Clinical and radiographic presentation of superior mesenteric vein thrombosis in Crohn's disease: A single center experience

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• 作者：Uri Kopylov^a ; ¹ ; ^{ukopylov@gmail.com} ; Marianne M. Amitai^b ; ¹ ; Aharon Lubetsky^c ; Rami Eliakim^a ; Yehuda Chowers^d ; Shomron Ben-Horin^a
• 关键词：SMV ; superior mesenteric vein ; MVT ; mesenteric vein thrombosis ; PT ; portal vein thrombosis ; VTE ; venous thromboembolism ; IPAA ; ileal pouch anal anastomosis
• 刊名：Journal of Crohn's and Colitis
• 出版年：2012
• 期刊代码：pca215_18739946
• 类别：med
• 出版时间：June, 2012
• 卷：6
• 期：5
• 页码：543-549
• 文件大小：627 K

摘要

Background

Mesenteric vein thrombosis (MVT) is a rare and frequently underdiagnosed complicationof Crohn's disease (CD). This study describes the clinical and radiological characteristics of CD /patients with superior mesenteric vein thrombosis (MVT) diagnosed by CT/MRI.

Patients and methods

The database of Crohn's disease patients treated in Sheba Medical Center between 2005-2010 was searched for MVT diagnosis. Imaging studies of identified patients were retrieved and reviewed by an experienced abdominal radiologist. MVT was defined by superior mesenteric vein obliteration and/or thrombus in the vessel lumen on abdominal imaging. The clinical and radiologic data of these patients were collected from the medical records.

Results

MVT was demonstrated in 6/460 CD patients. Five patients had stricturing disease, and one patient had a combined fistulizing and stricturing disease phenotype. All patients had small bowel disease, but 3/6 also had colonic involvement. No patient had a prior thromboembolic history or demonstrable hypercoagulability. One patient had an acute SMV thrombus demonstrable on CT scanning, the remaining patients showed an obliteration of superior mesenteric vein. Two patients received anticoagulation upon diagnosis of thrombosis. No subsequent thromboembolic events were recorded.

Conclusions

The incidence of mesenteric vein thrombosis is likely to be underestimated in patients with Crohn鈥檚 disease. Both CT and MRI imaging demonstrate the extent of enteric disease and coincident SMV thrombosis. In our cohort, thrombosis was associated with stricturing disease of the small bowel. The clinical impact of SMV thrombosis and whether anticoagulation is mandatory for all of these patients remains to be determined.