warfarin and Mesenteric-Vascular-Occlusion

A 60-year-old man was treated in the hospital for mesenteric vein thrombosis and discharged home on anticoagulation. On warfarin the patient started to bleed profusely from the nose and tongue. He was evaluated by ENT (ears, nose and throat); a nasal endoscopy revealed several vascular ectasias. Subsequent detailed history and general physical examination established the diagnosis of hereditary haemorrhagic telangiectasia also known as Osler-Weber-Rendu syndrome. On further evaluation, pulmonary arteriovenous malformations were diagnosed on imaging and treated by intervention radiology. In hindsight, the diagnosis could have been made in the general practitioner's office with just a routine thorough history and a physical examination at a new patient visit. We report this case to stress upon the importance of vigilant clinical, medical and family history and a thorough examination to establish an early diagnosis of this not-so-rare entity.

Topics: Angiography; Anticoagulants; Combined Modality Therapy; Diagnosis, Differential; Emergency Service, Hospital; Follow-Up Studies; Hemorrhage; Humans; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Middle Aged; Risk Assessment; Severity of Illness Index; Telangiectasia, Hereditary Hemorrhagic; Tomography, X-Ray Computed; Treatment Outcome; Venous Thrombosis; Warfarin

Topics: Adult; Anticoagulants; Female; Humans; Mesenteric Vascular Occlusion; Mesenteric Veins; Protein S Deficiency; Radiography; Venous Thrombosis; Warfarin

Mesenteric venous thrombosis is a rare, but potentially lethal, complication of pancreatitis. Although management is usually directed toward the underlying pancreatitis, there is no standard defined for treatment of the associated mesenteric venous thrombosis. Anticoagulant therapy was chosen as treatment for the case presented in this report, but other management methods for this entity have been described in the literature. Based on our experience and review of the literature, a management strategy for patients with pancreatitis-associated mesenteric venous thrombosis has been developed.

Topics: Acute Disease; Anticoagulants; Female; Heparin; Humans; Mesenteric Vascular Occlusion; Mesenteric Veins; Middle Aged; Pancreatitis; Thrombosis; Warfarin

We present a case of embolic acute mesenteric ischaemia (AMI) secondary to an underlying cardiac sarcoma, an exceedingly rare presentation only reported twice before. A 46-year-old man presented to accident and emergency department during the night with severe abdominal pain and vomiting. An urgent CT angiograph demonstrated superior mesenteric artery (SMA) occlusion with ischaemic small bowel. Joint surgical effort from vascular and general surgeons successfully recanalised the SMA and a 20 cm segment of small bowel was resected. Postoperatively, an echocardiogram demonstrated a mass within the left atrium. After cardiothoracic resection, the mass was found to be a rare undifferentiated cardiac sarcoma. Further staining on the embolus retrieved from the SMA revealed scattered spindle cells with a similar immunohistochemistry profile to that of the resected cardiac sarcoma. The patient was subsequently discharged well on lifelong warfarin.

Topics: Computed Tomography Angiography; Echocardiography; Heart Neoplasms; Humans; Male; Mesenteric Artery, Superior; Mesenteric Vascular Occlusion; Middle Aged; Sarcoma; Warfarin

Topics: Abdominal Pain; Anti-Bacterial Agents; Anticoagulants; Appendectomy; Appendicitis; Drainage; Escherichia coli Infections; Female; Heparin; Humans; Mesenteric Vascular Occlusion; Mesenteric Veins; Middle Aged; Radiography; Sclerosis; Venous Thrombosis; Warfarin

Mesenteric venous thrombosis (MVT) is a rare but life threatening form of bowel ischemia. It is implicated in 6%-9% of all cases of acute mesenteric ischemia. The proportion of patients with primary (or idiopathic) MVT varies from 0% to 49%, with a decrease in frequency secondary to more recent availability of newer investigations for hypercoagulability. The presence of factor V Leiden (FVL) and prothrombin G20210A mutations (PGM) have been well documented in these cases. However, there have been scarce case reports describing MVT in heterozygotes of both these mutations occurring simultaneously and its implications on long term management. Our case describes acute MVT in a previously asymptomatic young patient with no prior history of venous thromboembolism. The patient was found to be heterozygous for FVL and PGM and treated with lifelong anticoagulation with warfarin (goal international normalized ratio: 2-3) and avoidance of hormonal contraceptives.

