Seven of these 16 patients had previous deep vein thrombosis. Acute mesenteric venous thrombosis is an uncommon condition. Intestinal ischemia secondary to superior mesenteric venous. A number of conditions can cause mesenteric vein thrombosis, a vascular abnormality that is responsible for about 515% of all cases of mesenteric ischemia 1 2. 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.
Very few cases of superior mesenteric vein thrombosis have been reported as a complication of appendicitis. 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. Pdf superior mesenteric vein thrombosis researchgate. Mesenteric venous thrombosis circulation aha journals. Case reports two cases of gastrointestinal bleeding occurring in patients with crohns disease, and a third case, presenting with pain and diarrhoea, are described. Acute portal vein thrombosis pvt and superior mesenteric vein thrombosis smvt are relatively rare but insidious and potentially lethal abdominal diseases. Rg f volume 22 number 3 bradbury et al 531 figure 2. Superior mesenteric arterial catheter directed tpa for. In this study, we analyzed and compared the results obtained with surgical and medical treatment to determine the best initial management for this disease. Management of mesenteric and portal vein thrombosis includes both operative and nonoperative approaches. Ddimer as an early marker of severity in patients with acute superior mesenteric venous thrombosis. Mesenteric vein thrombosis is categorized as primary if no cause is identified or secondary if a hypercoagulable state or other prothrombotic condition is present table. Acute insufficiency of mesenteric arterial blood flow accounts for 60% 70% of instances of mesenteric.
Superior mesenteric vein thrombosis is a rare condition with an incidence varying between 0. Superior mesenteric vein thrombosis with radiologically. 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. Acute mesenteric ischemia ami is defined as a sudden interruption of the blood supply to a segment of the small intestine, leading to ischemia, intestinal necrosis, and potentially fatal illness. The superior mesenteric vein is a blood vessel that drains blood from the small intestine jejunum and ileum. Multidetector ct features of mesenteric vein thrombosis. To compare the ancillary ct findings between superior mesenteric artery thromboembolism smat and superior mesenteric vein thrombosis smvt, and to determine the independent ct findings of lifethreatening mesenteric occlusion. Associated portal venous thrombosis can be seen if the.
Acute thrombosis of the portal vein pv andor the mesenteric vein mv is a rare but potentially lifethreatening disease. Each of the aforementioned conditions requires a different approach to diagnosis and management. However, superior mesenteric venous thrombosis as a result of acute cytomegalovirus cmv infection is extremely rare, especially in immunocompetent patients. Thrombosis commonly involves the superior mesenteric vein, but rarely the inferior mesenteric vein. Mvt is a clot that blocks blood flow in a mesenteric vein. Superior mesenteric vein thrombosis as a complication of. Venous causes of acute mesenteric ischemia are less common 5%15% of cases 4,9 and are most often the result of a thrombosis of the superior mesenteric vein smv. Clinical management of acute portalmesenteric vein thrombosis. Superior mesenteric vein thrombosis mimicking acute. In these handful of cases, the thrombosis was identified early with computerised tomography scan and patients have been managed conservatively. There is evidence of filling defect in the superior mesenteric vein and its tributaries due to an isodense material within the lumen of the veins suggestive of acute superior mesenteric vein thrombosis.
Superior mesenteric vein thrombosis smvt is an uncommon disorder with nonspecific signs and symptoms, where missed catastrophic consequences often follow secondary to disease progression. Mesenteric venous thrombosis mvt is an uncommon form of mesenteric ischemia, occurring far less often than mesenteric ischemia resulting from arterial embolism or thrombosis. In the setting of antiphospholipid syndrome, it is rare. Acute appendicitis complicating into portal and superior. Chronic mesenteric ischemia, also known as intestinal angina, is most often due to arterial atherosclerotic disease.
