Rutherford's 137: Mesenteric Venous Thrombosis скачать в хорошем качестве

Rutherford's 137: Mesenteric Venous Thrombosis

#MesentericVenousThrombosis #MVT #BloodClot #IntestinalVein #SuperiorMesentericVein #AbdominalPain #Diagnosis #CTAngiography #Anticoagulation #VascularSurgery #EndovascularTreatment #Thrombophilia #RutherfordChapters Mesenteric Venous Thrombosis (MVT) is a condition involving a blood clot in the superior mesenteric vein, which drains the small intestine, sometimes extending into the portal or splenic veins. Historically, it was established as distinct from arterial blockages in the same area in 1935. MVT typically affects middle-aged and older adults, with a slight male predominance. Incidence rates appear to have increased, largely attributed to improved detection via CT scans compared to older autopsy-based diagnoses. Most cases (about 90%) are secondary to underlying conditions. Risk factors fall into three categories: direct injury (abdominal trauma, surgery, inflammation like pancreatitis or inflammatory bowel disease, IBD), local venous congestion or stasis (portal hypertension, heart failure, obesity, increased abdominal pressure), and thrombophilia (inherited conditions like Factor V Leiden mutation, protein C/S deficiency, and acquired ones like JAK2 mutation, cancer, oral contraceptives, or antiphospholipid syndrome). Screening for thrombophilia is important unless a clear cause is found. Acute MVT symptoms often begin insidiously with diffuse abdominal pain, nausea, and vomiting, sometimes lasting days or weeks before presentation. Severe pain may lead to peritonitis if the bowel wall is affected. Diagnosis is challenging based on symptoms alone. Imaging, particularly contrast-enhanced CT timed for the portal venous phase, is the gold standard, revealing the clot and secondary bowel signs like wall thickening or fluid. Treatment typically begins with conservative support (bowel rest, fluids, pain control, TPN) and immediate anticoagulation, usually with intravenous unfractionated heparin due to its rapid action and reversibility. Long-term anticoagulation (LMWH, warfarin, or DOACs) is continued for at least six months or lifelong if an underlying clotting disorder exists, as recurrence risk is significant. Anticoagulation helps recanalize the vein in about 70% of patients after six months. Endovascular therapies (mechanical thrombectomy, thrombolysis) may be used in specialized centers for early clots or when initial anticoagulation fails. Open surgery is reserved for emergencies like peritonitis, severe bleeding, or bowel perforation, often involving bowel resection. The prognosis has improved, with 30-day mortality now below 10%, thanks to earlier diagnosis and non-surgical management. However, outcomes are worse with underlying cancer.