Topics: Activated Protein C Resistance; Anticoagulants; Blood Coagulation; DNA Mutational Analysis; Factor V; Female; Genetic Predisposition to Disease; Heterozygote; Humans; International Normalized Ratio; Ischemia; Mesenteric Ischemia; Mesenteric Vascular Occlusion; Mesenteric Veins; Mutation; Phenotype; Phlebography; Prothrombin; Tomography, X-Ray Computed; Vascular Diseases; Venous Thrombosis; Warfarin; Young Adult

Mesenteric vein thrombosis is a rare disorder that is often the first manifestation of a systemic condition such as a hypercoagulable state or cancer. In particular, myeloproliferative disorders can present as mesenteric vein thrombosis even in the setting of relatively normal peripheral blood counts. A recent novel mutation in the Janus activated kinase 2 gene involving a gain-of-function substitute of valine to phenylalanine at position 617 (JAK2 V617F) has been discovered to be prevalent in patients with mesenteric vein thrombosis and myeloproliferative disorders. This article reports a patient who presented with mesenteric vein thrombosis and relatively normal peripheral blood counts. He was diagnosed with essential thrombocythemia after he tested positive for the JAK2 V617F mutation.

Topics: Aged; Anticoagulants; DNA Mutational Analysis; Genetic Predisposition to Disease; Genetic Testing; Humans; Janus Kinase 2; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Point Mutation; Thrombocythemia, Essential; Tomography, X-Ray Computed; Venous Thrombosis; Warfarin

The prevalence and clinical spectrum of acute mesenteric venous thrombosis (AMVT) in Pakistan is largely unknown. The authors report two patients with acute mesenteric, portal and inferior vena cava venous thrombosis confirmed on CT imaging. The diagnoses were established within 24 hours of presentation and both patients were successfully treated with therapeutic heparin during hospital admission and continued on oral warfarin because of hypercoagulable state. The protocol that we currently use is evidence based and is leading to optimal outcome.

Topics: Acute Disease; Adult; Anticoagulants; Female; Heparin; Humans; Liver; Mesenteric Vascular Occlusion; Mesenteric Veins; Peritoneal Diseases; Tomography, X-Ray Computed; Treatment Outcome; Vena Cava, Inferior; Venous Thrombosis; Warfarin

We present an unusual case of a 31-year-old nulliparous woman who was in her normal state of health until 3 weeks before her Emergency Department visit, when she began to have generalized abdominal pain that got acutely worse over a few days. She had a soft abdomen, but complained of excruciating pain. Her computed tomography (CT) scan revealed thrombosis in the superior mesenteric, splenic, and portal veins. Her hematological work-up detected a protein S deficiency, which is associated with recurrent venous thrombosis. The finding of mesenteric venous thrombosis associated with protein S deficiency is rare. The most important factor in survival is early diagnosis and prompt treatment with anticoagulants. Properly treated, patients with mesenteric venous thrombosis should have a good long-term prognosis. Past medical or family history of thrombosis in combination with abdominal symptoms should increase the suspicion for the disease.

Topics: Abdominal Pain; Adult; Anticoagulants; Female; Humans; Mesenteric Vascular Occlusion; Mesenteric Veins; Portal Vein; Prognosis; Protein S Deficiency; Splenic Vein; Venous Thrombosis; Warfarin

We present a case of acute intestinal infarction in a pregnant woman with chronic idiopathic mesenteric vein thrombosis (MVT) under regular anticoagulation treatment.. The condition of the 26-year-old woman who was diagnosed with chronic idiopathic MVT after detailed investigation was stable after receiving regular anticoagulation with warfarin. One year later, she presented with a 7-day episode of intermittent epigastric pain. Acute intestinal infarction and concomitant 7-week pregnancy were diagnosed. To preserve her life, a dilation and curettage procedure and emergency laparotomy with bowel resection were performed. Ten days later, she was discharged, having made a good recovery.. Although pregnancy was not the primary cause of chronic MVT, it did play a role in inducing the acute intestinal infarction. This case indicates that pregnant patients with known chronic idiopathic MVT should be counseled about the high risk of acute mesenteric thrombosis. This case also serves to remind physicians that there should always be a high level of suspicion of intestinal infarction in patients with an acute abdomen who are in a hypercoagulable state.

