Mesenteric vein thrombosis - Revision history

Ostermayer: Prepared the page for translation

2026-01-04T23:46:12Z

Prepared the page for translation

← Older revision		Revision as of 23:46, 4 January 2026
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			<languages/>
			<translate>

	==Background==		==Background==

	[[File:Gray591.png\|thumb\|The abdomen viewed from the front, showing the portal venous system, showing the superior mesenteric vein and its tributaries. (Lienal vein is an old term for splenic vein.)]]		[[File:Gray591.png\|thumb\|The abdomen viewed from the front, showing the portal venous system, showing the superior mesenteric vein and its tributaries. (Lienal vein is an old term for splenic vein.)]]
	*Local thrombus formation in mesenteric veins, which impairs venous return of the bowel		*Local thrombus formation in mesenteric veins, which impairs venous return of the bowel
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	*A previous history of DVT is reported in approximately 20-40 percent of patients with mesenteric venous thrombosis		*A previous history of DVT is reported in approximately 20-40 percent of patients with mesenteric venous thrombosis

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	{{Intestinal ischemia types}}		{{Intestinal ischemia types}}
			<translate>


	==Clinical Features==		==Clinical Features==

	''Depends on subtype and disease can exist along a continuum. ''		''Depends on subtype and disease can exist along a continuum. ''
	*Acute- expect typical features such as severe abdominal pain that is out of proportion to exam findings. Rebound and guarding may occur. Time course usually over days.		*Acute- expect typical features such as severe abdominal pain that is out of proportion to exam findings. Rebound and guarding may occur. Time course usually over days.
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	*Exam may show distended abdomen or positive fecal occult blood		*Exam may show distended abdomen or positive fecal occult blood
	*Rebound and guarding may occur if bowel wall edema progresses to ischemia		*Rebound and guarding may occur if bowel wall edema progresses to ischemia


	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{Abdominal Pain DDX Diffuse}}		{{Abdominal Pain DDX Diffuse}}
			<translate>


	==Evaluation==		==Evaluation==

	[[File:PMC3542301 kjr-14-38-g001.png\|thumb\|CT scan showing acute superior mesenteric vein thrombosis (black arrow) with bowel wall thickening (white arrowhead), mesenteric edema (black arrowhead) and ascites. Note the normal SMA enhancement (white arrow) and ratio of SMV to SMA diameters > 2.]]		[[File:PMC3542301 kjr-14-38-g001.png\|thumb\|CT scan showing acute superior mesenteric vein thrombosis (black arrow) with bowel wall thickening (white arrowhead), mesenteric edema (black arrowhead) and ascites. Note the normal SMA enhancement (white arrow) and ratio of SMV to SMA diameters > 2.]]
	[[File:PMC3881378 CRIM.SURGERY2013-952383.001.png\|thumb\|Contrast enhanced CT (axial and coronal views) of the abdomen demonstrated a filling defect in the superior mesenteric vein (arrow), suggesting thrombus.]]		[[File:PMC3881378 CRIM.SURGERY2013-952383.001.png\|thumb\|Contrast enhanced CT (axial and coronal views) of the abdomen demonstrated a filling defect in the superior mesenteric vein (arrow), suggesting thrombus.]]

	===Workup===		===Workup===

	*'''Labs''': CBC, CMP, Lipase, UA, HCG(when applicable), Lactate, Coags.		*'''Labs''': CBC, CMP, Lipase, UA, HCG(when applicable), Lactate, Coags.
	*'''Imaging'''		*'''Imaging'''
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	**Magnetic resonance venography is another option if testing is non-diagnostic.		**Magnetic resonance venography is another option if testing is non-diagnostic.
	**Doppler ultrasonography can detect thrombosis in larger veins but is less sensitive<ref>Singal AK, Kamath PS, Tefferi A. Mesenteric venous thrombosis. Mayo Clin Proc. 2013 Mar;88(3):285-94. doi: 10.1016/j.mayocp.2013.01.012. Epub 2013 Feb 27. PMID: 23489453.</ref>		**Doppler ultrasonography can detect thrombosis in larger veins but is less sensitive<ref>Singal AK, Kamath PS, Tefferi A. Mesenteric venous thrombosis. Mayo Clin Proc. 2013 Mar;88(3):285-94. doi: 10.1016/j.mayocp.2013.01.012. Epub 2013 Feb 27. PMID: 23489453.</ref>


