P245. Clinical and radiographic presentation of superior mesenteric vein thrombosis in Crohn's disease
U. Kopylov1, M. Amitai2, A. Lubetsky3, R. Eliakim1, Y. Chowers4, S. Ben-Horin5
1Sheba Medical Center, Gastroenterology, Ramat Gan, Israel; 2Sheba Medical Center, Imaging, Ramat Gan, Israel; 3Sheba Medical Center, National Hemophilia Center, Institute of Thrombosis and Hemostasis, Ramat Gan, Israel; 4Rambam Health Care Campus, Inflammatory Bowel Disease Service, Department of Gastroenterology, Haifa, Israel; 5Sheba Medical Center, Laboratory Of Gastro-Immunology, Tel Hashomer, Israel
Background: Mesenteric and portal vein thrombosis are rare and frequently underdiagnosed complications of Crohn's disease (CD). The data pertaining to the prevalence, clinico-radiologic features of these patients and the management approach is sparse. This study describes the clinical and radiological characteristics of CD patients with superior mesenteric vein thrombosis (MVT) diagnosed by CT or MRI.
Methods: The database of Crohn's disease patients treated in Sheba Medical Center between 20052010 was searched for MVT diagnosis. Imaging studies of identified patients were retrieved and reviewed by an experienced abdominal radiologist. MVT was defined by superior mesenteric vein obliteration and/or thrombus in the vessel lumen on abdominal imaging. The clinical and radiologic data of these patients were collected from the medical records.
Results: MVT was demonstrated in 6/460 CD patients in our center's database. The mean disease duration was 15 years. Five patients had stricturing disease, and one patient had a combined fistulizing and stricturing disease phenotype. All 6 patients had small bowel disease, but 3/6 also had colonic involvement. No patient had a prior thromboembolic history or demonstrable hypercoagulability. One patient had an acute SMV thrombus demonstrable on CT scanning, the remaining patients showed an obliteration of superior mesenteric vein. Two out of six patients received anticoagulation upon diagnosis of thrombosis, and four patients who were diagnosed retrospectively did not. None of the patients developed subsequent thromboembolic events (mean follow-up 2.25±1.5 years).
Conclusions: The incidence of mesenteric vein thrombosis is likely to be underestimated in patients with Crohn's disease. Both CT and MRI imaging demonstrate the extent of enteric disease and coincident SMV thrombosis. In our cohort, thrombosis was associated with stricturing disease of the small bowel. The clinical impact of SMV thrombosis and whether anticoagulation is mandatory for all of these patients remains to be determined.