Acute Mesenteric Venous Thrombosis Research Articles

MiR-138-5p ameliorates intestinal barrier disruption caused by acute superior mesenteric vein thrombosis injury by inhibiting the NLRP3/HMGB1 axis.

Acute superior mesenteric venous thrombosis (ASMVT) decreases junction-associated protein expression and intestinal epithelial cell numbers, leading to intestinal epithelial barrier disruption. Pyroptosis has also recently been found to be one of the important causes of mucosal barrier defects. However, the role and mechanism of pyroptosis in ASMVT are not fully understood. Differentially expressed microRNAs (miRNAs) in the intestinal tissues of ASMVT mice were detected by transcriptome sequencing (RNA-Seq). Gene expression levels were determined by RNA extraction and reverse transcription-quantitative PCR (RT-qPCR). Western blot and immunofluorescence staining analysis were used to analyze protein expression. H&E staining was used to observe the intestinal tissue structure. Cell Counting Kit-8 (CCK-8) and fluorescein isothiocyanate/propidine iodide (FITC/PI) were used to detect cell viability and apoptosis, respectively. Dual-luciferase reporter assays prove that miR-138-5p targets NLRP3. miR-138-5p expression was downregulated in ASMVT-induced intestinal tissues. Inhibition of miR-138-5p promoted NLRP3-related pyroptosis and destroyed tight junctions between IEC-6 cells, ameliorating ASMVT injury. miR-138-5p targeted to downregulate NLRP3. Knockdown of NLRP3 reversed the inhibition of proliferation, apoptosis, and pyroptosis and the decrease in tight junction proteins caused by suppression of miR-138-5p; however, this effect was later inhibited by overexpressing HMGB1. miR-138-5p inhibited pyroptosis, promoted intestinal epithelial tight junctions and alleviated ASMVT injury-induced intestinal barrier disruption via the NLRP3/HMGB1 axis.

Acute mesenteric venous thrombosis; underestimated and lethal cause of intestinal ischemia

Acute mesenteric venous thrombosis; underestimated and lethal cause of intestinal ischemia

Superior Mesenteric Vein Thrombosis as a Complication of Acute Appendicitis: A Rare Entity

The complications of acute appendicitis have been widely described in the literature; Mesenteric venous thrombosis is a rare manifestation of this pathology corresponding to less than 1% frequency, this can confuse the general surgeon as it coexists with acute appendicitis. We present the case of a 58-year-old male patient, with abdominal pain of 5 days of evolution, with symptoms that are not very specific for the specific diagnosis of appendicitis. Computed tomography of the abdomen was performed with findings of acute appendicitis and mesenteric venous thrombosis with a clot of 11.5 cm. An open appendectomy was performed and anticoagulation was started on hospital discharge

Integrated nursing of Traditional Chinese and western medicine for a patient undergoing thrombolytic therapy for acute mesenteric venous thrombosis

Integrated nursing of Traditional Chinese and western medicine for a patient undergoing thrombolytic therapy for acute mesenteric venous thrombosis

Obstructive Ileus Secondary to Acute Mesenteric Ischaemia: Internal Medicine Perspective

Acute mesenteric ischemia (AMI) could be a rare but potentially life-threatening condition due to poor understanding of the clinical presentation of abdominal pain and the differential diagnosis when it is not suspected and partly because of an unacceptable delay in making the diagnosis. A 59 years old man was brought to the hospital with abdominal pain, accompanied by obstructive ileus and sepsis. An urgent CT-scan showed the feature of intestinal infarction and portal vein thrombus. After giving fluid resuscitation and antibiotic injection, he was consulted to the surgery division and had jejunum resection. Since the etiology of the disease was suspected to be acute mesenteric venous thrombosis, he was given intravenous anticoagulants postoperatively and the condition improved. The clinical diagnosis of acute mesenteric ischemia is troublesome, and in most cases, abdominal pain is the main symptom. Ileus and sepsis are two complications that may mask the initial signs and symptoms of AMI. From the internal medicine’s point of view, the proper treatment of this disease is early diagnosis, the rebuilding of blood flows with anticoagulants, surgery division discussion, and post-operative supportive care. The underlying cause should be established to determine long-term management essential to anticipate a repeat.

