The superior mesenteric vein is most commonly involved. Mesenteric vein thrombosis is a potentially lifethreatening vascular disorder of the mesenteric venous system, which can arise due to numerous genetic, circulatory, neoplastic, infectious or iatrogenic conditions. Mesenteric venous thrombosis mayo clinic proceedings. Mesenteric venous thrombosis mvt is an uncommon form of mesenteric ischemia, occurring far less often than mesenteric. A ct scan was notable for occlusive thrombosis of the superior mesenteric vein with extension into the main portal vein. Mesenteric venous thrombosis mvt accounts for 515% of reported cases of acute mesenteric ischemia 1,2. The presentation may vary from an entirely asymptomatic. Mesenteric venous thrombosis is an uncommon but potentially lethal cause of bowel ischemia. Mesenteric venous thrombosis after laparoscopic rouxeny. Percutaneous pharmacomechanical thrombectomy of acute. Mesenteric venous thrombosis mvt is an uncommon cause of mesenteric ischemia accounting for 515% of the cases. Mesenteric vein thrombosis an overview sciencedirect topics. The patient, whose medical history was remarkable for a recent 2 weeks before this admission uncomplicated resection of the ileum and sigmoid colon for a tubular adenoma, was transferred to our interventional radiology.
Clinical management of acute portalmesenteric vein thrombosis. Mvt may present with acute abdominal pain or may be an asymptomatic incidental finding on abdominal imaging. Request pdf mesenteric venous thrombosis objective. Superior mesenteric vein stenosis complicating crohns. Overview mesenteric venous thrombosis mvt describes acute, subacute, or chronic thrombosis of the superior or inferior mesenteric vein or branches. Pain associated with dvt is often described as being a cramp or ache in the calf or thigh.
Acute mesenteric venous thrombosis in a pregnant woman at 35weeks of gestation. In the past, most cases were thought to be secondary to other intraabdominal pathologic conditions such as malignancy, intraabdominal sepsis, or pancreatitis or were. Acute superior mesenteric vein thrombosis is one of the less common causes of acute mesenteric ischemia. Abdominal venous thrombosis is a rare form of venous thromboembolic disease in children.
Superior mesenteric vein thrombosis is a rare complication following laparoscopic bariatric surgery. Mesenteric venous thrombosis venous and lymphatic disorders. Mesenteric venous thrombosis and factors associated with mortality. Historically, mvt has been described as a morbid clinical entity, but this may not necessarily be true. Acute insufficiency of mesenteric arterial blood flow accounts for 60% 70% of instances of mesenteric ischemia, with mesenteric venous thrombosis occurring in only 5% of instances. Mesenteric venous thrombosis mvt is the least common cause of mesenteric ischemia, representing up to 10% of all patients with mesenteric ischemia and 18% of those with ami. The initial 34% mortality rate reported by warren and eberhard 3 in 1935 remains relatively unchanged. There are several risk factors which include hypercoagulable states, local trauma e. Vmi was diagnosed in the presence of smv thrombosis and ct evidence of jejunal thickening. Mesenteric and portal venous thrombosis treated by.
Case reports two cases of gastrointestinal bleeding occurring in patients with crohns disease, and a third case, presenting with pain and diarrhoea, are described. The diagnosisis usually delayed because the signsand symptoms are nonspecific. Due to improvements in imaging, the diagnosis of both acute mesenteric ischaemia and splanchnic venous thrombosis has become more timely and accurate than in previous years. In patients with acute mesenteric venous thrombosis, the 3year survival rate is only 36%. Pdf first differentiated from arterial causes of acute mesenteric ischemia 75 years ago, acute mesenteric venous thrombosis mvt is an uncommon. However, mesenteric venous thrombosis mvt is a rare complication of dcs. Acute mesenteric ischemia refers to the sudden onset of intestinal hypoperfusion, one cause of which can be mesenteric venous occlusion. Several imaging methods are available for diagnosis, each of which has advantages and disadvantages. Laparoscopic vertical sleeve gastrectomy lsg has become an alternative bariatric procedure in select patients 3. Mesenteric venous thrombosis occurs when a blood clot forms in one or more of the major veins that drain blood from your intestines. Acute mesenteric venous thrombosis is a rare but potentially fatal cause of abdominal pain, accounting for 69% of all mesenteric ischemia cases.
