The management of mesenteric vein thrombosis: A single institution’s experience

AMAÇ Mezenter ven trombozu, akut mezenter iskemi olgularınınyaklaşık %5-15’inden sorumlu olan ve nadir görülen bir durumdur. Bu çalışmanın amacı, 34 hastalık tecrübemizi paylaşmak ve mezenter ven trombozuna yaklaşımı tartışmaktır. GEREÇ VE YÖNTEM Ocak 2007 ve Ocak 2010 tarihleri arasında acil cerrahi servisimize mezenter iskemi tanısı ile başvuran 34 hasta geriyedönük olarak incelendi. Peritonit bulgusu mevcut olan hastalara, başvurularında tanısal laparokopi uygulandı. Ameliyatın bitirilmesine yakın, karın sol alt kadrana 10 mm laparoskopi trokarı yerleştirildi. Anastomoz yapılan olgulardaameliyat sonrası ilk 72 saatlik dönemde laparoskopik ikincil bakı yapıldı. Tüm hastalar günde iki kez subkutan 100 mg/ kg enoksaparin uygulandı. Ven rekanalizasyonu değerlendirilmesi amacıyla tüm hastalara, 6. ve 12. aylarda bilgisayarlıtomografi (BT) anjiyografi görüntüleme yapıldı. BULGULAR Bilgisayarlı tomografi anjiyografi ile 25 (%73) hastada superiyor mezenterik ven trombozu, 24 (%70) hastada portal ven trombozu ve 12 (%35) hastada splenik ven trombozu saptandı. Peritonit bulgusu olan 11 hastaya tanısal laparoskopi yapıldı. Bu hastaların 8 tanesine ince bağırsak rezeksiyonu ve anastomozu yapılarak ikincil bakı için trokar yerleştirildi. İkincil bakı yapılan hastalardan 2 tanesinde ince bağırsak iskemisi saptanarak re-rezeksiyon gerçekleştirildi. SONUÇ Mezenterik ven trombozunun tedavisinde BT anjiyografi ile erken tanı, cerrahi ya da cerrahi dışı yöntemlerle kan akımının sağlanması, uygun antikoagülan kullanımı ve yoğun bakım destek tedavileri, hastalığın başarılı bir şekilde yönetilmesinde hayati rol oynamaktadırlar.

Anahtar Kelime:

Konular: Cerrahi

Mezenter ven trombozuna yaklaşım: Tek merkez deneyimi

Öz:

BACKGROUNDMesenteric vein thrombosis occurs rarely and is respon-sible for approximately 5-15% of all cases of acute mes- enteric ischemia. The aim of this report was to discuss themanagement of mesenteric vein thrombosis based on ourexperience with 34 patients.METHODSIn the present study, 34 patients who were admitted to our emergency surgery department between January 2007 and January 2010 with a diagnosis of acute mesenteric vein thrombosis were assessed retrospectively. Patients with peritoneal signs first underwent diagnostic laparoscopy to rule out perforation or bowel gangrene. We performed a second-look laparoscopy within 72 hours of the first operation. All patients were administered 100 mg/kg of the anticoagulant enoxaparin twice daily. In the 6th and 12th months of follow up, CT angiography was performed to evaluate recanalization of the veins. RESULTS CT angiography revealed superior mesenteric vein thrombosis in 25 (73%) patients, portal vein thrombosis in 24 (70%) patients, and splenic vein thrombosis in 12 (35%) patients. Eleven patients with peritoneal signs underwent diagnostic laparoscopy; eight of the patients underwent small bowel resection, anastomosis, and trocar insertion. During second-look laparoscopy, small bowel ischemia was found in two patients and re-resection was performed. CONCLUSION Early diagnosis with CT angiography, surgical and non- surgical blood flow restoration, proper anticoagulation, andsupportive intensive care are the cornerstones of successfultreatment of mesenteric vein thrombosis.

