Acute mesenteric venous ischemia
Morbid obese lady underwent sleeve gastrectomy a month ago. She now presented with acute severe left lumbar pain accompanied with vomiting and diarrhoea.
CT abdomen and pelvis with oral positive and i.v. iodinated contrast.
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Non opacification of bulk of superior mesenteric vein, predominantly the jejunal branches with thrombus extending proximally into the main portal vein.
Circumferential mural thickening seen involving approximately 25 cm of distal jejunum with fluid along the mesentery. The venous channels are thrombosed while the arterial tree is patent.
Mild free fluid in pelvis. No pneumatosis intestinalis. No free interperitoneal air. No air in biliary tree.
Recent abdominal surgery is a risk factor for a hypercoagulable state within the body. Venous mesenteric ischemia accounts for <15% of all mesenteric ischemia and tends to present with vague symptoms. With an intact arterial supply, manifestations will be less obvious. However, this condition still warrants surgical exploration as it could progress to arterial involvement and eventual necrosis.
- Duran, Rafael, et al. "Multidetector CT features of mesenteric vein thrombosis." Radiographics 32.5 (2012): 1503-1522. Pubmed citation