Superior mesenteric vein thrombosis

Case contributed by Dr Andrew Dixon

Presentation

3 day history of central abdominal pain.

Patient Data

Age: 45 years
Gender: Female
CT

CT Abdomen

CT shows wall thickening of a 15cm segment of small bowel centrally within the abdomen with related mesenteric vascular congestion. Non-enhancement of the superior mesenteric vein (but enhancement of the splenic and portal veins) and mild stranding adjacent to the superior mesenteric vein. Appearance suggests superior mesenteric venous thrombus with a related ischaemic segment of small bowel. 

Ultrasound

Doppler ultrasound confirms near-completely occlusive thrombus within the SMV. 

Annotated image

Segment of small bowel with pronounced wall thickening and adjacent mesenteric stranding (red arrow). There is distension of the mesenteric vessels related to this segment of bowel (blue arrow). The superior mesenteric vein is dilated and non-enhancing in keeping with SMV thrombosis complicated by a segment of small bowel ischaemia. Transient hepatic attenuation differences (THAD) are seen within the liver which is likely secondary to reduced portal vein flow. 

Case Discussion

CT shows wall thickening of a 15cm segment of small bowel centrally within the abdomen. Non-enhancement of the superior mesenteric vein (but enhancement of the splenic and portal veins) and mild mesenteric fat stranding adjacent to the SMV. Appearance suggests SMV thrombus with ischaemic segment of small bowel. Doppler ultrasound confirms near-completely occlusive thrombus within the SMV. No underlying cause was identified in this case. 

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Case information

rID: 16141
Case created: 20th Dec 2011
Last edited: 8th Nov 2017
Inclusion in quiz mode: Included

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