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Multimodality Diagnosis of Mesenteric Ischemia
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Acute Intestinal Obstruction as an Initial Presentation of Mesenteric Venous Thrombosis

Pradip Vekariya1, Dharanesh Daneti1, Kuppusamy Senthamizhselvan1

  • 1Medical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND.

Cureus
|July 19, 2021
PubMed

Insights

Superior mesenteric vein thrombosis (SMVT) can cause intestinal obstruction, even without acute symptoms. Early diagnosis and anticoagulation are crucial for managing this rare condition and preventing recurrence.

Area of Science:

  • Gastroenterology
  • Vascular Surgery
  • Internal Medicine

Background:

  • Intestinal ischemia typically results from arterial events, with mesenteric venous thrombosis accounting for <10% of cases.
  • Chronic superior mesenteric vein thrombosis (SMVT) often has sufficient collateral circulation, making acute ischemia less common.
  • Intestinal obstruction as a primary manifestation of mesenteric venous thrombosis is rare, with only 12 prior reports.

Observation:

  • A 44-year-old male presented with intestinal obstruction as the initial symptom of SMVT.
  • The patient underwent surgical resection and anastomosis for the obstruction.
  • Anticoagulation therapy was initiated post-operatively.

Findings:

  • This case highlights that persistent, low-grade mesenteric venous ischemia can lead to bowel stricture formation.
  • Intestinal obstruction can be the initial presentation of SMVT, contrary to typical presentations.
  • Successful management involved surgical intervention and anticoagulation.

Implications:

  • Early etiological workup for SMVT is essential, even with atypical presentations like intestinal obstruction.
  • Prompt initiation of anticoagulant therapy may improve outcomes and reduce recurrence rates.
  • This case underscores the importance of considering SMVT in the differential diagnosis of intestinal obstruction.
Keywords:
abdominal painanastomosisanticoagulantsintestinal obstructionmesenteric ischemia

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