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Thrombosis of mesenteric artery — Clinical Guidelines

Overview

Mesenteric venous thrombosis (MVT) is a rare but severe condition characterized by thrombosis within the mesenteric venous system, leading to intestinal ischemia and potentially significant morbidity or mortality 1 4 10 14.

Diagnosis

Clinical Presentation: Nonspecific abdominal pain, nausea, vomiting, and gastrointestinal bleeding 4 10 20.

Imaging: Enhanced CT and MRI are crucial for early diagnosis, showing characteristic findings such as mesenteric stranding and venous congestion 2 11 17.

Ultrasound: Useful in initial assessment but may have limitations in definitive diagnosis 1 11.

Laboratory Tests: Elevated inflammatory markers and coagulation studies may support the diagnosis 1 14.

Management

Anticoagulation: Direct oral anticoagulants (DOACs) and vitamin K antagonists are used for treatment; specific dosing varies but generally follows standard protocols for venous thrombosis 3 13.

Thrombolysis: Percutaneous transhepatic thrombolysis with agents like urokinase can be effective in extensive cases 8 16.

Surgical Intervention: Bowel resection may be necessary for bowel infarction or persistent ischemia 8 11 14.

Antibiotics: Empiric antibiotic therapy is sometimes used to prevent secondary infection, though evidence for its efficacy is limited 1.

Special Populations

Pregnancy: Limited data; careful consideration of anticoagulation risks and benefits is essential 26.

Elderly: Higher risk of complications; tailored management focusing on anticoagulation and close monitoring is advised 6 19.

Comorbidities: Hypercoagulable states, such as antithrombin III deficiency, increase risk and require specific management 21 28.

Key Recommendations

Early Imaging: Utilize CT or MRI for early diagnosis to improve outcomes 2 11 17 (Evidence: Strong).

Anticoagulation Therapy: Initiate anticoagulation with DOACs or vitamin K antagonists for treatment 3 13 (Evidence: Moderate).

Surgical Consultation: Consider surgical intervention for bowel infarction or refractory ischemia 8 11 14 (Evidence: Moderate).

Empiric Antibiotics: Use cautiously, as evidence for their benefit in MVT is limited 1 (Evidence: Weak).

Monitor for Comorbidities: Tailor management in patients with hypercoagulable states or advanced age 6 21 28 (Evidence: Moderate).

