Mesenteric venous thrombosis

Definition

Mesenteric venous thrombosis is a blood clot in one or more of the major veins that drain blood from the intestine.

Causes, incidence, and risk factors

Mesenteric venous thrombosis is a clot that blocks blood flow a mesenteric vein, one of two veins through which blood leaves the intestine. The condition interrupts the blood supply to the intestine and can result in damage to the intestines.

Mesenteric venous thrombosis has a variety of causes. Many of the diseases that lead to this condition cause swelling (inflammation) of the tissues surrounding the veins, including:

Patients who have disorders that make the blood more likely to stick together (clot) have a higher risk for mesenteric venous thrombosis. Birth control pills and estrogen medicines increase your risk of this condition.

Symptoms

  • Abdominal pain, which may get worse after eating and over time
  • Bloating
  • Diarrhea
  • Fever
  • Gastrointestinal bleeding
  • Vomiting

Signs and tests

A CT scan is the main test used to diagnose mesenteric venous thrombosis.

Other tests may include:

  • Angiogram (studying the blood flow to the intestine)
  • MRI of the abdomen
  • Ultrasound of the abdomen and mesenteric veins

Treatment

Blood thinners (most commonly heparin) are used to treat mesenteric venous thrombosis when there is no associated bleeding. In some cases, medicine can be delivered directly into the clot to dissolve it. This procedure is called thrombolysis.

Less often, the clot is removed with a type of surgery called thrombectomy.

If you have signs and symptoms of a severe infection called peritonitis, you will usually need surgery to remove the intestine. After surgery, you may need an ileostomy (opening from the small intestine into a bag on the skin) or colostomy (an opening from the colon into the skin).

Expectations (prognosis)

How well you do depends on the cause of the thrombosis. Getting treatment for the cause before the intestine has died can result in a good recovery.

Complications

Intestinal ischemia is a serious complication of mesenteric venous thrombosis. Some or all of the intestine dies because of poor blood supply.

Calling your health care provider

Call your health care provider if you have severe or repeated episodes of abdominal pain.

References

Hauser SC. Vascular disease of the gastrointestinal tract. In Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011: chap 145.

Revision

Last reviewed 6/5/2012 by David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

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