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05:07
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Mesenteric venous thrombosis
Ashwani K Singal1, Patrick S Kamath, Ayalew Tefferi
1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA.
Mayo Clinic Proceedings
|March 16, 2013
Summary
Mesenteric venous thrombosis, increasingly diagnosed with CT scans, is effectively managed with anticoagulation, reducing surgical needs. This approach improves outcomes for patients with acute or chronic conditions, including those with portal hypertension.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Radiology
Background:
- Mesenteric venous thrombosis (MVT) prevalence has risen due to increased contrast-enhanced computed tomography (CT) use for abdominal pain and portal hypertension.
- Anticoagulation has become standard, reducing surgical interventions and improving patient outcomes in MVT.
- Acute MVT typically presents with abdominal pain, while chronic MVT may be incidental or show signs of portal hypertension.
Purpose of the Study:
- To review the pathogenesis, diagnosis, and management of mesenteric venous thrombosis.
- To differentiate MVT from arterial ischemia.
- To discuss thrombophilia markers like JAK2, new anticoagulants, and provide management algorithms.
Main Methods:
- Review of literature on mesenteric venous thrombosis.
- Analysis of diagnostic imaging, particularly contrast-enhanced CT, for MVT.
- Discussion of management strategies including anticoagulation and surgical intervention.
Main Results:
- Contrast-enhanced CT accurately diagnoses approximately 90% of MVT cases.
- Collateral circulation and cavernoma distinguish chronic from acute MVT.
- Anticoagulation is the primary treatment, safe even in patients with cirrhosis and portal hypertension.
Conclusions:
- Increased CT utilization has led to higher MVT diagnoses.
- Anticoagulation is the cornerstone of MVT management, proving effective and safe.
- Understanding MVT pathogenesis, diagnostic criteria, and management algorithms is crucial for optimal patient care.
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