	===Diagnosis===		===Diagnosis===

	*Mesenteric vein filling defect is diagnostic		*Mesenteric vein filling defect is diagnostic
	**Bowel thickening, bowel hypoattenuation, bowel enhancement, fat-stranding pneumatosis, potential ascites may also be seen<ref> American Journal of Roentgenology. 2009;192: 408-416. 10.2214/AJR.08.1138</ref>		**Bowel thickening, bowel hypoattenuation, bowel enhancement, fat-stranding pneumatosis, potential ascites may also be seen<ref> American Journal of Roentgenology. 2009;192: 408-416. 10.2214/AJR.08.1138</ref>
	*Labs, other forms of imaging, and physical exam do not have high enough sensitivity to reliably exclude this diagnosis.		*Labs, other forms of imaging, and physical exam do not have high enough sensitivity to reliably exclude this diagnosis.


	==Management==		==Management==


	===Non-Operative===		===Non-Operative===
	*[[Anticoagulation]] is the mainstay of treatment
	**Depending on disposition, can utilize [[unfractionated heparin]], [[LMWH]], or [[DOACs]]		*[[Special:MyLanguage/Anticoagulation\|Anticoagulation]] is the mainstay of treatment
			**Depending on disposition, can utilize [[Special:MyLanguage/unfractionated heparin\|unfractionated heparin]], [[Special:MyLanguage/LMWH\|LMWH]], or [[Special:MyLanguage/DOACs\|DOACs]]
	**Consider if there are no planned operative management		**Consider if there are no planned operative management
	*[[IVF]], [[electrolyte repletion]], and [[pain control]]		*[[Special:MyLanguage/IVF\|IVF]], [[Special:MyLanguage/electrolyte repletion\|electrolyte repletion]], and [[Special:MyLanguage/pain control\|pain control]]
	*Bowel Rest		*Bowel Rest
	*Bowel decompression		*Bowel decompression
	*[[Antibiotics]]		*[[Special:MyLanguage/Antibiotics\|Antibiotics]]


	===Operative===		===Operative===

	*Reserved for patients with overt signs of intestinal necrosis or perforation		*Reserved for patients with overt signs of intestinal necrosis or perforation


	==Disposition==		==Disposition==

	*Consider admission depending on clinical status		*Consider admission depending on clinical status


	==See Also==		==See Also==
	*[[Portal vein thrombosis]]
			*[[Special:MyLanguage/Portal vein thrombosis\|Portal vein thrombosis]]


	==External Links==		==External Links==
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	==References==		==References==

	<references/>		<references/>

	[[Category:GI]]		[[Category:GI]]
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Rossdonaldson1: /* Non-Operative */

2023-10-18T16:40:58Z

Non-Operative

← Older revision		Revision as of 16:40, 18 October 2023
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	==Management==		==Management==
	===Non-Operative===		===Non-Operative===
	*[[~~Anti-coagulation~~]] is the mainstay of treatment		*[[Anticoagulation]] is the mainstay of treatment
	**Depending on disposition, can utilize [[unfractionated heparin]], [[LMWH]], or [[DOACs]]		**Depending on disposition, can utilize [[unfractionated heparin]], [[LMWH]], or [[DOACs]]
	**Consider if there are no planned operative management		**Consider if there are no planned operative management
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	*Bowel decompression		*Bowel decompression
	*[[Antibiotics]]		*[[Antibiotics]]


