UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Mesenteric venous thrombosis in adults

Authors
David A Tendler, MD
J Thomas Lamont, MD
Peter Grubel, MD
Section Editors
John F Eidt, MD
Joseph L Mills, Sr, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS

INTRODUCTION

Acute mesenteric ischemia refers to the sudden onset of intestinal hypoperfusion, one cause of which can be mesenteric venous occlusion. Mesenteric venous thrombosis can present acutely, or in a subacute or chronic manner. At one time, acute mesenteric venous thrombosis was thought to be the principal cause of acute mesenteric ischemia; however, with increasing recognition of and differentiation from the occlusive and nonocclusive forms of acute arterial mesenteric ischemia, the proportion of cases attributed to mesenteric venous thrombosis has decreased [1].

Mesenteric venous thrombosis will be reviewed here. Acute and chronic mesenteric arterial occlusion affecting the small intestine, nonocclusive mesenteric ischemia, and colonic ischemia are discussed separately. (See "Overview of intestinal ischemia in adults" and "Chronic mesenteric ischemia" and "Colonic ischemia" and "Nonocclusive mesenteric ischemia".)

MESENTERIC VENOUS ANATOMY AND PATHOPHYSIOLOGY

The venous drainage parallels the arterial circulation and drains into the portal venous system (figure 1 and figure 2). The anatomy of the intestinal circulation, normal physiology of the intestine, and response to ischemia are discussed in detail elsewhere. (See "Overview of intestinal ischemia in adults", section on 'Collateral circulation' and "Overview of intestinal ischemia in adults", section on 'Intestinal vascular anatomy' and "Overview of intestinal ischemia in adults", section on 'Physiology and mechanisms of ischemia'.)

Pathophysiology — Venous thrombosis is predominantly a result of stagnation of blood flow, vascular injury, and hypercoagulability (ie, Virchow’s triad). Local factors (eg, splenectomy, pancreatitis) appear to be associated with initial thrombus formation in the large veins, whereas systemic hypercoagulable states (eg, protein C deficiency) lead to thrombosis initiated in the intramural venules, vasa recta, and venous arcades [2]. Mesenteric vein thrombosis almost always involves the distal small intestine (superior mesenteric venous drainage) and rarely involves the colon (inferior mesenteric venous drainage) [3]. The anatomic site of involvement in acute mesenteric venous thrombosis is most often ileum (64 to 83 percent) or jejunum (50 to 81 percent), followed by colon (14 percent) and duodenum (4 to 8 percent) [4,5]. The inferior mesenteric venous distribution is less commonly involved for reasons that are poorly understood, but possibly related to collateral flow through the internal iliac system, rectal venous plexus, or systemic circulation via the left renal vein, splenic vein, and hemiazygous veins, though this is unproven [6-9].

Acute thrombotic occlusion of one or more mesenteric veins reduces perfusion pressure due to increased resistance in the mesenteric venous bed. As flow stagnates, increased venous pressure leads to efflux of fluid into the tissues, causing profound bowel-wall edema, which can lead to submucosal hemorrhage. If the venous arcades and vasa recta are involved and venous return from the bowel wall is completely occluded, bowel infarction will occur [6]. However, not all cases of mesenteric venous thrombosis are associated with intestinal infarction. In animal models, gradual occlusion of the superior mesenteric vein is associated with the development of collateral venous drainage without ischemic damage [10]. Chronic mesenteric venous thrombosis often features dilated venous collaterals, which can bleed, due to elevated venous pressures [1]. Many patients with chronic mesenteric venous thrombosis also exhibit portal vein thrombosis. (See "Chronic portal vein thrombosis in adults: Clinical manifestations, diagnosis, and management".)

                          

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Mon Jul 18 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Harnik IG, Brandt LJ. Mesenteric venous thrombosis. Vasc Med 2010; 15:407.
  2. Kumar S, Sarr MG, Kamath PS. Mesenteric venous thrombosis. N Engl J Med 2001; 345:1683.
  3. Clavien PA, Dürig M, Harder F. Venous mesenteric infarction: a particular entity. Br J Surg 1988; 75:252.
  4. Rhee RY, Gloviczki P, Mendonca CT, et al. Mesenteric venous thrombosis: still a lethal disease in the 1990s. J Vasc Surg 1994; 20:688.
