1/46. Intrahepatic hemorrhage after use of low-molecular-weight heparin for total hip arthroplasty.Low-molecular-weight heparin (LMWH) has become a popular agent for prophylaxis against deep vein thrombosis and thromboembolic disease after total joint arthroplasty. LMWH allows for consistent dosing in postoperative patients without the need for laboratory monitoring. hemorrhage is an uncommon but documented adverse reaction when using LMWH; however, intrahepatic hemorrhage has not been previously reported in conjunction with LMWH therapy. We report the case of a woman who suffered intrahepatic hemorrhage presenting with acute abdominal pain and vomiting after the use of enoxaparin for total hip arthroplasty.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
2/46. Primary liver carcinoma complicating membranous obstruction of the inferior vena cava.A rare autopsy case of primary liver carcinoma complicating a pre-existing, incomplete membranous obstruction of the inferior vena cava (MOVC) is reported. The patient, a 67-year-old Japanese male, was admitted to hospital following a 2 year illness of a left chest wall tumor and a 3 month illness with progressive abdominal pain. Computed tomography scans of the abdomen displayed space-occupying lesions in the third and seventh hepatic segments, respectively. One month later, the patient developed edema of the lower extremities and marked venous dilatation of the abdominal trunk. At that time, Doppler examination revealed the presence of intrahepatic large venovenous collaterals. The patient subsequently succumbed 82 days after hospitalization. At subsequent autopsy, the inferior vena cava was completely obstructed by tumor thrombus, which was formed caudally and cranially to a thin membrane and mimicked the valve, with calcification and elastic lamina, at the phrenic portion. Intrahepatic large collateral pathways were found between submembranous and supramembranous hepatic veins. Anomalous absence of the ostia of the middle hepatic vein was found. In addition, the portal venous trunk was occluded by tumor thrombus. histology of hepatic tumors revealed a combined hepatocellular and cholangiocellular carcinoma in the non-cirrhotic liver with severe acute centrilobular congestion. In MOVC patients such as the case presented, malignancy-induced thrombosis was deemed to be an important factor in prognosis.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
3/46. portal vein thrombosis in paroxysmal nocturnal haemoglobinuria.A 28-year-old man was hospitalized with nausea, vomiting, abdominal pain and low-grade fever. He had a 6-month history of paroxysmal nocturnal haemoglobinuria (PNH), and laboratory data showed anaemia and liver dysfunction. An abdominal ultrasonography showed ascites and portal vein thrombosis. After receiving antithrombotic treatment, the portal vein thrombosis did not extend. portal vein thrombosis is very rare but should be considered when we encounter liver dysfunction associated with PNH as well as hepatic vein thrombosis. ultrasonography is very useful in detecting portal vein thrombosis and facilitating early diagnosis. warfarin is very effective in preventing exacerbation of portal vein thrombosis in PNH.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
4/46. Mesenteric venous thrombosis associated with protein c deficiency.An 83-year-old man had gradually worsening abdominal pain and vomiting. laparotomy revealed segmental intestinal infarction resulting from thrombosis in the superior mesenteric vein. Necrosed intestine was resected and anastomosis was performed successfully. The patient was anticoagulated with intravenous heparin and nafamostat mesilate followed by oral aspirin. He recovered rapidly. blood chemistry revealed protein c deficiency, while protein S and antithrombin iii levels were normal. Laboratory evaluation of these proteins may help define the cause of mesenteric venous thrombosis.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
5/46. A case of idiopathic deep vein thrombosis improved with glucocorticoid therapy.A healthy, middle-aged Japanese man with no family history of thrombotic disorders presented with acute abdominal pain due to ischemic colitis. Two months later, he developed left leg pain and swelling. A venogram of the lower limbs, computed tomography, and a scintigram of pulmonary blood flow revealed deep vein thrombosis of the left lower limb extending to the inferior vena cava and emboli of both pulmonary arteries with bilateral pleural effusions. The responsible coagulation disorder was not detected in this case. Since these thrombi were refractory to the thrombolytic therapy with urokinase and anticoagulant therapy with warfarin, prednisolone was chosen for the suppression of accompanying thrombophlebitis. Two months following the initiation of prednisolone (20 mg/day), the venous thrombosis, abnormal pulmonary shadows, and pleural effusions had completely resolved. This case demonstrates the successful treatment of idiopathic venous and pulmonary thrombosis with glucocorticoids.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
