Treatment for MVT is mainly conservative, involving systemic anticoagulation, bowel rest, fluid resuscitation, and serial abdominal exams. The ultimate goal is to prevent extension of the thrombus, avoid intestinal infarction, and prevent recurrence. If evidence of clinical deterioration and bowel infarction is present, surgical intervention is necessary. Broad-spectrum antibiotics are generally reserved for the setting of pylephlebitis, septic thrombophlebitis, and sepsis secondary to bacterial translocation from an infarcted bowel.
Initiation of anticoagulation remains the cornerstone of treatment and should not be delayed.Research has shown that once a patient is transitioned to oral anticoagulation, treatment should continue for 3-6 months, unless a thrombophilia has been diagnosed. After anticoagulation, most MVTs partially or completely recanalize, with one study showing recanalization in 80% of patients who received anticoagulation. However, the recurrence rate has been reported at 15%.
Acute MVT carries a better prognosis than acute mesenteric ischemia. In one systematic review of nearly 3700 cases of acute mesenteric ischemia from 1966 to 2002, the mortality rate of those patients with MVT was 44%, compared with as much as 89% for those patients with advancement to mesenteric ischemia. However, with increasing physician awareness, the use of contrast-enhanced CT to investigate abdominal pain in combination with anticoagulation has improved outcomes in these patients. In more modern studies, the mortality rate of acute MVT is down to 20%, with the most common cause of death being sepsis and multiorgan failure.
In conclusion, acute superior MVT is a rare but important cause of mesenteric intestinal ischemia. It requires a high index of clinical suspicion. Rapid recognition and aggressive therapy are of extreme importance in order to prevent ischemic and infarcted bowel, sepsis, multiorgan failure, and eventual death. The 49-year-old man in this case had nonnecrotizing, alcohol-induced acute pancreatitis, complicated by acute superior MVT.
The patient in this case was eventually transitioned to rivaroxaban and discharged on day 4. Since his discharge, he has entered into alcohol rehabilitation and remains compliant with his anticoagulation.
Medscape © 2020 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Gregory Taylor, Michael Semple, Matthew Warpinski. Alcohol Abuse and Unusual Abdominal Pain in a 49-Year-Old - Medscape - Oct 02, 2020.