Akademik Veri Yönetim Sistemi
XII. Congress of the World Society of Emergency Surgery, Antalya, Türkiye, 21 - 25 Ekim 2025, ss.90-91, (Özet Bildiri)
Background: Venous mesenteric ischemia (VMI) is an uncommon but serious clinical condition characterized by impaired venous drainage of the intestines, most commonly due to thrombosis of the superior mesenteric vein (SMV). Although accounting for less than 10% of all mesenteric ischemia cases, VMI carries significant morbidity and mortality. The heterogeneous clinical presentation of VMI often leads to diagnostic delays, contributing to a wide range of clinical outcomes. The aim of this study is to evaluate and characterize the clinical features, diagnostic pathways, and outcomes of patients diagnosed with venous mesenteric ischemia in our institution. Material and Methods: We retrospectively analyzed patients diagnosed with acute mesenteric venous thrombosis with bowel involvement between January 1, 2015, and December 31, 2024. Exclusion criteria included chronic mesenteric venous thrombosis, referral after initial surgery for VMI at another center, and cases without bowel involvement. The diagnosis was established by contrast-enhanced computed tomography (CT) in all cases. Patient characteristics, treatment approaches, and outcomes were assessed. Results: A total of 31 patients were included in the study. One patient was moribund at admission and died shortly after CT; this case was excluded from further analysis. Of the remaining 30 patients, 19 (46.3%) were male and 22 (53.7%) were female, with a median age of 49 years [20-76]. The median duration of symptoms prior to diagnosis was 4 days [1–60]. The most common presenting symptom was abdominal pain, reported in 97.6% of patients. Twenty-one patients had purely acute mesenteric venous thrombosis, while in nine patients (30%) the thrombus was characterized as acute-on-chronic. SMV involvement alone was seen in 6 patients (20%), SMV + portal vein in 6 patients (20%), and thrombosis extending to the SMV–splenic vein–portal vein confluence in 13 patients (43.3%). The inferior mesenteric vein was affected in 7 patients (23.3%). Conservative treatment with low-molecular-weight heparin was applied in 23 patients (76.67%), while 6 patients (20%) underwent surgical intervention. Median time to surgery was 1 day [1–13]. Two surgeries were for increased intra-abdominal pressure, and four for peritonitis. Surgical procedures included resection and anastomosis, with or without open abdomen management using a vacuum-assisted closure (VAC) device. No postoperative complications occurred in the conservative group, whereas 4 patients (66.7%) in the surgical group developed complications—including atelectasis, anastomotic leakage, intra-abdominal abscess, and intracerebral hemorrhage. The median length of hospital stay was 4 days for the conservative group and 28 days for the surgical group. In-hospital mortality occurred in 1 patient (3.3%) in the surgical group. Conclusion: Mesenteric venous ischemia is a rare but potentially life-threatening clinical entity with heterogeneous presentations and outcomes. Early cross-sectional imaging has improved diagnostic accuracy, enabling timely anticoagulation and reducing the risk of irreversible intestinal damage. Nevertheless, delays in diagnosis remain closely associated with adverse outcomes, and VMI continues to pose a substantial mortality risk despite advances in management. Keywords: venous mesenteric ischemia, bowel infarct, conservative treatment