Is mesenteric venous occlusion as a cause of ischemic bowel disease?
Mesenteric venous occlusion is a rare cause of ischemic bowel disease, which requires an awareness of associated risk factors (often a hypercoagulable state) and a high index of suspicion for accurate diagnosis.
Patients with mesenteric venous occlusion generally present with severe midabdominal pain out of proportion to the minimal abdominal physical examination findings. Pain may be acute or subacute, occurring over weeks to months.
The gold standard for diagnosis is an abdominal CT with contrast, which reveals evidence of venous occlusion in more than 90% of patients.
These findings include thickening and contrast enhancement of the bowel wall (the result of delayed venous flow), enlarged SMV, thrombosis in the lumen of the SMV, and prominent collateral vessels.
If there is no sign of intestinal infarction, patients can be treated conservatively with anticoagulation and possibly thrombolytics.
If infarction is suspected, immediate surgical intervention should be undertaken to avoid irreversible ischemia and subsequent bowel resection.