Presentation
Acute abdominal pain with nausea - free fluid seen on POCUS - usually fit and well.
Patient Data
Moderate volume peritoneal free fluid is demonstrated. There is no peritoneal free gas.
The small bowel is not significantly dilated. There is a long segment of mid-to-distal small bowel that demonstrates moderate mural edema and hypoenhancement, with mesenteric congestion and a filling defect in the draining superior mesenteric vein tributary. There is no intramural or mesenteric venous gas. No portal venous gas. The main branch of the SMV opacifies normally. There is normal opacification of the portal vein and splenic vein.
The abdominal aorta, celiac trunk and superior mesenteric artery enhance normally.
The colon is unremarkable. The stomach is distended.
Conclusion:
Small bowel ischemia secondary to venous thrombosis in an SMV tributary.
Case Discussion
Bowel ischemia can be due to arterial or venous insufficiency. Arterial causes include thromboembolism and dissection. Venous causes include thrombosis. Volvulus or other mechanical causes usually lead to venous ischemia, as the venous system is under less pressure than the arterial system.
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