Superior mesenteric and portal vein thrombosis
Acute venous mesenteric thrombosis (VMT) is not the most frequent vascular pathology of the colon and/or small intestines. Arterial compromise is far more common. Signs and symptoms are vague and nonspecific, but a soon diagnosis is key to avoid complications and even death. Bowel ischemia and infarction is common in arterial occlusion but rare in venous occlusion. It represents 5-15% of the total mesenteric ischemic events.
CT signs you should intentionally search for are:
- venous filling defect
- mesenteric vein enlargement
- collateral circulation
- circumferential bowel wall thickening
- pneumatosis intestinali
- portomesenteric venous gas
- mesenteric fat edema
Different types of intra abdominal inflammation are a common cause of VMT (pancreatitis, diverticulitis, appendicitis, etc), as well as portal hypertension, hypercoagulable states, cancer (pancreas, liver) and myeloproliferative neoplasms. Systematic search for the underlying cause is mandatory.