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Intestinal infarction secondary to mesenteric venous thrombosis: CT-pathologic correlation
1Department of Radiology, Catholic University Medical College, Seoul, Korea.
Abstract:
We reviewed CT of four patients with surgically proved bowel infarction secondary to superior mesenteric vein (SMV) thrombosis. Pathologic correlation was available in all patients. Three patients had thrombus in both portal vein and proximal SMV and the remaining patient had thrombus that was seen only in the peripheral branches of the SMV. Contrast-enhanced CT showed a segmental distribution of marked concentric bowel wall thickening in all four patients. Two patients also showed zones of different attenuation in the bowel wall, which were caused by varying degrees of edema and hemorrhage in the submucosa. Dense peripheral enhancement of the bowel wall was present in one patient. Other CT findings included ascites and mesenteric changes such as edema and vascular engorgement. The combination of thrombus in the SMV with bowel wall thickening strongly suggests bowel infarction and, therefore, warrants initiation of appropriate therapy.
Insights
CT scans reveal that superior mesenteric vein (SMV) thrombosis often presents with bowel wall thickening, indicating bowel infarction. Early detection through imaging is crucial for timely treatment of this serious condition.
Area of Science:
- Radiology
- Gastroenterology
- Vascular Surgery
Background:
- Superior mesenteric vein (SMV) thrombosis is a critical condition leading to bowel infarction.
- Accurate and timely diagnosis is essential for patient outcomes.
Purpose of the Study:
- To evaluate the role of contrast-enhanced computed tomography (CT) in diagnosing bowel infarction secondary to SMV thrombosis.
- To correlate CT findings with surgical and pathological findings.
Main Methods:
- Retrospective review of CT scans from four patients with surgically confirmed bowel infarction due to SMV thrombosis.
- Analysis of CT findings including bowel wall thickening, attenuation patterns, ascites, and mesenteric changes.
- Pathological correlation was available for all cases.
Main Results:
- All four patients exhibited segmental marked concentric bowel wall thickening on contrast-enhanced CT.
- Three patients had thrombus in both the portal vein and proximal SMV; one had thrombus in peripheral SMV branches.
- Additional findings included bowel wall edema, hemorrhage, ascites, and mesenteric changes.
Conclusions:
- The combination of SMV thrombosis and characteristic bowel wall thickening on CT is a strong indicator of bowel infarction.
- CT imaging is valuable in identifying patients with SMV thrombosis and associated bowel infarction, necessitating prompt therapeutic intervention.