6/46. Mesenteric vein thrombosis due to factor v Leiden gene mutation.BACKGROUND: Mesenteric venous thrombosis is a rare cause of acute abdominal pain that may be the result of coagulation abnormalities. methods: Four consecutive patients with mesenteric venous thrombosis underwent haematological evaluation. RESULTS: All four had activated protein c resistance resulting from a single mutation in the gene coding for coagulation factor v. Three had surgery; in one patient the diagnosis was made by ultrasonography. One of the patients who had surgery died but the other three survived and were treated with long-term anticoagulation. CONCLUSION: activated protein c resistance may be an important pathogenetic factor in primary mesen-teric vein thrombosis.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
7/46. Mesenteric and portal vein thrombosis in a young patient with protein s deficiency treated with urokinase via the superior mesenteric artery.A 32-year-old man, who was previously healthy, had acute abdominal pain without peritonitis. Diffuse mesenteric and portal vein thrombosis were shown by means of a computed tomography scan. A protein s deficiency was found by means of an extensive workup for hypercoagulable state. Successful treatment was achieved with urokinase infusion via the superior mesenteric artery without an operation. This represents an attractive alternative approach to treating patients with this disease. The previous standard of operative intervention(1) can now be reserved for complications, such as bowel infarction with peritonitis, or for those patients with absolute contraindications to thrombolytic therapy.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
8/46. Clinics in diagnostic imaging (44). Testicular tumour with retroperitoneal lymphadenopathy and inferior vena cava thrombosis.A 20-year-old Indian man presented with a two week history of non-specific abdominal pain. Abdominal ultrasonograpy incidentally detected a thrombus in the inferior vena cava (IVC). Computed tomography revealed the presence of extensive para-aortic lymph node disease as well as a filling defect in the IVC. Scrotal ultrasonography located a heterogeneous intra-testicular tumour in an otherwise palpably-normal testis. The extent of the IVC thrombus was evaluated by the use of magnetic resonance imaging. Inguinal orchidectomy was performed and histology revealed a non-seminomatous germ cell tumour. Combination chemotherapy led to complete resolution of lymph node disease and IVC thrombus. The patient remained well 9 months after diagnosis. The causes of IVC obstruction, role of imaging in investigating IVC obstruction and the management of tumour involvement of the IVC are discussed.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
9/46. Superior mesenteric venous thrombosis in malrotation with chronic volvulus.Malrotation can be difficult to diagnose after the newborn period because of intermittent symptoms and vague clinical findings, but malrotation with midgut volvulus is usually quite striking in its presentation. early diagnosis and surgical treatment are essential to prevent acute ischemic infarction of the bowel, although chronic complications are rare. The authors present an unusual case of mesenteric venous thrombosis secondary to chronic midgut volvulus. A 13-year-old girl presented with an 11-year history of recurrent bouts of abdominal pain evaluated at 3 other institutions without a diagnosis. At the referring hospital, an episode of bilious emesis associated with abdominal pain prompted a computerized tomography scan of the abdomen. This showed a calcified thrombus within the superior mesenteric vein (SMV). At laparotomy, malrotation with chronic 270 degree volvulus was found with evidence of mesenteric venous hypertension. Segmental occlusion was documented on magnetic resonance angiography. SMV thrombosis is an unusual complication of malrotation with chronic midgut volvulus.- - - - - - - - - - ranking = 2keywords = abdominal pain (Clic here for more details about this article) |
10/46. Superior mesenteric and portal vein thrombosis following laparoscopic nissen fundoplication.This case report describes superior mesenteric and portal vein thrombosis after laparoscopic Nissen fundoplication. As a thromboembolic prophylaxis, 2,500 IU of dalteparin was given preoperatively. After postoperative day 19, the patient experienced gradually increasing abdominal pain, mostly related to meals. physical examination and laboratory tests were normal. CT scan revealed a portal and superior mesenteric vein thrombosis. dalteparin and warfarin treatment was started, and symptoms relieved rapidly. In a control Doppler ultrasound 1 month after the onset of the treatment, a good flow in the portal and superior mesenteric vein was seen. Possible mechanisms are discussed.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
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