Download PDF
Notfall Medizin 2003; 29(5): 200-207
DOI: 10.1055/s-2003-39619
Aktuelles Wissen

© Georg Thieme Verlag Stuttgart · New York

Entzündliche, infektiöse und maligne Erkrankungen - Thromboserisiko bei gastro-enterologischen Erkrankungen

S. Turi1 , D. Schilling1 , J. F. Riemann1
  • 1Medizinische Klinik C Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen am Rhein (Direktor: Prof. Dr. J. F. Riemann)
Further Information

Publication History

Publication Date:
30 May 2003 (online)

   Permissions and Reprints

Zusammenfassung

Thrombosen können bei entzündlichen, infektiösen und malignen gastroenterologischen Erkrankungen auftreten. Eine Notfallbehandlung ist bei akuten Mesenterialvenenthrombosen mit mesenterialer Ischämie und bei gastrointestinalen Blutungen aus Ösophagus- und Magenvarizen in Folge einer Milzvenen- oder Pfortaderthrombose erforderlich. Akute und chronische Pankreatitis sowie chronisch-entzündliche Darmerkrankungen sind Erkrankungen mit einem höheren Risiko einer Thrombose, bei anderen gastroenterologischen Erkrankungen sind Thrombosen seltene Ereignisse. Ätiologie, Pathogenese, Diagnostik und Therapie von Thrombosen bei gastroenterologischen Erkrankungen werden in der vorliegenden Übersichtsarbeit erläutert.

Summary

A thrombosis may occur in inflammatory, infectious and malignant gastrointestinal diseases. Emergency treatment is necessary in acute mesenterial venous thrombosis with mesenterial ischaemia and in gastrointestinal bleeding from oesophageal and gastric varices as a sequela of a splenic vein or portal vein thrombosis. Acute and chronic pancreatitis and chronic inflammatory bowel diseases carry a high risk of thrombosis while in other gastrointestinal diseases thromboses are rare occurrences. The aetiology, pathogenesis, diagnosis and treatment of thrombosis associated with gastrointestinal diseases are discussed.

