Acute mesenteric venous thrombosis: Case for nonoperative management

Objective: Initial treatment in the management of acute mesenteric vein thr ombosis (MVT) is controversial. Some authors have proposed a surgical appro ach, whereas others have advocated medical therapy (anticoagulation). In th is study, we analyzed and compared the results obtained with surgical and m edical treatment to determine the best initial management for this disease. Methods. We retrospectively reviewed the records of patients treated for MV T in a secondary care surgical department from January 1987 to December 199 9. Before January 1995, our departmental policy was to perform surgery in p atients with suspected MVT. Since January 1995, we have preferred a medical approach when achievable. Each patient in this study was assessed for diag nosis, initial management (laparotomy or anticoagulation), morbidity, morta lity, duration of hospitalization, the need for secondary operation, portal hypertension, and survival rates. Results: Twenty-six patients were treated, 14 before January 1995 (group 1) and 12 since January 1995 (group 2). Morbidity, mortality, secondary opera tion, portal hypertension, and 2-year survival rates were 34.6%, 19.2%, 15. 3%, 19.2%, and 76.9%, respectively. No statistical difference was observed between the two groups. The mean duration of hospitalization was 51.6 days in group 1 and 23.2 days in group 2 (P<.05). Among the 12 patients treated by means of laparotomy with bowel resection, 10 patients (83%) had mucosal necrosis without transmural necrosis at pathologic study. Conclusion: Nonoperative management for acute MVT is feasible when the init ial diagnosis with a computed tomography scan is certain and when the bowel infarction has not led to transmural necrosis and bowel perforation. The m orbidity, mortality, and survival rates are similar in cases of surgical an d nonoperative management. The length of hospital stay is shorter when pati ents are treated with a nonoperative approach. A nonoperative approach, whe n indicated, avoids the resection of macroscopically infarcted small bowel (without transmural necrosis) in cases that are potentially reversible with anticoagulation alone.