Acute Mesenteric Venous Thrombosis.. in Assiut University Hospital Management Controversies
Ключевые слова
абстрактный
Описание
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.
Даты
Последняя проверка: | 12/31/2017 |
Первый отправленный: | 01/19/2018 |
Предполагаемая регистрация отправлена: | 03/28/2018 |
Первое сообщение: | 03/29/2018 |
Последнее обновление отправлено: | 03/28/2018 |
Последнее обновление опубликовано: | 03/29/2018 |
Фактическая дата начала исследования: | 03/31/2018 |
Предполагаемая дата завершения начальной школы: | 11/30/2019 |
Предполагаемая дата завершения исследования: | 11/30/2019 |
Состояние или болезнь
Вмешательство / лечение
Drug: Warfarin
Procedure: MVT with failure of anticoagulation therapy
Drug: Heparin
Фаза
Группы рук
Рука | Вмешательство / лечение |
---|---|
Experimental: MVT with anticoagulation therapy(heparin &warfarin) 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. | |
Experimental: MVT with failure of anticoagulation therapy(heparin &warfarin) patients who underwent conservative therapy with anticoagulation (heparin &warfarin) but showed no improvement . |
Критерии приемлемости
Возраст, имеющий право на обучение | 18 Years Чтобы 18 Years |
Полы, имеющие право на обучение | All |
Принимает здоровых добровольцев | да |
Критерии | 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. |
Результат
Основные показатели результатов
1. Anticoagulation therapy (heparin &warfarin) in MVO [within 3-6 months of starting treatment.]
Меры вторичного результата
1. Recurrence rate [within six months of starting treatment.]
2. Mortality rate [within one year of starting treatment.]