Presentation
A week history of gradually worsening diffuse, colicky abdominal pain.
Patient Data
An extensive filling defect in the main portal vein and superior mesenteric vein with fat stranding in the root of the small bowel mesentery
No signs of intestinal ischemia
The heterogeneous density of liver parenchyma more obviously at the right liver lobe anterior segments and left medial lobe
Splenomegaly (17 cm in craniocaudal diameter - coronal plane)
Case Discussion
The patient presented with a gradually worsening of abdominal pain and no characteristic certain differential and so, a CT abdomen with contrast was done. The images showed occlusion of the portal and superior mesenteric veins with no signs of bowel ischemia. Clinical presentations of the portal vein and superior mesenteric vein thrombosis are often vague and non-specific. If extensive acute portal vein thrombosis is present, especially if the superior mesenteric venous system is also involved, then the presentation is likely to be with acute intestinal ischemia, infarction, and eventual necrosis in prolonged untreated phase.
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