Acute mesenteric venous ischaemia

Case contributed by Dr Varun Babu

Presentation

Morbid obese lady underwent sleeve gastrectomy a month ago. She now presented with acute severe left lumbar pain accompanied with vomiting and diarrhoea.

Patient Data

Age: 40 years
Gender: Female

CT abdomen and pelvis with oral positive and i.v. iodinated contrast.

Modality: CT

Non opacification of bulk of superior mesenteric vein, predominantly the jejunal branches with thrombus extending proximally into the main portal vein. 

Circumferential mural thickening seen involving approximately 25 cm of distal jejunum with fluid along the mesentery. The venous channels are thrombosed while the arterial tree is patent. 

Mild free fluid in pelvis. No pneumatosis intestinalis. No free interperitoneal air. No air in biliary tree. 

Case Discussion

Recent abdominal surgery is a risk factor for a hypercoagulable state within the body. Venous mesenteric ischaemia accounts for <15% of all mesenteric ischaemia and tends to present with vague symptoms. With an intact arterial supply, manifestations will be less obvious. However, this condition still warrants surgical exploration as it could progress to arterial involvement and eventual necrosis.

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Case Information

rID: 46041
Case created: 18th Jun 2016
Last edited: 25th Aug 2016
Inclusion in quiz mode: Included

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