  5. Abu-Daff S, Abu-Daff N, Al-Shahed M. Mesenteric venous thrombosis and factors associated with mortality: a statistical analysis with five-year follow-up. J Gastrointest Surg 2009; 13:1245.
  6. JOHNSON CC, BAGGENSTOSS AH. Mesenteric vascular occlusion; study of 99 cases of occlusion of veins. Proc Staff Meet Mayo Clin 1949; 24:628.
  7. Ookura R, Masuko H, Ishizu H, et al. Inferior mesenteric venous thrombosis that required operations: report of two cases. Hepatogastroenterology 2009; 56:687.
  8. NAITOVE A, WEISMANN RE. PRIMARY MESENTERIC VENOUS THROMBOSIS. Ann Surg 1965; 161:516.
  9. Abdu RA, Zakhour BJ, Dallis DJ. Mesenteric venous thrombosis--1911 to 1984. Surgery 1987; 101:383.
  10. Laufman H. Gradual occlusion of the mesenteric vessels: experimental study. Surgery 1942; 13:1406.
  11. McKinsey JF, Gewertz BL. Acute mesenteric ischemia. Surg Clin North Am 1997; 77:307.
  12. Polk HC Jr. Experimental mesenteric venous occlusion: 3. Diagnosis and treatment of induced mesenteric venous thrombosis. Ann Surg 1966; 163:432.
  13. Boley SJ, Kaleya RN, Brandt LJ. Mesenteric venous thrombosis. Surg Clin North Am 1992; 72:183.
  14. FRIEDENBERG MJ, POLK HC Jr, MCALISTER WH, SHOCHAT SJ. SUPERIOR MESENTERIC ARTERIOGRAPHY IN EXPERIMENTAL MESENTERIC VENOUS THROMBOSIS. Radiology 1965; 85:38.
  15. Acosta S, Alhadad A, Svensson P, Ekberg O. Epidemiology, risk and prognostic factors in mesenteric venous thrombosis. Br J Surg 2008; 95:1245.
  16. Acosta S, Ogren M, Sternby NH, et al. Mesenteric venous thrombosis with transmural intestinal infarction: a population-based study. J Vasc Surg 2005; 41:59.
  17. Schoots IG, Koffeman GI, Legemate DA, et al. Systematic review of survival after acute mesenteric ischaemia according to disease aetiology. Br J Surg 2004; 91:17.
  18. Brunaud L, Antunes L, Collinet-Adler S, et al. Acute mesenteric venous thrombosis: case for nonoperative management. J Vasc Surg 2001; 34:673.
  19. Kumar S, Kamath PS. Acute superior mesenteric venous thrombosis: one disease or two? Am J Gastroenterol 2003; 98:1299.
  20. Amitrano L, Guardascione MA, Scaglione M, et al. Prognostic factors in noncirrhotic patients with splanchnic vein thromboses. Am J Gastroenterol 2007; 102:2464.
  21. Harward TR, Green D, Bergan JJ, et al. Mesenteric venous thrombosis. J Vasc Surg 1989; 9:328.
  22. Ziakas PD, Poulou LS, Rokas GI, et al. Thrombosis in paroxysmal nocturnal hemoglobinuria: sites, risks, outcome. An overview. J Thromb Haemost 2007; 5:642.
  23. Johnson CA, Parker MV, Goff JM Jr. Mesenteric venous thrombosis in a patient with prothrombin 20210A mutation and antithrombin III deficiency: challenges to conventional anticoagulation--a case report. Vasc Endovascular Surg 2003; 37:293.
  24. Leach SD, Meier GH, Gusberg RJ. Endoscopic sclerotherapy: a risk factor for splanchnic venous thrombosis. J Vasc Surg 1989; 10:9.
  25. Fiorini A, Chiusolo P, Rossi E, et al. Absence of the JAK2 exon 12 mutations in patients with splanchnic venous thrombosis and without overt myeloproliferative neoplasms. Am J Hematol 2009; 84:126.