While mortality rates are low, a significant proportion of affected children may suffer longterm morbidity. Deep vein thrombosis should be suspected in any patient who presents with unexplained extremity swelling, pain, warmth or erythema. Primary mesenteric venous thrombosis a case report. Pain associated with dvt is often described as being a. All patients presented with mild to moderate peritonism, which allowed surgery to be.
Mesenteric venous thrombosis after laparoscopic sleeve. The acute form of the disease often presents with sudden severe abdominal pain and is associated with a high risk of death. Mesenteric vein thrombosis occurs rarely and is respon sible for approximately 515% of all cases of acute mes enteric ischemia. First differentiated from arterial causes of acute mesenteric ischemia 75 years ago, acute mesenteric venous thrombosis mvt is an uncommon disorder with nonspecific signs and symptoms, the. Acute mesenteric venous thrombosis is an uncommon condition. Treatment of acute superior mesenteric vein thrombosis with. Additionally, given the infrequency of these thrombi, there is lack of stringent research data and evidencebased treatment guidelines. Mesenteric vein thrombosis an overview sciencedirect. A form of mesenteric ischaemia caused by venous thrombosis, which has a high 30% mortality rate due to the delay in diagnosis. The full text of this article is available in pdf format.
Superior mesenteric artery thrombosis and partial dissection. Mesenteric venous thrombosis usually involves the superior mesenteric vein, with the danger of bowel infarction. Mesenteric venous thrombosis as a rare complication of. Acute superior mesenteric venous thrombosis in a young patient without risk factors in this case report, the authors address the diagnostic challenges of a young, healthy patient who presented to the ed with unrelenting abdominal pain. Acute mesenteric venous thrombosis is a rare but potentially fatal condition with a mortality rate of 2030%. Only after other causes of a hypercoagulable state have.
The anatomic site of involvement in acute mesenteric venous thrombosis is most often ileum 64 to 83 percent or jejunum 50 to 81 percent, followed by colon. The number of patients in this group has significantly decreased over the past decade because of improvement in diagnosis and. However, the specific aetiology may not be obvious. In hospital the mortality was lower for venous mesenteric infarction 5, 38 per cent than for mesenteric infarction of other aetiologies 7085, 82 per cent p 0002. Mesenteric vein thrombosis is increasingly recognized as a cause of mesenteric ischemia.
Imaging studies, primarily contrastenhanced computed tomography, are used to make the diagnosis. Fluorescein angiography with an ultraviolet lamp has also been used 15. The pattern and appearance of ischemic bowel is helpful in determining the cause of mesenteric ischemia. Despite thrombosis of the smv, small bowel necrosis is less likely to occur, presumably due to persistent arterial supply and some venous drainage via collaterals. Surgical intervention carried a high risk because of her underlying cirrhosis. Mesenteric venous thrombosis can be classified on the basis of its cause as primary or secondary. Like all thrombotic events, the formation of mesenteric venous thrombosis is a result of virchows triad endothelial injury, stasis of flow and hypercoagulability.
Mvt accounts for 515% of all cases of mesenteric ischemia 1,2. Frontiers thrombosis of the abdominal veins in childhood. Spontaneous, idiopathic thrombosis of the splanchnic veins not associated with any predisposing conditions has been termed primary mesenteric venous thrombosis. Apr, 2014 mesenteric venous thrombosis mvt is an uncommon cause of mesenteric ischemia accounting for 515% of the cases. A multitude of risk factors for acute portal vein thrombosis pvt mesenteric vein thrombosis mvt have been identified, including liver cirrhosis, malignancy, coagulation disorders, intraabdominal infectioninflammation, and postoperative condition. Mvt, defined as newonset symptomatic thrombosis of the superior mesenteric vein smv or its branches without evi dence of collateralization, typically. We describe a patient with liver cirrhosis who developed acute mvt while waiting for liver transplantation. To the best of our knowledge, only a few cases have been reported, and surgical. Mesenteric venous thrombosis may be the sentinel and only presentation of a hypercoagulable state. As such, a six to ten week course of anticoagulation intravenous heparin initially followed by oral warfarin was recommended. Mesenteric venous thrombosis mvt was first described as a distinct cause of mesenteric ischemia by warren and eberhard in 1935 1. Background venous thrombosis is a serious complication of combined contraceptive usage.
