Akut superior mezenterik ven trombozuna bağlı mezenterik iskeminin bilgisayarlı tomografi bulguları: Olgu sunumu
Öz
Akut mezenterik iskemi (AMI), mezenterik damarların tıkanması, vazospazm veya hipoperfüzyonun kan akışında azalmaya neden olduğu bir durumdur. Tüm AMI'nin yaklaşık% 5-15'i mezenterik venöz tromboz (MVT) ile ilgilidir. MVT, ileri medikal teknolojilere rağmen yüksek ölüm oranına sahiptir. Bu nedenle, hastalığın prognozunda erken tanı önemlidir. Kontrastlı bilgisayarlı tomografi (BT) ve BT anjiyografi erken tanı için en yararlı radyolojik incelemelerdir. Radyolojik görüntüleri olan 55 yaşındaki hastayı sunduk. Hastamız bir hafta boyunca mevcut olan şiddetli karın ağrısı ile hastaneye başvurdu. MVT'yi distal portal kavşağına kadar superior mezenterik ven boyunca izledik. Hasta bir ay önce başka bir hastanede peptik ülsere bağlı olarak üst gastrointestinal sistem kanama öyküsüne sahipti. Nekroz nedeniyle pnömatozis intestinalis vardı, ileal duvarlar konsantrik kalın ve ödem nedeniyle düşüktü. Segmental ileus bu olaya engel olmaksızın eşlik ediyordu. Radyolojik olarak, MVT'nin neden olduğu AMI olarak değerlendirdik.
Anahtar Kelimeler
Kaynakça
- 1. Herbert GS, Steele SR. Acute and chronic mesenteric ischemia. Surg Clin North Am. 2007;87:1115-34.
- 2. Brunaud L, Antunes L, Adler SC, Marchal F, Ayav A, Bresler L, et al. Acute mesenteric venous thrombosis: Case for nonoperative management. J Vas Surg. 2001;34:673-9.
- 3. Al Salamah S, Mirza SM. Acute Mesenteric Venous Thrombosis: Management Controversies. 2004;11:242-7.
- 4. Rhee RY, Gloviczki P. Mesenteric venous thrombosis. Surg Clin North Am. 1997;77:327-39.
- 5. Adaba F, Askari A, Dastur J, et al. Mortality after acute primary mesenteric infarction: a systematic review and meta-analysis of observational studies. Colorectal Dis. 2015;17(7):566-77.
- 6. Bala M, Kashuk J, Moore EE, Kluger Y, Biffl W, Gomes CA, et al. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2017 Aug 7;12:38.
- 7. Chang RW, Chang JB, Longo WE. Update in management of mesenteric ischemia. World J Gastroenterol. 2006;12:3243-7.
- 8. Williams LF. Mesenteric ischemia. Surg Clin North Am. 1988;68:331-53.
- 9. Witte CL, Brewer ML, Witte MH, Pond GB. Protean manifestations of Pyelothrombosis. Ann Surg. 1985;202:191-202.
- 10. Furukawa A, Kanasaki S, Kono N, Wakamiya M, Tanaka T, Takahashi M, Murata K. CT diagnosis of acute mesenteric ischemia from various causes. AJR Am J Roentgenol. 2009 Feb;192(2):408-16.
- 11. Hmoud B, Ashwani K, Kamathz PS. Mesenteric Venous Thrombosis. Journal of Clinical and Experimental Hepatology. 2014;4(3):257–63.
Computed tomography findings of mesenteric ischemia related to acute superior mesenteric vein thrombosis: A case report
Öz
Acute mesenteric ischemia (AMI) is a condition caused by a decrease in blood flow due to occlusion of the mesenteric vessels, vasospasm or hypoperfusion. Approximately 5-15% of all AMI are related to mesenteric venous thrombosis (MVT). MVT has high mortality rate despite of advanced medical technologies. Thus, early diagnosis is crucial in the prognosis of the disease. Contrast-enhanced computed tomography (CT) and CT angiography are the most helpful radiological examinations for early diagnosis. We present the case of 55 years old patient with AMI accompanied by radiological images. Our patient was admitted to hospital with severe abdominal pain persistent since a week. The patient had upper gastro-intestinal system (GIS) bleeding history due to peptic ulcer a month ago. In the CT imaging, we found thrombosis along superior mesenteric vein up to distal portal junction. There was pneumatosis intestinalis as a consequence of necrosis, ileal walls were concentric, thick and hypodense because of edema. Total intestinal segments were dilated with air-fluid levels. Ileus was present without obstruction. The findings support the diagnosis of AMI due to MVT.
Anahtar Kelimeler
Mesenteric ischemia Venous infarct Mesenteric venous thrombosis
Kaynakça
- 1. Herbert GS, Steele SR. Acute and chronic mesenteric ischemia. Surg Clin North Am. 2007;87:1115-34.
- 2. Brunaud L, Antunes L, Adler SC, Marchal F, Ayav A, Bresler L, et al. Acute mesenteric venous thrombosis: Case for nonoperative management. J Vas Surg. 2001;34:673-9.
- 3. Al Salamah S, Mirza SM. Acute Mesenteric Venous Thrombosis: Management Controversies. 2004;11:242-7.
- 4. Rhee RY, Gloviczki P. Mesenteric venous thrombosis. Surg Clin North Am. 1997;77:327-39.
- 5. Adaba F, Askari A, Dastur J, et al. Mortality after acute primary mesenteric infarction: a systematic review and meta-analysis of observational studies. Colorectal Dis. 2015;17(7):566-77.
- 6. Bala M, Kashuk J, Moore EE, Kluger Y, Biffl W, Gomes CA, et al. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2017 Aug 7;12:38.
- 7. Chang RW, Chang JB, Longo WE. Update in management of mesenteric ischemia. World J Gastroenterol. 2006;12:3243-7.
- 8. Williams LF. Mesenteric ischemia. Surg Clin North Am. 1988;68:331-53.
- 9. Witte CL, Brewer ML, Witte MH, Pond GB. Protean manifestations of Pyelothrombosis. Ann Surg. 1985;202:191-202.
- 10. Furukawa A, Kanasaki S, Kono N, Wakamiya M, Tanaka T, Takahashi M, Murata K. CT diagnosis of acute mesenteric ischemia from various causes. AJR Am J Roentgenol. 2009 Feb;192(2):408-16.
- 11. Hmoud B, Ashwani K, Kamathz PS. Mesenteric Venous Thrombosis. Journal of Clinical and Experimental Hepatology. 2014;4(3):257–63.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Olgu sunumu |
| Yazarlar | |
| Yayımlanma Tarihi | 15 Mart 2019 |
| Yayımlandığı Sayı | Yıl 2019 Cilt: 3 Sayı: 3 |
