A systematic review of the management of acute superior mesenteric vein thrombosis in adults

Abstract

Background: Acute thrombosis of the superior mesenteric vein (SMV) is a rare but potentially catastrophic condition. Clinically separate from portal venous thrombosis due to a higher proportion of associated thrombophilic disorders and intestinal infarction, SMV thrombosis warrants a distinct approach to management. The aim of this review is to report the evidence for current practice. Methods: A systematic review was carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four clinical trials databases and 4 trial registries were searched. This search was not limited by language or study type, but was limited to an adult population (18 years and above). The search period was between January 1, 2000 and February 28, 2019. The review was registered in the PROSPERO database: CRD42018116825. Bias was assessed using the ROBINS-I tool. Results: A total of 7989 studies were identified, resulting in 19 observational studies being analyzed. Eighteen studies reported on anti-coagulation, 1 reported on anti-coagulation plus endovascular thrombectomy, 9 reported on thrombolysis, and 10 reported on the role of surgery. Bias assessment showed that confounding was a significant area of potential bias. This review has reported that the management of SMV thrombosis is centered around a patients’ perceived hemodynamic stability. If there is evidence of perforation or peritonism then surgical intervention is advocated. Otherwise, anti-coagulation or thrombolysis is preferred. Conclusions: The data reported were compared with, and added to, that presented by the European Society for Vascular Surgery 2017 guidelines. Overall the source data were heterogenous, with multiple sources of bias and statistical comparison was not achievable.

Superior Mesenteric Venous Thrombosis - The Impact of Inflammation and Hypercoagulability

“…Anticoagulants administered as early as possible helped with recanalization. [16] Our patient had no evidence of ischemia, showed improvement upon administration of heparin (white blood cell counts and lactic acid trends), and was hemodynamically stable. No surgery was indicated in our patient and this method seems to be less favorable compared to non-invasive strategies.…”

Acute mesenteric ischemia secondary to superior mesenteric vein thrombosis in a patient with liver cirrhosis: A case report

“…Acute thrombosis of the SMV, initially described in 1894, is a rare cause of intestinal ischemia, with an incidence of 1.8 per 100,000 person-years. [1] Potential causes of thrombophilia or hypercoagulable state may include myeloproliferative disease, antiphospholipid syndrome, factor V Leiden mutation, paroxysmal nocturnal hemoglobinuria, hereditary deficiencies of protein S, protein C, and antithrombin, hyperhomocysteinemia, and oral contraceptive use. Thrombotic occlusion in the SMV leads to inadequate perfusion pressure and stagnating flow, resulting in significant bowel wall edema.…”