Superior Mesenteric Vein Occlusion Causing Severe Gastrointestinal Haemorrhage in Two Paediatric Cases

Anna L Fox,Matthew Jones,Marcus K H Auth,Andrew Healey

doi:10.1155/2012/964845

Abstract

Reports about superior mesenteric vein thrombosis in childhood are very rare and have not been associated with gastrointestinal bleeding. We describe two cases of severe bleeding from the upper and lower gastrointestinal tract in children who had undergone complex abdominal surgery at considerable time before. The first child had a tracheoesophageal fistula, corrected by division, gastrostomy insertion, and repair of duodenal rupture. The child presented with severe bleeding from the gastrostomy site and was diagnosed with a thrombosis of the proximal superior mesenteric vein. The second child had a gastroschisis and duodenal atresia, and required duodenoplasty, gastrostomy insertion, hemicolectomy, and adhesiolysis. The child presented with intermittent severe lower gastrointestinal bleeding, resulting from collateral vessels at location of the surgical connections. He was diagnosed with a thrombosis of the superior mesenteric vein. In both children, the extensive previous surgery and anastomosis were considered the cause of the mesenteric thrombosis. CT angiography confirmed the diagnosis in both cases, in addition to characteristic findings on endoscopy. Paediatricians should suspect this condition in children with severe gastrointestinal bleeding, particularly in children with previous, complex abdominal surgery.

Highlights

Superior mesenteric vein (SMV) thrombosis is an uncommon venous thromboembolic event
We believe that our case reports are the first paediatric cases to describe SMV thrombosis as the cause of intestinal varices leading to severe gastro-intestinal bleeding at a surgical site
In adults, SMV thrombosis and other intra-abdominal venous thromboses have been described in patients who have undergone abdominal surgery

Summary

Introduction

Superior mesenteric vein (SMV) thrombosis is an uncommon venous thromboembolic event It first appears in the medical literature at the end of the 19th Century, identified as a cause of intestinal gangrene by Elliot, who described his surgical experiences in cases of mesenteric venous and arterial occlusion [1]. Mesenteric vein thrombosis can cause acute intestinal ischaemia and necrosis requiring extensive bowel resection and is a surgical emergency. Mortality for such procedures is high and the resulting morbidity from short bowel syndrome, prolonged periods of intensive care treatment, and parenteral nutrition and its associated complications is significant. For the first time in paediatrics, we present two cases of SMV thrombosis as the cause of severe gastrointestinal bleeding at a surgical site

Case Presentations

Discussion