Mesenteric venous thrombosis has been described to occur in cases where there has been no apparent cause. The diagnosis is usually delayed because the signs and symptoms are non-specific. A case of primary mesenteric venous thrombosis is reported below. Its presentation and pathology are discussed. Treatment is surgery with resection of gangrenous bowel and primary anastomosis. Post-operative anticoagulation is advocated.
A 43 year-old woman presented with severe non-specific abdominal pain of 1-week duration. She was on oral contraceptive pills for the past 6 years. Clinically patient appeared ill with no specific abnormal physical sign. Moderate amount of free fluid in the peritoneal cavity on ultrasound prompted an urgent abdominal computed tomography (CT) scan, which revealed thrombosis of the superior mesenteric vein. Further investigations revealed a hypercoagulable state with protein C deficiency. Patient responded well to anticoagulation and supportive therapy. One month later patient readmitted with vomiting and signs of intestinal obstruction. Barium study revealed a moderately long tight stricture at mid jejunum with proximal dilation. A by-pass surgery was carried out. She was well at 3 months follow-up.
The effect of specific alpha[ or alpha2 adrenoceptor agents on the response of rat superior mesenteric-portal vein to field stimulation was investigated. In. a dose related manner, phenylephrine (alpha[ agonist) and yohimbine (alpha2 antagonists) increased while prazosin (alpha[ antagonist) and clonidine (alpha2 agonist) decreased the response of the vein to field stimulation. These effects are the same as those seen with these agents on rat and mouse vas deferens. It is suggested that, as in vas deferens, alpha1 postsynaptic and alpha2 presynaptic receptors exist in rat superior mesenteric-portal vein and that these receptors may be sufficiently sensitive in vein for their existence to be of significance in the action of these agents at clinical doses.
Jejunum is drained into superior mesenteric vein through a series of jejunal veins. The way in which the first jejunal vein terminates is of great importance in upper abdominal surgery and radiological procedures. Knowledge of its variations is particularly important in surgical procedures like orthotropic hepatic transplantation, hepatic vein reconstruction, pancreatic surgery and surgical procedures of duodenojejunal junction. We saw a first jejunal vein opening directly into the portal vein. Further, the inferior mesenteric vein drained into the first jejunal vein. This case could be useful to gastroenterologists, general surgeons and radiologists.
The effects of phentolamine and propranolol on contractural responses of guinea-pig superior mesenteric-portal vein to adrenaline and isoprenaline were investigated. Phentolamine was capable of completely abolishing the response to adrenaline and to isoprenaline while propranolol had no effect on responses to either agonist. It is suggested that Alpha receptors are the only type of adrenoceptor involved in adrenergic control of contraction of this vein and that isoprenaline is capable of stimulating these receptors.
Porto-spleno-mesenteric vein thrombosis is a rare, life-threatening condition of extrahepatic portal venous
system thrombosis. We report a rare case of a 49-year-old lady with late presentation of acute portal vein
thrombosis in a non-cirrhotic liver with an incidental finding of left adnexal teratoma. She presented with a
one-week history of severe abdominal pain associated with vomiting and diarrhea. She gave no history of prior
risk for venous thromboembolism or liver diseases. Physical examination revealed a tender mass extending from
suprapubic to left iliac fossa. Abdominal computed tomography scans showed a well-defined fat-containing left
adnexal mass, likely a benign teratoma, with no involvement of surrounding structures or calcification. There
was evidence of porto-splenic-mesenteric vein thrombosis with liver infarction, bowel and splenic ischemia.
Management of the extensive thrombosis causing multi-organ failure includes resuscitation, supportive care
and treatment of thrombosis. Treatment options include early anticoagulation and if feasible, thrombolysis.