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splanchnicvthrombosis

splanchnic vein thrombosis (SVT)

Introduction

  • an uncommon site for venous thrombosis
  • two thirds of SVT patients are men

Risk factors

Clinical features

  • generally non-specific symptoms (nausea, vomiting, anorexia, diarrhoea or constipation, and fever) although abdominal pain occurs in over half and less commonly GIT bleeding and/or ascites may occur
  • portal vein thrombosis (PVT)
    • acute presentation:
      • abdominal pain
    • chronic:
      • portal hypertension features such as hypersplenism, ascites, oesophageal varices, and the presence of portal cavernoma or other porto-systemic collateral veins on imaging
  • mesenteric vein thrombosis (MVT)
    • acute presentation:
      • sudden onset of abdominal pain and particularly if it extends into the superior mesenteric vein, may be complicated by intestinal infarction in one third of patients which may be fatal
    • subacute presentation:
      • abdominal pain lasting for several days without intestinal infarction
    • chronic presentation:
      • signs of portal hypertension
  • splenic vein thrombosis
    • up to 17% are asymptomatic
    • almost 2/3rds have abdominal pain
    • almost 1/3rd have gastrointestinal bleeding (29%)
    • around 23% have nausea
    • least common manifestation of SVT, with reported incidence rates of around 1–2 cases per million inhabitants per year (5-7 per million in the Eastern countries)
    • includes any obstruction of the hepatic venous outflow located between the small hepatic venules and the confluence of the IVC into the right atrium

Diagnosis

  • D-Dimer is generally elevated but has limited utility if there are other conditions present which may cause this such as cirrhosis, post-surgery, neoplasia or infections
  • Doppler USS is generally first line for suspected portal V thrombosis as has high sens and spec.
  • CT abdopelvis with contrast is the standard 1st line investigation for other types and for PVT when USS is not available

Treatment

splanchnicvthrombosis.txt · Last modified: 2021/06/03 17:18 by gary1