  26. Amitrano L, Brancaccio V, Guardascione MA, et al. High prevalence of thrombophilic genotypes in patients with acute mesenteric vein thrombosis. Am J Gastroenterol 2001; 96:146.
  27. Cohn DM, Roshani S, Middeldorp S. Thrombophilia and venous thromboembolism: implications for testing. Semin Thromb Hemost 2007; 33:573.
  28. Papa A, Danese S, Grillo A, et al. Review article: inherited thrombophilia in inflammatory bowel disease. Am J Gastroenterol 2003; 98:1247.
  29. Yoshida H, Granger DN. Inflammatory bowel disease: a paradigm for the link between coagulation and inflammation. Inflamm Bowel Dis 2009; 15:1245.
  30. Fichera A, Cicchiello LA, Mendelson DS, et al. Superior mesenteric vein thrombosis after colectomy for inflammatory bowel disease: a not uncommon cause of postoperative acute abdominal pain. Dis Colon Rectum 2003; 46:643.
  31. Di Fabio F, Obrand D, Satin R, Gordon PH. Intra-abdominal venous and arterial thromboembolism in inflammatory bowel disease. Dis Colon Rectum 2009; 52:336.
  32. Violi NV, Schoepfer AM, Fournier N, et al. Prevalence and clinical importance of mesenteric venous thrombosis in the Swiss Inflammatory Bowel Disease Cohort. AJR Am J Roentgenol 2014; 203:62.
  33. Morasch MD, Ebaugh JL, Chiou AC, et al. Mesenteric venous thrombosis: a changing clinical entity. J Vasc Surg 2001; 34:680.
  34. Bourke MG, Martin ST, O'Dwyer M, et al. Mesenteric venous thrombosis secondary to an unsuspected JAK2 V617F-positive myeloproliferative disorder. Ir J Med Sci 2012; 181:285.
  35. Owens CD. JAK2 V617F mutation, mesenteric vein thrombosis, and myeloproliferative disorders. J Vasc Surg 2010; 52:205.
  36. Singal AK, Kamath PS, Tefferi A. Mesenteric venous thrombosis. Mayo Clin Proc 2013; 88:285.
  37. Yoo EH, Jang JH, Park KJ, et al. Prevalence of overt myeloproliferative neoplasms and JAK2 V617F mutation in Korean patients with splanchnic vein thrombosis. Int J Lab Hematol 2011; 33:471.
  38. Colaizzo D, Amitrano L, Tiscia GL, et al. The JAK2 V617F mutation frequently occurs in patients with portal and mesenteric venous thrombosis. J Thromb Haemost 2007; 5:55.
  39. Riva N, Donadini MP, Dentali F, et al. Clinical approach to splanchnic vein thrombosis: risk factors and treatment. Thromb Res 2012; 130 Suppl 1:S1.
  40. Lin HY, Ho CM, Lai HS, Lee PH. Management of acute portomesenteric venous thrombosis induced by protein S deficiency: report of a case. Surg Today 2012; 42:1014.
  41. Collins MH, McGinn MK, Weber DJ. Mesenteric Thrombosis Complicating Influenza B Infection. Am J Med 2016; 129:e17.
  42. Otrock ZK, Soweid AM, Salem ZM, Jamali FR. Portal, splenic and mesenteric vein thrombosis in a patient with factor V Leiden mutation and antithrombin III deficiency. Ann Hematol 2006; 85:413.
  43. Mainwaring CJ, Makris M, Thomas WE, et al. Mesenteric infarction due to combined protein C deficiency and prothrombin 20210 defects. Postgrad Med J 1999; 75:742.
  44. Rackoff A, Shores N, Willner I. Mesenteric venous thrombosis in a patient with pancreatitis and protein C deficiency. South Med J 2005; 98:232.
  45. Grandone E, Colaizzo D, Tiscia GL, et al. Venous thrombosis in oral contraceptive users and the presence of the JAK2 V617F mutation. Thromb Haemost 2008; 99:640.
  46. Hertzberg MS, Underwood T, Favaloro EJ. Mesenteric vein thrombosis secondary to combined protein C deficiency and double heterozygosity for factor V Leiden and prothrombin G20210A. Am J Hematol 1999; 62:199.
