Mesenteric vein thrombosis: a case series and current literature review

Mesenteric vein thrombosis (MVT) is a rare clinical entity that occurs secondary to other diseases in approximately 90% of cases. Early diagnosis and treatment of intestinal hypoperfusion can be lifesaving for the patient. Here, we present a case series of MVT in our department over the past decade, highlighting how they were treated and the need for intervention in cases of intestinal ischemia, as well as the long-term results of newer anticoagulants.

Retrospective study of patients with MVT during the period 2013-2023 who were hospitalized in our department. We present the clinical presentation, the diagnostic process and the therapeutic measures, the follow-up of the patients to this day, and their outcomes.

Eleven patients suffering from MVT were admitted to our surgical department during the study, with a mean age of 59.7 years. Three of them had an extension of the thrombus into the portal vein. In total, six patients were taken to the operating room and underwent either thrombolysis (N.=3) or enterectomy (N.=3). The rest were treated conservatively with heparin or warfarin. Mortality was estimated at 18% (2/11), positive thrombophilia screening was found in six patients (66.6%, 6/9), while 4/11 were diagnosed with malignant disease. Three patients voluntarily discontinued their treatment 3 months after the episode; however, despite that, they did not develop a new thrombotic event.

Due to its rarity, the management of MVT has not been established with protocols based on thorough research. The initial conservative treatment, and the subsequent decision for surgical intervention, depending on the patient's clinical course, are still the pillars of treatment. In the long term, the newer anticoagulants and a finite course of treatment seem to be non-inferior to traditional treatment options. However, large-scale multicenter studies are needed to confirm the results.