Daily Bolus of LR: Mesenteric Vein Thrombosis

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December 12, 2011 by dailybolusoflr

Thrombosis of the inferior and superior mesenteric veins is a cause of abdominal pain that should be considered in certain situations.
The most common etiologies of mesenteric vein thrombosis include:
  • Prothrombotic states, in particular OCP use in young women, as well as inherited disorders (Protein C, Protein S deficiency etc) and acquired disorders (malignancies)
  • Pancreatitis
  • Peritonitis
  • Intra-abdominal surgery (with local trauma as the etiology)

Patients with acute presentations may present with severe abdominal pain, diarrhea, nausea/vomiting and can progress to have bowel ischemia, sepsis and evidence of peritonitis. Patients with subacute presentations are less likely to have ischemia and hemorrhage.

The diagnosis is typically made by CT. The CT above shows a thrombus in the inferior mesenteric vein and was the diagnosis made in a young woman with a new diagnosis of pancreatitis when she presented with abdominal pain and diarrhea. The superior mesenteric vein is more commonly involved.

Treatment involves anticoagulation and is recommended even in the setting of GI bleeding. Surgical treatment is reserved for patients with peritonitis and bowel ischemia.

Mortality ranges from 20-50% and is dependent on underlying medical problems (cancer), presumed etiology of the condition and whether or not patients require surgery (these patients tend to be sicker). Recurrence does occur and is most common in the first month after diagnosis.

Ref: NEJM 2001. 345(23): 1683-1688

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