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Acute pancreatitis is an acute inflammatory condition of the pancreas that has not only local but systemic effects as well. Venous thrombosis is one such complication which can give rise to thrombosis of the peripheral vasculature in the form of deep vein thrombosis, pulmonary embolism, and splanchnic vein thrombosis. The prevalence of these complications increases with the severity of the disease and adds to the adverse outcomes profile. With better imaging and awareness, more cases are being detected, although many at times it can be an incidental finding. However, it remains understudied and strangely, most of the guidelines on the management of acute pancreatitis are silent on this aspect. This review offers an overview of the incidence, pathophysiology, symptomatology, diagnostic work-up, and management of venous thrombosis that develops in AP. [ABSTRACT FROM AUTHOR]

Introduction: Acute mesenteric ischemia (AMI) is a rare but lethal disease. Mesenteric vein thrombosis (VAMI) is a subtype of AMI. Morbid obesity is usually accompanied by hypertension, hyperlipidemia, or diabetes mellitus, which are risk factors associated with AMI. Case Presentation: We present a 28-year-old man with VAMI post-laparoscopic sleeve gastrectomy. He was first misdiagnosed with intestinal obstruction. Superior VAMI was confirmed after computed tomography angiography. Laparotomy, resection of the necrotic small bowel, and ostomy were performed immediately. Conclusion: Patients with morbid obesity accompanied by hypertension, hyperlipidemia, or diabetes mellitus have a high risk of AMI. Abdominal pain with sudden onset should be considered AMI. Anticoagulation therapy post-sleeve gastrectomy might help reduce the incidence of AMI. [ABSTRACT FROM AUTHOR]

The incidence of splanchnic vein thrombosis (SVT) in cancer patients has increased in recent years and its real clinical significance and management can be challenging. This study aimed to describe the clinical presentation and short-term outcomes of patients with cancer-associated SVT. This was a retrospective observational study of consecutive patients with cancer-associated SVT diagnosed during the period 2015–2020. The primary objective was to describe the clinical presentation of SVT. Patients were clinically classified into two groups based on the presence of symptoms on SVT diagnosis. The main outcomes were overall and SVT-related mortality, major and non-major bleeding rates, and the thrombosis recurrence rate in the first 30 days of follow-up. This study enrolled 203 patients. Intra-abdominal tumors (76 %) and metastatic disease (68 %) predominated. A total of 79 (39 %) patients without symptoms were diagnosed with SVT during a scheduled radiological test and were classified as "asymptomatic", while 124 (61 %) patients presented some potential SVT symptoms and were considered as "symptomatic". Although the 30-day outcomes showed no significant differences between the two groups, mortality in the asymptomatic group was slightly lower compared to the symptomatic group (3 % vs. 10 %, p = 0.085). Almost 40 % of cases of cancer-associated SVT are asymptomatic. There were no significant differences in short-term outcomes between the symptomatic and asymptomatic patients. More studies are required to better define long-term management and outcomes in these patients. • The real clinical significance of SVT in patients with cancer remains challenging. • We describe the clinical presentation of cancer-associated SVT in a cohort of 203 patients. • Intra-abdominal tumors and metastatic disease predominate in cases of SVT. • 39 % of cases were asymptomatic while 61 % presented some potential SVT symptoms. • There were no differences in outcomes in the first 30 days of follow-up in both groups. [ABSTRACT FROM AUTHOR]

Coronavirus 2019 (COVID-19) is a predominantly respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It creates a hypercoagulable milieu, manifesting at varied extrapulmonary sites as pulmonary embolism, deep venous thrombosis, stroke, myocardial infarction, and mesenteric ischemia. The pathophysiology behind this hypercoagulability is still not entirely understood, although a heightened systemic inflammatory response to the virus is deemed responsible. We herein report a case of a 36-year-old healthy male who presented with an acute abdomen and was found to have extensive mesenteric and portal venous thrombosis with bowel gangrene. The patient underwent emergency exploration with ileal resection and end-ileostomy. The hypercoagulability panel was negative, but a postoperative chest radiograph revealed suspicious ground-glass opacities. Given the ongoing global COVID-19 pandemic, we considered testing for SARS-CoV-2. A positive test for SARS-CoV-2 led us to attribute the thrombotic event to COVID-19. With anticoagulation and supportive therapy, the patient went on to make a steady recovery. A non-specific clinical manifestation of COVID-19 necessitates considering mesenteric venous thrombosis as a differential diagnosis in patients with acute abdomen.

