Can partial Inferior Mesenteric Vein (IMV) thrombosis cause abdominal pain?

From the Guidelines

Yes, partial inferior mesenteric vein (IMV) thrombosis can cause abdominal pain. This condition occurs when a blood clot partially blocks the IMV, which is responsible for draining blood from the descending colon, sigmoid colon, and rectum. Patients typically experience dull, aching abdominal pain that may be localized to the left lower quadrant or diffuse across the abdomen. The pain often develops gradually over days and may worsen after eating.

Key Points to Consider

• The clinical diagnosis of mesenteric venous thrombosis is often difficult due to nonspecific abdominal symptoms 1.
• Diagnosis can be established by noninvasive means, such as multidetector CT and MR venography 1.
• The mainstay of therapy is systemic anticoagulation alone, with the first-line treatment being anticoagulation 1.
• Treatment usually involves anticoagulation therapy with low molecular weight heparin initially, followed by oral anticoagulants like warfarin or direct oral anticoagulants (DOACs) 1.
• Pain management with acetaminophen is preferred over NSAIDs, which may worsen gastrointestinal symptoms.
• The pain occurs because the partial blockage reduces blood flow, causing intestinal ischemia and inflammation in the affected bowel segments, which activates visceral pain receptors.

Treatment Approach

• Anticoagulation therapy is the primary treatment for partial IMV thrombosis, with the goal of preventing further clot formation and reducing the risk of complications.
• The choice of anticoagulant and treatment duration should be individualized based on patient-specific factors, such as risk of bleeding and underlying medical conditions.
• Close monitoring of patients with partial IMV thrombosis is essential to promptly identify any changes in clinical status that may require adjustment of treatment or intervention.

From the Research

Abdominal Pain and Partial Inferior Mesenteric Vein Thrombosis

• Abdominal pain can be a symptom of partial Inferior Mesenteric Vein (IMV) thrombosis, as seen in a case report of a 58-year-old male with suprapubic abdominal pain secondary to partial IMVT of unknown etiology with accompanying thrombophlebitis 2.
• Mesenteric venous thrombosis, including IMV thrombosis, can cause ischemia or infarction of the small intestine, leading to abdominal pain 3.
• The prevalence of mesenteric venous thrombosis has increased over the past 2 decades, and acute thrombosis often presents with abdominal pain, whereas chronic disease manifests either as an incidental finding on CT or with features of portal hypertension 4.
• A study of 80 patients with mesenteric venous thrombosis found that 80% presented with abdominal pain, highlighting the significance of abdominal pain as a symptom of this condition 5.

Diagnosis and Treatment of Partial IMV Thrombosis

• Diagnosis of mesenteric venous thrombosis, including IMV thrombosis, can be made using contrast-enhanced computed tomography (CT), which diagnoses about 90% of cases 4.
• Anticoagulation is the mainstay of management for mesenteric venous thrombosis, including IMV thrombosis, and has been safely used in patients with cirrhosis and portal hypertension 4, 5.
• In some cases, surgical intervention may be necessary, such as partial small bowel resection and double enterostomy, as seen in a case report of 4 patients with ischemic intestinal stenosis complicated with portal and superior mesenteric vein thrombosis 6.

Complications and Long-term Outcomes of Partial IMV Thrombosis

• Mesenteric venous thrombosis, including IMV thrombosis, can lead to significant sequelae of portal hypertension, including esophageal varices, portal vein cavernous transformation, splenomegaly, or hepatic atrophy 5.
• A study of 80 patients with mesenteric venous thrombosis found that 50% of patients with follow-up imaging available had long-term sequelae of portal hypertension, highlighting the importance of long-term follow-up and management 5.