Idiopathic acute mesenteric venous thrombosis causing ischemic enteritis: A case report.

Area of Science:

• Gastroenterology
• Vascular Surgery
• Internal Medicine

Background:

• Mesenteric venous thrombosis (MVT) is a rare cause of bowel ischemia compared to arterial thrombosis.
• MVT can lead to life-threatening bowel infarction, particularly when distal mesenteric vessels are involved.

Observation:

• A case of idiopathic MVT affecting the superior mesenteric vein and distal branches presented with diffuse peritonitis secondary to small bowel infarction.
• Clinical presentation included severe abdominal pain, hematochezia, and abdominal tenderness.
• CT revealed venous filling defects and segmental enteritis.

Findings:

• The patient underwent heparin therapy, laparotomy, and resection of ischemic ileum with an uncomplicated recovery.
• Idiopathic MVT accounts for a significant proportion of cases, with no identifiable cause in up to 49%.
• Occlusion of smaller, distal mesenteric veins increases the risk of bowel infarction.

Implications:

• Prompt diagnosis via contrast-enhanced CT and anticoagulation are crucial for managing MVT.
• Indefinite anticoagulation is recommended for idiopathic MVT cases.
• This case highlights the importance of recognizing idiopathic MVT and managing distal venous occlusions to prevent infarction.