Cases of thromboembolic events in 2021 flared up the discussion about the safety of Astra Zeneca’s AZD1222 vaccine. We hereby report three cases of pulmonary embolism (PE), one case of extended portal vein thrombosis, and one case of combined portal vein thrombosis and PE within 2 weeks after vaccination with the Astra Zeneca AZD1222 vaccine in a 60-year-old, a 50-year old, a 33-year-old, a 30-year old, and a 40-year-old male in that year. All patients were healthy before. In three patients, we observed thrombocytopenia and to some extent unusually low antibody levels for the Spike Protein (S-protein), while the other two had normal thrombocyte counts. Only one patient had anti-platelet factor 4 (PF4)-antibodies detectable as it has been described in the “heparin-induced thrombocytopenia (HIT)-like” disease of “vaccine-induced prothrombotic immune thrombocytopenia” (VIPIT) and we therefore assume that heterogeneous mechanisms led to PE. Therefore, we advise to collect and report more cases, in order to determine the age-related risks of vaccination balanced against the benefits of immunity to SARS-COV-2 for the AZD1222 vaccine in order to gain knowledge for the next pandemic.

Introduction: Acute mesenteric ischemia (AMI) is a rare but lethal disease. Mesenteric vein thrombosis (VAMI) is a subtype of AMI. Morbid obesity is usually accompanied by hypertension, hyperlipidemia, or diabetes mellitus, which are risk factors associated with AMI. Case Presentation: We present a 28-year-old man with VAMI post-laparoscopic sleeve gastrectomy. He was first misdiagnosed with intestinal obstruction. Superior VAMI was confirmed after computed tomography angiography. Laparotomy, resection of the necrotic small bowel, and ostomy were performed immediately. Conclusion: Patients with morbid obesity accompanied by hypertension, hyperlipidemia, or diabetes mellitus have a high risk of AMI. Abdominal pain with sudden onset should be considered AMI. Anticoagulation therapy post-sleeve gastrectomy might help reduce the incidence of AMI.

Porto-mesenteric vein thrombosis (PVMT) is a rare but life-threatening complication after laparoscopic sleeve gastrectomy (LSG). Laparoscopic sleeve gastrectomy (LSG) is considered the most common procedure for efficiently realizing weight loss and treating obesity-related co-morbidities. This study aimed to shed light on this relatively rare complication by presenting a series of patients who developed PMVT after LSG in light of the need to change the specific protocol of thromboprophylaxis in bariatric patients. We proposed to answer two questions: whether we should perform a thrombophilia workup as a standard practice and whether we should extend chemoprophylaxis to more than 3 weeks among all bariatric patients. This study also aimed to investigate the possible risk factors and eventually present our updated protocol for PMVT management and prophylaxis. [ABSTRACT FROM AUTHOR]

Background: Acute mesenteric vein thrombosis (MVT) accounts for only 2%-10% of all cases of acute mesenteric ischaemia, with an incidence rate of ~0.1% in Europe and the United States. It represents < 10% of mesenteric infarction cases and is seen predominantly in older adults. In younger individuals, MVT is uncommon, with 36% of cases having unidentified mechanisms and causes., Case Summary: A 27-year-old man presented to the emergency department on February 29, 2024, with a chief complaint of intermittent abdominal pain for 3 day. He was previously in good health. As the abdominal pain was not alleviated by conventional treatment, an abdominal computed tomography (CT) scan was performed, which showed increased density in the portal and mesenteric veins. Further imaging, including portal vein ultrasound, mesenteric CT angiography, and enhanced abdominal CT, revealed widespread thrombosis of the portal vein system (including the main portal vein, left and right branches, proximal mesenteric vein, and splenic vein). After 10 day of thrombectomy and anticoagulation therapy, the patient's abdominal pain had improved significantly. Follow-up assessments indicated that portal venous blood flow had largely returned to normal. He was discharged on March 9, 2024. During a follow-up exam 2 months later, repeat abdominal enhanced CT showed that the previously detected thrombi were no longer visible., Conclusion: Clinicians should remain vigilant for acute MVT in young patients presenting with abdominal pain, to prevent misdiagnosis of this fatal condition., Competing Interests: Conflict-of-interest statement: All authors declare that they have no competing interests to disclose., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

