Mesenteric venous thrombosis, though less common than arterial thrombosis, remains an important cause of mesenteric ischemia. Advances in imaging techniques have permitted the diagnosis of mesenteric venous thrombosis to be made before laparotomy is performed, but there is often a considerable delay in the diagnosis because of a low degree of suspicion on the part of clinicians and the nonspecific clinical presentation.

Early diagnosis and the immediate use of anticoagulation can improve the outcome. Surgery should be limited to patients with peritonitis or perforation. The objective of surgical management should be to conserve as much bowel as possible. In patients with inherited thrombotic disorders and those in whom a cause cannot be identified, lifelong anticoagulation is warranted. For patients with reversible predisposing causes, at least six months to one year of anticoagulation is recommended. The long-term prognosis of patients without cancer or other life-threatening disorders is generally good.

We are indebted to Douglas B. McGill, M.D., for helpful suggestions.

Source Information From the Divisions of Hematology and Internal Medicine (S.K.), Gastroenterologic and General Surgery (M.G.S.), and Gastroenterology and Hepatology and Internal Medicine (P.S.K.), Mayo Clinic, Rochester, Minn.

Address reprint requests to Dr. Kamath at the Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, or at kamath.patrick@mayo.edu.