内脏循环静脉血栓形成的患者是一组具有显著发病率和死亡率的高风险人群。如果治疗延迟。我们介绍了一名门静脉及其支流血栓形成合并下肢深静脉血栓形成(DVT)的患者,该患者已通过保守治疗成功。该病例强调了早期经验性抗炎治疗以及全身抗凝治疗的重要性,以减少肠道炎症和肠炎,并打破恶性回路,导致内脏静脉继发性进行性血栓形成。流体移位,和功能性肠梗阻。病例介绍:一名先前健康的61岁女性患者,无明显病史,因进行性上腹痛入院,恶心和呕吐,低烧,轻度肠梗阻,和不适。影像学检查显示,门静脉扩张达到〜20mm,血栓几乎完全闭塞了管腔。此外,发现肠系膜上静脉和脾静脉血栓形成伴血栓性静脉炎。影像学研究还证实了下肢DVT的存在,包括血栓扩散到髂静脉。立即开始使用肠胃外抗生素治疗,抗炎药,全身性抗凝剂,和静脉输液以恢复循环容量不足并治疗电解质失衡。有了这样的治疗,病人的症状在一个月内解决,她完全康复出院了.开始输注肝素以达到全身抗凝。随着症状的缓解,华法林继续抗凝治疗.当抗磷脂综合征也在鉴别诊断列表中时,我们使用非甾体抗炎药(NSAIDs)作为肠道和全身炎症以及多灶性血栓形成的治疗成分。结论:我们介绍了一名先前无症状的进行性门静脉血栓形成和上行DVT患者。早期诊断和全身抗凝药治疗的开始,抗炎和抗菌药物有助于阻止血栓进展,防止不可逆的肠缺血,并允许闭塞的静脉重新通化。该病例强调了早期干预对改善治疗结果的重要性。
Patients with venous thrombosis of splanchnic circulation represent a group of high risk with significant morbidity and mortality, if treatment is delayed. We present a patient with thrombosis of portal vein and its tributaries combined with deep venous thrombosis (DVT) of the lower extremities who was successfully treated with conservative management. This patient
case highlights the importance of early empiric anti-inflammatory therapy along with systemic anticoagulation to reduce the intestinal inflammation and enteritis and break the vicious circuit resulting in secondary progressive thrombosis of the splanchnic veins, fluid shifts, and functional ileus.
Case presentation: A previously healthy 61-years-old female patient with no significant medical history was admitted with progressive upper abdominal pain, nausea and vomiting, low-grade fever, mild signs of ileus, and malaise. Imaging studies revealed portal venous dilation reaching ∼20 mm with near-total obliteration of the lumen by a thrombus. In addition, thrombosis of superior mesenteric and splenic veins with thrombophlebitis was found. Imaging studies also confirmed the presence of DVT of lower extremities including thrombus propagation into the iliac veins. An immediate therapy was started with parenteral antibiotics, anti-inflammatory medications, systemic anticoagulants, and intravenous fluid infusions to restore the circulating volume deficit and treat electrolyte disbalance. With such therapy, the patient\'s symptoms resolved within a month, and she was discharged from the hospital with full recovery. Heparin infusion was started to reach systemic anticoagulation. With resolution of symptoms, anticoagulation was continued with warfarin. We used non-steroidal anti-inflammatory drugs (NSAIDs) as a component in management of intestinal and systemic inflammation and multifocal thrombosis when the antiphospholipid syndrome was also on the list of differential diagnoses. Conclusion: We present a previously asymptomatic patient with progressive portal venous thrombosis and ascending DVT. Early establishment of diagnosis and initiation of therapy with systemic anticoagulants, anti-inflammatory and antibacterial drugs helped to stop thrombus progression, prevent irreversible intestinal ischemia, and allow for re-canalization of the occluded veins. This
case highlights the importance of early interventions to improve the treatment outcome.