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Annals of African Medicine 2024Portomesenteric venous thrombosis (PMVT) may complicate sleeve gastrectomy. We believe that single dose of enoxaparin postoperatively can reduce the risk of PMVT.
INTRODUCTION
Portomesenteric venous thrombosis (PMVT) may complicate sleeve gastrectomy. We believe that single dose of enoxaparin postoperatively can reduce the risk of PMVT.
OBJECTIVE
The objective was to study the outcomes of enoxaparin single dose compared to other perioperative prophylactic doses in preventing PMVT.
METHODS
Participants included 590 patients who underwent laparoscopic sleeve gastrectomy (LSG). These retrospective cohort data were collected from patient medical charts after bariatric surgery. Patients were followed up in the close postoperative period and at 1, 3, 6, 12, and 18 months. Descriptive statistical analysis was carried out. The objective was to estimate the incidence of PMVT with postoperative single 40 mg subcutaneous enoxaparin prophylactic regimen.
RESULTS
From January 2017 to December 2021, 590 patients with obesity underwent LSG. Five patients developed PMVT with an estimate incidence of 0.85%. Three patients had unexplained tachycardia and three patients had postoperative bleeding.
CONCLUSIONS
Single-dose enoxaparin 40 mg is an effective thrombosis prophylaxis without increasing risk of bleeding.
Topics: Humans; Enoxaparin; Retrospective Studies; Obesity, Morbid; Laparoscopy; Portal Vein; Mesenteric Veins; Anticoagulants; Venous Thrombosis; Gastrectomy; Postoperative Complications
PubMed: 38358171
DOI: 10.4103/aam.aam_133_23 -
Idiopathic myointimal hyperplasia of mesenteric veins: radiological evaluation using CT angiography.BJR Case Reports Jan 2024A 44-year-old man presented with a chief complaint of constipation. Initial contrast-enhanced CT showed extensive bowel wall thickening, mainly in the left colon, with a...
A 44-year-old man presented with a chief complaint of constipation. Initial contrast-enhanced CT showed extensive bowel wall thickening, mainly in the left colon, with a thin cord-like inferior mesenteric vein (IMV), in contrast to ectatic mesenteric venous branches, suggesting bowel ischaemia owing to venous stasis. One month later, at the time of symptom exacerbation, CT angiography showed a cord-like IMV and ectatic mesenteric venous branches with early enhancement, suggesting the presence of an arteriovenous fistula (AVF). Owing to the progression of bowel ischaemia and necrosis with peritonitis, emergency surgery was performed. Surgical specimens showed focal myointimal hyperplasia of the proximal mesenteric veins in both ischaemic and non-ischaemic lesions of the resected colon, thus leading to the diagnosis of idiopathic myointimal hyperplasia of mesenteric veins (IMHMV) when combined with the clinical and imaging findings. IMHMV is a bowel ischaemic disease caused by non-thrombotic venous obstruction that requires bowel resection and has been suggested to be associated with AVF. Cord-like IMV and AVF in the mesentery are important CT findings that characterize IMHMV. CT angiography is useful in diagnosing IMHMV.
PubMed: 38352257
DOI: 10.1093/bjrcr/uaad009 -
Cureus Jan 2024Mesenteric arteriovenous dysplasia/vasculopathy (MAVD/V) is an exceedingly rare noninflammatory vascular disorder affecting small-calibre mesenteric arteries and veins....
Mesenteric arteriovenous dysplasia/vasculopathy (MAVD/V) is an exceedingly rare noninflammatory vascular disorder affecting small-calibre mesenteric arteries and veins. This report details a case of a 51-year-old male diagnosed with MAVD/V following abdominal pain and vomiting. Surgical exploration revealed distinctive smooth muscle collarette around subserosal arteries and veins. The rarity of this condition, with only 13 cases reported globally, underscores the importance of recognizing this rare entity to prevent misdiagnosis. Surgical resection remains the curative approach, ensuring a disease-free state after surgery. Awareness of MAVD/V is crucial for accurate diagnosis and avoiding unnecessary prolonged management.
PubMed: 38313915
DOI: 10.7759/cureus.51676 -
JGH Open : An Open Access Journal of... Jan 2024Idiopathic mesenteric phlebosclerosis (IMP) is characterized by mesenteric vein calcification and ischemic bowel disease. We describe a unique clinical case of IMP in a...
