Mesenteric vein thrombosis

Background

A rare (< 5% of all cases) subset of mesenteric ischemia that has a high rate of mortality approaching 50%. Risk factors include intrabdominal inflammation and hypercoaguability.

Differential Diagnosis

• Abdominal aortic aneurysm
  • Aortocaval fistula
• Acute gastroenteritis
• Aortoenteric fisulta
• Appendicitis (early)
• Bowel obstruction
  • Large bowel obstruction
    • Ogilvie's syndrome
  • Small bowel obstruction
  • Malignant bowel obstruction
• Bowel perforation
• Gastroparesis
• Diabetic ketoacidosis
• Hernia
• Inflammatory bowel disease
• Mesenteric ischemia
• Pancreatitis
• Peritonitis
• Sickle cell crisis
• Spontaneous bacterial peritonitis
• Volvulus

Evaluation

CT scan showing acute superior mesenteric vein thrombosis (black arrow) with bowel wall thickening (white arrowhead), mesenteric edema (black arrowhead) and ascites. Note the normal SMA enhancement (white arrow) and ratio of SMV to SMA diameters > 2.

Contrast enhanced CT (axial and coronal views) of the abdomen demonstrated a filling defect in the superior mesenteric vein (arrow), suggesting thrombus.