Mesenteric Venous Thrombosis

腸系膜靜脈栓塞症

10.6200/TCMJ.2006.3.3.11

陳哲雄(Jer-Shuang Chen)；沈希哲(Shi-Che Shen)

腸系膜靜脈栓塞 ； 腸壞死 ； 肝制凝素 ； Mesenteric Venous Thrombosis MVT ； bowel infarction ； heparin

北市醫學雜誌

3卷3期（2006 / 03 / 01）

294 - 299

英文

一名四十一歲男性，因急性腹痛及嘔吐咖啡渣狀吐物至本院急診治療。理學檢查發現腹部廣泛性壓痛及反彈痛，影像學檢查發現血性腹水及單段腸道腫大。因為明顯腹膜炎症狀及懷疑腸缺血，腸壞死病變，安排緊急剖腹手術。手術發現一段約四十公分空腸壞死及腸系膜靜脈栓塞。手術施行壞死腸段切除及吻合。住院期間，除了使用抗生素外，並給予注射肝制凝素(Heparin)，術後無併發症，病癒出院。原發性腸系膜靜脈栓塞，較為罕見，其病況常為腹部劇痛，死亡率約在5至15%之間，早期診斷及早期手術治療，並使用肝制凝素注射, 預防靜脈栓塞復發，可使死亡率降低。

Background and purpose: Mesenteric venous thrombosis is a rare but potentially lethal form of mesenteric ischemia. Its presentation may vary from an entirely asymptomatic clinical entity to intestinal infarction and shock. Methods: A patient with mesenteric venous thrombosis was sent to our hospital because of acute abdominal pain that had developed over a single day. The physical findings and imaging examination suggested peritonitis. Results: An emergency laparotomy revealed bowel infarction due to mesenteric venous thrombosis. Segmental resection of the involved bowel with primary anastomosis was performed and resulted in a rather smooth post-operative course with post-operative heparin administration. Conclusion: In review of the literature, the high index of suspicion of mesenteric venous thrombosis, early diagnosis, early surgical management and perioperative heparin therapy will improve the outcome of this disease.