Presentation
Left-sided abdominal pain for 1 week with associated diarrhea
Patient Data
Segmental dilatation of jejunal loops at left lumbar region with circumferential bowel wall thickening and edema. Bowel wall enhancement is still preserved. Associated vascular congestion of the adjacent small bowel mesentery with interloop fluid. Mild ascites. Rest of the bowels are normal. No pneumoperitoneum or intramural gas.
Superior mesenteric vein (SMV) is dilated and not opacified with poor opacification of its segmental branches with associated mesenteric fat streakiness and fluid. Portal vein is also dilated with partial long segment thrombus within the main portal vein extending to the proximal right and left portal veins with non-opacification of most of its distal branches.
Superior mesenteric artery (SMA) and its branches are well-opacified. Hepatic artery and veins are patent.
Rest of the abdomen is unremarkable.
IMPRESSION:
Features are suggestive of veno-occlusive mesenteric ischemia with thrombosis of the superior mesenteric and portal veins. Associated segmental jejunal small bowel edema and ischemia with ascites.
Case Discussion
In patients with signs of bowel ischemia or perforation, early surgical intervention is required. In some cases, endovascular thrombolysis/thrombectomy may also be considered.
This patient responded well to anticoagulant therapy (was given intravenous heparin infusion) and did not require surgical intervention.
Unable to process the form. Check for errors and try again.