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. Like all thrombotic events, the formation of mesenteric venous thrombosis is a result of virchows triad endothelial injury, stasis of flow and hypercoagulability. Acute superior mesenteric venous thrombosis in a young. Mvt may present with acute abdominal pain or may be an asymptomatic incidental finding on abdominal imaging. Surgical intervention carried a high risk because of her underlying cirrhosis. Overview mesenteric venous thrombosis mvt describes acute, subacute, or chronic thrombosis of the superior or inferior mesenteric vein or branches. To the best of our knowledge, only a few cases have been reported, and surgical. Mesenteric vein thrombosis mvt is a rare cause of intestinal ischemia. A case of primary mesenteric venous thrombosis is reported below. Mesenteric venous thrombosis ian g harnik, lawrence j. Mesenteric venous thrombosis mvt is the cause of 2.
Nonneoplastic portal vein thrombosis pvt is an uncommon complication of liver cirrhosis. Apr, 2014 mesenteric venous thrombosis mvt is an uncommon cause of mesenteric ischemia accounting for 515% of the cases. All hypercoagulable workup was done to rule out the causes of. Superior mesenteric vein thrombosis radiology case. The location, extent, and rapidity of thrombus formation determine whether intestinal infarction. However, the specific aetiology may not be obvious. To describe mesenteric venous thrombosis mvt as a pathological entity, as well as. Superior mesenteric venous thrombosis, hypercoagulable state, ct abdominal scanner. Mesenteric venous thrombosis and factors associated with mortality. Mesenteric venous thrombosis mesenteric venous thrombosis mvt accounts for less than 10% of cases of mesenteric infarction.
Mesenteric venous thrombosis mvt is an infrequent thrombotic event that can. 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 mvt accounts for 515% of reported cases of acute mesenteric ischemia 1,2. Thrombosis is attributed to a combination of virchows triad, i. Both acute and chronic forms have been described in the literature. The pattern and appearance of ischemic bowel is helpful in determining the cause of mesenteric ischemia. The number of patients in this group has significantly decreased over the past decade because of improvement in diagnosis. He was given intravenous fluid and was started on intravenous heparin. Acute superior mesenteric vein thrombosis is one of the less common causes of acute mesenteric ischemia. In part, this reflects the high rate of recurrence in this population, ranging from 14% to 71%. 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 thrombosis may be difficult to detect in noncontrast studies or at the.
A 44year old male presented to the ed complaining of abdominal pain. 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. Pain associated with dvt is often described as being a cramp or ache in the calf or thigh. 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. Therefore, acute mi ami can occur as a result of arterial embolism, arterial thrombosis, mesenteric venous thrombosis and nonocclusive causes. Often, an underlying disease process that predisposes a patient to mvt can be found and potentially treated. Mesenteric venous thrombosis mvt is a rare insidious condition with an incidence of 2. Cureus isolated thrombosis of the superior mesenteric vein. Spontaneous, idiopathic thrombosis of the splanchnic veins not associated with any predisposing conditions has been termed primary mesenteric venous thrombosis. 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. Pain associated with dvt is often described as being a. It can come on suddenly, known as acute mesenteric ischemia, or gradually, known as chronic mesenteric ischemia. 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. 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. Acute superior mesenteric vein smv and portal vein pv thrombosis can be a complication of hypercoagulable, inflammatory, or infectious states. Mesenteric venous thrombosis mvt is an uncommon cause of mesenteric ischemia accounting for 515% of the cases. The newer imaging techniques allow earlier diagnosis. Acute mesenteric venous thrombosis is a rare but potentially fatal condition with a mortality rate of 2030%. Guidance for the treatment of deep vein thrombosis and.
Frontiers thrombosis of the abdominal veins in childhood. 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. While mortality rates are low, a significant proportion of affected children may suffer longterm morbidity. Non operative management of superior mesenteric and portal.
Mesenteric venous thrombosis venous and lymphatic disorders. This case is presented in the hope of contributing something of value to the literature on vascular accidents. 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. Mesenteric ischemia is a medical condition in which injury to the small intestine occurs due to not enough blood supply. Nonetheless, pediatric hematologists and other subspecialists. 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.
Several imaging methods are available for diagnosis, each of which has advantages and disadvantages. From the history obtained it was difficult to estimate how long the mesenteric thrombosis had been present when the patient was first seen. Mesenteric venous thrombosis after laparoscopic sleeve. What is the pathophysiology of mesenteric venous thrombosis. Any information contained in this pdf file is automatically generated from. Acute mesenteric venous thrombosis is an uncommon condition.
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. Abdominal venous thrombosis is a rare form of venous thromboembolic disease in children. Mesenteric venous thrombosis mvt was first described as a distinct cause of mesenteric ischemia by warren and eberhard in 1935 1. The superior mesenteric vein is most commonly involved. Mesenteric venous thrombosis circulation aha journals. The presentation may vary from an entirely asymptomatic clinical scenario to intestinal infarction and shock. 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 is seen predominantly in middleaged patients presenting with vague symptoms, which makes this a challenging diagnosis to make in the acute care setting.
In the past, most cases were thought to be secondary to other intraabdominal pathologic conditions such as malignancy, intraabdominal sepsis, or pancreatitis or were. Superior mesenteric vein stenosis complicating crohns. Superior mesenteric artery thrombosis and partial dissection. Acute mesenteric venous thrombosis is a rare but potentially fatal cause of abdominal pain, accounting for 69% of all mesenteric ischemia cases. Mvt may present with acute abdominal pain or may be an asymptomatic incidental. Mesenteric vein thrombosis is increasingly recognized as a cause of mesenteric ischemia. Background venous thrombosis is a serious complication of combined contraceptive usage. Acute mesenteric ischaemia secondary to portal, splenic and. All patients presented with mild to moderate peritonism, which allowed surgery to be. Mesenteric vein thrombosis almost always involves the distal small intestine superior mesenteric venous drainage and rarely involves the colon inferior mesenteric venous drainage.
