1/12. Mesenteric venous thrombosis: a diagnosis not to be missed!Mesenteric venous thrombosis (MVT), an uncommon but important clinical entity, is one possible cause of ischemia or infarction of the small intestine. Diagnosis of this condition is sometimes difficult and treatment is often delayed because patients usually present with nonspecific abdominal symptoms. The hallmark is pain that is out of proportion to the physical findings. We report two cases of MVT, where the patients initially presented with vague abdominal symptoms. Diagnosis was made on the basis of computed tomography of the abdomen showing thrombus within the superior mesenteric vein. A search for a precipitating condition revealed no evidence of a hypercoagulable state, myeloproliferative disorder, or malignancy. These cases illustrate well the nonspecific clinical presentation of MVT. A high index of suspicion, recognition of known risk factors, or a previous history of venous thrombosis coupled with a history of nonspecific abdominal symptoms should alert clinicians to the possibility of MVT. early diagnosis and prompt anticoagulation are the mainstay of therapy unless there are signs of peritonitis that necessitate surgical resection of the infarcted bowel.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/12. Acute mesenteric vascular occlusion: A review of thirty-two patients.High mortality rates associated with mesenteric occlusion are a tremendous challenge. We reviewed 32 patients admitted to Beckley Appalachian Regional Hospital during the years 1965 to 1974. The majority of the patients were men. There was quite a variation in the symptoms and physical signs, with heart disease commonly associated with mesenteric occlusion. Massive gangrene involving the small and large bowels had the worst prognosis. thrombectomy and anticoagulation did not prove beneficial in our series. patients who survived massive resection are having intermittent diarrhea, responsive to medical treatment. The mortality rate in this series of 32 patients was 81.3 percent. It is hoped that with increased use of mesenteric angiography, early diagnosis, and prompt management the mortality rate can be brought down to acceptable levels.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/12. role of diagnostic laparoscopy in managing acute mesenteric venous thrombosis.We describe two cases with acute mesenteric venous thrombosis in which diagnostic laparoscopy helped to diagnose the possible bowel infarction. These patients presented with abdominal pain out of proportion to physical findings, and computed tomography demonstrated thrombus in the superior mesenteric vein. Anticoagulation with heparin followed by diagnostic laparoscopy was done immediately after the diagnosis was established. According to the laparoscopic findings, one was managed with full anticoagulation without laparotomy and the other was managed with full anticoagulation and surgical resection. Considering that delay in diagnosis and surgical exploration is still frequent and is a significant contributory factor to the reported high mortality rate, diagnostic laparoscopy in an early position in the management algorithm for acute mesenteric venous thrombosis can furnish a rapid precise diagnosis of bowel infarction. It can also reduce the unnecessary laparotomies in these difficult cases.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/12. Hepatic portal venous gas: clinical significance of computed tomography findings.Hepatic portal venous gas (HPVG) is a rare radiographic finding of significance. Most cases with HPVG are related to mesenteric ischemia that have been associated with extended bowel necrosis and fatal outcome. With the help of computed tomography (CT) in early diagnosis of HPVG, the clinical outcome of patients with mesenteric ischemia has improved. There has been also an increasing rate of detection of HPVG with certain nonischemic conditions. In this report, we present two cases demonstrating HPVG unrelated to mesenteric ischemia. One patient with cholangitis presented abdominal pain with local peritonitis and survived after appropriate antibiotic treatment. laparotomy was avoided as a result of lack of CT evidence of ischemic bowel disease besides the presence of HPVG. The other case had severe enteritis. Although his CT finding preluded ischemic bowel disease, conservative treatment was implemented because of the absence of peritoneal signs or clinical toxic symptoms. Therefore, whenever HPVG is detected on CT, urgent exploratory laparotomy is only mandatory in a patient with whom intestinal ischemia or infarction is suspected on the basis of radiologic and clinical findings. On the other hand, unnecessary exploratory laparotomy should be avoided in nonischemic conditions that are usually associated with a better clinical outcome if appropriate therapy is prompted for the underlying diseases. patients with radiographic diagnosis of HPVG should receive a detailed history review and physical examination. The patient's underlying condition should be determined to provide a solid ground for exploratory laparotomy. A flow chart is presented for facilitating the management of patients with HPVG in the ED.- - - - - - - - - - ranking = 10.128988583797keywords = physical examination, physical (Clic here for more details about this article) |