OBJECTIVE: Thrombosis represents one of the most feared complications of the COronaVIrus Disease-2019 (COVID-19). Although pulmonary embolism and deep venous thrombosis are the most described complications, some investigations reported thrombotic localization also in the splanchnic venous district. METHODS: We describe the case of a patient with SARS-CoV-2 infection presenting with abdominal pain and diagnosed with portal vein thrombosis. In addition, we shortly review available literature supporting the possible role of COVID-19 as leading cause of splanchnic venous thrombosis. RESULTS: After in-depth diagnostic workup, we excluded the commonest causes of portal thrombosis and concluded that SARS-CoV-2 infection represented the main explanation of this finding. CONCLUSIONS: Our study warns the clinicians to maintain a high index of suspicion for thrombosis in patients diagnosed with SARS-CoV-2 infection manifesting gastrointestinal symptoms. An appropriate diagnostic work-up could allow to obtain an early diagnosis and consequently improve the clinical outcome of patients. [ABSTRACT FROM AUTHOR]

Background: Fusobacterium bacteria are fastidious commensals in the human oropharyngeal microbiome. As pathogens, Fusobacterium are associated with diverse infectious and inflammatory conditions, including Lemierre's syndrome, colorectal cancer, and inflammatory bowel disease. Portal and mesenteric thromboses associated with Fusobacterium are case-reportable; due to the rarity of these reports, the full spectrum of presentations and outcomes remains unknown. Case presentation: A 71-year-old man presented with two weeks of abdominal pain and night sweats. He was found to have extensive portal and mesenteric venous thromboses and pancolitis. Initial workup for hypercoagulable risk factors was negative; after discharge, blood cultures became positive for Fusobacterium nucleatum. The patient was treated with antibiotics and anticoagulation with complete resolution of symptoms, thromboses, and colitis. Conclusions: This report demonstrates the protean nature of Fusobacterium-associated disease, which in this patient was portal and mesenteric venous thromboses without oropharyngeal disease. We discuss the modes of transmission, mechanisms of infection, and what remains unknown about the causes and consequences of Fusobacterium-associated disease. This report also demonstrates that cases with atypical abdominal thromboses, despite a negative comprehensive workup, deserve a high suspicion for other causal factors that are not part of standard diagnostic evaluation.

Acute non-cirrhotic and non-malignant portal vein thrombosis (aPVT) is a rare and heterogenous condition. Current guidelines recommend early initiation of therapeutic anticoagulation to prevent extension of thrombosis, and favor recanalization. Although not formally defined, a poor outcome in the acute setting would include thrombosis extension with progression to intestinal infarction. Patients are also at risk of negative long-term outcomes related to complications of portal hypertension, such as variceal bleeding, ascites, and portal cholangiopathy. Identifying patients at risk of these events despite early initiation of anticoagulation remains challenging. Trials comparing treatment strategies in those failing standard therapy with meaningful radiological and clinical endpoints, whether in the short or long term, are desperately needed. The objective of this review will be to discuss a real-life clinical case and propose a treatment approach for aPVT based on the available evidence. We will mainly focus on management strategies including anticoagulation, prognostic factors, and options beyond anticoagulation, such as thrombolysis, thrombectomy, and transjugular intrahepatic portosystemic shunts. This review will not cover tumor portal vein thrombosis or thrombosis associated with cirrhosis. • Acute portal vein thrombosis is an uncommon and heterogenous disease. • Complete thrombosis of portal and superior mesenteric vein predicts worse outcome. • Immediate anticoagulation is the mainstay of therapy. • If failing anticoagulation, consider thrombolysis and mechanical thrombectomy. [ABSTRACT FROM AUTHOR]

