Mesenteric venous thrombosis: A changing clinical entity

Objective: Mesenteric venous thrombosis (MVT) and its clinical spectrum hav e become better defined following improvements in diagnostic imaging. Histo rically, MVT has been described as a morbid clinical entity, but this may n ot necessarily be true. Often, an underlying disease process that predispos es a patient to MVT can be found and potentially treated. This study was de signed to evaluate the diagnostics and management of MVT and to review long term results of treatment. Patients. Thirty-one patients in whom MVT was diagnosed between 1985 and 19 99 were retrospectively reviewed. Survivors were contacted for follow-up. T here were 15 men and 16 women. Ages ranged from 22 to 80 years (mean, 49.1 years). Thirteen patients had documented hypercoagulability, 10 had a histo ry of previous abdominal Surgery, 6 had a prior thrombotic episode, and 4 h ad a history of cancer. MVT presented as abdominal pain (84%), diarrhea (42 %), and nausea/vomiting (32%). Computed tomography (CT) was considered diag nostic in 18 (90%) of 20 patients who underwent the test. CT diagnosed MVT in 15 (100%) of 15 patients presenting with vague abdominal pain or diarrhe a. Angiography demonstrated MVT in only five (55.5%) of nine patients. Results: Seven of 31 patients died within 30 days (<30-day mortality rate, 23%). Twenty-two patients (72%) were initially treated with heparin. Nine p atients were not heparinized: four of them died, and two were later given w arfarin sodium (Coumadin). Of the 31 patients, only one received lytic ther apy. Three patients became symptom free without anticoagulation. Ten patien ts (32%) underwent bowel resection. Overall, 19 (79%) of 24 survivors were treated with long-term warfarin therapy. Long-term follow-up was obtained i n 24 patients (mean, 57.7 months). Twenty-one (88%) of 24 survived in follo w-up. Conclusion: The diagnosis of MVT should be suspected when acute abdominal s ymptoms develop in patients with prior thrombotic episodes or a documented coagulopathy. CT scanning appears to be the primary diagnostic test of choi ce. Anticoagulation is recommended. If diagnosed and treated early, MVT is not likely to progress to gangrenous bowel. Recent mortality rates for MVT are lower than previously published, perhaps because of earlier diagnosis a nd aggressive treatment or possibly because we now readily diagnose a more benign form of the disease, which is due to widespread use of CT scanning.