782 A Rare Complication in A Post-Operative Bariatric Patient: COVID-19 Induced Mesenteric Venous Thrombosis

IntroductionThe emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has provided enormous challenges in the delivery of surgical care. In addition to respiratory tract infections, coronavirus disease 2019 (COVID-19) is associated with both arterial and venous thrombotic complications.Case Details:We present a case of acute superior mesenteric venous (SMV) thrombosis in a 36-year-old female patient who underwent Roux-en-Y gastric bypass three years previously. Her presentation with acute abdominal pain occurred 6 days after a positive nasopharyngeal swab. An admission CT scan demonstrated an abrupt cut off in the proximal SMV with resultant small bowel oedema. Subsequent thrombophilia screening and mutation testing for myeloproliferative neoplasms were all negative. She had also previously carried three pregnancies to term without any thrombotic complications. Hence, the high suspicion of acute COVID-19 induced mesenteric thrombosis.ConclusionsIn patients who have previously undergone Rouy-en-Y gastric bypass and lost significant weight, acute abdominal pain normally raises a high suspicion of internal hernia. However, as the pandemic progresses surgeons need to be mindful of COVID-19 induced mesenteric thrombosis as a differential diagnosis during the workup of acute abdominal pain. This was well demonstrated on a CT scan with intravenous contrast.

A systematic review and meta-analysis on endovascular treatment as an attractive alternative for acute superior mesenteric venous thrombosis.

This systematic review and meta-analysis evaluated the published data on the efficacy and safety of therapies for superior mesenteric venous thrombosis (SMVT), aiming to provide a reference and set of recommendations for clinical treatment. Relevant databases were searched for studies published from 2000 to June 2020 on SMVT treated with conservative treatment, surgical treatment, or endovascular approach. Different treatment types were grouped for analysis and comparison, and odds ratios with corresponding 95% confidence intervals were calculated. The outcomes were pooled using meta-analytic methods and presented by forest plots. Eighteen articles, including eight on SMVT patients treated with endovascular therapies, were enrolled. The treatment effectiveness was compared between different groups according to the change of symptoms, the occurrence of complications, and mortality as well. The conservative treatment group had better efficacy compared to the surgery group (89.0% vs. 78.6%, P <0.05), and the one-year survival rate was also higher (94.4% vs. 80.0%, P >0.05), but without statistical significance. As for endovascular treatment, the effectiveness was significantly higher than the surgery group (94.8% vs. 75.2%, P <0.05), and the conservative treatment group as well (93.3% vs. 86.3%, P >0.05), which still requires further research for the lack of statistical significance. Present findings indicate that anticoagulation, as conservative treatment should be the preferred clinical option in the clinic for SMVT, due to its better curative effect compared to other treatment options, including lower mortality, fewer complications, and better prognosis. Moreover, endovascular treatment is a feasible and promising approach that is worth in-depth research, for it is less invasive than surgery and has relatively better effectiveness, thus can provide an alternative option for SMVT treatment and may be considered as a reliable method in clinical.

A Case of Acute Superior Mesenteric Venous Thrombosis in a Male-to-Female Transsexual with Klinefelter Syndrome

A Case of Acute Superior Mesenteric Venous Thrombosis in a Male-to-Female Transsexual with Klinefelter Syndrome

Ultrasound features and clinical characteristics of intestinal ischemia secondary to acute mesenteric venous thrombosis

