Portal Vein Thrombosis & Superior Mesenteric Artery Thrombosis

Portal Vein Thrombosis:

• Etiology
  • Cirrhosis (25%)
  • Hypercoagulable state: PNH, factor V Leiden, PT gene mutation, protein C deficiency
  • Malignancy
  • Collagen vascular disease: SLE, Bechet’s
  • Inflammatory focus within abdomen: pancreatitis, IBD, abdominal sepsis
  • Myeloproliferative disorders
  • Pregnancy, OCPs
• Clinical presentation
  • Acute: typically silent, but can present with abdominal/back pain
  • Chronic: manifestations of portal hypertension (varices, splenomegaly, ascites, pylephlebitis)
• Management
  • In acute setting, anticoagulation is indicated, as it facilitates recanalization of the thrombus, potentially averting the development of portal hypertension
  • For chronic thrombus, main goal is to treat the consequences of portal hypertension (e.g. portocaval shunt, TIPS, splenectomy, variceal banding)
    • The issue of anticoagulation is more challenging, as the potential benefit must be balanced against the risk of variceal bleeding

Superior Mesenteric Artery Thrombosis:

• Etiology: typically hypercoagulable state
• Complications: resistance to venous outflow à bowel wall edema à diminished arterial blood flow --> bowel infarction
• Management: anticoagulation

(Christopher Woo MD, 4/14/11)