Superior mesenteric vein thrombosis with bowel ischaemia

Case contributed by Dr Ian Bickle

Presentation

No past medical history aside from C section. 4am. Septic. Clinical concern of biliary sepsis.

Patient Data

Age: 35-40Y
Gender: Female
CT

Ultrasound performed by on call radiologist in view of biliary sepsis query. Adynamic dilated small bowel - radiologist recommended CT

Large volume thrombosis in SMV.

Large amount of poorly enhancing mildly dilated small bowel ( jejenum and proximal ileum ).

Small bowel faeces sign.

Congested small bowel mesentery.

Small volume free fluid.

Histology report following emergency surgery.

Case Discussion

Ischaemic bowel if not promptly identified has a high morbidity and mortality.  It may, but not always, occurred in the context of a visible vascular thrombosis on CT.

It can be a difficult diagnosis to confidently identify.   Appearances include:

a.  Poorly or non enhancing bowel wall

b.  Intramural gas

c.  Small bowel faeces sign

d. Portal or mesenteric gas

e.  Arterial or venous thrombosis

f. Free fluid or gas

From a practical perspective

As a radiologist:

- always think out of the box

- be politely sceptical of all you are told

- follow your instincts

- finish the business you start: own your patient and score the diagnosis for their welfare 

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Case information

rID: 30701
Case created: 29th Aug 2014
Last edited: 24th Sep 2017
Inclusion in quiz mode: Included

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