Treatment of Mesenteric Venous Thrombosis

Abstract

Once the diagnosis of mesenteric venous thrombosis (MVT) is made, treatment varies with the form of MVT (acute, subacute, or chronic MVT). As with acute arterial mesenteric ischemia, acute MVT is a surgical emergency—it may (and usually does not) require emergency operative or endovascular intervention; acute MVT does require immediate anticoagulation to arrest the thrombotic process and prevent progression to irreversible intestinal venous infarction. Diagnosis (a high index of suspicion) and immediate systemic anticoagulation are requisites with careful observation for development of intestinal infarction requiring operative intervention. For subacute MVT, the treatment is similar—anticoagulation and investigation of underlying risk factors; need for operative or endovascular intervention is unusual. For chronic MVT, treatment involves either anticoagulation if there is an underlying systemic coagulopathy, management of intra-abdominal perivenous pathology if that is the cause of the MVT (e.g., chronic pancreatitis), or management of the hemorrhagic mesenteric or splenic venous consequences of venous hypertension. Interventional processes of thrombectomy/thrombolysis have been used in selected situations but are unusual.