Porto-Mesenteric Venous Thrombosis

Kim, Jong Tae; Lim, Jung Woo; Lee, Young Joon; Park, Soon Tae; Ha, Woo Song; Choi, Sang Kyung; Hong, Soon Chan; Kwon, Soo In; Jung, Eun Jung

Abstract

Porto-mesenteric venous thrombosis is a rare disorder, which can occur as a complication of many diseases. Porto-mesenteric venous thrombosis leads to venous hypertension, outpouring of blood into the bowel lumen and mesentery, distension and rupture of venules, and hemorrhgae and edema of the bowel wall. In cases of mild porto-mesenteric venous thrombosis, nonoperative management-consisting of fluid resuscitation, anticoagulation, and thrombolysis-may be acceptable in clinically stable patients with early diagnosis. If patients show clinical signs of peritonitis or deteriorates on medical management, prompt surgical intervention is warranted. At laparotomy, segmental resection of the involved bowel with primary anastomosis is easily accomplished, because the hemorrhagic infarction associated with porto-mesenteric venous thrombosis is limited. The optimal duration of anticoagulation therapy has not been defined. However, recommendation is that anticoagulation should be continued indefinitely, as it reduces the incidence of porto-mesenteric venous thrombosis recurrence. The patient in our study presented with a severely edematous duodenum and proximal jejunum in CT scan with signs of peritonitis due to perforation of the upper-jejunum. We had performed a percutaneous drainage for intraabdominal abscess which occurred the jejunal infarction. About 1 month later, a resection of a well-controlled fistula tract was done.