Small bowel ischaemia secondary to portal venous thrombosis
36 hours abdominal pain. Clinically suspicious for peritonitis. Previous splenectomy for idiopathic thrombocytopaenic purpura (ITP).
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Previous splenectomy. Long segment of proximal jejunum demonstrates mural oedema and is non-enhancing. Free fluid. No free gas.
SMV and tributaries, main portal vein, right and left portal veins are thrombosed. Minimal residual filling in the left portal vein and its intrahepatic branches.
Findings consistent with small bowel ischaemia (long segment of proximal jejunum) with the likely aetiology being extensive superior mesenteric and portal vein thrombosis.
Serial lactate was increasing up to a maximum of 5.7 mmol/L prior to bowel resection.
Haemorrhagic small bowel infarction with venous thrombosis, consistent with known venous obstruction.