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Small bowel ischemia secondary to portal venous thrombosis

Case contributed by Jeremy Lim
Diagnosis certain

Presentation

36 hours abdominal pain. Clinically suspicious for peritonitis. Previous splenectomy for idiopathic thrombocytopaenic purpura (ITP).

Patient Data

Age: 55
Gender: Male

Previous splenectomy. Long segment of proximal jejunum demonstrates mural edema 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.

Case Discussion

Findings consistent with small bowel ischemia (long segment of proximal jejunum) with the likely etiology 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.

Histopathology:

Hemorrhagic small bowel infarction with venous thrombosis, consistent with known venous obstruction.

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