  47. Orr DW, Harrison PM, Devlin J, et al. Chronic mesenteric venous thrombosis: evaluation and determinants of survival during long-term follow-up. Clin Gastroenterol Hepatol 2007; 5:80.
  48. NORTH JP, WOLLENMAN OJ Jr. Venous mesenteric occlusion in the course of migrating thrombophlebitis. Surg Gynecol Obstet 1952; 95:665.
  49. Bergentz SE, Ericsson B, Hedner U, et al. Thrombosis in the superior mesenteric and portal veins: report of a case treated with thrombectomy. Surgery 1974; 76:286.
  50. BERRY FB, BOUGAS JA. Agnogenic venous mesenteric thrombosis. Ann Surg 1950; 132:450.
  51. McCUNE WS, KESHISHIAN JM, BLADES BB. Mesenteric thrombosis following blunt abdominal trauma. Ann Surg 1952; 135:606.
  52. Zhang J, Duan ZQ, Song QB, et al. Acute mesenteric venous thrombosis: a better outcome achieved through improved imaging techniques and a changed policy of clinical management. Eur J Vasc Endovasc Surg 2004; 28:329.
  53. Acosta-Merida MA, Marchena-Gomez J, Hemmersbach-Miller M, et al. Mesenteric venous thrombosis. Associated systemic disorders and hypercoagulability status of 21 surgical patients. Hepatogastroenterology 2007; 54:1080.
  54. Grisham A, Lohr J, Guenther JM, Engel AM. Deciphering mesenteric venous thrombosis: imaging and treatment. Vasc Endovascular Surg 2005; 39:473.
  55. Font VE, Hermann RE, Longworth DL. Chronic mesenteric venous thrombosis: difficult diagnosis and therapy. Cleve Clin J Med 1989; 56:823.
  56. Haddad MC, Clark DC, Sharif HS, et al. MR, CT, and ultrasonography of splanchnic venous thrombosis. Gastrointest Radiol 1992; 17:34.
  57. Gehl HB, Bohndorf K, Klose KC, Günther RW. Two-dimensional MR angiography in the evaluation of abdominal veins with gradient refocused sequences. J Comput Assist Tomogr 1990; 14:619.
  58. Kreft B, Strunk H, Flacke S, et al. Detection of thrombosis in the portal venous system: comparison of contrast-enhanced MR angiography with intraarterial digital subtraction angiography. Radiology 2000; 216:86.
  59. Hagspiel KD, Leung DA, Angle JF, et al. MR angiography of the mesenteric vasculature. Radiol Clin North Am 2002; 40:867.
  60. Bradbury MS, Kavanagh PV, Chen MY, et al. Noninvasive assessment of portomesenteric venous thrombosis: current concepts and imaging strategies. J Comput Assist Tomogr 2002; 26:392.
  61. Lee SS, Park SH. Computed tomography evaluation of gastrointestinal bleeding and acute mesenteric ischemia. Radiol Clin North Am 2013; 51:29.
  62. Kernagis LY, Levine MS, Jacobs JE. Pneumatosis intestinalis in patients with ischemia: correlation of CT findings with viability of the bowel. AJR Am J Roentgenol 2003; 180:733.
  63. Ofer A, Abadi S, Nitecki S, et al. Multidetector CT angiography in the evaluation of acute mesenteric ischemia. Eur Radiol 2009; 19:24.
  64. Aschoff AJ, Stuber G, Becker BW, et al. Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography. Abdom Imaging 2009; 34:345.
  65. Acosta S, Alhadad A, Ekberg O. Findings in multi-detector row CT with portal phase enhancement in patients with mesenteric venous thrombosis. Emerg Radiol 2009; 16:477.
  66. Taourel PG, Deneuville M, Pradel JA, et al. Acute mesenteric ischemia: diagnosis with contrast-enhanced CT. Radiology 1996; 199:632.
  67. Rhee RY, Gloviczki P. Mesenteric venous thrombosis. Surg Clin North Am 1997; 77:327.
  68. Vogelzang RL, Gore RM, Anschuetz SL, Blei AT. Thrombosis of the splanchnic veins: CT diagnosis. AJR Am J Roentgenol 1988; 150:93.
