A Case Report of Small Bowel Necrosis Caused by Idiopathic Superior Mesenteric Venous Thrombosis

Abstract

A 53-year-old man was admitted to our institution because of upper abdominal pain. A physical examination revealed signs of peritoneal irritation in the right upper quadrant, and abdominal computed tomography revealed thrombi in the superior mesenteric vein and in an ischemic segment of the small bowel. Emergency surgery was performed. An intraoperative examination revealed an area of necrosis extending for approximately 70 cm; the necrotic area was removed by a partial resection of the intestine. A thrombectomy was not performed because the venous congestion in the mesentery had not diffused. The absence of a blood coagulation disorder confirmed a diagnosis of idiopathic superior mesenteric venous thrombosis. After the operation, the patient was continuously treated with heparin, which was then switched to oral anticoagulation therapy with warfarin. This patient is currently under observation and has not shown any recurrence of symptoms.