	===Operative===		===Operative===

Rossdonaldson1: /* Management */

2023-10-18T16:27:34Z

Management

← Older revision		Revision as of 16:27, 18 October 2023
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	==Management==		==Management==
	~~'''~~Non-Operative~~'''~~		===Non-Operative===
	*Anti-coagulation is the mainstay of treatment		*[[Anti-coagulation]] is the mainstay of treatment
	**Depending on ~~dispo~~, can utilize unfractionated heparin, LMWH, or DOACs		**Depending on disposition, can utilize [[unfractionated heparin]], [[LMWH]], or [[DOACs]]
	**Consider if there are no planned operative management		**Consider if there are no planned operative management
	*IVF, electrolyte repletion, and pain control		*[[IVF]], [[electrolyte repletion]], and [[pain control]]
	*Bowel Rest		*Bowel Rest
	*Bowel decompression		*Bowel decompression
	*~~ABX~~		*[[Antibiotics]]


	~~'''~~Operative~~'''~~		===Operative===
	*Reserved for patients with overt signs of intestinal necrosis or perforation		*Reserved for patients with overt signs of intestinal necrosis or perforation

Rossdonaldson1: /* See Also */

2023-10-04T19:08:48Z

Patricklin at 02:08, 30 September 2023

2023-09-30T02:08:56Z

← Older revision		Revision as of 02:08, 30 September 2023
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	==Background==		==Background==
	[[File:Gray591.png\|thumb\|The abdomen viewed from the front, showing the portal venous system, showing the superior mesenteric vein and its tributaries. (Lienal vein is an old term for splenic vein.)]]		[[File:Gray591.png\|thumb\|The abdomen viewed from the front, showing the portal venous system, showing the superior mesenteric vein and its tributaries. (Lienal vein is an old term for splenic vein.)]]
	*A rare (< 5% of all cases) subset of mesenteric ischemia that has a high rate of mortality approaching 50%.		*Local thrombus formation in mesenteric veins, which impairs venous return of the bowel
	*Risk factors include ~~intrabdominal~~ inflammation and ~~hypercoaguability~~.<ref>Harnik IG, Brandt LJ. Mesenteric venous thrombosis. Vasc Med. 2010 Oct;15(5):407-18. doi: 10.1177/1358863X10379673. PMID: 20926500.</ref>		**A rare (< 5% of all cases) subset of mesenteric ischemia that has a high rate of mortality approaching 50%.
			**Can be associated with concurrent portal vein thrombosis
			*Risk factors include intraabdominal inflammation (pancreatitis, IBD) and hypercoagulability (protein C/S deficiency, malignancy).<ref>Harnik IG, Brandt LJ. Mesenteric venous thrombosis. Vasc Med. 2010 Oct;15(5):407-18. doi: 10.1177/1358863X10379673. PMID: 20926500.</ref>
			*A previous history of DVT is reported in approximately 20-40 percent of patients with mesenteric venous thrombosis

	{{Intestinal ischemia types}}		{{Intestinal ischemia types}}
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	==Clinical Features==		==Clinical Features==
	''Depends on subtype and disease can exist along a continuum. ''		''Depends on subtype and disease can exist along a continuum. ''
	*Acute-expect typical features such as severe abdominal pain that is out of proportion to exam findings. Rebound and guarding may occur. Time course usually over days.		*Acute- expect typical features such as severe abdominal pain that is out of proportion to exam findings. Rebound and guarding may occur. Time course usually over days.
	*Subacute- abdominal pain can be vague and symptoms may be insidious over a period of days to weeks.		*Subacute- abdominal pain can be vague and symptoms may be insidious over a period of days to weeks.
	*Chronic- patients usually are asymptomatic and thrombosis is usually found on imaging incidentally. Some patients may have post prandial colicky abdominal pain that resolves.		*Chronic- patients usually are asymptomatic and thrombosis is usually found on imaging incidentally. Some patients may have post-prandial colicky abdominal pain that resolves.
			*Exam may show distended abdomen or positive fecal occult blood
			*Rebound and guarding may occur if bowel wall edema progresses to ischemia