  69. Lee SS, Ha HK, Park SH, et al. Usefulness of computed tomography in differentiating transmural infarction from nontransmural ischemia of the small intestine in patients with acute mesenteric venous thrombosis. J Comput Assist Tomogr 2008; 32:730.
  70. Clark RA, Gallant TE. Acute mesenteric ischemia: angiographic spectrum. AJR Am J Roentgenol 1984; 142:555.
  71. Kidambi H, Herbert R, Kidambi AV. Ultrasonic demonstration of superior mesenteric and splenoportal venous thrombosis. J Clin Ultrasound 1986; 14:199.
  72. Brandt LJ, Boley SJ. AGA technical review on intestinal ischemia. American Gastrointestinal Association. Gastroenterology 2000; 118:954.
  73. American Gastroenterological Association Medical Position Statement: guidelines on intestinal ischemia. Gastroenterology 2000; 118:951.
  74. Cenedese A, Monneuse O, Gruner L, et al. Initial management of extensive mesenteric venous thrombosis: retrospective study of nine cases. World J Surg 2009; 33:2203.
  75. Alvi AR, Khan S, Niazi SK, et al. Acute mesenteric venous thrombosis: improved outcome with early diagnosis and prompt anticoagulation therapy. Int J Surg 2009; 7:210.
  76. Plonka AJ, Schentag JJ, Messinger S, et al. Effects of enteral and intravenous antimicrobial treatment on survival following intestinal ischemia in rats. J Surg Res 1989; 46:216.
  77. Gathiram P, Wells MT, Brock-Utne JG, et al. Oral administered nonabsorbable antibiotics prevent endotoxemia in primates following intestinal ischemia. J Surg Res 1988; 45:187.
  78. Jamieson WG, Pliagus G, Marchuk S, et al. Effect of antibiotic and fluid resuscitation upon survival time in experimental intestinal ischemia. Surg Gynecol Obstet 1988; 167:103.
  79. Stein M, Link DP. Symptomatic spleno-mesenteric-portal venous thrombosis: recanalization and reconstruction with endovascular stents. J Vasc Interv Radiol 1999; 10:363.
  80. Akingba AG, Mangalmurti CS, Mukherjee D. Surgical management of chronic mesenteric venous thrombosis--a case report. Vasc Endovascular Surg 2006; 40:157.
  81. http://www.gastro.org/practice/medical-position-statements/archive (Accessed on June 25, 2013).
  82. NELSON LE, KREMEN AJ. Experimental occlusion of the superior mesenteric vessels with special reference to the role of intravascular thrombosis and its prevention by heparin. Surgery 1950; 28:819.
  83. Senzolo M, M Sartori T, Rossetto V, et al. Prospective evaluation of anticoagulation and transjugular intrahepatic portosystemic shunt for the management of portal vein thrombosis in cirrhosis. Liver Int 2012; 32:919.
  84. Martinez M, Tandra A, Vuppalanchi R. Treatment of acute portal vein thrombosis by nontraditional anticoagulation. Hepatology 2014; 60:425.
  85. Ageno W, Riva N, Schulman S, et al. Long-term Clinical Outcomes of Splanchnic Vein Thrombosis: Results of an International Registry. JAMA Intern Med 2015; 175:1474.
  86. Joh JH, Kim DI. Mesenteric and portal vein thrombosis: treated with early initiation of anticoagulation. Eur J Vasc Endovasc Surg 2005; 29:204.
  87. van Dongen CJ, van den Belt AG, Prins MH, Lensing AW. Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. Cochrane Database Syst Rev 2004; :CD001100.
  88. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133:381S.
  89. Ageno W, Dentali F, Squizzato A. How I treat splanchnic vein thrombosis. Blood 2014; 124:3685.
  90. Ageno W, Riva N, Schulman S, et al. Antithrombotic treatment of splanchnic vein thrombosis: results of an international registry. Semin Thromb Hemost 2014; 40:99.
  91. Petitti DB, Strom BL, Melmon KL. Duration of warfarin anticoagulant therapy and the probabilities of recurrent thromboembolism and hemorrhage. Am J Med 1986; 81:255.