5/12. A case of acute superior mesenteric embolism successfully treated by embolectomy.Superior mesenteric artery embolism is undoubtedly fatal unless operative intervention is promptly performed. The first case successfully managed by embolectomy in taiwan is reported in this communication. The key to successful management lies in the early suspicion in patients with atrial fibrillation or recent myocardial infarction, presenting with sudden abdominal pain and an unremarkable physical examination. Abdominal angiography is strongly recommended; however, immediate laparatomy should not be postponed if angiography is not available. Early embolectomy is the only useful means of treatment to restore mesenteric circulation, preserve the bowel and rescue the patient. A 56-year-old woman was admitted with a 5-year history of rheumatic heart disease and atrial fibrillation. She had a sudden attack of severe abdominal pain 8 hours after cardiac catheterization. Abdominal examination was not remarkable and plain abdominal X-ray was negative, while bloody stools and leukocytosis developed 7 hours later. Superior mesenteric embolism was highly suspected and emergency laparotomy was performed. Successful embolectomy was carried out through the distal approach and the patient recovered completely without requiring small bowel resection. All branches of the superior mesenteric artery were demonstrated patent upon postoperative angiography.- - - - - - - - - - ranking = 10.128988583797keywords = physical examination, physical (Clic here for more details about this article) |
6/12. Mesenteric venous thrombosis.Six cases of mesenteric venous thrombosis have occurred in the metropolitan area from 1982 through 1985. The most common findings were nonspecific abdominal pain associated with nausea and vomiting, subjective distress disproportionate to the objective findings, and signs of decreased intravascular fluid volume. In all six cases there was a rapid progression of physical findings to a level commensurate with the initial complaint. The most consistent laboratory abnormalities were an increase in leukocyte precursors, an elevated lactate dehydrogenase, and a mild metabolic acidosis. Mesenteric venous thrombosis is an unusual disease that is difficult to diagnose and manage.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/12. Chronic mesenteric ischemia in childhood and adolescence.Chronic mesenteric ischemia is uncommon in the atherosclerotic age group but is particularly rare in childhood. Because of the nonspecific nature of symptoms produced and absence of pathognomonic findings by physical examination or by routine laboratory testing, its recognition is difficult and its true incidence is unknown. Four children treated for chronic mesenteric ischemia in our center demonstrated the spectrum of clinical presentations and operative considerations important in the management of this uncommon malady. Ages at presentation ranged from 30 months to 17 years. These presentations ranged from clinically silent ischemia in the 30-month-old child to evolving gastrointestinal infarction in the 17-year-old adolescent. Coexistence of abdominal aortic coarctation and/or renal artery stenoses was present in three of the four children. Successful bowel revascularization was achieved by superior mesenteric artery revascularization alone in three children (reimplantation in two and a bypass in one) and by multiple celiac and superior mesenteric artery bypasses in one. Delayed distal small bowel and proximal colonic resection was required in one child. This experience increases awareness that mesenteric ischemia does occur in childhood and is a rare but potentially lethal cause of abdominal complaints in children. Finally, the finding of both renal and visceral artery disease in three of the four patients underscores the need for adequate evaluation of mesenteric vessels before renovascular procedures are undertaken in this age group.- - - - - - - - - - ranking = 10.128988583797keywords = physical examination, physical (Clic here for more details about this article) |
8/12. celiac artery embolism: case report.The authors describe an unusual case of acute gastrointestinal ischemia due to celiac artery embolism. The patient, a 23-year-old man who had recently suffered a myocardial infarction, underwent selective angiography under local anesthesia with intravenous sedation because angiography demonstrated good collateral filling and because of his poor cardiac status he was treated nonoperatively with intravenously administered heparin. Points to be considered in the diagnosis of acute intestinal ischemia include: (a) if the initial investigations are suggestive of the condition, angiography should be performed; it can be done easily and safely under local anesthesia with intravenous sedation, (b) the symptoms are often more severe than one would expect from the physical findings and (c) celiac artery occlusion may be more common than previously thought.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/12. Primary mesenteric venous thrombosis: an unusual cause of abdominal pain in a young, healthy woman.A 24-year-old woman presented to the emergency department with acute abdominal pain and a physical examination consistent with acute pelvic inflammatory disease. She was treated and released only to return several hours later with worsening of her condition and unstable vital signs. laparotomy revealed acute mesenteric venous thrombosis with patent mesenteric arteries. This is an unusual case of mesenteric thrombosis in a young, healthy woman.- - - - - - - - - - ranking = 10.128988583797keywords = physical examination, physical (Clic here for more details about this article) |
10/12. Mesenteric venous thrombosis: a case report.Mesenteric venous thrombosis is an uncommon entity. The preoperative diagnosis is largely clinical; the hallmark is pain that is out of proportion to the physical findings. Treatment consists of thrombectomy with resection of necrotic small bowel and mesentery. In the absence of trauma or infection, an investigation of intrinsic anticoagulant deficiencies is warranted since these deficiencies are inherited in an autosomal dominant fashion. Treatment is warfarin sodium therapy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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