The most frequent location of thrombosis development in acute mesenteric venous thrombosis is the superior mesenteric vein. It is an uncommon but potentially fatal condition. Patients with underlying medical conditions that interfere with the Virchow Triad hypercoagulability, stasis, and endothelial injury are more likely to experience it. A 37-year-old female reported to our emergency department with a 5-day history of severe abdominal discomfort, vomiting, and constipation, as well as two episodes of bleeding per rectum. The patient had a clean medical history, no HTN, no diabetes, no chronic medication, no history of contraceptive pill use or non-steroid anti-inflammatory drug use, no history of chronic disease or operation. Patient was directly transferred to the intensive care unit for additional evaluation and preoperative stabilization. A patient with acute mesenteric venous thrombosis and possible intestinal damage is the case we've presented. Upon presentation patient was unstable, we assessed her condition and transferred to the intensive care unit for stabilization and pre-operative preparation. She didn't respond to conservative management and we had to operate, we highly emphasize how crucial it is for early intervention in these type of conditions. Acute mesenteric venous thrombosis is a complicated case due to its nonspecific symptoms, it requires a multidisciplinary team approach between internal medicine and surgical team to plan for the most appropriate treatment strategy suitable for each patient as all options are associated with significant risks. Multiple options are available for the management of mesenteric venous thrombosis. In patients with peritoneal signs to suggestive bowel infarction or perforation or those who failed to progress with conservative management, operative intervention may be necessary. Other options include anticoagulation therapy, local or systemic thrombolysis, interventional or surgical thrombectomy. Acute mesenteric venous thrombosis is a complex situation that calls for a multidisciplinary team approach between the surgical and internal medicine departments to determine the best course of action for each patient, as there are major risks involved with each alternative. If peritonism is present, it is preferable to assess and resuscitate as soon as possible and to proceed with surgery. • A 37-year-old female reported to our emergency department with a 5-day history of severe abdominal discomfort, vomiting, and constipation, as well as two episodes of bleeding per rectum. The patient had a clean medical history, no HTN, no diabetes, • Chief Complaint : complian of severe abdominal pain, vomitting and constipation • Clinical Presentation : The patient presented with abdominal discomfort, guarding, and rigidity, on physical examination the abdomen was distended, tender in the midline and right lower quadrant. The patient was in shock state, with a blood pressure of 90/40, a pulse rate of 114, and a respiratory rate of 26. • Diagnostic Evaluation : Hb = 8, WBC = 28, Creatinine = 1.7, all other parameters were normal. There was free fluid collection in the peritoneal cavity, sluggish intestine, and gaseous distention on ultrasonography. There was intra-peritoneal free fluid accumulation on the CT scan, and intestinal infarction indicating the likelihood of mesenteric venous thrombosis. • Treatment Approach : exploratory laparotomy, a large ischemic portion of the small intestine (ileum). The entire unviable intestine was removed, and an ileostomy was done before being admitted to the intensive care unit for postoperative stabilization. [ABSTRACT FROM AUTHOR]

Emanuele Valeriani,1 Nicoletta Riva,2 Marcello Di Nisio,1 Walter Ageno3 1Department of Medicine and Ageing Sciences, University G. D’Annunzio, Chieti-Pescara, Italy; 2Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta; 3Department of Medicine and Surgery, University of Insubria, Varese, ItalyCorrespondence: Nicoletta RivaDepartment of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, MSD 2080, MaltaTel +356 2545 2518Fax +356 2545 0000Email nico.riva@hotmail.itAbstract: Splanchnic vein thrombosis (SVT) including portal, mesenteric, splenic vein thrombosis and the Budd-Chiari syndrome, is a manifestation of unusual site venous thromboembolism. SVT presents with a lower incidence than deep vein thrombosis of the lower limbs and pulmonary embolism, with portal vein thrombosis and Budd-Chiari syndrome being respectively the most and the least common presentations of SVT. SVT is classified as provoked if secondary to a local or systemic risk factor, or unprovoked if the causative trigger cannot be identified. Diagnostic evaluation is often affected by the lack of specificity of clinical manifestations: the presence of one or more risk factors in a patient with a high clinical suspicion may suggest the execution of diagnostic tests. Doppler ultrasonography represents the first line diagnostic tool because of its accuracy and wide availability. Further investigations, such as computed tomography and magnetic resonance angiography, should be executed in case of suspected thrombosis of the mesenteric veins, suspicion of SVT-related complications, or to complete information after Doppler ultrasonography. Once SVT diagnosis is established, a careful patient evaluation should be performed in order to assess the risks and benefits of the anticoagulant therapy and to drive the optimal treatment intensity. Due to the low quality and large heterogeneity of published data, guidance documents and expert opinion could direct therapeutic decision, suggesting which patients to treat, which anticoagulant to use and the duration of treatment.Keywords: Budd-Chiari syndrome, mesenteric vein thrombosis, portal vein thrombosis, splanchnic vein thrombosis, splenic vein thrombosis

There is increasing evidence that coronavirus disease 2019 (COVID-19) is associated with a significant risk of venous thromboembolism. While information are mainly available for deep vein thrombosis of the lower limb and pulmonary embolism, scarce data exist regarding acute splanchnic vein thrombosis (SVT) in this setting. PubMed, EMBASE and Google Scholar English-language articles published up to 30 January 2021 on SVT in COVID-19 were searched. Overall, 21 articles reporting equal number of patients were identified. 15 subjects presented with portal vein thrombosis, 11 with mesenteric vein thrombosis, four with splenic vein thrombosis, and two with Budd-Chiari syndrome. Male sex was prevalent (15 patients), and median age was 43 years (range 26–79 years). Three patients had a history of liver disease, while no subject had known myeloproliferative syndrome. Clinical presentation included mainly gastrointestinal symptoms. Anticoagulation was started in 16 patients. Three patients underwent bowel resection. Ten subjects developed gastric or bowel ischemia, seven of whom underwent bowel resection, and four died after SVT diagnosis. Although rare, SVT should be seen as a complication of COVID-19. Patients with severe gastrointestinal symptoms should be screened for SVT, as rapid recognition and correct management are essential to improve the outcome of these patients. [ABSTRACT FROM AUTHOR]

