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Yee-Huang Ku1 and Wen-Liang Yu2,3
1Division of Infectious Disease, Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
2Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan City, Taiwan
3Department of Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
Part of the book: Advances in Health and Disease. Volume 62
Superior mesenteric venous (SMV) thrombosis is an infrequent thrombotic event of hypercoagulable states that can cause intestinal ischemia, hemorrhage, or infarction. Despite severe consequences, SMV thrombosis often presents with nonspecific clinical features, including abdominal pain, distension, diarrhea, nausea, vomiting, intestinal obstruction, and bloody stool. SMV thrombosis may cause portal hypertension and its associated symptoms like intractable ascites of profuse production. Laboratory data may include elevation of hepatic enzyme, amylase, or lipase levels. SMV thrombosis is associated with a specific etiology (malignancy, thrombophilia, inflammatory bowel disease, intra-abdominal infection, or surgery). Other conditions or diseases such as pregnancy, puerperium, influenza, coronavirus disease-2019, and vaccine-induced immune thrombocytopenia are associated with thrombosis formation in various vessels, including SMV. Computed tomography (CT) imaging in the venous phase is considered the most reliable diagnostic method of choice. CT imaging may find acute thrombi present in SMV associated with submucosal edema in some intestinal loops. Management strategies are complicated by an underlying prothrombotic state and an increased risk of bleeding. SMV thrombosis can be reversed by effective anticoagulation. Prompt transcatheter thrombolysis can achieve early SMV revascularization. Early diagnosis prevents anticoagulation with continuous intravenous infusion of unfractionated heparin preventing subsequent consequences. Open laparotomy with mesenteric revascularization and resection of necrotic bowel has been considered the gold standard of care. Despite systemic anticoagulation therapy with intravenous heparin, the decision of an exploratory open thrombectomy could be made for patient deterioration clinically. The mortality rate among patients with acute SMV thrombosis ranges from less than 10% to 50%, depending on disease severity requiring surgical intervention. Negative predictors of survival include a higher Charlson comorbidity index and malignancy. Earlier diagnosis by the widespread use of CT scanning and aggressive treatment with anticoagulation may prevent progression to gangrenous bowel and lower mortality rates.
Keywords: anticoagulation, mesenteric, thrombectomy, thrombolysis, thrombosis
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