References

1 Lewcun JA, Khatun R, Allen S, Hazelton JP, Cooper A. Patient Outcomes in Mesenteric Venous Thrombosis Treated With Empiric Antibiotics. The American surgeon 2021. link 2 Acosta S, Salim S. Management of Acute Mesenteric Venous Thrombosis: A Systematic Review of Contemporary Studies. Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society 2021. link 3 Salim S, Ekberg O, Elf J, Zarrouk M, Gottsäter A, Acosta S. Evaluation of direct oral anticoagulants and vitamin K antagonists in mesenteric venous thrombosis. Phlebology 2019. link 4 Berbari I, Safa R, Abou Dagher G. Mesenteric venous thrombosis presenting as gastrointestinal bleeding, a challenging diagnosis. The American journal of emergency medicine 2019. link 5 Somma F, Berritto D, Iacobellis F, Landi N, Cavaliere C, Corona M et al.. 7T μMRI of mesenteric venous ischemia in a rat model: timing of the appearance of findings. Magnetic resonance imaging 2013. link 6 Galukande M, Fualal J, Nyangoma E. Mesenteric venous thrombosis in Uganda: a retrospective study of five cases. African health sciences 2009. link 7 Hotoleanu C, Andercou O, Andercou A. Mesenteric venous thrombosis: clinical and therapeutical approach. International angiology : a journal of the International Union of Angiology 2008. link 8 Lopera JE, Correa G, Brazzini A, Ustunsoz B, Patel S, Janchai A et al.. Percutaneous transhepatic treatment of symptomatic mesenteric venous thrombosis. Journal of vascular surgery 2002. link 9 Morasch MD, Ebaugh JL, Chiou AC, Matsumura JS, Pearce WH, Yao JS. Mesenteric venous thrombosis: a changing clinical entity. Journal of vascular surgery 2001. link 10 Choudhary AM, Grayer D, Nelson A, Roberts I. Mesenteric venous thrombosis: a diagnosis not to be missed!. Journal of clinical gastroenterology 2000. link 11 Rijs J, Depreitere B, Beckers A, Van Lerberghe E, Vollon H, Swinnen F. Mesenteric venous thrombosis. Diagnostic and therapeutic approach. Acta chirurgica Belgica 1997. link 12 Silvestri F, Dardik H, Vasquez R, Panella V, Lipman S. Mesoportal bypass: a unique operation for mesenteric hypertension. Journal of vascular surgery 1995. link70067-6) 13 Papalambros E, Bastounis E, Cyrochristos D, Balas P. Mesenteric venous thrombosis due to coagulation deficiencies - a case report. International angiology : a journal of the International Union of Angiology 1995. link 14 Rhee RY, Gloviczki P, Mendonca CT, Petterson TM, Serry RD, Sarr MG et al.. Mesenteric venous thrombosis: still a lethal disease in the 1990s. Journal of vascular surgery 1994. link70155-5) 15 Ellis DJ, Brandt LJ. Mesenteric venous thrombosis. The Gastroenterologist 1994. link 16 Crouch MA. Urokinase therapy in mesenteric venous thrombosis: a case study. Journal of vascular nursing : official publication of the Society for Peripheral Vascular Nursing 1993. link 17 Grieshop RJ, Dalsing MC, Cikrit DF, Lalka SG, Sawchuk AP. Acute mesenteric venous thrombosis. Revisited in a time of diagnostic clarity. The American surgeon 1991. link 18 Font VE, Hermann RE, Longworth DL. Chronic mesenteric venous thrombosis: difficult diagnosis and therapy. Cleveland Clinic journal of medicine 1989. link 19 Tay SK, Leong YP. Primary mesenteric venous thrombosis--a case report. The Medical journal of Malaysia 1989. link 20 Montany PF, Finley RK. Mesenteric venous thrombosis. The American surgeon 1988. link 21 Wilson C, Walker ID, Davidson JF, Imrie CW. Mesenteric venous thrombosis and antithrombin III deficiency. Journal of clinical pathology 1987. link 22 Dada FB, Balan AD. Recurrent primary mesenteric venous thrombosis. Southern medical journal 1987. link 23 Slutzker DM, Pigula F. Small bowel infarction and death from primary mesenteric venous thrombosis. The American journal of emergency medicine 1987. link90090-8) 24 Abdu RA, Zakhour BJ, Dallis DJ. Mesenteric venous thrombosis--1911 to 1984. Surgery 1987. link 25 Serreyn RF, Schoofs PR, Baetens PR, Vandekerckhove D. Laparoscopic diagnosis of mesenteric venous thrombosis. Endoscopy 1986. link 26 Naraynsingh V, Raju GC, Busby G. Mesenteric venous thrombosis and oral contraceptive use. Tropical and geographical medicine 1985. link 27 Smith RW, Selby JB. Scintiangiographic diagnosis of acute mesenteric venous thrombosis. AJR. American journal of roentgenology 1979. link 28 Peters TG, Lewis JD, Flip DJ, Morris L. Antithrombin III deficiency causing postsplenectomy mesenteric venous thrombosis coincident with thrombocytopenia. Annals of surgery 1977. link 29 Mitty WF, Purisima CO. Agnogenic venous mesenteric thrombosis. Journal of the American Geriatrics Society 1977. link 30 Nesbit RR, Deweese JA. Mesenteric venous thrombosis and oral contraceptives. Southern medical journal 1977. link 31 Milne PY, Thomas RJ. Mesenteric venous thrombosis associated with oral contraceptives: a case report. The Australian and New Zealand journal of surgery 1976. link 32 Clemett AR, Chang J. The radiologic diagnosis of spontaneous mesenteric venous thrombosis. The American journal of gastroenterology 1975. link

Thrombosis of mesenteric artery