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Thrombosis of mesenteric vein — Clinical Guidelines

Overview

Mesenteric vein thrombosis (MVT) is a rare but serious condition characterized by the formation of a blood clot within the mesenteric veins, leading to potential bowel ischemia or infarction. Early diagnosis and prompt treatment are crucial to improve outcomes 1 2 3.

Diagnosis

Clinical Presentation: Abdominal distension, vomiting, fever, and nonspecific abdominal pain 1 4.

Imaging:

- Ultrasound: Initial diagnostic tool, often revealing thrombosis 12. - CT: Useful for detecting bowel wall edema and mesenteric involvement 16. - MRI: Confirms diagnosis and monitors thrombus resolution 12.

Laboratory Tests: Elevated D-dimer levels, prothrombotic disorder screening (protein C, S, antithrombin III deficiencies, factor V Leiden, prothrombin G20210A mutations) 3 7 11.

Endoscopy: Often unrevealing but may show signs of ischemia 7.

Management

First-Line Treatment:

- Anticoagulation: Early initiation with heparin followed by warfarin (INR target 2.0-3.0) 1 2 12. - Thrombolysis: Streptokinase or other thrombolytics for extensive thrombosis 12.

Adjunctive Treatments:

- Surgical Intervention: Thrombectomy, bowel resection if bowel necrosis is present 14 18. - Diagnostic Laparoscopy: To assess intestinal viability and avoid unnecessary resection 6.

Special Populations

Pregnancy: Specific considerations and risks noted but detailed management not extensively covered in abstracts 1 2.

Comorbidities: Prothrombotic disorders (protein S, protein C deficiencies, factor V Leiden mutation) significantly increase risk 3 7 11.

Elderly and Pediatrics: Specific management nuances not extensively detailed in provided abstracts 1 3.

Key Recommendations

Early Diagnosis and Prompt Anticoagulation: Initiate anticoagulation therapy early to prevent progression and improve outcomes (Evidence: Moderate 1 2).

Imaging Utilization: Utilize ultrasound, CT, and MRI for accurate diagnosis and monitoring of thrombus resolution (Evidence: Moderate 12 16).

Consider Thrombolysis for Extensive Thrombosis: Use thrombolytic agents in cases of extensive thrombosis to facilitate rapid thrombus dissolution (Evidence: Weak 12).

Surgical Evaluation for Necrosis: Perform surgical exploration if signs of bowel necrosis are present to prevent complications (Evidence: Expert opinion 14 18).

References

1 Al-Thani H, El-Mabrok J, El-Menyar A, Al-Sulaiti M, Tabeb AH, Hajaji K et al.. Clinical presentation and outcome of mesenteric vein thrombosis: a single-center experience. Angiology 2015. link 2 Grisham A, Lohr J, Guenther JM, Engel AM. Deciphering mesenteric venous thrombosis: imaging and treatment. Vascular and endovascular surgery 2005. link 3 Ağaoğlu N, Mustafa NA, Türkyilmaz S. Prothrombotic disorders in patients with mesenteric vein thrombosis. Journal of investigative surgery : the official journal of the Academy of Surgical Research 2003. link 4 Shinodholimath VV, Gupta A, Chumber S, Srivastava A. Mesenteric and portal vein thrombosis presenting as acute intestinal obstruction. Tropical gastroenterology : official journal of the Digestive Diseases Foundation 2003. link 5 Tateishi A, Mitsui H, Oki T, Morishita J, Maekawa H, Yahagi N et al.. Extensive mesenteric vein and portal vein thrombosis successfully treated by thrombolysis and anticoagulation. Journal of gastroenterology and hepatology 2001. link 6 Chong AK, So JB, Ti TK. Use of laparoscopy in the management of mesenteric venous thrombosis. Surgical endoscopy 2001. link 7 Draganov P, Lazarchick J, Portwood G. Mesenteric vein thrombosis secondary to protein S deficiency. The American journal of gastroenterology 1999. link 8 Millikan KW, Szczerba SM, Dominguez JM, McKenna R, Rorig JC. Superior mesenteric and portal vein thrombosis following laparoscopic-assisted right hemicolectomy. Report of a case. Diseases of the colon and rectum 1996. link 9 Chen MC, Brown MC, Willson RA, Nicholls S, Surawicz CM. Mesenteric vein thrombosis. Four cases and review of the literature. Digestive diseases (Basel, Switzerland) 1996. link 10 Eugène C, Valla D, Wesenfelder L, Fingerhut A, Bergue A, Merrer J et al.. Small intestinal stricture complicating superior mesenteric vein thrombosis. A study of three cases. Gut 1995. link 11 Clark DA, Williams WL, Marlar RA. Mesenteric vein thrombosis associated with a familial deficiency of free protein S. Archives of pathology & laboratory medicine 1991. link 12 al Karawi MA, Quaiz M, Clark D, Hilali A, Mohamed AE, Jawdat M. Mesenteric vein thrombosis, non-invasive diagnosis and follow-up (US + MRI), and non-invasive therapy by streptokinase and anticoagulants. Hepato-gastroenterology 1990. link 13 Roman RJ, Loeb PM. Massive colonic dilatation as initial presentation of mesenteric vein thrombosis. Digestive diseases and sciences 1987. link 14 Ghaly M, Frawley JE. Superior mesenteric vein thrombosis. The Australian and New Zealand journal of surgery 1986. link 15 Blei A, Dux S, Grosskopf I, Garty M, Rosenfeld JB. Hyperammonemia complicating mesenteric vein thrombosis. The American journal of medicine 1986. link90027-6) 16 Nichols DM. Computed tomography in acute mesenteric vein thrombosis. Journal of computer assisted tomography 1984. link 17 Carr N, Jamison MH. Superior mesenteric venous thrombosis. The British journal of surgery 1981. link 18 Khodadadi J, Rozencwajg J, Nacasch N, Schmidt B, Feuchtwanger MM. Mesenteric vein thrombosis. The importance of a second-look operation. Archives of surgery (Chicago, Ill. : 1960) 1980. link

Thrombosis of mesenteric vein