A Case of Superior Mesenteric Venous Thrombosis Causing Small Bowel Necrosis

Abstract

A 74-year-old man presented with abdominal pain. He was diagnosed with superior mesenteric venous thrombosis (SMVT) accompanied by small bowel necrosis with a contrast-enhanced CT scan and underwent an emergency operation. Although we performed resection and anastomosis of the necrotic site, impaired blood flow at the anastomosed intestine was confirmed during the operation and additional bowel resection and re-anastomosis were conducted. A small intestine, totally 70 cm in length, was resected. A blood analysis indicated that coagulation abnormality was unlikely. As a previous upper gastrointestinal endoscopy detected esophageal varices, it was considered that SMVT had been formed due to portal hypertension. After the operation, anticoagulation therapy with low-molecular-weight heparin was started. The thrombosis started to shrink during hospital stay, he was discharged from our hospital on 22^nd postoperative day, and the thrombosis disappeared in 3 months after the operation. He has been free from recurrence up to now and is under anticoagulation therapy in our clinic.

We have reviewed a total of 30 domestic cases of SMVT + small bowel necrosis including our case in terms of the election of one- or two-step approach for surgery and anticoagulation therapy.