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In embolic acute intestinal ischemia, CT-Angiography can be of great value for diagnosis and treatment. It may reveal the emboli itself lodged in the superior mesenteric artery, as well as the presence or absence of distal mesenteric branches. [18] Late findings, which indicate dead bowel, include: Intramural bowel gas [29] Portal venous gas
Venous thromboembolism and superficial vein thrombosis account for about 90% of venous thrombosis. Other rarer forms include retinal vein thrombosis , mesenteric vein thrombosis (affecting veins draining blood from the gastrointestinal organs), cerebral venous sinus thrombosis , renal vein thrombosis , and ovarian vein thrombosis.
Thrombosis of the superior mesenteric vein is quite rare, but a significant cause of mesenteric ischemia and can be fatal. It is estimated that 10–15% of mesenteric ischemia is due to mesenteric thrombosis. [3]
SMA syndrome is also known as Wilkie's syndrome, cast syndrome, mesenteric root syndrome, chronic duodenal ileus and intermittent arterio-mesenteric occlusion. [3] It is distinct from nutcracker syndrome, which is the entrapment of the left renal vein between the AA and the SMA, although it is possible to be diagnosed with both conditions. [4]
Thrombosis of the superior mesenteric vein can cause mesenteric ischemia also known as ischemic bowel. Mesenteric ischemia can also result from the formation of a volvulus, a twisted loop of the small intestine that when it wraps around itself and also encloses the mesentery too tightly can cause ischemia. [13]
As the superior mesenteric vein drains to the hepatic portal vein, the middle colic vein is considered part of the hepatic portal system. This vein also carries nutrients absorbed from the large intestine to the liver. This vein is sometimes used as the point of catheter insertion for treatment of acute portal and mesenteric vein thrombosis. [2]
The superior mesenteric vein and the splenic vein come together to form the actual hepatic portal vein. The inferior mesenteric vein connects in the majority of people on the splenic vein, but in some people, it is known to connect on the portal vein or the superior mesenteric vein. Roughly, the portal venous system corresponds to areas ...
Portal hypertension is defined as increased portal venous pressure, with a hepatic venous pressure gradient greater than 5 mmHg. [3] [4] Normal portal pressure is 1–4 mmHg; clinically insignificant portal hypertension is present at portal pressures 5–9 mmHg; clinically significant portal hypertension is present at portal pressures greater than 10 mmHg. [5]
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