Hepatic Portal Venous Gas in Superior Mesenteric Vein Thrombosis?: Report of a Case

Abstract

Mesenteric vein thrombosis is an uncommon cause of small bowel ischemia. Most of the cases present with acute abdomen, and the diagnosis is usually made during laparotomy. Here, we report a case of a 45-year-old man suffering from intense abdominal pain and fever for 1 day. The physical and laboratory examinations revealed nothing in particular In light of the severe pain which was unresponsive to medical treatment and the presence of unexplained bacteremia with Klebsiella pneumonia, computed tomography was arranged, subsequently showing superior mesenteric vein thrombosis. Anticoagulant therapy with heparin infusion was administered promptly, with favorable results. Transient hepatic portal venous gas, detected by ultrasound, appeared simultaneously with dramatic relief of pain after bolus injection of heparin. In our case, we think that mesenteric vein thrombosis can occur without bowel gangrene and can be successfully treated by anticoagulant therapy. Hepatic portal venous gas, previously considered an ominous sign, may be a good sign in superior mesenteric vein thrombosis, indicating the patent flow from the bowel to the liver.