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Mesenteric vein thrombosis
Medical expert of the article
Thrombosis of the mesenteric veins can lead to acute bowel ischemia. Symptoms of thrombosis of mesenteric veins are characterized by the following manifestations:
- blurred and fuzzy localized abdominal pain;
- subfebrile body temperature;
- increased pain and localization of them in the epigastrium or near the umbilical area, the appearance of peritonitis symptoms, increasing leukocytosis - signs indicating the development of intestinal infarction;
- Expansion of the intestinal loops in the survey radiography of the abdominal cavity.
At present, laparoscopy is used to diagnose all forms of acute mesenteric ischemia.
For the recognition of mesenteric venous thrombosis, both angiography and an overview radiography of the abdominal organs are used, revealing signs of small intestinal obstruction with expansion of the intestinal loops and gas levels in this pathology. However, angiography is of particular diagnostic value. A complex of angiographic signs of mesenteric venous thrombosis is described and well known, including reflux of contrast material in the aorta, spasm of the upper brachial artery and its branches, contrasting of only a few distal arterial branches, prolongation of the arterial phase more than 40 s, absence of contrasting of the upper brachial artery within 40 seconds , intensive contrasting of the thickened wall of the large intestine, the entry of contrast material into the lumen of the intestine. In those cases when the patient's condition does not allow for angiographic examination, the diagnosis is established with laparotomy.
Mesenteric vein thrombosis is an urgent surgical disease and requires urgent surgery. According to available statistical data, the lethality of patients operated within 12 hours from the onset of acute manifestations of the disease is 25%, while during the operation within 24-48 hours it increases to 72%. Absence of surgical treatment leads to death in 100% of cases.
During the operation, the necrotic areas of the intestine are resected and thrombectomy is performed. The percentage of postoperative complications that may be caused by inadequate removal of the incompetent intestinal tract, anastomosis deficiency and sepsis, recurrent thrombosis and intestinal infarction, continues to be high.