Primary mesenteric venous thrombosis

Abstract

To elucidate further the characteristics, optimal management and ultimate outcome of patients with primary mesenteric venous thrombosis, the records of nine such patients were analyzed. There were seven male and two female patients, with a mean age of 47 years. Abdominal pain, vomiting, fever and hematochezia were the characteristics presenting complaints. Tenderness, distention and diminished intestinal sounds were the prominent abdominal physical findings and were often associated with tachycardia and hypotension. No one of the laboratory findings were specifically diagnostic for mesenteric venous thrombosis, but leukocytosis and hemoconcentration were commonly found. Roentgenographic findings were consistent with intestinal obstruction in six patients. Thrombosis of the mesenteric veins could not be attributed to any specific cause in these nine patients, thereby warranting the classification of primary. At operation, all nine patients were found to have a segment of infarcted small intestine--132 +/- 105 centimeters--with obvious thrombosis of the mesenteric veins but with patent mesenteric arteries. Five patients had bloody ascites. Two deaths occurred in the immediate postoperative period, both being due to sudden and unexpected cardiopulmonary arrest. Neither of these two patients received anticoagulant therapy. Two patients had undergone segmental resection at other hospitals and were referred to our institution because of a recurrence of acute abdominal signs and symptoms. Neither of these patients received anticoagulant therapy. At reoperation, both had recurrent segmental mesenteric venous thrombosis. Familiarity with this condition is essential in making the correct diagnosis, so that resection may be undertaken promptly. Heparin should immediately be administered intravenously after establishing the diagnosis of mesenteric venous thrombosis to prevent recurrent thrombosis and other possible thrombotic complications. If these steps are taken expeditiously, the prognosis of mesenteric venous thrombosis is often favorable.