Acute Superior Mesenteric Venous Thrombosis: A Clinical Analysis Of36Patients

Objective: By investigating36hospitalized patients with acute superior mesentericvenous thrombosis(ASMVT) for the study, to discuss the etiology、manifestations、diagnosis and therapy of acute superior mesenteric venous thrombosis in order toincrease awareness of the disease, improve early diagnosis rate, reduce misdiagnosisrate、case fatality rate.Methods: The obiect of36present study with acute superior mesenteric venousthrombosis were selected from patients who were consecutively admitted toDepartment of General Surgery in the First Affiliated Hospital of Fujian MedicalUniversity from January2002to March2012. Of all36patients with acute superiormesenterie venous thrombosis,17patients were treated by non-surgical therapy,19patients under surgical management were treated by partial resection of the smallintestine and after operation anticoagulant therapies were administrated.Results:1. Of all the36cases,15cases were found to have history of abdominal surgery(41.7%), thrombophilia and deep venous thrombosis were all in13cases (36.1%),10cases (27.8%) were misdiagnosed for intestinal obstruction and acute pancreatitiswas in6cases (16.7%).2. Of all the36cases,27cases were examinated by abdominal ultrasonography,17cases of which showed the superior mesenteric venous thrombosis, diagnostic rate is63%.34cases were examinated by superior mesenteric venous CTV, they were alldiagnosed for the superior mesenteric venous thrombosis, diagnostic rate is100%.3. When patients admitted to hospital, the heart rate、the level of white blood cellcount all had significant differences statistically（P<0.05、0.05）, the number of rised serum CK、CK-MB values all had significant differences statistically（P<0.01、0.01）,and the number of rised serum phosphorus value had no significant differencesstatistically between the surgical and non-surgical therapy groups.4. With a total of36cases,17of them（47.2%）were treated by non-surgical therapyand19（52.8%）by surgical therapy. All non-surgical cases were cured（100%）whereas18of surgical cases were cured（94.7%）, one case was given up treatment. After1to48months’follow-up, ASMVT recurrence was found in2（11.8%）in non-surgicalpatients and1（5.3%）in surgical patients, there were all no significant differences incure rate and recurernce rate, and there were significant differences in hospitalizationtime（P<0.01）between the two treatment methods.Conclusion:1. Acute superior mesenteric venous thrombosis was associated with history ofabdominal surgery、thrombophilia、deep vein thrombosis and so on, were easilymisdiagnosed as intestinal obstruction、acute pancreatitis and other diseases.2. When patients appeared faster heart rate、higher white blood cell count, it implyeda more serious condition, patients should be payed great attention, if necessary,surgical treatment was given timely.3. When serum CK、CK-MB value rised for ASMVT patients, it implyed intestinalnecrosis is more possible, patients should be payed great attention, if necessary,surgical treatment was given timely. Serum phosphorus was meaningless onjudging whether there was intestinal necrosis for ASMVT patients.4. For acute abdomen patients suspected highly ASMVT, superior mesenteric venousCTV examination should be done as earlier as possible in order to confirm thediagnosis, when intestinal ischemia have not yet led to transmural intestinalnecrosis and intestinal perforation, non-surgical therapy should be preferred.5. Earlier diagnosis, earlier anticoagulant therapy, grasping the timing of surgery,judging correctly the intestinal vitality in surgery and postoperativeanticoagulation therapy is key to improve cure rate、reduce case fatality rate.