Superior Mesenteric Vein Thrombosis After Bowel Resection in Patients With Inflammatory Bowel Disease

Abstract

Superior mesenteric vein thrombosis is one of many causes of mesenteric ischemia and may occur after intestinal surgery in patients with inflammatory bowel disease. While hypercoagulability is a known complication of inflammatory bowel disease, other risk factors may also coexist and play a role in the development of superior mesenteric vein thrombosis. The true etiology of hypercoagulability that seems to be present in the face of inflammatory bowel disease is unknown but thought to be related to multiple factors including vitamin deficiency, the inflammatory process, prothrombotic conditions, hypercoagulable states, and other abnormalities of coagulation. Symptoms of superior mesenteric vein thrombosis are often vague, leading to a delay in diagnosis, increasing not only the mortality rate but also the need for surgical intervention rather than medical management. Once diagnosed, patients are managed with anticoagulation alone or in combination with surgical intervention. Most patients improve and will continue anticoagulation therapy ranging from 3 months to lifelong treatment, depending on the origin of the hypercoagulable state and the extent of condition.

Clinical Presentation and Outcome of Mesenteric Vein Thrombosis

“…4 High-quality CT scanning is the modality of choice for the diagnosis of MVT which has a 90% diagnostic accuracy. 6,9 The CT imaging was the most useful test for establishing an MVT diagnosis in our study.…”

“…Medical management is acceptable if no signs of bowel infarction are present and the duration of oral anticoagulation therapy may range from 3 to 6 months or up to 1 year. 1,9,25 Lifelong anticoagulation may be used for patients with inherited coagulation disorders or in patients with recurrence. 25,26 The implication of anticoagulation therapy was highlighted by Abdu et al 24 and demonstrated that the anticoagulant has a significant impact in improving the clinical outcome of patients who had undergone bowel resection.…”

“…Table 4 summaries the prevention of occurrence, recurrence, and treatment of MVT. 6,9,12,27,28 Notably, those patients may be at risk of other vascular events (ie, myocardial infarction, pulmonary embolism, and stroke) that need particular attention and risk stratification. A subanalysis of the Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) demonstrated that rosuvastatin effect may reduce the risk of venous thromboembolic events; however, this particular effect of statins is still debatable.…”

“…4,5 In general, treatment of MVT depends on the underlying cause and severity and it aims to prevent or halt bowel infarction. 6,9 Herein, we evaluate the etiology, clinical presentation, management, and outcome of MVT in Qatar.…”

Extended thromboprophylaxis following colorectal surgery in patients with inflammatory bowel disease: a comprehensive systematic clinical review

“…Colorectal surgery carries a disproportionately higher risk of postoperative VTE compared with other general surgery specialities [5,6]. In patients with inflammatory bowel disease (IBD), the risk of VTE associated with colorectal surgery is increased by 1.5-to 3.5-fold [7][8][9][10]. Furthermore, studies have demonstrated that as many as 63.2% of postoperative VTEs in IBD patients occur following hospital discharge [11,12].…”