Ischemic jejunal stricture due to mesenteric vein thrombosis (MVT) rarely occurs in patients with extrahepatic portal vein obstruction (EHPVO). This is because the thrombus often occludes only a short segment of superior mesenteric vein adjacent to splenoportal confluence, facilitating development of collateral veins that protect bowel from ischemia. However, ischemic strictures can develop when the thrombus involves jejunal veins, venous arcades or vasa recta. We report three patients with EHPVO, who developed jejunal strictures due to MVT. They presented with symptoms of proximal bowel obstruction. Two of these patients had evidence of recurrent deep vein thrombosis (DVT), suggesting possibility of an underlying prothrombotic state. One of them had completely occluded bilateral iliac veins and inferior vena cava following DVT, 10 years ago. At the same time, he was identified as having a portal cavernoma. Contrast-enhanced computed tomography showed portal cavernoma together with MVT in all the patients. The thrombus was identified in the jejunal veins in two patients and in the entire superior mesenteric vein up to splenic vein in one patient. All three patients were found to have a tight concentric stricture involving a long length of proximal jejunum. Two patients required urgent surgical intervention and one died. [ABSTRACT FROM AUTHOR]

Portomesenteric vein thrombosis (PMVT) may occur after laparoscopic sleeve gastrectomy (LSG). Previous studies have shown that PMVT patients may have undiagnosed thrombophilia. We recently changed our practice to check thrombophilia panel in every LSG patient preoperatively. To estimate the thrombophilia prevalence in patients seeking LSG, and determine if extended chemoprophylaxis post LSG reduces PMVT. University hospital. Thrombophilia panels were drawn on every patient seeking LSG after July 2018 at 2 high-volume accredited bariatric surgery centers. A positive panel included factor VIII >150%; protein C <70%; protein S <55%; antithrombin III <83%; and activated protein C resistance <2.13. Patients with a positive panel were discharged on extended chemoprophylaxis. PMVT rates and bleeding occurrences were recorded for LSG patients from August 2018 to March 2019 and were compared with a historic cohort of LSG performed from January 2014 to July 2018. One thousand seventy-five patients seeking LSG had thrombophilia panel checked preoperatively. The cohort was 83% female; mean age and body mass index were 39.2 years and 43 kg/m2, respectively. Of the cohort, 52.4% (563/1075) had positive thrombophilia panel, including factor VIII elevation (91.5%), antithrombin III deficiency (6.0%), protein S deficiency (1.1%), protein C deficiency (.9%), and activated protein C resistance (.5%). Between January 2014 and July 2018, 13 PMVT were diagnosed among 4228 LSG (.3%) and there were 17 bleeding occurrences (.4%). After August 2018, one PMVT was diagnosed among 745 LSG (.1%) and there were 5 bleeding occurrences (.6%). The estimated thrombophilia prevalence in patients seeking LSG is 52.4%. The majority (91.5%) of these patients have factor VIII elevation. Extended prophylaxis may decrease PMVT postLSG. [ABSTRACT FROM AUTHOR]

Abstract Background Mesenteric cyst is a rare clinical entity especially in pregnancy; therefore, few cases have been reported in the literature. The standard method of their treatment is surgical excision either with laparotomy or laparoscopy. In addition, mesenteric vein thrombosis is a rare and life-threatening condition in pregnancy and needs immediate treatment because it can lead to intestinal necrotic ischemia. This is the first report of the coexistence of mesenteric cysts and mesenteric vein thrombosis during gestation. Case presentation A 27-year-old Greek woman, gravida 2 para 1, presented at 10 weeks’ gestation to the Emergency Unit of our hospital complaining of diffuse abdominal pain which deteriorated the last 3 days, which was localized in her right iliac fossa, along with vomiting. She had undergone open laparotomy and right salpingo-oophorectomy at the age of 23 due to an ovarian cyst. Besides this, her personal and family medical history was unremarkable. She had never received oral contraceptives or any hormone therapy. On arrival, a clinical examination revealed tenderness on palpation of her right iliac fossa, without rebound tenderness or muscle guarding. Within 10 hours of hospitalization, her symptoms deteriorated further with rebound tenderness during the examination, tachycardia, and a drop of 12 units in her hematocrit value. An emergency laparotomy was performed. Two mesenteric cysts and a 60 cm necrotic part of her intestine were revealed intraoperatively. In the postoperative period, she complained of acute abdominal pain, tachycardia, and dyspnea. Computed tomography imaging revealed mesenteric vein thrombosis and pulmonary thromboembolism. She was treated with low molecular weight heparin and she was discharged on the 11th postoperative day. Conclusions To the best of our knowledge, this is the first report in the literature of a simultaneous mesenteric cyst and mesenteric vein thrombosis in pregnancy. It is known that pregnancy is a state of hypercoagulation and clinicians should bear in mind this rare clinical condition in their diagnostic algorithm for acute abdominal pain.

