Portomesenteric venous thrombosis following major colon and rectal surgery: incidence and risk factors

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• 作者：Kristin A. Robinson ; Mark E. O’Donnell ; David Pearson…
• 关键词：Portomesenteric venous thrombosis ; Colorectal surgery ; Abdominal DVT ; Risk factors ; Inflammatory bowel disease
• 刊名：Surgical Endoscopy
• 出版年：2015
• 出版时间：May 2015
• 年：2015
• 卷：29
• 期：5
• 页码：1071-1079
• 全文大小：568 KB
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  3. Ogren, M, Bergqvist, D, Bjorck, M, Acosta, S, Eriksson, H, Sternby, NH (2006) Portal vein thrombosis: prevalence, patient characteristics and lifetime risk: a population study based on 23,796 consecutive autopsies. World J Gastroenterol 12: pp. 2115-2119
  4. Rosario, JF, Orenstein, SR, Bhargava, S, Putnam, PE (1994) Thrombotic complications in pediatric inflammatory bowel disease. Clin Pediatr (Phila) 33: pp. 159-161 g/10.1177/000992289403300307" target="_blank" title="It opens in new window">CrossRef
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  6. Smalberg, JH, Arends, LR, Valla, DC, Kiladjian, JJ, Janssen, HL, Leebeek, FW (2012) Myeloproliferative neoplasms in Budd-Chiari syndrome and portal vein thrombosis: a meta-analysis. Blood 120: pp. 4921-4928 g/10.1182/blood-2011-09-376517" target="_blank" title="It opens in new window">CrossRef
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  9. Abu-Daff, S, Abu-Daff, N, Al-Shahed, M (2009) Mesenteric venous thrombosis and factors associated with mortality: a statistical analysis with five-year follow-up. J Gastrointest Surg 13: pp. 1245-1250 g/10.1007/s11605-009-0833-7" target="_blank" title="It opens in new window">CrossRef
  10. Brunaud, L, Antunes, L, Collinet-Adler, S, Marchal, F, Ayav, A, Bresler, L, Boissel, P (2001) Acute mesenteric venous thrombosis: case for nonoperative management. J Vasc Surg 34: pp. 673-679 g/10.1067/mva.2001.117331" target="_blank" title="It opens in new window">CrossRef
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  15. Leebeek, FW, Smalberg, JH, Janssen, HL (2012) Prothrombotic disorders in abdominal vein thrombosis. Neth J Med 70: pp. 400-405
  16. Novacek G, Weltermann A, Sobala A, Tilg H, Petritsch W, Reinisch W, Mayer A, Haas T, Kaser A, Feichtenschlager T, Fuchssteiner H, Knoflach P, Vogelsang H, Miehsler W, Platzer R, Tillinger W, Jaritz B, Schmid A, Blaha B, Dejaco C, Eichinger S (2010) Inflammatory bowel disease is a risk factor for recurrent venous thromboembolism. Gastroenterology 139:779-87, 787 e771
  17. Ottinger, LW, Austen, WG (1967) A study of 136 patients with mesenteric infarction. Surg Gynecol Obstet 124: pp. 251-261
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• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Surgery
  Gynecology
  Gastroenterology
  Hepatology
  Proctology
  Abdominal Surgery
  
• 出版者：Springer New York
• ISSN：1432-2218

文摘

Background Portomesenteric venous thrombosis (PMVT) is an uncommon complication of abdominal surgery. The objective of this study was to assess PMVT risk factor profiles and patient outcomes after colorectal surgery. Methods A single center retrospective review of patients undergoing colorectal surgery was performed (2007-012). PMVT was defined as thrombus within the portal, splenic, or superior mesenteric vein on computed tomography (CT). Inferior mesenteric vein thrombosis was excluded. Independent samples t test was used to compare data variables between PMVT and non-PMVT patients. Univariate and multivariate logistic regression analyses were used to assess PMVT risk factors. Results There were 1,224 patients included (mean age 62?years, male?=?566). Elective bowel resection was performed for colon carcinoma (n?=?302), rectal carcinoma (n?=?112), ulcerative colitis (n?=?125), Crohn’s disease (n?=?78), polyps (n?=?117), and diverticulitis (n?=?215). Patients undergoing gynecological resections and emergent laparotomies were included (n?=?275). Thirty-six patients (3?%) were diagnosed with PMVT by CT: 17/36 on initial presentation and 19/36 by expert radiologist review. Patients with PMVT were younger (53 vs. 62?years, p?=?0.001) with higher BMI (30.5 vs. 26.7, p?p?p?p?p?p?p?p?p?=?0.001) were still significant predictors. No patients in the PMVT group suffered bowel infarction and no related mortalities occurred. Thirty-day readmission rates were higher in the PMVT group (53?% vs. 17?%, p? Conclusion BMI?≥?0?kg/m2, thrombocytosis, and restorative proctocolectomy were significant predictors of PMVT. Initial diagnostic studies showed a PMVT rate of 1.4?%; however, after expert focused radiologic review, the actual rate was 3?%. Thus, the diagnosis of PMVT is difficult and readmission after colorectal surgery should prompt its consideration.