Topics: Adult; Anticoagulants; Female; Humans; Jejunum; Mesenteric Vascular Occlusion; Mesenteric Veins; Pregnancy; Pregnancy Complications, Cardiovascular; Venous Thrombosis; Warfarin

The natural history of chronic portomesenteric (PM) and portosplenomesenteric (PSM) venous thrombosis is defined poorly. Therapeutic options are limited, and are directed at the prevention of variceal bleeding and the control of abdominal pain related to gastrointestinal hyperemia.. Patients with extensive PM and PSM thrombosis were reviewed retrospectively to evaluate the efficacy of medical therapy and to determine which clinical variables had prognostic significance regarding long-term survival.. Sixty patients, with a median age at diagnosis of 44 years (range, 18-68 y), were assessed. The median follow-up period was 3.5 years (range, 0.2-32.0 y). The overall survival rate was 73.3%, with 1- and 5-year survival rates of 81.6%, and 78.3%, respectively. One- and 5-year survival rates, excluding patients who died from malignancy-related causes, were 85.7% and 82.1%, respectively. Factors associated with improved survival included treatment with beta-blockers (P = .02; odds ratio [OR], .09; 95% confidence interval [CI], 0.01-0.70) and anticoagulation (P = .005; OR, 0.01; 95% CI, <0.01 to 0.26). Eighteen patients in total were anticoagulated, including 8 patients who had variceal bleeding, all of whom underwent endoscopic band ligation of esophageal varices before anticoagulation. By using Cox regression analysis, variables associated with reduced survival were the presence of ascites (P = .001; OR, 42.6; 95% CI, 5.03-360), and hyperbilirubinemia (P = .01; OR, 13.8; 95% CI, 1.9-100) at presentation. Six patients died of variceal hemorrhage.. Patients with chronic PM and PSM venous thrombosis without underlying malignancy have an acceptable long-term survival. Treatment with beta-blockers and anticoagulation appears to improve outcome.

Topics: Adolescent; Adrenergic beta-Antagonists; Adult; Aged; Anticoagulants; Ascites; Chronic Disease; Esophageal and Gastric Varices; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Hyperbilirubinemia; Ligation; London; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Middle Aged; Multivariate Analysis; Serum Albumin; Survival Rate; Venous Thrombosis; Warfarin

Mesenteric venous thrombosis (MVT) is an unusual site of deep venous thrombosis. Little is known about risk factors of MVT, but available data seem to confirm a pathogenetic role of acquired thrombotic risk factors as well as inherited thrombotic risk factors. However, few cases on the association of MVT with oral contraceptive use have been described. We here report a case of MVT in a woman on oral contraception with fine and complete resolution after a fast diagnosis with abdominal ultrasound imaging and prompt therapy based on low molecular weight heparin.

Topics: Administration, Oral; Adult; Anticoagulants; Contraceptives, Oral; Female; Follow-Up Studies; Heparin, Low-Molecular-Weight; Humans; Mesenteric Vascular Occlusion; Mesenteric Veins; Time Factors; Treatment Outcome; Ultrasonography; Venous Thrombosis; Warfarin; White People

A 43-year-old man presented 10 days after a Roux-en-Y gastric bypass with abdominal pain radiating to the back. Investigation revealed a thrombus in the superior mesenteric vein. The patient was found to have a hypercoagulable state. He responded successfully to anticoagulant therapy.

Topics: Adult; Anastomosis, Roux-en-Y; Anticoagulants; Gastric Bypass; Humans; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Obesity, Morbid; Radiography; Thrombophilia; Treatment Outcome; Venous Thrombosis; Warfarin

Mesenteric vein thrombosis (MVT) is rare. Its diagnosis is usually difficult and delayed. Herein, we report 2 patients who developed MVT as a complication of an appendicular mass. One of them had appendectomy and developed fever 10 days postoperatively. The other was treated conservatively. An abdominal computerized tomography (CT) scan with intravenous contrast was helpful in diagnosing the superior MVT in both patients, which were not suspected. Intravenous contrast should be used when performing CT of an appendicular mass. Special interest should be directed at studying the superior mesenteric vein. Early diagnosis of our patients helped to start early medical treatment with anticoagulation.

Topics: Abdominal Pain; Adult; Anticoagulants; Appendectomy; Appendicitis; Enoxaparin; Humans; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Radiography, Abdominal; Treatment Outcome; Venous Thrombosis; Warfarin

Mesenteric vein thrombosis is a relatively rare cause of intestinal ischemia. We present a case of idiopathic superior mesenteric and portal vein thrombosis, which was not associated with any infarcted bowel. The patient was treated successfully with anticoagulation using low-molecular weight heparin and warfarin, and did not require bowel resection. This case highlights the value of diagnostic laparoscopy for assessing intestinal viability in this situation, showing how it avoids the morbidity and complications associated with a formal laparotomy.