There are several risk factors which include hypercoagulable states, local trauma e. In patients with acute mesenteric venous thrombosis, the 3year survival rate is only 36%. Treatment of acute superior mesenteric vein thrombosis with. Clinical management of acute portalmesenteric vein thrombosis. However, mesenteric venous thrombosis and intestinal necrosis are infrequently seen in women using oral. Mesenteric venous thrombosis article pdf available in american journal of roentgenology 1794. Mesenteric venous thrombosis mvt and its clinical spectrum have become better defined following improvements in diagnostic imaging. Mesenteric venous thrombosis may be the sentinel and only presentation of a hypercoagulable state. Pdf first differentiated from arterial causes of acute mesenteric ischemia 75 years ago, acute mesenteric venous thrombosis mvt is an uncommon. 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. Historically, mvt has been described as a morbid clinical entity, but this may not necessarily be true.
Mesenteric venous thrombosis after laparoscopic rouxeny. 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. Mvt accounts for 515% of all cases of mesenteric ischemia 1,2. Superior mesenteric vein thrombosis is a rare complication following laparoscopic bariatric surgery. 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. 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.
Mesenteric venous thrombosis is an uncommon but potentially lethal cause of bowel ischemia. Mesenteric venous thrombosis mvt is an uncommon form of mesenteric ischemia, occurring far less often than mesenteric. Only after other causes of a hypercoagulable state have. 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. 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. Mvt must be distinguished from arterial and nonocclusive types of mesenteric ischemia, and accounts for 5% to 15% of all cases of mesenteric ischemia. Acute mesenteric venous thrombosis in a pregnant woman at 35weeks of gestation. Cardiac source embolism to the superior mesenteric artery usually lodges in the vessel distal to the. Historically, the etiology of the thrombus was unknown in most patients.
The acute form of the disease often presents with sudden severe abdominal pain and is associated with a high risk of death. 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. Mesenteric venous thrombosis can be classified on the basis of its cause as primary or secondary. However, mesenteric venous thrombosis mvt is a rare complication of dcs. A diagnosis of mesenteric venous thrombosis mvt is usually confirmed during laparotomy or autopsy. Percutaneous pharmacomechanical thrombectomy of acute. Mesenteric venous thrombosis mvt describes acute, subacute, or chronic thrombosis of the superior or inferior mesenteric vein or branches.
Mesenteric vein thrombosis an overview sciencedirect. Mesenteric vein thrombosis occurs rarely and is respon sible for approximately 515% of all cases of acute mes enteric ischemia. Mesenteric venous thrombosis mvt accounts for less than 10% of cases of mesenteric infarction. Mesenteric venous thrombosis as a rare complication of. Intestinal ischemia secondary to superior mesenteric venous. Mesenteric venous thrombosis occurs when a blood clot forms in one or more of the major veins that drain blood from your intestines. Review article current concepts michigan state university. Fluorescein angiography with an ultraviolet lamp has also been used 15. It can be either acute presenting commonly with abdominal pain or chronic presenting with features of portal hypertension. We describe a patient with liver cirrhosis who developed acute mvt while waiting for liver transplantation. Primary mesenteric venous thrombosis a case report. Mesenteric venous thrombosis has been described to occur in cases where there has been no apparent cause. Clinical findings vague abdominal discomfort that evolves over 710 days.
Vmi was diagnosed in the presence of smv thrombosis and ct evidence of jejunal thickening. 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. Mesenteric vein thrombosis an overview sciencedirect topics. Imaging studies, primarily contrastenhanced computed tomography, are used to make the diagnosis. Patients may have evocative signs, such as abdominal pain, nausea, or vomiting. Mesenteric and portal venous thrombosis treated by. Most cases of acute mesenteric venous thrombosis evolve toward the chronic form with vein stenosis or occlusion and development of collateral veins.
This condition is rare, but it can lead to lifethreatening. Request pdf mesenteric venous thrombosis objective. Mvt, defined as newonset symptomatic thrombosis of the superior mesenteric vein smv or its branches without evi dence of collateralization, typically. 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. 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. Mesenteric venous thrombosis mvt is a blood clot in one or more of the major veins that drain blood from the intestine. The number of patients in this group has significantly decreased over the past decade because of improvement in diagnosis and. The presentation may vary from an entirely asymptomatic.
Deep vein thrombosis should be suspected in any patient who presents with unexplained extremity swelling, pain, warmth or erythema. Aetiology idiopathic up to 50%, hypercoagulability e. Pdf acute mesenteric venous thrombosis induced by smoking. Mesenteric venous thrombosis mayo clinic proceedings. 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. Acute mesenteric ischemia refers to the sudden onset of intestinal hypoperfusion, one cause of which can be mesenteric venous occlusion. The inferior mesenteric vein imv drains the left colon and enters into the splenic vein. Mesenteric venous thrombosis usually involves the superior mesenteric vein, with the danger of bowel infarction. The initial 34% mortality rate reported by warren and eberhard 3 in 1935 remains relatively unchanged. As such, a six to ten week course of anticoagulation intravenous heparin initially followed by oral warfarin was recommended.
Primary mesenteric venous thrombosis since the report of berry and bougas 15 in 19. 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. Our practice has performed 800 lsg procedures for weight loss, with 3 cases. A ct scan was notable for occlusive thrombosis of the superior mesenteric vein with extension into the main portal vein. Acute thrombosis of the portal vein pv andor the mesenteric vein mv is a rare but potentially lifethreatening disease. Mesenteric venous thrombosis definition of mesenteric.
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