Anahtar Kelime:

Konular: Cerrahi

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	Yanar F, AĞCAOĞLU O, GÖK A, Sarici I, Ozcinar B, aksakal n, AKSOY M, Özkurt E, KURTOĞLU M (2013). The management of mesenteric vein thrombosis: A single institution’s experience. , 223 - 228.
Chicago	Yanar Fatih,AĞCAOĞLU ORHAN,GÖK Ali Fuat Kaan,Sarici Inanc Samil,Ozcinar Beyza,aksakal nihat,AKSOY Murat,Özkurt Enver,KURTOĞLU MEHMET HAMDİ The management of mesenteric vein thrombosis: A single institution’s experience. (2013): 223 - 228.
MLA	Yanar Fatih,AĞCAOĞLU ORHAN,GÖK Ali Fuat Kaan,Sarici Inanc Samil,Ozcinar Beyza,aksakal nihat,AKSOY Murat,Özkurt Enver,KURTOĞLU MEHMET HAMDİ The management of mesenteric vein thrombosis: A single institution’s experience. , 2013, ss.223 - 228.
AMA	Yanar F,AĞCAOĞLU O,GÖK A,Sarici I,Ozcinar B,aksakal n,AKSOY M,Özkurt E,KURTOĞLU M The management of mesenteric vein thrombosis: A single institution’s experience. . 2013; 223 - 228.
Vancouver	Yanar F,AĞCAOĞLU O,GÖK A,Sarici I,Ozcinar B,aksakal n,AKSOY M,Özkurt E,KURTOĞLU M The management of mesenteric vein thrombosis: A single institution’s experience. . 2013; 223 - 228.
IEEE	Yanar F,AĞCAOĞLU O,GÖK A,Sarici I,Ozcinar B,aksakal n,AKSOY M,Özkurt E,KURTOĞLU M "The management of mesenteric vein thrombosis: A single institution’s experience." , ss.223 - 228, 2013.
ISNAD	Yanar, Fatih vd. "The management of mesenteric vein thrombosis: A single institution’s experience". (2013), 223-228.

APA	Yanar F, AĞCAOĞLU O, GÖK A, Sarici I, Ozcinar B, aksakal n, AKSOY M, Özkurt E, KURTOĞLU M (2013). The management of mesenteric vein thrombosis: A single institution’s experience. Ulusal Travma ve Acil Cerrahi Dergisi, 19(3), 223 - 228.
Chicago	Yanar Fatih,AĞCAOĞLU ORHAN,GÖK Ali Fuat Kaan,Sarici Inanc Samil,Ozcinar Beyza,aksakal nihat,AKSOY Murat,Özkurt Enver,KURTOĞLU MEHMET HAMDİ The management of mesenteric vein thrombosis: A single institution’s experience. Ulusal Travma ve Acil Cerrahi Dergisi 19, no.3 (2013): 223 - 228.
MLA	Yanar Fatih,AĞCAOĞLU ORHAN,GÖK Ali Fuat Kaan,Sarici Inanc Samil,Ozcinar Beyza,aksakal nihat,AKSOY Murat,Özkurt Enver,KURTOĞLU MEHMET HAMDİ The management of mesenteric vein thrombosis: A single institution’s experience. Ulusal Travma ve Acil Cerrahi Dergisi, vol.19, no.3, 2013, ss.223 - 228.
AMA	Yanar F,AĞCAOĞLU O,GÖK A,Sarici I,Ozcinar B,aksakal n,AKSOY M,Özkurt E,KURTOĞLU M The management of mesenteric vein thrombosis: A single institution’s experience. Ulusal Travma ve Acil Cerrahi Dergisi. 2013; 19(3): 223 - 228.
Vancouver	Yanar F,AĞCAOĞLU O,GÖK A,Sarici I,Ozcinar B,aksakal n,AKSOY M,Özkurt E,KURTOĞLU M The management of mesenteric vein thrombosis: A single institution’s experience. Ulusal Travma ve Acil Cerrahi Dergisi. 2013; 19(3): 223 - 228.
IEEE	Yanar F,AĞCAOĞLU O,GÖK A,Sarici I,Ozcinar B,aksakal n,AKSOY M,Özkurt E,KURTOĞLU M "The management of mesenteric vein thrombosis: A single institution’s experience." Ulusal Travma ve Acil Cerrahi Dergisi, 19, ss.223 - 228, 2013.
ISNAD	Yanar, Fatih vd. "The management of mesenteric vein thrombosis: A single institution’s experience". Ulusal Travma ve Acil Cerrahi Dergisi 19/3 (2013), 223-228.