腸間膜静脈血栓症により広範囲回腸壊死をきたした1例

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  • A CASE OF MESENTERIC VENOUS THROMBOSIS WITH EXTENSIVE SMALL BOWEL NECROSIS

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A case of mesenteric venous thrombosis causing extensive small bowel necrosis during treatment for cerebral hemorrhage. A 72-year-old woman, who was admitted to the department of internal medicine in our hospital for treatment of intracerebral hemorrhage since October 1997, was referred to the department because of anal bleeding, a significant decrease in blood pressure, abdominal tenderness, and muscle gurding on February 6, 1998. Echo-guided puncture of peritoneal fluid confirmed bloody ascites. Emargency operation was performed under a diagnosis of perforation of the small intestine. There existed the necrotic ileum proximal 60cm and distal 160cm from the ileocaecal valve was resected and mesenteric venous thrombosis. About 130cm of the intestine was resected in determining intestinal viability safety included the necrotized bowel. Anticoagulant therapy, as not given, because of intracerebral hemorrhage. There have been no signs of recurrence as of nine months after the operation. If bowel ischemia occurs, the superior mesenteric vein is commonly involved and the affected bowel becomes edematous and necrotic. So anal bleeding suggests severe edema and necrosis of the intestine, and in this case the prognosis is believed to be poor. We must keep in mind the condition as a probable differential diagnosis for patients manifesting acute abdomen with vascular disease.

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