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Mesenteric venous thrombosis

MVT

Mesenteric venous thrombosis (MVT) is a blood clot in one or more of the major veins that drain blood from the intestine. The superior mesenteric vein is most commonly involved.

Causes

MVT is a clot that blocks blood flow in a mesenteric vein. There are two such veins through which blood leaves the intestine. The condition stops the blood circulation of the intestine and can result in damage to the intestine.

The exact cause of MVT is unknown. However, there are many diseases that can lead to MVT. Many of the diseases cause swelling (inflammation) of the tissues surrounding the veins, and include:

People who have disorders that make the blood more likely to stick together (clot) have a higher risk for MVT. Birth control pills and estrogen medicines also increase risk.

MVT is more common in men than women. It mainly affects middle aged or older adults.

Symptoms

Symptoms may include any of the following:

  • Abdominal pain, which may get worse after eating and over time
  • Bloating
  • Constipation
  • Bloody diarrhea
  • Fever
  • Septic shock
  • Lower gastrointestinal bleeding
  • Vomiting and nausea

Exams and Tests

A CT scan is the main test used to diagnose MVT.

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 or related medicines) are used to treat MVT 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 there are signs and symptoms of a severe infection called peritonitis, surgery to remove the intestine is done. After surgery, an ileostomy (opening from the small intestine into a bag on the skin) or colostomy (an opening from the colon into the skin) may be needed.

Outlook (Prognosis)

Outlook depends on the cause of the thrombosis and any damage to the intestine. Getting treatment for the cause before the intestine has died can result in a good recovery.

Possible Complications

Intestinal ischemia is a serious complication of MVT. Some or the entire intestine dies because of poor blood supply.

When to Contact a Medical Professional

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

References

Brandt LJ, Feuerstadt P. Intestinal ischemia. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 118.

Cloud A, Dussel JN, Webster-Lake C, Indes J. Mesenteric ischemia. In: Yeo CJ, ed. Shackelford's Surgery of the Alimentary Tract. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 87.

Roline CE, Reardon RF. Disorders of the small intestine. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 82.

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          Review Date: 4/11/2018

          Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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