Idiopathic mesenteric phlebosclerosis (IMP) is characterized by mesenteric vein calcification and ischemic bowel disease. We describe a unique clinical case of IMP in a patient with a history of oral administration of various drugs, including traditional Chinese medicines (mainly selfheal), vitamin D, and calcium supplements. The disease was not diagnosed in its early stages and was later detected because of the initial symptoms of chest tightness and difficulties in swallowing. During medical examination, esophageal venous sinuses were found through gastroscopy, and CT revealed thickening and widespread calcification of the colonic wall (esophageal wall calcification). Moreover, typical purple-brown changes in the colonic mucosa were found during colonoscopy. Microscopic examination showed more foam phagocyte, focal lymphocyte aggregation, small-vessel proliferation, and surrounding collagen-like deposition which is a typical finding of IMP. More specifically, the patient's mesenteric veins and colon veins were calcified, and the calcification extended to the esophageal veins. These findings were related to long-term use of traditional Chinese medicines (mainly selfheal). It is possible that excessive intake vitamin D and calcium supplementation may have played a role in the occurrence of vascular calcification, which might have exacerbated the progression of IMP disease.
PubMed: 38268963
DOI: 10.1002/jgh3.13027 -
Advances in Radiation Oncology Jan 2024In our experience treating locally advanced pancreatic cancer with magnetic resonance-guided radiation therapy (MRgRT), the true-fast imaging with steady-state free...
Initial Observation of Contrast Profiles for 2-Dimensional and 3-Dimensional Magnetic Resonance Imaging Sequences in Magnetic Resonance-Guided Radiation Therapy for Locally Advanced Pancreatic Cancer.
PURPOSE
In our experience treating locally advanced pancreatic cancer with magnetic resonance-guided radiation therapy (MRgRT), the true-fast imaging with steady-state free precession sequences used to generate both the real-time 2-dimensional (2D) magnetic resonance images (MRI; 2D cine) and the pretreatment high-resolution 3-dimensional (3D) MRI impart differing intensities for relevant structures between the 2 scans. Since these variations can confound target tracking selection, we propose that an understanding of the differing contrast profiles could improve selection of tracking structures.
METHODS AND MATERIALS
We retrospectively reviewed both 2D cine and 3D MRI images for 20 patients with pancreatic cancer treated with MRgRT. At simulation, an appropriate tracking target was identified and contoured on a single 3-mm sagittal slice of the 3D MRI. This sagittal slice was directly compared with the coregistered 7-mm 2D cine to identify structures with notable discrepancies in signal intensity. The 3D MRI was then explored in additional planes to confirm structure identities. For quantitative verification of the clinically observed differences, the pixel intensity distributions of 2D cine and 3D MRI digital imaging and communications in medicine data sets were statistically compared.
RESULTS
In all patients reviewed, arteries (aorta, celiac, superior mesenteric artery, hepatic artery) appeared mildly hyperintense on both scans. However, veins (portal vein, superior mesenteric vein) appeared hyperintense on 2D cine but isointense on 3D MRI. Biliary structures appeared mildly hyperintense on 2D cine but starkly hyperintense on 3D MRI. The pixel intensity distributions extracted from 2D cine and 3D MRI images were confirmed to differ significantly (2 sample Kolmogorov-Smirnov test; test statistic, 0.40; < .001).
CONCLUSIONS
There are significant variations in image intensity between the immediate pretreatment 2D cine compared with the initial planning 3D MRI. Understanding variations of image intensity between the different MRI sequences used in MRgRT is valuable to radiation oncologists and may lead to improved target tracking and optimized treatment delivery.
PubMed: 38260228
DOI: 10.1016/j.adro.2023.101314 -
Mesenteric Vein Thrombosis following Sleeve Gastrectomy: A Case Report and Review of the Literature.Obesity Facts 2024Acute mesenteric ischemia (AMI) is a rare but lethal disease. Mesenteric vein thrombosis (VAMI) is a subtype of AMI. Morbid obesity is usually accompanied by... (Review)
Review
INTRODUCTION
Acute mesenteric ischemia (AMI) is a rare but lethal disease. Mesenteric vein thrombosis (VAMI) is a subtype of AMI. Morbid obesity is usually accompanied by hypertension, hyperlipidemia, or diabetes mellitus, which are risk factors associated with AMI.
CASE PRESENTATION
We present a 28-year-old man with VAMI post-laparoscopic sleeve gastrectomy. He was first misdiagnosed with intestinal obstruction. Superior VAMI was confirmed after computed tomography angiography. Laparotomy, resection of the necrotic small bowel, and ostomy were performed immediately.
