Primary mesenteric vein thrombosis: a case series

Abstract

Mesenteric vein thrombosis (MVT) is a rare condition, often misdiagnosed due to its vague and misleading clinical presentation. It can cause intestinal infarction, peritonitis, and consequently necessitate bowel resection. CT scanning with intravenous contrast enhancement is the gold standard for its diagnosis. Radiologists have an important role in defining the extent of thrombosis and identifying any signs of intestinal infarction influencing the decision whether or not to operate. In patients with no clinical signs of peritonitis or radiological evidence of intestinal infarction, the treatment can be exclusively medical, based on full anticoagulation (initially with low molecular weight heparin, followed by vitamin K antagonists or direct acting oral-anticoagulants). The duration of medical treatment depends on radiological evidence of resolution of thrombosis and the identification of pro-coagulant risk factors.

Keywords: abdominal pain; intestinal infarction; mesenteric venous thrombosis; thrombophilia.

Figure 1

Abdominal CT scan with evidence of portal [1], splenic [2] and superior mesenteric vein [3] thrombosis, along with free fluid in the right iliac fossa [4] and small bowel thickening [5], suggesting of intestinal infarction.