Mesenteric venous thrombosis.

Mesenteric venous occlusion produces a spectrum of clinical presentations, the most common of which is the acute onset of abdominal pain with progressive signs and symptoms of bowel infarction. This acute form of mesenteric venous thrombosis, compared with other forms of acute mesenteric infarction, occurs in younger patients, typically has a more indolent and nonspecific course, involves shorter segments of bowel, and has a lower mortality rate. In contradistinction to our recommended therapy in other forms of acute mesenteric infarction, immediate anticoagulation is indicated for mesenteric venous thrombosis. Second-look operations are used, as in other forms of acute mesenteric infarction, whenever portions of bowel of questionable viability are not resected at the primary operation. Chronic mesenteric venous thrombosis may produce no symptoms or may cause gastrointestinal bleeding from portal hypertension. Newer imaging techniques have increased the ability to diagnose and define the extent of all forms of mesenteric venous thrombosis and have added to the therapeutic options available to manage them.