Aetiology idiopathic up to 50%, hypercoagulability e. Mesenteric venous thrombosis ian g harnik, lawrence j. Transabdominal color doppler ultrasonography 11 may demonstrate thrombus in the mesenteric veins, but computed tomography ct is the test of choice for suspected cases of mesenteric venous. May 14, 2017 acute mesenteric ischemia refers to the sudden onset of intestinal hypoperfusion, one cause of which can be mesenteric venous occlusion. Mesenteric venous thrombosis definition of mesenteric. To describe mesenteric venous thrombosis mvt as a pathological entity, as well as. Location, length of mesenteric venous thrombosis, transverse diameter of the vein, and mesenteric fat infiltration at diagnosis are determinant factors for mesenteric venous thrombosis evolution. This condition is rare, but it can lead to lifethreatening. Acute mesenteric ischaemia secondary to portal, splenic and. Acute thrombosis of the portal vein pv andor the mesenteric vein mv is a rare but potentially lifethreatening disease. Mvt must be distinguished from arterial and nonocclusive types of mesenteric ischemia, and accounts for 5% to 15% of all cases of mesenteric ischemia. It can come on suddenly, known as acute mesenteric ischemia, or gradually, known as chronic mesenteric ischemia. Mesenteric venous thrombosis is seen mainly in middleaged patients presenting with vague symptoms, which makes this a hard diagnosis to make in the acute care setting. Our practice has performed 800 lsg procedures for weight loss, with 3 cases.
Acute superior mesenteric vein smv and portal vein pv thrombosis can be a complication of hypercoagulable, inflammatory, or infectious states. Mesenteric venous thrombosis is seen predominantly in middleaged patients presenting with vague symptoms, which makes this a challenging diagnosis to make in the acute care setting. Often, an underlying disease process that predisposes a patient to mvt can be found and potentially treated. Bowel damage is in proportion to the mesenteric blood flow decrease and may vary from minimum lesions, due to reversible ischemia, to transmural injury, with subsequent necrosis and perforation.
Ct angiography of the abdomen showed thrombus extend from the proximal superior mesenteric artery 3 cm distal to the origin, with partial dissection of the superior mesenteric artery. Cureus isolated thrombosis of the superior mesenteric vein. A case of primary mesenteric venous thrombosis is reported below. This case is presented in the hope of contributing something of value to the literature on vascular accidents. Historically, the etiology of the thrombus was unknown in most patients. The number of patients in this group has significantly decreased over the past decade because of improvement in diagnosis. The clinical presentation, vague and misleading, may involve abdominal pain, nausea, vomiting, hematemesis, constipation or diarrhea and melena. With the improved sophistication in testing for hypercoagulable states, the underlying cause can now be. Superior mesenteric venous thrombosis, hypercoagulable state, ct abdominal scanner. Clinical findings vague abdominal discomfort that evolves over 710 days. Mesenteric venous thrombosis mvt accounts for less than 10% of cases of mesenteric infarction. Decompression sickness dcs induced by extravascular and intravascular gas bubbles during decompression can present with varying manifestations, such as joint pain, numbness, cutaneous symptoms, and cardiopulmonary dysfunction. Mesenteric venous thrombosis mesenteric venous thrombosis mvt accounts for less than 10% of cases of mesenteric infarction. Mesenteric venous thrombosis mvt describes acute, subacute, or chronic thrombosis of the superior or inferior mesenteric vein or branches.