It can be either acute presenting commonly with abdominal pain or chronic presenting with features of portal hypertension. Some authors have proposed a surgical approach, whereas others have advocated medical therapy anticoagulation. Mesenteric venous thrombosis mayo clinic proceedings. An abdominal xray documented only coprostasis, while ultrasound was suggestive of portal vein thrombosis. Apr 24, 2012 mesenteric venous thrombosis accounts for 5% to 15% of all mesenteric ischemic events and usually involves the superior mesenteric vein. 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 statpearls ncbi bookshelf. Apr, 2014 thrombosis of the larger distal portions of the mesenteric vein is mostly secondary to local factors, such as malignancy, pancreatitis and infection, and is associated with portal vein thrombosis while thrombosis that originate from the vena rectae, leading to isolated mvt thrombosis is most commonly related to a prothrombotic state. Ct scan demonstrating cavernous change of superior mesenteric vein as consequence of venous thrombosis. Acute superior mesenteric vein thrombosis is an uncommon but life threatening disease condition. Acute superior mesenteric vein thrombosis with small. May 14, 2017 acute superior mesenteric vein smv and portal vein pv thrombosis can be a complication of hypercoagulable, inflammatory, or infectious states.
The superior mesenteric vein is most commonly involved. Smallbowel necrosis complicating a cytomegalovirusinduced. A ct scan showed thrombosis of the superior mesenteric and portal veins, mesenteric and small bowel wall edema and free abdominal fluid. Imaging studies, primarily contrastenhanced computed tomography, are used to make the diagnosis. Mesenteric venous thrombosis mvt describes acute, subacute, or chronic thrombosis of the superior or inferior mesenteric vein or branches. We report here a case of superior mesenteric vein smv thrombosis in a 21 year old male patient with no history of crohns disease or other risk factors of thrombosis. What is the optimal treatment of superior mesenteric veinportal vein. We present the case of an immunocompetent man with acute superior mesenteric vein. Superior mesenteric vein stenosis complicating crohns. A ct scan was considered to be positive for mvt when a thrombus in the superior mesenteric vein or an abnormal thickening of ischemic bowel wall with streaky mesentery was demonstrated. Overview mesenteric venous thrombosis mvt describes acute, subacute, or chronic thrombosis of the superior or inferior mesenteric vein or branches. Superior mesenteric vein thrombosis is a rare complication following laparoscopic bariatric surgery. Acute mesenteric ischemia ami is typically defined as a group of diseases characterized by an interruption of the blood supply to varying portions of the small intestine, leading to ischemia and secondary inflammatory changes. Non operative management of superior mesenteric and portal.
For example, patients with pancreatitis or pancreatic cancer, hepatic malignancy and portal vein thrombosis, cirrhosis, and portal. Mvt involves the superior mesenteric vein in 95% of cases and the inferior mesenteric vein, which supplies the wellcollateralized distal colon, in only 4% to 6% of cases. May 23, 2011 mesenteric vein thrombosis is categorized as primary if no cause is identified or secondary if a hypercoagulable state or other prothrombotic condition is present table. A ct scan was notable for occlusive thrombosis of the superior mesenteric vein with extension into the main portal vein. Mesenteric vein thrombosis an overview sciencedirect topics. Mesenteric vein thrombosis an overview sciencedirect.
Mesenteric vein thrombosis mvt is a rare insidious disease with a high mortality rate, estimated to occur in 5% to 15% of patients with acute mesenteric ischemia. There are two such veins through which blood leaves the intestine. Acute superior mesenteric vein smv and portal vein pv thrombosis can be a complication of hypercoagulable, inflammatory, or infectious states. It is recognized as a clinical entity since 1935, by warren and eberhardt 3. Seven of these 16 patients had previous deepvein thrombosis. Superior mesenteric vein thrombosis radiology case. Minimal free fluid in around the liver and in the right pericolic gutter.
Mesenteric venous thrombosis accounts for 5% to 15% of all mesenteric ischemic events and usually involves the superior mesenteric vein. Portal vein thrombosis pvt may occur in 10 25% of patients with cirrhosis and may also be associated with hepatocellular carcinoma. Mesenteric vein thrombosis primarily involves superior mesenteric vein, and occasionally portal vein with or without acute ischemia of distal small bowel. It can also occur as a complication of medical or surgical intervention. The most common sites involved are ileum and jejunum. Systemic anticoagulation as well as systemic tissue plasminogen activator tpa both have high failure rates in cases of high grade. This case report highlights an unusual complication of. Acute superior mesenteric venous thrombosis in a young. Portomesenteric vein thrombosis after gastric surgery. 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. Embolization of the superior mesenteric artery is responsible for nearly half of all acute mesenteric ischemias, and a thrombosis at the ori. However, with the advent of readily available, highly sensitive, speci. At its termination behind the neck of the pancreas, the superior mesenteric vein combines with the splenic vein to form the hepatic portal vein.
