Acute Gangrenous Appendicitis with Superior Mesenteric Venous Thrombosis

Abstract

A 14-year-old girl presented to our hospital with lower abdominal pain and fever since 2 days. She was diagnosed with acute appendicitis on abdominal contrast-enhanced computed tomography (CT) and underwent appendectomy. Over the fourth postoperative day, her fever symptoms and inflammation did not improve, and abdominal CT revealed a surgical site abscess and thrombosis of the superior mesenteric vein ; therefore, she was started on 10,000 units of heparin. The CT scan at the initial visit was reviewed, and it was found that the thrombus had already formed in the superior mesenteric vein. On postoperative day-10, CT showed that the thrombus had spread to the left portal vein, but blood tests revealed no abnormal liver function. On postoperative day-13, heparin was switched to rivaroxaban (RVX). No change in thrombosis or any symptoms was observed, and the patient was discharged while continuing RVX on postoperative day-26. Six months after the surgery, RVX was discontinued and follow-up was continued.