Mesenteric venous thrombosis mvt is a rare insidious condition with an incidence of 2. He was given intravenous fluid and was started on intravenous heparin. The presentation may vary from an entirely asymptomatic clinical scenario to intestinal infarction and shock. What is the pathophysiology of mesenteric venous thrombosis. Acute insufficiency of mesenteric arterial blood flow accounts for 60%70% of instances of mesenteric ischemia, with mesenteric venous thrombosis occurring in only 5% of instances. Acute mesenteric venous thrombosis in a pregnant woman at. A diagnosis of mesenteric venous thrombosis mvt is usually confirmed during laparotomy or autopsy. A 44year old male presented to the ed complaining of abdominal pain. Intestinal ischemia secondary to superior mesenteric venous.
Guidance for the treatment of deep vein thrombosis and. Any information contained in this pdf file is automatically generated from. Background superior mesenteric vein stenosis as a consequence of mesenteric fibrosis, causing the development of small bowel varices, is an unrecognised association of crohns disease. Non operative management of superior mesenteric and portal. It can be either acute presenting commonly with abdominal pain or chronic presenting with features of portal hypertension. Acute superior mesenteric venous thrombosis in a young. Cardiac source embolism to the superior mesenteric artery usually lodges in the vessel distal to the. Primary mesenteric venous thrombosis since the report of berry and bougas 15 in 19. Mesenteric vein thrombosis mvt is a rare cause of intestinal ischemia. Mesenteric venous thrombosis following bariatric surgery. Pdf acute mesenteric venous thrombosis induced by smoking. Review article current concepts michigan state university.
All hypercoagulable workup was done to rule out the causes of. The newer imaging techniques allow earlier diagnosis. From the history obtained it was difficult to estimate how long the mesenteric thrombosis had been present when the patient was first seen. Thrombosis is attributed to a combination of virchows triad, i. First differentiated from arterial causes of acute mesenteric ischemia 75 years ago, acute mesenteric venous thrombosis mvt is an uncommon disorder with nonspecific signs and symptoms, the diagnosis of which requires a high index of suspicion. Acute thrombosis may be difficult to detect in noncontrast studies or at the. In part, this reflects the high rate of recurrence in this population, ranging from 14% to 71%. Nonneoplastic portal vein thrombosis pvt is an uncommon complication of liver cirrhosis.
Mesenteric venous thrombosis mvt and its clinical spectrum have become better defined following improvements in diagnostic imaging. The location, extent, and rapidity of thrombus formation determine whether intestinal infarction. Mesenteric venous thrombosis article pdf available in american journal of roentgenology 1794. In addition to accepted risk factors of hypercoagulability and localabdominal processes, increased intraabdominal pressure, intraoperative manipulation, or extrinsic anatomical compression might also contribute to venous compromise. Patients may have evocative signs, such as abdominal pain, nausea, or vomiting. Mesenteric venous thrombosis mvt is a blood clot in one or more of the major veins that drain blood from the intestine. Mesenteric venous thrombosis ian g harnik and lawrence j brandt abstract first differentiated from arterial causes of acute mesenteric ischemia 75 years ago, acute mesenteric venous thrombosis mvt is an uncommon disorder with nonspecific signs and symptoms, the diagnosis of which requires a high index of suspicion. Mesenteric venous thrombosis mvt is an infrequent thrombotic event that can. Therefore, acute mi ami can occur as a result of arterial embolism, arterial thrombosis, mesenteric venous thrombosis and nonocclusive causes.
Most cases of acute mesenteric venous thrombosis evolve toward the chronic form with vein stenosis or occlusion and development of collateral veins. Nonetheless, pediatric hematologists and other subspecialists. Mesenteric ischemia is a medical condition in which injury to the small intestine occurs due to not enough blood supply. Patients with primary venous mesenteric infarction showed a better survival rate one death in eight patients than patients with associated diseases such as liver. Mesenteric venous thrombosis mvt is the cause of 2. The inferior mesenteric vein imv drains the left colon and enters into the splenic vein. Mvt may present with acute abdominal pain or may be an asymptomatic incidental. Both acute and chronic forms have been described in the literature. Mesenteric venous thrombosis circulation aha journals. Superior mesenteric vein thrombosis radiology case. It can also occur as a complication of medical or surgical.