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A rare complication of acute appendicitis: Superior mesenteric vein thrombosis
N Bakti1, A Hussain, S El-Hasani
1Minimal Access Unit, General Surgery Department, Princess Royal University Hospital, Farnborough Common, Orpington, Greater London BR6 8ND, United Kingdom.
Introduction:
Very few cases of superior mesenteric vein thrombosis have been reported as a complication of appendicitis. In these handful of cases, the thrombosis was identified early with computerised tomography scan and patients have been managed conservatively with antibiotics and anticoagulation.
Presentation Of Case:
A 45-year-old gentleman presented to the emergency department with a 13-day history of right lower quadrant abdominal pain and rigors. CT scan of the abdomen revealed an appendicular mass and superior mesenteric vein thrombosis. The patient was initially managed by anticoagulation and antibiotics for two weeks and was discharged after satisfactory clinical improvement. He represented after discharge for increased severity of his abdominal pain and abnormal inflammatory markers. Emergency open appendicectomy for complicated appendicitis was performed and his postoperative course was unremarkable. He was discharged on the 7th postoperative day with anticoagulation. Outpatient review at two months was unremarkable.
Discussion:
Acute appendicitis is a common surgical presentation where history and examination is key in clinching the diagnosis. Inflammatory markers and imaging modalities such as a CT scan can be helpful. Although surgical intervention is the mainstay of treatment, conservative management with antibiotics is an option if the diagnosis of appendicitis is equivocal. Recent evidence has revealed that elective appendicectomy is not necessary upon successful conservative management. Acute appendicitis can lead to local perforations and abscesses. Complications such as thrombosis in the superior mesenteric vein are rare and can be managed successfully with anticoagulants.
Conclusion:
Although this is a rare complication of appendicitis, the case was managed successfully with a conservative approach. This is inline with the general consensus which is to treat superior mesenteric vein thrombosis secondary to appendicitis conservatively unless the patient deteriorates.
Insights
Superior mesenteric vein thrombosis is a rare complication of appendicitis. This case demonstrates successful conservative management with anticoagulation and antibiotics, aligning with current medical consensus for this condition.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Abdominal Imaging
Background:
- Superior mesenteric vein thrombosis (SMVT) is an infrequent complication of appendicitis.
- Early diagnosis via computed tomography (CT) scan and conservative management with antibiotics and anticoagulation are typical approaches.
Purpose of the Study:
- To present a case of SMVT secondary to appendicitis.
- To highlight the successful conservative management of this rare complication.
Main Methods:
- A 45-year-old male with a 13-day history of right lower quadrant pain and rigors presented with appendicitis and SMVT confirmed by CT scan.
- Initial conservative management included two weeks of antibiotics and anticoagulation.
- Following recurrence of severe pain, an emergency open appendectomy was performed, with an unremarkable postoperative course.
Main Results:
- The patient initially improved with conservative management but later presented with increased abdominal pain.
- Successful surgical intervention (appendectomy) was performed for complicated appendicitis.
- The patient was discharged on anticoagulation and had an unremarkable two-month outpatient follow-up.
Conclusions:
- Appendicitis diagnosis relies on clinical history, examination, inflammatory markers, and imaging.
- While surgery is standard for appendicitis, conservative management with antibiotics is viable for equivocal cases.
- SMVT secondary to appendicitis, though rare, can be successfully managed conservatively with anticoagulation, unless patient condition deteriorates.
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