Mesenteric vein thrombosis

Twenty-five percent ofthrombophilic patients develop thrombosis at unusual sites resulting in cerebral venous thrombosis, mesenteric vein thrombosis, hepatic venous thrombosis, retinal vein thrombosis, purpura fulminans, splenic vein thrombosis, portal vein thrombosis, renal vein thrombosis, or axillary vein thrombosis. The thrombotic disorders may involve inflammatory factors that contribute to the vascular deficit. In addition, embolic events also play a role in the development of these thrombotic complications. 

Hepatic venous thrombosis, also known as Budd-Chiari syndrome, is caused by hypercoagulable disorders precipitated by pregnancy, infection, and birth control medication. An acute painful abdomen, sudden enlargement of the liver, and the presence of ascites make up a triad of clinical symptoms that are important in the diagnosis of this syndrome. Myeloproliferative disorders such as polycythemia vera and paroxysmal nocturnal dyspnea were previously thought to be responsible. Factor V Leiden and prothrombin 20210 mutations are also known to be responsible, Other intraabdominal thromboses include portal vein thrombosis, mesenteric vein thrombosis and renal vein thrombosis. 

Venturini, I., Cioni, G., Turrini, F., Gandolfo, M., Modonesi, G., Cosenza, R., Miglioli, L., Cristani, A., D Alimonte, R, de Santis, M., Zeneroli, M.L. Mesenteric vein thrombosis a rare cause of abdominal pain in cirrhotic patients. Two case reports. Hepato-Gastroenterol. 1998 45 44-47... 

Unlabeled Uses Acute peripheral occlusive disease, basilar artery occlusion, cerebral infarction, deep vein thrombosis, femoropopliteal artery occlusion, mesenteric or subclavian vein occlusion, pleural effusion (parapneumonic)... 

Portal vein thrombosis (with open superior mesenteric vein)... 

Previous shunt operations and TIPS need to be removed in order to guarantee that the transplanted liver is sufficiently supplied with portovenous blood. In these cases, the portal system is checked preoperatively for thromboses by means of colour-encoded duplex sonography and X-ray techniques. In any case, the confluence of superior mesenteric vein and splenic vein must be free. (391) The main advantage of portacaval end-to-side anastomosis is its low thrombosis rate of < 5% in addition, there is no need for a distal shunt ligature. In shunts distal to the hilus (mesocaval, distal splenorenal), no preparation of the liver hilus is required however, in 10% of cases, these shunts show portal vein thrombosis (in TIPS, up to 15%). Usually, all surgical shunts are disconnected or ligated before the liver transplantation is completed in order to... 

Inhibition of plasminogen by tranexamic acid and aminocaproic acid conld theoretically facilitate the development of thrombosis, bnt whether it actnally does so has been the snbject of contradictory reports. Episodes of venous and arterial thrombosis have been reported in association with treatment using either tranexamic acid or aminocaproic acid. These include thrombosis at unusual sites such as mesenteric thrombosis (46), aorta (47), retinal artery occlusion (48), and intracranial arterial thrombosis (49-51), as well as deep vein thrombosis in the legs (52). 

Fig. 20.12a,b. Portal vein pathologies, a MIP image reconstruction from a CT dataset shows complete thrombosis of the portal vein and of its right branch, and partial thrombosis of the superior mesenteric vein, b MIP image reconstruction from a MR dataset shows a portal cavernoma... 

Fig.7.8a,b. Pyogenic abscess, a Pyogenic abscess in a 35-year old man status post laparoscopic right hepatectomy due to an hydatid cyst. Portal venous-phase contrast-enhanced CT scan shows a thick-walled cystic lesion with homogeneous low attenuation. b Pyogenic abscess with presence of gas within the lesion in a 52-year-old man with fever, head of pancreas neoplasia (not resectable due to superior mesenteric vein infiltration) and recent portal thrombosis. An axial portal phase CT scan shows an hypoattenuating lesion with non-homogeneous content and gas inside... 

Fig. 7.14a,b. A 43-year-old woman with abdominal discomfort image obtained 12 days after simultaneous pancreas-kidney transplantation, a, b Contrast-enhanced multidetector CT displays acute thrombosis of superior mesenteric vein (arrowheads) and splenic vein (arrowhead) but homogeneous contrast enhancement of pancreatic graft (arrow) with donor s duodenum (arrows) and renal graft (asterisk). (CIA common iliac artery, CIV common iliac vein, d donor s, IPDA inferior pancreaticoduodenal artery, / left, r right, SA splenic artery, SMA superior mesenteric artery)... 

To conclude, the epidemiological studies on oral contraceptives and thromboembolism all point to the same direction, i.e. to an increased risk of thromboembolic disease (deep vein thrombosis, pulmonary embolism, cerebral thrombosis, myocardial infarction) in women using oral contraceptives of the combined type. Support can also be obtained from the studies on changes in the fibrinolytic system (see below). For thrombosis with rare localization, e.g. in the mesenteric vessels, epidemiological data are still lacking. It remains to be seen whether the risk of thrombosis is reduced with the new low-dose combinations. 

It also appears that the incidence of hepatic adenomas is increased in women taking oral contraceptives. Ischemic bowel disease secondary to thrombosis of the celiac and superior and inferior mesenteric arteries and veins has also been reported in women using these drugs. 

Young (<50 years) and no other cause found past history or family history of venous thrombosis, especially if unusual site (cerebral, mesenteric, hepatic veins) recurrent miscarriage thrombocytopenia cardiac valve vegetations livedo reticularis raised ESR malaise positive syphilis serology... 

Clinical effects produced by thrombi and emboli are (1) no serious effects, the silent thrombus or embolus (2) oedema of a limb, venous thrombus and perivenous lymphangitis (3) post-thrombotic ulceration (4) gangrene of a limb (thrombosis of main artery or embolus from heart or aorta) (5) gangrene of bowel (thrombosis of mesenteric artery or vein, arterial embolism) ... 

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