Purpose: Mesenteric venous thrombosis (MVT) and its clinical spectrum have become better defined following improvements in diagnostic imaging. Historically, MVT has been described as a morbid clinical entity, but this may not necessarily be true. Often, an underlying disease process that predisposes a patient to MVT can be found and potentially treated. This study was designed to evaluate the diagnostics and management of MVT and to review long-term results of treatment.
Method: Fifteen patients in whom MVT was diagnosed from 1989 and March 2003 were retrospectively reviewed.
Result: There were 11 men and 4 women. Ages ranged from 29 to 73 years (mean, 47.4 years). 2 had a history of previous abdominal surgery, 3 had a prior hepatobiliary disease (liver cirrhrosis, pancreatitis), and 2 had a vascular disease (Buerger’s disease, Behcet’s vasculitis). MVT was presented as abdominal pain (73%) and diarrhea (60%). Computed tomography (CT) scan was considered diagnostic in all of 15 patients who underwent the diagnostic examination. The CT scan diagnosed MVT in 15 (100%) of 15 patients presenting with vague abdominal pain or diarrhea. Angiography demonstrated MVT in only two previous vascular disease patients. Thrombus of 9 patients (60%) located in only superior mesenteric vein thrombosis and 6 patients combined with superior mesenteric artery. One of 15 (6.7%) patient died after 30 days. All patients were initially and post operatively treated with low-molecular heparin and switched warfarin sodium (Coumadin). Two patients became symptom free without anticoagulation. 13 patients (87%) underwent bowel resection.
Conclusion: Clinicians should consider the possibility of acute mesenteric venous thrombosis when faced with a patient having abdominal pain out of proportion to the physical findings and with a negative workup for the common causes of abdominal pain especially in patients with prior thrombotic episodes or a documented coagulopathy. CT scanning appears to be the primary diagnostic test of choice. Anticoagulation is recommended. If diagnossis and proper management is performed early, MVT is not likely to progress to gangrenous bowel. Recent mortality rates for MVT are lower than previously published, perhaps because of earlier diagnosis and aggressive treatment or possibly because we now readily diagnose a more benign form of the disease, which is due to widespread use of CT scanning. (J Korean Soc Phlebol 2004;3:32-35)
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