Mesenteric venous thrombosis

Abstract

Clinical presentationA 78-year-old woman was referred from a peripheralhospital where she had been admitted 2 weeks previouslywith anorexia, abdominal discomfort, nausea and vomiting.On admission to the tertiary care center she was noted to bein congestive cardiac failure with peripheral and pulmon-ary edema, and bilateral pleural effusions. There were alsoischemic changes on her electrocardiograph (ECG). Med-ical therapy was undertaken, however, she collapsed anddied unexpectedly 2 days later.Autopsy findingsAt autopsy the body was that of an elderly Caucasianfemale of around the stated age. Her height was 175 cm,weight 84 kg, and body mass index (BMI) 27. There wascardiomegaly (615 gms) with evidence of left ventricularfailure (congestion and edema of the lungs with pleuraleffusions). Bilateral pulmonary thromboemboli werepresent obstructing both the right and left pulmonaryarteries. An additional finding was thrombosis of thesuperior mesenteric vein with ischemic changes within thejejunum (Fig. 1).Cause of deathBilateral pulmonary thromboembolism complicating mes-enteric venous thrombosis.Museum referenceThis case, # 24686, can be located at the Hans SchoppeMuseum of Pathology at the School of Medical Sciences,Medical School North, The University of Adelaide, FromeRd, Adelaide, SA, Australia.DiscussionIntestinal ischemia occurs when the blood supply to theintestine falls below that necessary to maintain normaltissue metabolic processes, oxygenation and integrity. TheAmerican Gastroenterological Association classifies intes-tinal ischemia into three broad categories of acute mesen-teric ischemia, chronic mesenteric ischemia and ischemiccolitis [1]. Mesenteric venous thrombosis falls within thefirst group and accounts for 1.5–6.2% of cases of acutemesenteric ischemia [2].Mesenteric venous thrombosis is an uncommon disorderand may have quite subtle clinical features, resulting indelay in diagnosis and identification only at the time ofautopsy, as occurred in the reported case; it is likely thatthe symptoms in the weeks preceding the fatal collapsefrom pulmonary thromboembolism were due to mesentericpathology. Clinical symptoms often consist of nonspecificand intermittent abdominal pain for days or weeks withanorexia and diarrhea [3] and may be precipitated by aviral infection [2]. Less than 10% of patients have histories