Venous Thrombosis

The less common condition of mensenteric venous thrombosis occurs in the face of a predisposing factor, such as severe, especially acute, portal hypertension, polycythemia vera, severe dehydration, and other hypercoagulable states, including, occasionally, pregnancy. In recent years, subclinical coagulopathies due to deficiencies in protein A, protein C, and factor V Leiden have been identified in many of these patients. Frequently, there is a history of (even minor) abdominal trauma. The diagnosis is suspected on the basis of the massive fluid losses and the more gradual onset of symptoms, in the presence of one of the predisposing factors. Abdominal symptoms may be subtle, but are usually progressive. After fluid resuscitation, which is often massive, the diagnosis can be confirmed by observing the venous phase of the mesenteric angiogram, but nowadays it is usually made by a CT scan with IV contrast. For the most part, treatment is by anticoagulation; surgery is reserved for the resection of dead bowel 24 to 48 hours later. There is little rationale for early laparotomy, as venous thrombectomy is rarely successful. In cases of acute portal hypertension, such as those due to the Budd-Chiari syndrome, a portasystemic shunt may be useful in combination with a successful mesenteric venous thrombectomy.

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