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Acute mesenteric ischaemia due to superior mesenteric vein (SMV) thrombosis
  1. Muhammad Salah Muhammad Ahmad1,2,
  2. Muhammad Rafaih Iqbal3 and
  3. Jonathan Simon Refson4
  1. 1 General Surgery, Princess Alexandra Hospital NHS Trust, Harlow, UK
  2. 2 General Surgery, Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust, King’s Lynn, UK
  3. 3 General Surgery—Colorectal, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
  4. 4 Department of Vascular Surgery, The Princess Alexandra Hospital, Harlow, UK
  1. Correspondence to Mr Muhammad Salah Muhammad Ahmad; m.ahmad7{at}nhs.net

Abstract

A 77-year-old male patient presented with a 5-day history of abdominal pain, coffee ground vomiting and blood-stained diarrhoea. CT scan of the abdomen and pelvis demonstrated a long segment thrombotic occlusion of the superior mesenteric vein (SMV) extending up to the proximal portion of the portal vein causing significant acute small bowel ischaemia. Patient’s deteriorating clinical condition warranted surgical management. Successful surgical management required multidisciplinary teamwork between emergency, vascular surgeons, anaesthetists and intensivists. Emergency laparotomy revealed gangrene of an estimated 120 cm of small bowel segment starting from duodenojejunal junction and a long segment thrombotic occlusion of the SMV extending up to the portal confluence. Resection of gangrenous small bowel without anastomosis and thrombo-embolectomy of SMV along with laparostomy was done at the initial operation. Patient was admitted in the intensive care unit on systemic heparinisation through intravenous administration of unfractionated heparin. Second relook exploration was done after 48 hours followed by anastomosis of the small bowel and closure of the abdomen. Patient made a good recovery following anticoagulation therapy and was discharged on postoperative day 10.

  • venous thromboembolism
  • gastrointestinal system
  • small intestine
  • vasculitis
  • gastrointestinal surgery

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Footnotes

  • Twitter @MRIqbalSurg

  • Contributors MSMA collected the data, drafted the form. MRI revised the report and collected the intraoperative images. JSR gave the final approval for the report to get published and patient was under his care.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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