splanchnic vein thrombosis (SVT)

Etiology

• hypercoagulability of malignancy
• JAK2 V617F mutation
• ingestion of a foreign body (fish bone), with penetration of the duodenum, pancreas, & superior mesenteric vein (case report)

Pathology

• portal vein thrombosis (78%)
• hepatic vein thrombosis
• mesenteric vein thrombosis
  • superior mesenteric vein thrombosis
  • inferior mesenteric vein thrombosis
• splenic vein thrombosis

Laboratory

• D-dimer level may be elevated
• JAK2 V617F mutation

Complications

• 3-month cancer risk is 8%
• predicts near-term appearance of liver cancer & pancreatic cancer with a poor prognosis
• increased risk of smoking-related cancers (lung cancer, gastrointestinal cancer, & urologic cancer) 3-14 fold

Management

• surgical consult if intestinal infarction, peritonitis, shock, lactic acidosis, or major hemorrhage
• upper GI endoscopy to evaluate for varices if risk for portal hypertension
• avoid thrombolysis (systemic or catheter-directed) unless intestinal ischemia is suspected or deterioration despite anticoagulation
• anticoagulation
  • >= 3-6 months of anticoagulation for acute or incidentally discovered SVT
  • consider direct oral anticoagulants (DOACs) in noncirrhotic patients
  • LMY heparin is preferred in patients with cirrhosis
  • vitamin K antagonists (warfarin) are alternatives
  • lifelong anticoagulation
    • patients with Budd-Chiari syndrome
    • consider for patients with unprovoked SVT
    • progression after discontinuation of anticoagulant
    • persisting thrombotic risk factors

More general terms

• deep vein thrombosis (DVT)

More specific terms

• hepatic vein thrombosis (Budd-Chiari syndrome)
• mesenteric vein thrombosis
• portal vein thrombosis
• renal vein thrombosis

Additional terms

• hypercoagulability associated with malignancy
• visceral; splanchnic