Abstract: Objective:To explore the diagnosis and treatment of mesenteric venous thrombosis secondary to long-term ischemic enteropathy.
Methods:The retrospective cross-sectional study was conducted. The clinical data of 36 patients with mesenteric venous thrombosis secondary to long-term ischemic enteropathy who were admitted to the Nanjing General Hospital of Nanjing Military Command from January 2009 to June 2017 were collected. Diagnostic methods: history inquiry, physical examination, laboratory test and image finding. Treatment methods: parenteral nutrition support, selective stage 1 bowel resection with anastomosis or stage 1 bowel resection and colostomy, definitive stage 2 operation for recovering digestive tract. Anticoagulation therapy was performed. Observation indicators: (1) clinical characteristics; (2) treatment; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect postoperative complications up to December 2017. Measurement data with skewed distribution were described as M (P25, P75) and M (range).
Results:(1) Clinical characteristics: ① the main clinical manifestations: 34, 33, 27, 20, 17 and 14 patients showed respectively discomfort after meal, abdominal pain, abdominal distension, nausea with vomiting, stop of analis exhaust and defecation and weight loss of different degree, and the worst patient lost 20 kg within 1 month. The clinical manifestations of 30 patients were more than 3. ② The score of acute physiology and chronic health evaluation (APACHE）Ⅱ in 36 patients was 4 (2, 6). ③ Laboratory test: total protein (TP), albumin and prealbumin were 55.8 g/L (45.2 g/L, 59.1 g/L), 30.6 g/L (27.3 g/L, 37.5 g/L) and 100.0 g/L (86.0 g/L, 132.0 g/L), respectively, showing a decreased trend. ④ Imaging finding: enhanced scans of abdominal CT showed the portal cavernous in 16 patients, the absence of main trunk of superior mesenteric vein with extensive collaterals in 12 patients, and dovelopment of portal vein and main trunk of superior mesenteric vein in 8 patients. One patients had intestinal edema and stenosis. X-ray contrast examination of digestive tract showed intestinal stenosis with mucosal erosion in 28 patients and complete intestinal obstruction in 8 patients. (2) Treatment: of 36 patients, 24 underwent stage 1 bowel resection with anastomosis and other 12 received stage 1 bowel resection and colostomy (11 undergoing definitive stage 2 operation for recovering digestive tract and 1 refusing stage 2 operation due to advanced age). The length of resected bowel was 30 cm (15 cm, 80 cm). One patient with stage 1 bowel resection with anastomosis was complicated with small bowel fistula, and was cured by conservative treatment. There was no complication in other patients. (3)Follow-up: all 36 patients were followed up for 3- 10 months, with a median time of 6 months. During the follow-up, 7 patients were complicated with secondary portal hypertension, 5 of 7 were improved by symptomatic treatment, and 2 died of severe digestive tract bleeding; other patients had no related complications.
Conclusions:The discomfort after meal and bowel obstruction are the main clinical manifestations of mesenteric venous thrombosis secondary to long-term ischemic enteropathy. The abdominal CT with X-ray contrast examination benefits to diagnosis of patients with poor nutrition status and mild infection. The main strategy includes early surgical resection and postoperative anticoagulation therapy after bleeding risk evaluation.