[Treatment of patients with massive mesenteric venous thrombosis].

Background: One of the causes of acute intestinal ischemia and necrosis is mesenteric venous thrombosis or its larger-scale and prognostically less favorable variant, i. e., portomesenteric thrombosis. Despite the fact that the main method of treatment for mesenteric venous thrombosis is anticoagulant therapy, the necessity to perform the operation of intestinal resection for mesenteric venous thrombosis remains high, accounting for 17-91%, with the pathology-related mortality amounting to 41%.

Objective: This study was aimed at analyzing possibilities of diagnostic methods and the use of various strategies in treatment of patients with massive mesenteric and portomesenteric venous thrombosis.

Patients and methods: The work was based on therapeutic outcomes in a total of 25 patients with mesenteric venous thrombosis. Of these, 19 patients underwent conservative treatment and 6 patients were subjected to resection of the necrotized intestine. The patients' age ranged from 33 to 92 years (mean 63±11 years). There were 15 (60%) men and 10 (40%) women. The diagnosis of mesenteric venous thrombosis was verified by means of the following instrumental diagnostic methods: laparoscopy (n=10), laparotomy (n=6), and computed tomography of the abdominal cavity with intravenous contrast enhancement (n=9).

Results and discussion: Amongst all patients admitted to our clinic with acute intestinal ischemia over a 12-year period, mesenteric venous thrombosis accounted for 7.7%. The need for small bowel resection appeared in 6 patients, with 5 of them requiring further programmed relaparotomy and formation of an anastomosis. All those 6 patients had presented with a clinical picture of peritonitis. The remaining 19 patients received anticoagulant therapy alone. 7 of the 25 patients with mesenteric venous thrombosis died, with the overall in-hospital mortality thus amounting to 28%. The mortality rate in the group of operated-on patients and in the group of conservative treatment amounted to 50% and 21%, respectively (p=0.169). The volume and spread of venous thrombosis in the portomesenteric venous system also significantly influenced the lethality rate. Amongst 14 patients having developed thrombosis only in the system of the superior mesenteric vein, mortality was 21%. In those with massive portomesenteric venous thrombosis (11 patients), mortality was 36% (p=0.409).

Conclusion: Intravenous contrast-enhanced computed tomography and diagnostic laparoscopy should be recognized as the main methods of making the diagnosis of mesenteric venous thrombosis. Anticoagulant therapy may prevent the development of intestinal venous gangrene and improve therapeutic outcomes in patients with mesenteric venous thrombosis.