Ulus Travma Acil Cerrahi Derg. 2013; 19(3): 223-228 | DOI: 10.5505/tjtes.2013.47542

Mezenter Ven Trombozuna Yaklaþým: Tek Merkez Deneyimi

Fatih Yanar, Orhan Agcaoglu, Ali Fuat Kaan Gok, Inanc Samil Sarici, Beyza Ozcinar, Nihat Aksakal, Recep Guloglu, Kayihan Gunay, Murat Aksoy, Enver Ozkurt, Mehmet Kurtoglu
Ýstanbul Üniversitesi, Ýstanbul Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Ýstanbul

Amaç:
Mezenter ven trombozu, akut mezenter iskemi olgularýnýn yaklaþýk %5-15’inden sorumlu olan ve nadir görülen bir durumdur. Bu çalýþmanýn amacý, 34 hastalýk tecrübemizi paylaþmak ve mezenter ven trombozuna yaklaþýmý tartýþmaktýr.

Gereç ve Yöntem:
Ocak 2007 ve Ocak 2010 tarihleri arasýnda, acil cerrahi servisimize mezenter iskemi tanýsý ile baþvuran 34 hasta retrospektif olarak incelendi.Peritonit bulgusu mevcut olan hastalara, baþvurularýnda tanýsal laparokopi uygulandý. Ameliyatýn bitirilmesine yakýn, karýn sol alt kadrana 10mm laparoskopi trokarý yerleþtirildi. Anastomoz yapýlan olgularda ameliyat sonrasý ilk 72 saatlik dönemde laparoskopik ikincil baký yapýldý.Tüm hastalar günde iki kez subkutan 100mg/kg enoxaparin uygulandý. Ven rekanalizasyonu deðerlendirilmesi amacýyla tüm hastalara, 6. ve 12. aylarda BT anjiografi görüntüleme yapýldý.

Bulgular:
BT anjiografi ile 25(%73) hastada superior mezenterik ven trombozu, 24(%70) hastada portal ven trombozu ve 12 (%35) hastada splenik ven trombozu saptandý. Peritonit bulgusu olan 11 hastaya tanýsal laparoskopi yapýldý. Bu hastalarýn 8 tanesine ince baðýrsak rezeksiyonu ve anastomozu yapýlarak ikincil baký için trokar yerleþtirildi. Ýkincil baký yapýlan hastalardan 2 tanesinde ince baðýrsak iskemisi saptanarak re-rezeksiyon gerçekleþtirildi.

Sonuç:
Mezenterik ven trombozunun tedavisinde BT anjiografi ile erken taný, cerrahi ya da cerrahi dýþý yöntemlerle kan akýmýnýn saðlanmasý, uygun antikoagulan kullanýmý ve yoðun bakým destek tedavileri, hastalýðýn baþarýlý bir þekilde yönetilmesinde hayati rol oynamaktadýrlar.

Anahtar Kelimeler: Mezenter ven, tromboz, antitrombotik tedavi, algoritma

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The Management of Mesenteric Vein Thrombosis: A Single Institution Experience

Fatih Yanar, Orhan Agcaoglu, Ali Fuat Kaan Gok, Inanc Samil Sarici, Beyza Ozcinar, Nihat Aksakal, Recep Guloglu, Kayihan Gunay, Murat Aksoy, Enver Ozkurt, Mehmet Kurtoglu
Istanbul University, Istanbul Medical Faculty, Department Of General Surgery, Istanbul

Background:
Mesenteric vein thrombosis is a rare occurrence that is responsible for approximately 5–15% of all cases of acute mesenteric ischemia.The aim of this presentation is to discuss the management of mesenteric vein thrombosis with our experience of 34 patients.

Methods:
Between January 2007 and January 2010, 34 patients who admitted to our emergency surgery department with a diagnosis of acute mesenteric vein thrombosis were assessed retrospectively.Patients with peritoneal signs were initially underwent diagnostic laparoscopy to rule out the perforation or bowel gangrene.We performed a second-look laparoscopy within 72h following the first operation.All patients anticoagulated with enoxaparin 100mg/kg/twice-daily.In 6th and 12th months of controls a CT-angiography was carried out to determine recanalization of the veins.

Results:
CT-angiography revealed superior mesenteric vein thrombosis in 25(73%) patients, portal vein thrombosis in 24(70%) patiens, and splenic vein thorombosis in 12(35%) patients. Eleven patients with peritoneal sign had underwent diagnostic laparoscopy. Among them, in 8 patients small bowel resection and anastomosis was performed and in a trocar was inserted.During the second look laparoscopy in 2 patients small bowel ischemia was found and re-resection was performed.

Conclusion:
Early diagnosis with CT angiography, surgical and non-surgical blood flow restoration, proper anticoagulation, and supportive intensive care are the cornerstones of successful treatment of mesenteric vein thrombosis.

Keywords: Mesenter vein, Thrombosis, Antithrombotic therapy, Algorithm

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ATIF KOPYALA