SS14. Acute Superior Mesenteric Venous Thrombosis Results in High Rates of Readmission and Long-term Morbidity

Abstract

Acute superior mesenteric venous thrombosis (MVT) is a relatively rare entity that accounts for 6% to 9% of all cases of acute mesenteric ischemia. We reviewed our experience with MVT, our approach to operative management, and long-term outcomes. We identified all patients who presented with abdominal pain and were found to have acute superior MVT on computed tomography scan from 2008 to 2018. Demographics, anatomic factors, management, and outcome variables were captured (Table). Variables associated with operative intervention, readmission, and chronic mesenteric congestion (defined as development of chronic bowel wall thickening, venous collaterals, or portal hypertension on computed tomography scan) were evaluated using univariate and multivariate statistics. There were 121 patients who presented with MVT, and 25 (20.7%) underwent operative intervention: 19 bowel resection, 2 negative exploratory laparotomy, 1 suction thrombectomy, 1 lysis (trans-splenic), and 2 with a combination of suction thrombectomy and lysis. Patients who underwent procedures had similar comorbidities to those managed conservatively on multivariate analysis except for hypercoagulable disorder, which was a predictor of operative intervention (odds ratio [OR], 3.88 [1.01-14.89]; P = .048); 52% of patients requiring surgery presented with peritonitis, whereas no peritonitis was observed in patients treated medically (P < .001). Patients with lactic acidosis (11.5% vs 36%; P = .003) and leukocytosis (34.4% vs 72%; P = .001) were more likely to undergo a procedure. Fifty patients in the medical group and 11 patients in the surgical group presented with concomitant portal vein thrombosis (52.1% vs 44%; P = .472). Forty (33.1%) patients were readmitted with abdominal pain, and 53 (43.8%) patients developed chronic mesenteric congestion on imaging (Table). Using multivariate analysis, variables predictive of readmission included chronic mesenteric venous thrombus (OR, 5.66 [2.25-14.24]; P < .001) and concomitant portal vein thrombus (OR, 3.15 [1.24-8.02]; P = .016). Chronic occlusive thrombus predicted development of chronic mesenteric congestion (OR, 3.77 [1.38-10.29]; P = .010). Mortality rates did not differ significantly between medically managed and surgically managed groups (Table). Patients who required bowel resection developed chronic mesenteric congestion at the same rates as those who were treated with anticoagulation alone. Mean follow-up time was 1.54 years. MVT leads to high rates of readmission and chronic mesenteric congestion, and chronic thrombus is a predictor of long-term morbidity. Poor outcomes persist for patients who are treated with anticoagulation with or without bowel resection. More studies are warranted to understand the role of endovascular recanalization and thrombolysis in relieving venous congestion and their effects on short- and long-term outcomes of MVT.TablePatients' characteristics and outcomes after mesenteric venous thrombosis (MVT)Medical management alone (96 patients)Operative and medical management (25 patients)P valuePatients' demographics Age, years50.66 (15.01)49.76 (13.17).786 Sex (female)39 (40.62)15 (60.00).083 Race (white)83 (86.46)20 (80.00).419 Hypercoagulable disorder19 (19.79)12 (48.00).004 History of DVT or PE8 (8.33)5 (20.00).093 Concomitant portal vein thrombus50 (52.08)11 (44.00).472Medical management Discharge anticoagulation71 (73.96)22 (88.00).138 Anticoagulation at 3 months60 (84.51)17 (77.27).270 Anticoagulation at 6 months41 (57.75)11 (50.00).757Follow-up CT findings73 patients (76.04)16 patients (64.00) Chronic occlusive thrombus39 (53.42)7 (43.75).247 Chronic small bowel wall thickening9 (12.33)5 (31.25).060 Chronic colon wall thickening7 (9.59)1 (6.25).672 Chronic venous collaterals33 (45.21)8 (50.00).727 Chronic portal venous hypertension19 (26.03)4 (25.00).932Outcomes Bleeding from anticoagulation17 (17.71)4 (16.00).841 TPN dependent5 (5.21)3 (12.50).200 Readmission31 (32.63)9 (37.50).652 Time to readmission, months4.80 (1.29)3.15 (0.99) In-hospital death3 (3.12)1 (4.00).827CT, Computed tomography; DVT, deep venous thrombosis; PE, pulmonary embolism; TPN, total parenteral nutrition.Continuous variables are presented with summary measure of mean (standard deviation) and P value from Student t-test. Categorical variables are summarized by number (%), and P values are calculated from the χ2 test. Open table in a new tab