Acute mesenteric venous thrombosis. Revisited in a time of diagnostic clarity

Historically, mesenteric venous thrombosis (MVT) has been found during laparotomy or at autopsy. Improvements in computed tomography (CT) and ultrasound (U/S) may identify patients earlier in their clinical course. How has this altered the treatment strategy of the authors? This 10-year retrospective study of acute MVT consisted of 12 men and three women (average age 43). Presenting signs and symptoms were nonspecific in 10/15 patients resulting in multiple diagnostic tests. All CT scans (10) and angiograms (4) revealed mesenteric clot. U/S exams detected clot in 6/9 patients. The remaining five patients exhibited clinical signs requiring operations rather than diagnostic studies. The only consistent laboratory abnormality was an elevated white blood cell count in 12/15 patients. Management of MVT varied. Five patients, heparinized once the diagnosis was made, did not experience dysfunction from MVT. Ten patients were not initially treated with heparin and were divided into three groups. Three patients received neither heparin nor surgery and have had no sequelae. MVT contributed to the death of two patients. The remaining five patients were diagnosed in the operating room following bowel resection. Two of these patients received postoperative heparin and had a favorable outcome. Two of the three patients not heparinized after surgery suffered additional bowel infarction. MVT can present as nonspecific abdominal pain, but also as peritonitis requiring operation. CT and U/S can identify patients with early MVT. It appears that heparin has both a primary therapeutic role in early disease and a postoperative adjunctive role in advanced disease. With such care, these patients can expect an acceptable prognosis (86% survival).