Objective: To examine the ultrasound features and clinical characteristics of the intestinal ischemia secondary to acute mesenteric venous thrombosis (AMVT). Methods: From January 2016 to June 2019, 11 patients were diagnosed as intestinal ischemia secondary to AMVT confirmed by surgical pathology or CT in Peking Union Medical College Hospital. The patients included 7 males and 4 females, aging of (52.8±11.9) years (range: 34 to 81 years).The clinical characters and ultrasound features were retrospectively reviewed. Results: Abdomen pain was the chief complaint of all patients. Other complaints include 2 cases of blood in the stool, 1 case of hematemesis, 2 cases of vomiting, 1 case of diarrhea. Six patients showed rebound pain on physical examination. All patients had elevated white blood cell account and D-Dimer. Nine patients had a thrombosis in the portal vein simultaneously. All 11 patients underwent the CT scan including 10 contrast-enhanced CT. Mesenteric venous thrombosis was detected in 10 cases who underwent contrast-enhanced CT imaging. On CT imaging, 11 patients demonstrated intestinal wall thicken, 5 patients showed intestinal dilation. Eight patients underwent superior mesenteric venous ultrasound examination. Of them, 7 patients were correctly diagnosed as AMVT. Of the 10 patients who underwent abdominal ultrasound, 5 patients showed intestinal lesions including intestinal wall thicken in 4 patients and intestinal dilation in 1 patient. Peritoneal fluid was detected in 10 patients by ultrasound, which was consistent with CT. Ten patients underwent surgical procedures while 1 patient received conservative treatment. Conclusion: Ultrasound is an accurate imaging method in diagnosing superior mesenteric vein thrombosis and can detect intestinal wall thickening, intestinal dilation, and peritoneal fluid.

Management of Acute Mesenteric Venous Thrombosis: A Systematic Review of Contemporary Studies.

Background and Aims:Acute mesenteric venous thrombosis accounts for up to 20% of all patients with acute mesenteric ischemia in high-income countries. Acute mesenteric venous thrombosis is nowadays relatively more often diagnosed with intravenous contrast-enhanced computed tomography in the portal phase than at explorative laparotomy No high-quality comparative studies between anticoagulation alone, endovascular therapy, or surgery exists. The aim of the present systematic review was to offer a contemporary overview on management.Materials and Methods:Eleven relevant published original studies with series of at least ten patients were retrieved from a Pub Med search between 2015 and 2020 using the Medical Subject Heading term “mesenteric venous thrombosis.”Results:When MVT is diagnosed early, immediate anticoagulation with either unfractionated heparin or subcutaneous low-molecular-weight heparin should commence. Surgeons need to be aware of the importance to scrutinize the computed tomography images themselves for assessment of secondary intestinal abnormalities to mesenteric venous thrombosis and the risk of bowel resection and worse prognosis. Progression toward peritonitis is an indication for explorative laparotomy and assessment of bowel viability. Frank transmural small bowel necrosis should be resected and bowel anastomosis may be delayed for several days until second look. Meanwhile, intravenous full-dose unfractionated heparin should be given at the end of the first operation. Postoperative major intra-abdominal or gastrointestinal bleeding occurs rarely, but the heparin effect can instantaneously be reversed by protamine sulfate. Patients who do not improve during conservative therapy with anticoagulation alone but without developing peritonitis may be subjected to endovascular therapy in expert centers. When the patient’s intestinal function has recovered, with or without bowel resection, switch from parenteral unfractionated heparin or low-molecular-weight heparin therapy to oral anticoagulation can be performed. There is a trend that direct oral anticoagulants are increasingly used instead of vitamin K antagonists. Up to now, direct oral anticoagulants have been shown to be equally effective with the same rate of bleeding complications. Patients with no strong permanent trigger factor for mesenteric venous thrombosis such as intra-abdominal cancer should undergo blood screening for inherited and acquired thrombophilia.Conclusion:Early diagnosis with emergency computed tomography with intravenous contrast-enhancement and imaging in the portal phase and anticoagulation therapy is necessary to be able to have a succesful non-operative succesful course.

Nomogram for predicting transmural bowel infarction in patients with acute superior mesenteric venous thrombosis.

