Abstract
<jats:p>Splanchnic vein system disorders encompass a heterogeneous spectrum of vascular conditions involving the portal, mesenteric, splenic, and hepatic vein territories, including portal vein thrombosis, mesenteric vein thrombosis, splenic vein thrombosis, and Budd–Chiari syndrome. These entities arise from a multifactorial pathophysiological interplay described by Virchow’s triad, integrating endothelial injury, hypercoagulability, and vein stasis, often in the context of cirrhosis, malignancy, inflammation, or inherited thrombophilia. Clinically, presentation ranges from asymptomatic incidental findings to acute abdominal emergencies characterized by intestinal ischemia or progressive portal hypertension with its sequelae. Early and accurate diagnosis remains challenging due to nonspecific symptoms; however, multimodal imaging has become central to disease detection and characterization. Doppler ultrasonography serves as a first-line modality, while contrast-enhanced computed tomography and magnetic resonance imaging provide detailed evaluation of thrombus extent, bowel viability, collateral pathways, and hepatic parenchymal involvement. These imaging techniques are essential for guiding therapeutic decision-making and prognostic assessment. Management strategies require a multidisciplinary approach integrating hepatology, interventional radiology, and surgery. Anticoagulation constitutes the cornerstone of treatment, even in cirrhotic patients, while endovascular interventions such as catheter-directed thrombolysis, mechanical thrombectomy, and transjugular intrahepatic portosystemic shunt (TIPS) have expanded therapeutic options. Surgical intervention remains critical in cases of bowel infarction, refractory portal hypertension, or advanced hepatic vein outflow obstruction. Despite advances, challenges persist in optimizing individualized treatment algorithms. Future developments in imaging, risk stratification, and precision medicine are expected to improve outcomes.</jats:p>