mesenteric venous thrombosis


Also found in: Acronyms.

mesenteric venous thrombosis

A form of mesenteric ischaemia caused by venous thrombosis, which has a high (±30%) mortality rate due to the delay in diagnosis.
 
Clinical findings
Vague abdominal discomfort that evolves over 7–10 days; abdominal distension and guaiac-positive stool.

Aetiology
Idiopathic (up to 50%), hypercoagulability (e.g., polycythemia vera), protein C and S deficiencies, intra-abdominal sepsis, systemic infection and a variety other conditions, including: portal hypertension, perforated viscus, blunt abdominal trauma, malignancy, prior abdominal surgery (open or laparoscopic), pancreatitis, smoking, oral contraceptive use, splenectomy, colectomy, Roux-en-Y gastric bypass.

Imaging
• CT (technique of choice)—Enlarged mesenteric or portal vein with sharp venous wall definition and low density within the vein.
• Arteriogram—Vasospasm, contrast in bowel lumen, non-visualised venous system, reflux of contrast into aorta, absent flow to necrotic bowel areas.

Lab
Cytology and lab data are completely ineffective, nonspecific or too late to help.

Management
Immediate bowel resection and maintain a low threshold for second-look laparotomy; long-term anticoagulation.

mesenteric venous thrombosis

Vascular disease A blood clot occluding the mesenteric vein, a major vein located in the tissue that connects the intestine to the posterior abdominal wall