Engineering, 2013, 5, 368-370 Published Online October 2013 (
Copyright © 2013 SciRes. ENG
Experience on Diagnosis and Treatment of Strangulated
Intestinal Obstruction Caused by Mesentery Vein
Thr ombosis on Account of Portal Hypertension*
Songbing He, Xinguo Zhu#
Department of General Surgery the First Affiliated Hospital of Soochow University, Suzhou, China
Received 2013
In the present study, to investigate diagnosis and treatment of strangulated intestinal obstruction caused by mesentery
vein thrombosis on account of portal hypertension, the data in twelve patients with this disease from 1998 to 2008 were
analyzed. All patients presented abdominal pain and vomiting and were confirmed strangulated intestinal obstruction
caused by mesentery thrombosis with operation. In this group, nine patients underwent part of small intestine excision,
and three patients underwent open-closed operation because of the whole small intestine necrosis caused by intensive
mesentery thrombosis. Five patients died after operation. The diagnosis of strangulated intestinal obstruction caused by
mesentery thrombosis was difficult because of the slow disease processes and severe outcomes. It is necessary to take
some measures to get over the dangers duration after operation.
Keywords: Portal Hypertension; Vein Thrombosis; Intestinal Obstruction
1. Introduction
The morbidity ratio of strangulated intestinal obstruction
caused by vena mesenteric thrombopoiesis pre-operation
is much lower than that of post-operation regarding to
portal hypertension [1]. In resent 10 years, there are 162
cases of strangulated intestinal obstruction treated in our
hospital, among which 12 cases (about 7.4%) are induced
by thrombopoiesis on account of portal hypertension. Here
is the analysis of pathogenesis, diagnosis and treatment
on the disease.
2. Clinical Mater ial s
1) General information
The clinical sample contains twelve cases in which pa-
tients suffer mesentery vein thrombosis caused by portal
hypertension induced by posthepatitic cirrhosis. In this
group, every patient has a history of type B hepatitis for
above five years with the symptoms of splenomegaly and
hypersplenism. Five patients have a history of upper di-
gestive tract hemorrhage. Portal hypertension is proved
only in two cases by ultrasound, CT scan or/and inter-
ventional radiography (Figure 1), while ascites in the
patients were detected in eight cases. In this group,
there is only one case in Grade A, eight cases in Grade
B and three cases in Grade C classified by Child-Pugh
Figure 1. Interventional radiography of mesentery vein
Supported by: Science an d Technology Research Proje ct of in Science
and Technology Bureau of Suzhou City, China (No. SYS201220);
Grants from Medical Science and Technology Development Founda-
tion, Jiangsu Province Department of Health, China (No.H201209).
#Corresponding author.
S. B. HE, X. G. ZHU
Copyright © 2013 SciRes. ENG
2) Clinical manifestation
Among twelve cases, there are six patients presenting
irregular or continuous fever of unknown origin between
38.5˚C to 40.2˚C lasting for ten to forty-one days. All
twelve cases have the symptoms of nausea, vomiting,
epigastric gas pains, but only six cases have intense bel-
lyache. The physical sign of per itonitis could be detected
in seven patients, and haemic ascites is punctured out
from abdominal cavity.
Pneumatics in enteric cavity is displayed in abdo minal
X-ray plains of all the cases, besides small amounts of
gas-fluid level without obviously distended ansa intersti-
nalis can be seen in only three cases.
3) Results
All cases have to be received emergency exploratory
laparotomy. The whole mesostenium which is diffusingly
dotted with bleeding points of unequal size are thickened
and congested extensively. Among them, two cases are
taken to emergency exploratory laparotomy without ob-
vious improvement after conservative treatment in twen-
ty-four hours. Nine cases underwent partial resection of
the small intes tine du e to small int estine, while three cases
underwent open-close operation because of full length
small intestine and part of colon necrosis simultaneously
with a great quantity of haemic ascites. Five cases died
after operation in which three cases are widespread
thrombosis and two cases are liver function failure after
partial resection of the small intestine. Also we can get
the immunohistochemistry result of the patients after
operation (Figure 2).