  92. D'ABREU F, HUMBLE JG. Mesenteric venous thrombosis; recovery after resection with heparin. Lancet 1946; 1:534.
  93. STROHL EL, LASNER J. Mesenteric vascular occlusion. Arch Surg 1950; 60:339.
  94. Condat B, Pessione F, Helene Denninger M, et al. Recent portal or mesenteric venous thrombosis: increased recognition and frequent recanalization on anticoagulant therapy. Hepatology 2000; 32:466.
  95. Tsochatzis EA, Senzolo M, Germani G, et al. Systematic review: portal vein thrombosis in cirrhosis. Aliment Pharmacol Ther 2010; 31:366.
  96. Spaander VM, van Buuren HR, Janssen HL. Review article: The management of non-cirrhotic non-malignant portal vein thrombosis and concurrent portal hypertension in adults. Aliment Pharmacol Ther 2007; 26 Suppl 2:203.
  97. Hedayati N, Riha GM, Kougias P, et al. Prognostic factors and treatment outcome in mesenteric vein thrombosis. Vasc Endovascular Surg 2008; 42:217.
  98. Trinkle JK, Rush BF, Fuller MA, et al. The operative management of idiopathic mesenteric venous thrombosis with intestinal infarction. Am Surg 1969; 35:338.
  99. Urbanavičius L, Pattyn P, de Putte DV, Venskutonis D. How to assess intestinal viability during surgery: A review of techniques. World J Gastrointest Surg 2011; 3:59.
  100. Grieshop RJ, Dalsing MC, Cikrit DF, et al. Acute mesenteric venous thrombosis. Revisited in a time of diagnostic clarity. Am Surg 1991; 57:573.
  101. Regner JL, Kobayashi L, Coimbra R. Surgical strategies for management of the open abdomen. World J Surg 2012; 36:497.
  102. Khodadadi J, Rozencwajg J, Nacasch N, et al. Mesenteric vein thrombosis. The importance of a second-look operation. Arch Surg 1980; 115:315.
  103. Kaplan JL, Weintraub SL, Hunt JP, et al. Treatment of superior mesenteric and portal vein thrombosis with direct thrombolytic infusion via an operatively placed mesenteric catheter. Am Surg 2004; 70:600.
  104. Ozdogan M, Gurer A, Gokakin AK, et al. Thrombolysis via an operatively placed mesenteric catheter for portal and superior mesenteric vein thrombosis: report of a case. Surg Today 2006; 36:846.
  105. Meilahn JE, Morris JB, Ceppa EP, Bulkley GB. Effect of prolonged selective intramesenteric arterial vasodilator therapy on intestinal viability after acute segmental mesenteric vascular occlusion. Ann Surg 2001; 234:107.
  106. Takahashi N, Kuroki K, Yanaga K. Percutaneous transhepatic mechanical thrombectomy for acute mesenteric venous thrombosis. J Endovasc Ther 2005; 12:508.
  107. Zhou W, Choi L, Lin PH, et al. Percutaneous transhepatic thrombectomy and pharmacologic thrombolysis of mesenteric venous thrombosis. Vascular 2007; 15:41.
  108. Haage P, Krings T, Schmitz-Rode T. Nontraumatic vascular emergencies: imaging and intervention in acute venous occlusion. Eur Radiol 2002; 12:2627.
  109. Semiz-Oysu A, Keussen I, Cwikiel W. Interventional radiological management of prehepatic obstruction of [corrected] the splanchnic venous system. Cardiovasc Intervent Radiol 2007; 30:688.
  110. Robin P, Gruel Y, Lang M, et al. Complete thrombolysis of mesenteric vein occlusion with recombinant tissue-type plasminogen activator. Lancet 1988; 1:1391.
  111. al Karawi MA, Quaiz M, Clark D, et al. Mesenteric vein thrombosis, non-invasive diagnosis and follow-up (US + MRI), and non-invasive therapy by streptokinase and anticoagulants. Hepatogastroenterology 1990; 37:507.
  112. Chen C. Direct thrombolytic therapy in portal and mesenteric vein thrombosis. J Vasc Surg 2012; 56:1124.
  113. Liu FY, Wang MQ, Fan QS, et al. Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis. World J Gastroenterol 2009; 15:5028.