Acute abdominal pain during pregnancy is challenging, both from a diagnostic and management perspective. A non-localized, persistent pain out of proportion to physical examination is a sign that advanced imaging may be necessary. Mesenteric venous thrombosis in a pregnant patient is extremely rare, but if diagnosis is delayed, can be potentially fatal to both the mother and the fetus. We present here a pregnant patient in the tenth week of gestation with classic clinical manifestations of mesenteric vein thrombosis and the corresponding findings on magnetic resonance imaging (MRI) and computed tomography (CT).

Elevated concentrations of factor VIII have recently been associated with de novo development of deep vein thrombosisand its recurrence Occurrence of mesenteric vein thrombosis in patients with elevated factor VIII has been rarely described but not well characterized. We describe in this article a young patient who developed superior mesenteric vein thrombosis and on evaluation was found to have abnormally elevated factor VIII.

Background: Obesity is a growing problem all over the world, including the United States. Single-incision laparoscopic sleeve gastrectomy is a surgery performed for patients who want to lose weight. The number of deaths resulting from thromboembolic complications from bariatric surgeries continues to be of major concern. Case Description: A 38-year-old female was admitted for single incision sleeve gastrectomy and was discharged home three days later. Subsequently she began to have abdominal pain, nausea and vomiting. A CT scan revealed superior mesenteric vein thrombosis with small bowel ischemia, splenic infarction and main and right portal vein branch thrombosis. An exploratory laparotomy demonstrated necrotic bowel due to abdominal compartment syndrome, and an area of small bowel was resected due to internal hernia. Surgical management of the patient during her second hospital stay included a decompressive laparotomy, internal hernia reduction, a small bowel resection. Discussion: Superior mesenteric vein thrombosis can be a life-threatening complication and present with non-specific presentations; thus, it is imperative that it is identified and managed promptly as these cases carry significant morbidity and mortality. Obese patients who undergo bariatric surgery frequently have other co-morbidities; many of which can complicate a case further. Mesenteric vein thromboses are normally treated with unfractionated or low-molecular-weight heparin.

Background Portomesenteric vein thrombosis (PMVT) has been increasingly reported after laparoscopic sleeve gastrectomy (LSG). Factor VIII (FVIII) is a plasma sialoglycoprotein that plays an essential role in hemostasis. There is increasing evidence that FVIII elevation constitutes a clinically important risk factor for venous thrombosis. Objectives To report the prevalence of FVIII elevation as well as other clinical characteristics in a multicenter series of patients who developed PMVT after LSG. Setting University hospitals. Methods A retrospective review was conducted of all patients that developed PMVT after laparoscopic bariatric surgery from 2006 to 2016 at 6 high-volume bariatric surgery centers. Results Forty patients who developed PMVT postoperatively, all after LSG, were identified. During this timeframe, 25,569 laparoscopic bariatric surgery cases were performed, including 9749 LSG (PMVT incidence after LSG = .4%). Mean age and body mass index were 40 years (18–65) and 43.4 kg/m 2 (35–59.7), respectively. Abdominal pain was the most common (98%) presenting symptom. Of patients, 92% had a hematologic abnormality identified, and of these, FVIII elevation was the most common (76%). The vast majority (90%) was successfully managed with therapeutic anticoagulation alone. A smaller number of patients required small bowel resection (n = 2) and surgical thrombectomy (n = 1). There were no mortalities. Conclusions A high index of clinical suspicion and prompt diagnosis/treatment of PMVT usually leads to favorable outcomes. FVIII elevation was the most common (76%) hematologic abnormality identified in this patient cohort. Further studies are needed to determine the prevalence of FVIII elevation in patients seeking bariatric surgery. [ABSTRACT FROM AUTHOR]