3. Discussion
The venous thrombosis is concerned with lesion of vas-
Figure 2. Immunohistochemistry of mesentery vein throm-
cular endothelial cell, adhering and assembling of plate-
lets, low serum antithrombase, and alteration of haemo-
dynamics [2,3]. Posthepatitic cirrhosis is a kind of hepat-
ic sinusoid cirrhosis, which has augmented resistance of
blood flow returning to liver resulting in hypertension in
vena mesenteric and torpidity of blood flow. Meanwhile
a bulk of fatty acid, amino acids and carbohydrate ab-
sorbed in small intestine are accumulated in mesostenium
which increase the viscosity. Chronic portal hypertension
plus ischemic and hypoxia of endothelial cells of vena
mesenteric could damage endothelial cells unavoidably.
The function of single platelet won’t be weakened, in-
stead, adhering and assembling of platelets will augment
due to the necessity of compensation in spite of the in-
creasing demolition of platelet leading by splenomegaly
and hypersplenism. In addition, patients of hepatic cirr-
hosis with low level of hepatic protein synthesis are in
the hypercoagulable state owing to the dysfunction of
antiprothrombin [4]. In a word, mesostenium in portal
system is prone to thrombopoiesis influenced by all the
factors mentioned above.
The disor der of hemorheology been secondary to throm-
bopoiesis in vena mesenteric which leads to completely
interruption of venous blood flow will result in the simi-
lar circumstance in the arterial mesenteric, and strangu-
lated intestinal obstruction will emerge ultimately [5,6].
It is different from acute volvulus with the interruption of
blood flow both in arterial and vena mesenteric simulta-
neously causing the typically manifestation such as in-
tense abdominal pain, nausea and vomiting. The symp-
tom of intense abdominal pain occurs only in seven cases
in this group, and all the others have non-specificity ma-
nifestations such as abdominal discomfort, nausea and
vomiting. Furthermore, two cases attempted to adopt con-
servative treatment before exploratory laparotomy. Thus,
the clinical manifestation of strangulated intestinal ob-
struction caused by vena mesenteric thrombopoiesis on
account of portal hypertension is so insidious that it is
difficult t o ha ve t imely and accura te diagnosis. C ontinuous
fever and general toxic symptoms with leucocytes count
of more than 20 × 109 per liter would emerge attachin g to
vena mesenteric thrombopoiesis. What’s more, ascites
even jaundice and alimentary tract hemorrhage could be
detected if infective pylephlebitis occurs in addition to
the aggravation of infective symptoms. Accordingly, it is
necessary to take ultrasound or CT scan for patients of
portal hypertension with the symptoms of continuous fev-
er, abdominal pain, abdominal distention, nausea and vo-
miting. Thrombopoiesis in vena mesenteric, thickened me-
sostenium, and haemic ascites can be considered as suf-
ficient indications of emergency exploratory laparotomy
[7]. Actually there are three cases in this group dying
from extensive thrombopoiesis owing to delayed diagno-
S. B. HE, X. G. ZHU
Copyright © 2013 SciRes. ENG
Since the residual embolic mesostenium is the original
cause of fever and thrombopoiesis after emergency ex-
ploratory laparotomy, pathologic mesostenium has to be
resected thoroughly when removing the necrosis intestine
for patients of the strangulated intestinal obstruction caused
by vena mesenteric thrombopoiesis on account of portal
hypertension. Meanwhile, adjunctive therapy such as pro-
tection of hepatic function, nutritional support, diureses,
and proper blood transfusion calls for more attention as
most patients in emergency operations occupying a he-
patic inadequacy state of Grade B even C.
4. Acknowledgements
We would like to express our thanks to the anonymous
reviewers for their suggestions, which helped to improve
this paper.
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