	==Differential Diagnosis==		==Differential Diagnosis==
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	[[File:PMC3881378 CRIM.SURGERY2013-952383.001.png\|thumb\|Contrast enhanced CT (axial and coronal views) of the abdomen demonstrated a filling defect in the superior mesenteric vein (arrow), suggesting thrombus.]]		[[File:PMC3881378 CRIM.SURGERY2013-952383.001.png\|thumb\|Contrast enhanced CT (axial and coronal views) of the abdomen demonstrated a filling defect in the superior mesenteric vein (arrow), suggesting thrombus.]]
	===Workup===		===Workup===
	*Labs- CBC, CMP, Lipase, UA, HCG(when applicable), Lactate, Coags.		*'''Labs''': CBC, CMP, Lipase, UA, HCG(when applicable), Lactate, Coags.
	*~~imaging~~		*'''Imaging'''
	**~~from~~ the ED ~~stand point~~ a multiphase contrast CT is the most accurate and timely.(Non-contrast, arterial phase, and venous phase).		**From the ED standpoint a multiphase contrast CT is the most accurate and timely (Non-contrast, arterial phase, and venous phase).
	**~~oral~~ contrast can help ~~dilineate~~ bowel thickness.		**Oral contrast can help delineate bowel thickness.
	**Magnetic resonance venography is another option if testing is non-diagnostic.		**Magnetic resonance venography is another option if testing is non-diagnostic.
			**Doppler ultrasonography can detect thrombosis in larger veins but is less sensitive<ref>Singal AK, Kamath PS, Tefferi A. Mesenteric venous thrombosis. Mayo Clin Proc. 2013 Mar;88(3):285-94. doi: 10.1016/j.mayocp.2013.01.012. Epub 2013 Feb 27. PMID: 23489453.</ref>

	===Diagnosis===		===Diagnosis===
	*~~meseteric~~ vein ~~filing~~ defect~~, bowel~~ thickening, bowel hypoattenuation, bowel enhancement, pneumatosis, potential ascites. <ref> American Journal of Roentgenology. 2009;192: 408-416. 10.2214/AJR.08.1138</ref>		*Mesenteric vein filling defect is diagnostic
	*~~labs~~, other forms of imaging, and physical exam do not have high enough sensitivity to reliably exclude this diagnosis.		**Bowel thickening, bowel hypoattenuation, bowel enhancement, fat-stranding pneumatosis, potential ascites may also be seen<ref> American Journal of Roentgenology. 2009;192: 408-416. 10.2214/AJR.08.1138</ref>
			*Labs, other forms of imaging, and physical exam do not have high enough sensitivity to reliably exclude this diagnosis.

	==Management==		==Management==
	Non-Operative		'''Non-Operative'''
	** IVF		*Anti-coagulation is the mainstay of treatment
	** Bowel Rest		**Depending on dispo, can utilize unfractionated heparin, LMWH, or DOACs
	** Bowel decompression		**Consider if there are no planned operative management
	** ABX		*IVF, electrolyte repletion, and pain control
	** Anti-coagulation		*Bowel Rest
	Operative		*Bowel decompression
	* Reserved for patients with overt signs of intestinal necrosis or perforation		*ABX


			'''Operative'''
			*Reserved for patients with overt signs of intestinal necrosis or perforation

	==Disposition==		==Disposition==
			*Consider admission depending on clinical status

	==See Also==		==See Also==
			[[Portal vein thrombosis]]

	==External Links==		==External Links==

Urbanspartan1 at 21:41, 1 January 2022

2022-01-01T21:41:55Z

← Older revision		Revision as of 21:41, 1 January 2022
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	==Management==		==Management==
			Non-Operative
			** IVF
			** Bowel Rest
			** Bowel decompression
			** ABX
			** Anti-coagulation
			Operative
			* Reserved for patients with overt signs of intestinal necrosis or perforation