BACKGROUNDThe prognosis of acute mesenteric ischemia (AMI) caused by superior mesenteric venous thrombosis (SMVT) remains undetermined and early detection of transmural bowel infarction (TBI) is crucial. The predisposition to develop TBI is of clinical concern, which can lead to fatal sepsis with hemodynamic instability and multi-organ failure. Early resection of necrotic bowel could improve the prognosis of AMI, however, accurate prediction of TBI remains a challenge for clinicians. When determining the eligibility for explorative laparotomy, the underlying risk factors for bowel infarction should be fully evaluated.AIMTo develop and externally validate a nomogram for prediction of TBI in patients with acute SMVT.METHODSConsecutive data from 207 acute SMVT patients at the Wuhan Tongji Hospital and 89 patients at the Guangzhou Nanfang Hospital between July 2005 and December 2018 were included in this study. They were grouped as training and external validation cohort. The 207 cases (training cohort) from Tongji Hospital were divided into TBI and reversible intestinal ischemia groups based on the final therapeutic outcomes. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for TBI using the training data, and a nomogram was subsequently developed. The performance of the nomogram was evaluated with respect to discrimination, calibration, and clinical usefulness in the training and external validation cohort.RESULTSUnivariate and multivariate logistic regression analyses identified the following independent prognostic factors associated with TBI in the training cohort: The decreased bowel wall enhancement (OR = 6.37, P < 0.001), rebound tenderness (OR = 7.14, P < 0.001), serum lactate levels > 2 mmol/L (OR = 3.14, P = 0.009) and previous history of deep venous thrombosis (OR = 6.37, P < 0.001). Incorporating these four factors, the nomogram achieved good calibration in the training set [area under the receiver operator characteristic curve (AUC) 0.860; 95%CI: 0.771-0.925] and the external validation set (AUC 0.851; 95%CI: 0.796-0.897). The positive and negative predictive values (95%CIs) of the nomogram were calculated, resulting in positive predictive values of 54.55% (40.07%-68.29%) and 53.85% (43.66%-63.72%) and negative predictive values of 93.33% (82.14%-97.71%) and 92.24% (85.91%-95.86%) for the training and validation cohorts, respectively. Based on the nomogram, patients who had a Nomo-score of more than 90 were considered to have high risk for TBI. Decision curve analysis indicated that the nomogram was clinically useful.CONCLUSIONThe nomogram achieved an optimal prediction of TBI in patients with AMI. Using the model, the risk for an individual patient inclined to TBI can be assessed, thus providing a rational therapeutic choice.

Predictors of irreversible intestinal resection in patients with acute mesenteric venous thrombosis.

Acute mesenteric venous thrombosis (AMVT) can cause a poor prognosis. Prompt transcatheter thrombolysis (TT) can achieve early mesenteric revascularization. However, irreversible intestinal ischemia still occurs and the mechanism is still unclear. To evaluate the clinical outcomes of and to identify predictive factors for irreversible intestinal ischemia requiring surgical resection in AMVT patients treated by TT. The records of consecutive patients with AMVT treated by TT from January 2010 to October 2017 were retrospectively analyzed. We compared patients who required resection of irreversible intestinal ischemia to patients who did not require. Among 58 patients, prompt TT was carried out 28.5 h after admission. A total of 42 (72.4%) patients underwent arteriovenous combined thrombolysis, and 16 (27.6%) underwent arterial thrombolysis alone. The overall 30-d mortality rate was 8.6%. Irreversible intestinal ischemia was indicated in 32 (55.2%) patients, who had a higher 30-d mortality and a longer in-hospital stay than patients without resection. The significant independent predictors of irreversible intestinal ischemia were Acute Physiology and Chronic Health Evaluation (APACHE) II score (odds ratio = 2.368, 95% confidence interval: 1.047-5.357, P = 0.038) and leukocytosis (odds ratio = 2.058, 95% confidence interval: 1.085-3.903, P = 0.027). Using the receiver operating characteristic curve, the cutoff values of the APACHE II score and leukocytosis for predicting the onset of irreversible intestinal ischemia were calculated to be 8.5 and 12 × 109/L, respectively. Prompt TT could achieve a favorable outcome in AMVT patients. High APACHE II score and leukocytosis can significantly predict the occurrence of irreversible intestinal ischemia. Therefore, close monitoring of these factors may help with the early identification of patients with irreversible intestinal ischemia, in whom ultimately surgical resection is required, before the initiation of TT.

