GASTROENTEROLOGY ARTICLE OF THE WEEK
January 10, 2002
Kumar S, Sarr MG, Kamath PS. Mesenteric venous thrombosis. N Engl J Med 2001;345:1683-1688.
1. CT findings of mesenteric vein thrombosis (MVT) include:
a. central lucency in the mesenteric vein
b. enlargement of superior mesenteric vein with a well defined wall with a rim of increased density
c. portal vein gas
d. pneumatosis intestinalis
e. formation of collateral circulation in cases of acute MVT
2. The clinical manifestations of (MVT) depend on
a. the patient’s age
b. the depth of bowel wall ischemia
c. extent of the thrombus
d. size of the vessel involved
3. Typical signs and symptoms of mesenteric ischemia include
a. rigid abdomen with rebound tenderness
b. hemoccult positive stools in about 50% of patients
c. colicky midabdominal pain
d. hematochezia and or melena in about 15% of patients
e. nausea, anorexia and diarrhea
True or False
4. A cause for mesenteric vein thrombosis can only be found in 20% of cases
5. MVT is more common than mesenteric artery occlusion.
6. Anticoagulation is recommended for chronic MVT only if a prothrombotic state can be confirmed
7. Plain abdominal films yield findings typical of MVT in only 5% of patients.
8. Small vessel MVT is more likely to be caused by a prothrombotic state, while large vessel MVT is more likely to be caused by intrabdominal pathology.
9. Bowel infarction and peritonitis is rare in subacute and chronic MVT
10. Mesenteric angiography is the test of choice for patients with suspected MVT
11. In patients with MVT and extensive collateral formation, heparin should be started as soon as the diagnosis is established.
12. Recurrence of MVT is rare.
13. The test of choice for suspected MVT is an ultrasound exam with dopplers.
14. The hallmark of mesenteric ischemia is abdominal pain with a rigid abdomen and rebound tenderness
15. All patients with acute MVT should be explored surgically.
16. Angiography is more
sensitive than CT Scan in patients with thrombophilia who may have small vessel
thrombosis.