Superior mesenteric vein thrombosis with subsequent collateral formation

Case contributed by Zemar Vajuhudeen
Diagnosis certain


Acute upper abdominal pain in the setting of recent laparoscopic sleeve gastrectomy (4 weeks ago)

Patient Data

Age: 45 years
Gender: Female

Non-opacification of multiple branches of the superior mesenteric vein as well as the main vein. A thrombus is seen to extend into the proximal portal vein. Fat stranding is noted around the SMV and its branches.  
No features of bowel obstruction. Evidence of gastric surgery is seen. No leak or collection is seen in this region.

An interval scan was performed 4 weeks later, following commencement of anticoagulation.

The main superior mesenteric vein has significantly reduced in size and is poorly opacified, suggestive of probable chronic thrombus formation. Interval resolution of adjacent mesenteric inflammatory changes. New prominence of multiple collateral draining veins are noted.
Thrombus extension into the main non-dilated portal vein is no longer seen. The splenic vein remains unaffected.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.