Acute Superior Mesenteric Vein Thrombosis With Small Intestinal Ischemia

Abstract

Acute superior mesenteric vein thrombosis results in sudden interruption of blood supply to a segment of small intestine leading to ischemia followed by intestinal infarction and necrosis of that segment. Immediate systemic anticoagulation and early surgical intervention are required to remove the infracted segment of bowel to prevent sepsis and death. The mesenteric ischemia due to thrombosis of superior mesenteric vein is a rare condition of the intestine, however intestinal infarction associated with it is even more uncommon. Systemic hypercoagulable state is usually present in most of these patients. I, report a case of 43 years old Caucasian male who presented to the emergency room with severe diffuse upper abdominal and back pains out of proportion of his abdominal findings associated with nausea and vomiting. Past history of deep vein thrombosis (DVT) of lower extremity in the patient and his sister was documented. Computed tomography of abdomen with intravenous contrast revealed superior mesenteric vein thrombosis and extension of thrombus into portal vein along with its segmental branches resulting in ischemia of distal small bowel. The patient was initially treated with systemic anticoagulation but due to lack of response to conservative management for 12 h the patient was taken to operating room and underwent resection of about 2 feet of ischemic distal small bowel with good post operative recovery. Acute superior mesenteric vein thrombosis associated with mesenteric ischemia requires prompt diagnosis, urgent medical and early surgical intervention to prevent sepsis, high morbidity and mortality. J Med Cases. 2018;9(9):293-295 doi: https://doi.org/10.14740/jmc3118w