Literatur

  • 1 Ammann RW, Akovbiantz A, Largiader F, Schueler G. Course and outcome of chronic pancreatitis. Longitudinal study of a mixed medical-surgical series of 245 patients.  Gastroenteroogy. 1984;  86 820-828
    PubMedGoogle Scholar
  • 2 Balfour GW, Stewart TG. Case of enlarged spleen complicated with aszites. Both depending upon varicose dilatation and thrombosis of the portal vein.  Edinburgh Med J. 1869;  14 589-598
    PubMedGoogle Scholar
  • 3 Bargen JA, Baker NW. Extensive arterial and venous thrombosis complicating chronic ulcerative colitis.  Arch Intern Med. 1936;  58 17-31
    PubMedGoogle Scholar
  • 4 Boley SJ, Kaleya RN, Brandt LJ. Mesenteric venous thrombosis.  Surg Clin North Am. 1992;  72 183-201
    PubMedGoogle Scholar
  • 5 Bradbury MS, Kavanagh PV, Bechtold RE. et al. . Mesenteric venous thrombosis diagnosis and noninvasive imaging.  Radiographics. 2002;  22 527-541
    CrossrefPubMedGoogle Scholar
  • 6 Bradley 3rd EL. The natural history of splenic vein thrombosis due to chronic pancreatitis: indications for surgery.  Int J Pancreatol. 1987;  2 87-92
    PubMedGoogle Scholar
  • 7 Bradley 3rd EL. Complications of chronic pancreatitis.  Surg Clin North Am. 1989;  69 481-497
    PubMedGoogle Scholar
  • 8 Cattaneo M, Vecchi M, Zighetti ML. et al. . High prevalence of hyperhomocysteinemia in patients with inflammatory bowel disease: a pathogenic link with thromboembolic complications?.  Thromb Haemost. 1998;  80 542-545
    PubMedGoogle Scholar
  • 9 Chowers Y, Sela BA, Holland R. et al. . Increased levels of homocysteine in patients with Crohn's disease are related to folate levels.  Am J Gastroenterol. 2000;  95 3498-3502
    CrossrefPubMedGoogle Scholar
  • 10 Cohen J, Edelmann RR, Chopra S. Portal vein thrombosis: A review.  Am J Med. 1992;  92 173-182
    CrossrefPubMedGoogle Scholar
  • 11 Collins CE, Rampton DS. Review article: platelets in inflammatory bowel disease - pathogenetic role and therapeutic implications.  Aliment Pharmacol Ther. 1997;  11 237-247
    CrossrefPubMedGoogle Scholar
  • 12 Conlan MG, Haire WD, Burnett DA. Prothrombotic abnormalities in inflammatory bowel disease.  Dig Dis Sci. 1989;  34 1089-1093
    CrossrefPubMedGoogle Scholar
  • 13 Crowe PM, Sagar G. Reversible superior mesenteric vein thrombosis in acute pancreatitis.  The CT appearances. Clin Radiol. 1995;  50 628-633
    PubMedGoogle Scholar
  • 14 Dörffel Y, Wruck U, Rückert RI. et al. . Vascular complications in acute pancreatitis assesed by color duplex ultrasonography.  Pancreas. 2000;  21 126-133
    PubMedGoogle Scholar
  • 15 Elliot JW. The operative relief of gangrene of intestine due to occlusion of the mesenteric vessels.  Ann Surg. 1895;  21 9
    PubMedGoogle Scholar
  • 16 Gaa J, Deininger HK. Das Budd-Chiari-Syndrom.  Radiologe. 1990;  30 24-28
    PubMedGoogle Scholar
  • 17 Glynn MJ. Isolated splenic vein thrombosis.  Arch Surg. 1986;  121 723-725
    PubMedGoogle Scholar
  • 18 Grendell JH, Ockner RK. Mesenteric venous thrombosis.  Gastroenterology. 1982;  82 358-372
    PubMedGoogle Scholar
  • 19 Guedon C, Le V Cam-Duchez, Lalaude O. et al. . Prothrombotic inherited abnormalities other than factor V Leiden mutation do not play a role in venous thrombosis in inflammatory bowel disease.  Am J Gastroenterol. 2001;  96 1448-1454
    PubMedGoogle Scholar
  • 20 Hudson M, Chitolie A, Hutton RA. et al. . Thrombotic vascular risk factors in inflammatory bowel disease.  Gut. 1996;  38 733-737
    CrossrefPubMedGoogle Scholar
  • 21 Janssen HL. Changing perspectives in portal vein thrombosis.  Scand J Gastroenterol Suppl. 2000;  232 69-73
    PubMedGoogle Scholar
  • 22 Kitchens CS. Evolution of our understanding of the pathophysiology of primary mesenteric venous thrombosis.  Am J Surg. 1992;  163 346-348
    CrossrefPubMedGoogle Scholar
  • 23 Koutroubakis IE. Role of thrombotic vascular risk factors in inflamatory bowel disease.  Dig Dis. 2000;  18 161-167
    PubMedGoogle Scholar
  • 24 Krummen DM, Cannova J, Schreiber H. Conservative management strategy for pancreatitis-associated mesenteric venous thrombosis.  Am Surg. 1996;  62 432-434
    PubMedGoogle Scholar
  • 25 Lankisch PG, Otto J, Erkelenz I, Lembcke B. Pancreatic calcifications: no indicator of severe exocrine pancreatic insufficiency.  Gastroenterology. 1986;  90 617-621
    CrossrefPubMedGoogle Scholar
