission, increased D-dimer level (> 1.44 mg/L) and reduced albumin (< 31.7 g/L) as independent factors. Conclusions Admission incidence of DVT was high in elderly patients with intertrochanteric fractures, especially the proximal DVT. Identification of associated risk factors is useful for individualized assessment risk of DVT and early targeted interventions.

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Portomesenteric Venous Thrombosis in Patients Undergoing Surgery for Medically Refractory Ulcerative Colitis

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz169 ◽

2019 ◽

Vol 26 (2) ◽

pp. 283-288 ◽

Cited By ~ 1

Author(s):

Maia Kayal ◽

Marlana Radcliffe ◽

Michael Plietz ◽

Alan Rosman ◽

Alexander Greenstein ◽

...

Keyword(s):

Ulcerative Colitis ◽

Abdominal Pain ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Thromboembolism Prophylaxis ◽

Venous Thromboembolism Prophylaxis ◽

Portomesenteric Venous Thrombosis

Portomesenteric venous thrombosis (PMVT) occurred in 8% of postoperative ulcerative colitis patients despite the administration of venous thromboembolism prophylaxis. The most common presenting symptom was abdominal pain. Preoperative C-reaction protein values >45 mg/L were significantly associated with PMVT development.

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