Background Portomesenteric vein thrombosis (PMVT) is considered an uncommon complication in general surgery; nevertheless, with the growing popularity of sleeve gastrectomy (SG) as a bariatric procedure we have seen an increase in the occurrence of this complication. Objectives To elucidate the question if it is a procedure-related complication and explore the modalities of prevention and treatment of this complication, a systematic review of available literature regarding PMVT events after SG was conducted. Methods Our systematic review yielded 28 studies enclosing 89 patients. Perioperative data was collected from each study and analyzed. Results The incidence of PMVT after SG ranged from .37% to 1%, 65% of the patients were female, and the mean body mass index was 41.63 kg/m 2 . Perioperative co-morbidities including hypertension, diabetes, and dyslipidemia were recorded in 39.7%, 41.63%, and 38.23% of cases respectively. Tachycardia and fever were reported only in 23.9% and 20.89%, respectively, and hereditary thrombophilia studies were positive in 30.43% of cases. The rate of acute major complications after PMVT was 14.6% (13 cases), and mortality was reported in 3 cases (average 3.37%). Conclusion PMVT seems to be an uncommon multifactorial disease, with unpredictable symptoms and varieties of the treatments options, but additional studies are required to further define optimal management and prevention algorithms. [ABSTRACT FROM AUTHOR]

Background: Mesenteric cyst is a rare clinical entity especially in pregnancy; therefore, few cases have been reported in the literature. The standard method of their treatment is surgical excision either with laparotomy or laparoscopy. In addition, mesenteric vein thrombosis is a rare and life-threatening condition in pregnancy and needs immediate treatment because it can lead to intestinal necrotic ischemia. This is the first report of the coexistence of mesenteric cysts and mesenteric vein thrombosis during gestation.Case Presentation: A 27-year-old Greek woman, gravida 2 para 1, presented at 10 weeks' gestation to the Emergency Unit of our hospital complaining of diffuse abdominal pain which deteriorated the last 3 days, which was localized in her right iliac fossa, along with vomiting. She had undergone open laparotomy and right salpingo-oophorectomy at the age of 23 due to an ovarian cyst. Besides this, her personal and family medical history was unremarkable. She had never received oral contraceptives or any hormone therapy. On arrival, a clinical examination revealed tenderness on palpation of her right iliac fossa, without rebound tenderness or muscle guarding. Within 10 hours of hospitalization, her symptoms deteriorated further with rebound tenderness during the examination, tachycardia, and a drop of 12 units in her hematocrit value. An emergency laparotomy was performed. Two mesenteric cysts and a 60 cm necrotic part of her intestine were revealed intraoperatively. In the postoperative period, she complained of acute abdominal pain, tachycardia, and dyspnea. Computed tomography imaging revealed mesenteric vein thrombosis and pulmonary thromboembolism. She was treated with low molecular weight heparin and she was discharged on the 11th postoperative day.Conclusions: To the best of our knowledge, this is the first report in the literature of a simultaneous mesenteric cyst and mesenteric vein thrombosis in pregnancy. It is known that pregnancy is a state of hypercoagulation and clinicians should bear in mind this rare clinical condition in their diagnostic algorithm for acute abdominal pain. [ABSTRACT FROM AUTHOR]

Background: Portomesenteric vein thrombosis following laparoscopic bariatric surgical procedures is a serious and potentially lethal complication. It is quite rare, and its clinical presentation, management, and sequelae remain poorly understood.Methods: We searched PubMed, Medline, Google Scholar, Ovid, and Cochrane databases for articles reporting case series and systematic reviews in the English language on patients who underwent laparoscopic bariatric surgery and had a subsequent portal or mesenteric vein thrombosis. Articles discussing laparoscopic gastric banding were excluded.Results: A total of 14 articles reporting on 36 cases were found. We analyzed the pooled data from these case reports and series with emphasis on number of reported patients, demographics, time of diagnosis, risk factors, symptoms, management, complications, and sequelae.Conclusions: Portomesenteric vein thrombosis is not uncommon following laparoscopic bariatric surgery and appears to occur more after laparoscopic sleeve gastrectomy. Bariatric surgeons should have a high index of suspicion for early detection and treatment of this potentially lethal complication. Obese patients at high risk for venous thrombosis should be screened for genetic predisposition for hypercoagulable state and should be considered for extended thromboprophylaxis postoperatively. [ABSTRACT FROM AUTHOR]

Mesenteric vein thrombosis is an uncommon complication following laparoscopic surgery. A review of the literature has shown that there is a higher incidence of thrombosis following laparoscopic bariatric procedures, including the gastric sleeve procedure and roux-en-y gastric bypass surgery. Additionally, pylephlebitis, thrombosis of portal or mesenteric veins, has been described following perforated appendicitis. However no report has described mesenteric vein thrombosis following laparoscopy for nonperforated appendicitis in the pediatric population. The cause of this thrombosis is hypothesized to be secondary to venous stasis secondary to insufflation during laparoscopy.

