A number of conditions can cause mesenteric vein thrombosis, a vascular abnormality that is responsible for about 5-15% of all cases of mesenteric ischemia [1] [2]. Inherited coagulopathies and thrombophilias (antithrombin, protein C, protein S, or factor V Leiden deficiencies), local disorders (pancreatitis, diverticulitis, peritonitis, and other inflammatory diseases), obesity, neoplasias, hematological disturbances (particularly thrombocytopenia and polycythemia vera), soft tissue trauma, previous abdominal surgery, but also liver cirrhosis and stasis of the venous blood flow are some of the most important etiologies [1] [3] [4] [5]. In a large number of cases (between 20-50%), however, the exact cause remains unclear, in which case the term idiopathic mesenteric vein thrombosis is used [1] [3] Typical patients are aged between 40-60 years and are more commonly males [3]. The clinical presentation of mesenteric vein thrombosis (MVT) is divided into acute and chronic forms. In the acute setting, a sudden onset of nonspecific abdominal pain is the principal manifestation, followed by nausea, vomiting, diarrhea and gastrointestinal bleeding (hematemesis, hematochezia, or melena) [1] [3] [6]. Mesenteric ischemia and bowel infarction are life-threatening complications of acute MVT, manifesting as dehydration, hypotension, fever, ascites, and shock [1]. Unfortunately, several studies have confirmed that the majority of patients (about 75%) are symptomatic for days before being diagnosed, putting them at a life-threatening risk [3]. A chronic course, on the other hand, may be completely asymptomatic, but persistent abdominal pain and edema are frequently reported [1] [3]. Malnutrition is also a frequent manifestation, which is why many individuals require parenteral nutrition, whereas existing portal hypertension could lead to hemorrhage from esophageal varices [1] [3] [6].

• Fever

  In all, a two stage clinical course (initial acute abdominal pain and fever, followed by chronic intestinal obstruction), corresponding to the sequence thrombosis/stricture, was found. x Ray studies showed a regularly contoured intestinal stricture. [ncbi.nlm.nih.gov]

  A 56-year-old female presented to our hospital with complaints of fever and diarrhea. [oatext.com]

  Always contact your doctor if you have severe stomach pain along with fever, diarrhea, and vomiting. [healthline.com]

  Mesenteric ischemia and bowel infarction are life-threatening complications of acute MVT, manifesting as dehydration, hypotension, fever, ascites, and shock. [symptoma.com]

• Severe Pain

  SMV Thrombosis is a rare condition that can cause an array of symptoms, from severe pain to diarrhea [1]. [oatext.com]

• Abdominal Pain

  […] with disease progression. 4 Case A 26-year-old man presented to the ED with periumbilical and lower abdominal pain for 1 week. [mdedge.com]

  We report a case of a 59-year-old man with a history of chronic obstructive pulmonary disease (COPD) stage III, who presented with abdominal pain. [ncbi.nlm.nih.gov]

  Furthermore, the differential diagnosis of nonspecific abdominal pain and associated symptoms is quite broad. [symptoma.com]

  Three weeks after an elective total abdominal colectomy for refractory ulcerative colitis, a 45-year-old woman presented to the emergency department with increasing abdominal pain. [cmaj.ca]

• Vomiting

  She presented with abdominal pain and vomiting, initially diagnosed with portal and superior mesenteric vein thrombosis. Immunophenotyping by flow cytometry revealed a diagnosis of paroxysmal nocturnal haemoglobinuria type III. [ncbi.nlm.nih.gov]

  Always contact your doctor if you have severe stomach pain along with fever, diarrhea, and vomiting. [healthline.com]

  In this case, abdominal pain, nausea, vomiting and diarrhea appeared nine days after surgical procedure. [thejh.org]

  Abstract A 66-year-old man admitted for abdominal pain and vomiting was found in abdominal contrast-enhanced computed tomography to have a thrombus of the superior mesenteric vein and thickened small-intestine walls. [jstage.jst.go.jp]

• Nausea

  In this case, abdominal pain, nausea, vomiting and diarrhea appeared nine days after surgical procedure. [thejh.org]

  She had no symptoms of sepsis or nausea. Her ileostomy continued to function well. On examination, her abdomen was soft without signs of peritonitis. Her pain was substantially out of proportion to her benign clinical examination. [cmaj.ca]

  In the acute setting, a sudden onset of nonspecific abdominal pain is the principal manifestation, followed by nausea, vomiting, diarrhea and gastrointestinal bleeding (hematemesis, hematochezia, or melena). [symptoma.com]

  Acute superior mesenteric vein thrombosis most frequently presented as abdominal pain (83%), anorexia (53%), nausea and vomiting (50%) and diarrhea (43%) [ 10 ]. [omicsonline.org]

  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 Blood thinners (most commonly heparin [medlineplus.gov]

• Acute Abdomen

  This case also serves to remind physicians that there should always be a high level of suspicion of intestinal infarction in patients with an acute abdomen who are in a hypercoagulable state. [ncbi.nlm.nih.gov]

