Acute Mesenteric Venous Occlusion in Patients with Warfarin: Warfarin Therapy May Complicate the Diagnosis of Intestinal Vascular Complications

使用抗凝血劑治療病患併發急性腸靜脈阻塞症

徐慧萍(Hui-Ping Hsu) ； 沈延盛(Yan-Shen Shan) ； 施俊偉(Edgar D. Sy) ； 林炳文(Pin-Wen Lin)

《Formosan Journal of Surgery》 38卷1期 (2005/02) Pp. 13-19

https://doi.org/10.29833/FJS.200502.0003

摘要

使用抗凝血劑預防血栓會産生腹腔腸道併發，如腸壁出血、腸繫膜血腫；而急性腸靜脈阻塞及腸道缺血是罕見的併發症，且進程緩慢。因爲臨床表徽和實驗室表現不特殊，在診斷上，對外科醫師是一大挑戰。我們報告五例長期使用抗凝血劑患者初期表現急性腹痛及腸道漲腫，經電腦斷層檢查顯示部份小腸壁增厚，疑似急性腸靜脈阻塞及腸道缺血，後經手術證實。病理報告除在一案例有急性腸靜脈血栓腸道缺血外，在另外三例發現有腸繫膜血腫及腸腔內出血，而五位病人的表徽皆似急性腸靜脈血栓腸道缺血症。術後，仍然給予抗凝血劑預防血栓栓塞併發症，患者復原良好。病患長期使用抗凝血劑，會困擾醫師對對腸道血管急症的判斷，保持高度懷疑才能早期診斷並立即治療。

並列摘要

Many intra-abdominal complications are associated with the usage of warfarin, including hematoma or hemorrhage within the gastrointestinal tract; however, acute mesenteric venous occlusion is a rare condition with an indolent course. Due to its nonspecific clinical presentation and laboratory results, it presents a great challenge for diagnosis. In this report, five patients on long-term anticoagulant therapy developed acute abdomen with small bowel dilatation initially. Acute mesenteric venous occlusion with focal small bowel wall thickening was suspected with computed tomography, and later shown by laparotomy. Associated pathology included mesenteric hematoma and intramural hemorrhage. Though the anticoagulant was still given to prevent thromboembolic events, the postoperative course was uneventful. Patients on long-term anticoagulant therapy may present a complex diagnosis of gastrointestinal vascular disease, so a high index of suspicion is important for early diagnosis and prompt treatment of the ischemic bowel.

並列關鍵字

acute abdomen ； ischemic bowel ； warfarin