Presentation
Epigastric abdominal pain for several days. The pain exacerbates by food consumption. No fever, vomiting, or changes in bowel habits. Proton pump inhibitors were started by a family physician, without improvement.
Patient Data
Doppler US examination shows the absence of blood flow in the portal vein.
Extensive thrombosis of superior mesenteric vein and portal vein. The splenic vein is opacified, without filling defects.
Mesenteric fat stranding and minimal ascites.
Normal small bowel walls thickness and enhancement, without dilatation.
Case Discussion
Acute venous mesenteric thrombosis can be caused by intra-abdominal inflammatory processes, portal hypertension, hypercoagulable states, and malignancy. Iatrogenic causes like abdominal surgical procedures are also well-recognized etiologies. Approximately 20% of cases are idiopathic
On detailed anamnesis, the patient was generally healthy before his admission, without any chronic medical conditions or surgeries in his past. No significant family medical history.
The patient underwent a systemic evaluation that included liver enzymes, hepatitis serology, hypercoagulability blood panel tests that came back normal.
The patient was referred for gastroscopy and colonoscopy for malignancy screening. Results are not available.
Courtesy of Dr Leonid Goldberg.