Mesenteric Venous Thrombosis: Diagnosis and Noninvasive Imaging

Abstract

Mesenteric venous thrombosis is an uncommon but potentially lethal cause of bowel ischemia. Several imaging methods are available for diagnosis, each of which has advantages and disadvantages. Doppler ultrasonography allows direct evaluation of the mesenteric and portal veins, provides semiquantitative flow information, and allows Doppler waveform analysis of the visceral vessels; however, it is operator dependent and is often limited by overlying bowel gas. Conventional contrast material-enhanced computed tomography (CT) allows sensitive detection of venous thrombosis within the central large vessels of the portomesenteric circulation and any associated secondary findings; however, it is limited by respiratory misregistration, motion artifact, and substantially decreased longitudinal spatial resolution. Helical CT and CT angiography, especially when performed with multi-detector row scanners, and magnetic resonance (MR) imaging, particularly gadolinium-enhanced MR angiography, enable volumetric acquisitions in a single breath hold, eliminating motion artifact and suppressing respiratory misregistration. Helical CT angiography and three-dimensional gadolinium-enhanced MR angiography should be considered the primary diagnostic modalities for patients with a high clinical suspicion of mesenteric ischemia. Conventional angiography is reserved for equivocal cases at noninvasive imaging and is also used in conjunction with transcatheter therapeutic techniques in management of symptomatic portal and mesenteric venous thrombosis.

The Management of Mesenteric Vein Thrombosis: A Single Institution Experience

“…[15,22] whereas, in our series the mortality rate was 8% (three patients). One patient had total small bowel, stomach, and colon ischemia, which was considered inoperable, and died at postoperative day 3.…”

“…[14] Venous phase CT angiography is the most accurate imaging modality (sensitivity 90%) for diagnosing mesenteric venous thrombosis. [15] The causes of MVT in young patients are generally thrombophilia and the use of oral contraceptives, whereas, in elderly patients, malignancies must be ruled out. Moreover, autopsy studies have determined that abdominal cancer is present in 22% of cases and hepatic cirrhosis is present in 17%.…”

“…The reported overall mortality rate of 50% in the literature is mainly attributed to difficulties in diagnosis and subsequent delay of necessary therapeutic intervention. [15,22] The first step in treatment is hemodynamic stabilization accompanied by hydration, correction of acidosis, and treatment of sepsis using broad spectrum antibiotics (Figure 3). During the acute phase, serial abdominal exams are necessary to detect peritoneal signs.…”

Cateterismo de artéria mesentérica para tratamento de trombose de veia porta

“…19 The procedure is conducted in two phases: first contrast is injected into the superior mesenteric artery and the arterial territory is examined, then a venous phase is conducted and any venous obstruction and intraluminal thrombi are recorded. 11 In the case described here, the obstruction was located at the confluence of the splenic and superior mesenteric veins (Figure 2) and it was this involvement that caused mesenteric ischemia, which is the principal complication of acute PVT. 4 Treatment of acute PVT is on a case-by-case basis and is dependent on the cause of the thrombosis.…”

Pileflebitis asociada a apenaicitis aguda en una niña de 11 años

“…Se puede observar alteración del flujo sanguíneo, trombos, engrosamiento de la pared intestinal o líquido intraperitoneal libre. En cuanto a sus limitaciones, es un método operador dependiente, la visualización puede variar por meteorismo, se pueden confundir colaterales periportales con vena porta permeable, entre otros 20 . Actualmente el estudio de elección es la TAC con contraste ya que permite evaluar la vasculatura y la pared intestinal, con una sensibilidad sobre el 90%.…”