Acute superior mesenteric venous thrombosis results in high rates of readmission and morbidity

ObjectiveSuperior mesenteric venous thrombosis (MVT) is a poorly understood clinical entity, and as such, outcomes are poorly described. This study aimed to identify predictors of bowel ischemia after MVT and to compare outcomes for patients treated medically (group 1) with those for patients treated with bowel resection (group 2). MethodsThis was a retrospective, single-institution study capturing all patients diagnosed with symptomatic acute MVT on computed tomography imaging from 2008 to 2018. Demographics, comorbidities, imaging, laboratory values, and treatment were included. Predictors of bowel resection were analyzed by univariate and multivariate statistics. Outcomes including mortality, readmissions for abdominal pain, and chronic mesenteric venous congestion were compared using χ2 test. ResultsThere were 121 patients included in the study; 98 patients were treated medically (group 1), 19 patients were treated with bowel resection (group 2), and 4 patients were treated with endovascular recanalization (group 3). Group 1 and group 2 were compared directly. Patients requiring bowel resection tended to have higher body mass index (P = .051) and a hypercoagulable disorder (P = .003). Patients who required bowel resection were more likely to present with lactic acidosis (P < .001) and leukocytosis (P < .001) with bowel wall thickening on scan (P < .001). On multivariable analysis, a genetic thrombophilia was a strong predictor of bowel ischemia (odds ratio, 3.81; 95% confidence interval, 1.12-12.37). One-year mortality and readmission rates did not differ between groups. However, readmission rates for abdominal pain were high for both groups (group 1, 44.90%; group 2, 57.89%; P = .317), and a significant proportion of patients exhibited chronic mesenteric venous congestion on repeated scan (group 1, 42.86%; group 2, 47.37%; P = .104). ConclusionsA genetic hypercoagulable disorder is a predictor of bowel ischemia due to MVT. Regardless of treatment, outcomes after MVT are morbid, with high rates of readmission for abdominal pain. An alternative approach to treat these patients is needed, given the poor outcomes with current strategies.

Mesenteric venous thrombosis complicating acute appendicitis: A case series

IntroductionAcute appendicitis is one of the most common surgical conditions. In the current era it rarely presents in association with mesenteric venous thrombosis. We present 4 cases of mesenteric venous thrombosis occurring in the setting of acute appendicitis. MethodsWe performed a retrospective review of Mayo Enterprise clinical database for inpatients with a diagnosis of acute appendicitis and venous thrombosis related ICD-10 codes. Charts for patients with a diagnosis of mesenteric venous thrombosis and acute appendicitis were reviewed to identify demographic data, findings at presentation, and management patterns. ResultsA total of 1,615 inpatients were identified with a principle diagnosis of acute appendicitis across the Mayo Enterprise from October 1st, 2015- March 31st, 2019. Four inpatients with a diagnosis of acute appendicitis were also noted to have a mesenteric venous thrombosis at presentation resulting in an incidence of 0.25 %. Mean duration of symptoms at presentation was 12.25 days. All patients with acute appendicitis and mesenteric venous thrombosis were initially managed with a heparin drip, antibiotics, and intravenous fluids. Ultimately, 3 of 4 patients underwent appendectomy. ConclusionMesenteric venous thrombosis complicating acute appendicitis is rare and typically presents in a delayed fashion. Patients without evidence of non-viable bowel are typically treated initially with intravenous fluid resuscitation, antibiotics, bowel rest, and anticoagulation with a heparin drip.

Acute inferior mesenteric venous thrombosis in a child

Inferior mesenteric venous thrombosis is a very rare condition with serious management challenge, especially in a resource-poor environment. The acute variety is associated with high morbidity and mortality, especially if there are accompanying bowel infarction and peritonitis. The case of a 12-year-old boy was referred from a private hospital after a failed attempt at appendicectomy. The patient presented with features of generalized peritonitis and severe sepsis. Exploratory laparotomy after optimization showed massive hemorrhagic ascetic fluid, extensive left colonic gangrene extending from distal transverse colon to the sigmoid colon, and thrombosis in the branches of the inferior mesenteric vessel. The patient died 36 h postoperatively at the intensive care unit. A high index of suspicion and early bowel resection in cases of associated bowel infarction will improve outcome.

