Acute Mesenteric Venous Thrombosis.. in Assiut University Hospital Management Controversies

Assiut University

Status: Unknown

Conditions: Mesenteric Vein Thrombosis

Treatments: Procedure: MVT with failure of anticoagulation therapy; Drug: Warfarin; Drug: Heparin

Study type: Interventional

Funder types: Other

Identifiers

NCT03483207

HF2018

Details and patient eligibility

About

Initial treatment in the management of acute mesenteric vein thrombosis (MVT) is controversial. Some authors have proposed a surgical approach, whereas others have advocated medical therapy (anticoagulation). In this study, the investigators analyzed and compared the results obtained with surgical and medical treatment to determine the best initial management for this disease.

Full description

Mesenteric venous thrombosis (MVT) is increasingly recognized as a cause of mesenteric ischemia. it must be distinguished from arterial and non occlusive types of ischemia, it accounts for 5% to 15% of all cases of mesenteric ischemia. Patients may have evocative signs,such as abdominal pain that is out of proportion to physical signs, nausea, or vomiting. However, a clinical diagnosis is often difficult because abdominal symptoms are non specific and high index of suspicion is often required for diagnosis.(1) Primary MVT accounted for 25% to 55% of cases in early studies, but recent reports show decline in primary MVT because of improvements in the diagnosis of hypercoagulable states.(2) Advances in new imaging techniques also have enabled early recognition of this disease without or before laparotomy.(3-5 ) Fortunately , there is no consensus about the initial management of MVT; Some authors have proposed an aggressive surgical approach (6) while others have advocated an initial conservative management with anticoagulation and close monitoring . ( 7) similarly,issue of second look laparotomy,mandatory or selective is yet not resolved.

The present study is prompted to analyze our experience in an effort to resolve these controversies and the results obtained will be assessed to determine the best management strategy for this uncommon disease.

Enrollment: 30 estimated patients

Sex: All

Ages: 18 to 70 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 1. Patients admitted in the department of surgery in Assiut University diagnosed to have mesenteric venous occlusion not presented by signs of peritonitis or confirmed radiological signs of bowel infarction.

Exclusion criteria

1-Patients diagnosed to have mesenteric venous occlusion but with signs of peritonitis or confirmed radiological signs of bowel infarction on admission.

Trial design

Primary purpose: Treatment

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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30 participants in 2 patient groups

MVT with anticoagulation therapy(heparin &warfarin)

Experimental group

Description:

patients with confirmed diagnosis of acute MVT on CT scan but having no signs of peritonitis or established CT signs of gangrene will be treated conservatively with anticoagulation(heparin \&warfarin) while other cases will be for surgical management and not included in the study.

Treatment:

Procedure: MVT with failure of anticoagulation therapy

Drug: Heparin

Drug: Warfarin

MVT with failure of anticoagulation therapy(heparin &warfarin)

Experimental group

Description:

patients who underwent conservative therapy with anticoagulation (heparin \&warfarin) but showed no improvement .

Treatment:

Procedure: MVT with failure of anticoagulation therapy

Drug: Heparin

Drug: Warfarin