Abstract:
:A previously fit 37-year-old man developed superior mesenteric venous thrombosis after undergoing a laparoscopic Nissen fundoplication. Despite receiving thrombo-embolic prophylaxis on postoperative day 16, he presented with a gradual onset of vague, but severe, umbilical and epigastric pains. Laboratory tests, abdominal ultrasound scan and gastroscopy were all unremarkable. Contrast enhanced abdominal spiral computerised tomography (CT) revealed a partial occlusion of the superior mesenteric and portal vein due to a thrombus; abnormal flow was confirmed on colour Doppler ultrasound. A predisposing hyper-coagulable condition was excluded. The patient responded rapidly to expectant management and a repeat spiral CT scan, 3 weeks after the initial presentation, demonstrated complete re-canalisation of the vessel. Although rare, superior mesenteric venous thrombosis is probably underdiagnosed due to the vague nature of the symptoms, the lack of clinical signs, a low index of suspicion on the part of the clinician, and then subsequent failure to request the optimal investigation--namely contrast enhanced abdominal spiral CT scan. We discuss the possible mechanisms by which laparoscopic surgery may increase the risks of developing superior mesenteric venous thrombosis, the pitfalls in diagnosis and treatment options.
journal_name
Ann R Coll Surg Engljournal_title
Annals of the Royal College of Surgeons of Englandauthors
Davies M,Satyadas T,Akle CAsubject
Has Abstractpub_date
2002-05-01 00:00:00pages
177-80issue
3eissn
0035-8843issn
1478-7083journal_volume
84pub_type
杂志文章abstract:INTRODUCTION:To address concerns about reduced opportunities for operative training, a programme of training operating lists for senior house officers was established. The entire patient pathway was used as a learning resource so that training was offered in a range of areas including development of knowledge, communic...
journal_title:Annals of the Royal College of Surgeons of England
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journal_title:Annals of the Royal College of Surgeons of England
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journal_title:Annals of the Royal College of Surgeons of England
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journal_title:Annals of the Royal College of Surgeons of England
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journal_title:Annals of the Royal College of Surgeons of England
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journal_title:Annals of the Royal College of Surgeons of England
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journal_title:Annals of the Royal College of Surgeons of England
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更新日期:2009-03-01 00:00:00
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journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章,评审
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更新日期:2012-05-01 00:00:00