  • 26 Lankisch PG. The spleen in inflammatory pancreatic disease.  Gastroenterology. 1990;  98 509-516
    PubMedGoogle Scholar
  • 27 Liebman HA, Kashani N, Sutherland D, McGehee W, Kam L. The factor V Leiden mutation increases the risk of venous thrombosis in patients with inflamatory bowel disease.  Gastroenterology. 1998;  115 830-834
    PubMedGoogle Scholar
  • 28 Ma SK, Kim SW, Kim NH, Choi KC. Renal vein and inferior vena cava thrombosis associated with acute pancreatitis.  Nephron. 2002;  92 475-477
    CrossrefPubMedGoogle Scholar
  • 29 Madsen MS, Petersen TH, Sommer H. Segmental portal hypertension.  Ann Surg. 1986;  204 72-77
    PubMedGoogle Scholar
  • 30 Mann O, Haag K, Hauenstein KH, Rössle M, Pausch J. Septische Pfortaderthrombose.  Dtsch med Wschr. 1995;  120 1201-1206
    PubMedGoogle Scholar
  • 31 Mortele KJ, Mergo PJ, Taylor HM. et al. . Splenic and perisplenic involvement in acute pancreatitis: determination of prevalence and morphologic helical CT features.  J Comput Assist Tomogr. 2001;  25 50-54
    CrossrefPubMedGoogle Scholar
  • 32 Moossa AR, Gadd MA. Isolated splenic vein thrombosis.  World J Surg. 1985;  9 384-390
    CrossrefPubMedGoogle Scholar
  • 33 Papa A, De V Stefano, Danese S. et al. . Hyperhomocysteinemia and prevalence of polymorphisms of homocysteine metabolism-related enzymes in patients with inflammatory bowel disease.  Am J Gastroenterol. 2001;  96 2677-2682
    CrossrefPubMedGoogle Scholar
  • 34 Probst A, Probst T, Kathrein H. et al. . Pfortaderthrombose.  Dtsch med Wschr. 1995;  120 651-655
    PubMedGoogle Scholar
  • 35 Rattner DW, Warshaw AL. Venous, biliary, and duodenal obstruction in chronic pancreatitis.  Hepatogastroenterology. 1990;  37 301-306
    PubMedGoogle Scholar
  • 36 Rhee RY, Gloviczki P. Mesenteric venous thrombosis.  Surg Clin North Am. 1997;  77 327-338
    CrossrefPubMedGoogle Scholar
  • 37 Rijs J, Depreitere B, Beckers A. et al. . Mesenteric venous thrombosis, diagnostic and therapeutic approach.  Acta chir belg. 1997;  97 247-249
    PubMedGoogle Scholar
  • 38 Romagnuolo J, Fedorak RN, Dias VC. et al. . Hyperhomocysteinemia and inflammatory bowel disease: prevalence and predictors in a cross-sectional study.  Am J Gastroenterol. 2001;  96 2143-2149
    CrossrefPubMedGoogle Scholar
  • 39 Sakorafas GH, Tsiotou AG. Splenic-vein thrombosis complicating chronic pancreatitis.  Scand J Gastroenterol. 1999;  34 1171-1177
    CrossrefPubMedGoogle Scholar
  • 40 Schapira M, Henrion J, Ravoet C. et al. . Thromboembolism in inflammatory bowel disease.  Acta Gastro-Enterologica Belgica. 1999;  182-186
    PubMedGoogle Scholar
  • 41 Smith CJ, Haire WD, Kaufman SS, Mack DR. Determination of prothrombin activation fragments in young patients with inflammatory bowel disease.  Am J Gastroenterol. 1996;  91 1221-1225
    PubMedGoogle Scholar
  • 42 Sobhonslidsuk A, Reddy KR. Portal vein thrombosis: A concise review.  Am J Gastroenterol. 2002;  97 535-541
    PubMedGoogle Scholar
  • 43 Stringer MD, Michell M, McIrvine AJ. Inferior vena caval thrombosis complicating acute pancreatitis.  Case report. Acta Chir Scand. 1988;  154 161-163
    PubMedGoogle Scholar
  • 44 Sutton JP, Yarborough DY, Richard JT. Isolated splenic vein occlusion. Review of literature and report of an additional case.  Arch Surg. 1970;  100 623-626
    PubMedGoogle Scholar
  • 45 Talbot RW, Heppell J, Dozois RR, Beart RW. Vascular complications of inflammatory bowel disease.  Mayo Clin Proc. 1986;  61 140-145
    CrossrefPubMedGoogle Scholar
  • 46 Tilanus HW. Budd-Chiari syndrome.  Br J Surg. 1995;  82 1023-1030
    PubMedGoogle Scholar
  • 47 Valla DC, Condat B. Portal vein thrombosis in adults: pathophysiology, pathogenesis and management.  J Hepatol. 2000;  32 865-871
    CrossrefPubMedGoogle Scholar
  • 48 Vecchi M, Sacchi E, Saibeni S. et al. . Inflammatory bowel diseases are not associated with major hereditary conditions predisposing to thrombosis.  Dig Dis Sci. 2000;  45 1465-1469
    CrossrefPubMedGoogle Scholar
  • 49 Warshaw AL, Jin GL, Ottinger LW. Recognition and clinical implications of mesenteric and portal vein obstruction in chronic pancreatitis.  Arch Surg. 1987;  122 410-415
    PubMedGoogle Scholar

Anschrift für die Verfasser

Dr. med. Stefan Turi

Medizinische Klinik C

Klinikum der Stadt Ludwigshafen gGmbH

Bremserstraße 79

67063 Ludwigshafen am Rhein

Fax: 06 21/5 03-41 14

Email: MedCLu@t-online.de

      >