Thrombectomy and Thrombolysis by Catheter Through Right Gastroepiploic Vein of Acute Superior Mesenteric Venous Thrombosis with Peritoneal Signs

Thrombectomy and Thrombolysis by Catheter Through Right Gastroepiploic Vein of Acute Superior Mesenteric Venous Thrombosis with Peritoneal Signs

Evaluation of Endovascular Therapy Combined with Bowel Resection Treatment on Patients with Acute Mesenteric Venous Thrombosis

This retrospective study aims to investigate the effects of the endovascular and surgical strategy for treating patients with acute mesenteric venous thrombosis (AMVT). We retrospectively studied 68 patients with AMVT who underwent treatment in Jinling Hospital during the period from January 2009 to December 2014. The mean age was 45±12years (range 20-72years). All patients were treated by using the combined treatment that included endovascular treatment, damage control surgery, surgical intensive care, and intestinal rehabilitation treatment. Clinical outcomes and complications were compared during the follow-up period. All the 68 cases received anticoagulant treatment. However, only 24 received the endovascular intervention, 19 received surgical resection, and 25 patients received endovascular treatment combined with bowel resection. The overall mortality rate was 2.94% (2 cases). Bowel resection range significantly decreased (92±14cm vs. 162±27cm, t=-2.377, P=0.022) in the combination therapy group, when compared with the surgery group. During the 1-year follow-up period, 4 cases suffered from short bowel syndrome. Our study indicates that AMVT can be successfully treated with the early improvement of intestinal blood circulation. Further, our applied combined approach showed a favorable outcome in mesenteric thrombosis patients and reduced the mortality rate by improving the prognosis significantly.

Prothrombin R541W Mutation Impairs Protein C Activation and Constitutes a New Genetic Risk Factor for Venous Thrombosis

Defective protein C (PC) pathway predisposes patients to venous thromboembolism (VTE)and is mostly, but not exclusively, attributed tohereditary PC or protein S (PS) deficiencies and activated PC resistance caused by factor V Leiden mutation. In a patient with acute mesenteric venous thrombosis and positive family history of VTE associated with the impaired PC pathway function determined by thrombin generation test, we identified a novel heterozygous prothrombin mutation p.Arg541Trp. Two more patients with positive family history of VTE carrying the same mutation were identified in a cohort of another 373 unrelated patients, making an overall prevalence of 0.8%. Family investigation revealed 11 individuals in the three pedigrees harboring the heterozygous prothrombin p.Arg541Trp mutation, and 8 of them (72%) had experienced episodes of VTE. Functional studies indicated the mutation moderately decreased procoagulant activity of prothrombin and had mild impact on the inactivation of thrombin by its inhibitor antithrombin. However, the amino acid residue substitution significantly compromised PC activation by thrombin, both in the absence and presence of soluble thrombomodulin, and thus rendered prothrombin function procoagulant biased. In conclusion, the prothrombin p.Arg541Trp mutation constitutes a new genetic risk factor of VTE by impairing function of PC pathway and tilting thrombin's procoagulant activity over anticoagulant function. Figure Disclosures Ding: Shanghai General Hospital affiliated to Shanghai Jiao Tong University, Shanghai: Patents &amp; Royalties: W.W, Q.D and X.W of the co-authors are named as inventors on a patent application related to this work.. Wang:Ruijin Hospital, Shanghai Jiao Tong University School of Medicine: Patents &amp; Royalties: W.W, Q.D and X.W of the co-authors are named as inventors on a patent application related to this work.. WU:Ruijin Hospital, Shanghai Jiao Tong University School of Medicine: Patents &amp; Royalties: W.W, Q.D and X.W of the co-authors are named as inventors on a patent application related to this work..

Acute mesenteric venous thrombosis after laparoscopic sleeve gastrectomy: a case report and a literature review

Over the last decade, laparoscopic sleeve gastrectomy has become an increasingly popular surgical procedure for morbid obesity. Moreover, post-laparoscopic sleeve gastrectomy mesenteric venous thrombosis is very rarely reported. The presentation varies from mild non-specific abdominal symptoms to life threatening surgical emergency. Superior mesenteric vein thrombosis after bariatric surgery is a difficult diagnosis that needs a high index of suspicion. We report a case of thrombosis of the superior mesenteric vein, who presented as acute emergency to emergency room, shortly after sleeve gastrectomy. Patient underwent laparotomy and offered a resection of 60 cm of infarcted proximal jejunum with restoration of bowel continuity later. Patient subsequently recovered and followed several times in our outpatient and was free of symptoms.

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

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