11/405. Mesenteric vein thrombosis secondary to protein s deficiency. Mesenteric vein thrombosis is an uncommon condition. Diagnosis is often difficult because of the nonspecific clinical presentation and findings on routine laboratory and radiological evaluation. endoscopy is usually unrevealing. An underlying hypercoagulable state is often present, but protein s deficiency has rarely been implicated. We describe a case in which chronic inferior mesenteric vein thrombosis, with remarkable endoscopic findings, occurred as the initial presentation of type I protein s deficiency. ( info) |
12/405. A case of carcinoid. A patient is described with a malignant carcinoid tumour of the ileum with nodal secondaries causing mesenteric vessel occlusion and ileal infarction. ( info) |
| BACKGROUND: Acute mesenteric ischemia can be a difficult diagnosis to make, but delay contributes directly to infarction, and this may provide a setting for malpractice claims. methods: We reviewed 180 consecutive malpractice claims submitted by attorneys for medical expert (ME) review during the 12 years ending in late 1998. Seven cases involved acute mesenteric ischemia. RESULTS: Alleged failure to make a timely diagnosis was the basis for 5 of these claims, failure to provide anticoagulant protection for 1, and failure to prevent nonocclusive ischemic infarction for 1. Six claims were closed after ME review and 1 claim involving late diagnosis was settled before trial. CONCLUSIONS: The risk of a malpractice claim is reduced by consideration of computed tomography (CT), angiography, and surgical consultation as soon as a patient is seen whose differential diagnosis includes acute mesenteric ischemia. ( info) |
14/405. Acute mesenteric infarction caused by small vessel disease. A case of acute mesenteric infarction caused by small vessel disease is reported. The patient recovered after 2 operations by which extensive bowel-resections were performed. The resected bowel showed intimal hyperplasia and atherosclerosis of the small mesenteric arteries. Since also thrombocytosis and increased platelet aggregation was demonstrated the main cause of thrombosis however is supposed to be hypercoagulability. ( info) |
15/405. Stenting of a superior mesenteric artery lesion via the right arm approach. Chronic mesenteric ischemia is rare and commonly presents with abdominal pain and weight loss. Treatment options are limited to surgical or endovascular revascularization. In this report we describe in detail successful stent-supported angioplasty of a high-grade superior mesenteric artery stenosis utilizing a right brachial artery approach. A brief review of the literature is provided. ( info) |
16/405. Disk embolization of a Bjork-Shiley convexo-concave mitral valve: a cause of sudden cardiovascular collapse and mesenteric ischemia. Strut fracture and disk embolization of a Bjork-Shiley convexo-concave valve is uncommon, but it should always be considered as a cause of sudden cardiovascular collapse in patients with such valves. Recognition of this clinical scenario is essential, given the importance of early diagnosis and the prevalence of these valves worldwide. We present a fatal case of disk embolization of a mitral prosthesis presenting with cardiogenic shock and mesenteric ischemia. ( info) |
17/405. 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. ( info) |
18/405. Spontaneous superior mesenteric vein thrombosis (SMVT) in primary protein s deficiency. A case report and review of the literature. Superior mesenteric vein thrombosis (SMVT) is an uncommon but important clinical entity that can induce ischemia or infarction of the small and large bowel. It is rare and accounts for 5-15% of mesenteric vascular occlusions. Bowel infarction due to SMVT can present as an acute abdominal disease, requiring urgent laparotomy with resection of the intestinal segment affected. However, the clinical diagnosis of this event remains difficult and invariably requires specific imaging investigations in order to be able to treat the condition as soon as possible. SMVT without bowel infarction can present as persistent, non-specific abdominal pain and nausea with minimal clinical signs, affecting young individuals without any known predisposing disorder, where laparotomy is not an urgent indication. We report a case of a young adult man with SMVT due to a hypercoagulable state (protein s deficiency), in whom an early diagnosis and appropriate anticoagulant treatment prevented any further extension of the thrombotic process and limited the hemorrhagic infarction of the ileum, which simply required a segmental resection. ( info) |
19/405. Massive colonic bleeding and oral contraceptive "pills". Two patients on oral contraceptives who developed massive colonic bleeding have been presented. The clinical course and various studies suggest the mesenteric insufficiency syndrome as being a possible result of oral contraceptive effect on mesenteric vasculature. Although no definite histologic confirmation is available, the onset, course, and follow-up of these patients suggest contraceptive-induced massive colonic bleeding. The spectrum of oral contraceptive-induced colonic bleeding may vary from mucosal injury with massive colonic bleeding to transmural infarction. Only the clinical follow-up would determine the severity of the involvement and that would determine whether surgical intervention will be necessary. ( info) |
20/405. Superior mesenteric vein thrombosis due to diverticulitis and spontaneous thrombolysis after ilio-cecal resection. A case report. inflammation or infection is one of the major causes of superior mesenteric vein thrombosis. A case of secondary superior mesenteric vein thrombosis is presented, which was identified with enhanced CT. The mesenteric venous thrombosis was due to diverticulitis of the ileum, and ilio-cecal resection was performed. Because no findings of intestinal ischemia were present, thrombectomy was not attempted. After surgery, the patient was followed up by repeated CT scan, and spontaneous thrombolysis without thrombectomy or thrombolytic therapy was exhibited. The present case indicated abdominal inflammation or infection strongly related to the development and regression of mesenteric venous thrombosis. ( info) |