Small Bowel Ischemia Secondary to Splanchnic Venous Thrombosis in a Postpartum Patient-A Case Report

Splanchnic vein thrombosis (SVT) is a rare but life-threatening condition. Pregnancy and the puerperium are hypercoagulable states that increase the risk of thrombosis, yet SVT remains an underrecognized cause of postpartum abdominal pain.

A 40-year-old Somali woman, four weeks postpartum after an uncomplicated vaginal delivery, presented with two weeks of progressive abdominal pain, distension, and anorexia. Physical examination revealed diffuse abdominal tenderness with voluntary guarding. Contrast-enhanced CT demonstrated extensive thrombosis of the superior mesenteric, portal, splenic, and middle hepatic veins, with extension into the inferior vena cava and common iliac veins. The postpartum state was the major suspected risk factor, although an unrecognized thrombophilia could not be excluded. She underwent emergency laparotomy with resection of gangrenous bowel (distal jejunum and 75% of ileum). Intraoperative heparin was initiated. Postoperatively, she was transitioned to warfarin but developed supratherapeutic International Normalized Ratio (INR) of 6.2 with hematochezia requiring transfusion.

SVT should be considered in postpartum patients with disproportionate abdominal pain. Prompt CT imaging is essential. Thrombophilia screening should be considered in postpartum patients with unprovoked SVT. Anticoagulation management requires careful monitoring, and direct oral anticoagulants (DOACs) may be considered in selected patients, though the evidence base after major bowel resection is limited.