SMV thrombosis with long segment jejunal infarction

Discussion:

It is uncommon for SMV thrombosis to result in such a large segment of intestinal necrosis (arterial thrombosis is more likely).

This patient had a remote history of pulmonary embolism, suggesting hypercoagulable state as the cause of thrombosis. The thrombosis likely developed rapidly given the acute presentation and lack of significant collaterals. There appears to be thrombosis of the distal venous branches (venous arcades and venae rectae), which is associated with higher risk of infarct. The patient also had a history of hypertension, which perhaps contributed to elevated arterial pressures resulting in more rapid progression of edema, hemorrhage, ischemia, infarction and necrosis. 

The most important sign of ischemia is wall thickening. The near complete lack of enhancement of a long segment of bowel indicates infarction, with gradual return of enhancement and resolution of wall thickening distally. 

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