Complicated idiopathic portal and mesenteric venous thrombosis: A case report

Abstract

Introduction

  Acute mesenteric ischemia is a life-threatening condition that can lead to intestinal obstruction or even septic shock. It is usually caused by arterial occlusion (due to acute arterial thromboembolism or acute thrombosis), but it can rarely be caused by mesenteric vein or portal vein thrombosis.

Case presentation

  We present the case of a 61-year-old man admitted to the emergency service complaining of intense abdominal pain and loss of bowel transit. To diagnose this patient, a CT Angiogram was performed, revealing portal vein and mesenteric vein thrombosis. Anticoagulant treatment was immediately established. The surgical team performed exploratory laparotomy, segmental ileal enterotomy.

The following day, the patient complained of intense pain in the left lower limb and a CT angiogram was performed showing acute ischemic phenomena due to postoperative atrial fibrillation. The surgical team performed a thrombectomy with a Fogarty catheter. The bowel transit restored after 3 days.

Conclusion

  Even though venous thrombosis is a very rare cause of intestinal infarction, it can be the cause of life-threatening gastrointestinal disfunction such as septic shock. Surgical treatment should not be postponed, and it is essential to operate in the first 6 hours after the onset of the symptoms.