Duodenal varices usually occur due to portal hypertension and are rare causes of gastrointestinal tract bleeding. We report a unique case of a previously fit patient who presented with melena and was found to have isolated duodenal varices (DV) in the third part on esophagogastroduodenoscopy. No esophageal or gastric varices were noticed. The duodenal varices were successfully managed by endoscopic banding. A computerized tomography scan of the abdomen to further investigate the cause confirmed duodenal varices and revealed superior mesenteric vein thrombosis. The liver was normal with patent hepatic and portal veins. No evidence of thrombophilia was found. Apixaban was prescribed for superior mesenteric vein thrombosis and on follow-up. no further bleeding was reported., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alsabban et al.)

Highlights • Mesenteric venous thrombosis (MVT) can be fatal with the superior mesenteric vein being the most common site of thrombus formation. • Intestinal ischemia often accompanies MVT in the acute setting, complicating its management. • Patients who present with MVT should be screened for conditions that cause disruption to Virchow's Triad. Abstract Introduction: Acute mesenteric venous thrombosis is a rare but potentially fatal condition with superior mesenteric vein being the most common site of thrombosis development [1]. It is more common in patients with underlying disorders which cause disruptions to Virchow's Triad of hypercoagulability, stasis and endothelial injury. The disease is often associated with intestinal ischemia in its acute form, further complicating its management. Presentation of case: We present a case of acute superior mesenteric venous thrombosis resulting in jejunal ischemia in a 60-year-old Caucasian male with possible ulcerative colitis. A computed tomography (CT) scan demonstrated features of intestinal infarction. However, the patient was stable after initial resuscitation with a non-peritonitic abdomen and was subsequently managed with conservative measures. Discussion: We have illustrated a case of a patient with acute mesenteric venous thrombosis with potential bowel compromise. Despite concerning CT features, the patient was clinically stable and responded to conservative management. We hope to emphasise that although radiology plays a crucial role in modern medicine, it is important to make therapeutic decisions based on clinical findings. Conclusion: Acute mesenteric venous thrombosis is a complex entity. It requires a multidisciplinary team approach to plan for the most appropriate treatment strategy suitable for each patient as all options are associated with significant risks. The underlying cause should be established as this will determine any long-term management necessary to prevent recurrence. [ABSTRACT FROM AUTHOR]

Elevated concentrations of factor VIII have recently been associated with de novo development of deep vein thrombosisand its recurrence Occurrence of mesenteric vein thrombosis in patients with elevated factor VIII has been rarely described but not well characterized. We describe in this article a young patient who developed superior mesenteric vein thrombosis and on evaluation was found to have abnormally elevated factor VIII. [ABSTRACT FROM AUTHOR]

Mesenteric vein thrombosis (MVT) is a rare condition that can present acutely, subacutely, or chronically. MVT can be isolated or within a splanchnic thrombosis (spleno-porto-mesenteric). Symptomatic cases usually present as nonspecific abdominal pain, with or without signs of intestinal ischemia, and the diagnosis is usually made by imaging test (abdominal CT or MRI) in patients with high clinical suspicion. An early clinical-surgical approach is recommended to screen those patients with warning signs and who benefit from an exploratory laparotomy in addition to anticoagulant treatment, which is the cornerstone of medical treatment. MVT is usually associated with prothrombotic states, with hematological disorders (myeloproliferative syndromes and/or JAK2 gene mutations) being of special clinical relevance. On the other hand, the 5-year survival rate is 70-82% and early overall 30-day mortality from MVT can reach 20-32%., (Copyright © 2023 Elsevier España, S.L.U. All rights reserved.)

Venous thromboembolism that occurs in unusual sites is challenging because of the potential severity of presentation, the presence of some major provoking risk factors, the high prevalence of potential contraindications to antithrombotic therapies, the lack of solid evidence to guide therapeutic decisions, and because of the severity of long-term consequences. For example, venous thrombosis in the splanchnic veins frequently occurs in patients with liver cirrhosis. Not uncommonly, these patients present with concomitant active gastrointestinal bleeding, and/or low platelet count or oesophageal varices. If inadequately treated, splanchnic vein thrombosis (SVT) may further worsen portal hypertension and, thus, increase the long-term risk of bleeding. Up to 40 % of patients with cerebral vein thrombosis (CVT) have signs of intracranial bleeding at the time of the diagnosis. This finding is associated with worst prognosis in terms of death or severe disability. Despite the apparent presence of a major contraindication to anticoagulation, only a timely administration of parenteral anticoagulant drugs may improve this unfavourable outcome. The available evidence on the management of these two challenging disorders, SVT and CVT, will be reviewed in this article. [ABSTRACT FROM AUTHOR]