- Case Report
- Open Access
Acute superior mesenteric venous thrombosis with advanced gastric cancer: a case report
© Goda et al; licensee BioMed Central Ltd. 2010
- Received: 6 January 2009
- Accepted: 9 March 2010
- Published: 9 March 2010
Although the advanced stages of neoplasms have a risk of superior mesenteric venous thrombosis (MVT), an initial clinical diagnosis of MVT is sometimes difficult and it can be treated as a cancer-related pain using NSAIDs and/or opioids.
We herein present a case of palliative stage of cancer with acute MVT, which was successfully treated with immediate anticoagulant therapy. We believe this case provides an important clinical lesson, which is that we should remember that MVT is one of the potential causes of abdominal pain with cancer patients and the thrombosis can be easily identified by US and CT.
- Advanced Gastric Cancer
- Anticoagulant Therapy
- Superior Mesenteric Vein
- Acute Mesenteric Ischemia
Although the advanced stage of the neoplasm has a risk of superior mesenteric venous thrombosis (MVT) , an initial clinical diagnosis of MVT is sometimes difficult and it can be treated as a cancer-related pain. We herein present a case of palliative stage of cancer with acute MVT, which was successfully treated with immediate anticoagulant therapy. His clinical course suggests we should remember that MVT is one of the potential causes of abdominal pain with cancer patients and the thrombosis can be easily identified by US and CT.
A 69-year-old male was admitted because of a continually worsening abdominal cramping pain, which had started two days before his admission. The pain was radiating to his back and it was associated with nausea and appetite loss. The patient had previously undergone a total gastrectomy for advanced gastric cancer two years earlier.
Incidence of Cancer relative MVT
The clinical diagnosis of MVT associated with a neoplasm is sometimes difficult. The symptoms and signs of MVT are non-specific, such as abdominal pain with nausea, vomiting, diarrhea/constipation and fever , and the initial physical findings may often appear to be entirely normal. These conditions are often assumed to be cancer related symptoms, which can be treated with NSAIDs and/or opioids. In the present case, the initial diagnosis was cancer-related pain during chemotherapy for gastric cancer with peritonitis carcinomatosa.
The use of advanced imaging techniques provided useful and helpful information. US is a powerful modality for the screening of a suspected thrombosis. Contrast-enhanced CT, which facilitates the early and accurate detection of thrombosis, including fresh thrombosis with a high sensitivity , therefore indicated the precise location of the thrombosis and the duration of the thrombosis in this case.
The best strategy for MVT is its early diagnosis and immediate treatment . Anticoagulant therapy, which generally allows for the re-canalization of the thrombosed vein in recently formed thromboses, is recommended in patients with acute MVT to improve the survival without increasing the risk of bleeding [4, 10], however, reliable data for the palliative stage of cancer patients with MVT is still scarce.
The palliative stage of a cancer patient with MVT was successfully treated. It is important to remember that MVT is one of the causes of abdominal pain in cancer patients and such thrombosis can be easily identified by both US and CT. Even in palliative stage cancer patients, the immediate use of anticoagulants can improve both the QOL and the prognosis of the patients.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
- Kumar S, Sarr MG, Kamath PS: Mesenteric venous thrombosis. N Engl J Med. 2001, 345: 1683-8. 10.1056/NEJMra010076.View ArticlePubMedGoogle Scholar
- Acosta S, Ogren M, Sternby NH, Bergqvist D, Bjorck M: Mesenteric venous thrombosis with transmural intestinal infarction: a population-based study. J Vasc Surg. 2005, 41: 1683-8. 10.1016/j.jvs.2004.10.011.View ArticleGoogle Scholar
- Acosta S, Alhadad A, Svensson P, Ekberg O: Epidemiology, risk and prognostic factors in mesenteric venous thrombosis. Br J Surg. 2008, 95: 1245-51. 10.1002/bjs.6319.View ArticlePubMedGoogle Scholar
- Kumar S, Kamath PS: Acute superior mesenteric venous thrombosis: one disease or two?. Am J Gastroenterol. 2003, 98: 1299-304. 10.1111/j.1572-0241.2003.07338.x.View ArticlePubMedGoogle Scholar
- Janssen HL, Wijnhoud A, Haagsma EB, van Uum SH, van Nieuwkerk CM, Adang RP, Chamuleau RA, van Hattum J, Vleggaar FP, Hansen BE, Rosendaal FR, van Hoek B: Extrahepatic portal vein thrombosis: aetiology and determinants of survival. Gut. 2001, 49: 720-4. 10.1136/gut.49.5.720.PubMed CentralView ArticlePubMedGoogle Scholar
- Sogaard KK, Astrup LB, Vilstrup H, Gronbaek H: Portal vein thrombosis; risk factors, clinical presentation and treatment. BMC Gastroenterol. 2007, 7: 34-10.1186/1471-230X-7-34.PubMed CentralView ArticlePubMedGoogle Scholar
- Morasch MD, Ebaugh JL, Chiou AC, Matsumura JS, Pearce WH, Yao JS: Mesenteric venous thrombosis: a changing clinical entity. J Vasc Surg. 2001, 34: 680-4. 10.1067/mva.2001.116965.View ArticlePubMedGoogle Scholar
- Brisse H, Orbach D, Lassau N, Servois V, Doz F, Debray D, Helfre S, Hartmann O, Neuenschwander S: Portal vein thrombosis during antineoplastic chemotherapy in children: report of five cases and review of the literature. Eur J Cancer. 2004, 40: 2659-66. 10.1016/j.ejca.2004.06.013.View ArticlePubMedGoogle Scholar
- Feenstra J, Vermeer RJ, Stricker BH: Mesenteric venous thrombosis attributed to docetaxel. Am J Clin Oncol. 2000, 23: 353-4. 10.1097/00000421-200008000-00008.View ArticlePubMedGoogle Scholar
- Spanier BW, Frederiks J: Aetiology of extrahepatic portal vein thrombosis. Gut. 2002, 51: 755-6. 10.1136/gut.51.5.755-b.PubMed CentralView ArticlePubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.