There is evidence of superior mesenteric vein and portal vein thrombosis causing proximal small bowel dilatation and wall thickening with poor enhancement of dilated small bowel loops with suspicion pneumatosis intestinalis highly suggestive for ischemia. What is the optimal treatment of superior mesenteric vein. Pdf on feb 25, 2006, a brandt and others published superior mesenteric vein thrombosis find, read and cite all the research you need on researchgate. Patients were included in the study if they were older than 2 years and had acute thrombosis in the superior mesenteric vein with radiologically occult cause. Recently, there has been a significant increase in the number of these cases after bariatric surgery. Upper gastrointestinal bleeding in superior mesenteric. Upper gastrointestinal bleeding in superior mesenteric vein. Mesenteric venous air red arrows and free intraperitoneal air white arrow.
Mesenteric venous thrombosis mvt is an uncommon cause of mesenteric ischemia accounting for 515% of the cases. Mesenteric venous thrombosis mvt is a blood clot in one or more of the major veins that drain blood from the intestine. Portomesenteric venous thrombosis in a 73yearold woman with abdominal pain and chole cystitis. The diagnosis of acute superior mesenteric venous thrombosis was made. Case report an 80yearold man presented to the emergency department complaining of progressive, worsening abdominal pain for 3 days and fever, which began on that morning.
If untreated, this process will eventuate in life threatening intestinal necrosis. Mesenteric vein thrombosis is increasingly recognized as a cause of mesenteric ischemia. Mesenteric vein thrombosis almost always involves the distal small intestine superior mesenteric venous drainage and rarely involves the colon inferior mesenteric venous drainage. Superior mesenteric vein is the most common site of thrombi formation, resulting in impaired venous return and subsequent venous engorgement and bowel ischemia. It was first described by elliot 1 in 1895 as intestinal gangrene resulting from thrombosis of the portomesenteric venous system. Unlike arterial thrombosis, the clinical line of demarcation is often not distinct for venous thrombosis. The newer imaging techniques allow earlier diagnosis. Its diagnosis is often delayed due to its nonspecific abdominal symptoms, low incidence, and low awareness among clinicians. Treatment of superior mesenteric vein thrombus by catheter. Mesenteric venous thrombosis journal of vascular surgery. The incidence of mesenteric venous thrombosis is 2.
The superior mesenteric vein is often involved, whereas involvement of the inferior mesenteric vein is rare. Intestinal ischemia secondary to superior mesenteric. Treatment of acute superior mesenteric vein thrombosis. Inherited coagulopathies and thrombophilias antithrombin, protein c, protein s, or factor v leiden deficiencies, local disorders pancreatitis, diverticulitis, peritonitis, and other inflammatory diseases, obesity, neoplasias. 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.
Acute superior mesenteric vein thrombosis associated with. Acute thrombosis of the portal vein pv and superior mesenteric vein smv is a relatively rare but insidious and potentially lethal abdominal complication. Smallbowel necrosis complicating a cytomegalovirus. Acute mesenteric ischemia refers to the sudden onset of intestinal hypoperfusion, one cause of which can be mesenteric venous occlusion. Acute superior mesenteric vein thrombosis in a patient with. Twelve patients had progressive abdominal pain, three had gastrointestinal bleeding, and one had general malaise. After negative routine gastrointestinal and hepatobiliary evaluation, 11 patients underwent an infusion. But thrombosis does occur in the inferior mesenteric vein resulting in ischemia of the colonic segment 6. 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. Serological markers showed neutrophilic leukocytosis, a mild increase in crp and normal serum lactates. A detailed description of mesenteric artery thrombosis is outside the scope of this chapter but is provided in other sources. Acute thrombotic process of mesenteric veins leads to decreased blood flow. Isolated superior mesenteric vein thrombosis in acute.
Hyperhomocysteinemia is one of the known causes of secondary venous thromboembolism vte and is specifically linked to the occurrence of mesenteric thromboses. Initial treatment in the management of acute mesenteric vein thrombosis mvt is controversial. Both acute and chronic forms have been described in the literature. Treatment of acute superior mesenteric vein thrombosis with. Mesenteric venous thrombosis following bariatric surgery. Pdf first differentiated from arterial causes of acute mesenteric ischemia 75 years ago, acute mesenteric venous thrombosis mvt is an uncommon. Mvt may present with acute abdominal pain or may be an asymptomatic incidental.
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