"Probably the safest way to directly access the portal circulation is via a transjugular-transhepatic approach (similar to the initial steps of a TIPS). A direct transhepatic approach has also been performed but is associated with a greater risk of haemorrhage 5."
Expected headings
"Technique"
"Findings"
"Complications"
"Acute superior mesenteric vein thrombosis presents vaguely as an acute abdomen with gradually worsening diffuse, colicky abdominal pain, associated with distention, and symptoms may have been present for a few days 2,3. Haem-positive stool may also be present 3. As ischaemia progresses, eventual necrosis, perforation, sepsis and shock ensue."
"As the superior mesenteric vein thrombosis occurs, back pressure builds as arterial supply to the bowel is uninterrupted. This leads to bowel wall oedema (and thus bowel wall thickening) and possible intramural haemorrhage (leading to hyperdense bowel wall) 1. Depending on how complete the occlusion is, and whether or not collateral drainage is available, the combination of backpressure, and bowel wall thickening can lead to inadequate tissue perfusion leading to intestinal ischaemia, infarction and eventual necrosis 1."
"Imaging is the only reliable way of making the diagnosis, especially as the clinical presentation is vague. CT is the most accurate test available to us at present, with excellent sensitivity (up to 100%). Ultrasound and catheter mesenteric angiography are reported to have ~70% sensitivity 3 but in practice are infrequently requested as a first-line investigation, unless the presentation suggests another diagnosis (e.g. cholecystitis)."
"Surgery is clearly still required in patients with intestinal infarction; however, in patients where this has not yet occurred, endovascular thrombolysis/thrombectomy is a viable option 2,3. Thrombolytic agents can be introduced either via a superior mesenteric artery catheter or a transhepatic transportal retrograde approach, whereas mechanic clot lysis can only be achieved via a retrograde transhepatic venous approach 2."