Search

A venous mesenteric infarction in a 27-year-old patient is reported. This patient presented a genetic quantitative AT-III deficiency without anticoagulation therapy. Ultrasonography revealed portal vein thrombosis and laparoscopy showed mesenteric vein infarction. Laparotomy was performed mmediately and revealed segmental infarction of 60 cm of the jejunum which was resected; the portal vein was considered to be partially occluded on palpation. No strangulation or mechanical factors were identified. Immediately postoperatively the patient received therapeutic doses of heparin with AT-III concentrates to increase AT-III levels; no recurrent thrombotic episode was observed. A systematic second-look operation 24 hours postoperatively showed good bowel viability. Five days later, long-term anticoagulation with acenocoumarol was decided. Twelve days later, ultrasonography showed complete portal revascularization which was confirmed by a third surgical operation on D60.

A case is reported of a 35-year-old woman who sustained a massive intestinal infarction requiring a total resection of small intestine and the colon, with a terminal duodenostomy. Preoperative arteriography and intraoperative findings at laparotomy showed a thrombosis of coeliac trunc, superior and inferior mesenteric arteries, originating possibly from a non atheromatous ostial stenosis of these vessels. The blood supply to stomach, duodenum, liver and spleen was maintained through collaterals from diaphragm. Postoperatively a dehiscence of duodenostomy suture occurred with a spontaneous favourable outcome. The closure of external duodenostomy orifice required an endoscopic aspirational gastrostomy. The patient was discharged with the perspective of intestinal transplantation, her nutrition being provided through an ambulatory parenteral nutritional support unit. A symptomatology of chronic mesenteric ischaemia should lead to an angiography of digestive arteries not only with a diagnostic but also a possible therapeutic goal using angioplasty techniques.