  2013/3/1/47/114296 Introduction Acute abdomen following an uneventful vaginal delivery is a rare occurrence. [joacc.com]

  Acute superior mesenteric vein thrombosis presents vaguely as an acute abdomen with gradually worsening diffuse, colicky abdominal pain, associated with distention, and symptoms may have been present for a few days 2,3. [radiopaedia.org]

  Surgical thrombectomy is performed only if the patient undergoes laparotomy for acute abdomen or intestinal ischaemia. [karger.com]

• Abdominal Distension

  Severe subcontinuous abdominal pain out of proportion to the physical findings and abdominal distension were the major symptoms in both patients. [ncbi.nlm.nih.gov]

  Case Report A 21-year-old woman, who was a known case of pre-eclampsia, diagnosed to have HELLP syndrome in the postpartum period was referred to our intensive care unit (ICU) with a history of increasing epigastric pain and abdominal distension for 3 [joacc.com]

  Acute occlusion of the portal vein rather than the superior mesenteric vein causes abdominal distension, ascites, and diffuse abdominal tenderness. [ahajournals.org]

• Protein S Deficiency

  An underlying hypercoagulable state is often present, but protein S deficiency has rarely been implicated. [ncbi.nlm.nih.gov]

  Laboratory test showed low protein S activity and protein S antigen, leading to a diagnosis of superior mesenteric vein thrombosis caused by protein S deficiency. [jstage.jst.go.jp]

• Vein Disorder

  Mesenteric, Venous Thrombosis, Mesenteric, Thrombosis of mesenteric vein, Thrombosis of mesenteric vein (disorder), mesenteric; thrombosis, thrombosis; mesenteric, Mesenteric venous thrombosis -RETIRED-, Thrombosis mesenteric vessel Dutch trombose mesenterisch [fpnotebook.com]

  veins veins from jejunum veins from ileum middle colic vein - drains the transverse colon right colic vein - drains the ascending colon ileocolic vein Disorders [ edit ] Thrombosis of the superior mesenteric vein is quite rare, but a significant cause [en.wikipedia.org]

• Confusion

  The problem is that the syndrome is rare and unusual and the clinical presentation is usually vague or confusing. [ncbi.nlm.nih.gov]

  Adults can present with confusion or other changes in mental status, cognitive decline, and megaloblastic anemia. Biochemical presentation includes methylmalonic aciduria and homocystinuria in urine organic acid or plasma amino acid analysis. [mayocliniclabs.com]

  […] symptoms of acute intestinal ischemia typically include: Sudden abdominal pain that may be mild, moderate or severe An urgent need to have a bowel movement Frequent, forceful bowel movements Abdominal tenderness or distention Blood in your stool Mental confusion [mayoclinic.org]

  Anticoagulants as a part of intensive care management were not considered in our patient because the coexisting HELLP and AFLP confused the diagnosis until later. [joacc.com]

  This study will show an area of absence of flow inside the lumen of the portal vein, with high sensitivity and specificity. 4 Occasionally if portal flow is very slow, it may not be detected in the color Doppler study and might be confused with thrombosis [radiologykey.com]

Because of the nonspecific clinical presentation of MVT, the diagnosis may be difficult to attain based on clinical criteria [6]. Furthermore, the differential diagnosis of nonspecific abdominal pain and associated symptoms is quite broad. For this reason, a detailed and comprehensive approach is necessary in order to raise valid clinical suspicion, which is vital for making the diagnosis [4]. Firstly, physicians should obtain a complete patient history, with an emphasis on the course and progression of symptoms, existence of comorbidities and underlying conditions in the patient or within the family that might be responsible for the presenting complaints, and a history of alcohol and medication use [3]. A thorough physical examination, because of its role in excluding certain pathologies, is equally important, but imaging studies are crucial in confirming MVT. Plain radiography of the abdomen is a useful initial method that might detect dilated bowel loops, ileus and in most severe cases, free air within the abdomen and gas in the portal vein [3]. Ultrasonography and magnetic resonance (MR) angiography have also been recommended for the evaluation of mesenteric veins, but contrast-enhanced computed tomography (CT) is the gold standard, with an accuracy of 90% [1] [3] [4] [5]. The thrombus, seen as a focal translucency, is the hallmark of MVT on CT studies, whereas dilation of the veins is also an important finding [1] [3] [4]. Laboratory workup, although very important for the assessment of the overall status of the patient, is of limited diagnostic benefit in the case of MVT, as only leukocytosis, thrombocytosis, and mild elevations of hepatic and pancreatic enzymes can be observed [1] [3]. Thus, the diagnosis of MVT rests on clinical findings and contrast-enhanced CT.

