P627. Peripheral mesenteric vein thromboses are frequently found in IBD patients and are associated with intestinal surgery in Crohn's disease
A. Schoepfer1, N. Vietti Violi2, N. Fournier3, A. Denys2, 1University Hospital Lausanne / CHUV, Gastroenterology and Hepatology, Lausanne, Switzerland, 2University Hospital Lausanne / CHUV, Radiology, Lausanne, Switzerland, 3University of Lausanne, Institute of Social and Preventive Medicine, Lausanne, Switzerland
There is a paucity of data systematically assessing the prevalence of mesenteric vein thrombosis (MVT) in patients with inflammatory bowel disease (IBD). We aimed to evaluate the prevalence of MVT and its association with bowel stenoses and IBD-related surgery.
Data from the Swiss IBD Cohort Study (SIBDCS) were analyzed. Patients were included in case they had an abdominal CT scan performed in our institution from 2006 onwards. Two expert radiologists analyzed the abdominal scans focusing on the presence of MVT in the superior and inferior mesenteric vein branches. Acute MVT was identified by intraluminal filling defects and chronic MVT was detected by the presence of venous narrowing and/or occlusions and the presence of distal venous collaterals.
A total of 160 IBD patients were included, 121 of them with Crohn's disease [CD], median age at enrolment into the SIBDCS 41 [30–49] years, and 39 of them with ulcerative colitis [UC], median age at enrolment 41 [27–50] years. Median disease duration at enrolment was 7 [3–18] years for CD patients compared with 5 [2–11] years for UC patients (p = 0.018). Medication history was meticulously analyzed and there were no differences in drug treatment between the CD cohort with and without MVT and the UC cohort with and without MVT. MVT was found in 43 IBD patients (26.9%). The MVT prevalence in CD patients was 28.9% (35/121) compared to 20.5% (8/39) in UC patients. MVT was chronic in 88.4% (38/43), acute in 2.3% (1/43) and mixed in 9.3% (4/43). The majority of MVT was found primarily in the periphery (42/43, 97.7%, periphery was defined as >5 cm distance from the trunk of the superior or inferior mesenteric vein), only one case (2.3%, 1/43) of central MVT (inferior mesenteric vein) was identified. The presence of MVT was significantly associated in CD patients with the presence of bowel stenosis (24/35 vs. 25/86, p < 0.001), intestinal surgery (21/38 vs. 31/86, p = 0.016), and overall IBD related surgery (27/38 vs. 46/86, p = 0.016). In UC patients, no association with surgery was found (2/8 vs. 6/31, p = 0.724).
MVT are frequently found in IBD patients. Most MVT are identified in the venous periphery. The presence of MVT in CD is associated with bowel stenosis and intestinal surgery. The pathogenetic role of MVT to IBD course needs to be further evaluated, as well as the question if IBD patients with MVT would clinically benefit from anticoagulation measures.