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[Mesenteric vein thrombosis: clinical manifestations, treatment and outcome]
Andrea Lui G1, Jaime Poniachik T, Rodrigo Quera P
1Sección de Medicina Interna, Departamento de Medicina Interna, Hospital Clínico, Universidad de Chile.
Background:
Mesenteric vein thrombosis (MVT) is uncommon and accounts for 5-10% of all mesenteric ischemic events. In 80% of cases, an etiologic factor is found. The clinical presentation varies and the diagnosis is made based on imaging studies. The treatment involves anticoagulation alone or in combination with surgery.
Aim:
To describe the clinical characteristics of patients with MVT.
Patients And Methods:
Retrospective and prospective review of all cases with MVT, treated between 1995-2001. The clinical presentation, imaging studies, treatment and outcome were evaluated.
Results:
29 cases of MVT were reviewed (14 females, age 56 +/- 15 years). Twenty two patients (76%) had recognizable risk factors. The main symptoms were abdominal pain (86%) and vomiting (55%). The diagnosis of acute mesenteric ischemia was suspected on admission only in 6 patients (21%). Thirteen patients underwent transabdominal color Doppler ultrasonography and the diagnosis was confirmed for 11 of these (85%). Twenty out of 24 patients (85%) studied with computed tomography, had positive signs of MVT. Twenty one patients (72%) received anticoagulation, 10 of whom also underwent surgery. Four patients (14%) received surgical treatment alone. Four patients were not treated. Seven patients (24%) died.
Conclusions:
MVT is difficult to identify. It is necessary to have a high degree of suspicion in patients who have risk factors. The diagnosis is made with imaging studies. The treatment consists of early anticoagulation and surgical intervention when indicated.
Insights
Mesenteric vein thrombosis (MVT) is challenging to diagnose, often presenting with abdominal pain and vomiting. Early anticoagulation and surgical intervention are key treatments for this uncommon condition.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Diagnostic Imaging
Context:
- Mesenteric vein thrombosis (MVT) is an uncommon cause of mesenteric ischemia, accounting for 5-10% of cases.
- Identifying an underlying etiologic factor is possible in 80% of MVT cases.
- Clinical presentation of MVT is variable, necessitating advanced diagnostic methods.
Purpose:
- To elucidate the clinical characteristics of patients diagnosed with MVT.
- To evaluate diagnostic imaging modalities for MVT detection.
- To assess treatment strategies and patient outcomes in MVT.
Summary:
- A review of 29 MVT cases (1995-2001) revealed a mean age of 56 years, with 76% having identifiable risk factors.
- Abdominal pain (86%) and vomiting (55%) were the primary symptoms; diagnosis on admission was low (21%).
- Transabdominal color Doppler ultrasonography and computed tomography confirmed MVT in 85% and 85% of cases, respectively. Treatment involved anticoagulation (72%) and surgery (36%), with a 24% mortality rate.
Impact:
- Highlights the diagnostic challenges of MVT, emphasizing the need for high clinical suspicion in at-risk patients.
- Underscores the critical role of imaging studies, particularly Doppler ultrasonography and CT, in confirming MVT.
- Recommends early anticoagulation and timely surgical intervention for improved outcomes in MVT management.
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