Acute mesenteric venous thrombosis: case for nonoperative management

Area of Science:

• Vascular Surgery
• Gastroenterology
• Internal Medicine

Background:

• Acute mesenteric vein thrombosis (MVT) management remains controversial, with differing opinions on surgical versus medical (anticoagulation) approaches.
• Determining the optimal initial treatment strategy for MVT is crucial for patient outcomes.

Purpose of the Study:

• To compare the outcomes of surgical versus medical initial management for acute mesenteric vein thrombosis.
• To identify the most effective initial treatment for MVT.

Main Methods:

• Retrospective review of 26 patients treated for MVT between January 1987 and December 1999.
• Patients were divided into two groups based on departmental policy: pre-1995 (surgical focus) and post-1995 (medical focus).
• Outcomes assessed included morbidity, mortality, hospitalization duration, secondary operations, portal hypertension, and survival rates.

Main Results:

• No significant statistical differences were found in morbidity, mortality, secondary operations, portal hypertension, or 2-year survival rates between surgical and nonoperative groups.
• Patients managed nonoperatively (group 2) had a significantly shorter mean hospital stay (23.2 days) compared to those treated surgically (group 1, 51.6 days).
• Of patients undergoing laparotomy with bowel resection, 83% showed mucosal but not transmural necrosis.

Conclusions:

• Nonoperative management of acute MVT is a viable option when diagnosed accurately (e.g., via CT scan) and if transmural necrosis or perforation has not occurred.
• Surgical and nonoperative approaches yield similar rates of morbidity, mortality, and survival.
• Nonoperative management, when appropriate, reduces hospital length of stay and avoids unnecessary bowel resection in potentially reversible cases.