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Clinical implications of CT findings in mesenteric venous thrombosis at admission

Salim, S. LU ; Ekberg, O. LU ; Elf, J. LU ; Zarrouk, M. LU ; Gottsäter, A. LU and Acosta, S. LU (2018) In Emergency Radiology 25(4). p.407-413
Abstract

Purpose: The main aim of this study was to evaluate the association of computed tomography (CT) findings at admission and bowel resection rate in patients with mesenteric venous thrombosis (MVT). It was hypothesized that abnormal intestinal findings on CT were associated with a higher bowel resection rate. Methods: Retrospective study of MVT patients treated between 2004 and 2017. CT images at admission and at follow-up were scrutinized according to a predefined protocol. Successful recanalization was defined as partial or complete recanalization of the portomesenteric venous thrombosis at the latest CT follow-up (n = 70). Results: We studied 102 patients (median age 58 years, 61 men). Lifelong anticoagulation was initiated in 64... (More)

Purpose: The main aim of this study was to evaluate the association of computed tomography (CT) findings at admission and bowel resection rate in patients with mesenteric venous thrombosis (MVT). It was hypothesized that abnormal intestinal findings on CT were associated with a higher bowel resection rate. Methods: Retrospective study of MVT patients treated between 2004 and 2017. CT images at admission and at follow-up were scrutinized according to a predefined protocol. Successful recanalization was defined as partial or complete recanalization of the portomesenteric venous thrombosis at the latest CT follow-up (n = 70). Results: We studied 102 patients (median age 58 years, 61 men). Lifelong anticoagulation was initiated in 64 patients, and bowel resection rate was 17%. No referral letter indicated suspicion of MVT, whereas three indicated suspected intestinal ischemia. Previous venous thromboembolism was associated with increased bowel resection rate (p = 0.049). No patient with acute pancreatitis (n = 17) underwent bowel resection (p = 0.068). The presence of mesenteric oedema (p = 0.014), small bowel wall oedema (p < 0.001), small bowel dilatation (p = 0.005), and ascites (p = 0.021) were associated with increased bowel resection rate. Small bowel wall oedema remained as an independent risk factor associated with bowel resection (OR 15.8 [95% CI 3.2–77.2]). Successful thrombus recanalization was achieved in 66% of patients. Conclusion: The presence of abnormal intestinal findings secondary to MVT confers an excess risk of need of bowel resection due to infarction. Responsible physicians should therefore scrutinize the CT images at diagnosis together with the radiologist to better tailor clinical surveillance.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Bowel resection, CT, Intestinal ischemia, Mesenteric venous thrombosis
in
Emergency Radiology
volume
25
issue
4
pages
407 - 413
publisher
Springer
external identifiers
  • pmid:29594895
  • scopus:85044480378
ISSN
1070-3004
DOI
10.1007/s10140-018-1601-3
language
English
LU publication?
yes
id
a0fc5160-efc8-49ea-a7ff-4359757c6f94
date added to LUP
2018-05-22 12:49:38
date last changed
2019-12-04 07:11:39
@article{a0fc5160-efc8-49ea-a7ff-4359757c6f94,
  abstract     = {<p>Purpose: The main aim of this study was to evaluate the association of computed tomography (CT) findings at admission and bowel resection rate in patients with mesenteric venous thrombosis (MVT). It was hypothesized that abnormal intestinal findings on CT were associated with a higher bowel resection rate. Methods: Retrospective study of MVT patients treated between 2004 and 2017. CT images at admission and at follow-up were scrutinized according to a predefined protocol. Successful recanalization was defined as partial or complete recanalization of the portomesenteric venous thrombosis at the latest CT follow-up (n = 70). Results: We studied 102 patients (median age 58 years, 61 men). Lifelong anticoagulation was initiated in 64 patients, and bowel resection rate was 17%. No referral letter indicated suspicion of MVT, whereas three indicated suspected intestinal ischemia. Previous venous thromboembolism was associated with increased bowel resection rate (p = 0.049). No patient with acute pancreatitis (n = 17) underwent bowel resection (p = 0.068). The presence of mesenteric oedema (p = 0.014), small bowel wall oedema (p &lt; 0.001), small bowel dilatation (p = 0.005), and ascites (p = 0.021) were associated with increased bowel resection rate. Small bowel wall oedema remained as an independent risk factor associated with bowel resection (OR 15.8 [95% CI 3.2–77.2]). Successful thrombus recanalization was achieved in 66% of patients. Conclusion: The presence of abnormal intestinal findings secondary to MVT confers an excess risk of need of bowel resection due to infarction. Responsible physicians should therefore scrutinize the CT images at diagnosis together with the radiologist to better tailor clinical surveillance.</p>},
  author       = {Salim, S. and Ekberg, O. and Elf, J. and Zarrouk, M. and Gottsäter, A. and Acosta, S.},
  issn         = {1070-3004},
  language     = {eng},
  number       = {4},
  pages        = {407--413},
  publisher    = {Springer},
  series       = {Emergency Radiology},
  title        = {Clinical implications of CT findings in mesenteric venous thrombosis at admission},
  url          = {http://dx.doi.org/10.1007/s10140-018-1601-3},
  doi          = {10.1007/s10140-018-1601-3},
  volume       = {25},
  year         = {2018},
}