Topics: Adult; Drug Therapy, Combination; Female; Heparin, Low-Molecular-Weight; Humans; Intestine, Small; Laparoscopy; Mesenteric Vascular Occlusion; Mesenteric Veins; Treatment Outcome; Venous Thrombosis; Warfarin

Mesenteric venous thrombosis (MVT), an uncommon but important clinical entity, is one possible cause of ischemia or infarction of the small intestine. Diagnosis of this condition is sometimes difficult and treatment is often delayed because patients usually present with nonspecific abdominal symptoms. The hallmark is pain that is out of proportion to the physical findings. We report two cases of MVT, where the patients initially presented with vague abdominal symptoms. Diagnosis was made on the basis of computed tomography of the abdomen showing thrombus within the superior mesenteric vein. A search for a precipitating condition revealed no evidence of a hypercoagulable state, myeloproliferative disorder, or malignancy. These cases illustrate well the nonspecific clinical presentation of MVT. A high index of suspicion, recognition of known risk factors, or a previous history of venous thrombosis coupled with a history of nonspecific abdominal symptoms should alert clinicians to the possibility of MVT. Early diagnosis and prompt anticoagulation are the mainstay of therapy unless there are signs of peritonitis that necessitate surgical resection of the infarcted bowel.

Topics: Abdominal Pain; Aged; Anticoagulants; Diagnosis, Differential; Female; Fibrinolytic Agents; Heparin; Humans; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Middle Aged; Postoperative Care; Time Factors; Tomography, X-Ray Computed; Venous Thrombosis; Warfarin

Deep venous thrombosis (DVT) is a common clinical problem. The aeromedical dispositions of three United States Air Force pilots with lower extremity deep venous thrombosis from Altus Air Force Base, OK are discussed, as well as the etiology, diagnosis, and treatment of this problem.

Topics: Adult; Aerospace Medicine; Bandages; Femoral Vein; Heparin; Humans; Iliac Vein; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Military Personnel; Popliteal Vein; Thrombosis; Warfarin

Four patients under 45 years old presented with small bowel infarction secondary to superior mesenteric venous thrombosis. Diagnosis was not made pre-operatively in three patients and delay to operation of over 4 days occurred in two patients. In each case infarcted bowel was resected and a primary anastomosis fashioned. A further resection of infarcted small bowel was necessary in three patients. Each patient was discharged on long-term warfarin therapy. Two patients required permanent total parenteral nutrition, one of whom died of liver failure at one year. The remaining patients remain well.

Topics: Adult; Female; Humans; Infarction; Intestine, Small; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Parenteral Nutrition, Total; Postoperative Complications; Prognosis; Thrombosis; Warfarin

Mesenteric vein thrombosis is an abdominal emergency that is rarely diagnosed early. Review of the literature has shown that most cases have been treated by intestinal resection, a few by thrombectomy with or without resection. Three cases of mesenteric vein thrombosis were treated by resection, heparinization, and a second-look operation after 24 hours. When necessary, resection was carried out at the second surgical procedure followed by a third-look operation after 24 hours. After the last inspecting operation without further resection, full heparinization was continued and anticoagulation was ultimately maintained with warafin sodium (Coumadin) for at least three months. The authors believe that optimal treatment for mesenteric vein thrombosis should include anticoagulation with heparin sodium and a mandatory second-look operation.

Topics: Adult; Female; Heparin; Humans; Ileum; Jejunum; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Middle Aged; Postoperative Complications; Thrombophlebitis; Thrombosis; Warfarin

Topics: Female; Humans; Mesenteric Vascular Occlusion; Mesenteric Veins; Middle Aged; Thrombophlebitis; Warfarin

Topics: Adult; Follow-Up Studies; Humans; Jejunum; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Pneumatosis Cystoides Intestinalis; Postoperative Care; Postoperative Complications; Recurrence; Sex Factors; Sodium; Surgical Wound Infection; Thrombophlebitis; Thrombosis; Warfarin

Topics: Aged; Electrocardiography; Hemoperitoneum; Humans; Intestinal Obstruction; Male; Mesenteric Vascular Occlusion; Middle Aged; Myocardial Infarction; Vitamin K; Warfarin

Topics: Atrial Fibrillation; Embolectomy; Embolism; Gastrointestinal Hemorrhage; Heparin; Humans; Mesenteric Artery, Superior; Mesenteric Vascular Occlusion; Postoperative Care; Postoperative Complications; Preoperative Care; Radiography; Rheumatic Heart Disease; Vascular Surgical Procedures; Warfarin