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

Andrew Samoyedny1, Sai Sajja2, Asanthi Ratnasekera2

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Mesenteric venous thrombosis (MVT) can cause serious bowel infarction, especially when affecting smaller veins. Idiopathic cases require indefinite anticoagulation for optimal patient outcomes.

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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.