	==Disposition==		==Disposition==

Rossdonaldson1: /* Background */

2021-11-27T04:07:07Z

Background

← Older revision		Revision as of 04:07, 27 November 2021
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	==Background==		==Background==
			[[File:Gray591.png\|thumb\|The abdomen viewed from the front, showing the portal venous system, showing the superior mesenteric vein and its tributaries. (Lienal vein is an old term for splenic vein.)]]
	*A rare (< 5% of all cases) subset of mesenteric ischemia that has a high rate of mortality approaching 50%.		*A rare (< 5% of all cases) subset of mesenteric ischemia that has a high rate of mortality approaching 50%.
	*Risk factors include intrabdominal inflammation and hypercoaguability.<ref>Harnik IG, Brandt LJ. Mesenteric venous thrombosis. Vasc Med. 2010 Oct;15(5):407-18. doi: 10.1177/1358863X10379673. PMID: 20926500.</ref>		*Risk factors include intrabdominal inflammation and hypercoaguability.<ref>Harnik IG, Brandt LJ. Mesenteric venous thrombosis. Vasc Med. 2010 Oct;15(5):407-18. doi: 10.1177/1358863X10379673. PMID: 20926500.</ref>

Rossdonaldson1 at 04:01, 27 November 2021

2021-11-27T04:01:40Z

← Older revision		Revision as of 04:01, 27 November 2021
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	==Background==		==Background==
	A rare (< 5% of all cases) subset of mesenteric ischemia that has a high rate of mortality approaching 50%. Risk factors include intrabdominal inflammation and hypercoaguability.<ref>Harnik IG, Brandt LJ. Mesenteric venous thrombosis. Vasc Med. 2010 Oct;15(5):407-18. doi: 10.1177/1358863X10379673. PMID: 20926500.</ref>		*A rare (< 5% of all cases) subset of mesenteric ischemia that has a high rate of mortality approaching 50%.
			*Risk factors include intrabdominal inflammation and hypercoaguability.<ref>Harnik IG, Brandt LJ. Mesenteric venous thrombosis. Vasc Med. 2010 Oct;15(5):407-18. doi: 10.1177/1358863X10379673. PMID: 20926500.</ref>

	{{Intestinal ischemia types}}		{{Intestinal ischemia types}}

Rossdonaldson1 at 04:01, 27 November 2021

2021-11-27T04:01:03Z

← Older revision		Revision as of 04:01, 27 November 2021
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	==Background==		==Background==
	A rare (< 5% of all cases) subset of mesenteric ischemia that has a high rate of mortality approaching 50%. Risk factors include intrabdominal inflammation and hypercoaguability.<ref>Harnik IG, Brandt LJ. Mesenteric venous thrombosis. Vasc Med. 2010 Oct;15(5):407-18. doi: 10.1177/1358863X10379673. PMID: 20926500.</ref>		A rare (< 5% of all cases) subset of mesenteric ischemia that has a high rate of mortality approaching 50%. Risk factors include intrabdominal inflammation and hypercoaguability.<ref>Harnik IG, Brandt LJ. Mesenteric venous thrombosis. Vasc Med. 2010 Oct;15(5):407-18. doi: 10.1177/1358863X10379673. PMID: 20926500.</ref>

			{{Intestinal ischemia types}}

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Differential Diagnosis */

2021-11-27T03:58:55Z

Differential Diagnosis

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 ==Differential Diagnosis==
-*[[Abdominal aortic aneurysm]]
+{{Abdominal Pain DDX Diffuse}}
 ==Evaluation==

← Older revision		Revision as of 19:08, 4 October 2023
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	==See Also==		==See Also==
	[[Portal vein thrombosis]]		*[[Portal vein thrombosis]]

	==External Links==		==External Links==