This protocol applies to patients with acute mesenteric venous thrombosis who present without peritonitis or peritoneal signs — a subgroup initially managed with endovascular techniques before surgical escalation is considered.
First-line management consists of endovascular venous thrombolysis and mechanical thrombectomy — with the treatment goal of achieving complete recanalisation of the mesenteric veins and resolution of thrombus (within a mean of 40 hours).
When that goal is not met — or when symptoms persist or worsen despite endovascular intervention — this protocol defines the next step.
At this stage, open surgical intervention is indicated. The operative approach centres on bowel preservation — a second assessment procedure may follow. The complete, structured operative protocol is available via the link below.
DOI: 10.1016/j.ejvs.2025.06.010
Anticoagulation with unfractionated or low molecular weight heparin as first line therapy is recommended for all patients with acute mesenteric vein thrombosis.
Figure 6. Suggested algorithm for the management of acute mesenteric venous thrombosis.
Patients with persisting or worsening symptoms, organ failure, and those with perforation or signs of peritonitis require open surgical intervention.
The aim of surgery is to remove irreversibly ischaemic bowel and preserve as much bowel as possible.
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