  114. Nakayama S, Murashima N, Isobe Y. Superior mesenteric venous thrombosis treated by direct aspiration thrombectomy. Hepatogastroenterology 2008; 55:367.
  115. Ferro C, Rossi UG, Bovio G, et al. Transjugular intrahepatic portosystemic shunt, mechanical aspiration thrombectomy, and direct thrombolysis in the treatment of acute portal and superior mesenteric vein thrombosis. Cardiovasc Intervent Radiol 2007; 30:1070.
  116. Uflacker R. Applications of percutaneous mechanical thrombectomy in transjugular intrahepatic portosystemic shunt and portal vein thrombosis. Tech Vasc Interv Radiol 2003; 6:59.
  117. Cappell MS. Intestinal (mesenteric) vasculopathy. I. Acute superior mesenteric arteriopathy and venopathy. Gastroenterol Clin North Am 1998; 27:783.
  118. Rivitz SM, Geller SC, Hahn C, Waltman AC. Treatment of acute mesenteric venous thrombosis with transjugular intramesenteric urokinase infusion. J Vasc Interv Radiol 1995; 6:219.
  119. Poplausky MR, Kaufman JA, Geller SC, Waltman AC. Mesenteric venous thrombosis treated with urokinase via the superior mesenteric artery. Gastroenterology 1996; 110:1633.
  120. Hollingshead M, Burke CT, Mauro MA, et al. Transcatheter thrombolytic therapy for acute mesenteric and portal vein thrombosis. J Vasc Interv Radiol 2005; 16:651.
  121. Rosen MP, Sheiman R. Transhepatic mechanical thrombectomy followed by infusion of TPA into the superior mesenteric artery to treat acute mesenteric vein thrombosis. J Vasc Interv Radiol 2000; 11:195.
  122. Sze DY, O'Sullivan GJ, Johnson DL, Dake MD. Mesenteric and portal venous thrombosis treated by transjugular mechanical thrombolysis. AJR Am J Roentgenol 2000; 175:732.
  123. Lopera JE, Correa G, Brazzini A, et al. Percutaneous transhepatic treatment of symptomatic mesenteric venous thrombosis. J Vasc Surg 2002; 36:1058.
  124. Kim HS, Patra A, Khan J, et al. Transhepatic catheter-directed thrombectomy and thrombolysis of acute superior mesenteric venous thrombosis. J Vasc Interv Radiol 2005; 16:1685.
  125. Yang SF, Liu BC, Ding WW, et al. Initial transcatheter thrombolysis for acute superior mesenteric venous thrombosis. World J Gastroenterol 2014; 20:5483.
  126. Ludwig DJ, Hauptmann E, Rosoff L Jr, Neuzil D. Mesenteric and portal vein thrombosis in a young patient with protein S deficiency treated with urokinase via the superior mesenteric artery. J Vasc Surg 1999; 30:551.
  127. Tateishi A, Mitsui H, Oki T, et al. Extensive mesenteric vein and portal vein thrombosis successfully treated by thrombolysis and anticoagulation. J Gastroenterol Hepatol 2001; 16:1429.
  128. Yang S, Zhang L, Liu K, et al. Postoperative Catheter-Directed Thrombolysis Versus Systemic Anticoagulation for Acute Superior Mesenteric Venous Thrombosis. Ann Vasc Surg 2016; 35:88.
  129. Dentali F, Ageno W, Witt D, et al. Natural history of mesenteric venous thrombosis in patients treated with vitamin K antagonists: a multi-centre, retrospective cohort study. Thromb Haemost 2009; 102:501.
  130. Park WM, Gloviczki P, Cherry KJ Jr, et al. Contemporary management of acute mesenteric ischemia: Factors associated with survival. J Vasc Surg 2002; 35:445.
  131. Glenister KM, Corke CF. Infarcted intestine: a diagnostic void. ANZ J Surg 2004; 74:260.
  132. Vietti Violi N, Fournier N, Duran R, et al. Acute mesenteric vein thrombosis: factors associated with evolution to chronic mesenteric vein thrombosis. AJR Am J Roentgenol 2014; 203:54.