• Pneumoperitoneum

  Complications related to pneumoperitoneum. In: Bailey RW, Flowers JL, eds. Complications of Laparoscopic Surgery. St. Louis: Q Med Publ Inc 45–48 Google Scholar Cohen J, Edelman RR, Chopra S (1992). Portal vein thrombosis: a review. [link.springer.com]

  […] intra-abdominal (eg, appendicitis, diverticulitis, or abscess) Venous congestion from cirrhosis (portal hypertension) Venous trauma from accidents or surgery, [38, 39, 40, 41, 42] especially portacaval surgery Increased intra-abdominal pressure from pneumoperitoneum [emedicine.medscape.com]

The clinical, biological, and morphological aspects as well as the treatment of this morbid association were studied in three patients. [ncbi.nlm.nih.gov]

Prognosis is good in this group of patients, with a mortality of only 7%, although bowel ischemia was noted in 21%. [ncbi.nlm.nih.gov]

The prognosis for patients with PVT is determined by the pathologic conditions that cause it and, in acute cases, by the degree of mesenteric involvement. [radiologykey.com]

Prognosis Prognosis is better in patients with later-onset disease. The documents contained in this web site are presented for information purposes only. [orpha.net]

In 30-50% of patients with portal thrombosis, no underlying etiology is found. The recent reports of new hereditary clotting defects are contributing to the understanding of this problem, but they only justify a small number of idiopathic cases. [ncbi.nlm.nih.gov]

Depending on local expertise, site-directed thrombolytic therapy may be used. 3 The duration of anticoagulation therapy depends on the suspected etiology of the thrombosis and may involve 6 to 12 months’ to life-long therapy. [cmaj.ca]

[…] diseases), obesity, neoplasias, hematological disturbances (particularly thrombocytopenia and polycythemia vera), soft tissue trauma, previous abdominal surgery, but also liver cirrhosis and stasis of the venous blood flow are some of the most important etiologies [symptoma.com]

Pneumatosis Intestinalis Predictive Evaluation Study (PIPES): A multicenter epidemiologic study of the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2013; 75 (1): 15-23[ DOI ][ PubMed ] 2. Galandiuk S, Fazio VW. [colorectalresearch.com]

Summary Epidemiology Prevalence of methylmalonic acidemia has been estimated at 1/48,000 to 1/61,000 in North America, and at 1/26,000 in China (these values may include patients with methylmalonic acidemia with homocystinuria; see this term). [orpha.net]

Medicine (33) Infectology (31) Endocrinology, Metabolism (29) Obstetrics, Gynaecology (29) Genetics (26) Respiratory Medicine (24) Health Care Sciences (23) Nephrology (21) Oncology, Radiation Therapy (20) Microbiology (20) Radiology and Imaging (19) Epidemiology [portal.mefanet.cz]

Epidemiology, risk and prognostic factors in mesenteric venous thrombosis. Br J Surg 2008;95:1245-51. 7. Lee SS, Ha HK, Park SH, Choi EK, Kim AY, Kim JC, et al. [jmgims.co.in]

While MVT has been established in hypercoagulable states and local-abdominal processes (splenectomy, pancreatitis, diverticulitis), its incidence and pathophysiology in the setting of laparoscopic bariatric surgery alone is relatively unknown and rarely [sages.org]

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. [medlineplus.gov]

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test Multiple causes of inborn errors of cobalamin (cbl; better known as vitamin B12) metabolism have been identified. [mayocliniclabs.com]

Internal Medicine (153) Physiology and Pathophysiology (150) Paediatrics, Neonatology (126) Neurology (104) Pathology and Forensic Medicine (90) Anatomy (84) Cardiology, Angiology (78) Surgery, Traumatology and Orthopaedics (77) Medical Chemistry and [portal.mefanet.cz]

Despite gastrointestinal bleeding, anticoagulation therapy with heparin had to be performed to prevent bowel infarction. [ncbi.nlm.nih.gov]

In chronic MVT, anticoagulation may promote recanalization and prevents new thrombosis. [ahajournals.org]

It has the advantage of rapid thrombus resolution and potential prevention of MVT-associated bowel ischemia. [evtoday.com]

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2. Cudnik MT, Darbha S, Jones J, Macedo J, Stockton SW, Hiestand BC. The diagnosis of acute mesenteric ischemia: A systematic review and meta-analysis. Acad Emerg Med. 2013;20(11):1087-1100.
3. Singal AK, Kamath PS, Tefferi A. Mesenteric venous thrombosis. Mayo Clin Proc. 2013;88(3):285-294.
4. Sucandy I, Gabrielsen JD, Petrick AT. Postoperative mesenteric venous thrombosis: Potential complication related to minimal access surgery in a patient with undiagnosed hypercoagulability. North American Journal of Medical Sciences. 2010;2(7):329-332.
5. Swartz DE, Felix EL. Acute Mesenteric Venous Thrombosis Following Laparoscopic Roux-en-Y Gastric Bypass. JSLS. 2004;8(2):165-169.
6. Lang SA, Loss M, Wohlgemuth WA, Schlitt HJ. Clinical Management of Acute Portal/Mesenteric Vein Thrombosis. Viszeralmedizin. 2014;30(6):394-400.