背景:急性肠系膜静脉血栓形成的最常见部位是肠系膜上静脉。这是一种罕见但可能致命的疾病。具有干扰VirchowTriad高凝状态的潜在医疗条件的患者,stasis,和内皮损伤更有可能经历它。
方法:一名37岁女性到我们的急诊科报告,有5天的严重腹部不适病史,呕吐,便秘,以及每个直肠两次出血。病人有干净的病史,没有HTN,没有糖尿病,没有慢性药物,无服用避孕药或非甾体抗炎药史,无慢性病及手术史。患者被直接转移到重症监护病房进行额外的评估和术前稳定。
结论:我们介绍了一例急性肠系膜静脉血栓形成和可能的肠道损害的患者。出现时患者不稳定,我们评估了她的病情,并转入重症监护病房进行稳定和术前准备.她没有回应保守的管理,我们不得不运作,我们高度强调早期干预这些疾病的重要性。急性肠系膜静脉血栓形成是一个复杂的病例,由于其非特异性症状,这需要内科和外科团队之间的多学科团队方法来计划适合每位患者的最合适的治疗策略,因为所有选择都与重大风险相关.肠系膜静脉血栓形成的管理有多种选择。对于腹膜征象提示肠梗塞或穿孔的患者,或保守治疗进展失败的患者,手术干预可能是必要的。其他选择包括抗凝治疗,局部或全身溶栓,介入或外科血栓切除术。
结论:急性肠系膜静脉血栓形成是一种复杂的情况,需要外科和内科之间的多学科团队方法来确定每位患者的最佳行动方案,因为每个替代方案都有重大风险。如果存在节间主义,最好尽快进行评估和复苏,并进行手术。
BACKGROUND: The most frequent location of thrombosis development in acute mesenteric venous thrombosis is the superior mesenteric vein. It is an uncommon but potentially fatal condition. Patients with underlying medical conditions that interfere with the Virchow Triad hypercoagulability, stasis, and endothelial injury are more likely to experience it.
METHODS: A 37-year-old female reported to our emergency department with a 5-day history of severe abdominal discomfort, vomiting, and constipation, as well as two episodes of bleeding per rectum. The patient had a clean medical history, no HTN, no diabetes, no chronic medication, no history of contraceptive pill use or non-steroid anti-inflammatory drug use, no history of chronic disease or operation. Patient was directly transferred to the intensive care unit for additional evaluation and preoperative stabilization.
CONCLUSIONS: A patient with acute mesenteric venous thrombosis and possible intestinal damage is the
case we\'ve presented. Upon presentation patient was unstable, we assessed her condition and transferred to the intensive care unit for stabilization and pre-operative preparation. She didn\'t respond to conservative management and we had to operate, we highly emphasize how crucial it is for early intervention in these type of conditions. Acute mesenteric venous thrombosis is a complicated
case due to its nonspecific symptoms, it requires a multidisciplinary team approach between internal medicine and surgical team to plan for the most appropriate treatment strategy suitable for each patient as all options are associated with significant risks. Multiple options are available for the management of mesenteric venous thrombosis. In patients with peritoneal signs to suggestive bowel infarction or perforation or those who failed to progress with conservative management, operative intervention may be necessary. Other options include anticoagulation therapy, local or systemic thrombolysis, interventional or surgical thrombectomy.
CONCLUSIONS: Acute mesenteric venous thrombosis is a complex situation that calls for a multidisciplinary team approach between the surgical and internal medicine departments to determine the best course of action for each patient, as there are major risks involved with each alternative. If peritonism is present, it is preferable to assess and resuscitate as soon as possible and to proceed with surgery.