CONCLUSION
Patients with morbid obesity accompanied by hypertension, hyperlipidemia, or diabetes mellitus have a high risk of AMI. Abdominal pain with sudden onset should be considered AMI. Anticoagulation therapy post-sleeve gastrectomy might help reduce the incidence of AMI.
Topics: Adult; Humans; Male; Diabetes Mellitus; Gastrectomy; Hyperlipidemias; Hypertension; Laparoscopy; Mesenteric Ischemia; Mesenteric Veins; Obesity, Morbid; Postoperative Complications; Venous Thrombosis
PubMed: 38246162
DOI: 10.1159/000536359 -
Revista Espanola de Enfermedades... Jan 2024Idiopathic mesenteric phlebosclerosis (IMP) is a rare ischemic colitis characterized by calcification of mesenteric veins and submucosal veins of the colon. Melanosis...
Idiopathic mesenteric phlebosclerosis (IMP) is a rare ischemic colitis characterized by calcification of mesenteric veins and submucosal veins of the colon. Melanosis coli (MC) is a pigmented mucosal lesion comprising macrophages in the lamina propria of the colorectal mucosa that contain lipofuscin. This study reports a case of IMP combined with MC.Clinicians should consider medication history, bowel preparation, and thorough observation to prevent missed IMP diagnosis when coexisting with MC.
PubMed: 38235670
DOI: 10.17235/reed.2024.10179/2023 -
Asian Journal of Surgery Apr 2024
Topics: Humans; Superior Mesenteric Artery Syndrome; Mesenteric Artery, Superior; Renal Veins; Renal Nutcracker Syndrome
PubMed: 38233274
DOI: 10.1016/j.asjsur.2024.01.004 -
Cureus Dec 2023The growth of several porto-portal collateral veins encircling an existing stenosed or obstructed entry vein is an uncommon condition known as portal cavernoma. It is...
The growth of several porto-portal collateral veins encircling an existing stenosed or obstructed entry vein is an uncommon condition known as portal cavernoma. It is traditionally shown as the entry vein thrombosis (portal vein thrombosis - PVT) outcome. A male of 25 years with stomach discomfort for three days that was acute, nonprogressive, and was not accompanied by fever, loose stools, or vomiting. After he had undergone abdominal ultrasonography, portal vein thrombosis was discovered, and based on no involvement of suprahepatic veins according to ultrasonography, Budd-Chiari syndrome was ruled out. It was accompanied by dilated periportal tortuous veins and visible mesenteric and peri-splenic collaterals. Moderate splenomegaly was also present. All these features on ultrasound were suggestive of the "portal cavernoma" formation. The patient is not an alcoholic and does not have any chronic, hereditary, or metabolic liver disease. Thrombophilia and cancer screening through tumor markers were also negative. We, with this, present a rare case of non-cirrhotic idiopathic portal cavernoma. This rare case contributes to advancing medical and scientific knowledge that will encourage further dialogue on the topic.
PubMed: 38229806
DOI: 10.7759/cureus.50570 -
Journal of Medical Case Reports Jan 2024The worldwide vaccination response to COVID-19 has been associated with rare thrombotic complications, including the case of postvaccination splanchnic venous thrombosis...
BACKGROUND
The worldwide vaccination response to COVID-19 has been associated with rare thrombotic complications, including the case of postvaccination splanchnic venous thrombosis we report here.
CASE PRESENTATION
An 80-year-old Japanese male with abdominal pain presented to our hospital six days after receiving a dose of the COVID-19 messenger ribonucleic acid vaccine. Abdominal computed tomography showed localized edema of the small intestine, increased density of the surrounding adipose tissue, and a thrombus in the superior mesenteric vein. Conservative inpatient treatment with unfractionated heparin relieved the thrombosis, and the patient is currently receiving oral apixaban as an outpatient.
CONCLUSION
Reported cases of thrombosis after COVID-19 vaccination typically have been associated with viral vector vaccines, with few reports of thrombosis induced by mRNA vaccines. The potential for venous thrombosis should be explored when patients present with abdominal pain soon after COVID-19 vaccination.
Topics: Aged, 80 and over; Humans; Male; Abdominal Pain; COVID-19; COVID-19 Vaccines; Heparin; Mesenteric Ischemia; Mesenteric Veins; Vaccination; Venous Thrombosis
PubMed: 38200562
DOI: 10.1186/s13256-023-04320-2